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Shouval R, Goldman A, Flynn JR, El-Moghraby A, Rehman M, Devlin SM, Corona M, Landego I, Lin RJ, Scordo M, Raj SS, Giralt SA, Palomba ML, Dahi PB, Walji M, Salles G, Nath K, Geyer MB, Park JH, Fein JA, Kosmidou I, Shah GL, Liu JE, Perales MA, Mahmood SS. Atrial arrhythmias following CAR-chimeric antigen receptor T-cell therapy: Incidence, risk factors and biomarker profile. Br J Haematol 2024. [PMID: 38735683 DOI: 10.1111/bjh.19497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 04/18/2024] [Indexed: 05/14/2024]
Abstract
Recent reports have raised concerns about the association of chimeric antigen receptor T cell (CAR-T) with non-negligible cardiotoxicity, particularly atrial arrhythmias. First, we conducted a pharmacovigilance study to assess the reporting of atrial arrhythmias following CD19-directed CAR-T. Subsequently, to determine the incidence, risk factors and outcomes of atrial arrhythmias post-CAR-T, we compiled a retrospective single-centre cohort of non-Hodgkin lymphoma patients. Only commercial CAR-T products were considered. Atrial arrhythmias were nearly fourfold more likely to be reported after CAR-T therapy compared to all other cancer patients in the FAERS (adjusted ROR = 3.76 [95% CI 2.67-5.29]). Of the 236 patients in our institutional cohort, 23 (10%) developed atrial arrhythmias post-CAR-T, including 12 de novo arrhythmias, with most (83%) requiring medical intervention. Atrial arrhythmias frequently co-occurred with cytokine release syndrome and were associated with higher post-CAR-T infusion peak levels of IL-10, TNF-alpha and LDH, and lower trough levels of fibrinogen. In a multivariable analysis, risk factors for atrial arrhythmia were history of atrial arrhythmia (OR = 6.80 [2.39-19.6]) and using CAR-T product with a CD28-costimulatory domain (OR = 5.17 [1.72-18.6]). Atrial arrhythmias following CD19-CAR-T therapy are prevalent and associated with elevated inflammatory biomarkers, a history of atrial arrhythmia and the use of a CAR-T product with a CD28 costimulatory domain.
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Mahmood SS, Riedell PA, Feldman S, George G, Sansoterra SA, Althaus T, Rehman M, Mead E, Liu JE, Devereux RB, Weinsaft JW, Kim J, Balkan L, Barbar T, Lee Chuy K, Harchandani B, Perales MA, Geyer MB, Park JH, Palomba ML, Shouval R, Tomas AA, Shah GL, Yang EH, Gaut DL, Rothberg MV, Horn EM, Leonard JP, Van Besien K, Frigault MJ, Chen Z, Mehrotra B, Neilan TG, Steingart RM. Biomarkers and cardiovascular outcomes in chimeric antigen receptor T-cell therapy recipients. Eur Heart J 2023; 44:2029-2042. [PMID: 36939851 PMCID: PMC10256191 DOI: 10.1093/eurheartj/ehad117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 02/10/2023] [Accepted: 02/16/2023] [Indexed: 03/21/2023] Open
Abstract
AIMS Chimeric antigen receptor T-cell therapy (CAR-T) harnesses a patient's immune system to target cancer. There are sparse existing data characterizing death outcomes after CAR-T-related cardiotoxicity. This study examines the association between CAR-T-related severe cardiovascular events (SCE) and mortality. METHODS AND RESULTS From a multi-centre registry of 202 patients receiving anti-CD19 CAR-T, covariates including standard baseline cardiovascular and cancer parameters and biomarkers were collected. Severe cardiovascular events were defined as a composite of heart failure, cardiogenic shock, or myocardial infarction. Thirty-three patients experienced SCE, and 108 patients died during a median follow-up of 297 (interquartile range 104-647) days. Those that did and did not die after CAR-T were similar in age, sex, and prior anthracycline use. Those who died had higher peak interleukin (IL)-6 and ferritin levels after CAR-T infusion, and those who experienced SCE had higher peak IL-6, C-reactive protein (CRP), ferritin, and troponin levels. The day-100 and 1-year Kaplan-Meier overall mortality estimates were 18% and 43%, respectively, while the non-relapse mortality (NRM) cumulative incidence rates were 3.5% and 6.7%, respectively. In a Cox model, SCE occurrence following CAR-T was independently associated with increased overall mortality risk [hazard ratio (HR) 2.8, 95% confidence interval (CI) 1.6-4.7] after adjusting for age, cancer type and burden, anthracycline use, cytokine release syndrome grade ≥ 2, pre-existing heart failure, hypertension, and African American ancestry; SCEs were independently associated with increased NRM (HR 3.5, 95% CI 1.4-8.8) after adjusting for cancer burden. CONCLUSION Chimeric antigen receptor T-cell therapy recipients who experience SCE have higher overall mortality and NRM and higher peak levels of IL-6, CRP, ferritin, and troponin.
