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1.
Sci Rep ; 14(1): 17031, 2024 07 23.
Article in English | MEDLINE | ID: mdl-39043722

ABSTRACT

Non-human primates remain the most useful and reliable pre-clinical model for many human diseases. Primate breath profiles have previously distinguished healthy animals from diseased, including non-human primates. Breath collection is relatively non-invasive, so this motivated us to define a healthy baseline breath profile that could be used in studies evaluating disease, therapies, and vaccines in non-human primates. A pilot study, which enrolled 30 healthy macaques, was conducted. Macaque breath molecules were sampled into a Tedlar bag, concentrated onto a thermal desorption tube, then desorbed and analyzed by comprehensive two-dimensional gas chromatography-time of flight mass spectrometry. These breath samples contained 2,017 features, of which 113 molecules were present in all breath samples. The core breathprint was dominated by aliphatic hydrocarbons, aromatic compounds, and carbonyl compounds. The data were internally validated with additional breath samples from a subset of 19 of these non-human primates. A critical core consisting of 23 highly abundant and invariant molecules was identified as a pragmatic breathprint set, useful for future validation studies in healthy primates.


Subject(s)
Breath Tests , Animals , Breath Tests/methods , Male , Pilot Projects , Female , Gas Chromatography-Mass Spectrometry/methods , Macaca , Volatile Organic Compounds/analysis
2.
Clin Exp Allergy ; 54(4): 265-277, 2024 Apr.
Article in English | MEDLINE | ID: mdl-38253462

ABSTRACT

INTRODUCTION: Previous bronchoalveolar lavage fluid (BALF) proteomic analysis has evaluated limited numbers of subjects for only a few proteins of interest, which may differ between asthma and normal controls. Our objective was to examine a more comprehensive inflammatory biomarker panel in quantitative proteomic analysis for a large asthma cohort to identify molecular phenotypes distinguishing severe from nonsevere asthma. METHODS: Bronchoalveolar lavage fluid from 48 severe and 77 nonsevere adult asthma subjects were assessed for 75 inflammatory proteins, normalized to BALF total protein concentration. Validation of BALF differences was sought through equivalent protein analysis of autologous sputum. Subjects' data, stratified by asthma severity, were analysed by standard statistical tests, principal component analysis and 5 machine learning algorithms. RESULTS: The severe group had lower lung function and greater health care utilization. Significantly increased BALF proteins for severe asthma compared to nonsevere asthma were fibroblast growth factor 2 (FGF2), TGFα, IL1Ra, IL2, IL4, CCL8, CCL13 and CXCL7 and significantly decreased were platelet-derived growth factor a-a dimer (PDGFaa), vascular endothelial growth factor (VEGF), interleukin 5 (IL5), CCL17, CCL22, CXCL9 and CXCL10. Four protein differences were replicated in sputum. FGF2, PDGFaa and CXCL7 were independently identified by 5 machine learning algorithms as the most important variables for discriminating severe and nonsevere asthma. Increased and decreased proteins identified for the severe cluster showed significant protein-protein interactions for chemokine and cytokine signalling, growth factor activity, and eosinophil and neutrophil chemotaxis differing between subjects with severe and nonsevere asthma. CONCLUSION: These inflammatory protein results confirm altered airway remodelling and cytokine/chemokine activity recruiting leukocytes into the airways of severe compared to nonsevere asthma as important processes even in stable status.


Subject(s)
Asthma , Vascular Endothelial Growth Factor A , Adult , Humans , Proteomics , Fibroblast Growth Factor 2 , Cytokines/metabolism , Bronchoalveolar Lavage , Chemokines , Bronchoalveolar Lavage Fluid
3.
Pediatr Cardiol ; 2023 Dec 08.
Article in English | MEDLINE | ID: mdl-38063897

ABSTRACT

The Zio® (Zio) XT Patch is a 14-day continuous ambulatory ECG monitor. During the Covid-19 pandemic, Zios were mailed directly to patients for self-application. The purpose of this study was to compare the percent artifact, a marker for quality, of in-clinic (IC) to mail-home (MH) applications in a pediatric population. A single-center, IRB-approved study of patients 0- < 21 years of age with Zios was studied for wear and artifact time filtered out based on iRhythm's proprietary algorithm. In total, 284 Zios were randomly selected and analyzed for total wear time and artifact. Of these, 149 were IC prior to 12/31/2019 and 135 MH patches prescribed after 1/1/2020. No significant difference was found for percent artifact between the IC (7.8%) and MH (8.3%) group. Average IC wear-time was 127 h compared to MH at 99 h (p = 0.02). In conclusion, application of Zio patches outside of the pediatric cardiology clinic offers equivalent artifact, a marker of quality, as those applied in clinic and should be consideration as a viable alternative.

