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Felzer JR, Fogwe DT, Samrah S, Michet CJ, Specks U, Baqir M, Kubbara AF. Association of COVID-19 antigenicity with the development of antineutrophilic cytoplasmic antibody vasculitis. Respirol Case Rep 2022; 10:e0894. [PMID: 34992785 PMCID: PMC8713005 DOI: 10.1002/rcr2.894] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 11/03/2021] [Revised: 12/02/2021] [Accepted: 12/07/2021] [Indexed: 01/23/2023] Open
Abstract
Inflammatory processes, such as an infection or drug reaction, can cause antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis (AAV). Although quite rare, AAV may occur with SARS-coronavirus disease 2019 (COVID-19) antigenic exposure, either from infection or immunization. We present two cases of AAV: one that developed after COVID-19 infection presenting as diffuse alveolar haemorrhage and another that developed shortly after vaccination, presenting as granulomatous pulmonary nodules. Both patients improved with supportive care and immunosuppressive therapies. This adverse event appears to be a very rare complication of COVID-19 infection or vaccination. Early diagnosis of AAV is important because immunosuppressive therapy may improve patient outcomes.
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Affiliation(s)
- Jamie R. Felzer
- Mayo Clinic School of Graduate Medical EducationMayo Clinic College of Medicine and ScienceRochesterMinnesotaUSA
| | - Delvise T. Fogwe
- Mayo Clinic School of Graduate Medical EducationMayo Clinic College of Medicine and ScienceRochesterMinnesotaUSA
| | - Shaher Samrah
- Department of MedicineJordan University of Science and TechnologyIrbidJordan
| | | | - Ulrich Specks
- Division of Pulmonary and Critical Care MedicineMayo ClinicRochesterMinnesotaUSA
| | - Misbah Baqir
- Division of Pulmonary and Critical Care MedicineMayo ClinicRochesterMinnesotaUSA
| | - Aahd F. Kubbara
- Division of Pulmonary and Critical Care MedicineMayo ClinicRochesterMinnesotaUSA
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Alkhatatbeh MJ, Almomani HS, Abdul-Razzak KK, Samrah S. Association of asthma with low serum vitamin D and its related musculoskeletal and psychological symptoms in adults: a case-control study. NPJ Prim Care Respir Med 2021; 31:27. [PMID: 33990605 PMCID: PMC8121852 DOI: 10.1038/s41533-021-00239-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 04/16/2021] [Indexed: 02/03/2023] Open
Abstract
There are complex potential inter-relationships between the chronic inflammation of asthma and poor control, vitamin D deficiency, musculoskeletal pain and anxiety and depression. The aim was to investigate associations between vitamin D and these possible co-morbidities. This case-controlled study involved 75 adults with asthma and 75 controls. Serum 25-hydroxyvitamin D (25(OH)D) was measured, levels of anxiety, depression, musculoskeletal pain, and asthma control were assessed. Participants with asthma had lower 25(OH)D and higher anxiety scores and higher measures of musculoskeletal pain compared to controls. Binary logistic regression showed that asthma was associated with decreased 25(OH)D (Odds ratio (OR) = 0.86), general weakness (OR = 13.29), complaint of musculoskeletal pain (OR = 13.73), and increased intensity of musculoskeletal pain (OR = 0.61) and number of painful sites (OR = 2.58). Asthma was not associated with anxiety or depression. Further studies are required to investigate if vitamin D supplementation can improve asthma symptoms and musculoskeletal pain.
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Affiliation(s)
- Mohammad J Alkhatatbeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan.
| | - Haneen S Almomani
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Khalid K Abdul-Razzak
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Shaher Samrah
- Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Samrah S, Sweidan A, Aleshawi A, Ayesh M. Fusarium-Induced Cellulitis in an Immunocompetent Patient With Sickle Cell Disease: A Case Report. J Investig Med High Impact Case Rep 2020; 8:2324709620934303. [PMID: 32539466 PMCID: PMC7298209 DOI: 10.1177/2324709620934303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Fungal infections due to Fusarium species are mostly
present in immunocompromised and patients with poorly controlled
diabetes mellitus. We report a case of lower extremity skin infection
caused by Fusarium species in a 61-year-old woman
diagnosed with sickle cell disease. Single skin ulceration caused by
Fusarium species can result from fungal
inoculation into damaged tissue, so any condition that damages the
skin can be considered as a risk factor for inoculation. Long-standing
sickle cell disease may develop vaso-occlusion in the skin that can
produce lower extremity ulcers and myofascial syndromes. The mechanism
is not completely characterized, but compromised blood flow,
endothelial dysfunction, thrombosis, inflammation, and delayed healing
are thought to contribute to locally compromised tissue that may
eventually lead to opportunistic infection such as in our case. Other
factors contribute to the pathophysiology of lower extremity ulcers
such as diabetes mellitus, with the resulting peripheral vascular
ischemia causing poor circulation to the lower extremity, and
peripheral neuropathy, which can make patients with diabetes unaware
of minor trauma leading to the development of skin infections.
