Pulmonology Commons^™

Do Critically Ill Patients With Guardianships Receive More Aggressive Treatment?, Misha Haq, Jacob Keeley, Enrique Calvo-Ayala

Posters

• Patients suffering from certain conditions can become unable, unwilling, or unavailable to make decisions regarding their end-of-life care1.
• • In these cases, a court appointed guardian is responsible for carrying out medical decisions on behalf of the patient2.
• Patients with guardians tend to receive more aggressive care, regardless of the benefit, because it is perceived as safer 3.
• Guidelines and laws for medical decision-making for patients with guardians are inconsistent, leaving this population vulnerable4.

Epic Best Practice Alerts Increases Sep1 Orderset Usage, Mark Munir, Zachary Awad, Paul Bozyk, Ramin Homayouni

Posters

Sepsis is a massive, system-wide inflammatory response to an infection that can lead to multisystem organ failure.1 Sepsis has a very high mortality rate of 20-50% in patients with severe sepsis and is the 10th leading cause of death in the United States.2 One of the most significant ways of reducing mortality from sepsis is timely detection and initiation of treatment in septic patients.3

Electronic medical records such as Epic have implemented sepsis warning algorithms and alerts to facilitate quicker detection of sepsis and thus earlier initiation of treatment. The goal of this study is to determine if an Epic …

Current Standards And Future Directions Of Duchenne Muscular Dystrophy Respiratory Care: The Ppmd Italy Meeting Report, Jane Black, David J. Birnkrant

Faculty Scholarship

Objective: This report summarizes key discussions from the meeting “Current Standards and Future Directions of Respiratory Assessment and Management of Duchenne Muscular Dystrophy (DMD),” organized by Parent Project Muscular Dystrophy (PPMD) Italy and the United States to address current challenges and opportunities in DMD respiratory care. Methods: The meeting brought together researchers, clinicians, and patient advocates who shared experiences, discussed advancements in DMD respiratory management, and identified areas of debate that require further research. Results: The speakers emphasized routine assessment of pulmonary function and of breathing during sleep to achieve timely diagnosis of respiratory complications. Therapeutic discussions focused on airway …

Discharge Practice Variability In Pediatric Chronic Home Invasive Ventilation, Guillermo Beltran-Ale, Ryne Simpson, Terri Magruder, Ajay S Kasi, Amit Agarwal, Jake A Kaslow

Faculty, Staff and Students Publications

Introduction: The Pediatric Mechanical Ventilation Society is a collaboration of pediatric pulmonologists with a focus on pediatric chronic home invasive ventilation (PCHIV). Since the initial discharge on PCHIV is not always directed by pediatric pulmonologists, we sought to understand how this variability between centers impact adherence to American Thoracic Society (ATS) guidelines for PCHIV.

Methods: A survey was distributed to pediatric pulmonologists across multiple platforms inquiring about discharging practices for PCHIV and adherence to six of the nine ATS recommendations for PCHIV. Two subgroups were created based on common practices - discharge by pediatric pulmonologists from a non-ICU unit (pulmonary …

Recurrent Endobronchial Coil Migration Associated With Needle Biopsy Following Pulmonary Artery Pseudoaneurysm Embolization., Michael H Koenig, Mina S Makary, Tejas Sinha, Jeffrey C Horowitz, Nicholas Pastis

Ambulatory and Primary Care Articles

Endobronchial coil migration is a rare complication of pulmonary artery embolization, occurring when coils erode through a vessel into an airway. We describe a patient who underwent embolization of pulmonary artery pseudoaneurysms associated with a lung mass. The unique aspect of this case is the development of recurrent endobronchial coil migration following a CT-guided core needle biopsy and a subsequent endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) of the mass. In both circumstances, the portion of the coil that migrated into the large airways was cut with endoscopic scissors and removed with a flexible bronchoscope. This case highlights that while cutting …

Successful Flexible Bronchoscopic Extraction Of A Dental Foreign Body Aspirated Into The Left Mainstem Bronchus, Alexys Bolden, Hayden Cooper, Lynnetta Payne, Mark Coomes, Mark Cooper

Marshall Journal of Medicine

Foreign body aspiration (FBA) is a potentially life-threatening emergency that commonly occurs in children but varies widely in clinical presentation. Rapid diagnosis and intervention are of the utmost importance to prevent complications such as airway obstruction, infection, and lung injury. While uncommon in adults, most encountered causes occur in the setting of intoxication, neuromuscular weakness, or iatrogenic dental work. Those with dental prostheses are especially susceptible due to the partially attached nature, rendering the risk of accidental dislodgement. This report discusses an uncommon case wherein an 82-year-old male aspirated a dental bridge into his left mainstem bronchus during routine dental …

