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  1. Article ; Online: A 56-Year-Old Woman With Nonresolving Pneumonia.

    Arabiat, Mohammad / Bhat, Priyanka / Steff, Rodney / Singh, Karan

    Chest

    2021  Volume 160, Issue 4, Page(s) e369–e370

    MeSH term(s) Biopsy, Large-Core Needle/methods ; Bronchoscopy/methods ; Carcinoma, Squamous Cell/diagnosis ; Carcinoma, Squamous Cell/pathology ; Endosonography/methods ; Female ; Humans ; Image-Guided Biopsy/methods ; Lung/diagnostic imaging ; Lung/pathology ; Lung Neoplasms/diagnosis ; Lung Neoplasms/pathology ; Middle Aged ; Pneumonia/diagnostic imaging ; Pneumonia/drug therapy ; Tomography, X-Ray Computed ; Ultrasonography
    Language English
    Publishing date 2021-08-07
    Publishing country United States
    Document type Case Reports ; Journal Article ; Video-Audio Media
    ZDB-ID 1032552-9
    ISSN 1931-3543 ; 0012-3692
    ISSN (online) 1931-3543
    ISSN 0012-3692
    DOI 10.1016/j.chest.2020.10.097
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  2. Article ; Online: Prior Use of Angiotensin-converting Enzyme Inhibitors or Angiotensin II Receptor Blockers and Clinical Outcomes of Sepsis and Septic Shock: A Systematic Review and Meta-analysis.

    Shrestha, Dhan Bahadur / Sedhai, Yub Raj / Oli, Prakash Raj / Proskuriakova, Ekaterina / Adelkhanova, Alla / Shtembari, Jurgen / Khan, Tahir Muhammad Abdullah / Singh, Karan / Ahmed, Muhammad Altaf / Waheed, Irfan / Kazimuddin, Nisarfathima / Steff, Rodney / Acharya, Roshan / Patel, Nimesh K

    Journal of cardiovascular pharmacology

    2024  Volume 83, Issue 1, Page(s) 16–22

    Abstract: Abstract: Sepsis and septic shock are life-threatening conditions that are associated with high mortality and considerable health care costs. The association between prior angiotensin-converting enzyme inhibitors (ACEi) or angiotensin II receptor ... ...

    Abstract Abstract: Sepsis and septic shock are life-threatening conditions that are associated with high mortality and considerable health care costs. The association between prior angiotensin-converting enzyme inhibitors (ACEi) or angiotensin II receptor blockers (ARBs) use and outcomes after sepsis is elusive. The aim of this study was to evaluate the role of the prior use of ACEi or ARBs and outcomes after sepsis and septic shock. A relevant literature review was performed in 4 databases from inception until July 2022. Independent reviewers first screened the title, abstract, and full text, and then, data extraction and analysis were performed. One post hoc analysis of a trial and 6 retrospective cohort studies were included in this review. There were 22% lower odds of in-hospital/30-day mortality among patients who have used ACEi/ARBs in the past [23.83% vs. 37.20%; odds ratio (OR), 0.78, 95% confidence interval (CI), 0.64-0.96], and reduced 90-day mortality (OR, 0.80, 95% CI, 0.69-0.92). ACEi/ARBs users were found to have 31% lesser odds of developing acute kidney injury as compared with nonusers (OR, 0.69, 95% CI, 0.63-0.76). There was no significant difference in the length of hospital stay (MD 1.26, 95% CI, ‒7.89 to 10.42), need for renal replacement therapy (OR, 0.71, 95% CI, 0.13-3.92), mechanical ventilation (OR, 1.10, 95% CI, 0.88-1.37) or use of vasopressors (OR, 1.21, 95% CI, 0.91-1.61). Based on this analysis, prior use of ACEi/ARBs lowers the risk of mortality and adverse renal events in patients with sepsis and septic shock.
    MeSH term(s) Humans ; Angiotensin-Converting Enzyme Inhibitors/adverse effects ; Angiotensin Receptor Antagonists/adverse effects ; Shock, Septic/diagnosis ; Shock, Septic/drug therapy ; Retrospective Studies ; Kidney
    Chemical Substances Angiotensin-Converting Enzyme Inhibitors ; Angiotensin Receptor Antagonists
    Language English
    Publishing date 2024-01-01
    Publishing country United States
    Document type Meta-Analysis ; Systematic Review ; Journal Article
    ZDB-ID 391970-5
    ISSN 1533-4023 ; 0160-2446
    ISSN (online) 1533-4023
    ISSN 0160-2446
    DOI 10.1097/FJC.0000000000001491
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  3. Article ; Online: COVID-19-RELATED ARDS PHENOTYPES AND PROGRESSION BETWEEN THEM