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Milling TJ, Middeldorp S, Xu L, Koch B, Demchuk A, Eikelboom JW, Verhamme P, Cohen AT, Beyer-Westendorf J, Michael Gibson C, Lopez-Sendon J, Crowther M, Shoamanesh A, Coppens M, Schmidt J, Albaladejo P, Connolly SJ, Bastani A, Clark C, Concha M, Cornell J, Dombrowski K, Fermann G, Fulmer J, Goldstein J, Kereiakes D, Milling T, Pallin D, Patel N, Refaai M, Rehman M, Schmaier A, Schwarz E, Shillinglaw W, Spohn M, Takata T, Venkat A, Welker J, Welsby I, Wilson J, Van Keer L, Verschuren F, Blostein M, Eikelboom J, Althaus K, Berrouschot J, Braun G, Doeppner T, Dziewas R, Genth-Zotz S, Greinacher P, Hamann F, Hanses F, Heide W, Kallmuenzer B, Kermer P, Poli S, Royl G, Schellong S, Schnupp S, Schwarze J, Spies C, Thomalla G, von Mering M, Weissenborn K, Wollenweber F, Gumbinger C, Jaschinski U, Maschke M, Mochmann HC, Pfeilschifter W, Pohlmann C, Zahn R, Bouzat P, Schmidt J, Vallejo C, Floccard B, Coppens M, van Wissen S, Arellano-Rodrigo E, Valles E, Alikhan R, Breen K, Hall R, Crowther M, Albaladejo P, Cohen A, Demchuk A, Schmidt J, Wyse D, Garcia D, Prins M, Nakamya J, Büller H, Mahaffey KW, Alexander JH, Cairns J, Hart R, Joyner C, Raskob G, Schulman S, Veltkamp R, Meeks B, Zotova E, Ahmad S, Pinto T, Baker K, Dykstra A, Holadyk-Gris I, Malvaso A, Demchuk A. Final Study Report of Andexanet Alfa for Major Bleeding With Factor Xa Inhibitors. Circulation 2023; 147:1026-1038. [PMID: 36802876 DOI: 10.1161/circulationaha.121.057844] [Citation(s) in RCA: 32] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
BACKGROUND Andexanet alfa is a modified recombinant inactive factor Xa (FXa) designed to reverse FXa inhibitors. ANNEXA-4 (Andexanet Alfa, a Novel Antidote to the Anticoagulation Effects of Factor Xa Inhibitors) was a multicenter, prospective, phase-3b/4, single-group cohort study that evaluated andexanet alfa in patients with acute major bleeding. The results of the final analyses are presented. METHODS Patients with acute major bleeding within 18 hours of FXa inhibitor administration were enrolled. Co-primary end points were anti-FXa activity change from baseline during andexanet alfa treatment and excellent or good hemostatic efficacy, defined by a scale used in previous reversal studies, at 12 hours. The efficacy population included patients with baseline anti-FXa activity levels above predefined thresholds (≥75 ng/mL for apixaban and rivaroxaban, ≥40 ng/mL for edoxaban, and ≥0.25 IU/mL for enoxaparin; reported in the same units used for calibrators) who were adjudicated as meeting major bleeding criteria (modified International Society of Thrombosis and Haemostasis definition). The safety population included all patients. Major bleeding criteria, hemostatic efficacy, thrombotic events (stratified by occurring before or after restart of either prophylactic [ie, a lower dose, for prevention rather than treatment] or full-dose oral anticoagulation), and deaths were assessed by an independent adjudication committee. Median endogenous thrombin potential at baseline and across the follow-up period was a secondary outcome. RESULTS There were 479 patients enrolled (mean age, 78 years; 54% male, 86% White; 81% anticoagulated for atrial fibrillation at a median time of 11.4 hours since last dose, with 245 (51%) on apixaban, 176 (37%) on rivaroxaban, 36 (8%) on edoxaban, and 22 (5%) on enoxaparin. Bleeding was predominantly intracranial (n=331 [69%]) or gastrointestinal (n=109 [23%]). In evaluable apixaban patients (n=172), median anti-FXa activity decreased from 146.9 ng/mL to 10.0 ng/mL (reduction, 93% [95% CI, 94-93]); in rivaroxaban patients (n=132), it decreased from 214.6 ng/mL to 10.8 ng/mL (94% [95% CI, 95-93]); in edoxaban patients (n=28), it