4.
Ann Med Surg (Lond) ; 85(6): 2916-2923, 2023 Jun.
Article in English | MEDLINE | ID: mdl-37363488

ABSTRACT

There are limited data available on outcomes and pathophysiology behind ST-segment elevation myocardial infarction (STEMI) in populations without standard modifiable risk factors (SMuRFs). The authors carried out this meta-analysis to understand the differences in treatment and outcomes of STEMI patients with and without SMuRFs. Methods: A systematic database search was performed for relevant studies. Studies reporting desired outcomes among STEMI patients with and without SMuRFs were selected based on predefined criteria in the study protocol (PROSPERO: CRD42022341389). Two reviewers independently screened titles and abstracts using Covidence. Full texts of the selected studies were independently reviewed to confirm eligibility. Data were extracted from all eligible studies via a full-text review of the primary article for qualitative and quantitative analysis. In-hospital mortality following the first episode of STEMI was the primary outcome, with major adverse cardiovascular events (MACE), repeat myocardial infarction (MI), cardiogenic shock, heart failure, and stroke as secondary outcomes of interest. Odds ratio (OR) with a 95% CI was used to estimate the effect. Results: A total of 2135 studies were identified from database search, six studies with 521 150 patients with the first STEMI episode were included in the analysis. The authors found higher in-hospital mortality (OR: 1.43; CI: 1.40-1.47) and cardiogenic shock (OR: 1.59; 95% CI: 1.55-1.63) in the SMuRF-less group with no differences in MACE, recurrent MI, major bleeding, heart failure, and stroke. There were lower prescriptions of statin (OR: 0.62; CI: 0.42-0.91) and Angiotensin converting enzyme inhibitor /Angiotensin II receptor blocker (OR: 0.49; CI: 0.28-0.87) at discharge in SMuRF-less patients. There was no difference in procedures like coronary artery bypass graft, percutaneous coronary intervention, and thrombolysis. Conclusion: In the SMuRF-less STEMI patients, higher in-hospital mortality and treatment discrepancies were noted at discharge.

5.
Ann Med Surg (Lond) ; 85(5): 1584-1589, 2023 May.
Article in English | MEDLINE | ID: mdl-37228944

ABSTRACT

Acinetobacter spp. have been a primary cause of nosocomial infections worldwide, causing significant morbidity and mortality, especially in Pakistan. The purpose of this study was to investigate the trend of antimicrobial resistance over a 5-year period in a tertiary care hospital in Pakistan. Methods: A retrospective cross-sectional study regarding the occurrence and antimicrobial resistance of Acinetobacter spp. recovered from clinical specimens that were referred to the Pathology Laboratory of Northwest General Hospital, Peshawar. The data from 2014 to 2019 was recorded and analyzed by the laboratory. Sociodemographic characteristics and laboratory record data was analyzed using SPSS, version 25. A chi-square test was applied to see the significance. Results: Of 59 483 clinical samples, Acinetobacter baumannii strains were detected in 114 of them. The majority of the clinical samples were from blood (89.5%) followed by sputum (7.9%), wound swab (1.8%), and bone marrow (0.9%). A. baumannii has been found in 52 men (67.53%) and 28 women (75.67%), with an overall risk of 0.669 times. In 76 men (98.70%), sensitivity for ertapenem (99.1), colistin (96.49), and tigecycline (78.9%) were also observed which indicated the potential viability of these drugs to treat multidrug-resistant (MDR) Acinetobacter infections. The male-to-female risk ratio was 0.98 for colistin and 0.71 for amikacin. Conclusion: Increased frequency of MDR supports the need for continuous surveillance to determine the prevalence and evolution of MDR Acinetobacter spp. in Pakistan. Colistin, tigecyclines, and ertapenem remain the possible line of drugs to treat MDR Acinetobacter.

