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Abdalla M, Faris ME, Saad E, Meng Q, Friedman H, Soifer N. Profound metabolic acidosis in association with sodium thiosulfate therapy in a patient with calcific uremic arteriolopathy: a case report and literature review. CEN Case Rep 2024; 13:59-65. [PMID: 37273129 PMCID: PMC10834920 DOI: 10.1007/s13730-023-00801-x] [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: 03/01/2023] [Accepted: 05/15/2023] [Indexed: 06/06/2023] Open
Abstract
Calciphylaxis, also known as Calcific uremic arteriolopathy (CUA), is a serious disorder that presents with skin necrosis due to calcification of dermal and subcutaneous adipose tissue capillaries and arterioles. The condition occurs primarily in patients with end-stage renal disease (ESRD) on dialysis, and it carries high morbidity and mortality, primarily due to sepsis, with an estimated six-month survival of approximately 50%. Although there are no high-quality studies to guide the optimal treatment approach for patients with calciphylaxis, many retrospective studies and case series support treatment with sodium thiosulfate (STS). Despite the frequent use of STS as an off-label treatment, data regarding its safety and efficacy are limited. STS has generally been considered a safe drug with mild side effects. However, severe metabolic acidosis associated with STS is a rare and life-threatening complication of STS treatment and is often unpredictable. Herein, we report a 64-year-old female with ESRD on peritoneal dialysis (PD) who presented with a profound high anion gap metabolic acidosis and severe hyperkalemia while on STS treatment for CUA. No other etiology for her severe metabolic acidosis other than STS was identified. ESRD patients receiving STS should be monitored closely for this side effect. Dose reduction, increasing the duration of infusion, or even discontinuing STS treatment should be considered if severe metabolic acidosis develops.
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Affiliation(s)
- Mohammed Abdalla
- Medical Residents, Department of Internal Medicine, Ascension Saint Francis Hospital, 355 Ridge Ave, Evanston, IL, 60202, USA.
| | - Mohammed Elamin Faris
- Medical Residents, Department of Internal Medicine, Ascension Saint Francis Hospital, 355 Ridge Ave, Evanston, IL, 60202, USA
| | - Eltaib Saad
- Medical Residents, Department of Internal Medicine, Ascension Saint Francis Hospital, 355 Ridge Ave, Evanston, IL, 60202, USA
| | - Qingqing Meng
- Medical Residents, Department of Internal Medicine, Ascension Saint Francis Hospital, 355 Ridge Ave, Evanston, IL, 60202, USA
| | - Harvey Friedman
- Pulmonary and Critical Care Attending, Department of Critical Care and Pulmonology, Ascension Saint Francis Hospital, Evanston, IL, USA
| | - Neil Soifer
- Lakeside Nephrology, Ascension Saint Francis Hospital, Evanston, IL, USA
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Babiker HA, Al-Jardani A, Al-Azri S, Petit RA, Saad E, Al-Mahrouqi S, Mohamed RA, Al-Hamidhi S, Balkhair AA, Al Kharusi N, Al Balushi L, Al Zadjali S, Pérez-Pardal L, Beja-Pereira A, Babiker A. Mycobacterium tuberculosis epidemiology in Oman: whole-genome sequencing uncovers transmission pathways. Microbiol Spectr 2023; 11:e0242023. [PMID: 37768070 PMCID: PMC10581073 DOI: 10.1128/spectrum.02420-23] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/07/2023] [Indexed: 09/29/2023] Open
Abstract
Tuberculosis (TB) originating from expatriates that hail from high TB-burden countries is hypothesized to play a role in continued TB transmission in Oman. Here, we used whole-genome sequencing (WGS) to assess national TB transmission dynamics. The annual incidence per 100,000 population per year was calculated for nationals and expatriates. A convenience sample of Mycobacterium tuberculosis (MTB) isolates from 2018 to 2019 was sequenced and analyzed with publicly available TB sequences from Bangladesh, Tanzania, the Philippines, India, and Pakistan. Relatedness was assessed by generating core-genome single nucleotide polymorphism (SNP) distances. The incidence of TB was five cases per 100,000 persons in 2018 and seven cases per 100,000 persons in 2020 (R2 = 0.34, P = 0.60). Incidence among nationals was 3.9 per 100,000 persons in 2018 and 3.5 per 100,000 persons in 2020 (R2 = 0.20, P = 0.70), and incidence among expatriates was 7.2 per 100,000 persons in 2018 and 12.7 per 100,000 persons in 2020 (R2 = 0.74, P = 0.34). Sixty-eight local MTB isolates were sequenced and analyzed with 393 global isolates. Isolates belonged to nine distinct spoligotypes. Two isolates, originating from an expatriate and an Omani national, were grouped into a WGS-based cluster (SNP distance < 12), which was corroborated by an epidemiological investigation. Relatedness of local and global isolates (SNP distance < 100) was also seen. The relatedness between MTB strains in Oman and those in expatriate countries of origin can aid inform TB control policy. Our results provide evidence that WGS can complement epidemiological analysis to achieve the End TB strategy goal in Oman. IMPORTANCE Tuberculosis (TB) incidence in Oman remains above national program control targets. TB transmission originating from expatriates from high TB-burden countries has been hypothesized to play a role. We used whole-genome sequencing (WGS) to assess TB transmission dynamics between expatriates and Omani nationals to inform TB control efforts. Available Mycobacterium tuberculosis isolates from 2018 to 2019 underwent WGS and analysis with publicly available TB sequences from Bangladesh, the Philippines, India, and Pakistan to assess for genetic relatedness. Our analysis revealed evidence of previously unrecognized transmission between an expatriate and an Omani national, which was corroborated by epidemiological investigation. Analysis of local and global isolates revealed evidence of distant relatedness between local and global isolates. Our results provide evidence that WGS can complement classic public health surveillance to inform targeted interventions to achieve the End TB strategy goal in Oman.
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Affiliation(s)
- Hamza A Babiker
- Biochemistry Department, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
- Institute of Immunology and Infection Research, School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Amina Al-Jardani
- Central Public Health Laboratories, National Tuberculosis Reference Laboratory, Directorate General for Disease Surveillance and Control, Ministry of Health, Muscat, Oman
| | - Saleh Al-Azri
- Central Public Health Laboratories, National Tuberculosis Reference Laboratory, Directorate General for Disease Surveillance and Control, Ministry of Health, Muscat, Oman
| | - Robert A. Petit
- Wyoming Department of Health, Wyoming Public Health Laboratory, Cheyenne, Wyoming, USA
| | - Eltaib Saad
- Department of Medicine, Ascension Saint Francis Hospital, Evanston, Illinois, USA
| | - Sarah Al-Mahrouqi
- Central Public Health Laboratories, National Tuberculosis Reference Laboratory, Directorate General for Disease Surveillance and Control, Ministry of Health, Muscat, Oman
| | - Reham A.H. Mohamed
- Biochemistry Department, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Salama Al-Hamidhi
- Biochemistry Department, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Abdullah A. Balkhair
- Department of Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Najma Al Kharusi
- Central Public Health Laboratories, National Tuberculosis Reference Laboratory, Directorate General for Disease Surveillance and Control, Ministry of Health, Muscat, Oman
| | - Laila Al Balushi
- Central Public Health Laboratories, National Tuberculosis Reference Laboratory, Directorate General for Disease Surveillance and Control, Ministry of Health, Muscat, Oman
| | - Samiya Al Zadjali
- Central Public Health Laboratories, National Tuberculosis Reference Laboratory, Directorate General for Disease Surveillance and Control, Ministry of Health, Muscat, Oman
| | - Lucía Pérez-Pardal
- CIBIO, Centro de Investigação em Biodiversidade e Recursos Genéticos, InBIO Labora tório Associado, Campus de Vairão, Universidade do Porto, Vairão, Portugal, Vairão, Portugal
- BIOPOLIS Program in Genomics, Biodiversity and Land Planning, CIBIO, Campus de Vairão, Vairão, Portugal
| | - Albano Beja-Pereira
- CIBIO, Centro de Investigação em Biodiversidade e Recursos Genéticos, InBIO Labora tório Associado, Campus de Vairão, Universidade do Porto, Vairão, Portugal, Vairão, Portugal
- BIOPOLIS Program in Genomics, Biodiversity and Land Planning, CIBIO, Campus de Vairão, Vairão, Portugal
- DGAOT, Faculty of Sciences, Universidade do Porto, Porto, Portugal
| | - Ahmed Babiker
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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Saad E, Faris ME, Abdalla MS, Prasai P, Ali E, Stake J. A Rare Pathogen of Bones and Joints: A Systematic Review of Osteoarticular Infections Caused by Gemella morbillorum. J Clin Med Res 2023; 15:187-199. [PMID: 37187711 PMCID: PMC10181354 DOI: 10.14740/jocmr4891] [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: 02/22/2023] [Accepted: 04/05/2023] [Indexed: 05/17/2023] Open
Abstract
Osteoarticular infections (OAIs) caused by Gemella morbillorum (G. morbillorum) are a rare clinical entity. This study aimed to review all published cases of OAI due to G. morbillorum. A systematic review of PubMed, Scopus, and Cochrane Library was conducted to report the demographic and clinical characteristics, microbiological data, management, and outcome of OAIs caused by G. morbillorum in the adult population. A total of 16 studies reporting on 16 patients were included in this review. Eight patients had arthritis and eight patients had osteomyelitis/discitis. The most reported risk factors were immunosuppression, poor dental hygiene/dental infections, and recent gastrointestinal (GI) endoscopy. Five cases of arthritis occurred in a native joint while three patients had prostheses. The potential source of G. morbillorum infection was documented in more than half of the cases (56%) (most commonly odontogenic and GI sources (25% and 18%, respectively). The knee and hip joints were the most frequently affected joints in patients with arthritis, while the thoracic vertebrae were the most common sites for osteomyelitis/discitis. The blood cultures were positive in three patients with arthritis (37.5%) and five patients with osteomyelitis/discitis (62.5%). Associated endovascular infection was found in five patients with bacteremia. Contiguous spread (adjacent mediastinitis) was documented in two patients with sternal osteomyelitis and thoracic vertebral osteomyelitis. Surgical interventions were performed for 12 patients (75%). Most strains of G. morbillorum were susceptible to penicillin and cephalosporins. All patients with reported outcomes had achieved complete recovery. G. morbillorum is an emerging pathogen for OAIs in certain susceptible populations with specific risk factors. This review reported the demographic, clinical, and microbiological features of OAIs caused by G. morbillorum. A careful evaluation of an underlying infectious focus is warranted to control the source. When G. morbillorum bacteremia is present, it is also necessary to have a high index of suspicion to rule out an associated endovascular infection.