decreased from 121.1 ng/mL to 24.4 ng/mL (71% [95% CI, 82-65); and in enoxaparin patients (n=17), it decreased from 0.48 IU/mL to 0.11 IU/mL (75% [95% CI, 79-67]). Excellent or good hemostasis occurred in 274 of 342 evaluable patients (80% [95% CI, 75-84]). In the safety population, thrombotic events occurred in 50 patients (10%); in 16 patients, this occurred during treatment with prophylactic anticoagulation that began after the bleeding event. No thrombotic episodes occurred after oral anticoagulation restart. Specific to certain populations, reduction of anti-FXa activity from baseline to nadir significantly predicted hemostatic efficacy in patients with intracranial hemorrhage (area under the receiver operating characteristic curve, 0.62 [95% CI, 0.54-0.70]) and correlated with lower mortality in patients <75 years of age (adjusted P=0.022; unadjusted P=0.003). Median endogenous thrombin potential was within the normal range by the end of andexanet alfa bolus through 24 hours for all FXa inhibitors. CONCLUSIONS In patients with major bleeding associated with the use of FXa inhibitors, treatment with andexanet alfa reduced anti-FXa activity and was associated with good or excellent hemostatic efficacy in 80% of patients. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT02329327.
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Gendia A, Rehman M, Cota A, Gilbert J, Clark J. Can virtual reality technology be considered as a part of the surgical care pathway? Ann R Coll Surg Engl 2023; 105:2-6. [PMID: 36374265 PMCID: PMC9773243 DOI: 10.1308/rcsann.2022.0125] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2022] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Virtual reality (VR) is emerging as a new technology in the healthcare sector. It has been shown to enhance the patient's experience and satisfaction in various settings. This review aims to give a brief description of the use of VR and establish validity of its applications to improve the patient's pathway through surgery. METHODS A literature search was conducted using the PubMed and Embase™ databases to identify fields in which VR technology has been trialled in relation to surgery. The search terms 'virtual reality' and 'surgery' were employed. RESULTS Although benefits relating to VR use have been identified in mental health, obesity management, and physical and cognitive rehabilitation, those in surgery have been less well documented. There are, however, some important but limited benefits reported in managing surgery related stress and improving preoperative patient education as well as VR being an adjunct to some level of postoperative analgesia. CONCLUSIONS The current applications of VR in relation to surgical care fall into four main categories: preoperative education, supporting mental health, postoperative pain management, and pre and postoperative patient optimisation. Future studies and validation of VR applications should be carried out so the technology can be utilised throughout the entire patient pathway as VR surgical care bundles.
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Rehman M, Adiyaman A, Smit JJJ, Manfai B, Elvan A. Comparison of safety and efficacy between POLARx and Arctic Front cryoballoon ablation. Europace 2022. [DOI: 10.1093/europace/euac053.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Pulmonary vein isolation (PVI) remains the cornerstone of atrial fibrillation (AF) ablation. The POLARx cryoballoon, which maintains a constant balloon pressure during ablation, was recently introduced for the treatment of AF. We present a comparison of acute and follow-up efficacy and safety outcomes between POLARx and Arctic Front, a frequently used second-generation used cryoballoon.
