Publications by authors named "Ayman O Soubani"

96 Publications

Comparison Between the 2021 USPSTF Lung Cancer Screening Criteria and Other Lung Cancer Screening Criteria for Racial Disparity in Eligibility.

JAMA Oncol 2022 Jan 13. Epub 2022 Jan 13.

Karmanos Cancer Institute, Detroit, Michigan.

Importance: In 2021, the US Preventive Services Task Force (USPSTF) broadened its age and smoking pack-year requirement for lung cancer screening.

Objectives: To compare the 2021 USPSTF lung cancer screening criteria with other lung cancer screening criteria and evaluate whether the sensitivity and specificity of these criteria differ by race.

Design, Setting, And Participants: This study included 912 patients with lung cancer and 1457 controls without lung cancer enrolled in an epidemiology study (INHALE [Inflammation, Health, Ancestry, and Lung Epidemiology]) in the Detroit metropolitan area between May 15, 2012, and March 31, 2018. Patients with lung cancer and controls were 21 to 89 years of age; patients with lung cancer who were never smokers and controls who were never smokers were not included in these analyses. Statistical analysis was performed from August 31, 2020, to April 13, 2021.

Main Outcomes And Measures: The study assessed whether patients with lung cancer and controls would have qualified for lung cancer screening using the 2013 USPSTF, 2021 USPSTF, and 2012 modification of the model from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCOm2012) screening criteria. Sensitivity was defined as the percentage of patients with lung cancer who qualified for screening, while specificity was defined as the percentage of controls who did not qualify for lung cancer screening.

Results: Participants included 912 patients with a lung cancer diagnosis (493 women [54%]; mean [SD] age, 63.7 [9.5] years) and 1457 control participants without lung cancer at enrollment (795 women [55%]; mean [SD] age, 60.4 [9.6] years). With the use of 2021 USPSTF criteria, 590 patients with lung cancer (65%) were eligible for screening compared with 619 patients (68%) per the PLCOm2012 criteria and 445 patients (49%) per the 2013 USPSTF criteria. With the use of 2013 USPSTF criteria, significantly more White patients than African American patients with lung cancer (324 of 625 [52%] vs 121 of 287 [42%]) would have been eligible for screening. This racial disparity was absent when using 2021 USPSTF criteria (408 of 625 [65%] White patients vs 182 of 287 [63%] African American patients) and PLCOm2012 criteria (427 of 625 [68%] White patients vs 192 of 287 [67%] African American patients). The 2013 USPSTF criteria excluded 950 control participants (65%), while the PLCOm2012 criteria excluded 843 control participants (58%), and the 2021 USPSTF criteria excluded 709 control participants (49%). The 2013 USPSTF criteria excluded fewer White control participants than African American control participants (514 of 838 [61%] vs 436 of 619 [70%]). This racial disparity is again absent when using 2021 USPSTF criteria (401 of 838 [48%] White patients vs 308 of 619 [50%] African American patients) and PLCOm2012 guidelines (475 of 838 [57%] White patients vs 368 of 619 [60%] African American patients).

Conclusions And Relevance: This study suggests that the USPSTF 2021 guideline changes improve on earlier, fixed screening criteria for lung cancer, broadening eligibility and reducing the racial disparity in access to screening.
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http://dx.doi.org/10.1001/jamaoncol.2021.6720DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8759029PMC
January 2022

Azithromycin and Septic Shock Outcomes.

J Pharm Pract 2021 Dec 30:8971900211064193. Epub 2021 Dec 30.

Department of Pharmacy, 2970Harper University Hospital, Detroit, MI, USA.

Although there is evidence describing the immunomodulatory effects of macrolide antibiotics, there is little literature exploring the clinical effects these properties may have and their impact on measurable outcomes. The purpose of this study was to determine if empiric antimicrobial regimens containing azithromycin shorten time to shock resolution. A retrospective study was performed in adults with septic shock admitted to intensive care units (ICUs) of 3 university-affiliated, urban teaching hospitals between June 2012 and June 2016. Eligible patients with septic shock required treatment with norepinephrine as the first-line vasopressor for a minimum of 4 hours and received at least 48 hours of antimicrobial treatment from the time of shock onset. Propensity scores were utilized to match patients who received azithromycin to those who did not. A total of 3116 patients met initial inclusion criteria. After propensity score matching, 258 patients were included, with 124 and 134 patients in the azithromycin and control groups, respectively. Median shock duration was similar in patients treated with or without azithromycin (45.6 hr vs 59.7 hr, = .44). In-hospital mortality was also similar (37.9% vs 38.1%, = .979). There were no significant differences in mechanical ventilation duration, ICU length of stay (LOS), or hospital LOS. In patients admitted to the ICU with septic shock, empiric azithromycin did not have a significant effect on shock duration, mechanical ventilation duration, ICU LOS, hospital LOS, or in-hospital mortality.
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http://dx.doi.org/10.1177/08971900211064193DOI Listing
December 2021

Mortality outcomes associated with invasive aspergillosis among acute exacerbation of chronic obstructive pulmonary disease patient population.

