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Article: Why Pulmonary Vasodilation May Be Part of a Key Strategy to Improve Survival in COVID-19.

Solaimanzadeh, Isaac

2021 Volume 13, Issue 12, Page(s) e20746

Abstract: Oxygenation is a function of both ventilation and perfusion. While approaches to the treatment of COVID-19 have focused largely on ventilation strategies and antiviral therapies, attention towards the improvement of vascular perfusion defects has been ... ...

Abstract	Oxygenation is a function of both ventilation and perfusion. While approaches to the treatment of COVID-19 have focused largely on ventilation strategies and antiviral therapies, attention towards the improvement of vascular perfusion defects has been neglected. This article examines clinical findings that indicate perfusion defects are a critical component of COVID-19 pathophysiology. They also support the notion that medications that promote perfusion with pulmonary vasodilatation can yield significantly improved outcomes that include overall survival. Calcium channel blocker usage has been associated with improved survival and outcomes in several retrospective reviews of patient populations with COVID-19 from across the world. This includes studies conducted in Paris, France; Wuhan, China; Daegu, South Korea; Brooklyn, New York; Brussels, Belgium; and a national sample from across the United States
Language	English
Publishing date	2021-12-27
Publishing country	United States
Document type	Journal Article
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.20746
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Heterogeneous Perfusion in COVID-19 and High Altitude Pulmonary Edema: A Review of Two Cases Followed by Implications for Hypoxic Pulmonary Vasoconstriction, Thrombosis Development, Ventilation Perfusion Mismatch and Emergence of Treatment Approaches.

Solaimanzadeh, Isaac

Cureus

2020 Volume 12, Issue 9, Page(s) e10230

Abstract: Coronavirus disease 2019 (COVID-19) has been compared to high altitude pulmonary edema (HAPE). Multiple similarities between the two conditions were drawn in the past. This article seeks to further clarify potential underlying mechanisms related to ... ...

Abstract	Coronavirus disease 2019 (COVID-19) has been compared to high altitude pulmonary edema (HAPE). Multiple similarities between the two conditions were drawn in the past. This article seeks to further clarify potential underlying mechanisms related to hypoxia and pulmonary vascular responses. It does so by looking at perfusion imaging of patients with COVID-19 and comparing them with patterns observed in HAPE and hypoxic exposure. Two separate clinical cases are reviewed. The salient aspect of each case that is emphasized is the perfusion scintigraphy results that revealed heterogeneous perfusion patterns in both patients. Heterogeneous or non-homogeneous perfusion is also observed in HAPE. A detailed clinical course of each patient is described. Medications utilized to treat the conditions are outlined as well as laboratory parameters and clinical findings. Interestingly, both of these patients were treated with calcium channel blockers and this class of medications is utilized to prevent HAPE as well. Discussion following the case presentations attempts to contextualize possible implications of this and other studies on the broader pathophysiology of COVID-19 disease. Findings related to pathophysiologic patterns and treatment strategies are also described. Micro-thrombi formation has been reported in both COVID-19 and HAPE as well and may be an accessory complication of perfusion compromise. In a separate study, vasodilatation with calcium channel blocker (CCB) therapy has been associated with improved mortality in COVID-19 and potential pathophysiologic mechanisms were previously presented. This case report provides further clinical findings that support the notion that perfusion deficits are an integral component of hypoxia in COVID-19. It also advances the basis for use of vasodilator therapy as part of treatment regimens in COVID-19. Vasodilators may improve micro-perfusion. In this way, oxygenation may be promoted by decreasing impedance and improving flow via the alveolar-capillary unit.
Keywords	covid19
Language	English
Publishing date	2020-09-03
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.10230
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Acetazolamide, Nifedipine and Phosphodiesterase Inhibitors: Rationale for Their Utilization as Adjunctive Countermeasures in the Treatment of Coronavirus Disease 2019 (COVID-19).

Solaimanzadeh, Isaac

Cureus

2020 Volume 12, Issue 3, Page(s) e7343

Abstract: Effective treatments for Coronavirus Disease 2019 (COVID-19) outbreak are urgently needed. While anti-viral approaches and vaccines are being considered immediate countermeasures are unavailable. The aim of this article is to outline a perspective on the ...

