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Younis M, Al-Antary N, Dalbah R, Qarajeh A, Khanfar AN, Kar AA, Reddy R, Alzghoul BN. Echocardiography and pulmonary hypertension in patients with chronic obstructive pulmonary disease undergoing lung transplantation evaluation. Am J Med Sci 2024; 367:95-104. [PMID: 37967751 DOI: 10.1016/j.amjms.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 10/01/2023] [Accepted: 11/10/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND The use of echocardiography in pulmonary hypertension (PH) in advanced chronic obstructive pulmonary disease (COPD) is understudied. We aimed to compare the performance of echocardiography with right heart catheterization (RHC) in the diagnosis of PH in COPD patients undergoing lung transplant evaluation. METHODS We included 111 patients with severe COPD who underwent RHC in a single center as part of lung transplantation evaluation. COPD-PH and severe COPD-PH were defined based on RHC per the 6th world symposium on pulmonary hypertension. Echocardiographic probability of PH was described according to the European Society of Cardiology guidelines. Summary and univariate analyses were performed. RESULTS The mean age (±SD) was 62 (8) and 47% (n=52) were men. A total of 82 patients (74 %) had COPD-PH. The sensitivity, specificity, positive predictive, and negative predictive values of echocardiography in diagnosing COPD-PH were 43 %, 83 %, 88 %, and 34 % respectively and for severe COPD-PH were 67 %, 75 %, 50 %, and 86 % respectively. Echocardiography was consistent with RHC in ruling in/out PH in 53% (n=59) of patients. After controlling for age, sex. BMI, pack year, echocardiography-RHC time difference, GOLD class, FVC, and CT finding of emphysema, higher TLC decreased consistency (parameter estimate=-0.031; odds ratio: 0.97, 95%CI 0.94-0.99; p=0.037) and higher DLCO increased consistency (parameter estimate=0.070; odds ratio: 1.07, 95%CI 0.94-0.99; p=0.026). CONCLUSIONS Echocardiography has high specificity but low sensitivity for the diagnosis of PH in advanced COPD. Its performance improves when ruling out severe COPD-PH. This performance correlates inversely with lung hyperinflation.
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Affiliation(s)
- Moustafa Younis
- Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, Florida, United States.
| | | | - Rami Dalbah
- Internal Medicine, East Tennessee State University, Johnson City, Tennessee, United States
| | - Ahmad Qarajeh
- Faculty of Medicine, University of Jordan, Amman, Jordan
| | - Asim N Khanfar
- Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Abdullah Abu Kar
- Division of Hospital Medicine, University of California San Francisco, San Francisco, California, United States
| | - Raju Reddy
- Pulmonary, Critical Care and Sleep Medicine, Oregon Health and Science University, Portland, Oregon, United States
| | - Bashar N Alzghoul
- Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, Florida, United States
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Zayed Y, Alzghoul BN, Hyde R, Wadood Z, Banifadel M, Khasawneh M, Maharrey PB, Saker H, Harden C, Barnes G, Gomez-Manjarres D, Patel D, Faruqi I, Mehrad B, Mehta HJ. Role of Transbronchial Lung Cryobiopsy in the Diagnosis of Interstitial Lung Disease: A Meta-analysis of 68 Studies and 6300 Patients. J Bronchology Interv Pulmonol 2023; 30:99-113. [PMID: 35698283 PMCID: PMC10448786 DOI: 10.1097/lbr.0000000000000865] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 04/06/2022] [Indexed: 01/23/2023]
Abstract
BACKGROUND Diagnosis of interstitial lung disease (ILD) is based on multidisciplinary team discussion (MDD) with the incorporation of clinical, radiographical, and histopathologic information if available. We aim to evaluate the diagnostic yield and safety outcomes of transbronchial lung cryobiopsy (TBLC) in the diagnosis of ILD. METHODS We conducted a meta-analysis by comprehensive literature search to include all studies that evaluated the diagnostic yields and/or adverse events with TBLC in patients with ILD. We calculated the pooled event rates and their 95% confidence intervals (CIs) for the diagnostic yield by MDD, histopathologic diagnostic yield, and various clinical adverse events. RESULTS We included 68 articles (44 full texts and 24 abstracts) totaling 6386 patients with a mean age of 60.7±14.1 years and 56% men. The overall diagnostic yield of TBLC to achieve a definite or high-confidence diagnosis based on MDD was 82.3% (95% CI: 78.9%-85.2%) and histopathologic diagnosis of 72.5% (95% CI: 67.7%-76.9%). The overall rate of pneumothorax was 9.6% (95% CI: 7.9%-11%), while the rate of pneumothorax requiring drainage by a thoracostomy tube was 5.3% (95% CI: 4.1%-6.9%). The rate of moderate bleeding was 11.7% (95% CI: 9.1%-14.9%), while the rate of severe bleeding was 1.9% (95% CI: 1.4%-2.6%). The risk of mortality attributed to the procedure was 0.9% (95% CI: 0.7%-1.3%). CONCLUSION Among patients with undiagnosed or unclassified ILD requiring tissue biopsy for diagnosis, transbronchial cryobiopsy represents a reliable alternative to surgical lung biopsy with decreased incidence of various clinical adverse events.