From Molars To Bronchus; The Tale Of An Aspirated Dental Instrument, Yisroel Grabie, Sudeep Acharya, Fasih Sami Siddiqui, Gabriel A. Chavez Reyna, Michel Chalhoub

HCA Healthcare Journal of Medicine

Background

Aspiration of dental instruments is a rare event that carries potentially serious complications when it occurs, especially in older patients, where protective reflexes are diminished. Clinical management may be difficult because of the risk of granulation tissue and different retrieval strategies according to the object’s characteristics. In this report, we describe the case of an 84-year-old man who aspirated a dental bur during a routine dental procedure, necessitating immediate intervention. Timely and precise management was essential to avert severe complications.

Case Presentation

During a routine dental procedure, an 84-year-old man aspirated a bud-shaped cross-cut carbide dental bur. Despite initial …

Utility Of Incorporating Radiological Findings Of Right Heart Strain In Patients With Acute Pulmonary Embolism For Risk Stratification Of Adverse Outcomes: A Retrospective Analysis, Joshua Amaya, Sameer Allahabadi, Daniel L. Habenicht, John Hunton, Amal M. Khan, Subhash Venigalla, Curran Reddy, Jeremy V. Doan, Grace Wang, Daniel R. Eickenhorst, Shovendra Gautam

HCA Healthcare Journal of Medicine

Background

Right heart (RH) strain in the setting of pulmonary embolisms can significantly increase the risk of mortality. Thus, screening for risk of complications in these patients is crucial. The goal of our study was to assess the strength of specific diagnostic findings of RH strain for predicting adverse outcomes including mortality, hospital length of stay, and the requirement of advanced interventions.

Methods

A single-center, retrospective cohort study of 81 patients diagnosed with acute pulmonary embolism with RH strain on computed tomography pulmonary angiogram (CTPA) from September 12, 2019, to August 30, 2023. Data were collected on patient computed tomography …

Liposomes As Imaging Agents Of Inflammation And Oxidative Stress In Bone Implants, Delia Danila, Patricia S Pardo, R Devesh Kumar Misra, Aladin M Boriek

Faculty, Staff and Students Publications

Liposomes are tiny, spherical vesicles made from cholesterol and natural phospholipids that are promising imaging agents for detecting medical complications. They can carry fluorescent markers or other imaging agents, making them effective for medical imaging. Furthermore, liposomes can target specific cells involved in inflammation, such as macrophages, and accumulate at inflammation sites when injected. Additionally, liposomes can be designed to respond to oxidative stress, which is often associated with bone implant complications. By detecting areas of stress, liposomes provide valuable information about implant health. However, challenges such as rapid clearance from the body, precise targeting, immune reactions, and high production …

Tetralogy Of Fallot And Its Many Effects, Kolby White

Undergraduate Research Conference

No abstract provided.

Impact Of Shift Length On Burnout And Job Or Life Satisfaction Among Allied Healthcare Professionals, Tareq F. Alotaibi, Abdulmohsen Altayyar, Muteb Al Muflih, Nawaf Alqahtani, Naif Alhawiti, Badi A. Alotaibi, Sami Al Ossaimi, Hassan Y. Aljohani, Mobarak Alqahtani, Taha Ismaeil, Mohammed Al Qahtani, Saleh Al Garni

Internet Journal of Allied Health Sciences and Practice

Abstract: Background/Objectives: Healthcare professionals are critical to community well-being, but the 12-versus 8-hour shifts on their stress and burnout are unclear. This study examines the effects of work patterns on the quality of life, job satisfaction, and burnout among allied healthcare professionals. Method: a validated questionnaire was used. A descriptive analysis, independent samples t-test and Mann–Whitney U test were used, and the significance level was p < 0.05. Results: Among the 340 participants, the mean age was 28 years, and most were women (63.5%), single (58%), and worked 8-hour shifts (54.4%). Most (78%) of the participants reported their job satisfaction …

Early Nintedanib Deployment In Covid-19 Interstitial Lung Disease (Endcov-I): Study Protocol Of A Randomised, Double-Blind, Placebo-Controlled Trial, Valeria Santibanez, Aditi Mathur, Jigna Zatakia, Nicole Ng, Michele Cohen, Emilia Bagiella, Stacey-Ann Brown, Ivan O Rosas, Nina M Patel, Amy Olson, Peide Li, Maria Padilla

Faculty, Staff and Students Publications

Introduction: In December 2019, the novel SARS-CoV-2 triggered a global pneumonia outbreak, leading to millions of deaths worldwide. A subset of survivors faces increased morbidity and mortality, particularly due to subacute lung injury evolving to chronic fibrosing interstitial lung disease. While nintedanib, a tyrosine-kinase inhibitor, shows promise in treating progressive fibrotic lung disease, limited randomised trial data exists for post-COVID-19-induced lung injury. We hypothesise that treatment with nintedanib may attenuate advancement to the fibrotic stages, offering a potential avenue for improving outcomes in this specific patient subset.