6.
Cardiovasc Revasc Med ; 43: 80-84, 2022 10.
Article in English | MEDLINE | ID: mdl-35595607

ABSTRACT

BACKGROUND: Intravascular lithotripsy (IVL) is a novel endovascular treatment for calcified common femoral artery disease (CFA). Data on midterm effectiveness for clinically driven target lesions revascularization (CD-TLR) is lacking. This study investigated CD-TLR during 18-month follow-up in patients requiring IVL for CFA disease treatment. METHODS: In a single-center retrospective cohort study, electronic medical record of patients undergoing IVL for CFA disease from January 2018 to March 2020 were reviewed. Primary outcome was CD-TLR estimated by Kaplan-Meier method during 18-month follow-up. Univariate logistic regression was used to compare differences in CD-TLR by the type of adjunct therapy used. RESULTS: Among 54 CFA lesions in 50 patients, mean age (SD) was 75(8) years, gender and race were predominantly male (74%, n = 37) and white (94%, n = 47), respectively. Rutherford class III claudication was most common (70%, n = 35) with mean ABI of 0.66 (0.26) and mean angiographic stenosis of 77% (13%). Adjunct use of drug-coated balloon (DCB) angioplasty was 83% (n = 45) and atherectomy was 39% (n = 21). Residual angiographic stenosis was <30% in all cases. Complications included dissection requiring stent placement (2%, n = 1). After 18-months, 18% (n = 9) died unrelated to procedural complications and 6% (n = 3) were lost to follow-up. 18-month cumulative freedom from CD-TLR was 80.6% (95% CI: 69.1%, 92%). Univariate logistic regression did not reveal a statistically significant difference in CD-TLR with type of adjunct therapy used (p > 0.05). CONCLUSION: IVL with adjunct use of DCB and/or atherectomy is safe and effective in treatment of calcified CFA disease. Randomized studies are required to confirm these findings.


Subject(s)
Angioplasty, Balloon , Lithotripsy , Peripheral Arterial Disease , Aged , Angioplasty, Balloon/adverse effects , Coated Materials, Biocompatible , Constriction, Pathologic , Female , Femoral Artery/diagnostic imaging , Follow-Up Studies , Humans , Lithotripsy/adverse effects , Male , Peripheral Arterial Disease/diagnostic imaging , Peripheral Arterial Disease/etiology , Peripheral Arterial Disease/therapy , Popliteal Artery , Retrospective Studies , Treatment Outcome , Vascular Patency
7.
Pediatr Cardiol ; 43(4): 923-925, 2022 Apr.
Article in English | MEDLINE | ID: mdl-35024901

ABSTRACT

Phrenic nerve injury can lead to a disruption of the autonomic nervous system (ANS) resulting in episodes of bradycardic arrest. Implanted diaphragmatic pacing has been used to overcome phrenic nerve paralysis, but these do not change the ANS. Therefore, patients with phrenic nerve paralysis may require the implantation of a permanent cardiac pacemaker to overcome bradycardic episodes. Having two electronic devices in the same patient may lead to device-device interaction (DDI). This can result in over-sensing leading to lack of pacing of either device. We present the case of a 17-year-old pediatric male with phrenic nerve injury who required implantation of both diaphragm and cardiac pacemaker. Intra-procedural interrogation of the cardiac pacemaker demonstrated DDI in unipolar mode, but not in bipolar. Thus, we demonstrated the safe utilization of multiple implantable electronic devices in the pediatric patient without device-device interaction.


Subject(s)
Pacemaker, Artificial , Phrenic Nerve , Adolescent , Bradycardia , Child , Diaphragm/innervation , Humans , Male , Paralysis
8.
Sci Rep ; 12(1): 339, 2022 01 10.
Article in English | MEDLINE | ID: mdl-35013420