Respir Med 2021 Dec 21;191:106720. Epub 2021 Dec 21.

Division of Pulmonary and Critical Care and Sleep Medicine, Wayne State University, Detroit, MI, USA. Electronic address:

Background: Literature regarding trends of mortality, and complications of aspergillosis infection among patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is limited.

Methods: Data from the National Readmissions Database (NRD) that constitutes 49.1% of the stratified sample of all hospitals in the United States (US), representing more than 95% of the national population were analyzed for hospitalizations with aspergillosis among AECOPD. Predictors and trends related to aspergillosis in AECOPD were evaluated. A Linear p-trend was used to assess the trends.

Results: Out of the total 7,282,644 index hospitalizations for AECOPD (mean age 69.17 ± 12.04years, 55.3% females), 8209 (11.2/10,000) with primary diagnosis of invasive aspergillosis were recorded in the NRD for 2013-2018. Invasive aspergillosis was strongly associated with mortality (OR 4.47, 95%CI 4.02-4.97, p < 0.001) among AECOPD patients. Malignancy and organ transplant status were predominant predictors of developing aspergillosis among AECOPD patients. The IA-AECOPD group had higher rates of multi-organ manifestations including ACS (3.7% vs 0.44%; p-value0.001), AF (20% vs 18.4%; p-value0.001), PE (4.79% vs1.87%; p-value0.001), AKI (22.3% vs17.5%; p-value0.001), ICU admission (16.5% vs11.9%; p-value0.001), and MV (22.3% vs7.31%; p-value0.001) than the AECOPD group. The absolute yearly trend for mortality of aspergillosis was steady (linear p-trend 0.22) while the yearly rate of IA-AECOPD had decreased from 15/10,000 in 2013 to 9/10,000 in 2018 (linear p-trend 0.02).

Interpretation: Aspergillosis was related with high mortality among AECOD hospitalizations. There has been a significant improvement in the yearly rates of aspergillosis while the mortality trend was steady among aspergillosis subgroups. Improved risk factor management through goal-directed approach may improve clinical outcomes.
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http://dx.doi.org/10.1016/j.rmed.2021.106720DOI Listing
December 2021

Immune checkpoint inhibitor-induced pneumonitis: Incidence, clinical characteristics, and outcomes.

Hematol Oncol Stem Cell Ther 2021 Oct 18. Epub 2021 Oct 18.

Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, MI, USA. Electronic address:

Background: Immune checkpoint inhibitors (ICIs) are the newest class of anticancer drugs. Pneumonitis is increasingly being recognized as a potential complication of these agents.

Methods: We conducted a retrospective study of patients who received ICIs at a comprehensive cancer center. We collected data on demographics, type of malignancy, type of ICI agent, incidence of pneumonitis up to 6 weeks after receiving ICI agent, clinical characteristics, and risk factors for overall survival in patients who develop pneumonitis.

Results: A total of 654 patients received ICIs during the study period. The most common type of cancer for which ICI was given was adenocarcinoma of the lung (29%), followed by renal cell cancer (12%) and squamous cell lung cancer (12%). Among the study patients, 41% received nivolumab and 32% received pembrolizumab. Other patients in the study received combination of ICIs or ICI plus chemotherapeutic agent, or were part of clinical trial involving ICI. Overall 42 (6.4%) patients developed pneumonitis within 6 weeks after the last dose of treatment of any ICI agent. Of these, 81% of patients had Grade ≥ 2 pneumonitis and 45% of these required hospital admission for pneumonitis, with 10% of them requiring admission to intensive care unit. Overall, patients who received pembrolizumab-containing regimen, had prior chemotherapy, or who never had cancer-related surgery had increased risk of death.

Conclusion: Our large retrospective study shows real-life data of incidence of pneumonitis in patients who are treated with ICIs for cancer treatment. Our data indicate that the incidence of pneumonitis is overall lower than that reported previously with relatively good outcomes.
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http://dx.doi.org/10.1016/j.hemonc.2021.09.005DOI Listing
October 2021

Is isolated from respiratory cultures clinically significant?

Cleve Clin J Med 2021 Oct 1;88(10):543-546. Epub 2021 Oct 1.

Professor of Medicine, Wayne State University School of Medicine; Medical Director, Medical ICU, Harper University Hospital; Service Chief, Pulmonary and Critical Care, Karmanos Cancer Center; Medical Director, Critical Care Service, Karmanos Cancer Center, Detroit, MI

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http://dx.doi.org/10.3949/ccjm.88a.20188DOI Listing
October 2021

Trends in Incidence, and Mortality of Acute Exacerbation of Chronic Obstructive Pulmonary Disease in the United States Emergency Department (2010-2018).

COPD 2021 10 16;18(5):567-575. Epub 2021 Sep 16.

Division of Pulmonary and Critical Care Medicine, Wayne State University, Detroit, MI, USA.