Abstract	Effective treatments for Coronavirus Disease 2019 (COVID-19) outbreak are urgently needed. While anti-viral approaches and vaccines are being considered immediate countermeasures are unavailable. The aim of this article is to outline a perspective on the pathophysiology of COVID-19 in the context of the currently available clinical data published in the literature. This article appreciates clinical data published on COVID-19 in the context of another respiratory illness - high altitude pulmonary edema (HAPE). Both conditions have significant similarities that portend pathophysiologic trajectories. Following this potential treatment options emerge. Both COVID-19 and HAPE exhibit a decreased ratio of arterial oxygen partial pressure to fractional inspired oxygen with concomitant hypoxia and tachypnea. There also appears to be a tendency for low carbon dioxide levels in both as well. Radiologic findings of ground glass opacities are present in up to 86% of patients with COVID-19 in addition to patchy infiltrates. Patients with HAPE also exhibit patchy infiltrates throughout the pulmonary fields, often in an asymmetric pattern and CT findings reveal increased lung markings and ground glass-like changes as well. Widespread ground-glass opacities are most commonly a manifestation of hydrostatic pulmonary edema. Similarly, elevated fibrinogen levels in both conditions are likely an
Keywords	covid19
Language	English
Publishing date	2020-03-20
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.7343
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Nifedipine and Amlodipine Are Associated With Improved Mortality and Decreased Risk for Intubation and Mechanical Ventilation in Elderly Patients Hospitalized for COVID-19.

Solaimanzadeh, Isaac

Cureus

2020 Volume 12, Issue 5, Page(s) e8069

Abstract: Dihydropyridine calcium channel blockers (CCB) are typically used agents in the clinical management of hypertension. Yet, they have also been utilized in the treatment of various pulmonary disorders with vasoconstriction. Severe acute respiratory ... ...

Abstract	Dihydropyridine calcium channel blockers (CCB) are typically used agents in the clinical management of hypertension. Yet, they have also been utilized in the treatment of various pulmonary disorders with vasoconstriction. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been implicated in the development of vasoconstrictive, proinflammatory, and pro-oxidative effects. A retrospective review was conducted on CCB use in hospitalized patients in search of any difference in outcomes related to specific endpoints: survival to discharge and progression of disease leading to intubation and mechanical ventilation. The electronic medical records for all patients that tested positive for SARS-CoV-2 that were at or above the age of 65 and that expired or survived to discharge from a community hospital in Brooklyn, NY, between the start of the public health crisis due to the viral disease up until April 13, 2020, were included. Of the 77 patients that were identified, 18 survived until discharge and 59 expired. Seven patients from the expired group were excluded since they died within one day of presentation to the hospital. Five patients were excluded from the expired group since their age was above that of the eldest patient in the survival group (89 years old). With 65 patients left, 24 were found to have been administered either amlodipine or nifedipine (CCB group) and 41 were not (No-CCB group). Patients treated with a CCB were significantly more likely to survive than those not treated with a CCB: 12 (50%) survived and 12 expired in the CCB group vs. six (14.6%) that survived and 35 (85.4%) that expired in the No-CCB treatment group (P<.01; p=0.0036). CCB patients were also significantly less likely to undergo intubation and mechanical ventilation. Only one patient (4.2%) was intubated in the CCB group whereas 16 (39.0%) were intubated in the No-CCB treatment group (P<.01; p=0.0026). Nifedipine and amlodipine were found to be associated with significantly improved mortality and a decreased risk for intubation and mechanical ventilation in elderly patients hospitalized with COVID-19. Further clinical studies are warranted. Including either nifedipine or amlodipine in medication regimens for elderly patients with hypertension hospitalized for COVID-19 may be considered.
Keywords	covid19
Language	English
Publishing date	2020-05-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.8069
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Heterogeneous Perfusion in COVID-19 and High Altitude Pulmonary Edema: A Review of Two Cases Followed by Implications for Hypoxic Pulmonary Vasoconstriction, Thrombosis Development, Ventilation Perfusion Mismatch and Emergence of Treatment Approaches

Solaimanzadeh, Isaac

Cureus

Abstract: Coronavirus disease 2019 (COVID-19) has been compared to high altitude pulmonary edema (HAPE) Multiple similarities between the two conditions were drawn in the past This article seeks to further clarify potential underlying mechanisms related to hypoxia ...

