1
|
Obri MS, Fahoury AM, Alhaj Ali S, Samad M, Alluri S, Obri AS, Almajed MR, Harris KB, Jafri SM. Pulmonary Complications of Everolimus in Liver Transplant Patients: A 10-Year Experience. Cureus 2024; 16:e53334. [PMID: 38435956 PMCID: PMC10907112 DOI: 10.7759/cureus.53334] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 03/05/2024] Open
Abstract
This retrospective study aims to evaluate the safety of everolimus when used as part of the immunosuppression regimen in patients who underwent liver transplant from 2009 to 2019 at a tertiary liver transplant center. Patients were divided into two groups: those who received everolimus as part of the post-transplant regimen and those who did not. The primary safety outcome measured was the development of new pulmonary complications that had been associated with everolimus use in prior studies. Lung function was determined by pulmonary function tests if available or CT scans of the chest. Secondary outcomes measured included everolimus discontinuation rates and survival rates. During the study period, 450 patients underwent liver transplant; 35% of patients received everolimus (n=156) and 65% of patients did not receive everolimus (n=292). Primary safety outcome of pulmonary complications was seen in 3.9% of patients who received everolimus (n=6) and 6.3% of the control group patients who did not receive everolimus (n=19). The association between everolimus use and new pulmonary complications was not significant with a chi-square statistic of 1.33 (p=0.249). Overall, 51.3% of patients who received everolimus during their post-transplant course discontinued the medication (n=80). Everolimus is safe from a pulmonary toxicity standpoint in liver transplant immunosuppression regimens as there was no significant difference found in pulmonary complications between patients who received the medication and those who did not.
Collapse
Affiliation(s)
- Mark S Obri
- Internal Medicine, Henry Ford Health System, Detroit, USA
| | - Alan M Fahoury
- Internal Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, USA
| | | | - Momin Samad
- Internal Medicine, Henry Ford Health System, Detroit, USA
| | | | - Alex S Obri
- Pharmacy, College of Pharmacy, University of Toledo, Toledo, USA
| | | | - Kevin B Harris
- Gastroenterology, Henry Ford Health System, Detroit, USA
| | | |
Collapse
|
2
|
Almajed MR, Almajed A, Khan N, Obri MS, Ananthasubramaniam K. Systemic right ventricle complications in levo-transposition of the great arteries: A case report and review of literature. World J Cardiol 2023; 15:542-552. [PMID: 37900900 PMCID: PMC10600789 DOI: 10.4330/wjc.v15.i10.542] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 08/23/2023] [Accepted: 09/27/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND Congenitally corrected levo-transposition of the great arteries (L-TGA) is a congenital heart disease in which the ventricles and great arteries are transposed from their typical anatomy. In L-TGA, the double discordance, atrioventricular and ventriculoarterial, create an acyanotic milieu which allows patients to survive their early decades, however, progressive systemic right ventricle (sRV) dysfunction creates complications later in life. sRV dysfunction and remodeling predisposes patients to intracardiac thrombus (ICT) formation. CASE SUMMARY A 40-year-old male with L-TGA presented with symptoms of acute decompensated heart failure. In childhood, he had surgical repair of a ventricular septal defect. In adulthood, he developed sRV dysfunction, systemic tricuspid valve (sTV) regurgitation, and left-bundle branch block for which he underwent cardiac resynchronization therapy. Transthoracic echocardiogram showed a sRV ejection fraction of 40%, severe sTV regurgitation, and a newly identified sRV ICT. ICT was confirmed by ultrasound-enhancing agents and transesophageal echocardiography. Our patient was optimized with guideline-directed medical therapy and diuresis. Anticoagulation was achieved with a vitamin K antagonist (VKA) and he was later referred for evaluation by advanced heart failure and heart transplant services. CONCLUSION Anticoagulation with VKA is the mainstay of treatment in the absence of conclusive data supporting direct oral anticoagulant use in ICT in patients with congenital heart disease. This case illustrates the natural history of L-TGA and highlights the importance of surveillance and monitoring with dedicated cardiac imaging to identify complications.