Literature regarding trends of incidence, mortality, and complications of acute exacerbation of chronic obstructive pulmonary disease (COPD) in the emergency departments (ED) is limited. What are trends of COPD exacerbation in ED? Data were obtained from the Nationwide Emergency Department Sample (NEDS) that constitutes a 20% sample of hospital-owned EDs and inpatient sample in the US. All ED encounters were included in the analysis. Complications of AECOPD were obtained by using ICD codes. Out of 1.082 billion ED encounters, 5,295,408 (mean age 63.31 ± 12.63 years, females 55%) presented with COPD exacerbation. Among these patients, 353,563(6.7%) had AECOPD-plus (features of pulmonary embolism, acute heart failure and/or pneumonia) while 4,941,845 (93.3%) had exacerbation without associated features or precipitating factors which we grouped as AECOPD. The AECOPD-plus group was associated with statistically significantly higher proportion of cardiovascular complications including AF (5.6% vs 3.5%;  < 0.001), VT/VF (0.14% vs 0.06%;  < 0.001), STEMI (0.22% vs 0.11%;  < 0.001) and NSTEMI (0.65% vs 0.2%;  < 0.001). The in-hospital mortality rates were greater in the AECOPD-plus population (0.7% vs 0.1%;  < 0.001). The incidence of both AECOPD and AECOPD-plus had worsened (-trend 0.004 and 0.0003) and the trend of mortality had improved (-trend 0.0055 and 0.003, respectively). The prevalence of smoking for among all COPD patients had increased (-value 0.004), however, the prevalence trend of smoking among AECOPD groups was static over the years 2010-2018. There was an increasing trend of COPD exacerbation in conjunction with smoking; however, mortality trends improved significantly. Moreover, the rising burden of AECOPD would suggest improvement in diagnostics and policy making regarding management.
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http://dx.doi.org/10.1080/15412555.2021.1979500DOI Listing
October 2021

Sepsis Hospitalizations With Versus Without Cancer: Epidemiology, Outcomes, and Trends in Nationwide Analysis From 2008 to 2017.

Am J Clin Oncol 2021 10;44(10):505-511

Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, MI.

Background: Sepsis and cancer continue to be one of the leading causes of death in the United States. Concomitantly, hospitalizations for sepsis with underlying cancer over the years have shown a decrease in mortality. However, large-scale contemporary data on mortality trends in sepsis hospitalizations with underlying malignancy are lacking.

Research Question: Are there any identifiable trends in patients hospitalized for sepsis with underlying malignancy versus without malignancy?

Study Design And Methods: We performed a retrospective cohort study using the National Inpatient Sample database from 2008 to 2017 to identify sepsis hospitalizations with versus without cancer. Baseline variables and mortality trends were compared between the 2 groups.

Results: Of the 19,160,734 sepsis hospitalizations identified between 2008 and 2017, 3,913,813 (20.4%) were associated with cancer and 15,246,921 (79.6%) did not have underlying malignancy. Compared with 2008 to 2009, the multivariable-adjusted odds ratio (aOR) of death was lower in 2016 to 2017 for both cancer (aOR: 0.55, 95% confidence interval [CI]: 0.53-0.57) and noncancer-associated (aOR: 0.55, 95% CI: 0.53-0.57) sepsis hospitalizations. The nonsignificant interaction term (P=0.2239) revealed that the rate of decline in mortality did not differ between the 2 groups. Stratification of the mortality in sepsis hospitalizations by various age groups revealed that the odds of death associated with cancer were highest in the younger population (18 to 44 y) with an aOR: 3.40, 95% CI: 3.24-3.57. The aOR: showed a declining trend with increasing age until cancer-associated admissions had slightly lower odds of mortality than the noncancer group at age 85 years old and older (aOR: 0.93, 95% CI: 0.91-0.95).

Conclusion: In the 10-year study period, mortality in cancer and noncancer-associated sepsis hospitalizations has shown a declining trend. Furthermore, differences in mortality between the 2 groups decreased with increasing age.
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http://dx.doi.org/10.1097/COC.0000000000000859DOI Listing
October 2021

Major pulmonary complications following Hematopoietic stem cell transplantation: What the pulmonologist needs to know.

Respir Med 2021 Aug-Sep;185:106493. Epub 2021 Jun 2.

Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, MI, 48201, USA. Electronic address:

Hematopoietic stem cell transplantation (HSCT) is used for treatment of a myriad of both malignant and non-malignant disorders. However, despite many advances over the years which have resulted in improved patient mortality, this subset of patients remains at risk for a variety of post-transplant complications. Pulmonary complications of HSCT are categorized into infectious and non-infectious and occur in up to one-third of patients undergoing HSCT. Infectious etiologies include bacterial, viral and fungal infections, each of which can have significant mortality if not identified and treated early in the course of infection. Advances in the diagnosis and management of infectious complications highlight the importance of non-infectious pulmonary complications related to chemoradiation toxicities, immunosuppressive drugs toxicities, and graft-versus-host disease. This report aims to serve as a guide and clinical update of pulmonary complications following HSCT for the general pulmonologist who may be involved in the care of these patients.
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http://dx.doi.org/10.1016/j.rmed.2021.106493DOI Listing
January 2022

Management of ARDS - What Works and What Does Not.

