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Weber AG, Mastroianni F, Koenig S, Mayo PH. Transesophageal Lung Ultrasonography as Part of the Critical Care Transesophageal Echocardiography Examination. Chest 2022; 161:e335-e336. [DOI: 10.1016/j.chest.2022.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 01/16/2022] [Indexed: 11/26/2022] Open
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Weber AG, Lou B, Simonson J, Rabascall C, Mayo P, Hasan Z. A 31-Year-Old Man With Respiratory Failure. Chest 2021; 159:e413-e415. [PMID: 34099160 DOI: 10.1016/j.chest.2020.03.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/06/2020] [Accepted: 03/13/2020] [Indexed: 10/21/2022] Open
Affiliation(s)
- Andrew G Weber
- Long Island Jewish Medical Center Ringgold standard institution-Pulmonology, Critical Care, and Sleep Medicine, New Hyde Park, NY; North Shore University Hospital at Manhasset Ringgold standard institution-Pulmonology, Critical Care, and Sleep Medicine, Manhasset, NY.
| | - Becky Lou
- The Long Island Jewish Medical Center-Medicine, New Hyde Park, NY
| | - Joseph Simonson
- Long Island Jewish Medical Center Ringgold standard institution-Pulmonology, Critical Care, and Sleep Medicine, New Hyde Park, NY; North Shore University Hospital at Manhasset Ringgold standard institution-Pulmonology, Critical Care, and Sleep Medicine, Manhasset, NY
| | - Carlos Rabascall
- Long Island Jewish Medical Center Ringgold standard institution-Pulmonology, Critical Care, and Sleep Medicine, New Hyde Park, NY; North Shore University Hospital at Manhasset Ringgold standard institution-Pulmonology, Critical Care, and Sleep Medicine, Manhasset, NY
| | - Paul Mayo
- Long Island Jewish Medical Center - Pulmonary and Critical Care Medicine, New Hyde Park, NY
| | - Zubair Hasan
- Northwell Health System-Pulmonary & Critical Care, Manhasset, NY
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Chau AS, Weber AG, Maria NI, Narain S, Liu A, Hajizadeh N, Malhotra P, Bloom O, Marder G, Kaplan B. The Longitudinal Immune Response to Coronavirus Disease 2019: Chasing the Cytokine Storm. Arthritis Rheumatol 2020; 73:23-35. [PMID: 32929876 DOI: 10.1002/art.41526] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/31/2020] [Indexed: 12/20/2022]
Abstract
The clinical progression of the severe acute respiratory syndrome coronavirus 2 infection, coronavirus 2019 (COVID-19), to critical illness is associated with an exaggerated immune response, leading to magnified inflammation termed the "cytokine storm." This response is thought to contribute to the pathogenicity of severe COVID-19. There is an initial weak interferon response and macrophage activation that results in delayed neutrophil recruitment leading to impeded viral clearance. This causes prolonged immune stimulation and the release of proinflammatory cytokines. Elevated inflammatory markers in COVID-19 (e.g., d-dimer, C-reactive protein, lactate dehydrogenase, ferritin, and interleukin-6) are reminiscent of the cytokine storm seen in severe hyperinflammatory macrophage disorders. The dysfunctional immune response in COVID-19 also includes lymphopenia, reduced T cells, reduced natural killer cell maturation, and unmitigated plasmablast proliferation causing aberrant IgG levels. The progression to severe disease is accompanied by endotheliopathy, immunothrombosis, and hypercoagulability. Thus, both parts of the immune system-innate and adaptive-play a significant role in the cytokine storm, multiorgan dysfunction, and coagulopathy. This review highlights the importance of understanding the immunologic mechanisms of COVID-19 as they inform the clinical presentation and advise potential therapeutic targets.
