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Article: Anti-N-Methyl-D-Aspartate Receptor Encephalitis Complicated by Autoimmune Enteropathy and Pulmonary Embolism: A Rare Case.

Haider, Maryam B / Din, Noren / Dar, Sophia / Basida, Brinda

2022 Volume 14, Issue 7, Page(s) e26496

Abstract: Anti-N-methyl-D-aspartate (anti-NMDA) receptor encephalitis is an autoimmune disorder affecting the N-methyl-D-aspartate receptors in the central and peripheral nervous systems. Gastrointestinal (GI) complications are rarely manifested in this disease. ... ...

Abstract	Anti-N-methyl-D-aspartate (anti-NMDA) receptor encephalitis is an autoimmune disorder affecting the N-methyl-D-aspartate receptors in the central and peripheral nervous systems. Gastrointestinal (GI) complications are rarely manifested in this disease. Autoimmune dysregulation of the GI tract is considered a potential cause. We present a challenging case of a 38-year-old male with a history of newly diagnosed epilepsy. He was admitted for three weeks of confusion, hallucinations, and bizarre behavior, and was later diagnosed with anti-NMDA encephalitis from a cerebrospinal fluid (CSF) immunological study. He was treated with a five days course of intravenous immunoglobulin (IVIG) and high-dose steroids. His course was further complicated with GI obstruction and upper GI bleed. His laboratory workup showed lactic acidosis and there was a concern for ischemic bowel injury. Computed tomography (CT) of the abdomen with contrast showed diffuse moderate to pronounced dilated small intestine swirling the mesenteric vessels, concerning for intestinal vascular compromise. The patient also became tachypneic and hypoxic, requiring 6 L of oxygen with a venti-mask. CT of the chest, abdomen, and pelvis with contrast revealed saddle pulmonary embolism (PE) extending to the right and left pulmonary arteries with right heart strain. He underwent emergent explorative laparotomy and emergent catheter-directed thrombectomy. Neither necrotic bowel nor any evidence of perforation or volvulus was noted during the laparotomy; however, the small bowel and the colon were reported to be significantly dilated, hyperemic, and engorged with blood without any evidence of ischemic bowel. He had a complicated 29-day admission course and recovered functional capacity to be safely discharged to a skilled nursing facility for further care. Physicians should keep in mind the gut-brain axis and autonomic effects on gut receptors of any patient presenting with psychosis and seizure disorder to provide timely care and improve morbidity and mortality in this patient population.
Language	English
Publishing date	2022-07-01
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.26496
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Recurrent Unprovoked Deep Vein Thromboses in the Setting of Sarcoidosis.

Basida, Brinda / Haider, Maryam B / Barbosa, Joshua

Cureus

2021 Volume 13, Issue 10, Page(s) e18528

Abstract: Sarcoidosis is described as a state of immune-mediated chronic systemic inflammatory disease that is typically characterized by non-caseating granulomas. It involves multiple organs like the lungs, lymph nodes, eyes, skin, and liver. Besides the solid ... ...

Abstract	Sarcoidosis is described as a state of immune-mediated chronic systemic inflammatory disease that is typically characterized by non-caseating granulomas. It involves multiple organs like the lungs, lymph nodes, eyes, skin, and liver. Besides the solid organ involvement, it is also known to be associated with various pro-thrombotic states leading to pulmonary embolism and deep vein thrombosis. Mechanical factors causing the venous stasis were considered the major contributing factors. However, based on recent studies, chronic inflammation from macrophages and activated leukocytes are also hypothesized to further activate thrombin and fibrin formation. Regardless of the etiology, the management focuses on life-long anticoagulation to prevent further episodes of thrombosis. Herein we present a case of a 38-year-old male with a history of sarcoidosis who was admitted after having recurrent deep vein thromboses. Further investigations revealed a negative hypercoagulable workup or other auto-immune processes and the absence of any granulomas causing mechanical compression on large vessel venous vasculature. He was adequately managed with anticoagulation therapy and followed up outpatient with no further similar episodes. This case adds to the growing understanding that the mechanisms by which sarcoidosis induces thromboembolism is primarily pro-inflammatory rather than mechanical in nature.
Language	English
Publishing date	2021-10-06
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.18528
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Celiac Disease Patients With Coronary Artery Disease: A Nationwide Population-Based Study.