ABSTRACT

Insulin resistance (IR) affects a quarter of the world's adult population and is a major factor in the pathogenesis of cardio-metabolic disease. In this pilot study, we implemented a non-invasive breathomics approach, combined with random forest machine learning, to investigate metabolic markers from obese pre-diabetic Hispanic adolescents as indicators of abnormal metabolic regulation. Using the ReCIVA breathalyzer device for breath collection, we have identified a signature of 10 breath metabolites (breath-IR model), which correlates with Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) (R = 0.95, p < 0.001). A strong correlation was also observed between the breath-IR model and the blood glycemic profile (fasting insulin R = 0.91, p < 0.001 and fasting glucose R = 0.80, p < 0.001). Among tentatively identified metabolites, limonene, undecane, and 2,7-dimethyl-undecane, significantly cluster individuals based on HOMA-IR (p = 0.003, p = 0.002, and p < 0.001, respectively). Our breath-IR model differentiates between adolescents with and without IR with an AUC-ROC curve of 0.87, after cross-validation. Identification of a breath signature indicative of IR shows utility of exhaled breath metabolomics for assessing systemic metabolic dysregulation. A simple and non-invasive breath-based test has potential as a diagnostic tool for monitoring IR progression, allowing for earlier detection of IR and implementation of early interventions to prevent onset of type 2 diabetes mellitus.


Subject(s)
Breath Tests , Hispanic or Latino , Insulin Resistance/ethnology , Metabolome , Metabolomics , Pediatric Obesity/metabolism , Prediabetic State/metabolism , Volatile Organic Compounds/metabolism , Adolescent , Age Factors , Biomarkers/metabolism , Cross-Sectional Studies , Feasibility Studies , Female , Health Status , Humans , Machine Learning , Male , Pediatric Obesity/diagnosis , Pediatric Obesity/ethnology , Pediatric Obesity/physiopathology , Pilot Projects , Prediabetic State/diagnosis , Prediabetic State/ethnology , Prediabetic State/physiopathology , Predictive Value of Tests , Race Factors , Texas/epidemiology
9.
J Soc Cardiovasc Angiogr Interv ; 1(4): 100374, 2022.
Article in English | MEDLINE | ID: mdl-39131925

ABSTRACT

Background: Common femoral artery (CFA) disease is often heavily calcified and prone to low patency rates with endovascular treatment compared with surgical endarterectomy. Recent data suggest promising short-term outcomes with the adjunct use of intravascular lithotripsy; however, data on its midterm effectiveness are lacking. We compared clinically driven target lesion revascularization (CD-TLR) between patients receiving drug-coated balloon angioplasty with adjunct intravascular lithotripsy (IVL-DCB) vs adjunct atherectomy (Ath-DCB) for treatment of CFA disease. Methods: In a single-center retrospective cohort study, patients receiving IVL-DCB vs Ath-DCB for symptomatic CFA disease from January 2015 to March 2020 were included. The primary outcome was cumulative CD-TLR with angiographic restenosis ≥50%, estimated by Kaplan-Meier analysis during 18-month follow-up and compared by log-rank test. Results: Total of 68 CFA lesions (Ath-DCB, 35; IVL-DCB, 33) were included. Patients had a mean age (standard deviation) of 72 (8) years and were predominantly male (63.3%) and White (92%). Mean baseline angiographic stenosis was 78% (11) in the Ath-DCB group and 70% (10) in the IVL-DCB group (P = .002). Technical success was 100% in both groups. One flow-limiting dissection occurred in IVL-DCB requiring stent placement, whereas 2 bailout stentings were performed in the Ath-DCB group. Cumulative Kaplan-Meier freedom from CD-TLR was 91.2% (95% CI, 81.6%-100%) in the Ath-DCB group vs 79.4% (95% CI, 64.6%-94.2%) in the IVL-DCB group (Log-rank P = .167). Conclusions: The safety and effectiveness of IVL-DCB were comparable to those of Ath-DCB in the treatment of calcified CFA disease during the 18-month follow-up. Further studies are required to verify these findings.

11.
Microorganisms ; 9(6)2021 Jun 03.
Article in English | MEDLINE | ID: mdl-34205044

ABSTRACT

The current outbreak caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), termed coronavirus disease 2019 (COVID-19), has generated a notable challenge for diabetic patients. Overall, people with diabetes have a higher risk of developing different infectious diseases and demonstrate increased mortality. Type 2 diabetes mellitus (T2DM) is a significant risk factor for COVID-19 progression and its severity, poor prognosis, and increased mortality. How diabetes contributes to COVID-19 severity is unclear; however, it may be correlated with the effects of hyperglycemia on systemic inflammatory responses and immune system dysfunction. Using the envelope spike glycoprotein SARS-CoV-2, COVID-19 binds to angiotensin-converting enzyme 2 (ACE2) receptors, a key protein expressed in metabolic organs and tissues such as pancreatic islets. Therefore, it has been suggested that diabetic patients are more susceptible to severe SARS-CoV-2 infections, as glucose metabolism impairments complicate the pathophysiology of COVID-19 disease in these patients. In this review, we provide insight into the COVID-19 disease complications relevant to diabetes and try to focus on the present data and growing concepts surrounding SARS-CoV-2 infections in T2DM patients.

