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Article ; Online: Risk stratification of pulmonary embolism.

Chowdhury, Junad M / Brown, Patrick / Kasarabada, Aditya

2023 Volume 29, Issue 5, Page(s) 363–369

Abstract: Purpose of review: Pulmonary embolism is the third most frequent type of cardiovascular disease behind coronary artery disease and stroke. Patients with acute pulmonary embolism have significant variability in short-term mortality from less than 0.6% in ...

Abstract	Purpose of review: Pulmonary embolism is the third most frequent type of cardiovascular disease behind coronary artery disease and stroke. Patients with acute pulmonary embolism have significant variability in short-term mortality from less than 0.6% in low-risk patients to 19% in high-risk patients. Risk stratification plays an important role in the management of acute pulmonary embolism as it can determine the need for urgent reperfusion therapies versus conservative strategies. Recent findings: The three fundamental steps of risk stratification include the immediate identification of patients that are at high risk for mortality, the identification of patients that are at an increased risk of complications from pulmonary embolism that requires hospital monitoring and potential escalation of therapies, and the identification of patients at a low risk that can be treated as an outpatient. Summary: It is vital to immediately identify high-risk patients for mortality so that they can be evaluated for urgent reperfusion therapies to improve outcomes. Risk stratification for intermediate-risk patients is based on right ventricular dysfunction in patients with hemodynamic stability. RV dysfunction can be assessed by clinical signs and symptoms along with ECHO and cardiac biomarkers. Identifying the low-risk population can help reduce the healthcare burden by allowing for early discharge and outpatient management.
MeSH term(s)	Humans ; Risk Assessment ; Risk Factors ; Pulmonary Embolism/therapy ; Pulmonary Embolism/drug therapy ; Ventricular Dysfunction, Right ; Acute Disease
Language	English
Publishing date	2023-07-13
Publishing country	United States
Document type	Review ; Journal Article
ZDB-ID	1285505-4
ISSN	1531-6971 ; 1070-5287 ; 1078-1641
ISSN (online)	1531-6971
ISSN	1070-5287 ; 1078-1641
DOI	10.1097/MCP.0000000000000998
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Article ; Online: Obesity Paradox in VTE Outcomes: An Evolving Concept.

Chowdhury, Junad M / Zhao, Huaqing / Moores, Lisa K / Rali, Parth

Chest

2020 Volume 158, Issue 3, Page(s) 1290–1291

MeSH term(s)	Body Mass Index ; Humans ; Obesity, Morbid ; Risk Factors
Language	English
Publishing date	2020-09-06
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	1032552-9
ISSN	1931-3543 ; 0012-3692
ISSN (online)	1931-3543
ISSN	0012-3692
DOI	10.1016/j.chest.2020.02.081
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Article ; Online: Mobilization and Preparation of a Large Urban Academic Center during the COVID-19 Pandemic.

Chowdhury, Junad M / Patel, Maulin / Zheng, Matthew / Abramian, Osheen / Criner, Gerard J

Annals of the American Thoracic Society

2020 Volume 17, Issue 8, Page(s) 922–925

MeSH term(s)	Academic Medical Centers/organization & administration ; Academic Medical Centers/trends ; Betacoronavirus/isolation & purification ; COVID-19 ; Clinical Protocols ; Coronavirus Infections/epidemiology ; Coronavirus Infections/prevention & control ; Coronavirus Infections/therapy ; Critical Pathways/trends ; Disease Transmission, Infectious/prevention & control ; Hospital Restructuring/methods ; Humans ; Infection Control/methods ; Infection Control/organization & administration ; Organizational Innovation ; Pandemics/prevention & control ; Pneumonia, Viral/epidemiology ; Pneumonia, Viral/prevention & control ; Pneumonia, Viral/therapy ; SARS-CoV-2 ; Staff Development/trends ; Subacute Care/methods ; Subacute Care/organization & administration ; United States/epidemiology
Keywords	covid19
Language	English
Publishing date	2020-05-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	2717461-X
ISSN	2325-6621 ; 1943-5665 ; 2325-6621
ISSN (online)	2325-6621 ; 1943-5665
ISSN	2325-6621
DOI	10.1513/AnnalsATS.202003-259PS
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Article ; Online: Meta-analysis and Systematic Review of Bronchoscopic Lung Volume Reduction Through Endobronchial Valves in Severe Emphysema.

