Pulmonology Commons^™

Diaphragmatic Paralysis: A Presentation Of Spontaneous Chest Pain And Shortness Of Breath, Donna Dorriz, Hilary Lois, Candace Wise, Brady Dehart

Capital Division GME Virtual Research Day 2020

Chest pain accounts for approximately 7.6 million annual visits to emergency departments (ED) in the United States and can include a broad differential1. The workup warranted includes extensive testing with the goal of demonstrating a reassuring cardiopulmonary status. When preliminary chest pain workup is negative, the subtle features of common primary symptoms can provide insight into other less common etiologies. This case looks to highlight the rare presentation of a relatively healthy middle age male with complaint of chest pain and shortness of breath, worsened with exertion and supine position. When standard cardiopulmonary workup was negative, further specialty testing was …

The Role Of Slc7a11 In Controlling Extracellular And Intracellular Redox Environments Of Lung Fibroblasts - Potential Targets For Intervention In Aging And Idiopathic Pulmonary Fibrosis., Yuxuan Zheng

Electronic Theses and Dissertations

Idiopathic pulmonary fibrosis (IPF) is a fatal lung disease characterized by extracellular matrix deposition by fibroblasts. Aging and oxidative stress increase the susceptibility to IPF. Redox couples, cysteine/cystine (Cys/CySS) and glutathione/glutathione disulfide (GSH/GSSG), and their redox potentials (E_h) quantify oxidative stress. Fibroblasts from old mice maintain more oxidized extracellular E_h(Cys/CySS) than young mice. Microarray shows down-regulation of Slc7a11 potentially mediates this age-related oxidation. Slc7a11 is the key component of system X_c^-, an antiporter that imports CySS and exports glutamate. The first aim of this dissertation is to investigate the mechanistic link between Slc7a11 …

When Treating Sick Joints Harms Lungs, Ixekizumab Induced Pleural Effusion, Rami Batarseh, Kyle Smith, Mohammed Al-Ourani, Amro K. Al-Astal

Marshall Journal of Medicine

Immunological therapies have provided a multitude of new and effective treatment strategies for various disease states. While monoclonal antibody therapy benefits many patients, side effects are widely variable. here we present a case of pleural effusion complicating psoriatic arthritis treatment.

Development Of Drive-Through And Mail-In Systems For Obtaining Surveillance Respiratory Specimens In A Pediatric Cystic Fibrosis Center, Ellen Meier, Paula Capel, Christopher M. Oermann

Posters

Routine surveillance cultures are an essential part of health maintenance for people with cystic fibrosis (CF). The Cystic Fibrosis Foundations (CFF) recommends that respiratory cultures be obtained every three months. The CF Care Center at Children’s Mercy Kansas City (CMKC) also obtains respiratory cultures when there is an acute change in respiratory symptoms. The COVID-29 pandemic resulted in ambulatory clinic closures and an inability to obtain surveillance respiratory cultures. A creative solution for obtaining respiratory cultures was needed during the pandemic.

How Immune T-Cell Augmentation Can Help Prevent Covid-19: A Possible Nutritional Solution Using Ketogenic Lifestyle, Ravi K. Kamepalli Md,Fidsa,Cwsp

The University of Louisville Journal of Respiratory Infections

No abstract provided.

When Rationing Becomes Part Of Clinical Decision-Making, Christopher A. Hopper, Mitra Bahaee

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical practice-based reflection on Noack DP, Newton G. Compared to maximal current management standards, oscillating positive expiratory pressure devices have not been shown to improve clinically relevant outcomes in COPD patients with acute exacerbation. Clin. Res. Prac. 2017;3(2):eP1516. doi: 10.22237/crp/149886732.

Engagement Of Private Healthcare Providers For Case Finding Of Tuberculosis And Diabetes Mellitus In Pakistan, Shifa Salman Habib, Sana Rafiq, Wafa Zehra Jamal, Shaikh Muhammad Ayub, Rashida Abbas Ferrand, Aamir Khan, Syed Mohammad Asad Zaidi

Community Health Sciences

Background: The rising co-epidemic of tuberculosis (TB) and diabetes mellitus (DM) is a challenge for constrained health systems in low and middle-income countries. Diabetes is a known risk factor for tuberculosis and associated with poor tuberculosis treatment outcomes, while tuberculosis is associated with worsening glycemic control. We investigated the performance of bi-directional TB and DM case finding approaches through a private-sector engagement model in Karachi, Pakistan.
Methods: Between July 2016 and July 2018, private health care providers were engaged to generate referrals for bi-directional TB and DM screening at private diagnostic and treatment centers in Karachi, Pakistan. Individuals diagnosed with …

Evaluation Of Computer Aided Detection Of Tuberculosis On Chest Radiography Among People With Diabetes In Karachi Pakistan, Shifa Salman Habib, Sana Rafiq, Syed Mohammad Asad Zaidi, Rashida Abbas Ferrand, Jacob Creswell, Bram Van Ginneken, Wafa Zehra Jamal, Kiran Sohail Azeemi, Saira Khowaja, Aamir Khan