Collapse
Affiliation(s)
- Mohamed Ramzi Almajed
- Department of Internal Medicine, Henry Ford Hospital, Detroit, MI 48202, United States
| | - Abdulla Almajed
- College of Medicine and Medical Sciences, Arabian Gulf University, Manama 00000, Bahrain
| | - Naoshin Khan
- Department of Internal Medicine, Henry Ford Hospital, Detroit, MI 48202, United States
| | - Mark S Obri
- Department of Internal Medicine, Henry Ford Hospital, Detroit, MI 48202, United States
| | | |
Collapse
|
3
|
Obri MS, Nimri F, Kamran W, Nimri R, Pompa R, Zuchelli T. Gastrointestinal Stromal Tumor Presenting as Food Impaction and Pseudo-Achalasia. ACG Case Rep J 2023; 10:e01116. [PMID: 37583506 PMCID: PMC10424890 DOI: 10.14309/crj.0000000000001116] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 07/06/2023] [Indexed: 08/17/2023] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are one of the most common mesenchymal tumors of the gastrointestinal tract. Studies report the incidence of GIST to be 14.5 per million, with 18% being diagnosed incidentally. The most common location is the stomach while the esophagus is the rarest, representing only 0.7% of cases. The clinical manifestations of GISTs vary. Most patients present with bleeding and gastric discomfort. Some may present with life-threatening hematemesis or melena. We present a unique case of a GIST presenting as pseudo-achalasia and food impaction.
Collapse
Affiliation(s)
- Mark S. Obri
- Division of Internal Medicine, Henry Ford Health, Detroit, MI
| | - Faisal Nimri
- Division of Gastroenterology and Hepatology, Henry Ford Health, Detroit, MI
| | - Wasih Kamran
- Division of Internal Medicine, Henry Ford Health, Detroit, MI
| | - Rund Nimri
- Jordan University of Science and Technology, School of Medicine, Irbid, Jordan
| | - Robert Pompa
- Division of Gastroenterology and Hepatology, Henry Ford Health, Detroit, MI
| | - Tobias Zuchelli
- Division of Gastroenterology and Hepatology, Henry Ford Health, Detroit, MI
| |
Collapse
|
4
|
Mangal R, Hasso MF, Obri MS, Almajed MR, Entz A. A Case of a Large and Rare Incidental Pleural Tumor in an Elderly Female. Cureus 2023; 15:e42198. [PMID: 37601997 PMCID: PMC10439741 DOI: 10.7759/cureus.42198] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2023] [Indexed: 08/22/2023] Open
Abstract
Solitary fibrous tumors are very rare in the pleura, and they are generally found incidentally. Even though they can potentially become malignant and metastasize, they have minimal clinical symptoms and can still be benign. Due to the low incidence of these tumors, there is no standard of therapy beyond surgical resection. We present an asymptomatic case of a large, rapidly expanding solitary fibrous tumor of the pleura in an elderly female.