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Affiliation(s)
- Yazan Zayed
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, Florida, USA
| | - Bashar N. Alzghoul
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, Florida, USA
| | - Ryan Hyde
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, Florida, USA
| | - Zerka Wadood
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, Florida, USA
| | - Momen Banifadel
- Division of Pulmonary and Critical Care, Case Western Reserve University, University Hospitals, Cleveland, Ohio, USA
| | - Majd Khasawneh
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, Florida, USA
| | - P. Brandon Maharrey
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, Florida, USA
| | - Haneen Saker
- Department of Internal Medicine, University of Florida, Gainesville, FL, USA
| | - Christopher Harden
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, Florida, USA
| | - Gabrielle Barnes
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, Florida, USA
| | - Diana Gomez-Manjarres
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, Florida, USA
| | - Divya Patel
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, Florida, USA
| | - Ibrahim Faruqi
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, Florida, USA
| | - Borna Mehrad
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, Florida, USA
| | - Hiren J. Mehta
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, Florida, USA
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Alzghoul H, Jin P, Vahdatpour C, Alzghoul BN. Fatal venous air embolism in the setting of hemodialysis and pulmonary hypertension: A point of care ultrasound diagnosis. Respir Med Case Rep 2023; 42:101819. [PMID: 36860648 PMCID: PMC9969267 DOI: 10.1016/j.rmcr.2023.101819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 11/27/2022] [Accepted: 02/15/2023] [Indexed: 02/19/2023] Open
Abstract
Air emboli are rare and often difficult to diagnose. Transesophageal echocardiography remains the most definitive method of diagnosis, but this is not feasible in emergencies. We present a case of fatal air embolism in the setting of hemodialysis with recent evidence of pulmonary hypertension. The diagnosis was made by visualizing air in the right ventricle using bedside point of care ultrasound (POCUS). While POCUS is not routinely used for the diagnosis of air embolism, its accessibility makes it a powerful yet practical emerging tool for the diagnosis of respiratory and cardiovascular emergencies.
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Affiliation(s)
- Hamza Alzghoul
- Faculty of Medicine, Hashemite University, Zarqa, 13133, Jordan
| | - Phoebe Jin
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Cyrus Vahdatpour
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL, USA
| | - Bashar N. Alzghoul
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL, USA,Corresponding author. Division of Pulmonary, Critical Care and Sleep Medicine University of Florida, 1600 Southwest Archer Rd Gainesville, FL, 32610, USA.
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Innabi A, Alzghoul BN, Kalra S, Al-Hakim T, Buchanan M, Shivas T, Xue W, Gomez-Manjarres D, Patel DC. Sarcoidosis among US Hispanics in a Nationwide Registry. Respir Med 2021; 190:106682. [PMID: 34788736 DOI: 10.1016/j.rmed.2021.106682] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 10/14/2021] [Accepted: 11/08/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND Sarcoidosis has been well studied in multiple races and ethnic groups. However, there is a paucity of data that describes sarcoidosis in Hispanics. We aimed to determine the prevalence of Hispanic ethnicity, clinical characteristics and impact of sarcoidosis among Hispanics from a US based national registry. METHODS We conducted a national registry-based study investigating 3835 respondents to the Sarcoidosis Advanced Registry for Cures questionnaire. This registry is a web-based, self-reported questionnaire that provides data related to demographics, diagnostics, organ involvement, treatment modalities, and the physical and psychosocial impact of sarcoidosis. We compared Hispanic patients to non-Hispanics. We performed multivariate logistic regression analysis adjusting for age, gender, education, income and insurance status and looked at the association between Hispanic ethnicity with depression, chronic pain syndrome, chronic fatigue syndrome, impact on family finances, employment-based disability and job termination. RESULTS Nine percent of the patients reported a Hispanic ethnicity and the majority of these patients self-identified as white women. The most common organs involved were the lungs (74.9%), central lymph nodes (53.8%), and peripheral lymph nodes (37.1%). Hispanics reported more peripheral nerves and peripheral lymph nodes involvement than non-Hispanics. Hispanics experienced more depression, sleep apnea, and chronic pain syndrome than non-Hispanics. The use of mobility assistive devices was more common among Hispanics, as well as employment-based disability, and disease-related job termination compared to non-Hispanics. The majority of Hispanics reported significantly more pain that interfered with the enjoyment of life than non-Hispanics. On multivariate logistic regression analysis, Hispanic ethnicity was associated with depression (adjusted odds ratio (aOR) = 1.5; 95% CI: 1.01-2.2), chronic pain syndrome (aOR = 1.7; 1.1-2.6), job termination due to sarcoidosis (aOR = 1.7; 1.1-2.7) and higher impact on family finances (aOR = 1.7; 1.1-2.5). CONCLUSION The clinical presentation of sarcoidosis in Hispanic patients differs from that in non-Hispanic patients living in the United States. These differences should be considered when managing Hispanic patients with sarcoidosis. We encourage more studies that investigate phenotyping among Hispanics with sarcoidosis.
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Affiliation(s)
- Ayoub Innabi
- Division of Pulmonary, Critical Care and Sleep Medicine; University of Florida; Gainesville, Florida, USA
| | - Bashar N Alzghoul
- Division of Pulmonary, Critical Care and Sleep Medicine; University of Florida; Gainesville, Florida, USA
| | - Saminder Kalra
- Division of Pulmonary, Critical Care and Sleep Medicine; University of Florida; Gainesville, Florida, USA
| | | | - Mindy Buchanan
- Foundation for Sarcoidosis Research; Chicago, Illinois, USA
| | - Tricha Shivas
- Foundation for Sarcoidosis Research; Chicago, Illinois, USA
| | - Wei Xue
- Department of Biostatistics, College of Public Health and Health Professions and College of Medicine; University of Florida; Gainesville, FL, USA
| | - Diana Gomez-Manjarres
- Division of Pulmonary, Critical Care and Sleep Medicine; University of Florida; Gainesville, Florida, USA
| | - Divya C Patel
- Division of Pulmonary, Critical Care and Sleep Medicine; University of Florida; Gainesville, Florida, USA.