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Affiliation(s)
- Alice S Chau
- University of Washington Center for Immunity and Immunotherapies and Seattle Children's Research Institute, Seattle, Washington, United States
| | | | - Naomi I Maria
- Feinstein Institutes for Medical Research, Manhasset, New York, and Red Cross Blood Bank Foundation Curaçao, Willemstad, Curaçao
| | - Sonali Narain
- Northwell Health, Manhasset, New York, and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
| | - Audrey Liu
- Northwell Health, Manhasset, New York, United States
| | - Negin Hajizadeh
- Northwell Health, Manhasset, New York, and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
| | - Prashant Malhotra
- Northwell Health, Manhasset, New York, and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
| | - Ona Bloom
- Northwell Health, Manhasset, New York, and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
| | - Galina Marder
- Northwell Health, Manhasset, New York, and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
| | - Blanka Kaplan
- Northwell Health, Manhasset, New York, and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
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Narain S, Stefanov DG, Chau AS, Weber AG, Marder G, Kaplan B, Malhotra P, Bloom O, Liu A, Lesser ML, Hajizadeh N. Comparative Survival Analysis of Immunomodulatory Therapy for Coronavirus Disease 2019 Cytokine Storm. Chest 2020; 159:933-948. [PMID: 33075378 PMCID: PMC7567703 DOI: 10.1016/j.chest.2020.09.275] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/07/2020] [Accepted: 09/30/2020] [Indexed: 12/15/2022] Open
Abstract
Background Cytokine storm is a marker of coronavirus disease 2019 (COVID-19) illness severity and increased mortality. Immunomodulatory treatments have been repurposed to improve mortality outcomes. Research Question Do immunomodulatory therapies improve survival in patients with COVID-19 cytokine storm (CCS)? Study Design and Methods We conducted a retrospective analysis of electronic health records across the Northwell Health system. COVID-19 patients hospitalized between March 1, 2020, and April 24, 2020, were included. CCS was defined by inflammatory markers: ferritin, > 700 ng/mL; C-reactive protein (CRP), > 30 mg/dL; or lactate dehydrogenase (LDH), > 300 U/L. Patients were subdivided into six groups: no immunomodulatory treatment (standard of care) and five groups that received either corticosteroids, anti-IL-6 antibody (tocilizumab), or anti-IL-1 therapy (anakinra) alone or in combination with corticosteroids. The primary outcome was hospital mortality. Results Five thousand seven hundred seventy-six patients met the inclusion criteria. The most common comorbidities were hypertension (44%-59%), diabetes (32%-46%), and cardiovascular disease (5%-14%). Patients most frequently met criteria with high LDH (76.2%) alone or in combination, followed by ferritin (63.2%) and CRP (8.4%). More than 80% of patients showed an elevated D-dimer. Patients treated with corticosteroids and tocilizumab combination showed lower mortality compared with patients receiving standard-of-care (SoC) treatment (hazard ratio [HR], 0.44; 95% CI, 0.35-0.55; P < .0001) and with patients treated with corticosteroids alone (HR, 0.66; 95% CI, 0.53-0.83; P = .004) or in combination with anakinra (HR, 0.64; 95% CI, 0.50-0.81; P = .003). Corticosteroids when administered alone (HR, 0.66; 95% CI, 0.57-0.76; P < .0001) or in combination with tocilizumab (HR, 0.43; 95% CI, 0.35-0.55; P < .0001) or anakinra (HR, 0.68; 95% CI, 0.57-0.81; P < .0001) improved hospital survival compared with SoC treatment. Interpretation The combination of corticosteroids with tocilizumab showed superior survival outcome when compared with SoC treatment as well as treatment with corticosteroids alone or in combination with anakinra. Furthermore, corticosteroid use either alone or in combination with tocilizumab or anakinra was associated with reduced hospital mortality for patients with CCS compared with patients receiving SoC treatment.