12.
Comput Biol Med ; 136: 104684, 2021 09.
Article in English | MEDLINE | ID: mdl-34332352

ABSTRACT

In this paper, we detect the occurrence of epileptic seizures in patients as well as activities namely stand, walk, and exercise in healthy persons, leveraging EEG (electroencephalogram) signals. Using Hilbert vibration decomposition (HVD) on non-linear and non-stationary EEG signal, we obtain multiple monocomponents varying in terms of amplitude and frequency. After decomposition, we extract features from the monocomponent matrix of the EEG signals. The instantaneous amplitude of the HVD monocomponents varies because of the motion artifacts present in EEG signals. Hence, the acquired statistical features from the instantaneous amplitude help in identifying the epileptic seizures and the normal human activities. The features selected by correlation-based Q-score are classified using an LSTM (Long Short Term Memory) based deep learning model in which the feature-based weight update maximizes the classification accuracy. For epilepsy diagnosis using the Bonn dataset and activity recognition leveraging our Sensor Networks Research Lab (SNRL) data, we achieve testing classification accuracies of 96.00% and 83.30% respectively through our proposed method.


Subject(s)
Epilepsy , Vibration , Epilepsy/diagnosis , Human Activities , Humans , Seizures , Walking
13.
Head Neck Pathol ; 15(1): 113-119, 2021 Mar.
Article in English | MEDLINE | ID: mdl-33723763

ABSTRACT

Rapidly growing, symptomatic, non-hematological, malignant neck masses are unusual in young adults. We report a case of a 34-year-old African American male with sickle cell trait who presented with a large left supraclavicular/cervical mass comprising of poorly differentiated malignant epithelial cells consistent with metastatic carcinoma of unknown origin. Upon immunohistochemistry, the tumor showed loss of INI1 (BAF47) and retained PAX-8 expression. After extensive clinical and radiological work-up the primary tumor was found to be a 2.6 cm renal medullary carcinoma. This case highlights the role of multidisciplinary approach to the diagnosis of a neck mass and to understanding that certain genetically-defined tumors can occur at and metastasize to any site.


Subject(s)
Carcinoma, Medullary/pathology , Kidney Neoplasms/pathology , Lymphatic Metastasis/pathology , Adult , Humans , Male , Neck/pathology , Sickle Cell Trait
14.
Sci Rep ; 11(1): 2704, 2021 02 01.
Article in English | MEDLINE | ID: mdl-33526828

ABSTRACT

Pediatric tuberculosis (TB) remains a global health crisis. Despite progress, pediatric patients remain difficult to diagnose, with approximately half of all childhood TB patients lacking bacterial confirmation. In this pilot study (n = 31), we identify a 4-compound breathprint and subsequent machine learning model that accurately classifies children with confirmed TB (n = 10) from children with another lower respiratory tract infection (LRTI) (n = 10) with a sensitivity of 80% and specificity of 100% observed across cross validation folds. Importantly, we demonstrate that the breathprint identified an additional nine of eleven patients who had unconfirmed clinical TB and whose symptoms improved while treated for TB. While more work is necessary to validate the utility of using patient breath to diagnose pediatric TB, it shows promise as a triage instrument or paired as part of an aggregate diagnostic scheme.


Subject(s)
Respiratory Tract Infections/diagnosis , Tuberculosis/diagnosis , Breath Tests , Child , Child, Preschool , Diagnosis, Differential , Female , Humans , Male , Respiratory Tract Infections/physiopathology , Sensitivity and Specificity , Tuberculosis/physiopathology
15.
J Family Community Med ; 27(3): 178-185, 2020.
Article in English | MEDLINE | ID: mdl-33354148