Haider, Maryam B / Naylor, Paul / Das, Avijit / Haider, Syed M / Ehrinpreis, Murray N

Cureus

2022 Volume 14, Issue 6, Page(s) e26151

Abstract: Background Coronary artery disease (CAD) is associated with celiac disease (CD) with limited evidence. However, the common risk factors linking CD and CAD are still lacking in the literature. Known CAD risk factors include hypertension, hyperlipidemia, ... ...

Abstract	Background Coronary artery disease (CAD) is associated with celiac disease (CD) with limited evidence. However, the common risk factors linking CD and CAD are still lacking in the literature. Known CAD risk factors include hypertension, hyperlipidemia, type 2 diabetes, obesity, and tobacco use. Common risk factors linking CD and CAD are poorly documented. Objective There are three objectives: Firstly, to evaluate potential demographic differences between CD patients with CAD and without CAD. Secondly, to analyze the risk factors of CAD in CD patients. Lastly, to compare CD-CAD and matched non-CD CAD to determine whether there are additional CAD risks in individuals with CD. Methods The study is a nationwide retrospective case-control study. The National Inpatient Sample (NIS) database was used to identify patients admitted between 2016 and 2018 with a principal or secondary diagnosis of CD. We analyzed sociodemographic and clinical risk factors of CAD in CD patients and compared the CD-CAD population with the matched non-CD CAD cohort. Results Out of 23,441 hospitalizations with CD in 2016-2018, 4244 (18%) were found to have CAD. Established CAD risk factors identified in CD patients included hypertension, hyperlipidemia, type 2 diabetes, and a family history of CAD. In contrast, tobacco use is not a CAD risk factor in CD patients. Female patients with CD had 55% lesser odds of CAD than male patients. The odds of CAD in CD patients with hyperlipidemia were five times higher, 1.2 times higher with essential hypertension, and two times higher with type 2 diabetes. Patients with CAD had a higher prevalence of iron deficiency anemia (9.33% CD-CAD and 8.28% non-CAD CD Vs. 7.32% non-CD CAD). Conclusions Our study confirms that, as with non-CD individuals, males and the White race are at increased CAD risk in the CD population. CD-CAD patients have a higher hyperlipidemia prevalence than non-CD CAD patients. CD patients with type 1 diabetes have an early diagnosis of CAD compared to CD patients with type 2 diabetes. Iron deficiency anemia is a statistically significant risk factor for CAD in CD patients.
Language	English
Publishing date	2022-06-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.26151
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: A 46-Year-Old Woman Who Presented with Diabetic Ketoacidosis and COVID-19 Pneumonia with Multiple Pulmonary Thromboemboli: A Case Report.

Haider, Maryam B / Abbas, Farrukh / Hafeez, Wasif

The American journal of case reports

2020 Volume 21, Page(s) e925794

Abstract: BACKGROUND Coronavirus disease 2019 (COVID-19) occurs because of a novel enveloped ribonucleic acid coronavirus called severe acute respiratory distress syndrome coronavirus-2 (SARS-CoV-2). One of the major reported complications of COVID-19 includes ... ...