Methods
251 consecutive patients who underwent first-time cryoballoon AF ablation with POLARx (n=118) or Arctic Front (n=133) with a follow-up of at least 6 months, were retrospectively included.
Results
Of the total 251 patients who were included, mean age was 63 ± 9 years and 161 (64%) participants were male. The majority of the patients suffered from paroxysmal atrial fibrillation (95%). Follow-up success rates did not significantly differ between the POLARx (79%) and Artic Front (75%) groups at 6 months. Antiarrhythmic drug-use after the blanking period of 3 months was 9% for the POLARx group. Complication rates, excluding groin complications, were low in both study groups and were not significantly different (4% in POLARx vs 3% in Arctic Front). Procedure times (71 ± 23 minutes vs. 120 ± 36 minutes) and fluoroscopy times (20 ± 10 minutes vs. 33 ± 18 minutes) were both more favourable in the POLARx group. Lastly, nadir balloon temperatures were significantly lower (-57 ± 7 ºC vs -51 ± 7 ºC) for the POLARx group for all pulmonary veins (p<0.001).
Conclusion
Cryoballoon AF ablation with the POLARx cryoballoon results in similar success and complication rates at 6 months, in comparison with Arctic Front. Procedure and fluoroscopy times are shorter and balloon nadir temperatures are significantly lower for the POLARx cryoballoon. This can lead to optimal logistics and thus cost-effective use of lab and personnel.
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Rehman M, El-Dabh A, Mandal S, Sattur S. A case report of a massive cardiac intimal sarcoma manifesting as syncope during a stress test. EUROPEAN HEART JOURNAL-CASE REPORTS 2021; 5:ytab258. [PMID: 34377908 PMCID: PMC8343455 DOI: 10.1093/ehjcr/ytab258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/24/2020] [Accepted: 06/07/2021] [Indexed: 11/21/2022]
Abstract
Background Syncope has many aetiologies but from a cardiac standpoint, if arrhythmogenic and ischaemic causes are not present, obstructive lesions should be considered. Cardiac spindle cell sarcomas are incredibly rare and difficult to cure. Case summary A 62-year-old man presented for exercise stress test and had a syncopal episode on the treadmill. He was found to have a massive mass obstructing the transmitral flow. Patient was taken to the operating room and the mass was resected successfully. Histopathological confirmation revealed the mass to be a cardiac intimal sarcoma. Patient was initiated on a trial regimen of doxorubin, ifosfamide, and mesna. Discussion Cardiac intimal sarcomas are aggressive cancers and are difficult to treat; there are no established treatment guidelines. They can lead to obstruction of blood flow through the cardiac chambers. From a cardiac perspective, without arrhythmogenic and ischaemic causes of syncope, obstructive lesions should be considered.
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Xing R, Mustapha O, Ali T, Rehman M, Zaidi SS, Baseer A, Batool S, Mukhtiar M, Shafique S, Malik M, Sohail S, Ali Z, Zahid F, Zeb A, Shah F, Yousaf A, Din F. Development, Characterization, and Evaluation of SLN-Loaded Thermoresponsive Hydrogel System of Topotecan as Biological Macromolecule for Colorectal Delivery. BIOMED RESEARCH INTERNATIONAL 2021; 2021:9968602. [PMID: 34285920 PMCID: PMC8275402 DOI: 10.1155/2021/9968602] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/21/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Chemotherapeutic drugs cause severe toxicities if administered unprotected, without proper targeting, and controlled release. In this study, we developed topotecan- (TPT-) loaded solid lipid nanoparticles (SLNs) for their chemotherapeutic effect against colorectal cancer. The TPT-SLNs were further incorporated into a thermoresponsive hydrogel system (TRHS) (TPT-SLNs-TRHS) to ensure control release and reduce toxicity of the drug. Microemulsion technique and cold method were, respectively, used to develop TPT-SLNs and TPT-SLNs-TRHS. Particle size, polydispersive index (PDI), and incorporation efficiency (IE) of the TPT-SLNs were determined. Similarly, gelation time, gel strength, and bioadhesive force studies of the TPT-SLNs-TRHS were performed. Additionally, in vitro release and pharmacokinetic and antitumour evaluations of the formulation were done. RESULTS TPT-SLNs have uniformly distributed particles with mean size in nanorange (174 nm) and IE of ~90%. TPT-SLNs-TRHS demonstrated suitable gelation properties upon administration into the rat's rectum. Moreover, drug release was exhibited in a control manner over an extended period of time for the incorporated TPT. Pharmacokinetic studies showed enhanced bioavailability of the TPT with improved plasma concentration and AUC. Further, it showed significantly enhanced antitumour effect in tumour-bearing mice as compared to the test formulations. CONCLUSION It can be concluded that SLNs incorporated in TRHS could be a potential source of the antitumour drug delivery with better control of the drug release and no toxicity.