Am J Med Sci 2021 07 26;362(1):13-23. Epub 2020 Dec 26.

Division of Pulmonary Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, MI, USA. Electronic address:

Acute respiratory distress syndrome (ARDS) is a clinically and biologically heterogeneous disorder associated with a variety of disease processes that lead to acute lung injury with increased non-hydrostatic extravascular lung water, reduced compliance, and severe hypoxemia. Despite significant advances, mortality associated with this syndrome remains high. Mechanical ventilation remains the most important aspect of managing patients with ARDS. An in-depth knowledge of lung protective ventilation, optimal PEEP strategies, modes of ventilation and recruitment maneuvers are essential for ventilatory management of ARDS. Although, the management of ARDS is constantly evolving as new studies are published and guidelines being updated; we present a detailed review of the literature including the most up-to-date studies and guidelines in the management of ARDS. We believe this review is particularly helpful in the current times where more than half of the acute care hospitals lack in-house intensivists and the burden of ARDS is at large.
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http://dx.doi.org/10.1016/j.amjms.2020.12.019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7997862PMC
July 2021

Survival in Immunocompromised Patients Ultimately Requiring Invasive Mechanical Ventilation: A Pooled Individual Patient Data Analysis.

Am J Respir Crit Care Med 2021 07;204(2):187-196

Medical ICU, Saint-Louis Teaching Hospital, Paris, France.

Acute respiratory failure (ARF) is associated with high mortality in immunocompromised patients, particularly when invasive mechanical ventilation is needed. Therefore, noninvasive oxygenation/ventilation strategies have been developed to avoid intubation, with uncertain impact on mortality, especially when intubation is delayed. We sought to report trends of survival over time in immunocompromised patients receiving invasive mechanical ventilation. The impact of delayed intubation after failure of noninvasive strategies was also assessed. Systematic review and meta-analysis using individual patient data of studies that focused on immunocompromised adult patients with ARF requiring invasive mechanical ventilation. Studies published in English were identified through PubMed, Web of Science, and Cochrane Central (2008-2018). Individual patient data were requested from corresponding authors for all identified studies. We used mixed-effect models to estimate the effect of delayed intubation on hospital mortality and described mortality rates over time. A total of 11,087 patients were included (24 studies, three controlled trials, and 21 cohorts), of whom 7,736 (74%) were intubated within 24 hours of ICU admission (early intubation). The crude mortality rate was 53.2%. Adjusted survivals improved over time (from 1995 to 2017, odds ratio [OR] for hospital mortality per year, 0.96 [0.95-0.97]). For each elapsed day between ICU admission and intubation, mortality was higher (OR, 1.38 [1.26-1.52];  < 0.001). Early intubation was significantly associated with lower mortality (OR, 0.83 [0.72-0.96]), regardless of initial oxygenation strategy. These results persisted after propensity score analysis (matched OR associated with delayed intubation, 1.56 [1.44-1.70]). In immunocompromised intubated patients, survival has improved over time. Time between ICU admission and intubation is a strong predictor of mortality, suggesting a detrimental effect of late initial oxygenation failure.
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http://dx.doi.org/10.1164/rccm.202009-3575OCDOI Listing
July 2021

Prophylactic unfractionated heparin and hemorrhage in neurocritically ill underweight patients: A case series and review of the literature.

Am J Health Syst Pharm 2020 09;77(19):1571-1577

Department of Pharmacy Services, Harper University Hospital, Detroit, MI.

Purpose: Three cases of major bleeding associated with thromboprophylactic unfractionated heparin (UFH) therapy in underweight neurocritically ill patients are reported.

Summary: Three underweight patients (body mass index of <18.5 kg/m2) were treated in the intensive care unit with major bleeds associated with UFH thromboprophylaxis. Two of the patients, a 76-year-old female and a 56-year-old female, had hemorrhages on presentation; the third patient, a 29-year-old male, developed bleeding during his admission. All 3 patients had past medical histories consisting of acute neurologic conditions within 6 weeks of presentation, including subdural hematoma, subarachnoid hemorrhage, and obstructive hydrocephalus secondary to a brain mass. All hemorrhages developed following the receipt of prophylactic UFH at doses of 5,000 units every 8 to 12 hours, which translated to high weight-based dosages (>300 units/kg/d). Additionally, hemorrhages were associated with prolonged activated partial thromboplastin time, which declined following heparin discontinuation. The major bleeds following UFH administration included an acute on chronic subdural hematoma, acute rectus sheath hematoma, and cerebellar hematoma. Stabilization of the subdural hematoma was achieved without the use of protamine and the patient was discharged in stable condition. The other 2 patients expired secondary to their hemorrhagic events. Naranjo nomogram scores for the patients indicated that heparin was the probable cause of bleed in 2 cases and a possible cause in 1 case.

Conclusion: Three major hemorrhages developed following the administration of UFH. Underweight patients with neurologic injury may require increased clinical vigilance, reduced doses, and pharmacodynamic monitoring to improve safety outcomes associated with thromboprophylaxis.
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http://dx.doi.org/10.1093/ajhp/zxaa225DOI Listing
September 2020

Noninfectious pulmonary complications of haematopoietic stem cell transplantation.