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Abbas HK, Alzghoul BN, Jaber J, Mehta HJ. Response. Chest 2021; 160:e371-e372. [PMID: 34625188 DOI: 10.1016/j.chest.2021.06.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
- Hawazin K Abbas
- Division of Pulmonary, Critical Care and Sleep Medicine, Gainesville, FL; Department of Medicine, University of Florida, Gainesville, FL
| | - Bashar N Alzghoul
- Division of Pulmonary, Critical Care and Sleep Medicine, Gainesville, FL; Department of Medicine, University of Florida, Gainesville, FL
| | - Johnny Jaber
- Department of Medicine, University of Florida, Gainesville, FL
| | - Hiren J Mehta
- Division of Pulmonary, Critical Care and Sleep Medicine, Gainesville, FL; Department of Medicine, University of Florida, Gainesville, FL.
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6
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Jantz MA, Omballi M, Alzghoul BN, Fernandez Bussy S, Becnel D, Majid A, Mehta HJ. Utility of bronchoscopic intra-tumoral alcohol injection to restore airway patency. J Thorac Dis 2021; 13:4956-4964. [PMID: 34527334 PMCID: PMC8411124 DOI: 10.21037/jtd-20-3554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 07/23/2021] [Indexed: 11/06/2022]
Abstract
Background In cases of malignant airway obstruction, achieving airway patency using conventional bronchoscopic modalities can be challenging and may not be satisfactory. We aim to present our experience of using intra-tumoral alcohol injection (ITAI) to help achieve airway patency in malignant airway obstruction. Methods A retrospective study of adult patients presenting with malignant airway obstruction who underwent bronchoscopy with ITAI at a university center between 2015 and 2020 was conducted. We present procedural and patients' characteristics along with any additional bronchoscopic or systemic interventions received. Patients were classified based on airway patency response (assessed qualitatively by an interventional pulmonologist) into those with good response (≥50% improvement in airway patency) vs. those with low response (<50% improvement in airway patency). Results Forty-two patients underwent ITAI, of which 34 (81%) had at least two bronchoscopies to evaluate response. The patient median age was 65.5 [interquartile range (IQR) 57.8-72]. Most patients had stage IV malignancy at the time of the bronchoscopy (57.1%) and had Eastern Cooperative Oncology Group (ECOG) performance status score of between 2-3. Eighty-two percent of the patients achieved good airway patency response at the conclusion of the procedures. The procedures were generally well-tolerated and only one patient had significant bleeding that was not directly related to ITAI and required intensive care unit monitoring for 24 hours after the procedure. Conclusions Dehydrated alcohol is readily available, inexpensive and a safe drug that can be potentially injected directly in malignant airway obstructive lesions in a multimodality approach to achieve airway patency when traditional modalities reach their limitation. Further studies are warranted to determine whether ITAI is superior to other interventional methods, explore its utilization to treat peripheral malignant tumors, as well as to standardize the treatment protocol and determine the effects of ITAI on patient symptoms and quality of life.
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Affiliation(s)
- Michael A Jantz
- Pulmonary Medicine, North Florida Regional Medical Center, Gainesville, FL, USA
| | - Mohamed Omballi
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL, USA
| | - Bashar N Alzghoul
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL, USA
| | | | - David Becnel
- Division of Pulmonary, Critical Care and Sleep Medicine, Tulane University, New Orleans, LA, USA
| | - Adnan Majid
- Division of Pulmonary and Critical Care Medicine, Beth Israel Deaconess medical center, Boston, MA, USA
| | - Hiren J Mehta
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL, USA
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7
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Alzghoul BN, Kay D, Innabi A, Omballi M, Kavesh MH, Mehta HJ. A 57-Year-Old Man With Stridor and Critical Tracheal Narrowing. Chest 2021; 159:e385-e388. [PMID: 34099155 DOI: 10.1016/j.chest.2021.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 10/21/2020] [Accepted: 01/06/2021] [Indexed: 11/24/2022] Open
Abstract
CASE PRESENTATION A 57-year-old man with a history of polysubstance use presented with shortness of breath, wheezing, productive cough, subjective fever, and chills of 3-day duration. Additionally, he reported worsening shortness of breath for the last 3 months. Of note, the patient was reported to have had, in the previous 6 months, two episodes of pneumonia that was treated with antibiotics and steroids. He was also diagnosed several years prior with adult-onset asthma due to intermittent wheezing and was prescribed an albuterol inhaler. The albuterol did not help relieve his wheezing, and he stopped refilling it.
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Affiliation(s)
- Bashar N Alzghoul
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL
| | - Dana Kay
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL
| | - Ayoub Innabi
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL
| | - Mohamed Omballi
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL
| | - Mark H Kavesh
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida, Gainesville, FL
| | - Hiren J Mehta
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL.