Methods and analysis: We describe the design of a multicentre, randomised, double-blind, placebo-controlled …

Hickam’S Dictum Of The Great Vessels: Saddle Embolism And Dissection, Eric Wetzel, Do, Kyle Mohney, Do, Jessica Schumann, Do, Olubunmi Olarewaju, Do

Jefferson Health - Northeast Posters (formerly Aria Health Posters)

History of Present Illness

Chief Complaint:
Shortness of breath

History of Present:
Illness A 66-year-old female with a past medical history of hypertension presents to the emergency department concerned for shortness of breath and palpitations. She reports her symptoms started abruptly while on a morning walk. She notes she took her home blood pressure medication this morning per her usual routine and had otherwise been feeling well. She describes feeling like she is having a “high grade panic attack”, similar to past panic attacks but with increased intensity. She denies associated weakness, numbness, chest pain, nausea, vomiting, or abdominal pain. …

Single Dose Nivolumab And Ipilimumab Treatment Causing Complete And Durable Response In Extensive Stage - Small Cell Lung Cancer Complicated By Severe Sensory Autoimmune Neuropathy, Aaron Lobo Md, Nur Rahman Md, Nicholas Blondin Md, Neal Fischbach

Posters

The use of immune checkpoint inhibitors (ICI) in recent years has increasingly emerged as a second-line treatment in the management of extensive-stage small cell lung cancer (ES-SCLC) compared to conventional chemotherapy alone.

The use of combined ICI therapy by inhibiting two distinct pathways in patients with ES-SCLC has been evaluated in clinical trials. The increase incidence of immune related adverse events (Ir-AE) in these trials due to excessive immune system activation or multiple organ disorders has posed serious clinical challenges.

Here we report a dramatic and durable response to combined immune checkpoint blockade without chemotherapy and discuss the relationship between …

Examining The Role Of Corticosteroids In The Management Of Acute Interstitial Pneumonia: A Systematic Review., Carlos Valladares, Aalia Narvel, Bianna Koutsenko, Alexa Simonetti, Fatima Mossolem, Alexis Chow, Samrat Gollapudi, Usmaan Al-Shehab, Nicholas Averell, Katherine Chiapaikeo-Poco, Adam Kaplan

Rowan-Virtua School of Osteopathic Medicine Departmental Research

BACKGROUND: Acute interstitial pneumonia (AIP), also known as Hamman-Rich syndrome, is a rapidly progressive interstitial lung disease. In addition to being challenging to diagnose, AIP is also difficult to treat. The mortality rate of AIP is greater than 70% due to the disease's rapid progression. Furthermore, survivors are likely to develop chronic interstitial lung disease as a sequela. Treatment primarily focuses on supportive care, which consists of oxygenation through mechanical ventilation, administration of broad-spectrum antibiotics, and the use of corticosteroids. Although the use of steroids as empiric treatment is controversial and results on its mortality benefit are variable, some studies …

Genetic Testing Utilization In The U.S. Registry For Childhood Interstitial And Diffuse Lung Diseases., Laura A. Voss, Rebekah J. Nevel, Jennifer A. Wambach, Lawrence M. Nogee, Robin R. Deterding, Alicia M. Casey, Michael G. O'Connor, Daniel I. Craven, Jane B. Taylor, Gail H. Deutsch, Jade B. Tam-Williams, Lea C. Steffes, Steven K. Brennan, Maria T. Santiago, Sara C. Sadreameli, Andrea F. Heras, Michael R. Powers, Antonia P. Popova, Manvi Bansal, Aaron Hamvas, William A. Gower, Fernando Urrego, Lisa R. Young, Child Registry Collaborative

Manuscripts, Articles, Book Chapters and Other Papers

INTRODUCTION: Childhood interstitial and diffuse lung diseases (chILD) comprise a diverse group of rare disorders. Identifying the underlying cause is crucial for treatment, prognosis, and estimating recurrence risk. The objective of this study was to assess the utilization of genetic testing for subjects enrolled in the United States National Registry for ChILD, a multicenter observational study.