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Affiliation(s)
- Eltaib Saad
- Department of Internal Medicine, Ascension Saint Francis Hospital, Evanston, IL, USA
- Corresponding Author: Eltaib Saad, Department of Internal Medicine, Ascension Saint Francis Hospital, Evanston, IL, USA.
| | - Mohammed Elamin Faris
- Department of Internal Medicine, Ascension Saint Francis Hospital, Evanston, IL, USA
| | - Mohammed S. Abdalla
- Department of Internal Medicine, Ascension Saint Francis Hospital, Evanston, IL, USA
| | - Paritosh Prasai
- Department of Internal Medicine, Ascension Saint Francis Hospital, Evanston, IL, USA
| | - Elrazi Ali
- Department of Internal Medicine, One Brooklyn Health, Interfaith Medical Center, Brooklyn, NY, USA
| | - Jonathan Stake
- Department of Infectious Diseases and Infection Control, Ascension Saint Francis Hospital, Evanston, IL, USA
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Saad E, Abunseir M, Abdalla MS, Mustafa A, Faris ME, Friedman H. A Case Series of Non-Tuberculous Mycobacterial Pulmonary Disease Masquerading as Malignancy From a Community-Based Hospital. J Med Cases 2023; 14:141-147. [PMID: 37188296 PMCID: PMC10181294 DOI: 10.14740/jmc4098] [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: 04/10/2023] [Accepted: 04/20/2023] [Indexed: 05/17/2023] Open
Abstract
Non-tuberculous mycobacteria (NTM) are ubiquitous organisms in the environment that can potentially cause a range of pulmonary and extrapulmonary infections in humans. Epidemiological risk factors and the host's immune status determine the susceptibility to various clinical syndromes caused by different NTM species. Non-tuberculous mycobacteria pulmonary disease (NTM-PD) is primarily reported in patients with underlying lung disease. These infections often pose a significant disease burden on affected patients as they are often chronic, difficult to treat, and necessitate long-term multi-drug therapy. Mycobacterium avium complex (MAC) is the most common causative pathogen of NTM-PD in the USA, followed by Mycobacterium kansasii (M. kansasii). Less common species in the USA include Mycobacterium xenopi (M. xenopi), Mycobacterium abscessus, and others, largely depending upon the geographic location and exposure to species-specific predisposing risks. In this case series, the authors report on three elderly patients with chronic lung diseases who had pulmonary NTM disease caused by M. xenopi and MAC. The patients were encountered in both inpatient and outpatient settings from a community-based hospital in the midwestern USA. The clinical and radiological features of NTM-PD masqueraded as malignancy and posed a diagnostic dilemma. The epidemiology, clinical and radiological features, diagnosis, and management of NTM-PD are reviewed in this report.
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Affiliation(s)
- Eltaib Saad
- Department of Internal Medicine, Ascension Saint Francis Hospital, Evanston, IL, USA
- Corresponding Author: Eltaib Saad, Department of Internal Medicine, Ascension Saint Francis Hospital, Evanston, IL, USA.
| | - Maria Abunseir
- Department of Internal Medicine, Ascension Saint Francis Hospital, Evanston, IL, USA
| | - Mohammed S. Abdalla
- Department of Internal Medicine, Ascension Saint Francis Hospital, Evanston, IL, USA
| | - Abdurrahman Mustafa
- Department of Internal Medicine, Ascension Saint Francis Hospital, Evanston, IL, USA
| | - Mohammed Elamin Faris
- Department of Internal Medicine, Ascension Saint Francis Hospital, Evanston, IL, USA
| | - Harvey Friedman
- Department of Critical Care and Pulmonology, Ascension Saint Francis Hospital, Evanston, IL, USA
- University of Illinois College of Medicine, IL, USA
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Abdalla MS, Smith BC, Kirchner A, Abu Nseir M, Mokhtar M, Abdulrahman A, Saad E. Subarachnoid Hemorrhage From Cavernous Malformation Masquerading as Myocardial Infarction. J Med Cases 2023; 14:105-110. [PMID: 37032743 PMCID: PMC10079361 DOI: 10.14740/jmc4064] [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] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 03/28/2023] [Indexed: 04/05/2023] Open
Abstract
Intracranial hemorrhage, including subarachnoid hemorrhage (SAH), is associated with many cardiac effects, including cardiac rhythm abnormalities, ischemic electrocardiographic (ECG) changes, elevated cardiac troponin levels, and regional wall motion abnormalities on echocardiogram. About 40% of patients with SAH demonstrate increased serum markers for myocardial necrosis. Approximately 10% of patients with SAH demonstrate left ventricular (LV) wall motion abnormalities; a subset of these patients will have irreversible myocardial damage, but most regain LV function in several weeks. Cardiac effects of SAH are thought to be a result of an imbalance of the autonomic nervous system with resultant increased catecholamine effect on the myocardial cells rather than due to preexisting coronary artery disease. These cardiovascular complications carry a prognostic significance in patients with SAH and can also be misdiagnosed as primary cardiac problems and delay the diagnosis of SAH. Herein, we present a case of a 68-year-old female who presented to the emergency department with acute onset of upper back and neck pain. She was initially misdiagnosed with myocardial infarction in view of the ischemic changes in the ECG and elevated cardiac troponins. She was started on antiplatelets and anticoagulation but was later found to have a negative coronary angiography and was diagnosed with SAH via a computed tomography (CT) scan. Intracranial hemorrhage can be associated with elevated cardiac enzymes and ECG changes and can sometimes masquerade as an acute coronary syndrome (ACS). A careful history and examination and a high index of clinical suspicion are pivotal in such cases since early diagnosis significantly impacts prognosis and prevents the inadvertent use of antiplatelets and anticoagulation, which can be detrimental if used in such cases.
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Affiliation(s)
- Mohammed S. Abdalla
- Department of Internal Medicine, Ascension Saint Francis Hospital, Evanston, IL, USA
- Corresponding Author: Mohammed S. Abdalla, Department of Internal Medicine, Ascension Saint Francis Hospital, Evanston, IL 60202, USA.
| | - Ben Carlton Smith
- Department of Internal Medicine, Ascension Saint Francis Hospital, Evanston, IL, USA
| | - Allison Kirchner
- Department of Internal Medicine, Ascension Saint Francis Hospital, Evanston, IL, USA
| | - Maria Abu Nseir
- Department of Internal Medicine, Ascension Saint Francis Hospital, Evanston, IL, USA
| | - Mousab Mokhtar
- Department of Internal Medicine, Ascension Saint Francis Hospital, Evanston, IL, USA
| | - Ahmed Abdulrahman
- Department of Internal Medicine, Ascension Saint Francis Hospital, Evanston, IL, USA
| | - Eltaib Saad
- Department of Internal Medicine, Ascension Saint Francis Hospital, Evanston, IL, USA
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Prasai P, Shrestha D, Saad E, Trongtorsak A, Adhikari A, Gaire S, Adhikari P, Devkota A, Oli PR, Shtembari J, Sedhai YR, Akbar MS. ELECTRIC CARDIOVERSION VS PHARMACOLOGICAL THEN ELECTRIC CARDIOVERSION FOR NEW ONSET ATRIAL FIBRILLATION: A META-ANALYSIS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)00619-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Abdalla M, Saad E, Abdalla MS, Faris ME, Abdulrahman AA, Mohamed K, Abdulrahman AM, Mustafa A, Fillipuk D. Metastatic Squamous Cell Carcinoma From Primary Hypopharynx Source to Gastric Mucosa Presenting as Massive Gastrointestinal Bleeding. J Med Cases 2023; 14:100-104. [PMID: 37032740 PMCID: PMC10079363 DOI: 10.14740/jmc4059] [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] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 03/13/2023] [Indexed: 04/05/2023] Open
Abstract
Percutaneous endoscopic gastrostomy (PEG) is a relatively safe procedure that represents an important supportive adjunctive component for patients with primary head and neck squamous cell carcinoma (HNSCC). The HNSCC population is considered a high-risk group for developing critical nutritional deficiency due to a multitude of factors. Nevertheless, as the use of PEG in modern practice is gaining more popularity due to various indications, unusual complications have been increasingly reported. PEG site metastasis from primary HNSCC has emerged as a rare, yet serious oncological phenomenon that warrants careful consideration. The authors report an unusual case of squamous cell carcinoma (SCC) of the hypopharynx that metastasized to the gastric body mucosa through a PEG site. The metastatic SCC presented as massive gastrointestinal bleeding, and esophagogastroscopy revealed an ulcerated mass in the gastric body masquerading as a primary gastric adenocarcinoma. Histopathology and immunohistochemistry examination confirmed metastatic SCC which concurred with the patient's primary hypopharyngeal SCC. The review of the updated literature revealed that a total of 121 cases of this rare oncological entity have been reported to date. Physicians need to be vigilant of the symptoms of PEG site metastasis to accurately diagnose and manage the care of this rare occurrence as it is associated with poor prognosis.
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Affiliation(s)
- Monzer Abdalla
- Department of Internal Medicine, Ascension Saint Francis Hospital, Evanston, IL, USA
| | - Eltaib Saad
- Department of Internal Medicine, Ascension Saint Francis Hospital, Evanston, IL, USA
- Corresponding Author: Eltaib Saad, Department of Internal Medicine, Ascension Saint Francis Hospital, Evanston, IL, USA.
| | - Mohammed S. Abdalla
- Department of Internal Medicine, Ascension Saint Francis Hospital, Evanston, IL, USA
| | - Mohammed Elamin Faris
- Department of Internal Medicine, Ascension Saint Francis Hospital, Evanston, IL, USA
| | - Ahmed A. Abdulrahman
- Department of Internal Medicine, Ascension Saint Francis Hospital, Evanston, IL, USA
| | - Khalid Mohamed
- Department of Internal Medicine, Ascension Saint Francis Hospital, Evanston, IL, USA
| | - Ahmed M. Abdulrahman
- Department of Internal Medicine, Ascension Saint Francis Hospital, Evanston, IL, USA
| | - Abdurrahman Mustafa
- Department of Internal Medicine, Ascension Saint Francis Hospital, Evanston, IL, USA
| | - Dorota Fillipuk
- Department of Pathology, Ascension Saint Francis Hospital, Evanston, IL, USA
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Prasai P, Shrestha DB, Saad E, Trongtorsak A, Adhikari A, Gaire S, Oli PR, Shtembari J, Adhikari P, Sedhai YR, Akbar MS, Elgendy IY, Shantha G. Electric Cardioversion vs. Pharmacological with or without Electric Cardioversion for Stable New-Onset Atrial Fibrillation: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:jcm12031165. [PMID: 36769812 PMCID: PMC9918032 DOI: 10.3390/jcm12031165] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/16/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND There is no clear consensus on the preference for pharmacological cardioversion (PC) in comparison to electric cardioversion (EC) for hemodynamically stable new-onset atrial fibrillation (NOAF) patients presenting to the emergency department (ED). METHODS A systematic review and meta-analysis was conducted to assess PC (whether being followed by EC or not) vs. EC in achieving cardioversion for hemodynamically stable NOAF patients. PubMed, PubMed Central, Embase, Scopus, and Cochrane databases were searched to include relevant studies until 7 March 2022. The primary outcome was the successful restoration of sinus rhythm, and secondary outcomes included emergency department (ED) revisits with atrial fibrillation (AF), hospital readmission rate, length of hospital stay, and cardioversion-associated adverse events. RESULTS A total of three randomized controlled trials (RCTs) and one observational study were included. There was no difference in the rates of successful restoration to sinus rhythm (88.66% vs. 85.25%; OR 1.14, 95% CI 0.35-3.71; n = 868). There was no statistical difference across the two groups for ED revisits with AF, readmission rates, length of hospital stay, and cardioversion-associated adverse effects, with the exception of hypotension, whose incidence was lower in the EC group (OR 0.11, 95% CI 0.04-0.27: n = 727). CONCLUSION This meta-analysis suggests that there is no difference in successful restoration of sinus rhythm with either modality among patients with hemodynamically stable NOAF.