Collapse
Affiliation(s)
- Ruchi Mangal
- Internal Medicine, Henry Ford Health System, Detroit, USA
| | - Muneer F Hasso
- Internal Medicine, Henry Ford Health System, Detroit, USA
| | - Mark S Obri
- Internal Medicine, Henry Ford Health System, Detroit, USA
| | | | - Abigail Entz
- Internal Medicine, Henry Ford Health System, Detroit, USA
| |
Collapse
|
5
|
Obri MS, Youssef RM, Alluri S, Vemulapalli K, Ichkhanian Y, Todter EN, Jesse MT, Salgia R. Disparities in Referrals to End-of-Life Care in Eligible Hepatocellular Carcinoma Patients. Dig Dis Sci 2023:10.1007/s10620-023-07992-4. [PMID: 37289417 DOI: 10.1007/s10620-023-07992-4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/30/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Hepatocellular Carcinoma (HCC) is a malignancy with increasing incidence and morbidity. For patients with a poor prognosis, engagement with advanced care planning and end-of life (EOL) services (I.e., palliative care, hospice) can address physical, financial, and social complications of a terminal diagnosis. Minimal data exist on the demographics of the patients being referred to and enrolling in EOL services for HCC. AIMS We aim to report the relationship between demographics and EOL service referral. METHODS Retrospective review of a prospectively maintained high-volume liver center registry of patients diagnosed with HCC from 2004 to 2022. EOL services eligible patients were defined as BCLC stage C or D, evidence of metastases, and/or transplant ineligible. RESULTS Black patients were more likely to be referred than white patients (OR 1.47 (1.03, 2.11)). Once referred, patients were significantly more likely to be enrolled if they had insurance coverage, though no other factors in models were significant. There were no significant differences in survival among those referred who did or did not enroll, after controlling for other factors. CONCLUSION Black patients were more likely to be referred compared to white patients and patients who were insured were more likely to be enrolled. Whether this is indicative of black patients being appropriately referred at a higher rate, being offered EOL care instead of aggressive treatment, or other unknown factors warrants further study.
Collapse
Affiliation(s)
- Mark S Obri
- Division of Internal Medicine, Henry Ford Health, 2799 West Grand Boulevard, Detroit, MI, 48202, USA.
| | - Rami M Youssef
- Division of Internal Medicine, Henry Ford Health, 2799 West Grand Boulevard, Detroit, MI, 48202, USA
| | - Spandana Alluri
- Division of Internal Medicine, Henry Ford Health, 2799 West Grand Boulevard, Detroit, MI, 48202, USA
| | - Krishna Vemulapalli
- Division of Internal Medicine, Henry Ford Health, 2799 West Grand Boulevard, Detroit, MI, 48202, USA
| | - Yervant Ichkhanian
- Division of Internal Medicine, Henry Ford Health, 2799 West Grand Boulevard, Detroit, MI, 48202, USA
| | - Erika N Todter
- Public Health Sciences, Henry Ford Health, Detroit, MI, USA
| | - Michelle T Jesse
- Division of Internal Medicine, Henry Ford Health, 2799 West Grand Boulevard, Detroit, MI, 48202, USA
- Transplant Institute, Henry Ford Health, Detroit, MI, USA
| | - Reena Salgia
- Division of Gastroenterology and Hepatology, Henry Ford Health, Detroit, USA
| |
Collapse
|
6
|
Obri MS, Kamran W, Almajed MR, Eid D, Venkat D. Splenic Artery Embolism in Liver Transplant Patients: A Single-Center Experience. Cureus 2023; 15:e38599. [PMID: 37168407 PMCID: PMC10166421 DOI: 10.7759/cureus.38599] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Hypersplenism, portal hypertension, and ascites have been seen after liver transplants. Patients are usually treated medically with refractory patients potentially undergoing splenectomy. Splenic artery embolism (SAE) is an alternative that can be performed to limit the surgical intervention that may have the benefit of improving portal hypertension. Few studies have studied the effect on main portal vein (MPV) velocities and hepatic artery resistive indices (HARIs) which may be beneficial as markers of portal hypertension. PURPOSE This study aims to evaluate the efficacy and safety of interventional radiology (IR)-guided SAE for the management of portal hypertension in patients who have had liver transplants. METHODS A retrospective analysis was conducted on liver transplant patients who had undergone IR-guided SAE post-transplant at a single tertiary transplant center from 2012 to 2022. The primary outcome of intervention efficacy was quantified by peak HARIs and MPV velocities. Ultrasound with Doppler obtained before and after the intervention was reviewed for these parameters. Secondary outcomes included adverse events at the time of the procedure and within one year of the procedure, the need for splenectomy, and spleen size. RESULTS Twenty-eight patients met the criteria for inclusion. The mean age of patients was 52.5 years (21-71 years) and the time after transplant was 149.5 days (2-1588 days). About 96.4% of SAEs were technically successful (n=27). Twenty-one patients had MPV velocities available, and 24 had peak HARIs available. In these patients, HARIs decreased by an average of 0.063 (95% CI 0.014-0.112) after SAE. MPV velocity decreased by an average of 47.2 cm/s (95% CI 27.3-67.1) after SAE. About 10.4% of patients (n=3) developed a procedure-related complication, all of which were femoral access site aneurysms. No (0) patients suffered from bleeding, infections, or abscesses after the procedure. About 10.7% of patients (n=3) required splenectomy after SAE: one splenectomy was due to technical failure and two were due to refractory symptoms. CONCLUSION We performed one of the first analyses on MPV and RI and showed that our patients saw an improvement post-embolization with a theoretical improvement in portal hypertension. The complication rate and risk of infection seem to be acceptable risks, making SAE a feasible option for management.