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Rehman M, Lucero D, Khan S, Molina J. A RARE CASE OF AN ENDOBRONCHIAL PLASMACYTOMA. Chest 2020. [DOI: 10.1016/j.chest.2020.09.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Khan S, Rehman M, McElhaney N, Siddiqui F, Karki A. THAT NAGGING COUGH: INTRATHORACIC SCHWANNOMA WITH HORNERS SYNDROME. Chest 2020. [DOI: 10.1016/j.chest.2020.08.1430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Rehman M, Gondal A, Khan S, Rehman NU, Molina J. Neutropenic Enterocolitis and Rapid Spontaneous Resolution of Portal Venous Gas: A Non-Respiratory Manifestation of COVID-19. Cureus 2020; 12:e9445. [PMID: 32742892 PMCID: PMC7389872 DOI: 10.7759/cureus.9445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The COVID-19 pandemic is affecting millions across the globe. The population of immunosuppressed individuals are at greatest risk of morbidity and mortality. Data on COVID-19 induced illness in the immunocompromised host are sparse. We aim to highlight the possibility of atypical and non-respiratory presentations of COVID-19 (severe acute respiratory syndrome coronavirus 2, SARS-CoV-2) in immunosuppressed individuals as our case reveals a rare COVID-19 associated GI presentation of neutropenic enterocolitis with bloody diarrhea.
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Rehman M, Rehman NU. Precordial ECG Lead Mispositioning: Its Incidence and Estimated Cost to Healthcare. Cureus 2020; 12:e9040. [PMID: 32656045 PMCID: PMC7343296 DOI: 10.7759/cureus.9040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Mohamud AY, Griffith B, Rehman M, Miller D, Chebl A, Patel SC, Howell B, Kole M, Marin H. Intraluminal Carotid Artery Thrombus in COVID-19: Another Danger of Cytokine Storm? AJNR Am J Neuroradiol 2020; 41:1677-1682. [PMID: 32616585 DOI: 10.3174/ajnr.a6674] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 06/01/2020] [Indexed: 12/11/2022]
Abstract
Coronavirus disease 2019 (COVID-19) is associated with a severe inflammatory response. Inflammation affects atherosclerotic plaque vulnerability and promotes a thrombogenic environment. We report a series of 6 patients with COVID-19 with acute ischemic stroke due to intraluminal carotid artery thrombus presenting during an 8-day period. Six patients were included (5 men) with a mean age of 65.8 years (range, 55-78 years). COVID-19 was diagnosed by detection of Severe Acute Respiratory Syndrome coronavirus 2 in 5 patients and was presumed due to typical clinical and imaging findings in 1 patient. All patients had vascular risk factors including diabetes (83%), hyperlipidemia (100%), and smoking (17%). Four patients presented with large infarcts with initial NIHSS scores of 24-30. During their hospitalization, all patients had elevated D-dimer and C-reactive protein levels, 5 patients had elevated lactate dehydrogenase and ferritin levels, 3 had elevated interleukin-6 levels, and 2 had elevated troponin levels. Inflammation related to COVID-19 may result in rupture of vulnerable atherosclerotic plaques, resulting in thrombosis and acute ischemic stroke.
