Pulmonology Commons^™

Bronchial Carcinoid Presenting As Multiple Lung Abscesses, Zeeshan Waheed, Muhammad Irfan, Saulat Fatimi, Ruqaiya Shahid

Section of Pulmonary & Critical Care

Bronchial carcinoid tumours is a rare group of pulmonary malignant neoplasm that is derived from neuroendocrine system. Bronchial carcinoid usually present with hilar masses, atelactasis, bronchiectasis, or post-obstructive pneumonia. This case describes a very unusual presentation of bronchial carcinoid tumour with multiple lung abscesses involving the whole lung. This report is of an adult lady who presented with multiple lung abscesses involving her whole of the right lung. She was found to have an endo-bronchial lesion in her right main bronchus which eventually turned out to be carcinoid tumour. She responded to resection and antibiotic therapy.

Bronchial Thermoplasty, Javier Diaz-Mendoza, Chong Bai, Hai-Dong Huang, Michael J. Simoff

Internal Medicine Faculty Publications

No abstract provided.

Is Chest Tube Insertion With Ultrasound Guidance Safe In Patients Using Clopidogrel?, Wissam Abouzgheib, Yousef R. Shweihat, Nikhil Meena, Thaddeus Barrter

Internal Medicine

Background and objective: Drainage of the pleural space is a common procedure.The safety of chest tube insertion in patients using clopidogrel has not been investigated.

Methods: Ultrasound-guided chest tube insertions performed on 24 patients who were being actively treated with clopidogrel were retrospectively reviewed.

Results: No excessive bleeding occurred in any of these patients.

Conclusions: Given the known effects of clopidogrel on platelet function, these results were interpreted as indicating that clopidogrel therapy is a relative but not an absolute contraindication to chest tube insertion, if an experienced operator places a small-bore tube under ultrasound guidance.

Evaluation Of A Mechanical Ventilator Education Program For Intern Physicians In An Intensive Care Nursery, William Bucher, Brian Glynn

Division of Pulmonary, Allergy, and Critical Care Medicine Posters

Background: Thomas Jefferson University Hospital is a large urban Academic Medical Center with a level III Intensive Care Nursery (ICN). A new group of pediatric interns rotate through the ICN every year and receive limited education on mechanical ventilation. We developed a live, one hour training session performed by a Respiratory Therapist and a Respiratory Challenge Test to be completed by the physicians before and after each session. Clinical training was defined as routine training acquired during daily rotation in the ICN. We hypothesized that classroom and clinical training would be more effective than clinical training alone.

Method: After a …

Serial Analysis Of The Gut And Respiratory Microbiome In Cystic Fibrosis In Infancy: Interaction Between Intestinal And Respiratory Tracts And Impact Of Nutritional Exposures, J. C. Madan, D. C. Koestler, B. A. Stanton, L. Davidson, L. A. Moulton, M. L. Housman, J. H. Moore, M. F. Guill, H. G. Morrison, M. L. Sogin, T. H. Hampton, M. R. Karagas, P. E. Palumbo, J. A. Foster, P. L. Hibberd, G. A. O’Toole

Dartmouth Scholarship

Pulmonary damage caused by chronic colonization of the cystic fibrosis (CF) lung by microbial communities is the proximal cause of respiratory failure. While there has been an effort to document the microbiome of the CF lung in pediatric and adult patients, little is known regarding the developing microflora in infants. We examined the respiratory and intestinal microbiota development in infants with CF from birth to 21 months. Distinct genera dominated in the gut compared to those in the respiratory tract, yet some bacteria overlapped, demonstrating a core microbiota dominated by Veillonella and Streptococcus. Bacterial diversity increased significantly over time, …

Multidrug Resistant Pulmonary Tuberculosis Treatment Regimens And Patient Outcomes: An Individual Patient Data Meta-Analysis Of 9,153 Patients, Shama D. Ahuja, David Ashkin, Monika Avendano, Rita Banerjee, Melissa Bauer, Jamie N. Bayona

Dartmouth Scholarship

Dick Menzies and colleagues report findings from a collaborative, individual patient-level meta-analysis of treatment outcomes among patients with multidrug-resistant tuberculosis.

Background: Treatment of multidrug resistant tuberculosis (MDR-TB) is lengthy, toxic, expensive, and has generally poor outcomes. We undertook an individual patient data meta-analysis to assess the impact on outcomes of the type, number, and duration of drugs used to treat MDR-TB.

Atypical Pathogens Causing Community-Acquired Pneumonia In Adults., Ali Bin Sarwar Zubairi, Afia Zafar, Nawal Salahuddin, Ahmed Suleman Haque, Shahan Waheed, Javaid Khan

Department of Medicine

Objective: To determine the frequency of community-acquired respiratory pathogens with special focus on atypical organisms in patients presenting to a tertiary care facility with community-acquired pneumonia (CAP).