Abstract	BACKGROUND Coronavirus disease 2019 (COVID-19) occurs because of a novel enveloped ribonucleic acid coronavirus called severe acute respiratory distress syndrome coronavirus-2 (SARS-CoV-2). One of the major reported complications of COVID-19 includes both arterial and venous thromboembolism (VTE). Here we describe a case of COVID-19 provoked pulmonary embolism in a young patient already receiving prophylactic treatment for VTE. CASE REPORT A 46-year-old female with past medical history of diabetes mellites, hypertension, and asthma presented in the emergency department (ED) with dyspnea requiring 6 liters per minute of oxygen on presentation. Her main complaints were cough and vomiting. In the ED, hypoxemia worsened, and she ultimately required endotracheal intubation. Labs were suggestive of diabetic ketoacidosis (DKA) and showed increase in all inflammatory markers and absolute lymphocytopenia. Chest X-ray showed bilateral diffuse patchy airspace opacities. Standard DKA management was started. She was also started on ceftriaxone, azithromycin, hydroxychloroquine, and subcutaneous heparin (5000 U every 8 h) for VTE prophylaxis. SARS-Cov2 reverse transcription-polymerase chain reaction returned positive. Ceftriaxone and azithromycin were discontinued the very next day because of low suspicion of bacterial infection while hydroxychloroquine was completed for 5 days. On the third day of admission, the patient self-extubated and was immediately placed on nonrebreather with spO₂ in low 90s. On the fourth day of admission, D-dimer came back 4.74 mg/L, which was elevated from a prior value, so computed tomography angiography of the lungs was done, which disclosed multiple emboli in the lungs. She was started on therapeutic doses of enoxaparin sodium, which was continued through her admission. She was switched to Apixaban on discharge. CONCLUSIONS The finding of the case suggested that low-molecular-weight heparin prophylaxis may not be sufficient to prevent VTE in COVID-19 pneumonia. Some of these patients may benefit from receiving prophylactic half doses or full doses of anticoagulants.
MeSH term(s)	Betacoronavirus ; COVID-19 ; Coronavirus Infections/complications ; Coronavirus Infections/virology ; Diabetic Ketoacidosis/diagnosis ; Diabetic Ketoacidosis/etiology ; Female ; Humans ; Middle Aged ; Pandemics ; Pneumonia, Viral/complications ; Pneumonia, Viral/virology ; Pulmonary Embolism/diagnosis ; Pulmonary Embolism/etiology ; SARS-CoV-2
Keywords	covid19
Language	English
Publishing date	2020-07-20
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	2517183-5
ISSN	1941-5923 ; 1941-5923
ISSN (online)	1941-5923
ISSN	1941-5923
DOI	10.12659/AJCR.925794
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Major depressive disorders in patients with inflammatory bowel disease and rheumatoid arthritis.

Haider, Maryam Bilal / Basida, Brinda / Kaur, Jasleen

World journal of clinical cases

2023 Volume 11, Issue 4, Page(s) 764–779

Abstract: Background: Various immune-mediated inflammatory diseases consisting of inflammatory bowel disease (IBD) and rheumatoid arthritis (RA), are found to have a substantial societal burden, increased healthcare costs, and progressive disability. Studies ... ...

Abstract	Background: Various immune-mediated inflammatory diseases consisting of inflammatory bowel disease (IBD) and rheumatoid arthritis (RA), are found to have a substantial societal burden, increased healthcare costs, and progressive disability. Studies suggest that patients with Aim: To identify the prevalence level and temporal trends of depression in hospitalized IBD-RA patients. Methods: All adult hospitalized patients from January 2000 to December 2019 in the nationwide inpatient sample (NIS) were captured. The study population included all patients with a primary or secondary IBD-RA overlap disease using corresponding international classification of diseases (ICD)-9 and ICD-10 codes. IBD includes Crohn's disease and ulcerative colitis. The study population was divided into IBD-RA without MDD (controls) and IBD-RA with MDD (cases). For group comparison between MDD Results: A total of 133315 records were identified with IBD-RA overlap, of which 26155 patients (19.62%) had MDD. Among the IBD-RA patients, those who had MDD were younger [mean age of 56 years (SD ± 15)] to IBD-RA without MDD patients with a Conclusion: There is a rise in the prevalence of depression in younger patients with IBD-RA combined compared to their counterparts. These patients are also at higher risk for the increased cost of care and poor treatment compliance. It is crucial to educate the involved clinicians to identify the early signs and symptoms of depression in patients with IBD or RA or IBD-RA combined and treat them to have a better overall prognosis.
Language	English
Publishing date	2023-01-06
Publishing country	United States
Document type	Journal Article
ISSN	2307-8960
ISSN	2307-8960
DOI	10.12998/wjcc.v11.i4.764
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Beneath the Layers: Deciphering the Molecular Pathways, Therapeutic Avenues, and Neurological Connections of Soft Tissue Sarcomas.