Abstract	Coronavirus disease 2019 (COVID-19) has been compared to high altitude pulmonary edema (HAPE) Multiple similarities between the two conditions were drawn in the past This article seeks to further clarify potential underlying mechanisms related to hypoxia and pulmonary vascular responses It does so by looking at perfusion imaging of patients with COVID-19 and comparing them with patterns observed in HAPE and hypoxic exposure Two separate clinical cases are reviewed The salient aspect of each case that is emphasized is the perfusion scintigraphy results that revealed heterogeneous perfusion patterns in both patients Heterogeneous or non-homogeneous perfusion is also observed in HAPE A detailed clinical course of each patient is described Medications utilized to treat the conditions are outlined as well as laboratory parameters and clinical findings Interestingly, both of these patients were treated with calcium channel blockers and this class of medications is utilized to prevent HAPE as well Discussion following the case presentations attempts to contextualize possible implications of this and other studies on the broader pathophysiology of COVID-19 disease Findings related to pathophysiologic patterns and treatment strategies are also described Micro-thrombi formation has been reported in both COVID-19 and HAPE as well and may be an accessory complication of perfusion compromise In a separate study, vasodilatation with calcium channel blocker (CCB) therapy has been associated with improved mortality in COVID-19 and potential pathophysiologic mechanisms were previously presented This case report provides further clinical findings that support the notion that perfusion deficits are an integral component of hypoxia in COVID-19 It also advances the basis for use of vasodilator therapy as part of treatment regimens in COVID-19 Vasodilators may improve micro-perfusion In this way, oxygenation may be promoted by decreasing impedance and improving flow via the alveolar-capillary unit
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #761123
Database	COVID19

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Article: Nifedipine and Amlodipine Are Associated With Improved Mortality and Decreased Risk for Intubation and Mechanical Ventilation in Elderly Patients Hospitalized for COVID-19

Solaimanzadeh, Isaac

Cureus

Abstract: Dihydropyridine calcium channel blockers (CCB) are typically used agents in the clinical management of hypertension Yet, they have also been utilized in the treatment of various pulmonary disorders with vasoconstriction Severe acute respiratory syndrome ... ...

Abstract	Dihydropyridine calcium channel blockers (CCB) are typically used agents in the clinical management of hypertension Yet, they have also been utilized in the treatment of various pulmonary disorders with vasoconstriction Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been implicated in the development of vasoconstrictive, proinflammatory, and pro-oxidative effects A retrospective review was conducted on CCB use in hospitalized patients in search of any difference in outcomes related to specific endpoints: survival to discharge and progression of disease leading to intubation and mechanical ventilation The electronic medical records for all patients that tested positive for SARS-CoV-2 that were at or above the age of 65 and that expired or survived to discharge from a community hospital in Brooklyn, NY, between the start of the public health crisis due to the viral disease up until April 13, 2020, were included Of the 77 patients that were identified, 18 survived until discharge and 59 expired Seven patients from the expired group were excluded since they died within one day of presentation to the hospital Five patients were excluded from the expired group since their age was above that of the eldest patient in the survival group (89 years old) With 65 patients left, 24 were found to have been administered either amlodipine or nifedipine (CCB group) and 41 were not (No-CCB group) Patients treated with a CCB were significantly more likely to survive than those not treated with a CCB: 12 (50%) survived and 12 expired in the CCB group vs six (14 6%) that survived and 35 (85 4%) that expired in the No-CCB treatment group (P< 01;p=0 0036) CCB patients were also significantly less likely to undergo intubation and mechanical ventilation Only one patient (4 2%) was intubated in the CCB group whereas 16 (39 0%) were intubated in the No-CCB treatment group (P< 01;p=0 0026) Nifedipine and amlodipine were found to be associated with significantly improved mortality and a decreased risk for intubation and mechanical ventilation in elderly patients hospitalized with COVID-19 Further clinical studies are warranted Including either nifedipine or amlodipine in medication regimens for elderly patients with hypertension hospitalized for COVID-19 may be considered
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #263511
Database	COVID19

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Article: Acetazolamide, Nifedipine and Phosphodiesterase Inhibitors: Rationale for Their Utilization as Adjunctive Countermeasures in the Treatment of Coronavirus Disease 2019 (COVID-19)

Solaimanzadeh, Isaac

Cureus

Abstract: Effective treatments for Coronavirus Disease 2019 (COVID-19) outbreak are urgently needed While anti-viral approaches and vaccines are being considered immediate countermeasures are unavailable The aim of this article is to outline a perspective on the ... ...