    Steff, Rodney / Qadir, Ahmed / Ahmed, Muhammad / Singh, Karan / Kazimuddin, Nisarfathima

    Chest

    A CASE REPORT

    2020  Volume 158, Issue 4, Page(s) A773

    Keywords Critical Care and Intensive Care Medicine ; Pulmonary and Respiratory Medicine ; Cardiology and Cardiovascular Medicine ; covid19
    Language English
    Publisher Elsevier BV
    Publishing country us
    Document type Article ; Online
    ZDB-ID 1032552-9
    ISSN 1931-3543 ; 0012-3692
    ISSN (online) 1931-3543
    ISSN 0012-3692
    DOI 10.1016/j.chest.2020.08.720
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  4. Article: Covid-19-related Ards Phenotypes and Progression between Them: a Case Report

    Steff, R. / Qadir, A. / Ahmed, M. / Singh, K. / Kazimuddin, N.

    Chest

    Abstract: ... relevant relationships by karan Singh, source=Web Response No relevant relationships by Rodney Steff ...

    Abstract SESSION TITLE: Fellows' COVID-19 SESSION TYPE: Fellow Case Reports PRESENTED ON: October 18-21, 2020 INTRODUCTION: Since January 20th, 2020 when the first case of the novel coronavirus SARS-CoV-2 was confirmed in the United States [1], there have been several reports of the disease caused by the virus known as COVID19 In the recent literature there have been descriptions of two different phenotypes of the virus presentation among hospitalized patients and particularly those requiring mechanical ventilation These phenotypes, known as “L type” and “H type”, report what appear to be two distinct presentations with drastically different management which a patient can transition between [2] We present a case of a patient with confirmed COVID19 who progressed through both phenotypes during his treatment consistent with these theorized phenotypes CASE PRESENTATION: A 40 year old male presented to the hospital with shortness of breath and cough Medical and social history was unremarkable Workup initially showed patchy bilateral infiltrates, negative procalcitonin, fever of 103, and sats of 93% on 4L The patient’s respiratory status quickly degraded and he required mechanical ventilation He tested positive for SARS-CoV-2 via PCR Initially the patient had subpleural ground glass opacities and low peep requirements before stress index became >1 He developed dyssynchrony and required more peep causing higher pressure with worse compliance Standard supportive care for ARDS was followed After several days the peak and plateau pressures continued to be elevated The patient was started on nitric oxide and flolan with paralytics He returned to a high compliance state and was ultimately extubated and discharged DISCUSSION: There are two phenotypes with COVID-19 ARDS The first, L-type, has high compliance, low V/Q ratio, and low lung recruitability It has been theorized that viral infection leads to interstitial edema with vasoplegia accounting for the severe hypoxemia This leads to increased minute volume and a more negative intrathoracic pressure with little dyspnea The increased negative intrathoracic pressure and high tidal volumes likely lead to edema due to inflammation and increased lung permeability This leads to dependent atelectasis and increased work of breathing It is unclear if this is from the virus itself versus and/or high-stress ventilation The second, H-type, has decreased compliance and high recruitability One of the crucial things to prevent progression from L to H type is controlling work of breathing In community hospital settings this is hard to monitor The patient's dyssynchrony caused a significantly negative intrathoracic pressure and resulted in a form of patient-self inflicted lung injury that caused the transition from L to H phenotype Once this was controlled with paralytics, the patient returned to L-type and recovered CONCLUSIONS: Control of the work of breathing in a patient with COVID-19 ARDS is critical in preventing progression between L and H phenotypes Reference #1: 1 Holshue LH, DeBolt C, Lindquist S, et al First Case of 2019 Novel Coronavirus in the United States N Engl J Med 2020;382:929-936 Reference #2: 2 Gattinoni DC, Caironi P, Busana M, et al COVID-19 pneumonia: different respiratory treatment for different phenotypes? J Intens Care Med 2020;DOI: 10 1007/s00134-020-06033-2 Reference #3: 3 Yoshida T, Grieco DL, Brochard L, Fujino Y Patient self inflicted lung injury and positive end-expiratory pressure for safe spontaneous breathing Curr Opin Crit Care 2020;26(1):59-65 DISCLOSURES: No relevant relationships by Muhammad Ahmed, source=Admin input no disclosure on file for Nisarfathima Kazimuddin;No relevant relationships by Ahmed Qadir, source=Web Response No relevant relationships by karan Singh, source=Web Response No relevant relationships by Rodney Steff, source=Web Response
    Keywords covid19
    Publisher WHO
    Document type Article
    Note WHO #Covidence: #860889
    Database COVID19

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