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Affiliation(s)
- Paritosh Prasai
- Department of Internal Medicine, Ascension Health St. Francis Hospital, Evanston, IL 60202, USA
- Correspondence: (P.P.); (D.B.S.)
| | - Dhan Bahadur Shrestha
- Department of Internal Medicine, Mount Sinai Hospital, Chicago, IL 60608, USA
- Correspondence: (P.P.); (D.B.S.)
| | - Eltaib Saad
- Department of Internal Medicine, Ascension Health St. Francis Hospital, Evanston, IL 60202, USA
| | - Angkawipa Trongtorsak
- Department of Internal Medicine, Ascension Health St. Francis Hospital, Evanston, IL 60202, USA
| | - Aarya Adhikari
- Department of Internal Medicine, Chitwan Medical College, Chitwan 44200, Nepal
| | - Suman Gaire
- Department of Internal Medicine, Mount Sinai Hospital, Chicago, IL 60608, USA
| | - Prakash Raj Oli
- Department of Internal Medicine, Province Hospital, Birendranagar 21700, Nepal
| | - Jurgen Shtembari
- Department of Internal Medicine, Mount Sinai Hospital, Chicago, IL 60608, USA
| | - Pabitra Adhikari
- Department of Internal Medicine, Ascension Health St. Francis Hospital, Evanston, IL 60202, USA
| | - Yub Raj Sedhai
- Division of Pulmonary Disease and Critical Care Medicine, University of Kentucky College of Medicine, Bowling Green, KY 42101, USA
| | - Muhammad Sikander Akbar
- Department of Internal Medicine, Division of Cardiology, Ascension Health St. Francis Hospital, Evanston, IL 60202, USA
| | - Islam Y. Elgendy
- Division of Cardiology, University of Kentucky, Lexington, KY 40506, USA
| | - Ghanshyam Shantha
- Department of Internal Medicine, Division of Electrophysiology, Atrium Health, Wake Forest Baptist Health, Medical Center Boulevard, Winston-Salem, NC 27157, USA
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El Kai C, Geagea M, Saad E, Azar R, Abdel Massih T. Prognostic value of cardiac power output in chronic heart failure patients: A systematic review. Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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10
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Saad E, Abdalla MS, Abdulrahman A, Faris ME, Mustafa A, Abdalla M, Stake J, Friedman H. Persistent Norovirus infection in a young patient with renal transplant: The challenging cost of immunosuppression and the negative impact on patient's quality of life. IDCases 2023; 32:e01783. [PMID: 37207171 PMCID: PMC10189512 DOI: 10.1016/j.idcr.2023.e01783] [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] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/01/2023] [Accepted: 05/02/2023] [Indexed: 05/21/2023] Open
Abstract
Norovirus (NoV) is one of the most common causes of acute infectious gastroenteritis in the United States (US). The infection is typically short-lasting and self-limiting in immunocompetent hosts. Renal transplant recipients on immunosuppressive therapy are more prone to infectious gastroenteritis that can be caused by various common and opportunistic organisms. NoV infection in renal transplant patients presents as an acute diarrheal illness that may progress to a chronic infection with frequent relapses leading to adverse short-term complications (acute renal injury (AKI) and acute graft rejection from the reduction of the dose of immunosuppressive medications) and possibly long-term morbidities (malabsorption syndrome, and a decline in graft survival). The management of chronic NoV infections in renal transplant patients may be quite challenging, as no specific antiviral treatment is presently approved, and frequent adjustments of immunosuppressive therapy may be required in the setting of reduced renal clearance and the attempts to decrease immunosuppressive effects to enhance the viral clearance.Herein, the authors present a case of persistent NoV in a young female patient with a renal transplant that was associated with recurrent admissions with AKI, gross electrolyte disturbances, and significant weight loss. The relapsing NoV infection has negatively impacted the patient's quality of life and socioeconomic performance.
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Affiliation(s)
- Eltaib Saad
- Department of Internal Medicine, Ascension Saint Francis Hospital, Evanston, IL, USA
- Corresponding author.
| | - Mohammed S. Abdalla
- Department of Internal Medicine, Ascension Saint Francis Hospital, Evanston, IL, USA
| | - Ahmed Abdulrahman
- Department of Internal Medicine, Ascension Saint Francis Hospital, Evanston, IL, USA
| | - Mohammed Elamin Faris
- Department of Internal Medicine, Ascension Saint Francis Hospital, Evanston, IL, USA
| | - Abdurrahman Mustafa
- Department of Internal Medicine, Ascension Saint Francis Hospital, Evanston, IL, USA
| | - Monzer Abdalla
- Department of Internal Medicine, Ascension Saint Francis Hospital, Evanston, IL, USA
| | - Jonathan Stake
- Department of Infectious Diseases and Infection Control, Ascension Saint Francis Hospital, Evanston, IL, USA
| | - Harvey Friedman
- Department of Critical Care and Pulmonology, Ascension Saint Francis Hospital, Evanston, IL, USA
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Saad E, Adhikari P, Antala D, Abdulrahman A, Begiashvili V, Mohamed K, Ali E, Zhang Q. Steven-Johnson Syndrome: A Rare but Serious Adverse Event of Nivolumab Use in a Patient With Metastatic Gastric Adenocarcinoma. J Med Cases 2022; 13:449-455. [PMID: 36258702 PMCID: PMC9534193 DOI: 10.14740/jmc3992] [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: 08/02/2022] [Accepted: 08/24/2022] [Indexed: 11/24/2022] Open
Abstract
Nivolumab is a humanized monoclonal anti-programmed cell death receptor-1 (PD-1) antibody that has been authorized for use in the treatment of advanced malignancies. Cutaneous reactions are the most common immune-related adverse events reported with anti-PD-1 agents, and they range broadly from mild localized reactions to rarely severe or life-threatening systemic dermatoses. The occurrence of Steven-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN) with nivolumab use is an exceedingly rare phenomenon that was only documented in a handful of cases in the current literature, but it deserves careful attention as SJS/TEN may be associated with fatal outcomes. We present a case of nivolumab-induced SJS/TEN in a middle-aged female patient with metastatic gastric adenocarcinoma that was successfully treated with immunosuppressive therapy and supportive care. Prompt recognition of SJS/TEN with discontinuation of nivolumab is warranted when SJS/TEN is suspected clinically. Multidisciplinary management in a specialized burn unit is the key to improving outcomes of SJS/TEN.
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Affiliation(s)
- Eltaib Saad
- Department of Internal Medicine, Ascension Saint Francis Hospital, Evanston, IL, USA
- Corresponding Author: Eltaib Saad, Department of Internal Medicine, Ascension Saint Francis Hospital, Evanston, IL, USA.
| | - Pabitra Adhikari
- Department of Internal Medicine, Ascension Saint Francis Hospital, Evanston, IL, USA
| | - Drashti Antala
- Department of Internal Medicine, Ascension Saint Francis Hospital, Evanston, IL, USA
| | - Ahmed Abdulrahman
- Department of Internal Medicine, Ascension Saint Francis Hospital, Evanston, IL, USA
| | - Valiko Begiashvili
- Department of Internal Medicine, Ascension Saint Francis Hospital, Evanston, IL, USA
| | - Khalid Mohamed
- Department of Internal Medicine, Ascension Saint Francis Hospital, Evanston, IL, USA
| | - Elrazi Ali
- Department of Internal Medicine, One Brooklyn Health, Interfaith Medical Center, Brooklyn, NY, USA
| | - Qishou Zhang
- Department of Internal Medicine, Ascension Saint Francis Hospital, Evanston, IL, USA
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12
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Ali EAH, Khamees I, Alshurafa A, Qasim H, Abu-Tineh MA, Ahmed K, Saad E, Yassin M. Severe Acute Respiratory Syndrome Coronavirus 2 Omicron Variant in Patients with Philadelphia-Negative Myeloproliferative Neoplasm: A Single Center Experience. Oncology 2022; 100:460-466. [PMID: 35882185 DOI: 10.1159/000525750] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/22/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the viral agent responsible for the coronavirus disease of 2019. The disease is primarily a respiratory illness; however, multisystem involvement is not uncommon. The infection is reported to be more severe in patients with multiple comorbidities and immunocompromised patients. Patients with hematological malignancies are immunocompromised and prone to develop severe SARS-CoV-2 infection. The SARS-CoV-2 had developed several mutations that resulted in different strains with different virulence and different degree of protection by vaccination or prior infection. The Omicron variant is reported to cause mild illness; however, the effect on patients with hematological malignancies like myeloproliferative neoplasms (MPNs) is not clear. We present patients with MPNs who had infection with the Omicron variant of the SARS-CoV-2 and their outcomes. METHODS Retrospective data from the National Center for Cancer Care and Research records from December 20, 2021, to January 30, 2022. Participants were adults over the age of 18 years with Omicron infection who had been diagnosed with Philadelphia-negative MPNs, essential thrombocythemia, polycythemia vera (PV), and primary myelofibrosis according to the 2008/2016 WHO classification for MPN. RESULTS Twenty-two patients with Philadelphia-negative MPN had Omicron infection. All patients had a mild disease according to the WHO classification of COVID-19 severity. Most of the patients had medical comorbidities, with hypertension being the most common comorbidity. However, only one patient with PV required hospitalization. DISCUSSION/CONCLUSIONS In patients with Philadelphia-negative MPN, the Omicron variant of SARS-CoV-2 usually results in mild infection.
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Affiliation(s)
| | - Ibrahim Khamees
- Internal Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Awni Alshurafa
- Department of Hematology and Medical Oncology, Hamad Medical Corporation, Doha, Qatar
| | - Hanaa Qasim
- Department of Hematology and Medical Oncology, Hamad Medical Corporation, Doha, Qatar
| | | | - Khaled Ahmed
- Department of Hematology and Medical Oncology, Hamad Medical Corporation, Doha, Qatar
| | - Eltaib Saad
- AMITA Saint Francis Hospital at AMITA St Francis Presence Hospital, Evanston, Illinois, USA
| | - Mohamed Yassin
- Department of Hematology and Medical Oncology, Hamad Medical Corporation, Doha, Qatar
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13
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Saad E, Babkir A, Awadelkarim AM, Qureshi F. Leuprolide-Induced Hyperosmolar Hyperglycemic State in an Elderly Patient: A Case Report and Literature Review. Cureus 2022; 14:e26993. [PMID: 35865181 PMCID: PMC9293791 DOI: 10.7759/cureus.26993] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2022] [Indexed: 11/19/2022] Open
Abstract
We present a novel case of severe hyperosmolar hyperglycemic derangement in an elderly patient - without a known history of diabetes mellitus - after the first injection of leuprolide for the treatment of metastatic prostate adenocarcinoma. Whilst the available literature provided accumulative evidence of an association between insulin resistance and the use of gonadotropin-releasing hormone (GnRH) agonists, the initial presentation of leuprolide-induced impaired glycemic tolerance with a hyperosmolar hyperglycemic state (HHS) represents a clinical rarity that was seldom reported. A literature review was conducted to explore the underlying mechanisms of leuprolide-associated glucose intolerance. Screening for diabetes is recommended for patients receiving leuprolide therapy to identify at-risk patients and close glycemic monitoring is warranted in diabetic patients to minimize serious complications from poor glycemic control induced by leuprolide.