Methods: The descriptive study on adult patients was conducted from February 2007 to March 2008 at the Aga Khan University Hospital, Karachi. It comprised 124 consenting patients of age 16 and above who presentd with a diagnosis of community-acquired pneumonia. The diagnostic modalities used were based on significant changes in antibody titer or persisting high antibody titers in the case of Mycoplasma pneumoniae and Chalmydia pneumoniae infections, or bacterial antigen in urine, in …

Brief Report: A Phase Ii "Window-Of-Opportunity" Frontline Study Of The Mtor Inhibitor, Temsirolimus Given As A Single Agent In Patients With Advanced Nsclc, An Ncctg Study, Nicholas F. Reuter Md

Articles

BACKGROUND:

In an effort to evaluate the single agent activity of temsirolimus in previously untreated non-small-cell lung cancer, the North Central Cancer Treatment Group undertook a frontline "window-of-opportunity" study.

METHODS:

Patients received 25 mg of temsirolimus administered intravenously as a weekly 30 minute infusion, on a 4-week cycle. Based on a two-stage Fleming design, the treatment would be promising if at least four of the first 25 evaluable patients in stage I or at least six of the 50 evaluable patients at the end of stage II have a confirmed response. Fresh tumor biopsies were obtained to evaluate predictive markers …

Inhibition Of Adhesion And Invasion Of Pseudomonas Aeruginosa To Lung Epithelial Cells: A Model Of Cystic Fibrosis Infection, Ayman Noreddin, Ghada Sawy, Walid Elkhatib, Ehab Noreddin, Atef Shibl

Pharmacy Faculty Books and Book Chapters

"Over their life time, CF patients experience multiple infections by various pneumoniacausing bacteria [6]. With more patients surviving to adulthood, chronic infections with Pseudomonas aeruginosa are coming to the forefront as a leading cause of death [7]. Problems presented by infected CF lung are multi-dimensional; the electrolyte balance and pH of the fluids are abnormal. The mucus is thick and of an alternative composition compared to normal lung and may contribute to colonization with Pseudomonas aeruginosa [2, 3, 5]. As such, research is multi-pronged and includes gene therapy to correct the defective protein, amelioration of inflammatory response and thinning of …

Cross-Sectional Study Identifying Forms Of Tobacco Used By Shisha Smokers In Pakistan, Sameer-Ur-Rehman, Mohammed Ali Sadiq, Maria Adnan Parekh, Ali Bin Sarwar Zubairi, Philippe. Frossard, Javaid Khan

Section of Otolaryngology, Head & Neck Surgery

Objectives: To estimate the frequency of different forms of tobacco intake such as smoker's tobacco, chewable tobacco and snuff tobacco among shisha smoker's and to study the patterns and predictors of shisha smoking affecting youth from different cities of Pakistan.
Methods: A cross-sectional study was conducted including youth from four cities. Participants were asked to fill out a data collection tool at shisha cafes, shopping malls and restaurants. Data was analyzed using SPSSv.18.
Results: A total of 406 participants, 296 (73%) males and 110 (27%) females were included in the study. There were 163 (40%) cigarette smokers; 65 (16%) chewed …

Cross-Sectional Study Identifying Forms Of Tobacco Used By Shisha Smokers In Pakistan, Sameer Ur Rehman, Mohammed Ali Sadiq, Maria Adnan Parekh, Ali Bin Sarwar Zubairi, Javaid Khan, Philippe M. Frossard

Department of Medicine

Objectives: To estimate the frequency of different forms of tobacco intake such as smoker's tobacco, chewable tobacco and snuff tobacco among shisha smoker's and to study the patterns and predictors of shisha smoking affecting youth from different cities of Pakistan.
Methods: A cross-sectional study was conducted including youth from four cities. Participants were asked to fill out a data collection tool at shisha cafes, shopping malls and restaurants. Data was analyzed using SPSSv.18.
Results: A total of 406 participants, 296 (73%) males and 110 (27%) females were included in the study. There were 163 (40%) cigarette smokers; 65(16%) chewed tobacco …

A Study Of Emergency Room Utilization Related To Poorly Controlled Asthma In Pediatrics, Leistey T. Wortman

Nursing Theses and Capstone Projects

Asthma is a disease of the respiratory system, which causes swelling and narrowing of the airways. Asthma is commonly seen in children. It is the leading cause of hospital stays and school absences. Hospitalization accounts for the single largest portion of the direct health care costs for asthma, estimated at nearly $18 billion a year (Everage, et al, 2010). Children with asthma may be able to breathe normally most of the time but when they encounter a substance that can cause problems (a "trigger"); an asthma attack (exacerbation) can occur (PubMed Health, 2011). The purpose of this study is to …

Relationship Of Main Pulmonary Artery Diameter To Pulmonary Arterial Pressure In Scleroderma Patients With And Without Mild To Moderate Interstitial Fibrosis, Robert Kane Mccall