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Kalra SS, Jaber J, Alzghoul BN, Hyde R, Parikh S, Urbine D, Reddy R. Pre-Existing Psychiatric Illness Is Associated With an Increased Risk of Delirium in Patients With Acute Respiratory Distress Syndrome. J Intensive Care Med 2021; 37:647-654. [PMID: 34041934 DOI: 10.1177/08850666211019009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Patients with acute respiratory distress syndrome (ARDS) are highly susceptible to developing delirium for a multitude of reasons. Previous studies have linked pre-existing depression with an increased risk of postoperative delirium in patients undergoing cardiac and non-cardiac surgery. However, the evidence regarding the association between pre-existing psychiatric illnesses and delirium in ARDS patients is unknown. In this study, we aim to determine the relationship between pre-existing psychiatric illness and the risk of development of delirium amongst ARDS patients. STUDY DESIGN AND METHODS We performed a retrospective study of a mixed group of patients admitted to the intensive care unit (ICU) between January 2016 and December 2019 with a diagnosis of ARDS per the Berlin definition. The study group was divided into 2 cohorts: subjects with delirium and subjects without delirium. Comparison between the 2 groups was conducted to examine the impact of pre-existing psychiatric illnesses including major depressive disorder (MDD), generalized anxiety disorder (GAD), bipolar disorder, schizophrenia, or post-traumatic stress disorder. Multivariable logistic regression analysis was performed adjusting for benzodiazepine use, sedatives, analgesics, sequential organ failure assessment score, and corticosteroid use to determine the association between pre-existing psychiatric disorders and delirium. RESULTS 286 patients with ARDS were identified; 124 (43%) of whom were diagnosed with ICU delirium. In patients diagnosed with ICU delirium, 49.2% were found to have preexisting psychiatric illnesses, compared to 34.0% without any preexisting psychiatric illness (OR = 1.94, P = 0.01). In a subgroup analysis of individual psychiatric illnesses, GAD and MDD were associated with the development of delirium (OR = 1.88, P = 0.04 and OR = 1.76, P = 0.05 respectively). INTERPRETATION ARDS patients with preexisting psychiatric illnesses, particularly GAD and MDD are associated with an increased risk of developing ICU delirium. Clinicians should be aware of the effect of psychiatric co-morbidities on developing delirium in critically ill patients.
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Affiliation(s)
- Saminder Singh Kalra
- Division of Pulmonary, Critical Care and Sleep Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Johnny Jaber
- Division of Pulmonary, Critical Care and Sleep Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Bashar N Alzghoul
- Division of Pulmonary, Critical Care and Sleep Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Ryan Hyde
- Division of Pulmonary, Critical Care and Sleep Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Sarina Parikh
- Division of Pulmonary, Critical Care and Sleep Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Daniel Urbine
- Division of Pulmonary, Critical Care and Sleep Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Raju Reddy
- Division of Pulmonary, Critical Care and Sleep Medicine, College of Medicine, University of Florida, Gainesville, FL, USA.,Oregon Health and Science University, Portland, Oregon
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Abbas HK, Alzghoul BN, Jaber JF, Mehta HJ. Low Risk of COVID-19 Infection Among Bronchoscopy Suite Personnel in a Hospital Without Preprocedural Outpatient Testing Mandate. Chest 2021; 160:1565-1567. [PMID: 33971145 PMCID: PMC8105141 DOI: 10.1016/j.chest.2021.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/03/2021] [Accepted: 05/04/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
- Hawazin K Abbas
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL; Department of Medicine, University of Florida, Gainesville, FL
| | - Bashar N Alzghoul
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL; Department of Medicine, University of Florida, Gainesville, FL
| | - Johnny F Jaber
- Department of Medicine, University of Florida, Gainesville, FL
| | - Hiren J Mehta
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL; Department of Medicine, University of Florida, Gainesville, FL.
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10
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Innabi A, Gomez-Manjarres D, Alzghoul BN, Chizinga M, Mehrad B, Patel DC. Cyclophosphamide for the treatment of Acute Exacerbation of Interstitial Lung Disease: A Review of the Literature. Sarcoidosis Vasc Diffuse Lung Dis 2021; 38:e2021002. [PMID: 33867789 PMCID: PMC8050619 DOI: 10.36141/svdld.v38i1.11271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/30/2021] [Indexed: 12/23/2022]
Abstract
Acute exacerbation of interstitial lung disease is a serious and life-threatening event but little is known about its treatment. Cyclophosphamide has been proposed in randomized clinic trials as a treatment option in progressive cases of systemic sclerosis related interstitial lung disease. However, in acute exacerbation of interstitial lung disease, we found only small case series, and retrospective studies, mostly with no comparative groups which described the role of cyclophosphamide. Results of these studies showed mixed outcomes, with no robust evidence that cyclophosphamide adds any benefit in treating acute exacerbations of interstitial lung disease. More well-designed studies including randomized clinical trials are needed to better understand the role of cyclophosphamide during exacerbations of interstitial lung disease. In this review article, we summarize the current evidence on the use of cyclophosphamide in interstitial lung disease with a focus on the acute exacerbation events.