Patel, Maulin / Chowdhury, Junad / Zhao, Huaqing / Lu, Xiaoning / Roth, Stephanie / Giovacchini, Coral X / Wahidi, Momen M / Criner, Gerard

Journal of bronchology & interventional pulmonology

2022 Volume 29, Issue 3, Page(s) 224–237

Abstract: Background: Pharmacologic therapeutics for advanced emphysema have limited benefit. Bronchoscopic lung volume reduction with endobronchial valves (EBVs) have reported improvements in lung function, breathlessness, and quality of life through randomized ... ...

Abstract	Background: Pharmacologic therapeutics for advanced emphysema have limited benefit. Bronchoscopic lung volume reduction with endobronchial valves (EBVs) have reported improvements in lung function, breathlessness, and quality of life through randomized clinical trials, with less morbidity as comparted to Surgical Lung volume Reduction. We here present a Meta-analysis and systematic review of bronchoscopic lung volume reduction in advanced chronic obstructive lung disease patients. Methods: PubMed (NLM), Embase (Elsevier), and Web of Science (Clarivate Analytics) search was conducted using a combination of keywords and subject headings. The search was confined to the last 15 years and was completed on October 23, 2020. Only placebo-controlled randomized control trials of emphysema patients with EBV were included. Quality assessment was done by 2 independent reviewers. Results: Nine studies were included for the meta-analysis with a total number of 1383 patients of whom 888 received EBV and 495 standard of care (SOC) medications. Our Metanalysis show statistically significant improvement in forced expiratory volume in first second, percentage forced expiratory volume in first second, St. George's respiratory questionnaire, and 6-minute walk distance in EBV group compared with SOC. Residual volume had statistically significant reduction after EBV placement compared with SOC. These differences continued to be present during short-term (<=6 mo) and long-term follow-up (>=6 mo). These improvements were even higher when the EBV patients'. Collateral ventilation was negative/fissure was intact (CV-/FI >90%). The rate of hemoptysis and pneumothorax was higher in the EBV group compared with SOC, however, did not lead to increased fatal outcomes. Conclusion: In conclusion, EBV has favorable effects on patients' outcomes in patients who have heterogeneous emphysema particularly with no collateral ventilation.
MeSH term(s)	Bronchoscopy/adverse effects ; Emphysema/etiology ; Forced Expiratory Volume ; Humans ; Pneumonectomy/adverse effects ; Pulmonary Emphysema ; Quality of Life ; Treatment Outcome
Language	English
Publishing date	2022-05-27
Publishing country	United States
Document type	Journal Article ; Meta-Analysis ; Systematic Review
ZDB-ID	2478320-1
ISSN	1948-8270 ; 1944-6586
ISSN (online)	1948-8270
ISSN	1944-6586
DOI	10.1097/LBR.0000000000000872
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Article: Mobilization and Preparation of a Large Urban Academic Center during the COVID-19 Pandemic

Chowdhury, Junad M / Patel, Maulin / Zheng, Matthew / Abramian, Osheen / Criner, Gerard J

Ann Am Thorac Soc

Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #101322
Database	COVID19

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Article ; Online: Utility of the ROX Index in Predicting Intubation for Patients With COVID-19-Related Hypoxemic Respiratory Failure Receiving High-Flow Nasal Therapy: Retrospective Cohort Study.

Patel, Maulin / Chowdhury, Junad / Mills, Nicole / Marron, Robert / Gangemi, Andrew / Dorey-Stein, Zachariah / Yousef, Ibraheem / Zheng, Matthew / Tragesser, Lauren / Giurintano, Julie / Gupta, Rohit / Rali, Parth / D'Alonzo, Gilbert / Zhao, Huaqing / Patlakh, Nicole / Marchetti, Nathaniel / Criner, Gerard / Gordon, Matthew

JMIRx med

2021 Volume 2, Issue 3, Page(s) e29062

Abstract: ... 6) years, mean BMI was 32.6 (SD 8) kg/m², 58 (45%) were female, 72 (55.8%) were African American, 40 ...