Collapse
Affiliation(s)
- Mark S Obri
- Internal Medicine, Henry Ford Health System, Detroit, USA
| | - Wasih Kamran
- Radiology, Henry Ford Health System, Detroit, USA
| | | | - Daniel Eid
- College of Medicine, Northeast Ohio Medical University, Detroit, USA
| | - Deepak Venkat
- Division of Gastroenterology and Hepatology, Henry Ford Health System, Detroit, USA
| |
Collapse
|
7
|
Obri MS, Goleniak R, Almajed MR, Eid D, Entz A. False Reassurance From a Stool Test: A Delayed Cancer Diagnosis. Cureus 2023; 15:e38107. [PMID: 37252586 PMCID: PMC10211267 DOI: 10.7759/cureus.38107] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2023] [Indexed: 05/31/2023] Open
Abstract
Colorectal cancer (CRC) is an increasingly prevalent condition in the United States and the world. Numerous screening tools have been created to help prevent and identify early cases of CRC, which have led to better outcomes for patients. These screening tools range from stool tests to more invasive procedures like a colonoscopy. With this array of screening options, patients are often presented with a bevy of choices in their primary care clinic and may have difficulty understanding the difference between screening and treatment. Popular culture has also influenced these decisions as both traditional media and social media have weighed in on the experience with these screening tools. We present a unique case where our patient tested negative on a stool screening exam and proceeded to be diagnosed with CRC within the negative screening period. The case was complicated by the patient's reluctance to undergo a colonoscopy and a unique combination of symptoms that led to a difficult diagnosis.
Collapse
Affiliation(s)
- Mark S Obri
- Internal Medicine, Henry Ford Health System, Detroit, USA
| | - Ryan Goleniak
- Internal Medicine, Henry Ford Health System, Detroit, USA
| | | | - Daniel Eid
- College of Medicine, Northeast Ohio Medical University, Detroit, USA
| | - Abigail Entz
- Internal Medicine, Henry Ford Health System, Detroit, USA
| |
Collapse
|
8
|
Ghandour B, Keane MG, Shinn B, Dawod QM, Fansa S, El Chafic AH, Irani SS, Pawa R, Gutta A, Ichkhanian Y, Paranandi B, Pawa S, Al-Haddad MA, Zuchelli T, Huggett MT, Sharaiha RZ, Kowalski TE, Khashab MA, Shrigiriwar A, Zhang L, Mony S, Khan A, Loren DE, Chiang A, Schlachterman A, Kumar A, Saab O, Blake B, Obri MS. Factors predictive of persistent fistulas in EUS-directed transgastric ERCP: a multicenter matched case-control study. Gastrointest Endosc 2023; 97:260-267. [PMID: 36228699 DOI: 10.1016/j.gie.2022.09.028] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 09/16/2022] [Accepted: 09/26/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND AIMS EUS-directed transgastric ERCP (EDGE) is an established method for managing pancreaticobiliary pathology in Roux-en-Y gastric bypass patients, with high rates of technical success and low rates of serious adverse events (AEs). However, widespread adoption of the technique has been limited because of concerns about the development of persistent gastrogastric or jejunogastric fistulas. Gastrogastric and jejunogastric fistulas have been reported in up to 20% of cases in some series, but predictive risk factors and long-term management and outcomes are lacking. Therefore, our aims were to assess factors associated with the development of persistent fistulas and the technical success of endoscopic fistula closure. METHODS This is a case-control study involving 9 centers (8 USA, 1 Europe) from February 2015 to September 2021. Cases of persistent fistulas were defined as endoscopic or imaging evidence of fistula more than 8 weeks after lumen-apposing metal