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Affiliation(s)
- Ayoub Innabi
- Division of Pulmonary, Critical Care and Sleep Medicine; University of Florida; Gainesville, FL
| | - Diana Gomez-Manjarres
- Division of Pulmonary, Critical Care and Sleep Medicine; University of Florida; Gainesville, FL
| | - Bashar N Alzghoul
- Division of Pulmonary, Critical Care and Sleep Medicine; University of Florida; Gainesville, FL
| | - Mwelwa Chizinga
- Division of Pulmonary, Critical Care and Sleep Medicine; University of Florida; Gainesville, FL
| | - Borna Mehrad
- Division of Pulmonary, Critical Care and Sleep Medicine; University of Florida; Gainesville, FL
| | - Divya C Patel
- Division of Pulmonary, Critical Care and Sleep Medicine; University of Florida; Gainesville, FL
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11
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Alzghoul BN, As Sayaideh M, Moreno BF, Singh SK, Innabi A, Reddy R, Papierniak ES, Alnuaimat HM. Pulmonary hypertension in eosinophilic versus noneosinophilic COPD. ERJ Open Res 2021; 7:00772-2020. [PMID: 33718496 PMCID: PMC7938054 DOI: 10.1183/23120541.00772-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/27/2021] [Indexed: 11/25/2022] Open
Abstract
Background The eosinophilic COPD phenotype is associated with greater airway remodelling, exacerbation risk and steroid responsiveness. However, little is known about the prevalence and characteristics of pulmonary hypertension (PH) in this patient population. Methods We retrospectively evaluated a cohort of COPD patients with right heart catheterisation (RHC) data at a university hospital between January 2011 and May 2019 and compared the pulmonary vascular profile and prevalence of PH between eosinophilic and noneosinophilic patients using a definition of eosinophilic COPD as at least three blood eosinophil values ≥300 cells·µL−1. We used multivariable logistic regression analyses to examine the association between eosinophilic COPD and various PH categories adjusting for age, sex, body mass index, forced expiratory volume in 1 s (%), smoking status and use of supplemental oxygen. Results Among 106 COPD patients with RHC data and at least three blood eosinophil values, 25% met the definition of eosinophilic COPD. Fewer patients among the eosinophilic group required long-term oxygen therapy (69% versus 93%, p=0.001) and total lung capacity was significantly lower in the eosinophilic group (p=0.006). This group had higher mean pulmonary arterial pressure (mPAP) (median (interquartile range) 30 (27–41) mmHg versus 25 (22–30) mmHg, p=0.001) and pulmonary vascular resistance (PVR) (4 (2.8–5.1) Wood units versus 2.9 (2.1–4.1) Wood units, p=0.018). On multivariable logistic regression analyses, eosinophilic phenotype was associated with PH (adjusted (a)OR 6.5, 95% CI 1.4–30.7; p=0.018) and pre-capillary PH (aOR 3.2, 95% CI 1.1–9; p=0.027), but not severe PH (aOR 2.1, 95% CI 0.6–7.2; p=0.219). Conclusion Eosinophilic COPD was associated with higher mPAP and PVR and increased likelihood of PH. More studies are needed to further explore this finding. In COPD patients with right heart catheterisation, eosinophilic COPD confers a 7-fold increase in the likelihood of pulmonary hypertension and a 3-fold increase in the likelihood of pre-capillary pulmonary hypertension compared to noneosinophilic COPDhttps://bit.ly/2YJk7aB
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Affiliation(s)
- Bashar N Alzghoul
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL, USA.,Dept of Medicine, University of Florida, Gainesville, FL, USA
| | | | - Brian F Moreno
- Dept of Medicine, University of Florida, Gainesville, FL, USA
| | - Saminder K Singh
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL, USA.,Dept of Medicine, University of Florida, Gainesville, FL, USA
| | - Ayoub Innabi
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL, USA.,Dept of Medicine, University of Florida, Gainesville, FL, USA
| | - Raju Reddy
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL, USA.,Dept of Medicine, University of Florida, Gainesville, FL, USA
| | - Eric S Papierniak
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL, USA.,Dept of Medicine, University of Florida, Gainesville, FL, USA
| | - Hassan M Alnuaimat
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL, USA.,Dept of Medicine, University of Florida, Gainesville, FL, USA
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12
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Zayed Y, Alzghoul BN, Banifadel M, Venigandla H, Hyde R, Sutchu S, Khasawneh M, Borok Z, Urbine D, Jantz M, Reddy R. Vitamin C, Thiamine, and Hydrocortisone in the Treatment of Sepsis: A Meta-Analysis and Trial Sequential Analysis of Randomized Controlled Trials. J Intensive Care Med 2021; 37:327-336. [PMID: 33511898 DOI: 10.1177/0885066620987809] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND There is a conflicting body of evidence regarding the benefit of vitamin C, thiamine, and hydrocortisone in combination as an adjunctive therapy for sepsis with or without septic shock. We aimed to assess the efficacy of this treatment among predefined populations. METHODS A literature review of major electronic databases was performed to include randomized controlled trials (RCTs) evaluating vitamin C, thiamine, and hydrocortisone in the treatment of patients with sepsis with or without septic shock in comparison to the control group. RESULTS Seven studies met our inclusion criteria, and 6 studies were included in the final analysis totaling 839 patients (mean age 64.2 ± 18; SOFA score 8.7 ± 3.3; 46.6% female). There was no significant difference between both groups in long term mortality (Risk Ratio (RR) 1.05; 95% CI 0.85-1.30; P = 0.64), ICU mortality (RR 1.03; 95% CI 0.73-1.44; P = 0.87), or incidence of acute kidney injury (RR 1.05; 95% CI 0.80-1.37; P = 0.75). Furthermore, there was no significant difference in hospital length of stay, ICU length of stay, and ICU free days on day 28 between the intervention and control groups. There was, however, a significant difference in the reduction of SOFA score on day 3 from baseline (MD -0.92; 95% CI -1.43 to -.41; P < 0.05). In a trial sequential analysis for mortality outcomes, our results are inconclusive for excluding lack of benefit of this therapy. CONCLUSION Among patients with sepsis with or without septic shock, treatment with vitamin C, thiamine, and hydrocortisone was not associated with a significant reduction in mortality, incidence of AKI, hospital and ICU length of stay, or ICU free days on day 28. There was a significant reduction of SOFA score on day 3 post-randomization. Further studies with a larger number of patients are needed to provide further evidence on the efficacy or lack of efficacy of this treatment.
