1
|
Gao L, Dhilipkannah P, Holden VK, Deepak J, Sachdeva A, Todd NW, Stass SA, Jiang F. Differential Non-Coding RNA Profiles for Lung Cancer Early Detection in African and White Americans. medRxiv 2024:2024.03.27.24304977. [PMID: 38585975 PMCID: PMC10996737 DOI: 10.1101/2024.03.27.24304977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Introduction Lung cancer leads in cancer-related deaths. Disparities are observed in lung cancer rates, with African Americans (AAs) experiencing disproportionately higher incidence and mortality compared to other ethnic groups. Non-coding RNAs (ncRNAs) play crucial roles in lung tumorigenesis. Our objective was to identify ncRNA biomarkers associated with the racial disparity in lung cancer. Methods Using droplet digital PCR, we examined 93 lung-cancer-associated ncRNAs in the plasma and sputum samples from AA and White American (WA) participants, which included 118 patients and 92 cancer-free smokers. Subsequently, we validated our results with a separate cohort comprising 56 cases and 72 controls. Results In the AA population, plasma showed differential expression of ten ncRNAs, while sputum revealed four ncRNAs when comparing lung cancer patients to the control group. In the WA population, the plasma displayed eleven ncRNAs, and the sputum had five ncRNAs showing differential expression between the lung cancer patients and the control group. For AAs, we identified a three-ncRNA panel (plasma miRs-147b, 324-3p, 422a) diagnosing lung cancer in AAs with 86% sensitivity and 89% specificity. For WAs, a four-ncRNA panel was developed, comprising sputum miR-34a-5p and plasma miRs-103-3p, 126-3p, 205-5p, achieving 88% sensitivity and 87% specificity. These panels remained effective across different stages and histological types of lung tumors and were validated in the independent cohort. Conclusions The ethnicity-related ncRNA signatures have promise as biomarkers to address the racial disparity in lung cancer.
Collapse
|
2
|
Verdone JE, Marciniak ET, Deepak J. Tobacco treatment in the setting of lung cancer screening. Curr Opin Pulm Med 2024; 30:3-8. [PMID: 37933671 DOI: 10.1097/mcp.0000000000001030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
PURPOSE OF REVIEW Lung cancer screening by low-dose CT is an increasingly implemented preventive medicine tool. Screening for lung cancer is incomplete without addressing problematic tobacco use, the greatest modifiable risk factor in the development of lung cancer. This review describes recent work related to lung cancer screening and treatment of tobacco use in that context. RECENT FINDINGS Implementation of lung cancer screening demonstrates socioeconomic disparities in terms of adherence to screening as well as likelihood of successful tobacco dependence treatment. Active tobacco dependence is a common comorbidity for patients undergoing lung cancer screening. The optimal implementation of tobacco dependence treatment in the context of lung cancer screening is still an area of active investigation. SUMMARY Treatment of tobacco dependence at time of lung cancer screening is a major opportunity for clinicians to intervene to reduce the major modifiable risk factor for lung cancer, tobacco use. Providing comprehensive tobacco dependence treatment is most effective using combination pharmacologic and behavioral interventions. Practices providing comprehensive treatment will benefit from accurate documentation for billing and coding and supplementing with external resources such as state Quit Lines.
Collapse
Affiliation(s)
- James E Verdone
- Department of Medicine, Division of Pulmonary & Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | | |
Collapse
|
3
|
Melzer AC, Reese ZA, Mascarhenas L, Clancy CB, Deepak J, Gogineni H, Gesthalter Y, Hart JL. Education for Tobacco Use Disorder Treatment: Current State, Evidence, and Unmet Needs. ATS Sch 2023; 4:546-566. [PMID: 38196686 PMCID: PMC10773493 DOI: 10.34197/ats-scholar.2022-0131re] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 06/20/2023] [Indexed: 01/11/2024] Open
Abstract
Background Tobacco use is undertreated in the medical setting. One driver may be inadequate tobacco use disorder treatment (TUDT) training for clinicians in specialties treating tobacco-dependent patients. Objective We sought to evaluate the current state of TUDT training for diverse professionals and how these skills are assessed in credentialing exams. Methods We performed a focused review of current educational practices, evidence-based strategies, and accreditation exam contents focused on TUDT. Results Among medical students, participants in reviewed studies reported anywhere from 45 minutes to 3 hours of TUDT training throughout their 4-year programs, most often in the form of didactic sessions. Similarly, little TUDT training was reported at the post-graduate (residency, fellowship, continuing medical education) levels, and reported training was typically delivered as time-based (expected hours of instruction) rather than competency-based (demonstration of mastery) learning. Multiple studies evaluated effective TUDT curricula at varied stages of training. More effective curricula incorporated longitudinal sessions and active learning, such as standardized patient encounters or proctored patient visits. Knowledge of TUDT is minimally evaluated on certification exams. For example, the American Board of Internal Medicine blueprint lists TUDT as <2% of one subtopic on both the internal medicine and pulmonary exams. Conclusion TUDT training for most clinicians is minimal, does not assess competency, and is minimally evaluated on certification exams. Effective, evidence-based TUDT training incorporating active learning should be integrated into medical education at all levels, with attention paid to inclusion on subsequent certifying exams.