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14
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Awadelkarim A, Yassin AS, Ali M, Dayco J, Saad E, Idris I, Alhusain R, Sebastian J, Afonso L. The Ominous Triad of Severe Takotsubo Cardiomyopathy. J Med Cases 2022; 13:341-348. [PMID: 35949947 PMCID: PMC9332829 DOI: 10.14740/jmc3946] [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: 06/13/2022] [Accepted: 07/05/2022] [Indexed: 11/27/2022] Open
Abstract
QT prolongation is present in 26-52% of cases of Takotsubo cardiomyopathy (TCM). It has been postulated to result from reduced cardiac repolarization reserve and reflects the transient myocardial insult observed in TCM. Bradycardia-induced QT interval prolongation is amplified by the occurrence of TCM, a combination that potentially carries a significant risk for torsade de pointes (TdP). We present a unique case of an 80-year-old female with TCM-related cardiac arrest. The patient had acquired long QT syndrome in which TCM myocardial insult led to the precipitation of a third-degree atrioventricular (AV) block and subsequent bradycardia-induced TdP. Due to the lack of robust literature, there is no clear guideline in the management of third-degree AV block in the setting of TCM. In our case, because of recurrent ventricular tachycardia (VT) and ventricular fibrillation (VF) arrest, we opted for temporary pacing at a high ventricular rate, followed by a biventricular implantable cardioverter-defibrillator (BiV/ICD). Follow-up 3 months later revealed improvement of left ventricular (LV) dysfunction and resolution of QT prolongation. However, the noticed AV conduction defects persisted. In the available literature, we identified five reported cases that bear similarity with our patient’s presentation. The identified cases were middle-aged to elderly females with no significant cardiac history, who exhibited a similar triad of TCM associated with high-grade AV block, acquired long QT syndrome, and a rapid progression of bradycardia-induced TdP, resulting in a near cardiac arrest within the first 24 - 48 h of admission. It is crucial to monitor corrected QT (QTc), correct electrolyte abnormalities, and minimize QT-prolonging medications in patients with TCM. The recognition of AV conduction defects in patients with TCM is critical, especially if it is associated with significant QT prolongation. Such situations are underrecognized, and are potentially fatal, necessitating close monitoring and timely intervention.
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Affiliation(s)
- Abdalaziz Awadelkarim
- Department of Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, MI, USA
- Corresponding Author: Abdalaziz Awadelkarim, Department of Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, MI, USA.
| | - Ahmed S. Yassin
- Department of Cardiology, Wayne State University/Detroit Medical Center, Detroit, MI, USA
| | - Mohammed Ali
- Department of Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, MI, USA
| | - John Dayco
- Department of Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, MI, USA
| | - Eltaib Saad
- Department of Internal Medicine, AMITA Saint Francis, Evanston, IL, USA
| | - Isra Idris
- Department of Pediatrics, Woodhull Medical Center, Brooklyn, NY, USA
| | - Rashid Alhusain
- Department of Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, MI, USA
| | - Joseph Sebastian
- Department of Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, MI, USA
| | - Luis Afonso
- Department of Cardiology, Wayne State University/Detroit Medical Center, Detroit, MI, USA
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15
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Awadelkarim AM, Idris I, Abdelhai M, Yeddi A, Saad E, Alhusain R, Dayco J, Ali M, Salih L. Daptomycin-Associated Diarrhea: A Case Report and Review of the Literature. Cureus 2022; 14:e26135. [PMID: 35747108 PMCID: PMC9209589 DOI: 10.7759/cureus.26135] [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: 06/20/2022] [Indexed: 11/11/2022] Open
Abstract
Antibiotic-associated diarrhea (AAD) describes any unexplained diarrhea associated with the use of antibiotics. AAD develops through diverse mechanisms, ranging from pharmacologic effects on gut motility to disturbance of the function and carbohydrate metabolism of the indigenous intestinal flora and overgrowth by pathogenic micro-organisms. Clostridioides difficile-associated diarrhea (CDAD) is a subset of AAD; however, it accounts only for a small percentage of diarrhea caused by antibiotics. Diarrhea has been reported as a side effect of daptomycin use, nevertheless, it's thought to be mild and carries significantly less risk of diarrhea than other alternative treatments of S. aureus bacteremia, i.e., vancomycin or cefazolin. The authors present an interesting case of daptomycin-associated diarrhea presenting with a protracted and severe course. Patient symptoms didn’t improve with empiric Clostridioides difficile therapy and CDAD testing was negative. Diarrhea promptly resolved after discontinuation of daptomycin. Furthermore, a thorough literature review was conducted and discussed in this article to raise awareness of this under-recognized complication. Clinicians should be mindful of daptomycin-associated diarrhea along with its presentation and treatment. Further studies are needed to identify the pathophysiology of daptomycin-associated diarrhea and other forms of AAD. Understanding their mechanism could help prevent, treat, and reduce the significant medical costs associated with antibiotic adverse events.
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16
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Mohamed A, Saad E, Babkir A, Khtab K, Abdalla M. Pulmonary Kaposi Sarcoma as an Unusual Etiology of Acute Hypoxemic Respiratory Failure in the Era of Highly Active Antiretroviral Therapy: A Case Report. Cureus 2022; 14:e25014. [PMID: 35712335 PMCID: PMC9196811 DOI: 10.7759/cureus.25014] [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: 05/12/2022] [Indexed: 11/21/2022] Open
Abstract
Kaposi sarcoma (KS) is caused by human herpesvirus 8 (HHV-8). Epidemic KS is described in the human immunodeficiency virus (HIV) population with acquired immune deficiency syndrome (AIDS). It primarily affects the skin, but it may uncommonly disseminate to involve extracutaneous sites such as the gastrointestinal (GI) tract, liver, and lungs. In this case report, the authors report a 26-year-old homosexual male who was admitted with acute hypoxemic respiratory failure. He was diagnosed with an HIV infection about five months before index presentation, and he was commenced on highly active antiretroviral therapy (HAART). Physical examination was remarkable for diffuse cutaneous nodules over the lower extremities, back, and oropharynx. Chest imaging revealed diffuse bilateral infiltrates, mediastinal adenopathy, and a persistent bilateral pleural effusion. Extensive diagnostic workup was negative for underlying infectious etiology. Transbronchial biopsy demonstrated proliferated spindle cells that stained positive for HHV-8 in keeping with pulmonary KS. Skin biopsies also concurred with the diagnosis of cutaneous KS. Interestingly, the cluster of differentiation 4 (CD4) count was 647 cells/mm3, and HIV viral load (VL) was 500 copies/ml. This case demonstrated an atypical natural history of pulmonary KS in an HIV patient as pulmonary and disseminated mucocutaneous KS occurred with a relatively higher CD4 count (≥500 cells/mm3). It also reminds pulmonologists and infectious disease specialists to consider pulmonary KS as a differential diagnosis of acute hypoxemic respiratory failure in HIV patients, even in the absence of other clinical and laboratory criteria that define the AIDS stage.
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Saad E, Egoryan G, Padmanabhan SV, Trongtorsak A, Ramachandran A, Zhang Q, Mohamed K, Friedman HJ. Clostridium tertium Bacteremia: A Marker of an Underlying Perforated Colonic Diverticular Disease in a Non-Neutropenic Patient With COVID-19. J Med Cases 2022; 13:212-218. [PMID: 35655631 PMCID: PMC9119365 DOI: 10.14740/jmc3916] [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: 02/12/2022] [Accepted: 03/22/2022] [Indexed: 11/11/2022] Open
Abstract
Clostridium tertium (C. tertium) is an aero-tolerant, gram-positive, endospore-forming, and non-exotoxin-producing bacillus that has colonized the gastrointestinal tract of animals and humans. It is considered a rare pathogen of humans, possibly because of its low virulence. Most C. tertium infections in the reviewed literatures were predominately reported among neutropenic hosts with hematological malignancies. A 66-year-old female patient with a past medical history of type II diabetes mellitus and chronic obstructive pulmonary disease was admitted with coronavirus disease 2019 (COVID-19) that initially required non-invasive ventilation. The patient developed septic shock due to C. tertium bacteremia. Computed tomography of the abdomen depicted free intraperitoneal gas and sigmoid colon perforation. Exploratory laparotomy revealed perforated sigmoid diverticulitis, and Hartmann’s procedure was performed. The patient received a prolonged course of susceptibility-guided antibiotics to clear C. tertium bacteremia. The authors described a rare case of C. tertium bacteremia as a marker of underlying perforated colonic diverticulitis in a non-neutropenic patient with COVID-19 that necessitated operative procedure intervention for primary source control and an extended course of targeted antibiotic therapy to treat the Clostridial infection. Our case reaffirmed the available literature that suggested the presence of C. tertium bacteremia in non-neutropenic patients raises suspicion of an associated gastrointestinal tract pathology that should warrant a diagnostic workup to identify the infection source culprit.
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Affiliation(s)
- Eltaib Saad
- Department of Internal Medicine, Saint Francis Presence Hospital, Evanston, IL, USA
- Corresponding Author: Eltiab Saad, Department of Internal Medicine, Saint Francis Presence Hospital, Evanston, IL 60202, USA.
| | - Goar Egoryan
- Department of Internal Medicine, Saint Francis Presence Hospital, Evanston, IL, USA
| | | | | | - Akshaya Ramachandran
- Department of Internal Medicine, Saint Francis Presence Hospital, Evanston, IL, USA
| | - Qishuo Zhang
- Department of Internal Medicine, Saint Francis Presence Hospital, Evanston, IL, USA
| | - Khalid Mohamed
- Department of Internal Medicine, Saint Francis Presence Hospital, Evanston, IL, USA
| | - Harvey J. Friedman
- Department of Pulmonology and Critical Care, Saint Francis Presence Hospital, Evanston, IL, USA
- Department of Internal Medicine, College of Medicine, the University of Illinois at Chicago (UIC), Chicago, IL, USA
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18
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Trongtorsak A, Saad E, Mustafa A, Won KS, Haery C, Hamblin MH, Akbar MS. Incidental detection of an intracardiac cement embolism complicating percutaneous vertebroplasty during cardiac catheterization: A case report. J Cardiol Cases 2022; 26:151-153. [DOI: 10.1016/j.jccase.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 03/03/2022] [Accepted: 04/04/2022] [Indexed: 11/27/2022] Open
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19
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Agab M, Saad E, Babkir A, Filipiuk D, Friedman H. A Suspicious Hilar Mass Revealing an Uncommon Diagnosis of Pulmonary Actinomycosis in an Immunocompromised Young Female Patient: A Case Report and Literature Review. Cureus 2022; 14:e24549. [PMID: 35664389 PMCID: PMC9143781 DOI: 10.7759/cureus.24549] [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: 04/28/2022] [Indexed: 11/05/2022] Open
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20
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Saad E, Awadelkarim A, Agab M, Babkir A. Extensive Aortic Thrombosis and Renal Infarction in Association With an Active Flare-Up of Crohn’s Disease. Gastroenterology Res 2022; 15:100-105. [PMID: 35572474 PMCID: PMC9076158 DOI: 10.14740/gr1504] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 02/23/2022] [Indexed: 11/11/2022] Open
Abstract
Venous thromboembolism (VTE) is a recognized extraintestinal manifestation of inflammatory bowel disease (IBD), with deep venous thrombosis (DVT) and pulmonary embolism being reported as the most frequent vascular complications in IBD patients. Much less frequently, arterial thromboembolic events may also be associated with greater morbidity and mortality. Aortic mural thrombosis is a rare phenomenon described in patients with IBD that often results in serious consequences such as visceral infarction and acute ischemia of the lower extremities. We described an unusual case of a female patient with Crohn’s disease (CD) who presented with generalized abdominal pain and vomiting. Imaging showed an active flare-up of intestinal CD as well as two mural thrombi in the distal descending thoracic aorta and the abdominal aorta at the level of the left renal artery, respectively, with a left renal infarction. The mesenteric angiogram revealed a patent celiac axis and mesenteric arteries. The patient was therapeutically anticoagulated, and she underwent a right hemicolectomy for the perforated ileal disease. A comprehensive diagnostic workup for hypercoagulability and thrombophilia was negative for an underlying etiology, and the active CD flare-up was considered the main culprit triggering the aortic thrombosis in this reported patient. Our case highlighted the occurrence of aortic thrombosis in a patient with IBD and that entails careful attention. Early recognition and timely management with a multidisciplinary team is the key to improving the outcome of aortic events that coincide with the active flare-up of IBD.