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Affiliation(s)
- Sonali Narain
- Division of Rheumatology, Department of Medicine, Northwell Health, Great Neck, NY; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Hempstead, NY.
| | - Dimitre G Stefanov
- Biostatistics Unit, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY; Institute of Health Innovations and Outcomes Research, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY
| | - Alice S Chau
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington and Center for Immunity and Immunotherapies, Seattle Children's Research Institute, Seattle, WA
| | - Andrew G Weber
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Northwell Health, Manhasset, NY
| | - Galina Marder
- Division of Rheumatology, Department of Medicine, Northwell Health, Great Neck, NY; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Hempstead, NY
| | - Blanka Kaplan
- Division of Allergy and Immunology, Department of Pediatrics, Northwell Health, Great Neck, NY; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Hempstead, NY
| | - Prashant Malhotra
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Hempstead, NY; Division of Infectious Diseases, Department of Medicine, Northwell Health, Manhasset, NY
| | - Ona Bloom
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Hempstead, NY; Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, Manhasset, NY
| | - Audrey Liu
- Department of Medicine, Northwell Health, Manhasset, NY
| | - Martin L Lesser
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Hempstead, NY; Biostatistics Unit, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY; Institute of Health Innovations and Outcomes Research, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY; Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, Manhasset, NY
| | - Negin Hajizadeh
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Hempstead, NY; Institute of Health Innovations and Outcomes Research, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY; Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Northwell Health, Manhasset, NY
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Fryman C, Lou B, Weber AG, Steinberg HN, Khanijo S, Iakovou A, Makaryus MR. Acute Respiratory Failure Associated With Vaping. Chest 2020; 157:e63-e68. [PMID: 32145818 DOI: 10.1016/j.chest.2019.10.057] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 10/10/2019] [Accepted: 10/25/2019] [Indexed: 11/29/2022] Open
Abstract
The use of e-cigarettes to deliver aerosolized nicotine has gained popularity in recent years. Numerous reports have cited the development of acute pulmonary disease linked to vaping nicotine as well as marijuana-based products. As cultural attitudes evolve and policies shift toward the legalization of marijuana, its use has become more prevalent. Given the increased prevalence of marijuana consumption and e-cigarette usage, better insight into its potential to cause lung toxicity is warranted. The clinical, radiographic, and histopathologic characteristics of lung injury associated with vaping, particularly with marijuana-based products, have yet to be well described in the literature. We present eight patients, most of whom were admitted recently to our institution with acute respiratory failure following vaping. The majority of patients were young, with a median age of 31.5 years (range, 24-62 years) and with no known underlying lung disease. This case series highlights common clinical findings as well as the varied radiographic and histopathologic features of acute respiratory failure associated with vaping predominantly marijuana-based products. As more cases of vaping-associated pulmonary injury unfold, data will be available to further characterize this emerging disease entity. Improved understanding of disease pathogenesis and its clinical course will help clinicians determine optimal management and follow-up strategies for this patient population.
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Affiliation(s)
- Craig Fryman
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY.