Eur Respir Rev 2020 Jun 23;29(156). Epub 2020 Jun 23.

Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, MI, USA

Haematopoietic stem cell transplantation (HSCT) is an established treatment for a variety of malignant and nonmalignant conditions. Pulmonary complications, both infectious and noninfectious, are a major cause of morbidity and mortality in patients who undergo HSCT. Recent advances in prophylaxis and treatment of infectious complications has increased the significance of noninfectious pulmonary conditions. Acute lung injury associated with idiopathic pneumonia syndrome remains a major acute complication with high morbidity and mortality. On the other hand, bronchiolitis obliterans syndrome is the most challenging chronic pulmonary complication facing clinicians who are taking care of allogeneic HSCT recipients. Other noninfectious pulmonary complications following HSCT are less frequent. This review provides a clinical update of the incidence, risk factors, pathogenesis, clinical characteristics and management of the main noninfectious pulmonary complications following HSCT.
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http://dx.doi.org/10.1183/16000617.0119-2019DOI Listing
June 2020

Influenza-Associated Aspergillosis: Nationwide Trends, Predictors and Outcomes From 2005 to 2014.

Chest 2020 11 18;158(5):1857-1866. Epub 2020 Jun 18.

Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, MI. Electronic address:

Background: Influenza-associated aspergillosis (IAA) has been increasingly reported in the literature in recent years, but contemporary large-scale data on the morbidity and mortality burden of IAA are lacking.

Research Question: The goal of this study was to estimate the predictors, associations, and outcomes of IAA in the United States.

Study Design And Methods: This retrospective cohort study was performed by using the National (Nationwide) Inpatient Sample database from 2005 to 2014 to identify influenza and IAA hospitalizations. Baseline variables and outcomes were compared between influenza hospitalizations without IAA and those with IAA. These variables were then used to perform an adjusted analysis for obtaining predictors and associations of the diagnosis and in-hospital mortality of IAA.

Results: Of the 477,556 hospitalizations identified with the principal diagnosis of influenza, IAA was identified in 823 (0.17%) hospitalizations. The IAA cohort consisted more commonly of 45- to 65-year-olds in urban teaching hospitals with substance abuse. Yearly trends revealed that both influenza and IAA hospitalizations have increased over time, with a peak observed in 2009, the year of the influenza A(H1N1) pandemic. Mortality was higher (20.58% vs 1.36%), average length of stay was longer (17.94 vs 4.05 days), and mean cost per hospitalization was higher ($194,932 vs $24,286) in the IAA cohort compared with the influenza cohort without IAA (P < .005). Solid-organ transplantation, hematologic malignancies, and use of invasive mechanical ventilation were associated with higher odds of IAA, among other factors. Use of invasive mechanical ventilation (adjusted OR, 13.43; P < .005), longer length of stay (adjusted OR, 5.47; P < .005), utilization of extracorporeal membrane oxygenation (adjusted OR, 4.99; P = .014), and the group aged 45 to 64 years (adjusted OR, 3.03; P = .012) were associated with higher in-hospital mortality in the IAA cohort.

Interpretation: Although IAA is a rare complication of influenza hospitalizations, it is associated with increased all-cause mortality, more extended hospital stays, and higher hospital charges compared with influenza without IAA.
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http://dx.doi.org/10.1016/j.chest.2020.06.010DOI Listing
November 2020

Pulmonary manifestations of gastroesophageal reflux disease.

Expert Rev Respir Med 2020 08 27;14(8):767-775. Epub 2020 Apr 27.

Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine , Detroit, MI, USA.

Introduction: Gastroesophageal reflux disease (GERD) is a widespread condition with a significant impact on the quality of life and healthcare resources. In addition to its gastrointestinal problems, GERD has been linked to a variety of respiratory diseases either as a direct cause, or as a risk factor to the inability to control or worsening of the disease.

Areas Covered: We performed a literature search in the PubMed database for articles addressing GERD and pulmonary diseases. This review will discuss several different pulmonary diseases affected by GERD ranging from upper airway including chronic cough, vocal cord dysfunction, lower airway diseases including COPD, asthma, and bronchiolitis obliterans syndrome to parenchymal diseases such as interstitial lung diseases. The review will discuss several different pulmonary manifestations of GERD and their contribution to patient mortality and morbidity. It will also review the mechanisms leading to these diseases, diagnostic workup, and the role of the available treatment options.

Expert Opinion: GERD is often overlooked as a cause of respiratory symptoms and illnesses. The literature is sparse on the relation between GERD and respiratory diseases such as interstitial lung diseases and bronchiolitis obliterans including its role in pathogenesis, mechanisms of lung injury, and whether treatment of GERD is effective in managing such illnesses.
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http://dx.doi.org/10.1080/17476348.2020.1758068DOI Listing
August 2020

What mask should I wear to protect against transmissible acute respiratory infections?

Cleve Clin J Med 2020 05 13;87(5):262-265. Epub 2020 Apr 13.