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Affiliation(s)
- Eltaib Saad
- Department of Internal Medicine, Saint Francis Presence Hospital, Evanston, IL, USA
- Corresponding Author: Eltiab Saad, Department of Internal Medicine, Saint Francis Presence Hospital, Evanston, IL, USA.
| | - Abdalaziz Awadelkarim
- Department of Internal Medicine, Detroit Medical Center/Wayne State University, Detroit, MI, USA
| | - Mohamed Agab
- Department of Internal Medicine, Saint Francis Presence Hospital, Evanston, IL, USA
| | - Akram Babkir
- Department of Internal Medicine, Saint Francis Presence Hospital, Evanston, IL, USA
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21
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Khaliel F, Alshamdin F, Alsanei A, Alburaiki J, Alhussein M, Saad E, Alhalees Z. Heart Transplant Challenges and Long-Term Outcome in Saudi Arabia: Single High-Volume Center. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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22
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Saad E, Tummala A, Agab M, Rodriguez-Nava G. Gemella morbillorum as the Culprit Organism of Post-Colonoscopy Necrotizing Perineal Soft Tissue Infection in a Diabetic Patient With Crohn’s Disease. J Med Cases 2022; 13:99-103. [PMID: 35356394 PMCID: PMC8929211 DOI: 10.14740/jmc3896] [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: 01/03/2022] [Accepted: 01/27/2022] [Indexed: 12/01/2022] Open
Abstract
Gemellsa morbillorum (G. morbillorum) is a Gram-positive facultative anaerobe and a known commensal organism of the oropharyngeal and gastrointestinal tracts. It is considered a rare cause of infections in humans. Most of the documented infections, whereas G. morbillorum has been implicated as a causative pathogen, were infective endocarditis and deep visceral abscesses. However, there are only a handful of cases in the current literature that have reported G. morbillorum as the primary organism causing necrotizing soft tissue infections. The authors presented a rare case of post-colonoscopy necrotizing perineal soft tissue infections in an elderly patient with poorly controlled diabetes mellitus and Crohn’s disease with G. morbillorum being the culprit pathogen of this necrotizing infection. The reported case raises concerns for this commensal organism as an emerging virulent pathogen in certain high-risk patients. The authors proposed that a combination of the long-standing Crohn’s disease and the recent colonoscopy with rectal polypectomy has predisposed the patient to G. morbillorum bacteremia with perineal sepsis in the setting of diabetic immunosuppression. Further studies are warranted to ascertain whether G. morbillorum is acquiring increased virulence that would have enabled this organism to cause novel soft tissue infections.
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Affiliation(s)
- Eltaib Saad
- Department of Internal Medicine, Saint Francis Presence Hospital, Evanston, IL, USA
- Corresponding Author: Eltaib Saad, Department of Internal Medicine, Saint Francis Presence Hospital, Evanston, IL, USA.
| | - Apoorva Tummala
- School of Medicine, the University of Illinois at Chicago, Chicago, IL, USA
| | - Mohamed Agab
- Department of Internal Medicine, Saint Francis Presence Hospital, Evanston, IL, USA
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23
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Saad E, Awadelkarim A, Agab M, Babkir A. Tocilizumab-Associated Small Bowel Perforation in a Young Patient With Rheumatoid Arthritis: A Lesson to Remember During COVID-19 Pandemic. J Med Cases 2022; 13:135-139. [PMID: 35356392 PMCID: PMC8929210 DOI: 10.14740/jmc3902] [Citation(s) in RCA: 4] [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: 01/14/2022] [Accepted: 02/18/2022] [Indexed: 11/17/2022] Open
Abstract
Tocilizumab is a recombinant humanized monoclonal antibody directed against the interleukin-6 (IL-6) receptor, which has been used for the treatment of rheumatoid arthritis (RA). A range of side effects have been associated with tocilizumab, with gastrointestinal perforation (GIP) being described as a rare but potentially life-threatening complication that deserves considerable attention. The authors report a case of a young male patient with a history of challenging RA who encountered a lower GIP that was associated with tocilizumab therapy. The occurrence of tocilizumab-induced GIP in this reported patient had initially posed a diagnostic dilemma, as its clinical presentation mimicked other autoimmune inflammatory and infectious diseases that are commonly associated with RA. Physicians should be aware of GIPs as a serious adverse event of tocilizumab use despite being a rare phenomenon, particularly in the era of the global pandemic of coronavirus disease 2019 (COVID-19), when this novel drug has been authorized for the management of selected patients with severe COVID-19 infection. Therefore, early recognition and timely management of GIPs would minimize potential morbidities associated with critically ill COVID-19 patients.
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Affiliation(s)
- Eltaib Saad
- Department of Internal Medicine, AMITA Saint Francis Hospital, Evanston, IL, USA
- Corresponding Author: Eltiab Saad, Department of Internal Medicine, Saint Francis Presence Hospital, Evanston, IL, USA.
| | - Abdalaziz Awadelkarim
- Department of Internal Medicine, Detroit Medical Center/Wayne State University, Detroit, MI, USA
| | - Mohamed Agab
- Department of Internal Medicine, AMITA Saint Francis Hospital, Evanston, IL, USA
| | - Akram Babkir
- Department of Internal Medicine, AMITA Saint Francis Hospital, Evanston, IL, USA
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24
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Mohammed O, Osman S, Mohammed A, Hussein S, Alkhedir S, Mirghni S, Koko A, Saad E, Salman M, Suleiman S. 102 Quality of Life After Intestinal Stoma: A Cross Sectional Study Among a Sample of Sudanese Patients. Br J Surg 2022. [DOI: 10.1093/bjs/znac039.053] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aim
The effects of stoma surgery are multiple, and patient’s quality of life is affected in many ways. Stoma is increasingly used as surgical technique in Sudan, however; studies assessing its effects are lacking.
Method
a descriptive cross-sectional study was conducted in 3 hospitals in Khartoum state. Patients were interviewed using structure questionnaire
Results
65.9% (27) of the patients were males, the mean age was 44.36 (±14.3) and 36.6% had primary school education. 43.9% were unemployed. Mean duration of stoma was 10.67(±10.5) months, and it was temporal in 61% (25). Colorectal cancer was the most indication for the stoma. 70.7% (29) were married, 34.3% (12) reported change in their work after surgery and 68% (17) said it was due to the stoma surgery. Of those who were sexually active, 45.2% (14) didn’t resume their sexual life after it, and most of those who returned report it not to be satisfactory. The entire social and most of the religious practices were found to be statistically different before and after surgery. The mean score for the psychological quality of life was 58.47 (±13.32) out of 80.
Conclusions
Although stoma patients generally have poor quality of life, they struggle in sexual, social, work, and religious aspects. Patients have good psychological quality of life. Efforts to improve the quality of life and incorporation into the community are needed
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Affiliation(s)
| | - S.M.A. Osman
- University of Khartoum, Faculty of Medicine, Khartoum, Sudan
| | | | | | | | - S.A.A. Mirghni
- Almadain College for Medical Sciences and Technology, Khartoum, Sudan
| | - A.I.E.A. Koko
- University Of Khartoum, Faculty of Medicine, Khartoum, Sudan
| | - E. Saad
- Kingston Hospital Foundation Trust, Kingston Upon Thames, United Kingdom
| | - M.S.T. Salman
- University Of Khartoum, Faculty of Medicine, Khartoum, Sudan
| | - S.H. Suleiman
- University Of Khartoum, Faculty of Medicine, Khartoum, Sudan
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25
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Saad E, Awadelkarim A, Agab M, Babkir A, Yeddi A. Omental Fat Torsion: A Rare Mimicker of a Common Condition. J Investig Med High Impact Case Rep 2022; 10:23247096221076271. [PMID: 35199590 PMCID: PMC8883395 DOI: 10.1177/23247096221076271] [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] [Indexed: 11/23/2022] Open
Abstract
Acute abdomen is a common emergency condition affecting young adults, and the first consideration is usually aimed to rule out acute appendicitis in this age group. Omental fat torsion has emerged as one of the rare etiologies of acute abdomen in the younger population. It warrants serious consideration as it closely mimics acute appendicitis in its clinical presentation. Herein we report a case of omental fat torsion in a 22-year-old male patient who presented with an acute right-sided lower abdominal pain which was highly suggestive of acute appendicitis. However, the diagnostic laparoscopy revealed a normally looking appendix and terminal ileum with an infarcted omental segment on the right side of the greater omentum. A laparoscopic omentectomy and an appendectomy were performed with an uneventful postoperative recovery. The pathology report confirmed omental fat infarction and a normal appendix. This case highlights omental fat infarction as a rare etiology of acute abdomen in a young male patient.
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Affiliation(s)
- Eltaib Saad
- AMITA Health Saint Francis Hospital Evanston, IL, USA
| | | | - Mohamed Agab
- AMITA Health Saint Francis Hospital Evanston, IL, USA
| | - Akram Babkir
- AMITA Health Saint Francis Hospital Evanston, IL, USA
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Alkassis S, Ali M, Awadelkarim AM, Saad E, Halboni A, Alhusain R, Kamatham S, Idris I. Lutetium-177 Dotatate-Induced Hemolytic Anemia and Myelodysplastic Syndrome. Cureus 2022; 14:e22392. [PMID: 35371754 PMCID: PMC8938243 DOI: 10.7759/cureus.22392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2022] [Indexed: 11/24/2022] Open
Abstract
Lutetium-177 (177Lu) dotatate is a type of peptide receptor radioligand therapy (PRRT) using radiolabeled somatostatin for patients with progressive somatostatin receptor-positive gastrointestinal neuroendocrine tumors. While cases of therapy-related myeloid neoplasms (t-MN) have been described as a consequence of 177 Lu dotatate, there are no reports of hemolytic anemia associated with therapy. We present a case of a 68-year-old woman with metastatic low-grade neuroendocrine tumor who presented four weeks after the second dose of 177Lu dotatate with progressive fatigue and dyspnea. Laboratory workup was remarkable for hemolytic anemia. Lutetium-177 dotatate-induced hemolysis was suspected after ruling out other causes. Corticosteroid treatment was initiated with improvement in hemoglobin, and dose-reduced PRRT was planned upon discharge. Six months into the treatment course of 177Lu dotatate, macrocytic anemia was noticed on routine follow-up with normal vitamin B12 and folic acid levels. A bone marrow biopsy was done, revealing myelodysplastic syndrome (MDS) features. Given the temporal relationship between drug introduction and the objective findings, early-onset 177Lu dotatate-induced MDS was diagnosed with a plan for close hematologic follow-up. Myelodysplastic syndrome should be suspected when megaloblastic anemia develops in patients with previous 177Lu dotatate therapy. The latency period between initial treatment and MDS diagnosis reported in the literature ranges between 15 months to seven years. Apart from the unusually early onset of MDS, what is unique about our case is the development of hemolytic anemia after administration of PRRT. The clinical course and the brisk response to steroid therapy, suggest other mechanisms of PRRT toxicity besides DNA breaks, genetic mutations, and myelosuppression by an immune-mediated component that likely plays a role in 177Lu dotatate toxicity. Further investigation and monitoring are needed to identify the frequency of such adverse events and the pathophysiology of their occurrence.