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Affiliation(s)
- Yazan Zayed
- Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL, USA
| | - Bashar N Alzghoul
- Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL, USA
| | - Momen Banifadel
- Pulmonary, Critical Care and Sleep Medicine, Case Western University, University Hospitals, Cleveland, OH, USA
| | - Hima Venigandla
- Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL, USA
| | - Ryan Hyde
- Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL, USA
| | - Selina Sutchu
- Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL, USA
| | - Majd Khasawneh
- Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL, USA
| | - Zea Borok
- Division of Pulmonary, Critical Care and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Daniel Urbine
- Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL, USA
| | - Michael Jantz
- Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL, USA
| | - Raju Reddy
- Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL, USA
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13
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Alzghoul BN, Amer FN, Barb D, Innabi A, Mardini MT, Bai C, Alzghoul B, Al-Hakim T, Singh N, Buchanan M, Serchuck L, Gomez Manjarres D, Woodmansee WW, Maier LA, Patel DC. Prevalence and characteristics of self-reported hypothyroidism and its association with nonorgan-specific manifestations in US sarcoidosis patients: a nationwide registry study. ERJ Open Res 2021; 7:00754-2020. [PMID: 33816601 PMCID: PMC8005680 DOI: 10.1183/23120541.00754-2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 12/24/2020] [Indexed: 12/15/2022] Open
Abstract
Little is known about the prevalence, clinical characteristics and impact of hypothyroidism in patients with sarcoidosis. We aimed to determine the prevalence and clinical features of hypothyroidism and its relation to organ involvement and other clinical manifestations in patients with sarcoidosis. We conducted a national registry-based study investigating 3835 respondents to the Sarcoidosis Advanced Registry for Cures Questionnaire between June 2014 and August 2019. This registry is based on a self-reported, web-based questionnaire that provides data related to demographics, diagnostics, sarcoidosis manifestations and treatment. We compared sarcoidosis patients with and without self-reported hypothyroidism. We used multivariable logistic regression and adjusted for potential confounders to determine the association of hypothyroidism with nonorgan-specific manifestations. 14% of the sarcoidosis patients self-reported hypothyroidism and were generally middle-aged white women. Hypothyroid patients had more comorbid conditions and were more likely to have multiorgan sarcoidosis involvement, especially with cutaneous, ocular, joints, liver and lacrimal gland involvement. Self-reported hypothyroidism was associated with depression (adjusted odds ratio (aOR) 1.3, 95% CI 1.01-1.6), antidepressant use (aOR 1.3, 95% CI 1.1-1.7), obesity (aOR 1.7, 95% CI 1.4-2.1), sleep apnoea (aOR 1.7, 95% CI 1.3-2.2), chronic fatigue syndrome (aOR 1.5, 95% CI 1.2-2) and was borderline associated with fibromyalgia (aOR 1.3, 95% CI 1-1.8). Physical impairment was more common in patients with hypothyroidism. Hypothyroidism is a frequent comorbidity in sarcoidosis patients that might be a potentially reversible contributor to fatigue, depression and physical impairment in this population. We recommend considering routine screening for hypothyroidism in sarcoidosis patients especially in those with multiorgan sarcoidosis, fatigue and depression.
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Affiliation(s)
- Bashar N. Alzghoul
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL, USA
| | - Farah N. Amer
- Dept of Internal Medicine, University of Central Florida/North Florida Regional Medical Center, Gainesville, FL, USA
| | - Diana Barb
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL, USA
| | - Ayoub Innabi
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL, USA
| | - Mamoun T. Mardini
- Dept of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
- Dept of Aging and Geriatric Research, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Chen Bai
- Dept of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Bara Alzghoul
- Dept of Internal Medicine, University of Kentucky, Lexington, KY, USA
| | | | - Noopur Singh
- Foundation for Sarcoidosis Research, Chicago, IL, USA
| | | | | | - Diana Gomez Manjarres
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL, USA
| | - Whitney W. Woodmansee
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL, USA
| | - Lisa A. Maier
- Division of Environmental and Occupational Health Sciences, National Jewish Health, Denver, CO, USA
- Division of Pulmonary Sciences and Critical Care Medicine, Dept of Medicine, School of Medicine, Dept of Environmental/Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Campus, Aurora, CO, USA
| | - Divya C. Patel
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL, USA
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14
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Alzghoul BN, Hamburger R, Lewandowski T, Janssen B, Grey D, Xue W, Ataya A, Alnuaimat H, Gomez-Manjarres DC, Patel D, Reddy R. Pulmonary hypertension in patients with interstitial pneumonia with autoimmune features. Pulm Circ 2020; 10:2045894020944117. [PMID: 33343878 DOI: 10.1177/2045894020944117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/29/2020] [Indexed: 11/16/2022] Open
Abstract
Pulmonary hypertension in interstitial lung diseases is associated with increased mortality and hospitalizations and reduced exercise capacity. Interstitial pneumonia with autoimmune features (IPAF) is a recently described interstitial lung disease. The characteristics of pulmonary hypertension in IPAF patients are unknown. We sought to characterize patients with IPAF based on their echocardiographic probability of pulmonary hypertension and compare patients with and without pulmonary hypertension identified by right heart catheterization. We conducted a retrospective study of patients seen in the interstitial lung disease clinic from 2015 to 2018. Forty-seven patients with IPAF were identified. Patients were classified into low, intermediate and high echocardiographic pulmonary hypertension probabilities. A sub-group analysis of patients with pulmonary hypertension and without pulmonary hypertension (IPAF-PH vs. IPAF-no PH) identified by right heart catheterization was also performed. Linear regression analysis was performed to study the association between 6-min-walk-distance (6MWD) and pulmonary vascular resistance (PVR) while adjusting for age and body mass index. Right ventricular hypertrophy (>5 mm), right ventricular enlargement (>41 mm) and right ventricular systolic dysfunction defined as fractional area change% ≤35 was present in 76%, 24%, and 39% of patients, respectively. Pulmonary hypertension was identified in 12.7% of patients. IPAF-PH patients had higher mean pulmonary artery pressure and lower cardiac output compared to the IPAF-no PH group (34 mmHg vs. 19 mmHg, p = 0.002 and 4.0 vs. 5.7 L/min, p = 0.023, respectively). Lower 6MWD was associated with higher PVR on regression analysis (p = 0.002). Pulmonologists should be aware that a significant number of IPAF patients may develop pulmonary hypertension. Reduced 6MWD may suggest the presence of pulmonary hypertension in IPAF patients.