Abstract	Effective treatments for Coronavirus Disease 2019 (COVID-19) outbreak are urgently needed While anti-viral approaches and vaccines are being considered immediate countermeasures are unavailable The aim of this article is to outline a perspective on the pathophysiology of COVID-19 in the context of the currently available clinical data published in the literature This article appreciates clinical data published on COVID-19 in the context of another respiratory illness - high altitude pulmonary edema (HAPE) Both conditions have significant similarities that portend pathophysiologic trajectories Following this potential treatment options emerge Both COVID-19 and HAPE exhibit a decreased ratio of arterial oxygen partial pressure to fractional inspired oxygen with concomitant hypoxia and tachypnea There also appears to be a tendency for low carbon dioxide levels in both as well Radiologic findings of ground glass opacities are present in up to 86% of patients with COVID-19 in addition to patchy infiltrates Patients with HAPE also exhibit patchy infiltrates throughout the pulmonary fields, often in an asymmetric pattern and CT findings reveal increased lung markings and ground glass-like changes as well Widespread ground-glass opacities are most commonly a manifestation of hydrostatic pulmonary edema Similarly, elevated fibrinogen levels in both conditions are likely an epiphenomenon of edema formation rather than coagulation activation Autopsy results of a COVID-19 fatality revealed bilateral diffuse alveolar damage associated with pulmonary edema, pro-inflammatory concentrates, and indications of early-phase acute respiratory distress syndrome (ARDS) HAPE itself is initially caused by an increase in pulmonary capillary pressure and induces altered alveolar-capillary permeability via high pulmonary artery hydrostatic pressures that lead to a protein-rich and mildly hemorrhagic edema It appears that COVID-19 and HAPE both discretely converge on ARDS In light of this, a countermeasure that has been shown to be effective in the analogous condition of HAPE is Acetazolamide Acetazolamide has a myriad of effects on different organ systems, potently reduces hypoxic pulmonary vasoconstriction, improves minute ventilation and expired vital capacity Other therapeutics to consider that are also directed towards decreased pulmonary pressure include Nifedipine and Phosphodiesterase inhibitors This review describes COVID-19 in parallel to HAPE Deranged respiratory parameters that are present in both conditions are highlighted The utilization of medications found to be effective in HAPE, for the treatment of COVID-19, is proposed Given the medical emergency of a growing contagion and the thousands of lives at stake, expedient attempts to improve survival are needed Acetazolamide, Nifedipine and Phosphodiesterase inhibitors may be potential countermeasures
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #24419
Database	COVID19

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Article: A Rare Presentation of Levetiracetam-Induced Torsades De Pointes.

Mann, Henry / Kusayev, Josef / Pandey, Sagar / Aryal, Binit / Solaimanzadeh, Isaac

Cureus

2023 Volume 15, Issue 6, Page(s) e40866

Abstract: Torsades de pointes occurs in the presence of a prolonged QTc interval, which has many congenital and acquired causes. Levetiracetam is a widely used anti-epileptic medication secondary to its favorable safety profile. We present a rare case of a 59-year- ...

Abstract	Torsades de pointes occurs in the presence of a prolonged QTc interval, which has many congenital and acquired causes. Levetiracetam is a widely used anti-epileptic medication secondary to its favorable safety profile. We present a rare case of a 59-year-old male who developed torsades de pointes and cardiac arrest after levetiracetam administration. To our knowledge, there is only one other case report documenting torsades de pointes after levetiracetam administration, and our case report will be the first documenting cardiac arrest after levetiracetam administration.
Language	English
Publishing date	2023-06-23
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.40866
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Case Report of Acute Pancreatitis Associated With Combination Treatment of Dulaglutide and Glipizide.

Babajide, Oyedotun / K C, Nabin / Solaimanzadeh, Isaac / Shiferaw-Deribe, Zewge

Cureus

2022 Volume 14, Issue 1, Page(s) e20938

Abstract: The objective of this report is to discuss a case of drug-induced acute pancreatitis in a patient on a combination of dulaglutide and glipizide. The patient was a 61-year-old African American male with a past medical history of diabetes mellitus type 2 ... ...

Abstract	The objective of this report is to discuss a case of drug-induced acute pancreatitis in a patient on a combination of dulaglutide and glipizide. The patient was a 61-year-old African American male with a past medical history of diabetes mellitus type 2 and essential hypertension, who was admitted for acute pancreatitis after presenting with upper abdominal pain. He was initially on glipizide but dulaglutide was added to improve control. The patient was a social drinker and an ex-cigarette smoker. He had serum lipase greater than 900 U/L, serum alcohol was negative, and abdominal computed tomography reported significant pancreatic edema consistent with acute pancreatitis but without features of necrotizing pancreatitis and no evidence of cholelithiasis or choledocholithiasis. His clinical state deteriorated after being complicated by paralytic ileus. He was managed conservatively, improved clinically, and was discharged home. Seeing that the incidence of pancreatitis is higher in patients with diabetes when compared to non-diabetics, it is important to counsel and monitor patients for risk factors of pancreatitis including medications. In the absence of other common causes in this case and considering the temporal relationship between presentation and the addition of dulaglutide to ongoing glipizide regimen, the combination of both drugs may have induced acute pancreatitis.
Language	English
Publishing date	2022-01-04
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.20938
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: ALTERNATING THYROID STATUS BETWEEN THYROTOXICOSIS AND HYPOTHYROIDISM IN A PATIENT WITH VARYING ANTITHYROID ANTIBODIES.