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Idris I, Awadelkarim AM, Saad E, Dayco J, Beker S. Incomplete Kawasaki Disease in an Infant: A Case Report and Literature Review. Cureus 2022; 14:e22122. [PMID: 35308689 PMCID: PMC8918302 DOI: 10.7759/cureus.22122] [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: 02/11/2022] [Indexed: 11/29/2022] Open
Abstract
The term "incomplete Kawasaki Disease (IKD)" was first used to describe patients with coronary complications who did not fulfill the classical diagnostic criteria for Kawasaki Disease (KD). The risk of coronary artery involvement is similar if not greater in cases of IKD. However, the recognition of IKD is challenging and often delayed, especially in infants. Multiple algorithms have been formulated to identify cases of IKD utilizing supplemental clinical, echocardiographic, and laboratory features. Although fever is not required for a diagnosis of KD in the Japanese guideline, most of the current guidelines, including those of the American Heart Association (AHA), consider the presence of fever for at least seven days a requirement for the diagnosis of both KD and IKD in infants. We present a case of IKD in a four-month-old female who presented with fever for less than three days and did not follow the current AHA algorithm for IKD. An echocardiogram obtained 10 days later revealed a coronary artery aneurysm, and a retrospective diagnosis of IKD was made. A review of the literature identified similar cases with a growing consensus on the need to redefine the role of fever. Pediatricians should search for coronary artery lesions in cases of high clinical suspicion, even if the fever period is short, particularly in those less than six months. Additionally, further innovative research is directly needed to identify immunological and cellular markers that could be tested early in the course of the disease and guide the management.
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Abou-Ghanem N, Saad E, Oliff IA, Gidron A, Filipiuk D. Isolated Enteric Myeloid Sarcoma as a Rare Etiology of Small Bowel Obstruction in a Young Female Patient. Gastroenterology Res 2022; 15:39-46. [PMID: 35369676 PMCID: PMC8913021 DOI: 10.14740/gr1481] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 12/30/2021] [Indexed: 12/02/2022] Open
Abstract
Myeloid sarcoma (MS) is an extra-medullary solid tumor consisting of myeloid blasts or immature myeloid cells. MS is usually associated with acute myeloid leukemia (AML) and other myeloproliferative neoplasms or myelodysplastic disorders. Isolated MS is a rare clinical entity, and the small bowel is a rare phenomenon for the occurrence of MS. A 30-year-old African American female patient with a past medical history of asthma presented with acute abdominal pain and vomiting for 3 days. Imaging revealed small bowel obstruction with a transition point at a suspicious mass in the distal ileum mimicking carcinoid tumors. She underwent an uneventful laparoscopic resection of this mass with primary bowel anastomosis. Histopathology of the resected mass revealed immature myeloid cells that stained positive for myeloperoxidase and CD34/CD117, in keeping with a small bowel MS. A bone marrow examination was negative for concurrent AML. Cytogenetic analysis revealed MYH11/CBFB fusion and an inversion 16 chromosomal aberration which are rarely associated with myeloid disorders. The patient was commenced on systemic chemotherapy to achieve remission and prevent progression to AML. The literature is reviewed, and all cases of small bowel MS are presented in this report. Non-leukemic small bowel MS is an exceptional presentation. We described a case of isolated enteric MS, which was associated with a rare MYH11/CBFB fusion and inversion 16 chromosomal aberration. The diagnosis of small bowel MS can be extremely challenging due to the rarity of the disease and non-specific nature of clinical and radiological features. A histopathological examination with immunohistochemistry staining is imperative to establish an accurate diagnosis. Isolated small bowel MS deserves special attention as it warrants systemic chemotherapy to prevent transformation into AML.
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Affiliation(s)
- Nagwa Abou-Ghanem
- Department of Internal Medicine, Saint Francis Presence Hospital, Evanston, IL, USA
| | - Eltaib Saad
- Department of Internal Medicine, Saint Francis Presence Hospital, Evanston, IL, USA
- Corresponding Author: Eltaib Saad, Department of Internal Medicine, Saint Francis Presence Hospital, Evanston, IL, USA.
| | - Ira A. Oliff
- Department of Oncology, Saint Francis Presence Hospital, Evanston, IL, USA
| | - Adi Gidron
- Department of Oncology, Saint Francis Presence Hospital, Evanston, IL, USA
| | - Dorota Filipiuk
- Department of Pathology, Saint Francis Presence Hospital, Evanston, IL, USA
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Saad E, Agab M, Zhang Q, Egoryan G, Babkir A, Filipiuk D. Multisystemic Sarcoidosis Presenting with Widespread Vertebral Osseous and Visceral Lesions Masquerading as Metastatic Disease: A Case Report and Literature Review. Am J Case Rep 2022; 23:e935158. [PMID: 35125492 PMCID: PMC8833267 DOI: 10.12659/ajcr.935158] [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] [Indexed: 11/19/2022] Open
Abstract
Patient: Female, 78-year-old
Final Diagnosis: Multisystem sarcoidosis with visceral and vertebral disease • sarcoidosis
Symptoms: Weaknes of lower limbs
Medication:—
Clinical Procedure: —
Specialty: Rheumatology
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Affiliation(s)
- Eltaib Saad
- Department of Internal Medicine, Saint Francis Presence Hospital, Evanston, USA, IL
| | - Mohamed Agab
- Department of Internal Medicine, Saint Francis Presence Hospital, Evanston, USA, IL
| | - Qishuo Zhang
- Department of Internal Medicine, Saint Francis Presence Hospital, Evanston, USA, IL
| | - Goar Egoryan
- Department of Internal Medicine, Saint Francis Presence Hospital, Evanston, USA, IL
| | - Akram Babkir
- Department of Internal Medicine, Saint Francis Presence Hospital, Evanston, USA, IL
| | - Dorota Filipiuk
- Department of Pathology, Saint Francis Presence Hospital, Evanston, USA, IL
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Saad E, Agab M, Ozcekirdek EC, Awadelkarim A, Idris I. The Diagnostic Dilemma of Acute Granulomatous Hepatitis in a Patient With Crohn's Disease: A Case Report and Review of Literature. J Investig Med High Impact Case Rep 2022; 10:23247096211069764. [PMID: 35343257 PMCID: PMC8966121 DOI: 10.1177/23247096211069764] [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] [Indexed: 11/22/2022] Open
Abstract
Liver involvement is not an uncommon extraintestinal manifestation of inflammatory bowel disease (IBD). IBD-associated liver diseases may have a variety of etiopathogenetic origins (including shared autoimmune pathogenesis, the effect of chronic inflammatory status, and adverse effects of drugs). Nevertheless, acute granulomatous hepatitis in the setting of Crohn’s disease (CD) is a rare clinical entity. It warrants, however, a careful assessment as both clinical and pathological features of Crohn’s-associated granulomatous hepatitis closely mimic extrapulmonary hepatic sarcoidosis, with considerable overlaps between the 2 diseases, which certainly makes a definitive diagnosis quite challenging. It is crucial to exclude infectious etiologies during the evaluation of acute granulomatous hepatitis, as inappropriate immunosuppressive treatment may cause a systemic flare-up of an underlying liver infection. We report a rare case of a 35-year-old female with a history of CD who presented with recurrent fevers, acute abdominal pain, and cholestasis. She was found to have acute hepatitis with noncaseating granulomas on liver biopsy. A comprehensive diagnostic workup did not ultimately prove a specific etiological culprit. The patient was treated with oral corticosteroids, and she demonstrated a positive clinical and laboratory response to the treatment. Our case highlights the diagnostic dilemma of acute granulomatous hepatitis in the setting of co-existent CD with a multisystemic syndrome. Granulomatous hepatitis represents a relatively rare manifestation of both extraintestinal CD and extrapulmonary sarcoidosis, with potential difficulties discriminating between the 2 entities on many occasions. The case also demonstrates the value of an interdisciplinary approach in the context of multisystemic disease to achieve the best outcome.
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Affiliation(s)
- Eltaib Saad
- Saint Francis Presence Hospital, Evanston, IL, USA
| | - Mohamed Agab
- Saint Francis Presence Hospital, Evanston, IL, USA
| | | | | | - Isra Idris
- Woodhull Medical Center, Brooklyn, NY, USA
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Saad E, O'Connell L, Khan I, Barry K. 143 Massive Intra-Hepatic Subcapsular Liver Haematoma Post-Laparoscopic Cholecystectomy- A Rare Complication of a Common Procedure'. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.271] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Laparoscopic Cholecystectomy (LC) is currently considered the gold standard for the management of symptomatic gallbladder stones disease. Specific complications remain challenging, particularly postoperative bleeding, bile leak, and bile duct injury. We report a rare case of a giant intrahepatic subcapsular haematoma (ISH) complicating LC.
Case Presentation
A 59-year-old female presented with symptomatic biliary colic. Her past medical history was noted for obesity (BMI>50). She underwent an elective LC with an uncomplicated intraoperative course; however, post-operatively she developed hypovolaemic shock with an acute haemoglobin drop requiring fluid resuscitation and blood transfusion. Emergency CT revealed a massive subcapsular haematoma measuring 21cm×3.1cm× 17cm at the right liver margin without evidence of ongoing bleeding. She was managed conservatively- as per a tertiary hepatobiliary surgery centre’s advice- with meticulous clinical observations, serial monitoring of haemoglobin, and repeat CT to assess for interval progressions. She progressed well with conservative management and did not require surgical or radiological intervention. A follow-up liver sonography performed eight weeks post-discharge confirmed a complete resolution.
Conclusion
Giant ISH is an exceedingly rare but life-threatening complication following LC which merits special attention. Our case demonstrates the necessity of close postoperative monitoring of patients undergoing LC and considering the possibility of ISH in those who experience refractory postoperative hypotension. It also highlights the decisive role of diagnostic imaging in securing a timely and accurate diagnosis of post-LC ISH.
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Affiliation(s)
- E Saad
- Mayo University Hospital, Mayo, Ireland
| | | | - I Khan
- Mayo University Hospital, Mayo, Ireland
| | - K Barry
- Mayo University Hospital, Mayo, Ireland
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Saad E, O'Connell L. 237 Massive Subcapsular Intra-hepatic Haematoma Post-laparoscopic Cholecystectomy: A Rare Complication of a Common Procedure. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.277] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Abstract
Laparoscopic cholecystectomy (LC) is currently considered the gold standard for the management of symptomatic gallbladder stones disease. Specific complications remain challenging, particularly postoperative bleeding, bile leak, and bile duct injury. We report a rare case of a giant intrahepatic subcapsular haematoma (ISH) complicating LC.