| | - Becky Lou
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY
| | - Andrew G Weber
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY
| | - Harry N Steinberg
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY
| | - Sameer Khanijo
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY
| | - Annamaria Iakovou
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY
| | - Mina R Makaryus
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY
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Weber AG, Chau AS, Egeblad M, Barnes BJ, Janowitz T. Nebulized in-line endotracheal dornase alfa and albuterol administered to mechanically ventilated COVID-19 patients: A case series. medRxiv 2020. [PMID: 32511514 PMCID: PMC7273282 DOI: 10.1101/2020.05.13.20087734] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Mechanically ventilated patients with coronavirus disease 2019 (COVID-19) have a mortality of 24–53%, in part due to distal mucopurulent secretions interfering with ventilation. Dornase alfa is recombinant human DNase 1 and digests DNA in mucoid sputum. Nebulized dornase alfa is FDA-approved for cystic fibrosis treatment. DNA from neutrophil extracellular traps (NETs) contributes to the viscosity of mucopurulent secretions. NETs are found in the serum of patients with severe COVID-19, and targeting NETs reduces mortality in animal models of acute respiratory distress syndrome (ARDS). Thus, dornase alfa may be beneficial to patients with severe COVID-19—acting as a mucolytic and targeting NETs. However, delivery of nebulized drugs can aerosolize SARS-CoV-2, which causes COVID-19, increasing the infection risk for staff. Here, we report a single center case series where dornase alfa was administered through an in-line nebulizer system to minimize risk of virus aerosolization. Methods Demographic, clinical data, and outcomes were collected from the electronic medical records of five mechanically ventilated patients with COVID-19—including three requiring veno-venous extracorporeal membrane oxygenation (VV-ECMO)—treated with nebulized in-line endotracheal dornase alfa co-administered with albuterol (used to increase delivery to the alveoli), between March 31 and April 24, 2020. Data on tolerability and responses, including longitudinal values capturing respiratory function and inflammatory status, were analyzed. Results Following nebulized in-line administration of dornase alfa with albuterol, the fraction of inspired oxygen requirements was reduced for all five patients. All patients remain alive and two patients have been discharged from the intensive care unit. No drug associated toxicities were identified. Conclusions The results presented in this case series suggest that dornase alfa will be well-tolerated by critically ill patients with COVID-19. Clinical trials are required to formally test the dosing, safety, and efficacy of dornase alfa in COVID-19, and two have recently been registered (NCT04359654 and NCT04355364). With this case series, we hope to contribute to the development of management approaches for critically ill patients with COVID-19.
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Affiliation(s)
- Andrew G Weber
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Northwell Health, 300 Community Drive, Manhasset, NY, 11030
| | - Alice S Chau
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington and the Center for Immunity and Immunotherapies, Seattle Children's Research Institute, 1900 9 Ave, Seattle, WA 98101
| | - Mikala Egeblad
- Cancer Center, Cold Spring Harbor Laboratory, 1 Bungtown Road, Cold Spring Harbor, NY 11724
| | - Betsy J Barnes
- Center for Autoimmune, Musculoskeletal and Hematopoietic Diseases, The Feinstein Institutes for Medical Research and the Departments of Molecular Medicine and Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 350 Community Drive, Manhasset, NY, 11030
| | - Tobias Janowitz
- Cancer Center, Cold Spring Harbor Laboratory, 1 Bungtown Road, Cold Spring Harbor, NY 11724.,Northwell Health Cancer Institute, 450 Lakeville Road, New Hyde Park, NY 11042
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Weber AG, Perez T, Bouche O, Journu J, Poilblanc M, Levy-Chazal N, Avisse C, Lubrano D. [Fistula between Wirsung and psoas muscle]. ACTA ACUST UNITED AC 2005; 130:487-90. [PMID: 15982631 DOI: 10.1016/j.anchir.2005.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2004] [Indexed: 11/19/2022]
Abstract
We describe a rare case of fistula between the Wirsung duct and the right psoas muscle. The initial clinical presentation was localised in the thigh and successful treatment was achieved by exclusive mini-invasive techniques.
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Affiliation(s)
- A G Weber
- Service de chirurgie viscérale, digestive et endocrinienne, CHU Robert-Debré, avenue du Général-Koenig, 51100 Reims, France.
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Huang KS, Sawchuk AA, Jenkins BK, Chavel P, Wang JM, Weber AG, Wang CH, Glaser I. Digital optical cellular image processor (DOCIP): experimental implementation. Appl Opt 1993; 32:166-173. [PMID: 20802673 DOI: 10.1364/ao.32.000166] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
We demonstrate experimentally the concept of the digital optical cellular image processor architecture by implementing one processing element of a prototype optical computer that includes a 54-gate processor, an instruction decoder, and electronic input-output interfaces. The processor consists of a twodimensional (2-D) array of 54 optical logic gates implemented by use of a liquid-crystal light valve and a 2-D array of 53 subholograms to provide interconnections between gates. The interconnection hologram is fabricated by a computer-controlled optical system.
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