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Affiliation(s)
- Bashar N Alzghoul
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL, USA
| | - Robert Hamburger
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, USA
| | - Thomas Lewandowski
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, USA
| | - Brandon Janssen
- Department of Internal Medicine, University of Florida, Gainesville, FL, USA
| | - Daniel Grey
- Department of Internal Medicine, University of Florida, Gainesville, FL, USA
| | - Wei Xue
- Department of Biostatistics, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
| | - Ali Ataya
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL, USA
| | - Hassan Alnuaimat
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL, USA
| | - Diana C Gomez-Manjarres
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL, USA
| | - Divya Patel
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL, USA
| | - Raju Reddy
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL, USA
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15
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Alzghoul BN, Li P, Zaki S, Patel DC. Bronchoalveolar lavage flow cytometry for the diagnosis of pulmonary post-transplant lymphoproliferative disorder. QJM 2020; 113:813-814. [PMID: 32277822 DOI: 10.1093/qjmed/hcaa124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- B N Alzghoul
- From the Pulmonary, Critical Care and Sleep Medicine, University of Florida, 1600 SW Archer Road, Room M452, PO Box 100225, Gainesville, FL 32610-0225, USA
| | - P Li
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, 1600 SW Archer Road, Room M452, PO Box 100225, Gainesville, FL 32610-0225, USA
| | - S Zaki
- Department of Internal Medicine, Florida State University, 600 W College Ave, Tallahassee, FL 32306, USA
| | - D C Patel
- From the Pulmonary, Critical Care and Sleep Medicine, University of Florida, 1600 SW Archer Road, Room M452, PO Box 100225, Gainesville, FL 32610-0225, USA
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16
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Alzghoul BN, Innabi A, Mukhtar F, Jantz MA. Rapid Resolution of Severe Vaping-induced Acute Lipoid Pneumonia after Corticosteroid Treatment. Am J Respir Crit Care Med 2020; 202:e32-e33. [PMID: 32142357 DOI: 10.1164/rccm.201909-1826im] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Bashar N Alzghoul
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, and
| | - Ayoub Innabi
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, and
| | - Faisal Mukhtar
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida, Gainesville, Florida
| | - Michael A Jantz
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, and
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17
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Alzghoul BN, Reddy R, Chizinga M, Innabi A, Zou B, Papierniak ES, Faruqi I. Pulmonary Embolism in Acute Asthma Exacerbation: Clinical Characteristics, Prediction Model and Hospital Outcomes. Lung 2020; 198:661-669. [PMID: 32424799 DOI: 10.1007/s00408-020-00363-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 05/11/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE Little is known about the characteristics and impact of acute pulmonary embolism (PE) during episodes of asthma exacerbation. We aimed to characterize patients diagnosed with acute PE in the setting of asthma exacerbation, develop a prediction model to help identify future patients and assess the impact of acute PE on hospital outcomes. METHODS We included 758 patients who were treated for asthma exacerbation and underwent a computed tomographic pulmonary angiography (CTA) during the same encounter at a university-based hospital between June 2011 and October 2018. We compared clinical characteristics of patients with and without acute PE and developed a machine learning prediction model to classify the PE status based on the clinical variables. We used multivariable regression analysis to evaluate the impact of acute PE on hospital outcomes. RESULTS Twenty percent of the asthma exacerbation patients who underwent CTA had an acute PE. Factors associated with acute PE included previous history of PE, high CHA2DS2-VASc score, hyperlipidemia, history of deep vein thrombosis, malignancy, chronic systemic corticosteroids use, high body mass index and atrial fibrillation. Using these factors, we developed a random forest machine learning prediction model which had an 88% accuracy in classifying the acute PE status of the patients (area under the receiver operating characteristic curve = 0.899; 95% confidence interval: 0.885-0.913). Acute PE in asthma exacerbation was associated with longer hospital stay and intensive care unit stay. CONCLUSION It is important to consider acute PE, a potentially life-threatening event, in the setting of asthma exacerbation especially when other risk factors are present.