Community Health Sciences

Pakistan ranks fifth among high tuberculosis (TB) burden countries and also has seventh highest burden for diabetes mellitus (DM). DM increases the risk of developing TB and contributes to adverse TB treatment outcomes hence screening and integrated management for both diseases in high burden countries is suggested. Computer-Aided Detection for TB (CAD4TB) can potentially be used as triage tool in low resource settings to pre-screen individuals for Xpert MTB/RIF testing. The aim of this study was to evaluate the diagnostic accuracy and performance of CAD4TB software in people with diabetes (PWD) enrolled in a TB screening program in Karachi, Pakistan. …

Imatinib-Induced Interstitial Pneumonitis – A Literature Review And Case Report, Olga Hilda Orasan, Andreea Maria Stefan, Iulia Minciuna, Adela Sitar-Taut, George Ciulei, Simina Tarmure, Ioana Para, Flaviu Muresan, Ovidiu Fabian, Sorina Cezara Coste, Vasile Negrean, Angela Cozma, Laura Urian

Journal of Mind and Medical Sciences

Imatinib is generally well tolerated, with mild common side effects such as nausea and vomiting, diarrhea, muscle cramps, fatigue, skin rash and edema; however, pulmonary complications are uncommon. A 73-year-old woman undergoing one month treatment with Imatinib for chronic myeloid neoplasm associated with eosinophilia was admitted for sudden alteration of her performance status, dyspnea at rest and productive cough. On clinical examination, the patient was hypoxic (oxygen saturation on room air was 87%), and auscultation of her lungs revealed diffuse bilateral fine crackles. Computed tomography showed bilateral pulmonary interstitial syndrome. Imatinib was discontinued and the patient received systemic corticosteroid therapy …

Computer Aided Detection Of Tuberculosis On Chest Radiographs: An Evaluation Of The Cad4tb V6 System, Keelin Murphy, Shifa Salman Habib, Syed Mohammad Asad Zaidi, Saira Khowaja, Aamir Khan, Jaime Melendez, Ernst T. Scholten, Farhan Amad, Steven Schalekamp, Maurits Verhagen

Community Health Sciences

There is a growing interest in the automated analysis of chest X-Ray (CXR) as a sensitive and inexpensive means of screening susceptible populations for pulmonary tuberculosis. In this work we evaluate the latest version of CAD4TB, a commercial software platform designed for this purpose. Version 6 of CAD4TB was released in 2018 and is here tested on a fully independent dataset of 5565 CXR images with GeneXpert (Xpert) sputum test results available (854 Xpert positive subjects). A subset of 500 subjects (50% Xpert positive) was reviewed and annotated by 5 expert observers independently to obtain a radiological reference standard. The …

Etiology, Clinical, Radiological, And Microbiological Profile Of Patients With Non-Cystic Fibrosis Bronchiectasis At A Tertiary Care Hospital Of Pakistan, Nadia Sharif, Mirza Saifullah Baig, Sana Sharif, Muhammad Irfan

Section of Pulmonary & Critical Care

Objectives: To identify the etiology of non-cystic fibrosis bronchiectasis (NCFB), to assess the clinical presentation, radiological findings, and microbiological profile of patients presenting with a diagnosis of bronchiectasis in a tertiary care center of Pakistan.
Methods: This was a prospective observational cohort study where patients with a diagnosis of bronchiectasis proven by high-resolution computed tomography (HRCT) were evaluated for etiology, clinical characteristics, microbiology, radiology, spirometric profile, and in-hospital outcomes.
Results: During the study period, 196 patients were diagnosed with NCFB. The majority of the patients were men 76.5% (n = 150) and 83.6% (n = 163) of the total patients …

Anomalous Origin Of The Left Coronary Artery From The Pulmonary Artery: A Surgical Certainty, Ayesha Butt, Muhammad Muneer Amanullah, Mehnaz Atiq Ahmed, Asif Hasan, Waris Ahmad

Medical College Documents

This study aims to assess the clinical presentation and the outcomes of a surgical correction of an anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA). A retrospective review was carried out on the charts of six patients admitted for ALCAPA surgery at Aga Khan University Hospital, Karachi from March 2017 to May 2018.Dyspnoea, palpitation, poor feeding, fatiguability, pallor and a murmur of mitral regurgitation were the main presenting features. The pre-operative median left ventricular ejection fraction (LVEF) was 64%. Coronary reimplantation was performed in all the patients with a mitral valve repair being done in only …

Immediate Changes In Hemodynamics And Gas Exchange After Initiation Of Noninvasive Ventilation In Cardiac Surgical Patients, Mohammad Hamid, Mohammad Irfan Akhtar, Saba Ahmed

Department of Anaesthesia

Introduction: Cardiac surgery is associated with pulmonary dysfunction and complications such as prolonged intubation and reintubation. Bilevel positive airway pressure (BiPAP) machine has been used in the clinical settings to improve oxygenation, reduce work of breathing, and avoid reintubation. The effect of BiPAP on cardiovascular parameters is not well established, and very few studies have targeted hemodynamic changes. The aim of the study was to assess the immediate effect of BiPAP on respiratory and hemodynamic parameters in post-cardiac surgery patients.
Materials and methods: This quasi-experimental study was done on 33 adult cardiac surgery patients. Ethical review committee approval was sought …

Galcanezumab-Induced Anaphylaxis: A Case Report, Erick Perez Sifontes, Sonja Knittel-Hliddal, Zhao Han, Rahimullah Asad, Aya Marachi, Uma Iyer

Pulmonary Disease

Introduction: Case Report: Galcanezumab is a monoclonal antibody recently approved by the FDA for migraine prevention. Common side effects include injection site reactions, nasopharyngitis, and nausea. However, there have been no reported cases of anaphylaxis.