Abstract	Background: The use of high-flow nasal therapy (HFNT) to treat COVID-19 pneumonia has been greatly debated around the world due to concerns about increased health care worker transmission and delays in invasive mechanical ventilation (IMV). Herein, we analyzed the utility of the noninvasive ROX (ratio of oxygen saturation) index to predict the need for and timing of IMV. Objective: This study aimed to assess whether the ROX index can be a useful score to predict intubation and IMV in patients receiving HFNT as treatment for COVID-19-related hypoxemic respiratory failure. Methods: This is a retrospective cohort analysis of 129 consecutive patients with COVID-19 admitted to Temple University Hospital in Philadelphia, PA, from March 10, 2020, to May 17, 2020. This is a single-center study conducted in designated COVID-19 units (intensive care unit and other wards) at Temple University Hospital. Patients with moderate and severe hypoxemic respiratory failure treated with HFNT were included in the study. HFNT patients were divided into two groups: HFNT only and intubation (ie, patients who progressed from HFNT to IMV). The primary outcome was the value of the ROX index in predicting the need for IMV. Secondary outcomes were mortality, rate of intubation, length of stay, and rate of nosocomial infections in a cohort treated initially with HFNT. Results: Of the 837 patients with COVID-19, 129 met the inclusion criteria. The mean age was 60.8 (SD 13.6) years, mean BMI was 32.6 (SD 8) kg/m², 58 (45%) were female, 72 (55.8%) were African American, 40 (31%) were Hispanic, and 48 (37.2%) were nonsmokers. The mean time to intubation was 2.5 (SD 3.3) days. An ROX index value of less than 5 at HFNT initiation was suggestive of progression to IMV (odds ratio [OR] 2.137, Conclusions: The ROX index helps decide which patients need IMV and may limit eventual morbidity and mortality associated with the progression to IMV.
Language	English
Publishing date	2021-08-27
Publishing country	Canada
Document type	Journal Article
ISSN	2563-6316
ISSN (online)	2563-6316
DOI	10.2196/29062
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Retrospective analysis of high flow nasal therapy in COVID-19-related moderate-to-severe hypoxaemic respiratory failure.

Patel, Maulin / Gangemi, Andrew / Marron, Robert / Chowdhury, Junad / Yousef, Ibraheem / Zheng, Matthew / Mills, Nicole / Tragesser, Lauren / Giurintano, Julie / Gupta, Rohit / Gordon, Matthew / Rali, Parth / D'Alonso, Gilbert / Fleece, David / Zhao, Huaqing / Patlakh, Nicole / Criner, Gerard

BMJ open respiratory research

2020 Volume 7, Issue 1

Abstract: Invasive mechanical has been associated with high mortality in COVID-19. Alternative therapy of high flow nasal therapy (HFNT) has been greatly debated around the world for use in COVID-19 pandemic due to concern for increased healthcare worker ... ...

Abstract	Invasive mechanical has been associated with high mortality in COVID-19. Alternative therapy of high flow nasal therapy (HFNT) has been greatly debated around the world for use in COVID-19 pandemic due to concern for increased healthcare worker transmission.This was a retrospective analysis of consecutive patients admitted to Temple University Hospital in Philadelphia, Pennsylvania, from 10 March 2020 to 24 April 2020 with moderate-to-severe respiratory failure treated with HFNT. Primary outcome was prevention of intubation. Of the 445 patients with COVID-19, 104 met our inclusion criteria. The average age was 60.66 (+13.50) years, 49 (47.12 %) were female, 53 (50.96%) were African-American, 23 (22.12%) Hispanic. Forty-three patients (43.43%) were smokers. Saturation to fraction ratio and chest X-ray scores had a statistically significant improvement from day 1 to day 7. 67 of 104 (64.42%) were able to avoid invasive mechanical ventilation in our cohort. Incidence of hospital-associated/ventilator-associated pneumonia was 2.9%. Overall, mortality was 14.44% (n=15) in our cohort with 13 (34.4%) in the progressed to intubation group and 2 (2.9%) in the non-intubation group. Mortality and incidence of pneumonia was statistically higher in the progressed to intubation group. CONCLUSION: HFNT use is associated with a reduction in the rate of invasive mechanical ventilation and overall mortality in patients with COVID-19 infection.
MeSH term(s)	Adrenal Cortex Hormones/therapeutic use ; African Americans ; Aged ; Anti-Bacterial Agents/therapeutic use ; Antibodies, Monoclonal, Humanized/therapeutic use ; Antirheumatic Agents/therapeutic use ; Azithromycin/therapeutic use ; Betacoronavirus ; COVID-19 ; Cannula ; Comorbidity ; Coronavirus Infections/epidemiology ; Coronavirus Infections/therapy ; Diabetes Mellitus/epidemiology ; European Continental Ancestry Group ; Female ; Healthcare-Associated Pneumonia/epidemiology ; Heart Diseases/epidemiology ; Hispanic Americans ; Humans ; Hydroxychloroquine/therapeutic use ; Hypertension/epidemiology ; Hypoxia/therapy ; Immunoglobulins, Intravenous/therapeutic use ; Immunologic Factors/therapeutic use ; Intubation, Intratracheal/statistics & numerical data ; Lung Diseases/epidemiology ; Male ; Middle Aged ; Oxygen Inhalation Therapy/methods ; Pandemics ; Philadelphia/epidemiology ; Pneumonia, Ventilator-Associated/epidemiology ; Pneumonia, Viral/epidemiology ; Pneumonia, Viral/therapy ; Pulse Therapy, Drug ; Renal Insufficiency, Chronic/epidemiology ; Respiratory Insufficiency/therapy ; Retrospective Studies ; SARS-CoV-2 ; Severity of Illness Index ; Smoking/epidemiology
Chemical Substances	Adrenal Cortex Hormones ; Anti-Bacterial Agents ; Antibodies, Monoclonal, Humanized ; Antirheumatic Agents ; Immunoglobulins, Intravenous ; Immunologic Factors ; Hydroxychloroquine (4QWG6N8QKH) ; Azithromycin (83905-01-5) ; sarilumab (NU90V55F8I)
Keywords	covid19
Language	English
Publishing date	2020-08-26
Publishing country	England
Document type	Journal Article
ZDB-ID	2736454-9
ISSN	2052-4439 ; 2052-4439
ISSN (online)	2052-4439
ISSN	2052-4439
DOI	10.1136/bmjresp-2020-000650
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: High Resolution CHEST CT(HRCT) Evaluation in Patients Hospitalized with COVID-19 Infection