Collapse
Affiliation(s)
- Anne C. Melzer
- Center for Care Delivery and Outcomes
Research, Minneapolis VA Health Care System, Minneapolis, Minnesota
- Division of Pulmonary, Allergy, Critical
Care, and Sleep, and
| | - Zachary A. Reese
- Division of Pulmonary, Allergy, and
Critical Care, Department of Medicine
| | - Lorraine Mascarhenas
- Department of Internal Medicine,
University of Minnesota Medical School, Minneapolis, Minnesota
| | - Caitlin B. Clancy
- Division of Pulmonary, Allergy, and
Critical Care, Department of Medicine
| | - Janaki Deepak
- Division of Pulmonary and Critical Care,
Department of Medicine, University of Maryland School of Medicine, Baltimore,
Maryland
| | - Hyma Gogineni
- Department of Pharmacy, Western University
of Health Sciences, Pomona, California
| | - Yaron Gesthalter
- Department of Pulmonary and Critical Care,
University of California San Francisco, San Francisco, California; and
| | - Joanna L. Hart
- Division of Pulmonary, Allergy, and
Critical Care, Department of Medicine
- Palliative and Advanced Illness Research
Center, and
- Department of Medical Ethics and Health
Policy, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Medicine, Corporal Michael
J. Crescenz Department of Veterans Affairs Medical Center, Philadelphia,
Pennsylvania
| |
Collapse
|
4
|
Lang AE, Kathuria H, Braillon A, Ewart G, Dagli E, Stepp EL, Galiatsatos P, Deepak J, Jordt SE, Hayes D. England Is Handing out E-Cigarettes: Is the "Swap to Stop" Tobacco Control Scheme Harm Reduction or Harm Production? Am J Respir Crit Care Med 2023; 208:1024-1025. [PMID: 37682082 PMCID: PMC10867939 DOI: 10.1164/rccm.202308-1354vp] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 09/08/2023] [Indexed: 09/09/2023] Open
Affiliation(s)
- Adam Edward Lang
- Department of Family Medicine and Population Health, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Hasmeena Kathuria
- The Pulmonary Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | | | - Gary Ewart
- American Thoracic Society, Washington, DC
| | - Elif Dagli
- Marmara University, Health Institute Association, Istanbul, Turkey
| | - Evan L. Stepp
- Division of Pulmonary, Critical Care & Sleep Medicine, National Jewish Health, Highlands Ranch, Colorado
| | - Panagis Galiatsatos
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Janaki Deepak
- Veterans Affairs Maryland Health Care System, Baltimore Veterans Affairs Medical Center, Baltimore, Maryland
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Sven E. Jordt
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina; and
| | - Don Hayes
- Department of Pediatrics, Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| |
Collapse
|
5
|
Patel P, Abbas H, Alghanim F, Deepak J. Incidental Pulmonary Nodules and Lung Cancer Screening. ATS Sch 2023; 4:243-245. [PMID: 37538072 PMCID: PMC10394585 DOI: 10.34197/ats-scholar.2022-0055vo] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 01/31/2023] [Indexed: 08/05/2023] Open
Abstract
Incidental nodules and lung cancer screening nodules are causes of concern and anxiety for the patients. Both these require diligent follow up according to their respective guidelines.