Division of Pulmonary, Critical Care, and Sleep Medicine, Wayne State University School of Medicine; Professor of Medicine, Wayne State University School of Medicine; Medical Director, Medical ICU, Harper University Hospital; Service Chief, Pulmonary and Critical Care, Karmanos Cancer Center; Medical Director, Critical Care Service, Karmanos Cancer Center, Detroit, MI

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http://dx.doi.org/10.3949/ccjm.87a.19057DOI Listing
May 2020

Pulmonary Aspergillosis: What the Generalist Needs to Know.

Am J Med 2020 06 30;133(6):668-674. Epub 2020 Mar 30.

Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, Mich. Electronic address:

Aspergillus spp. is a ubiquitous mold found commonly in our environment that can cause a spectrum of pulmonary disorders, ranging from a hypersensitivity reaction to an acutely invasive disease with significant mortality. Allergic bronchopulmonary aspergillosis results from airway hypersensitivity from aspergillus colonization almost exclusively in patients with asthma and cystic fibrosis. Chronic pulmonary aspergillosis typically presents in immunocompetent patients with underlying lung pathology. Treatment is primarily with antifungal agents; however, other measures such as surgical resection may be necessary. Invasive pulmonary aspergillosis is a severe infection in immunocompromised patients and is characterized by invasion of pulmonary vasculature by the Aspergillus hyphae. Recent advances in the diagnosis and management of invasive pulmonary aspergillosis include emerging risk factors such as critically ill patients, and those with chronic obstructive pulmonary disease and liver disease. In addition, noninvasive biomarkers have made it easier to suspect and diagnose invasive pulmonary aspergillosis. There are more effective and better-tolerated antifungal agents that have improved patient outcomes. This review introduces the spectrum of pulmonary aspergillosis geared toward generalists, including disease manifestations, most recent diagnostic criteria, and first-line treatment options. Involving a multidisciplinary team is vital to the early diagnosis and management of these diseases.
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http://dx.doi.org/10.1016/j.amjmed.2020.02.025DOI Listing
June 2020

COPD-dependent effects of genetic variation in key inflammation pathway genes on lung cancer risk.

Int J Cancer 2020 08 12;147(3):747-756. Epub 2019 Dec 12.

Department of Oncology, Wayne State University School of Medicine, Detroit, MI.

Genome-wide association studies (GWAS) have identified several loci contributing to lung cancer and COPD risk independently; however, inflammation-related pathways likely harbor additional lung cancer risk-associated variants in biologically relevant immune genes that differ dependent on COPD. We selected single nucleotide polymorphisms (SNPs) proximal to 2,069 genes within 48 immune pathways. We modeled the contribution of these variants to lung cancer risk in a discovery sample of 1,932 lung cancer cases and controls stratified by COPD status and validation sample of 953 cases and controls also stratified by COPD. There were 43 validated SNPs in those with COPD and 60 SNPs in those without COPD associated with lung cancer risk. Furthermore, 29 of 43 and 28 of 60 SNPs demonstrated a statistically significant interaction with COPD in the pooled sample. These variants demonstrated tissue-dependent effects on proximal gene expression, enhanced network connectivity and resided together in specific immune pathways. These results reveal that key inflammatory related genes and pathways, not found in prior GWAS, impact lung cancer risk in a COPD-dependent manner. Genetic variation identified in our study supplements prior lung cancer GWAS and serves as a foundation to further interrogate risk relationships in smoking and COPD populations.
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http://dx.doi.org/10.1002/ijc.32780DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7211135PMC
August 2020

What are the risks to inpatients during hospital construction or renovation?

Cleve Clin J Med 2019 10;86(10):650-652

Division of Pulmonary, Critical Care, and Sleep Medicine, Wayne State University School of Medicine; Professor of Medicine, Wayne State University School of Medicine; Medical Director, Medical ICU, Harper University Hospital; Service Chief, Pulmonary and Critical Care, and Medical Director, Critical Care Service, Karmanos Cancer Center, Detroit, MI

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http://dx.doi.org/10.3949/ccjm.86a.19008DOI Listing
October 2019

Are daily chest radiographs and arterial blood gas tests required in ICU patients on mechanical ventilation?

Cleve Clin J Med 2019 Sep;86(9):582-585

Professor of Medicine, Wayne State University School of Medicine, Detroit, MI, USA.

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http://dx.doi.org/10.3949/ccjm.86a.18141DOI Listing
September 2019

Weaning outcome of solid cancer patients requiring mechanical ventilation in the ICU: Other factors to explore.

J Formos Med Assoc 2019 12 30;118(12):1676-1677. Epub 2019 Aug 30.

División of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, MI, USA.

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http://dx.doi.org/10.1016/j.jfma.2019.08.014DOI Listing
December 2019

Serial transarterial embolization for the management of unresectable malignant pulmonary hemangiopericytoma: A case report and review of the literature.

Respir Med Case Rep 2019 3;28:100920. Epub 2019 Aug 3.

Wayne State University, School of Medicine Division of Pulmonary and Critical Care Medicine, USA.