stent (LAMS) removal. Control subjects were defined as endoscopic or imaging confirmation of no fistula more than 8 weeks after LAMS removal. AEs were defined and graded according to the American Society for Gastrointestinal Endoscopy lexicon. RESULTS Twenty-five patients identified to have evidence of a persistent fistula on follow-up surveillance (cases) were matched with 50 patients with no evidence of a persistent fistula on follow-up surveillance (control subjects) based on age and sex. Mean LAMS dwell time was 74.7 ± 106.2 days. After LAMS removal, argon plasma coagulation (APC) ablation of the fistula was performed in 46 patients (61.3%). Primary closure of the fistula was performed in 26.7% of patients (20: endoscopic suturing in 17, endoscopic tacking in 2, and over-the-scope clips + endoscopic suturing in 1). When comparing cases with control subjects, there was no difference in baseline demographics, fistula site, LAMS size, or primary closure frequency between the 2 groups (P > .05). However, in the persistent fistula group, the mean LAMS dwell time was significantly longer (127 vs 48 days, P = .02) and more patients had ≥5% total body weight gain (33.3% vs 10.3%, P = .03). LAMS dwell time was a significant predictor of persistent fistula (odds ratio, 4.5 after >40 days in situ, P = .01). The odds of developing a persistent fistula increased by 9.5% for every 7 days the LAMS was left in situ. In patients with a persistent fistula, endoscopic closure was attempted in 19 (76%) with successful resolution in 14 (73.7%). CONCLUSIONS Longer LAMS dwell time was found to be associated with a higher risk of persistent fistulas in EDGE patients. APC or primary closure of the fistula on LAMS removal was not found to be protective against developing a persistent fistula, which, if present, can be effectively managed through endoscopic closure in most cases.
Collapse
Affiliation(s)
- Bachir Ghandour
- Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Margaret G Keane
- Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Brianna Shinn
- Division of Gastroenterology and Hepatology, Thomas Jefferson Hospital, Philadelphia, Pennsylvania, USA
| | - Qais M Dawod
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, New York, USA
| | - Sima Fansa
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Abdul Hamid El Chafic
- Division of Gastroenterology and Hepatology, Ochsner Medical Center-New Orleans, New Orleans, Louisiana, USA
| | - Shayan S Irani
- Division of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Rishi Pawa
- Division of Gastroenterology and Hepatology, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Aditya Gutta
- Division of Gastroenterology and Hepatology, Indiana University Medical Center, Indianapolis, Indiana, USA
| | - Yervant Ichkhanian
- Division of Gastroenterology and Hepatology, Henry Ford Health System, Detroit, Michigan, USA
| | - Bharat Paranandi
- Division of Gastroenterology and Hepatology, Leeds Teaching Hospitals NHS Trust, Leeds, Leeds, UK
| | - Swati Pawa
- Division of Gastroenterology and Hepatology, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Mohammad A Al-Haddad
- Division of Gastroenterology and Hepatology, Indiana University Medical Center, Indianapolis, Indiana, USA
| | - Tobias Zuchelli
- Division of Gastroenterology and Hepatology, Henry Ford Health System, Detroit, Michigan, USA
| | - Matthew T Huggett
- Division of Gastroenterology and Hepatology, Leeds Teaching Hospitals NHS Trust, Leeds, Leeds, UK
| | - Reem Z Sharaiha
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, New York, USA
| | - Thomas E Kowalski