Solaimanzadeh, Isaac / Hossain, Muhammad Rajib / Shiferaw-Deribe, Zewge / Sandhu, Hargeet

AACE clinical case reports

2018 Volume 5, Issue 2, Page(s) e112–e118

Abstract: Objective: Autoimmune pathologies are a growing aspect of medicine. Knowledge about atypical cases is essential. This report will describe a case of unusual, alternating fluctuations in thyroid function.: Methods: We report a case of thyrotoxicosis ... ...

Abstract	Objective: Autoimmune pathologies are a growing aspect of medicine. Knowledge about atypical cases is essential. This report will describe a case of unusual, alternating fluctuations in thyroid function. Methods: We report a case of thyrotoxicosis alternating with hypothyroidism in a 44-year-old, African-American woman and detail the clinical course and management. Results: The patient presented in a mildly thyrotoxic state with features of thyroiditis that resolved soon thereafter. Subsequently, the course shifted toward a hypothyroid state with a thyroid-stimulating hormone (TSH) level of 24.53 μIU/ml (normal range is 0.45 to 4.5 μIU/ml; measured September 5, 2013) and free thyroxine (FT4) of 0.35 ng/dL (normal range is 0.5 to 1.40 ng/dL; measured September 5, 2013). It ensued with alternating hypothyroid and hyperthyroid trajectories for several cycles. Clinical management was adjusted to negotiate each progression. During certain intervals, levothyroxine was increased. At other visits, it was decreased. Periods without medication were observed as well. Furthermore, methimazole and metoprolol were utilized when required. Reversal of the condition occurred repeatedly. The entire course is tracked with over 30 instances of thyroid function measures that included hypothyroid, euthyroid (TSH at 1.54 μIU/mL, FT4 at 1.16 ng/dL) and thyrotoxic states (TSH at <0.005 μIU/mL, FT4 at 2.67 ng/dL). Various antibody titers were elevated including thyroid-stimulating immunoglobulin, thyroid peroxidase antibody, and TSH receptor antibody. Close monitoring of TSH and FT4 allowed for appropriate medication dose adjustment. Conclusion: This case highlights the unusual phenomenon of fluctuating thyroid function with autoimmune involvement of thyroid-stimulating immunoglobulin and TSH receptor antibodies. Close follow up aided responsive clinical management throughout the fluctuating clinical course.
Language	English
Publishing date	2018-11-01
Publishing country	United States
Document type	Case Reports
ISSN	2376-0605
ISSN (online)	2376-0605
DOI	10.4158/ACCR-2018-0167
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Why Pulmonary Vasodilation May Be Part of a Key Strategy to Improve Survival in COVID-19.

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Article: Heterogeneous Perfusion in COVID-19 and High Altitude Pulmonary Edema: A Review of Two Cases Followed by Implications for Hypoxic Pulmonary Vasoconstriction, Thrombosis Development, Ventilation Perfusion Mismatch and Emergence of Treatment Approaches.

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Article: Acetazolamide, Nifedipine and Phosphodiesterase Inhibitors: Rationale for Their Utilization as Adjunctive Countermeasures in the Treatment of Coronavirus Disease 2019 (COVID-19).

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Article: Nifedipine and Amlodipine Are Associated With Improved Mortality and Decreased Risk for Intubation and Mechanical Ventilation in Elderly Patients Hospitalized for COVID-19.

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Article: Heterogeneous Perfusion in COVID-19 and High Altitude Pulmonary Edema: A Review of Two Cases Followed by Implications for Hypoxic Pulmonary Vasoconstriction, Thrombosis Development, Ventilation Perfusion Mismatch and Emergence of Treatment Approaches

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Article: Nifedipine and Amlodipine Are Associated With Improved Mortality and Decreased Risk for Intubation and Mechanical Ventilation in Elderly Patients Hospitalized for COVID-19

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Article: Acetazolamide, Nifedipine and Phosphodiesterase Inhibitors: Rationale for Their Utilization as Adjunctive Countermeasures in the Treatment of Coronavirus Disease 2019 (COVID-19)

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Article: A Rare Presentation of Levetiracetam-Induced Torsades De Pointes.

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Article: Case Report of Acute Pancreatitis Associated With Combination Treatment of Dulaglutide and Glipizide.

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Article ; Online: ALTERNATING THYROID STATUS BETWEEN THYROTOXICOSIS AND HYPOTHYROIDISM IN A PATIENT WITH VARYING ANTITHYROID ANTIBODIES.

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