Hemangiopericytomas (HPC) are perivascular neoplasms that are rarely encountered as primary lung malignancy. Surgical resection remains the mainstay therapy of HPC. A 37-year old African American female initially presented with fatigue, chest pain and palpitations. Chest radiography showed a well-circumscribed large heterogeneous vascular mass of the right hemithorax. She underwent a CT-guided biopsy of the thoracic mass and was diagnosed with low-grade pulmonary hemangiopericytoma. High tumor vascularity burden and liver metastases precluded her from being a surgical candidate. Three years ago, she referred to our facility seeking further management. She did not tolerate systemic chemotherapy. Alternatively, she had been successfully managed with serial transarterial embolization and oral angiogenesis inhibitor to date. This therapeutic approach can be further explored for long term control of unresectable pulmonary HPC.
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http://dx.doi.org/10.1016/j.rmcr.2019.100920DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6704372PMC
August 2019

Unusual presentation of primary lung adenocarcinoma mimicking pneumonia: Case report and literature review.

Respir Med Case Rep 2019 14;28:100881. Epub 2019 Jun 14.

Internal Medicine Department, Division of Pulmonary and Critical Care Medicine, Wayne State University School of Medicine, Detroit, MI, United States.

Primary lung adenocarcinoma, diffuse pneumonic type, can mimic the clinical presentation of an infectious or inflammatory lung disease, which can represent a diagnostic challenge. We present an unusual case of adenocarcinoma of the lung refractory to treatment, associated with rapid deterioration of respiratory status, ARDS requiring intubation and ultimately death.
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http://dx.doi.org/10.1016/j.rmcr.2019.100881DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6586773PMC
June 2019

Pulmonary complications of influenza infection: a targeted narrative review.

Postgrad Med 2019 Jun 20;131(5):299-308. Epub 2019 Mar 20.

a Division of Pulmonary, Critical Care and Sleep Medicine , Wayne State University, School of Medicine , Detroit , MI , USA.

Severe influenza infection represents a leading cause of global morbidity and mortality. Several clinical syndromes that involve a number of organs may be associated with Influenza infection. However, lower respiratory complications remain the most common and serious sequel of influenza infection. These include influenza pneumonia, superinfection with bacteria and fungi, exacerbation of underlying lung disease and ARDS. This review analyzes the available literature on the epidemiology and clinical considerations of these conditions. It also provides an overview of the effects of type of influenza, antiviral therapy, vaccination and other therapies on the outcome of these complications.
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http://dx.doi.org/10.1080/00325481.2019.1592400DOI Listing
June 2019

Noninvasive ventilation: education and training. A narrative analysis and an international consensus document.

Adv Respir Med 2019 4;87(1):36-45. Epub 2019 Mar 4.

Respiratory Unit, AO Ospedali dei Colli Naples PO, Monaldi, Italy.

Noninvasive ventilation (NIV) is an increasingly used method of respiratory support. The use of NIV is expanding over the time and if properly applied, it can save patients' lives and improve long-term prognosis. However, both knowledge and skills of its proper use as life support are paramount. This systematic review aimed to assess the importance of NIV education and training. Literature search was conducted (MEDLINE: 1990 to June, 2018) to identify randomized controlled studies and systematic reviews with the results analyzed by a team of experts across the world through e-mail based communications. Clinical trials examining the impact of education and training in NIV as the primary objective was not found. A few studies with indirect evidence, a simulation-based training study, and narrative reviews were identified. Currently organized training in NIV is implemented only in a few developed countries. Due to a lack of high-grade experimental evidence, an international consensus on NIV education and training based on opinions from 64 experts across the twenty-one different countries of the world was formulated. Education and training have the potential to increase knowledge and skills of the clinical staff who deliver medical care using NIV. There is a genuine need to develop structured, organized NIV education and training programs, especially for the developing countries.
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http://dx.doi.org/10.5603/ARM.a2019.0006DOI Listing
February 2020

Repeating blood cultures after initial bacteremia: When and how often?

Cleve Clin J Med 2019 Feb;86(2):89-92

Department of Medicine, Detroit Medical Center, Detroit, MI, USA.

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http://dx.doi.org/10.3949/ccjm.86a.18001DOI Listing
February 2019

Quantitative Imaging Markers of Lung Function in a Smoking Population Distinguish COPD Subgroups with Differential Lung Cancer Risk.

Cancer Epidemiol Biomarkers Prev 2019 04 14;28(4):724-730. Epub 2019 Jan 14.

Karmanos Cancer Institute, Detroit, Michigan.

Background: Chronic obstructive pulmonary disease (COPD) is a heterogeneous condition with respect to onset, progression, and response to therapy. Incorporating clinical- and imaging-based features to refine COPD phenotypes provides valuable information beyond that obtained from traditional clinical evaluations. We characterized the spectrum of COPD-related phenotypes in a sample of former and current smokers and evaluated how these subgroups differ with respect to sociodemographic characteristics, COPD-related comorbidities, and subsequent risk of lung cancer.