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Khan S, Rehman M, Achakzai B, Khan A, Khan I, McElhaney N, Siddiqui F, Karki A. Incidental intrathorcic schwannoma post upper respiratory tract infection associated with Horner's syndrome: A case report. Respir Med Case Rep 2020; 30:101126. [PMID: 32577367 PMCID: PMC7303989 DOI: 10.1016/j.rmcr.2020.101126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 06/09/2020] [Indexed: 11/09/2022] Open
Abstract
Background Schwannomas may remain asymptomatic, and may be discovered incidentally. Case presentation Here we describe a case of a young female complaining of upper respiratory tract symptoms who was incidentally found to have an intrathoracic neurogenic tumor consistent with schwannoma associated with Horner's syndrome. Biopsy of the tumor revealed S100, BCL-2 and CD 99+ compatible with schwannoma. Patient had brachial plexus exploration and dissection of thoracic inlet tumor resected through video assisted thoracoscopic surgery (VATS). Patient did exceptionally well afterwards with no documented Horner's symptoms. Conclusion Characterized as a rare case, this patient presented post viral infection and found to have a rare tumor. Successful surgical treatment alleviated her symptoms.
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Rehman M, Gondal A, Rehman NU. Atypical Manifestation of COVID-19-Induced Myocarditis. Cureus 2020; 12:e8685. [PMID: 32577331 PMCID: PMC7305571 DOI: 10.7759/cureus.8685] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/18/2020] [Indexed: 12/11/2022] Open
Abstract
We present a case of a 39-year-old male who presented with chest pain without fever or respiratory symptoms. Troponins were elevated and electrocardiogram (ECG) was inconclusive for ST-elevation myocardial infarction (STEMI). Angiography revealed normal coronaries and the patient was found to be coronavirus disease 2019 (COVID-19) positive; he was diagnosed with COVID-19 myocarditis. With the global pandemic, more cases are emerging regarding myocardial injury induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. Although COVID-19 manifests primarily as respiratory disease, few cases of cardiac injury without respiratory involvement or febrile illness have been reported. This case illustrates that COVID-19 can present atypically and affect an isolated non-respiratory organ system.
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Rehman M, Sharma S. RISK CONSIDERATIONS OF LARGE PAPILLARY FIBROELASTOMAS: A CASE OF RISK VS. BENEFIT IN AN OCTOGENARIAN. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)33584-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rehman M, Sharma S, Ronsivalle J, Rehman N, McClintic B. A UNIQUE RCA: AN ANOMALOUS ORIGIN WITH A COURSE BETWEEN THE GREAT VESSELS. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)33767-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Rehman M, Sharma S, Ronsivalle J, Rehman N, Aitsebaomo J. THE IMPLICATIONS OF AN ANATOMICAL ANOMALY: A CASE OF AN INTRACAMERAL RIGHT CORONARY ARTERY (RCA). J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)33766-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Rehman M, Roden A, Mansfield A. P1.06-22 Pathologic and Imaging Response Correlations in Patients Treated with Neoadjuvant Chemotherapy for Mesothelioma. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mishra NK, Mishra JK, Srivastava GN, Shah D, Rehman M, Latheef NA, Maurya A, Rajak BK. Should vitamin D be routinely checked for all chronic obstructive pulmonary disease patients? Lung India 2019; 36:492-498. [PMID: 31670296 PMCID: PMC6852226 DOI: 10.4103/lungindia.lungindia_141_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Aims and Objectives: This study aimed to compare the vitamin D levels between chronic obstructive pulmonary disease (COPD) patients and healthy controls and to describe the correlation between vitamin D levels and lung functions. Methods: Fifty COPD patients (cases) and 30 healthy volunteers (controls) were recruited and their serum vitamin D level was measured together with lung function (forced vital capacity and forced expiratory volume in 1 s [FEV1]) by spirometry. vitamin D was categorized as ≤20 nmol/l: deficient, 21–50 nmol/l: inadequate, and ≥51 nmol/l as sufficient. Results: In this case–control cross-sectional study, lower vitamin D levels were associated with lower lung function in both cases as well as controls, the effect being more pronounced in cases. Mean FEV1 at vitamin D ≤20 nmol/l (0.98 ± 0.40 vs. controls 1.93 ± 0.24 with P = 0.006), mean FEV1 at vitamin D 21–50 nmol/l (1.55 ± 0.54 vs. 2.20 ± 0.31 with P = 0.000), and mean FEV1 at vitamin D ≥51 nmol/l (2.06 ± 0.54 vs. 2.20 ± 0.31 with P = 0.002). Moreover, the severity of predicted postbronchodilator FEV1% was also much lower among COPD cohort versus healthy volunteers (mean FEV1%: cases 47.88 ± 14.22 vs. controls 58.76 ± 15.05 with P = 0.002). Conclusions: Importantly, lung function in both the groups was affected by decreased vitamin D level; decrease in FEV1 was more pronounced among COPD patients compared to controls showing more expiratory airflow limitation. Vitamin D levels are associated with changes in lung function in cases of COPD as well as healthy controls. Larger studies to confirm the association in Indian context are required and routine assessment of vitamin D may be undertaken to obviate the effects of low vitmain D level on lung function.