ABSTRACT

BACKGROUND: Patient satisfaction is the ultimate goal in any healthcare system. Together with other traditional quality indicators, patient satisfaction must be addressed to improve the quality of health care. The strategic objectives of the Ministry of Health (MOH) formulated by the Saudi National Transformation Program are to improve the quality of healthcare services, expand privatization of governmental services, and create an attractive environment for both local and international investors. The objective of this study was to apply Kano model to determine quality attributes of patient care at primary healthcare centers in Saudi Arabia. MATERIALS AND METHODS: This cross-sectional study was conducted at primary healthcare centers (PHCs) under the MOH in Saudi Arabia between October 2018 and February 2019. Study included all Saudi adult patients aged 18 years or older attending the selected PHCs of MOH. Patients who had difficulty in comprehending were excluded. Data was collected by using a structured questionnaire based on the Kano model for the assessment of patients' expectations of the quality of care and provided services. Data was entered and analysed using SPSS. Chi-square test and t-test were used to test for statistical significance. RESULTS: The study included a total of 243 patients from 10 PHCs, 51% from consulting PHCs and 49% from nonconsulting PHCs. Response rate was 97.2%, and 44.9% respondents were males. Of the 18 attributes chosen for our study, 14 were one-dimensional, three belonged to the attractive type, and one was indifferent type. The top three one-dimensional attributes were "friendliness and respectfulness of the clinic receptionist," "friendliness and respectfulness of the nurses and laboratory staff," and "care and attention of the doctor". CONCLUSION: The investors and policymakers need to turn their attention to assisting in the privatization of governmental services by creating a good climate for both local and international investors.

17.
Cureus ; 11(7): e5182, 2019 Jul 20.
Article in English | MEDLINE | ID: mdl-31565591

ABSTRACT

OBJECTIVE:  Pericardial effusion is not an uncommon finding in hospitalized patients. Many pericardial effusions are found incidentally through computed tomography (CT) performed for other indications. Echocardiography is usually ordered when an incidentally discovered pericardial effusion is found on the CT to examine the effect of the effusion on hemodynamics and to detect early signs of tamponade. However, in clinical practice, the discrepancy between CT and echocardiography regarding the size of pericardial effusions is common. The accuracy of CT in the evaluation of the size of pericardial effusions is not well-studied. Our study aims to evaluate the accuracy of CT in assessing the size of a pericardial effusion compared with the gold standard echocardiography. METHODS:  This is a retrospective study examining patients presenting to the University of Toledo Medical Center (UTMC) with pericardial effusions. One hundred and forty-one patient charts were reviewed and 45 subjects were excluded. Ninety-six patients in whom both CT and echocardiography were performed were enrolled in the final analysis. The time interval between both imaging modalities was limited to less than 14 days and no interventions on the effusion (e.g., pericardiocentesis) occurred in the time interval between the two imaging modalities. RESULTS:  The size of the pericardial effusion was assessed similarly between CT and echocardiography in 50% of the cases (48/96). In the other half of the study population, the results were discrepant; CT was found to overestimate the size of pericardial effusion in 44% of the cases (42/96). The agreement rate between the two modalities is significantly low kappa = 0.111, P = 0.028. The independent variables age, gender, body mass index (BMI), use of anticoagulants, and renal function had no effect on the agreement between CT and echocardiography. CONCLUSION:  Computerized tomography tends to overestimate the size of the pericardial effusion compared to echocardiography. Based on an incidental finding of pericardial effusion on CT scan, this discrepancy should be recognized prior to ordering an echocardiogram. Echocardiography can be considered in relevant clinical settings.

18.
Autops Case Rep ; 9(3): e2019111, 2019.
Article in English | MEDLINE | ID: mdl-31528628

ABSTRACT

Pulmonary capillary hemangiomatosis (PCH) is a rare and controversial entity that is known to be a cause of pulmonary hypertension and is microscopically characterized by proliferation of dilated capillary-sized channels along and in the alveolar walls. Clinically, it is mostly seen in adults. Clinical features are characterized by nonspecific findings such as shortness of breath, cough, chest pain, and fatigue. It can be clinically indistinguishable from pre-capillary pulmonary arterial hypertension disorders such as primary pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension. However, the diagnostic distinction, which usually requires a multidisciplinary approach, is crucial in order to avoid inappropriate treatment with vasodilator medications usually used for PAH treatment. Prognosis of PCH remains poor with lung transplant being the only definitive treatment. We report an autopsy case of pulmonary capillary hemangiomatosis unmasked at autopsy that was treated with a prostacyclin analog, usually contraindicated in such patients. We emphasize that this entity should always be on the differential diagnosis in a patient with pulmonary hypertension and requires great vigilance on the part of the clinician, radiologist and pathologist to make the diagnosis and guide appropriate management.