MUSC Theses and Dissertations

Purpose: To determine the validity of main pulmonary artery diameter (MPAD) as a marker of pulmonary hypertension in scleroderma patients with and without interstitial lung disease (lLD). Materials and Methods: We cross-referenced the radiologic database with medical records to identify patients with both computed tomography (CT) scans of the chest and right-heart catheterization separated by no more than six months. Computed tomography scans were reviewed to determine MPAD and extent of ILD for each patient. Ground glass opacity and fibrosis were individually scored by a single thoracic radiologist on a five-point scale. The same radiologist also determined the quality of …

Pulmonary Talcosis 10 Years After Brief Teenage Exposure To Cosmetic Talcum Powder., Amarah Shakoor, Arsalan Rahatullah, Adil Aijaz Shah, Ali Bin Sarwar Zubairi

Department of Medicine

Pulmonary talcosis is a rare but debilitating variant of pneumoconiosis often presenting with isolated non-specific symptoms of progressive exertional dyspnoea or cough. Occupational exposure to talc dust and intravenous drug abuse are well-recognised aetiological factors with only a few cases related to cosmetic talc exposure being reported to date. The authors report a case of a young woman in whom a mere 4 month ritual of inhaling cosmetic talcum powder led to full-blown pulmonary talcosis being diagnosed 10 years later. The importance of a taking a pertinent history relating to environmental exposures in all patients presenting with respiratory symptoms is …

Differentiating Asthma From Its Mimics, Zeeshan Waheed, Muhammad Irfan, Mohammad Salih, Ali Bin Sarwar Zubairi

Section of Pulmonary & Critical Care

All that wheezes is not asthma this adage accredited to Chevalier Jackson emphasizes the importance of differentiating asthma from its mimics, particularly if the patient is not responding to usual therapy. The above statement also warrants further diagnostic evaluation and management of non-asthma conditions that mimic asthma. We present here a case of a middle aged female who presented with severe bronchospasm, initially labeled as asthma but was resistant to usual anti-asthma therapy. After further workup she was eventually diagnosed to have esophageal achalasia.

Measuring The Symptom Burden Of Lung Cancer: The Validity And Utility Of The Lung Cancer Module Of The M D Anderson Symptom Inventory, Tito R Mendoza, Xin Shelley Wang, Charles Lu, Guadalupe R Palos, Zhongxing Liao, Gary M Mobley, Shitij Kapoor, Charles S Cleeland

Faculty, Staff and Student Publications

We conducted a study to establish the psychometric properties of a module of the M. D. Anderson Symptom Inventory (MDASI) developed specifically for patients with lung cancer (MDASI-LC). The MDASI measures 13 common "core" symptoms of cancer and its treatment. The MDASI-LC includes the 13 core MDASI symptom items and three lung cancer-specific items: coughing, constipation, and sore throat. MDASI-LC items were administered to three cohorts of patients with lung cancer undergoing either chemotherapy or chemoradiotherapy. Known-group validity and criterion (concurrent) validity of the MDASI-LC were evaluated using the Eastern Cooperative Oncology Group performance status and the 12-item Short-Form Health …

Undetected Common Variable Immune Deficiency In A Young Adult Of Pakistani Descent., M Owais Khan, Adil Iqba Memon, Ali Bin Sarwar Zubairi, Asifali Imam

Department of Medicine

Common variable immune deficiency (CVID) is a syndrome which is due to deficiency of humoral immune response resulting in increased susceptibility to infections We report a case of CVID in a 24-year-old male whopresented with a history of recurrent pneumonias.

Copd Care Coordination Program, Glenda Mccall

Nursing Theses and Capstone Projects

COPD is the fourth leading cause of death in the United States. Several studies confirm only 50% of COPD patients receive optimal care. The disease is greatly under-recognized and generally is not diagnosed until it is clinically apparent and moderately advanced. COPD is also a major resource consuming disease. Considering these facts, Mission Hospitals realized the opportunity to improve evidence based quality care for patients diagnosed with COPD as well as the development of a Care Coordinated Program to improve outcomes for the patient as well as the organization. The goal of the program is to provide correct, comprehensive, and …

Variables Predictive Of Outcome In Patients With Acute Hypercapneic Respiratory Failure Treated With Noninvasive Ventilation., Nawal Salahuddin, Muhammad Irfan, Shereen Khan, Muhammad Naeem, Ahmad Suleman Haque, Shahid Javed Husain, Nisar Rao, Ali Bin Sarwar Zubairi, Javaid Khan

Department of Medicine

Objective: To assess results with NIV in acute hypercapneic respiratory failure and to identify outcome predictors.

Methods: This was a retrospective observational study on consecutive patients presenting with acute type II respiratory failure and meeting criteria for NIV use over a 5 year period. Patients presenting with haemodynamic instability, inability to protect their airway, malignant arrhythmias and recent oesophageal surgery were excluded. Univariate and Multivariate regression analysis was used to determine the impact on survival. A p value of < 0.05 was considered statistically significant. Software used was SPSS 14.

Results: Total numbers of patients included were 119; 52.9% were males. Mean age was 63.4 ± 11.9 years. Overall Survival …