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Garcia R, Guenancia C, Le Gal F, Rehman M, Tao Kong Man V, Christiaens L, Ingrand P, Degand B. Contractibility sensor signal evolution predicts cardiovascular events in patients with cardiac resynchronization therapy. ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2019. [DOI: 10.1016/j.acvdsp.2018.10.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Krishnamachari B, Rehman M, Cohn JE, Chan V, Modi N, Leitner O, Tangney K, O'Connor A, Blazey W, Koehler S, Tegay D. Video Education on Hereditary Breast and Ovarian Cancer (HBOC) for Physicians: an Interventional Study. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:1213-1221. [PMID: 28573517 DOI: 10.1007/s13187-017-1233-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The National Comprehensive Cancer Network (NCCN) guidelines are the gold standard in hereditary cancer risk assessment, screening, and treatment. A minority of physicians follow NCCN guidelines for BRCA1 or BRCA2 mutations. This study assesses the impact of an interventional educational program on HBOC in terms of knowledge. Physicians were sent an invite to join either an intervention survey (web-training offered prior to the knowledge survey) or control survey (web-training offered after the knowledge survey). Sixty-nine physicians in the intervention arm and 67 physicians in the control arm completed the survey. The interventional group regularly answered items correctly at a higher frequency than the control group. For example, 64.71% (n = 44) of physicians in the intervention group knew that multi-gene testing does not have to include only highly penetrant genes compared to 32.84% (n = 22) of the control group (p < 0.01). Similar results were seen with other specific survey items. The current study is important in that it shows web-based education to be a feasible and effective modality for training on hereditary breast cancer. This type of education may be incorporated into CME programs and can be used as a foundation for further studies as well.
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Hummaira Qudsia Y, Rehman M. Explore the Factors Affecting Behavioral and Psychological Changes on Obstetricians/Gynecologists in Maternal Health Care Center. CLINICAL SOCIAL WORK AND HEALTH INTERVENTION 2018. [DOI: 10.22359/cswhi_9_3_03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Kocijan T, Cappelletto A, Rehman M, Tang Y, Vodret S, Zentilin L, Giacca M, Zacchigna S. Understanding the poor angiogenic capacity of the mammalian heart. Vascul Pharmacol 2018. [DOI: 10.1016/j.vph.2017.12.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Schaerer F, Kerforne T, Lacroix C, Chauvet S, Rayed-Pelardy F, Biedermann C, Lequeux B, Corbi P, Christiaens L, Rehman M, Larrieu-Ardilouze E. Predictors for myocardial recovery of patients implanted with an ECMO device following myocardial infarction. ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2018. [DOI: 10.1016/j.acvdsp.2017.11.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Khatoon SS, Rehman M, Rahman A. The Role of Natural Products in Alzheimer's and Parkinson's Disease. STUDIES IN NATURAL PRODUCTS CHEMISTRY 2018. [DOI: 10.1016/b978-0-444-64058-1.00003-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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