Patel, Maulin / Chowdhury, Junad / Zheng, Matthew / Abramian, Osheen / Verga, Steven / Zhao, Huaqing / Patlakh, Nicole / Fleece, David / Montecalvo, Nicholas / Cohen, Gary / Kumaran, Maruti / Dass, Chandra / Criner, Gerard

medRxiv

Abstract: Abstract Introduction: Currently the main diagnostic modality for COVID-19 (Coronavirus disease-2019) is reverse transcriptase polymerase chain reaction (RT-PCR) via nasopharyngeal swab which has high false negative rates. We evaluated the performance of ...

Abstract	Abstract Introduction: Currently the main diagnostic modality for COVID-19 (Coronavirus disease-2019) is reverse transcriptase polymerase chain reaction (RT-PCR) via nasopharyngeal swab which has high false negative rates. We evaluated the performance of high-resolution computed tomography (HRCT) imaging in the diagnosis of suspected COVID-19 infection compared to RT-PCR nasopharyngeal swab alone in patients hospitalized for suspected COVID-19 infection. Methods: This was a retrospective analysis of 324 consecutive patients admitted to Temple University Hospital. All hospitalized patients who had RT-PCR testing and HRCT were included in the study. HRCTs were classified as Category 1, 2 or 3. Patients were then divided into four groups based on HRCT category and RT-PCR swab results for analysis. Results: The average age of patients was 59.4 (+15.2) years and 123 (38.9%) were female. Predominant ethnicity was African American 148 (46.11%). 161 patients tested positive by RT-PCR, while 41 tested positive by HRCT. 167 (52.02%) had category 1 scan, 63 (19.63%) had category 2 scan and 91 (28.35%) had category 3 HRCT scans. There was substantial agreement between our radiologists for HRCT classification (κ = 0.64). Sensitivity and specificity of HRCT classification system was 77.6 and 73.7 respectively. Ferritin, LDH, AST and ALT were higher in Group 1 and D-dimers levels was higher in Group 3; differences however were not statistically significant. Conclusion: Due to its high infectivity and asymptomatic transmission, until a highly sensitive and specific COVID-19 test is developed, HRCT should be incorporated into the assessment of patients who are hospitalized with suspected COVID-19.
Keywords	covid19
Language	English
Publishing date	2020-05-28
Publisher	Cold Spring Harbor Laboratory Press
Document type	Article ; Online
DOI	10.1101/2020.05.26.20114082
Database	COVID19

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Article ; Online: Anakinra and Intravenous IgG versus Tocilizumab in the Treatment of COVID-19 Pneumonia

Zantah, Massa / Dominguez Castillo, Eduardo / Gangemi, Andrew J. / Patel, Maulin / Chowdhury, Junad / Verga, Steven / Abramian, Osheen / Zheng, Mattew / Lu, Kevin / Lau, Arthur / Levinson, Justin / Zhao, Hauquing / Criner, Gerard J. / Caricchio, Roberto

medRxiv

Abstract: Background: COVID-19 can lead to acute respiratory failure and an exaggerated inflammatory response. Studies have suggested promising outcomes using monoclonal antibodies targeting IL-1β (Anakinra) or IL6 (Tocilizumab), however no head to head comparison ...