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Affiliation(s)
- Shaher Samrah
- Jordan University of Science and Technology, Irbid, Jordan
| | - Aroob Sweidan
- Jordan University of Science and Technology, Irbid, Jordan
| | | | - Mahmoud Ayesh
- Jordan University of Science and Technology, Irbid, Jordan
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Samrah S, Shraideh H, Rawashdeh S, Khassawneh B. Tricuspid valve calcification in familial pulmonary alveolar microlithiasis: A case report. Ann Med Surg (Lond) 2020; 55:256-259. [PMID: 32528675 PMCID: PMC7281303 DOI: 10.1016/j.amsu.2020.05.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/21/2020] [Accepted: 05/22/2020] [Indexed: 01/05/2023] Open
Abstract
Background Pulmonary Alveolar Microlithiasis (PAM) is an uncommon, gradually progressive and eventually fatal hereditary disease that affects young population. Familial cases account for up to 50% of reported cases. There are few described cases of extrapulmonary manifestations of PAM and rare reports of cardiac involvement. Case report A 45-year-old male patient presented to our center with progressive shortness of breath and dry cough. On physical examination, he was tachypneic and chest examination revealed diminished breath sounds with bilateral early inspiratory crackles. Further workup revealed the diagnosis of PAM. Echocardiography revealed calcifications covering the tricuspid valve with elevated right ventricular systolic pressure. He reported having two sisters with similar illnesses and chest radiographic abnormalities, one died at the age of 38 years from respiratory failure and the other is 42-year-old and still alive and was diagnosed with PAM. Another 35 member of his family were diagnosed with PAM. Unfortunately, few days after discharge, he arrested at home. Conclusions Recently, type-II sodium/phosphate co-transporter has been identified in a human aortic valve. Studies have suggested penetrance of mutations of SLC34A2 gene might explain such variability of pulmonary and extrapulmonary involvement. Our case reports a familial cluster of PAM, and the first case of concomitant tricuspid calcification. This finding might be a useful in the investigation for a future genetic targeted therapy. PAM is a fatal hereditary disease that affects young population. There are few described cases of extrapulmonary manifestations of PAM. Mutations of SLC34A2 gene might explain variability of extrapulmonary involvement.
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Affiliation(s)
- Shaher Samrah
- Department of Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | | | - Sukiana Rawashdeh
- Department of Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Basheer Khassawneh
- Department of Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Yusef D, Hayajneh W, Awad S, Momany S, Khassawneh B, Samrah S, Obeidat B, Raffee L, Al-Faouri I, Issa AB, Al Zamel H, Bataineh E, Qdaisat R. Large Outbreak of Coronavirus Disease among Wedding Attendees, Jordan. Emerg Infect Dis 2020; 26. [PMID: 32433907 PMCID: PMC7454095 DOI: 10.3201/eid2609.201469] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
In March 2020, a wedding in Jordan led to a large outbreak of coronavirus disease (COVID-19). We collected data on 350 wedding attendees, 76 who of whom developed COVID-19. Our study shows high communicability of COVID-19 and the enormous risk for severe acute respiratory syndrome 2 virus transmission during mass gatherings.
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Samrah S, Aleshawi A, Khassawneh B, Lahren K. Bronchoscopy in the diagnosis of pulmonary blastomycosis. Int J Infect Dis 2020; 96:187-191. [PMID: 32371194 DOI: 10.1016/j.ijid.2020.04.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/26/2020] [Accepted: 04/28/2020] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Diagnosing pulmonary blastomycosis (PB) requires the detection of Blastomyces dermatitidis in pulmonary secretions or tissue, which can be achieved via bronchoscopic procedures like bronchoalveolar lavage (BAL) or brush and transbronchial biopsy (TBBx). This descriptive study retrieved the data of PB that was diagnosed by bronchoscopy to define which bronchoscopic procedure produced the highest yield. METHODS Retrospectively, all patients diagnosed with PB via bronchoscopic approach were identified. Non-invasive BAL was referred to when performed first in the order of bronchoscopic procedures, and invasive BAL was used when it was performed after other bronchoscopic procedures. RESULTS A total of 111 patients were included in the study. BAL produced the highest yield of all bronchoscopic procedures (>87%), regardless if it was performed first in order (non-invasive, 87.3%) or not (invasive BAL, 89.6%) (p = 0.43). Performing bronchoscopy and BAL earlier in the course of the disease resulted in a significantly better diagnostic yield. CONCLUSIONS BAL is probably enough to diagnose PB. Also, it had the best yield when performed earlier, regardless of whether it was performed first in order or not. BAL culture had a better yield in detecting Blastomyces dermatitidis over fungal stain and cytology.