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Affiliation(s)
- Bashar N Alzghoul
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, 1600 SW Archer Road, Box 100277, Gainesville, FL, 32608, USA. .,Department of Medicine, University of Florida, Gainesville, FL, USA.
| | - Raju Reddy
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, 1600 SW Archer Road, Box 100277, Gainesville, FL, 32608, USA.,Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Mwelwa Chizinga
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, 1600 SW Archer Road, Box 100277, Gainesville, FL, 32608, USA.,Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Ayoub Innabi
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, 1600 SW Archer Road, Box 100277, Gainesville, FL, 32608, USA.,Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Baiming Zou
- Department of Biostatistics and School of Nursing, University of North Carolina, Chapel Hill, NC, USA
| | - Eric S Papierniak
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, 1600 SW Archer Road, Box 100277, Gainesville, FL, 32608, USA.,Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Ibrahim Faruqi
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, 1600 SW Archer Road, Box 100277, Gainesville, FL, 32608, USA.,Department of Medicine, University of Florida, Gainesville, FL, USA
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18
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Alzghoul BN, Abualsuod A, Alqam B, Innabi A, Palagiri DR, Gheith Z, Amer FN, Meena NK, Kenchaiah S. Cocaine Use and Pulmonary Hypertension. Am J Cardiol 2020; 125:282-288. [PMID: 31757354 DOI: 10.1016/j.amjcard.2019.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/08/2019] [Accepted: 10/10/2019] [Indexed: 10/25/2022]
Abstract
Evidence linking cocaine to the risk of pulmonary hypertension (PH) is limited and inconsistent. We examined whether cocaine use, in the absence of other known causes of PH, was associated with elevated systolic pulmonary artery pressure (sPAP) and increased probability of PH. We compared patients with documented cocaine use to a randomly selected age, sex, and race-matched control group without history of cocaine use. All participants had no known causes of PH and underwent echocardiography for noninvasive estimation of sPAP. We used routinely reported echocardiographic parameters and contemporary guidelines to grade the probability of PH. In 88 patients with documented cocaine use (mean age ± standard deviation 51.7 ± 9.5 years), 33% were women and 89% were of Black race. The commonest route of cocaine use was smoking (74%). Cocaine users compared with the control group had significantly higher sPAP (mean ± standard deviation, 30.1 ± 13.1 vs 22.0 ± 9.8 mm Hg, p <0.001) and greater likelihood of PH (25% vs 10%, p = 0.012). In multivariable analyses adjusted for potential confounders including left ventricular diastolic dysfunction, cocaine use conferred a fivefold greater odds of echocardiographic PH (p = 0.006). Additionally, a stepwise increase in the likelihood of PH was noted across cocaine users with negative or no drug screen on the day of echocardiography to cocaine users with a positive drug screen (multivariable p for trend = 0.008). In conclusion, cocaine use was associated with a higher sPAP and an increased likelihood of echocardiographic PH with a probable acute-on-chronic effect.
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19
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Burgess MJ, Rosenbaum ER, Pritt BS, Haselow DT, Ferren KM, Alzghoul BN, Rico JC, Sloan LM, Ramanan P, Purushothaman R, Bradsher RW. Possible Transfusion-Transmitted Babesia divergens-like/MO-1 Infection in an Arkansas Patient. Clin Infect Dis 2018; 64:1622-1625. [PMID: 28329282 DOI: 10.1093/cid/cix216] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 03/07/2017] [Indexed: 12/27/2022] Open
Abstract
A patient with asplenia and multiple red blood cell transfusions acquired babesiosis infection with Babesia divergens-like/MO-1 organisms and not Babesia microti, the common United States species. He had no known tick exposure. This is believed to be the first transfusion-transmitted case and the fifth documented case of B. divergens-like/MO-1 infection.
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Affiliation(s)
| | | | - Bobbi S Pritt
- Division of Clinical Microbiology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Bashar N Alzghoul
- Internal Medicine Residency Program, University of Arkansas for Medical Sciences, and
| | | | - Lynne M Sloan
- Division of Clinical Microbiology, Mayo Clinic, Rochester, Minnesota
| | - Poornima Ramanan
- Division of Clinical Microbiology, Mayo Clinic, Rochester, Minnesota
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20
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Raman T, Chatterjee K, Alzghoul BN, Innabi AA, Tulunay O, Bartter T, Meena NK. A bronchoscopic approach to benign subglottic stenosis. SAGE Open Med Case Rep 2017; 5:2050313X17713151. [PMID: 28620493 PMCID: PMC5464515 DOI: 10.1177/2050313x17713151] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 05/10/2017] [Indexed: 11/16/2022] Open
Abstract
Objectives: Subglottic stenosis is an abnormal narrowing of the tracheal lumen at the level of subglottis (the area in between the vocal cords and the cricoid cartilage). It can cause significant symptoms due to severe attenuation of airflow. We describe our experience in alleviating symptoms by addressing the stenosis using fibreoptic bronchoscopic methods. Methods: We report all concurrent cases performed between September 2015 and July 2016. We use a combination of balloon dilation, electro-surgery knife to dilate and incise stenotic segments followed by steroid injection to modulate healing. Results: We treated 10 patients in the study period, 8 of which were women. A total of 39 procedures were performed on these patients during this period. Gastro-esophageal reflux was the most common comorbidity associated with stenosis. The majority of the patients required more than 2 therapeutic procedures, but none required more than 4 procedures. There were no complications. Conclusion: Tracheal stenosis and in particular subglottic stenosis is a recurrent process and its management requires extensive collaboration amongst treating specialties. Our technique of steroid injection after dilation of the stenosis was effective in symptom control and decreased the number of repeat procedures.
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Affiliation(s)
- Tuhina Raman
- Division of Pulmonary and Critical Care Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Kshitij Chatterjee
- Residency Program, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Bashar N Alzghoul
- Residency Program, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ayoub A Innabi
- Residency Program, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ozlem Tulunay
- Department of Otolaryngology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Thaddeus Bartter
- Division of Pulmonary and Critical Care Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Nikhil K Meena
- Division of Pulmonary and Critical Care Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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