- Division of Gastroenterology and Hepatology, Thomas Jefferson Hospital, Philadelphia, Pennsylvania, USA
| | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Almajed MR, Obri MS, Kamran W, Entz A. Malignant Cardiac Tamponade: A Complication of Untreated Breast Cancer. Cureus 2022; 14:e26787. [PMID: 35967180 PMCID: PMC9366026 DOI: 10.7759/cureus.26787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2022] [Indexed: 11/24/2022] Open
Abstract
Carcinomatous pericarditis is a rare complication of locally aggressive breast cancer in which malignant cells directly extend into the pericardium causing inflammation and creating a pericardial effusion. A 40-year-old woman with untreated metastatic breast cancer presented to an outpatient clinic in significant distress with symptoms of progressive shortness of breath and bilateral leg swelling. An urgent echocardiogram demonstrated a large pericardial effusion with echocardiographic evidence of cardiac tamponade. She underwent emergent pericardiocentesis of the effusion that was deemed to be malignant after cytologic evaluation. Subsequently, she opted for palliative treatment involving the surgical creation of a right pericardial window and placement of an indwelling pleural catheter. Internists should maintain a high index of suspicion for malignant cardiac tamponade in at-risk patients, especially those with locally aggressive and advanced malignancies.
Collapse
|
10
|
Almajed MR, Obri MS, Mahmood S, Demertzis ZD. Shrinking Lung Syndrome in a Young Female: A Rare Pulmonary Manifestation of Systemic Lupus Erythematosus. Cureus 2022; 14:e24320. [PMID: 35607575 PMCID: PMC9122614 DOI: 10.7759/cureus.24320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2022] [Indexed: 11/05/2022] Open
|
11
|
Shuman H, Obri MS, Artz C, Fadel R, Williams J. Nonuremic Calciphylaxis Precipitated by COVID-19 Infection. Cureus 2022; 14:e22796. [PMID: 35382212 PMCID: PMC8976412 DOI: 10.7759/cureus.22796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2022] [Indexed: 11/05/2022] Open
Abstract
Calciphylaxis is a rare dermatologic condition that is primarily associated with end-stage renal disease (ESRD). Nonuremic calciphylaxis has been reported in patients with autoimmune disorders such as systemic lupus erythematosus and other hypercoagulable states such as anti-phospholipid syndrome. New research throughout the COVID-19 pandemic has shown an increased inflammatory and coagulopathic complication of COVID-19. We present a case of a patient with nonuremic calciphylaxis following treatment for severe COVID-19 and no known cause of hypercoagulability. A 40-year-old Caucasian female with a history of recent COVID-19 infection requiring hospitalization, hypertension, alcohol abuse, anxiety, and one prior spontaneous miscarriage presented to the hospital with bilateral lower extremity wounds. The wounds were seen to have necrosis and eschar formation, as well as blackened mottled skin, and were extremely painful to the patient. The initial lesions were on the anterior thighs bilaterally and spread laterally and to the lower back. Initial autoimmune workup was non-specific, and biopsy confirmed calciphylaxis. Calciphylaxis is a known dermatologic disease that has high mortality and morbidity, but it is usually associated with ESRD. Some cases have been reported for autoimmune or hypercoagulable states. The disease presents with non-healing, painful skin ulcers that are at a high risk of infection and have poor healing. The case presented shows biopsy-confirmed calciphylaxis in the absence of known etiologies, and we hypothesize that it is due to COVID-19 or COVID-19 aggravating an underlying but unidentified hypercoagulable condition.