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Affiliation(s)
- Shaher Samrah
- Department of Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
| | | | - Basheer Khassawneh
- Department of Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Samrah S, Bashtawi Y, Hayajneh W, Almomani B, Momany S, Khader Y. Impact of colistin-initiation delay on mortality of ventilator-associated pneumonia caused by A. baumannii. J Infect Dev Ctries 2016; 10:1129-1134. [DOI: 10.3855/jidc.7203] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 07/26/2015] [Accepted: 08/01/2015] [Indexed: 10/31/2022] Open
Abstract
Introduction: There has been increased incidence and high mortality in cases with ventilator-associated pneumonia (VAP) caused by colistin-only-susceptible Acinetobacter baumannii (COS-AB). Colistin has emerged as a therapeutic option for VAP caused by multidrug-resistant Gram-negative organisms including COS-AB. A retrospective study was conducted to examine the impact of early versus late initiation of colistin on 30-day mortality of critically ill patients with VAP caused by COS-AB. Methodology: Critically ill patients with VAP caused by COS-AB who received colistin were enrolled. The receiver operating characteristic (ROC) curve was used to identify the temporal breakpoint that maximized the difference in 30-day mortality. Results: A total of 56 patients (34 men and 22 women) were included in the study. About 86% of all cases were late-onset VAP. The 30-day mortality was 46.4%. The rate was higher among patients with admission Acute Physiology and Chronic Health Evaluation II (APACHE II) score > 18 and patients with a delay of more than four days in initiating colistin treatment. The mortality rate was 26.9% among patients with treatment delay of four or fewer days and 63.3% for patients with a treatment delay of more than four days. Conclusions: A delay of four days or more in initiating colistin in patients with VAP caused by COS-AB significantly increases mortality. Colistin should be considered in the empirical protocols in late-onset VAP cases when COS-AB is highly suspected.
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Almomani BA, McCullough A, Gharaibeh R, Samrah S, Mahasneh F. Incidence and predictors of 14-day mortality in multidrug-resistant Acinetobacter baumannii in ventilator-associated pneumonia. J Infect Dev Ctries 2015; 9:1323-30. [PMID: 26719938 DOI: 10.3855/jidc.6812] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 04/27/2015] [Accepted: 05/04/2015] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION Ventilator-associated pneumonia (VAP) caused by multidrug-resistant Acinetobacter baumannii (MDR-AB) is common in hospitals and impacts patient survival. We determined the incidence of MDR-AB VAP in critical care units and examined the predictors of 14-day mortality in these patients. METHODOLOGY A retrospective case series study was conducted at a tertiary referral teaching hospital in north Jordan. A list of patients with a positive culture of A. baumannii between January 2007 and June 2013 was retrieved using computerized hospital databases. Medical records of all these patients were reviewed, and cases of VAP infected with MDR-AB were identified. Predictors of 14-day mortality were determined using multivariable logistic regression adjusted for possible confounders. RESULTS Out of 121 A. baumannii-VAP cases, 119 (98.3%) were caused by MDR-AB. The incidence rate of MDR-AB VAP was 1.59 cases per 100 critical care unit admissions. The mortality of A. baumannii-VAP cases in critical care units was 42% (50/119). Being prescribed two or more definitive antibiotics (prescribed based on susceptibility data) (OR = 0.075, 95% CI = 0.017-0.340, p = 0.001) and ipratropium/salbutamol during mechanical ventilation (OR = 0.140, 95% CI = 0.028-0.705, p = 0.017) were independently associated with lower hospital mortality. CONCLUSIONS Our results suggest incidence of MDR-AB VAP in critical care units is high and that prescription of antibiotics based on antibiotic susceptibility and use of bronchodilators is associated with lower mortality in this population. Larger prospective studies are needed to explore whether these findings can be replicated in different clinical settings.