Ekhator, Chukwuyem / Grezenko, Han / Haider, Zaroon / Ali Cheema, Usama / Haider, Haseeb / Mohsin, Syed Naveed / Affaf, Maryam / Bellegarde, Sophia B / Amir, Saniya / Kumar, Sahil / Shehryar, Abdullah / Arif, Sidra / Fareed, Muhammad Usman / Rehman, Abdur

Cureus

2023 Volume 15, Issue 9, Page(s) e44694

Abstract: Soft tissue sarcomas (STSs) are a heterogeneous group of malignancies that have long posed challenges in terms of diagnosis, treatment, and management. This narrative review provides a comprehensive exploration into the multifaceted realm of STS, ... ...

Abstract	Soft tissue sarcomas (STSs) are a heterogeneous group of malignancies that have long posed challenges in terms of diagnosis, treatment, and management. This narrative review provides a comprehensive exploration into the multifaceted realm of STS, spanning from its historical origins to the latest advancements in research and clinical care. We delve into the molecular intricacies of STS, highlighting the genetic and epigenetic aberrations that drive these tumors. The review emphasizes the neurological implications of STS, a relatively underexplored area, shedding light on the interplay between tumor biology and neural processes. The evolving therapeutic landscape is discussed, with a focus on the promise of targeted therapies, immunotherapy, and precision medicine. A significant portion is dedicated to the patient-centric approach, underscoring the importance of holistic care that addresses both the physical and psychological needs of STS patients. Furthermore, we highlight the gaps in current research and clinical practices, offering insights into potential avenues for future exploration. This review serves as a valuable resource for clinicians, researchers, and the broader scientific community, encapsulating the current state of STS knowledge and pointing toward future directions in this dynamic field.
Language	English
Publishing date	2023-09-04
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.44694
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Subhepatic Abscess Unmasking the Silent Gastric and Pulmonary Sarcoidosis.

Basida, Brinda / Haider, Maryam B / Bapatla, Anusha / Zalavadiya, Nirav / Iqbal, Sana

Cureus

2021 Volume 13, Issue 8, Page(s) e16957

Abstract: Sarcoidosis is a non-necrotizing granulomatous disease of unknown etiology presenting with variable systemic manifestations. Lung involvement is the most common initial presentation of sarcoidosis. Rarely, patients can present with initial non-pulmonary ... ...

Abstract	Sarcoidosis is a non-necrotizing granulomatous disease of unknown etiology presenting with variable systemic manifestations. Lung involvement is the most common initial presentation of sarcoidosis. Rarely, patients can present with initial non-pulmonary symptoms. Asymptomatic gastric sarcoidosis is a difficult diagnosis as it is not only rare but also under-recognized in the majority of cases. Its treatment is exclusively recommended for symptomatic cases only. However, it is of extreme significance to have the asymptomatic patients follow up outpatient regularly to prevent any major complications. Here, we present an interesting case of a 54-year-old African American female patient with only abdominal pain symptoms attributed to a hepatic abscess. A diagnosis of gastric sarcoidosis was solely based on the presence of non-necrotizing granulomas on biopsy following esophagogastroduodenoscopy (EGD). Incidentally, she was also found to have pulmonary sarcoidosis based on imaging. Her abdominal symptoms improved with abscess drainage and so, she was never started on steroids. She was followed up outpatient for pulmonary function tests. The patient continues to do well without any specific treatment for sarcoidosis. This case demonstrates the variability of sarcoidosis and the significance of biopsy in gastric sarcoidosis.
Language	English
Publishing date	2021-08-06
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.16957
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Barriers to research productivity amongst postgraduate trainees: results from a survey of 333 medical and surgical residents.