METHODS: Genetic data from participating sites were reviewed and analyzed in relationship to clinical characteristics.

RESULTS: Of 609 children enrolled from 22 centers, genetic testing was performed for 55.5% (n = 338). Genetic testing results were positive (diagnostic) for 22.8% (n = 77), negative …

Pulmonary Function Testing In Pediatric Allogeneic Stem Cell Transplant Recipients To Monitor For Bronchiolitis Obliterans Syndrome: A Systematic Review, William A Gower, Maximiliano Tamae-Kakazu, Shivanthan Shanthikumar, Saumini Srinivasan, Erin E Reardon, Amisha V Barochia, Edward Charbek, Charlotte Calvo, Pi Chun Cheng, Shailendra Das, Stella M Davies, Jessica Gross, Ajay Sheshadri, Christoper T Towe, Samuel B Goldfarb, Narayan P Iyer

Faculty, Staff and Students Publications

Background: Bronchiolitis obliterans syndrome (BOS) represents a significant source of morbidity and non-relapse mortality among children and young adults treated with allogeneic hematopoietic stem cell transplantation (aHSCT). Pulmonary function testing (PFT) pre- and post-aHSCT may allow for pre-symptomatic detection of BOS, and thus early intervention. Current guidelines and practices vary regarding which tests to perform and timing relative to transplant. A systematic review evaluating PFT before and after pediatric aHSCT was conducted to inform American Thoracic Society clinical practice guidelines on detection of BOS.

Objective: To determine the optimal approach to conducting PFT prior to and after pediatric aHSCT.

Study …

A Geospatial Analysis Of The Lung Cancer Burden In Philadelphia, Using Pennsylvania Cancer Registry Data From 2008-2017, Russell K. Mcintire, Katherine Senter, Christine S. Shusted, Rickisa Yearwood, Julie Barta, Scott W. Keith, Charnita Zeigler-Johnson

Division of Pulmonary, Allergy, and Critical Care Medicine Faculty Papers

(1) Background: Lung cancer is the deadliest and second most prevalent cancer in Pennsylvania (PA), and African American patients are disproportionately affected. Lung cancer morbidity and mortality in Philadelphia County are among the highest in PA. Geographic information systems (GIS) are useful to explore geospatial variations in the cancer burden and risk factors. Therefore, we used GIS to analyze the lung cancer burden in Philadelphia to assess which areas of the city have the highest morbidity and mortality, identify potential clusters, and determine which census tract-level characteristics were associated with higher tract-level cancer burden. (2) Methods: Using secondary data from …

Management Of Pulmonary Arterial Hypertension: Current Strategies And Future Prospects, Munish Sharma, Vivek Paudyal, Saifullah Khalid Syed, Rubi Thapa, Nadeem Kassam, Salim Surani

Internal Medicine, East Africa

Primary pulmonary hypertension (PPH), now known as pulmonary arterial hypertension (PAH), has induced significant treatment breakthroughs in the past decade. Treatment has focused on improving patient survival and quality of life, and delaying disease progression. Current therapies are categorized based on targeting different pathways known to contribute to PAH, including endothelin receptor antagonists (ERAs), phosphodiesterase-5 inhibitors (PDE-5 inhibitors), prostacyclin analogs, soluble guanylate cyclase stimulators, and activin signaling inhibitors such as Sotatercept. The latest addition to treatment options is soluble guanylate cyclase stimulators, such as Riociguat, which directly stimulates the nitric oxide pathway, facilitating vasodilation. Looking to the future, advancements in …

Chronic Hepatitis And Hemophagocytic Lymphohistiocytosis Associated With Systemic Chronic Active Epstein-Barr Virus Disease, Emmanuel Palomera-Tejeda, Lauren Shaffer, Michael Shi, Nagasri Shankar, Roshan Raza, George Cholankeril

Faculty, Staff and Students Publications

Systemic chronic active Epstein-Barr virus (EBV) disease is a rare, delayed, and life-threatening complication of EBV infection. It is characterized by persistent viremia and a mononucleosis-like syndrome with multisystemic involvement because of lymphocytic tissue infiltration. We present the case of an 82-year-old woman without known immunodeficiency who presented with abnormal liver enzymes and interstitial pneumonia. Investigations revealed hyperferritinemia, elevated soluble interleukin-2 receptor levels, hypofibrinogenemia, and hepatosplenomegaly, consistent with hemophagocytic lymphohistiocytosis, as well as a high EBV viral load. Liver biopsy demonstrated portal chronic lymphocytic inflammation and positive EBV in situ hybridization, suggesting systemic chronic active Epstein-Barr virus disease as the …