Description: We describe the first case of galcanezumab-induced anaphylaxis in a 47-year-old female with history of asthma and a prior episode of topiramate-induced anaphylaxis requiring intubation. The patient presented to the emergency department (ED) complaining of sudden onset shortness of breath, generalized pruritus, flushing, throat and mouth swelling 20 minutes after self- administration of two 120 mg doses of galcanezumab IM. Prior to ED presentation, …

Linkage Between Poverty And Smoking In Philadelphia And Its Impact On Future Directions For Tobacco Control In The City., Christine S. Shusted, Gregory C. Kane

Department of Medicine Faculty Papers

Poverty is linked to negative health consequences and harmful health behaviors such as smoking. Despite this established correlation, few comparative studies have investigated the relationship between local poverty rates and smoking in urban settings through a Social Ecological Model framework. The authors sought to examine the linkage between local poverty rates in Philadelphia, Pennsylvania and adult smoking rates by scrutinizing existing patterns and potential mediating factors via publicly accessible data in established planning districts. The authors determined several individual, interpersonal, organizational, community, and environmental factors, varying across these districts, that impact smoking in Philadelphia. Poverty rates influence the resources, demographic …

The Elevated Systemic Cytokine Levels In Hiv Patients Are Not Associated With An Elevated Pulmonary Cytokine Environment., Rafael Fernandez-Botran, Andrea Reyes-Vega, Yasmany García, Chanakya Charan Tirumala, Praneet Kumar Srisailam, Anupama Raghuram, Paula Peyrani, Stephen P. Furmanek, Mahder A. Tella, Jeffrey D. Ritzenthaler, Jesse Roman, Julio A. Ramirez

Faculty and Staff Scholarship

Background

HIV-positive patients on anti-retroviral therapy (ART) are at higher risk of developing many non-AIDS related chronic diseases, including chronic obstructive pulmonary disease (COPD), compared to HIV-negative individuals. While the mechanisms are not clear, a persistent pro-inflammatory state appears to be a key contributing factor. The aims of this study were to investigate whether HIV-positive patients without COPD present evidence of potentially predisposing abnormal pulmonary cytokine/chemokine environment and to explore the relationship between pulmonary and systemic cytokine levels.

Methods

This study included 39 HIV-seropositive and 34 HIV-seronegative subjects without COPD. All were subjected to outpatient bronchoscopy with bronchoalveolar lavage fluid …

Modern Ventilator Management In Surgical/Trauma Patients, Errington C. Thompson

Marshall Journal of Medicine

Physicians have a lot to consider when they place a patient on the ventilator. This article reviews the literature and provides the physician with a clear guide to managing the ventilator in the ICU. This manuscript is meant to be a practical guide to managing the ventilator at the patient's bedside.

Cryptococcal Antigen Testing In An Integrated Medical System: Eastern Wisconsin, Marianne Klumph, Brian Hoeynck, Dennis J. Baumgardner

Journal of Patient-Centered Research and Reviews

Cryptococcosis is a serious environmentally acquired endemic fungal infection commonly associated with immunocompromised hosts. Little is known regarding frequency or distribution in Wisconsin. We explored the geodemographic and clinical features of patients tested with cryptococcal antigen tests (CrAg) — previously shown to be >90% sensitive and >90% specific — within a large health care system located in eastern Wisconsin. To examine this, we retrospectively analyzed 1465 CrAg tests on 1211 unique patients (female: 50.2%; white race: 73.9%; mean age: 53.7 ± 16.5 years). At least one CrAg result was positive in 23 of 1211 patients (1.9%). From these, 21 of …

Mitochondrial Quality Control In Age-Related Pulmonary Fibrosis., Willy Roque, Karina Cuevas-Mora, Freddy Romero

Center for Translational Medicine Faculty Papers

Idiopathic pulmonary fibrosis (IPF) is age-related interstitial lung disease of unknown etiology. About 100,000 people in the U.S have IPF, with a 3-year median life expectancy post-diagnosis. The development of an effective treatment for pulmonary fibrosis will require an improved understanding of its molecular pathogenesis and the "normal" and "pathological' hallmarks of the aging lung. An important characteristic of the aging organism is its lowered capacity to adapt quickly to, and counteract, disturbances. While it is likely that DNA damage, chronic endoplasmic reticulum (ER) stress, and accumulation of heat shock proteins are capable of initiating tissue repair, recent studies point …

Pulmonary Artery Aneurysm: A Review, M. Gupta, A. Agrawal, A. Iakovou, S. Cohen, R. Shah, A. Talwar

Journal Articles

No abstract provided.