Methods: White ( = 659) and African American ( = 520) male and female participants without lung cancer (controls) in the INHALE study who completed a chest CT scan, interview, and spirometry test were used to define distinct COPD-related subgroups based on hierarchical clustering. Seven variables were used to define clusters: pack years, quit years, FEV/FVC, % predicted FEV, and from quantitative CT (qCT) imaging, % emphysema, % air trapping, and mean lung density ratio. Cluster definitions were then applied to INHALE lung cancer cases ( = 576) to evaluate lung cancer risk.

Results: Five clusters were identified that differed significantly with respect to sociodemographic (e.g., race, age) and clinical (e.g., BMI, limitations due to breathing difficulties) characteristics. Increased risk of lung cancer was associated with increasingly detrimental lung function clusters (when ordered from most detrimental to least detrimental).

Conclusions: Measures of lung function vary considerably among smokers and are not fully explained by smoking intensity.

Impact: Combining clinical (spirometry) and radiologic (qCT) measures of COPD defines a spectrum of lung disease that predicts lung cancer risk differentially among patient clusters.
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http://dx.doi.org/10.1158/1055-9965.EPI-18-0886DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6449213PMC
April 2019

Factors Associated with Mortality in Patients with a Solid Malignancy Admitted to the Intensive Care Unit - A Prospective Observational Study.

J Crit Care Med (Targu Mures) 2018 Oct 1;4(4):137-142. Epub 2018 Oct 1.

Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine, 3990 John R, 3 Hudson, Detroit MI 48201, USA.

Purpose: Several studies show conflicting results regarding the prognosis and predictors of the outcome of critically ill patients with a solid malignancy. This study aims to determine the outcome of critically ill patients, admitted to a hospital, with a solid malignancy and the factors associated with the outcomes.

Methods And Materials: All patients with a solid malignancy admitted to an intensive care unit (ICU) at a tertiary academic medical center were enrolled. Clinical data upon admission and during ICU stay were collected. Hospital, ICU, and six months outcomes were documented.

Results: There were 252 patients with a solid malignancy during the study period. Urogenital malignancies were the most common (26.3%) followed by lung cancer (23.5%). Acute respiratory failure was the most common ICU diagnosis (51.6%) followed by sepsis in 46%. ICU mortality and hospital mortality were 21.8% and 34.3%. Six months mortality was 38.4%. Using multivariate analysis, acute kidney injury, OR 2.82, 95% CI 1.50-5.32 and P=0.001, use of mechanical ventilation, OR 2.67 95% CI 1.37 - 5.19 and P=0.004 and performance status of ≥2 with OR of 3.05, 95% CI of 1.5-6.2 and P= 0.002 were associated with hospital mortality. There were no differences in outcome between African American patients (53% of all patients) and other races.

Conclusion: This study reports encouraging survival rates in patients with a solid malignancy who are admitted to ICU. Patients with a poor baseline performance status require mechanical ventilation or develop acute renal failure have worse outcomes.
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http://dx.doi.org/10.2478/jccm-2018-0019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6296272PMC
October 2018

Critically ill haematological cancer patients: How far the severity index score can determine the outcome and duration of aggressive support?

Aust Crit Care 2018 11 4;31(6):337-338. Epub 2018 Jul 4.

Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Raipur, India. Electronic address:

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http://dx.doi.org/10.1016/j.aucc.2018.06.002DOI Listing
November 2018

Migrating gossypiboma mimicking aspergilloma twenty years after mediastinal surgery.

Respir Med Case Rep 2018 23;25:184-186. Epub 2018 Aug 23.

American University of Beirut Medical Center, Division of Pulmonary and Critical Care, Lebanon.

A gossypiboma refers to a surgical sponge or gauze accidentally retained inside a patient during a procedure. It is more commonly encountered after abdominal surgeries. When seen in the thorax, it is usually located within the pleural cavity. We report a case of a 42-year old woman who was found to have a gossypiboma mimicking a simple aspergilloma twenty years after a left thoracotomy. The surgical gauze identified on a CT-scan of her chest appears to have migrated into her lung airways.
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http://dx.doi.org/10.1016/j.rmcr.2018.08.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6125766PMC
August 2018

Traumatic Pulmonary Pseudocyst Mimicking a Congenital Cystic Lung Disease.

Case Rep Pulmonol 2018 11;2018:7269694. Epub 2018 Jul 11.

American University of Beirut, Division of Pulmonary and Critical Care, Lebanon.

Traumatic pulmonary pseudocyst (TPP) is a rare entity that occurs following a trauma to the chest. It usually presents as multiple cystic lesions on thoracic imaging. It is treated conservatively and tends to completely resolve after few months. In the absence of striking signs of trauma such as rib fractures, TPP can be mistaken for other cystic lung diseases. We present a case of TPP in a 17-year-old male who was seen for mild hemoptysis after falling off a cliff. The extent of his right lower lobe cystic lesions along with the lack of major signs of trauma led to an incorrect diagnosis of congenital pulmonary airway malformation. The patient was considered for lobectomy, which he refused. Imaging of the chest repeated one and three years later showed complete resolution of the lesions.
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http://dx.doi.org/10.1155/2018/7269694DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6077363PMC
July 2018
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