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Samrah S, Khatib I, Omari M, Khassawneh B, Momany S, Daoud A, Malkawi M, Khader Y. Vitamin D deficiency and level of asthma control in women from North of Jordan: a case-control study. J Asthma 2014; 51:832-8. [PMID: 24779968 DOI: 10.3109/02770903.2014.919316] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Reduced vitamin-D levels in patients with asthma have been associated with impaired lung function, increased airway hyper-responsiveness, and reduced glucocorticoid responsiveness. Nationwide studies revealed a considerable prevalence of vitamin-D deficiency (VDD) in Jordanian women. OBJECTIVE A case-control study was conducted to determine the relationship between serum vitamin A and D levels and asthma among women in North of Jordan. METHODS Sixty-eight asthmatics, age range between 14 and 65 years and 77 healthy women, age range between 19 and 51 years, were enrolled. Asthma severity was classified using Global Initiative for Asthma (GINA) guidelines and Asthma Control Test (ACT) questionnaire. Serum vitamin-A and 25-hydroxyvitamin-D (25(OH)D3) levels were measured using high-performance liquid chromatography (HPLC) and liquid chromatography-tandem mass spectrometry (LC-MS/MS) methods, respectively. RESULTS The prevalence of VDD (<15 ng/ml) was higher but not statistically significant for women with asthma compared with controls (95.6% vs. 87.0%; p = 0.070). The severity of VDD correlated with the number of asthma medications (p = 0.020). 25(OH)-D3 serum levels directly correlated with asthma control level using ACT score (p = 0.012) and GINA classification (p = 0.046). After adjusting for age, the odds of having VDD for asthmatic women were 35.9 times higher than that for women with no asthma. There was no difference in serum vitamin-A level between healthy and asthmatic women (p = 0.214) and none had vitamin-A deficiency (<200 µg/dl). CONCLUSIONS VDD is prevalent in women with asthma in northern Jordan. The severity of VDD correlated with poor asthma control and a need for more medications to control asthma. There was no association between vitamin-A and asthma.
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Samrah S, Khatib I, Momany S, Daoud A, Khassawneh B, Omari M, Khader Y. Vitamin D Deficiency Correlates With Number of Treatments Required to Control Asthma in Adult Women in Northern Jordan. Chest 2013. [DOI: 10.1378/chest.1702140] [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: 11/01/2022] Open
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Jamous M, Barbarawi M, Samrah S, Khabaz MN, Al-Jarrah M, Dauod S. Emergency decompressive craniectomy for trauma patients with Glasgow Coma Scale of 3 and bilateral fixed dilated pupils. Eur J Trauma Emerg Surg 2010; 36:465-9. [DOI: 10.1007/s00068-010-0002-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Accepted: 11/14/2009] [Indexed: 11/24/2022]
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Hoffman EA, Reinhardt JM, Sonka M, Simon BA, Guo J, Saba O, Chon D, Samrah S, Shikata H, Tschirren J, Palagyi K, Beck KC, McLennan G. Characterization of the interstitial lung diseases via density-based and texture-based analysis of computed tomography images of lung structure and function1. Acad Radiol 2003; 10:1104-18. [PMID: 14587629 DOI: 10.1016/s1076-6332(03)00330-1] [Citation(s) in RCA: 122] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
RATIONALE AND OBJECTIVES Efforts to establish a quantitative approach to the computed tomography (CT)-based character ization of the lung parenchyma in interstitial lung disease (including emphysema) has been sought. The accuracy of these tools must be site independent. Multi-detector row CT has remained the gold standard for imaging the lung, and it provides the ability to image both lung structure as well as lung function. MATERIAL AND METHODS Imaging is via multi-detector row CT and protocols include careful control of lung volume during scanning. Characterization includes not only anatomic-based measures but also functional measures including regional parameters derived from measures of pulmonary blood flow and ventilation. Image processing includes the automated detection of the lungs, lobes, and airways. The airways provide the road map to the lung parenchyma. Software automatically detects the airways, the airway centerlines, and the branch points, and then automatically labels the airway tree segments with a standardized set of labels, allowing for intersubject as well intrasubject comparisons across time. By warping all lungs to a common atlas, the atlas provides the range of normality for the various parameters provided by CT imaging. RESULTS Imaged density and textural changes mark underlying structural changes at the most peripheral regions of the lung. Additionally, texture-based alterations in the parameters of blood flow may provide early evidence of pathologic processes. Imaging of stable xenon gas provides a regional measure of ventilation which, when coupled with measures of flow, provide for a textural analysis regional of ventilation-perfusion matching. CONCLUSION With the improved resolution and speed of CT imaging, the patchy nature of regional parenchymal pathology can be imaged as texture of structure and function. With careful control of imaging protocols and the use of objective image analysis methods it is possible to provide site-independent tools for the assessment of interstitial lung disease. There remains a need to validate these methods, which requires interdisciplinary and cross-institutional efforts to gather appropriate data bases of images along with a consensus on appropriate ground truths associated with the images. Furthermore, there is the growing need for scanner manufacturers to focus on not just visually pleasing images, but on quantitatifiably accurate images.
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Affiliation(s)
- Eric A Hoffman
- Department of Radiology, University of Iowa, Iowa City, IA, USA
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