Bakhshi, Saqib K / Abdul Rahim, Komal / Merchant, Asma A H / Afzal, Noreen / Qadeer Shaikh, Namra / Noorali, Ali A / Lakhdir, Maryam P A / Mahmood, Saad B Z / Tariq, Muhammad / Haider, Adil H

Postgraduate medical journal

2023 Volume 99, Issue 1177, Page(s) 1182–1188

Abstract: Purpose: We aimed to determine the perceptions of, barriers to, and predictors of research engagement amongst residents at a national level in Pakistan.: Methods: This cross-sectional study used REDCap for online survey dissemination to residents ... ...

Abstract	Purpose: We aimed to determine the perceptions of, barriers to, and predictors of research engagement amongst residents at a national level in Pakistan. Methods: This cross-sectional study used REDCap for online survey dissemination to residents from 12 institutes accredited by the national accreditation body (College of Physicians and Surgeons Pakistan) for core medical and surgical specialties. Logistic regression was used to estimate associations between likelihood of publications and participant characteristics. Results: The response rate was 79% (333/423), with 171 (51%) medical and 162 (49%) surgical residents. The mean ± standard deviation age was 28.8 ± 2.7 years; 137 (41%) were males and 195 (59%) females. More than half the residents, 202 (61%), had received research training, but 189 (57%) scored <33% on basic research knowledge. While most residents agreed on the positive impact of research on their careers (P = .012) and realized that they should be involved in it (P = .33), they also strongly believed that it was difficult to engage in research during training (P < .01). Only 60 (18%) trainees had published a paper in local and 37 (11%) in international journals, respectively. The most significant barriers to conducting research included time limitation due to clinical work, lack of financial support, and unavailability of data (P < .01). Conclusion: Residents have a positive attitude towards research. However, research engagement among residents is low. Improving research mentorship and creating systems that enable protected time and institutional access to data are needed to increase research output of postgraduate trainees. Key messages What is already known on this topic Postgraduate trainees benefit academically from research conducted during residency training. However, in low- and middle-income countries like Pakistan, research output among residents has remained low over the years. The nation has consistently produced very little research. What this study adds The current study helped shed light on the reasons for low research productivity amongst medical and surgical residents in Pakistan. How this study might affect research, practice, or policy The potential predictors for low research involvement highlighted in this study necessitate modification of the existing national residency curriculum to increase research engagement and productivity among residents. Not only can the potential factors be improved, but the study also helps in bringing stakeholders' attention to increasing research opportunities in Pakistan.
Language	English
Publishing date	2023-08-04
Publishing country	England
Document type	Journal Article
ZDB-ID	80325-x
ISSN	1469-0756 ; 0032-5473
ISSN (online)	1469-0756
ISSN	0032-5473
DOI	10.1093/postmj/qgad062
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Article: A 46-Year-Old Woman Who Presented with Diabetic Ketoacidosis and COVID-19 Pneumonia with Multiple Pulmonary Thromboemboli: A Case Report