Case Presentation
A 59-year-old female presented with symptomatic biliary colic. Her past medical history was noted for obesity (BMI > 50). She underwent an elective LC with an uncomplicated intraoperative course; however, post-operatively she developed hypovolaemic shock with an acute haemoglobin drop requiring fluid resuscitation and blood transfusion. Emergency CT revealed a massive subcapsular haematoma measuring 21cm×3.1cm× 17cm at the right liver margin without evidence of ongoing bleeding. She was managed conservatively- as per a tertiary hepatobiliary surgery centre’s advice- with meticulous clinical observations, serial monitoring of haemoglobin, and repeat CT to assess for interval progressions. She progressed well with conservative management and did not require surgical or radiological intervention. A follow-up liver US performed eight weeks post-discharge confirmed a complete resolution.
Conclusions
Giant ISH is an exceedingly rare but life-threatening complication following LC which merits special attention. Our case demonstrates the necessity of close postoperative monitoring of patients undergoing LC and considering the possibility of ISH in those who experience a refractory postoperative hypotension. It also highlights the decisive role of diagnostic imaging in securing a timely and accurate diagnosis of post LC-ISH
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Affiliation(s)
- E Saad
- Mayo University Hospital, Mayo, Ireland
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Abuelgasim M, Baggaley A, Saad E. 236 Omental Fat Torsion Masquerading Clinically as Acute Appendicitis in a Young Male Patient: A Rare Aetiology of Acute Abdomen and The Value of Diagnostic Laparoscopy. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.276] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Acute abdominal pain is a common surgical presentation and acute appendicitis remains the top differential for most young adults. Omental fat torsion has emerged as a rare aetiology of an acute surgical abdomen in the younger population that closely mimics acute appendicitis in its clinical presentation. Preoperative diagnosis is extremely challenging in this age group due to the rarity of the condition and the non-specific nature of its clinical and laboratory findings, and hence most reported diagnoses were made intra-operatively.
We report a case of omental fat torsion in a 22-year-old male who presented with clinical features that were highly suggestive of acute appendicitis. However, the diagnostic laparoscopy revealed a normally looking appendix and terminal ileum, with the presence of a twisted segment of the greater omentum in the right lumbar region. A laparoscopic omentectomy and a prophylactic appendectomy to prevent furture acute appendicitis were performed with an uneventful postoperative recovery. Histology confirmed omental fat infarction and a normal appendix.
This reported case highlights a rare cause of right iliac fossa pain and demonstrates the value of diagnostic laparoscopy in the context of clinically suspected acute appendicitis in younger male patients. Diagnostic imaging was not deemed necessary in our patient given the strong clinical suspicion of acute appendicitis. Prompt laparoscopy led to definitive diagnosis as well as treatment and avoided the radiation exposure necessitated during a diagnostic computed tomography scan.
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Affiliation(s)
- M Abuelgasim
- Kingston Hospital Foundation Trust, London, United Kingdom
| | - A Baggaley
- Kingston Hospital Foundation Trust, London, United Kingdom
| | - E Saad
- Kingston Hospital Foundation Trust, London, United Kingdom
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Saad E, Awadelkarim A, Ali M, Yeddi A. Recurrent renal abscess complicating Staphylococcus saprophyticus infection in an immunocompetent young female patient: A case report and review of literature. IDCases 2021; 26:e01290. [PMID: 34621618 PMCID: PMC8482430 DOI: 10.1016/j.idcr.2021.e01290] [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: 08/01/2021] [Revised: 09/13/2021] [Accepted: 09/22/2021] [Indexed: 11/25/2022] Open
Abstract
Staphylococcus saprophyticus is second only to Escherichia coli as the most frequent causative organism of uncomplicated urinary tract infections (UTIs) among the sexually active female population. However, it is considered a rare cause of complicated UTIs in immunocompetent hosts with no identifiable risk factors for the occurrence of a complicated urinary tract infection. We report an exceedingly rare case of a 20-year-old otherwise healthy female patient, with no identifiable risk factors for complicated UTIs, who presented with a recurrent renal abscess secondary to S. saprophyticus. Serial cultures from multiple sources were negative, and the culprit organism was identified by a polymerase chain reaction (PCR) analysis of the drained pus that identified the 16 s rDNA sequences of S. saprophyticus on serial occasions. To our current date, similar cases have been rarely reported in the available literature. Our case also highlights the diagnostic value of molecular biology techniques in the identification of causative pathogens in cases of culture-negative infections when conventional microbiologic tests fail to isolate the culprit organisms. Clinical microbiology studies are needed to further explore the exact possible interactions between bacterial-specific characteristics and host-related factors that may explain the occurrence of the complicated UTIs that are associated with S. Saprophyticus among patients who are not considered to have certain risk factors that would usually predispose to complicated UTIs.
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Affiliation(s)
- Eltaib Saad
- Department of Internal Medicine, Saint Francis Presence Hospital, Evanston, IL, USA
| | - Abdelaziz Awadelkarim
- Department of Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, MI, USA
| | - Mohammed Ali
- Department of Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, MI, USA
| | - Ahmed Yeddi
- Department of Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, MI, USA
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Laimoud M, Saad E, Koussayer S. Acute vascular complications of femoral venoarterial ECMO; a single center retrospective study. European Heart Journal. Acute Cardiovascular Care 2021; 10. [DOI: m laimoud, e saad, s koussayer, acute vascular complications of femoral venoarterial ecmo; a single center retrospective study, european heart journal.acute cardiovascular care, volume 10, issue supplement_1, april 2021, zuab020.150, https:/doi.org/10.1093/ehjacc/zuab020.150] [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] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Backgroud
Emergent veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used to provide rapid cardiopulmonary resuscitation in adult patients with refractory cardiogenic shock . Femoral arterial cannulation may result in ipsilateral limb ischemia due to reduced distal blood flow below the insertion point of the cannula .We retrospectively studied adult patients supported with femoral VA-ECMO for cardiogenic shock between 2015 and 2019 at our tertiary care hospital.
Results : the study included 65 adult patients supported on femoral VA-ECMO for refractory cardiogenic shock . The studied patients had a mean age of 37.9 ± 14.87 years , mostly males (70.8%) , a mean BSA of 1.77 ±0.27 m2 and a mean BMI of 26.1 ± 6.7 kg/m2 . Twenty one (32.3%) patients developed acute lower limb ischemia. Femoral thrombectomy and angioplasty were done in 20 (30.8% ) patients . Four (6.2%) patients developed limb compartmental syndrome and fasciotomy was done . Amputation of toes was done in one patient . The vascular complications included cannulation site bleeding in 24.6% of patients , femoral arteriovenous fistula in one patient and large pseudoaneurysm after ECMO decannulation and required vascular surgical repair . Three (4.6%) patients developed chronic limb ischemia manifestations after hospital discharge . The patients who developed acute limb ischemia had significantly frequent AKI (<0.001) without significant use of haemodialysis (p = 0.07) and longer ICU stay (p = 0.028) compared to the patients without limb ischemia. The hospital mortality occurred in 29 (44.6%) patients without significant difference between the patients with and without acute limb ischemia. The occurrence of acute limb ischemia was significantly correlated with failed percutaneous femoral cannulation (p = 0.039 ) while there was no significant statistical correlation between the cut-down technique and occurrence of limb ischemia(p = 0.053). The occurrence of femoral cannulation site bleeding was significantly correlated with failed percutaneous cannulation (p = 0.001 ) and cut-down technique (p = 0.001) .
Conclusion : Acute vascular complications are frequent after femoral VA-ECMO. Failed percutaneous femoral cannulation has been, in this study identified as the most important risk factor for acute limb ischemia and cannulation site bleeding. Recommendation: A careful approach during femoral cannulation is recommended to prevent occurrence of acute limb ischemia and femoral cannulation site bleeding. Abstract Figure. Cannulation approaches of VA-ECMO .
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Affiliation(s)
- M Laimoud
- King Faisal Specialist Hospital and Research Centre (Gen. Org.), Riyadh, Saudi Arabia
| | - E Saad
- King Faisal Specialist Hospital and Research Centre (Gen. Org.), Riyadh, Saudi Arabia
| | - S Koussayer
- King Faisal Specialist Hospital and Research Centre (Gen. Org.), Riyadh, Saudi Arabia
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Laimoud M, Saad E, Alburaiki J, Alibrahim M, Alsomali A, Alhussein M, Khaliel F. Outcome of durable mechanical circulatory support devices in a tertiary care hospital in Saudi Arabia. European Heart Journal. Acute Cardiovascular Care 2021; 10. [DOI: m laimoud, e saad, j alburaiki, m alibrahim, a alsomali, m alhussein, f khaliel, outcome of durable mechanical circulatory support devices in a tertiary care hospital in saudi arabia, european heart journal.acute cardiovascular care, volume 10, issue supplement_1, april 2021, zuab020.156, https:/doi.org/10.1093/ehjacc/zuab020.156] [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] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Heart failure (HF) remains a significant cause of morbidity and mortality. Heart transplantation is the gold standard treatment for end stage heart failure. Durable mechanical circulatory support devices became a modality of treatment as bridge to transplantation or destination therapy because of the shortage of donor hearts.
Objective
To report the experience of durable mechanical circulatory devices in our tertiary care hospital as compared with the report of the International Society of Mechanically Assisted Circulatory Support (IMACS) registry.
Results
Between 2013 until December 2019, 73 durable mechanical circulatory support devices were implanted. Mean age 41.36 ±14.1 years and 83.6% of them were male. Etiology: 52.1% of the patients had dilated cardiomyopathy while 34.2% had ischemic cardiomyopathy. Age distribution: 45.2% of the patients were in the age group of 30-49 years while 32.9% were in the age group of 50-69 years. No devices were inserted in patients within the age group ≥70 years. Left ventricular assist devices with continuous pump flow accounted for 82.2% of implanted devices while biventricular support accounted for 15.1%. Total artificial hearts were implanted in 2.7% of the patients. INTERMACS categories at the time of implantation: 20.6% of patients were in INTERMACS I, INTERMACS II 38.4%, INTERMACS III 22%, INTERMACS IV17.6% while only 1.4% were INTERMACS V. Device strategy: 73.9% of devices were implanted as a bridge to candidacy for transplantation, 15.1 % were implanted as a bridge to cardiac recover, 8.2% were listed to heart transplantation while only 2.7% were left for destination therapy strategy. 50.7% of patients were discharged home after fulfilling education requirements. Forty per cent of the patients underwent heart transplantation. Major adverse events: 5.4% of the patients developed major cerebrovascular strokes after device implantation. Mediastinal significant bleeding and exploration occurred in 12.3% of patients and gastrointestinal bleeding in 8.2%. Driveline infection occurred in 16.4% of patients but only 2.7% had deep wound infection requiring urgent heart transplantation. Mortality on the device was 31.5%.
Conclusion
Our experience with mechanical circulatory support is similar to the reported major events and survival from the International Society of Mechanically Assisted Circulatory Support.