Collapse
|
12
|
Moussa FM, Cook BP, Sondag GR, DeSanto M, Obri MS, McDermott SE, Safadi FF. The role of miR-150 regulates bone cell differentiation and function. Bone 2021; 145:115470. [PMID: 32526406 DOI: 10.1016/j.bone.2020.115470] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/03/2020] [Accepted: 06/03/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND mir-RNAs play a role in regulating bone homeostasis. In this study we assessed the functional role of mir-RNA 150 in bone homeostasis. We also assess the effects of miR-150 deficiency on osteoblast and osteoclast differentiation and function using in vivo and in vitro approaches. METHODS Wild type (WT) (C57BL/6J) and miR-150 KO mice were compared for a variety of parameters. Micro-CT imaging was conducted to quantify trabecular bone mass inferior to the distal growth plate of the femur. Von Kossa staining was performed for osteoblast culture mineralization. RT-qPCR, biochemical analysis and bone histomorphometry were utilized for quantification of relevant genes and serum protein measurements. Differentiation and function of osteoblasts and osteoclasts was performed using primarily cultures and assessed the cell autonomous response of mir-RNA-150 on cell differentiation and function. RESULTS Mir-150 exhibited expression in a variety of tissues and increases progressively with age. Through micro-CT imaging, we found that KO mice presented reduced bone mass at 4, 8, and 16 weeks of age compared to WT mice. Furthermore, histomorphometric analysis revealed increased trabecular separation, decreased bone thickness, and decreased osteoblast number in KO compared to WT mice. Mir-150 deficiency also correlated with higher bone resorption, accompanied with significant increases in CTX-1 serum levels, and a decrease in cell apoptotic rate ex vivo. Additionally, miR-150 KO mice showed increased osteoblast differentiation and decreased osteoclastogenesis ex vivo. Luciferase assay showed increased Osteoactivin/GPNMB expression in miR-150 KO osteoblasts compared to WT cells. CONCLUSION Our data suggests that miR-150 influences osteoblast and osteoclast functionality and differentiation; specifically, miR-150 serves as a negative regulator for osteoblasts and a positive regulator for osteoclasts by regulating, at least in part, Osteoactivin/GPNMB expression.
Collapse
Affiliation(s)
- Fouad M Moussa
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University (NEOMED), College of Medicine, Rootstown, OH, United States of America; Musculoskeletal Research Group, NEOMED, Rootstown, OH, United States of America; School of Biomedical Sciences, Kent State University, Kent, OH, United States of America
| | - Bryson P Cook
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University (NEOMED), College of Medicine, Rootstown, OH, United States of America; Musculoskeletal Research Group, NEOMED, Rootstown, OH, United States of America
| | - Greg R Sondag
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University (NEOMED), College of Medicine, Rootstown, OH, United States of America; Musculoskeletal Research Group, NEOMED, Rootstown, OH, United States of America; School of Biomedical Sciences, Kent State University, Kent, OH, United States of America
| | - Matthew DeSanto
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University (NEOMED), College of Medicine, Rootstown, OH, United States of America; Musculoskeletal Research Group, NEOMED, Rootstown, OH, United States of America
| | - Mark S Obri
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University (NEOMED), College of Medicine, Rootstown, OH, United States of America; Musculoskeletal Research Group, NEOMED, Rootstown, OH, United States of America
| | - Scott E McDermott
- Department of Orthopaedics, SUMMA Health System, Rebecca D. Considine Research Institute, Akron Children's Hospital, Akron, OH, United States of America
| | - Fayez F Safadi
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University (NEOMED), College of Medicine, Rootstown, OH, United States of America; Musculoskeletal Research Group, NEOMED, Rootstown, OH, United States of America; School of Biomedical Sciences, Kent State University, Kent, OH, United States of America; Department of Orthopaedics, SUMMA Health System, Rebecca D. Considine Research Institute, Akron Children's Hospital, Akron, OH, United States of America.
| |
Collapse
|