Collapse
Affiliation(s)
| | - Hatoon Abbas
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Fahid Alghanim
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Janaki Deepak
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| |
Collapse
|
6
|
Khanna N, Klyushnenkova E, Gaynor A, Dark M, Melamed J, Bennett M, Deepak J. Integrating a Systematic, Comprehensive E-Cigarette and Vaping Assessment Tool into the Electronic Health Record. J Am Board Fam Med 2023; 36:405-413. [PMID: 37290827 DOI: 10.3122/jabfm.2022.220410r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/08/2023] [Accepted: 02/13/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Recently, the use of electronic cigarettes increased sharply, leading to increased e-cigarette, or Vaping Product Use-Associated Lung Injury (EVALI), and other acute pulmonary conditions. There is an urgent need for clinical information about e-cigarette users to identify factors that contribute to EVALI. We developed an e-cigarette/vaping assessment tool (EVAT) that was integrated into the Electronic Health Record (EHR) of a large state-wide medical system and initiated a system-wide dissemination and education to support its use. METHODS EVAT documented current vaping status, history, and e-cigarette content (nicotine, cannabinoids, and/or flavoring). Educational materials and presentations were developed via a comprehensive literature review. EVAT utilization in the EHR was assessed quarterly. Patients' demographic data and clinical site name were also collected. RESULTS The EVAT was built, validated, and integrated with the EHR in July 2020. Live and virtual seminars were conducted for prescribing providers and clinical staff. Asynchronous training was offered using podcasts, e-mails, and Epic tip sheets. Participants were informed about vaping harm and EVALI and instructed on the use of EVAT. As of December 31, 2022, EVAT was used 988,181 times, with 376,559 unique patients evaluated. Overall, 1,063 hospital units and affiliated ambulatory clinics used EVAT, including 64 Primary Care, 95 Pediatrics, and 874 Specialty sites. CONCLUSIONS EVAT was successfully implemented. Continued outreach efforts are needed to further increase its usage. Education materials should be enhanced to help providers to reach youth and vulnerable populations and connect patients to the tobacco treatment resources.
Collapse
Affiliation(s)
- Niharika Khanna
- From the Department of Family and Community Medicine, University of Maryland, Baltimore, (NK, EK, AG, MD); Department of Internal Medicine, Department of Pulmonology and Critical Care, University of Maryland, Baltimore (JM, JD); Department of Psychiatry, University of Maryland, Baltimore (MB)
| | - Elena Klyushnenkova
- From the Department of Family and Community Medicine, University of Maryland, Baltimore, (NK, EK, AG, MD); Department of Internal Medicine, Department of Pulmonology and Critical Care, University of Maryland, Baltimore (JM, JD); Department of Psychiatry, University of Maryland, Baltimore (MB)
| | - Adam Gaynor
- From the Department of Family and Community Medicine, University of Maryland, Baltimore, (NK, EK, AG, MD); Department of Internal Medicine, Department of Pulmonology and Critical Care, University of Maryland, Baltimore (JM, JD); Department of Psychiatry, University of Maryland, Baltimore (MB)
| | - Michael Dark
- From the Department of Family and Community Medicine, University of Maryland, Baltimore, (NK, EK, AG, MD); Department of Internal Medicine, Department of Pulmonology and Critical Care, University of Maryland, Baltimore (JM, JD); Department of Psychiatry, University of Maryland, Baltimore (MB)
| | - Julia Melamed
- From the Department of Family and Community Medicine, University of Maryland, Baltimore, (NK, EK, AG, MD); Department of Internal Medicine, Department of Pulmonology and Critical Care, University of Maryland, Baltimore (JM, JD); Department of Psychiatry, University of Maryland, Baltimore (MB)
| | - Melanie Bennett
- From the Department of Family and Community Medicine, University of Maryland, Baltimore, (NK, EK, AG, MD); Department of Internal Medicine, Department of Pulmonology and Critical Care, University of Maryland, Baltimore (JM, JD); Department of Psychiatry, University of Maryland, Baltimore (MB)
| | - Janaki Deepak
- From the Department of Family and Community Medicine, University of Maryland, Baltimore, (NK, EK, AG, MD); Department of Internal Medicine, Department of Pulmonology and Critical Care, University of Maryland, Baltimore (JM, JD); Department of Psychiatry, University of Maryland, Baltimore (MB)
| |
Collapse
|
7
|
Li N, Zhou H, Holden VK, Deepak J, Dhilipkannah P, Todd NW, Stass SA, Jiang F. Streptococcus pneumoniae promotes lung cancer development and progression. iScience 2023; 26:105923. [PMID: 36685035 PMCID: PMC9852931 DOI: 10.1016/j.isci.2022.105923] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 11/12/2022] [Accepted: 12/30/2022] [Indexed: 01/06/2023] Open
Abstract
Streptococcus pneumoniae (SP) is associated with lung cancer, yet its role in the tumorigenesis remains uncertain. Herein we find that SP attaches to lung cancer cells via binding pneumococcal surface protein C (PspC) to platelet-activating factor receptor (PAFR). Interaction between PspC and PAFR stimulates cell proliferation and activates PI3K/AKT and nuclear factor kB (NF-kB) signaling pathways, which trigger a pro-inflammatory response. Lung cancer cells infected with SP form larger tumors in BALB/C mice compared to untreated cells. Mice treated with tobacco carcinogen and SP develop more lung tumors and had shorter survival period than mice treated with the carcinogen alone. Mutating PspC or PAFR abolishes tumor-promoting effects of SP. Overabundance of SP is associated with the survival. SP may play a driving role in lung tumorigenesis by activating PI3K/AKT and NF-kB pathways via binding PspC to PAFR and provide a microbial target for diagnosis and treatment of the disease.