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Affiliation(s)
- M Laimoud
- King Faisal Specialist Hospital and Research Centre (Gen. Org.), Riyadh, Saudi Arabia
| | - E Saad
- King Faisal Specialist Hospital and Research Centre (Gen. Org.), Riyadh, Saudi Arabia
| | - J Alburaiki
- King Faisal Specialist Hospital and Research Centre (Gen. Org.), Riyadh, Saudi Arabia
| | - M Alibrahim
- King Faisal Specialist Hospital and Research Centre (Gen. Org.), Riyadh, Saudi Arabia
| | - A Alsomali
- King Faisal Specialist Hospital and Research Centre (Gen. Org.), Riyadh, Saudi Arabia
| | - M Alhussein
- King Faisal Specialist Hospital and Research Centre (Gen. Org.), Riyadh, Saudi Arabia
| | - F Khaliel
- King Faisal Specialist Hospital and Research Centre (Gen. Org.), Riyadh, Saudi Arabia
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Saad E, Rayan A. P-353 Colorectal cancer liver metastases challenges and potential opportunities: Systematic review and meta-analysis. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Hannan E, Saad E, Hoashi S, Toomey D. The clinical dilemma of the persistent idiopathic pneumoperitoneum: A case report. Int J Surg Case Rep 2019; 63:10-12. [PMID: 31499325 PMCID: PMC6734534 DOI: 10.1016/j.ijscr.2019.08.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 05/27/2019] [Revised: 08/12/2019] [Accepted: 08/14/2019] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Idiopathic pneumoperitoneum (IP) is a rare phenomenon which merits special attention. It is defined as free intraperitoneal air which is not caused by viscus perforation and does not require surgical intervention. It is generally considered a diagnosis of exclusion and often poses a genuine diagnostic dilemma. PRESENTATION OF CASE We present an unusual case of persistent pneumoperitoneum with no identifiable cause which was found incidentally on a computed tomography (CT) scan in a patient with chronic cough and no prior surgical history. Serial consults revealed no abdominal symptoms or signs. He was managed conservatively and remains asymptomatic despite having a persistent IP on serial radiology. DISCUSSION To our knowledge, our case is the first in the literature of an idiopathic pneumoperitoneum that persisted on subsequent radiology and was managed successfully without surgical intervention. This is a highly important case for all practicing general surgeons to learn from as knowledge of this phenomenom may help avoid unnecessary surgical intervention and potential morbidities associated with this. CONCLUSION IP is a diagnosis of exclusion which should only be made after surgical and non-surgical causes have been outruled. In the absence of signs of peritonitis and evidence of gastrointestinal perforation on CT, a conservative approach is warranted, allowing patients to avoid unnecessary surgical intervention.
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Affiliation(s)
- Enda Hannan
- Department of General Surgery, Regional Hospital Mullingar, Ireland.
| | - Eltaib Saad
- Department of General Surgery, Regional Hospital Mullingar, Ireland
| | - Shu Hoashi
- Department of General Surgery, Regional Hospital Mullingar, Ireland
| | - Desmond Toomey
- Department of General Surgery, Regional Hospital Mullingar, Ireland
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A. ES, Al-Gamal M, Abo-Gabal M, Basuony H, Saad E. Broiler Productive and Physiological Performance under Different Heat Combating Practices during Acute Heat Stress. Egyptian Academic Journal of Biological Sciences C, Physiology and Molecular Biology 2019. [DOI: 10.21608/eajbsc.2019.27332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Saad E, Hadi EA, Radwan RH, Abdulla M. PO-048 Hypofractionated dose escalated VMAT; comparable efficacy and less toxicity than standard CCRT in HNC. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30214-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sapetti J, Sakat J, Saad E, Zerbib M, Belas O, Doru-Pop C, Peyromaure M, Delongchamps N. Incontinence urinaire après énucléation endoscopique de la prostate au laser Holmium : fréquence, évolution, et facteurs prédictifs de survenue. Prog Urol 2019; 29:101-107. [DOI: 10.1016/j.purol.2018.12.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 10/07/2018] [Accepted: 12/12/2018] [Indexed: 11/24/2022]
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Mkimel M, Mesradi M, El Baydaoui R, Benameur Y, Tahiri M, Saad E, Hilali A. 51 Estimation of the organ and effective dose during CT chest examination: A Monte Carlo study. Phys Med 2018. [DOI: 10.1016/j.ejmp.2018.09.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Mkimel M, Mesradi M, El Baydaoui R, Saad E, Hilali A. 37 Simulation of CTDI using GATE for 2, 16, 64 slices CT system. Phys Med 2018. [DOI: 10.1016/j.ejmp.2018.09.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Abdellah W, Abdelfattah E, Diab H, Saad E. Removal of Chromium from Liquid Waste by Gamma Aluminum Oxide (γ-Al2O3) Nanoparticles Synthesized Using Citrate Sol-gel Method. Arab Journal of Nuclear Sciences and Applications 2018. [DOI: 10.21608/ajnsa.2018.12728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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45
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Tamraoui Y, Manoun B, Mirinioui F, Saadoune I, Haloui R, Elhachmi A, Saad E, Lazor P. Temperature and composition induced phase transitions in Sr2−xCa1+xTeO6 (0 ≤ x ≤ 2) double perovskite oxides. J Mol Struct 2017. [DOI: 10.1016/j.molstruc.2016.11.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Khafagy T, Regal S, ElKassaby M, Saad E. Early Results of Brachial Arterio-Arterial Prosthetic Loop (AAPL) for Hemodialysis. Eur J Vasc Endovasc Surg 2016; 51:867-71. [PMID: 27052262 DOI: 10.1016/j.ejvs.2016.02.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 10/13/2015] [Accepted: 02/11/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Vascular access has always been the Achilles heel of hemodialysis. Advances in health care have brought forward patients requiring treatment who have no veins suitable for creation of arteriovenous fistula (AVF) or insertion of central venous catheters. Use of an artery as permanent vascular access has been reported by many authors. This study reports brachial AAPL as an efficient and safe access for hemodialysis patients with central venous occlusion. METHODS Between January 2011 and December 2014, 35 brachial arterio-arterial prosthetic loops (AAPL) were created. The age of patients ranged between 27 and 72 years, with a mean age of 52.8 years. RESULTS The primary patency rates were 87.9%, 70.4%, and 38.8% at 12, 24, and 36 months, respectively. The secondary patency was 90.7%, 80.3%, and 67.6% at 12, 24, and 36 months, respectively, after successful thrombectomy in seven cases. CONCLUSION Mid-term follow-up results demonstrate patency rates comparable with those of the synthetic AVF. The rate of complications, although slightly higher than that with traditional synthetic AVF, is still acceptable in this population with no option for access.
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Affiliation(s)
- T Khafagy
- Department of Vascular and Endovascular Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - S Regal
- Department of Vascular and Endovascular Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - M ElKassaby
- Department of Vascular and Endovascular Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt; Western Vascular Institute (WVI), Department of Vascular and Endovascular Surgery, University College Hospital Galway (UCHG), Newcastle Road, Galway, Ireland.
| | - E Saad
- Department of Vascular and Endovascular Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Abstract
Serratia, Pseudomonas/Providencia, indole-positive Proteus/Acinetobacter/Morganella, Citrobacter, Enterobacter and Hafnia group of organisms cause peritoneal dialysis (PD)-related peritonitis with high morbidity and mortality. Peritonitis caused by Citrobacter freundii is uncommon, and it may lead to catheter removal despite antimicrobial treatment. We describe a case of PD-related peritonitis caused by C. freundii, which was successfully treated with double antibiotic coverage.
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Affiliation(s)
- A Kataria
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - E Saad
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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Amin A, Mustafa M, Abd El-Hadi E, Monier A, Badwey A, Saad E. Pentavalent technetium-99m-dimercaptosuccinic acid [Tc-99m (V) DMSA] brain SPECT: does it have a place in predicting survival in patients with glioblastoma multiforme? J Neurooncol 2014; 121:303-9. [PMID: 25349131 DOI: 10.1007/s11060-014-1633-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 10/17/2014] [Indexed: 10/24/2022]
Abstract
Pentavalent technetium-99m dimercaptosuccinic acid (Tc-99m (V) DMSA) is reported as a useful tool for detection of residual or recurrent gliomas. We aimed to investigate the prognostic value of Tc-99m (V) DMSA brain SPECT in patients with glioblastoma multiforme (GBM). 40 patients [21 males and 19 females; mean age 48.6 ± 12.2 years] with GBM were included. Tc-99m (V) DMSA brain SPECT was done after surgery and before onset of radiation therapy or chemotherapy (Baseline study), at 4-6 weeks and at 6 months as a follow-up after therapy. The end point of the study was clinical follow-up for 2 years and/or death. 4-6 weeks after therapy, 40 and 60 % had negative and positive Tc-99m (V) DMSA for viable tumor tissues respectively (P = 0.09). At 6 months follow-up, 62.5 % of (V) DMSA negative patients and 12.5 % of the positive subjects were responders (P = 0.001). The median over-all survival (OS) of all patients was 12.3 month [range 5-24 month]. Patients with positive (V) DMSA had worse survival (8.87 month) compared to the negative ones (16.67 month) (P = 0.0001). Multivariate Cox regression analysis showed that Tc-99m (V) DMSA brain SPECT studies at 4-6 weeks and 6-months follow-up were independent prognostic factors for survival [OR 1.069; 95 % CI 1.417-2.174; P = 0.03 and OR 1.055; 95 % CI 0.821-1.186; P = 0.01 respectively]. Stratification of tumors into risk groups based on prognostic parameters may improve outcome by altering or intensifying treatment methods. Technetium-99m dimercaptosuccinic acid brain SPECT may have an additional prognostic role in patients with GBM which needs further evaluation in larger future series.
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Affiliation(s)
- Amr Amin
- Nuclear Medicine Department, Faculty of Medicine, Cairo University, 32, Soliman Abaza St. Al-Mohandeseen, Giza, Egypt,
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Kataria A, Cohen E, Saad E, Atallah E, Bresnahan B. Large granular lymphocytic leukemia presenting late after solid organ transplantation: a case series of four patients and review of the literature. Transplant Proc 2014; 46:3278-81. [PMID: 25240311 DOI: 10.1016/j.transproceed.2014.05.083] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 05/27/2014] [Indexed: 10/24/2022]
Abstract
Post-transplantation lymphoproliferative disorder (PTLD) is a significant complication of solid organ transplantation. Most PTLD is of the B-cell subtype, although T-cell subtype PTLD uncommonly occurs. T-cell PTLDs are usually aggressive neoplasms and shorten patient and allograft survivals significantly. We present a single-center case series of 4 patients who developed T-cell large granular lymphocytic (LGL) leukemia, a rare T-cell PTLD characterized by large granular lymphocytes that have characteristic azurophilic granules and a highly variable clinical course.
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Affiliation(s)
- A Kataria
- Division of Nephrology, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - E Cohen
- Division of Nephrology, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Medicine, Veterans Administration Zablocki Medical Center, Milwaukee, Wisconsin
| | - E Saad
- Division of Nephrology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - E Atallah
- Division of Hematology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - B Bresnahan
- Division of Nephrology, Medical College of Wisconsin, Milwaukee, Wisconsin
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Selimovic N, Alhalees Z, Kjellman U, Alsanei A, Eyjolfsson A, Alhabeeb W, Alburaiki J, Khouqeer F, Saad E, Khaliel F. Current Status of Heart Transplantation in the Kingdom of Saudi Arabia. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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