19.
Autops. Case Rep ; 9(3): e2019111, July-Sept. 2019. ilus
Article in English | LILACS | ID: biblio-1016910

ABSTRACT

Pulmonary capillary hemangiomatosis (PCH) is a rare and controversial entity that is known to be a cause of pulmonary hypertension and is microscopically characterized by proliferation of dilated capillary-sized channels along and in the alveolar walls. Clinically, it is mostly seen in adults. Clinical features are characterized by nonspecific findings such as shortness of breath, cough, chest pain, and fatigue. It can be clinically indistinguishable from pre-capillary pulmonary arterial hypertension disorders such as primary pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension. However, the diagnostic distinction, which usually requires a multidisciplinary approach, is crucial in order to avoid inappropriate treatment with vasodilator medications usually used for PAH treatment. Prognosis of PCH remains poor with lung transplant being the only definitive treatment. We report an autopsy case of pulmonary capillary hemangiomatosis unmasked at autopsy that was treated with a prostacyclin analog, usually contraindicated in such patients. We emphasize that this entity should always be on the differential diagnosis in a patient with pulmonary hypertension and requires great vigilance on the part of the clinician, radiologist and pathologist to make the diagnosis and guide appropriate management.


Subject(s)
Humans , Female , Aged , Hemangioma, Capillary/diagnosis , Hemangioma, Capillary/pathology , Pulmonary Heart Disease , Autopsy , Pulmonary Veno-Occlusive Disease , Fatal Outcome , Diagnosis, Differential , Hypertension, Pulmonary
20.
Cureus ; 11(5): e4698, 2019 May 21.
Article in English | MEDLINE | ID: mdl-31355060

ABSTRACT

INTRODUCTION: Intensive Care Units (ICUs) are among the most expensive components of hospital care. Experts believe that ICUs are overused; however, hospitals vary in their ICU admission rate. Our hypothesis is based on clinical observations that many patients with diabetic ketoacidosis (DKA), stroke, and gastrointestinal (GI) bleeding admitted to the ICU don't really need it and could be managed safely in a non-ICU level of care. Reducing inappropriate admissions would reduce healthcare costs and improve outcomes. Our primary objective was to determine the frequency of inappropriate ICU admissions. Secondary objectives were to evaluate which diagnoses were more unnecessarily admitted to the ICU, evaluate different variables and comorbidities, and determine the mortality rates during ICU admissions. METHODS:  Patients admitted to the ICU, from the Emergency Department (ED) or transferred from the floor, during a one-year period were evaluated in this retrospective study. Patients 18-years old and above who had an admitting diagnosis of DKA, GI bleed, ischemic stroke, or hemorrhagic stroke were included. Patients in a comatose state, intubated, on vasopressors, hemodynamically unstable or had an unstable comorbid disease, subarachnoid hemorrhage, surgery during hospitalization prior to the ICU admission were excluded. Patients were categorized as having an appropriate or inappropriate ICU admission based on our institutional ICU admission criteria and data from available literature and guidelines. RESULTS: A total of 95 patients were included in our cohort. Seventy-two out of 95 (76%) were considered as inappropriate ICU admissions. When comparing each of the four admitting diagnoses, a significantly higher proportion of DKA patients were considered inappropriate ICU admissions when compared to the other diagnoses (P = 0.001). The overall mortality rate of ICU admissions was 16%, 15 patients out of 95 study population. When comparing each of the four admitting diagnoses, there was a significant difference in mortality rate with DKA having the lowest mortality (3%) and GI bleed having the highest mortality (43%). Out of the 15 patients who died, only 1 patient was categorized as an inappropriate ICU admission. CONCLUSIONS:  More than three-quarters of our study population was admitted to the ICU inappropriately. Incorporating severity scores in ICU admission criteria could improve the appropriateness of ICU admission and financial feasibility. This article is based on a poster: Alsamman S, Alsamman MA, Castro M, Koselka H, Steinbrunner J: ICU admission patterns in patients with DKA, stroke and GI bleed: do they all need ICU? J Hosp Med. March 2015.

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