Abstract	Background: COVID-19 can lead to acute respiratory failure and an exaggerated inflammatory response. Studies have suggested promising outcomes using monoclonal antibodies targeting IL-1β (Anakinra) or IL6 (Tocilizumab), however no head to head comparison was done between the two treatments. Herein, we report our experience in treating COVID-19 pneumonia associated with cytokine storm with either subcutaneous Anakinra given concomitantly with intravenous immunoglobulin (IVIG), or intravenous Tocilizumab. Methods: Comprehensive clinical and laboratory data from patients with COVID-19 pneumonia admitted at our hospital between March and May 2020 were collected. Patients who received either Anakinra/ IVIG or Tocilizumab were selected. Baseline characteristics including oxygen therapy, respiratory status evaluation using ROX index, clinical assessment using NEWS score and laboratory data were collected. Outcomes included mortality, intubation, ICU admission and length of stay. In addition, we compared the change in ROX index, NEWS score and inflammatory markers at days 7 and 14 post initiation of therapy. Results: 84 consecutive patients who received either treatment (51 in the Anakinra/ IVIG group and 33 in the Tocilizumab group) were retrospectively studied. Baseline inflammatory markers were similar in both groups. There was no significant difference regarding to death (21.6% vs 15.2%, p 0.464), intubation (15.7% vs 24.2%, p 0.329), ICU need (57.1% vs 48.5%, p 0.475) or length of stay (13+9.6 vs 14.9+11.6, p 0.512) in the Anakinra/IVIG and Tocilizumab, respectively. Additionally, the rate of improvement in ROX index, NEWS score and inflammatory markers was similar in both groups at days 7 and 14. Furthermore, there was no difference in the incidence of superinfection in both groups. Conclusion: Treating COVID-19 pneumonia associated with cytokine storm features with either subcutaneous Anakinra/IVIG or intravenous Tocilizumab is associated with improved clinical outcomes in most subjects. The choice of treatment does not appear to affect morbidity or mortality. Randomized controlled trials are needed to confirm our study findings. Funding: None.
Keywords	covid19
Language	English
Publishing date	2020-09-13
Publisher	Cold Spring Harbor Laboratory Press
Document type	Article ; Online
DOI	10.1101/2020.09.11.20192401
Database	COVID19

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Article ; Online: High Resolution CHEST CT(HRCT) Evaluation in Patients Hospitalized with COVID-19 Infection

Abstract	Abstract Introduction: Currently the main diagnostic modality for COVID-19 (Coronavirus disease-2019) is reverse transcriptase polymerase chain reaction (RT-PCR) via nasopharyngeal swab which has high false negative rates. We evaluated the performance of high-resolution computed tomography (HRCT) imaging in the diagnosis of suspected COVID-19 infection compared to RT-PCR nasopharyngeal swab alone in patients hospitalized for suspected COVID-19 infection. Methods: This was a retrospective analysis of 324 consecutive patients admitted to Temple University Hospital. All hospitalized patients who had RT-PCR testing and HRCT were included in the study. HRCTs were classified as Category 1, 2 or 3. Patients were then divided into four groups based on HRCT category and RT-PCR swab results for analysis. Results: The average age of patients was 59.4 (+15.2) years and 123 (38.9%) were female. Predominant ethnicity was African American 148 (46.11%). 161 patients tested positive by RT-PCR, while 41 tested positive by HRCT. 167 (52.02%) had category 1 scan, 63 (19.63%) had category 2 scan and 91 (28.35%) had category 3 HRCT scans. There was substantial agreement between our radiologists for HRCT classification ({kappa} = 0.64). Sensitivity and specificity of HRCT classification system was 77.6 and 73.7 respectively. Ferritin, LDH, AST and ALT were higher in Group 1 and D-dimers levels was higher in Group 3; differences however were not statistically significant. Conclusion: Due to its high infectivity and asymptomatic transmission, until a highly sensitive and specific COVID-19 test is developed, HRCT should be incorporated into the assessment of patients who are hospitalized with suspected COVID-19.
Keywords	covid19
Publisher	MedRxiv; WHO
Document type	Article ; Online
Note	WHO #Covidence: #20114082
DOI	10.1101/2020.05.26.20114082
Database	COVID19

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