Haider, Maryam B / Abbas, Farrukh / Hafeez, Wasif

Am J Case Rep

Abstract	BACKGROUND Coronavirus disease 2019 (COVID-19) occurs because of a novel enveloped ribonucleic acid coronavirus called severe acute respiratory distress syndrome coronavirus-2 (SARS-CoV-2). One of the major reported complications of COVID-19 includes both arterial and venous thromboembolism (VTE). Here we describe a case of COVID-19 provoked pulmonary embolism in a young patient already receiving prophylactic treatment for VTE. CASE REPORT A 46-year-old female with past medical history of diabetes mellites, hypertension, and asthma presented in the emergency department (ED) with dyspnea requiring 6 liters per minute of oxygen on presentation. Her main complaints were cough and vomiting. In the ED, hypoxemia worsened, and she ultimately required endotracheal intubation. Labs were suggestive of diabetic ketoacidosis (DKA) and showed increase in all inflammatory markers and absolute lymphocytopenia. Chest X-ray showed bilateral diffuse patchy airspace opacities. Standard DKA management was started. She was also started on ceftriaxone, azithromycin, hydroxychloroquine, and subcutaneous heparin (5000 U every 8 h) for VTE prophylaxis. SARS-Cov2 reverse transcription-polymerase chain reaction returned positive. Ceftriaxone and azithromycin were discontinued the very next day because of low suspicion of bacterial infection while hydroxychloroquine was completed for 5 days. On the third day of admission, the patient self-extubated and was immediately placed on nonrebreather with spO2 in low 90s. On the fourth day of admission, D-dimer came back 4.74 mg/L, which was elevated from a prior value, so computed tomography angiography of the lungs was done, which disclosed multiple emboli in the lungs. She was started on therapeutic doses of enoxaparin sodium, which was continued through her admission. She was switched to Apixaban on discharge. CONCLUSIONS The finding of the case suggested that low-molecular-weight heparin prophylaxis may not be sufficient to prevent VTE in COVID-19 pneumonia. Some of these patients may benefit from receiving prophylactic half doses or full doses of anticoagulants.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #655120
Database	COVID19

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Article: Pattern of Adolescent Suicides in Pakistan: A content analysis of Newspaper reports of two years.

Imran, Nazish / Naveed, Sadiq / Rafiq, Bariah / Tahir, Sania Mumtaz / Ayub, Maryam / Haider, Imran Ijaz

Pakistan journal of medical sciences

2023 Volume 39, Issue 1, Page(s) 6–11

Abstract: Background and objective: Suicide is a serious, yet preventable global mental health problem for people of all ages and countries. It is the third leading cause of death in 15-19-year-olds. There is paucity of systematic studies and official statistics ... ...

Abstract	Background and objective: Suicide is a serious, yet preventable global mental health problem for people of all ages and countries. It is the third leading cause of death in 15-19-year-olds. There is paucity of systematic studies and official statistics on child & adolescent suicides in Pakistan. In the absence of other means, newspaper coverage of adolescent suicides may serve as a useful source to understand the phenomena. Our objective was to report pattern of suicide deaths in children and adolescents across Pakistan and to determine the predominant methods of suicide precipitating events and associated factors. Methods: This study used content analysis to analyze newspaper reports of adolescent suicide in four leading newspapers of Pakistan from January 1 Results: Total 289 suicides in children and adolescents in Pakistan were reported in selected newspapers during two years among both genders (51.5 % boys and 48.5% girls) with high incidence in late adolescence (66%). The predominant method of suicide in this group was ingestion of poisonous substances (50%) followed by hanging (35%) and use of firearms (7%). The behavior usually takes place within or near the adolescent's home environment. The act was often attributed to domestic conflicts including arguments with parents of the deceased and relationship problems. Conclusion: To develop effective suicide prevention strategies for a population, it must be studied within its own socio-cultural context. Study results emphasize adolescent suicide being a reality in Pakistan. There is urgent need for further culture specific research in this area in the country.
Language	English
Publishing date	2023-01-24
Publishing country	Pakistan
Document type	Journal Article
ZDB-ID	2032827-8
ISSN	1681-715X ; 1682-024X ; 1017-4699
ISSN (online)	1681-715X
ISSN	1682-024X ; 1017-4699
DOI	10.12669/pjms.39.1.6851
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