Collapse
Affiliation(s)
- Ning Li
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Huifen Zhou
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Van K. Holden
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Janaki Deepak
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Pushpa Dhilipkannah
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Nevins W. Todd
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sanford A. Stass
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Feng Jiang
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, USA
| |
Collapse
|
8
|
Marciniak ET, LaRocco AM, Deepak J. Promoting Training and Education in Tobacco Dependence Treatment. Respir Med 2023. [DOI: 10.1007/978-3-031-24914-3_13] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
|
9
|
Unger S, Golden SE, Melzer AC, Tanner N, Deepak J, Delorit M, Scott JY, Slatore CG. Study design for a proactive teachable moment tobacco treatment intervention among patients with pulmonary nodules. Contemp Clin Trials 2022; 121:106908. [PMID: 36087843 DOI: 10.1016/j.cct.2022.106908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/19/2022] [Revised: 09/01/2022] [Accepted: 09/01/2022] [Indexed: 01/27/2023]
Abstract
INTRODUCTION We developed Teachable Moment to Opt-Out of Tobacco (TeaM OUT) as a tobacco treatment intervention based on a foundation of a theoretical model of teachable moments, "naturally occurring life transitions or health events thought to motivate individuals to spontaneously adopt risk-reducing health behaviors". The TeaM OUT intervention combines a teachable moment for patients with newly detected incidental pulmonary nodules with a proactive interactive voice response (IVR) system to increase connections to evidence-based tobacco treatment interventions. METHODS We will perform a convergent, nested observational mixed-methods study utilizing both randomized trial and observational methods to test the effectiveness and generalizability of the TeaM OUT intervention through three aims. AIM 1: Among patients recently diagnosed with a pulmonary nodule, we will utilize a pragmatic, stepped wedge randomized controlled design to evaluate the effectiveness of a proactive, teachable moment-based, tobacco treatment outreach intervention (TeaM OUT) on increasing engagement with tobacco treatment resources compared to Enhanced Usual Care. AIM 2: Using a longitudinal observational design, we will evaluate the association of receipt of the TeaM OUT intervention with seven-day point abstinence prevalence and quit motivation compared to Enhanced Usual Care. AIM 3: Qualitatively elicit perspectives from key stakeholders to inform acceptability and utility, implementation barriers and facilitators, and scalability of the TeaM OUT intervention. DISCUSSION We are hopeful that implementation of TeaM OUT will increase the number of patients who quit using cigarettes with subsequent improvements in their health.
Collapse
Affiliation(s)
- Stephanie Unger
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System; Portland, OR, USA
| | - Sara E Golden
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System; Portland, OR, USA.
| | - Anne C Melzer
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System; Minneapolis, MN, USA; Division of Pulmonary, Allergy, Critical Care and Sleep, Department of Medicine, University of Minnesota; Minneapolis, MN, USA
| | - Nichole Tanner
- Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Veteran Affairs Hospital, Charleston, SC, USA; Division of Pulmonary, Critical Care, Allergy & Sleep, Department of Medicine, Medical University of South Carolina; Charleston, SC, USA
| | - Janaki Deepak
- Division of Pulmonary & Critical Care Medicine, University of Maryland Medical System; Baltimore, MD, USA; Baltimore VA Medical Center; Baltimore, MD, USA
| | - Molly Delorit
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System; Portland, OR, USA
| | - Jennifer Y Scott
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System; Portland, OR, USA
| | - Christopher G Slatore
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System; Portland, OR, USA; Section of Pulmonary & Critical Care Medicine, VA Portland Health Care System; Portland, OR, USA; Division of Pulmonary & Critical Care Medicine, Department of Medicine, Oregon Health & Science University; Portland, OR, USA
| |
Collapse
|
10
|
Grier W, Abbas H, Gebeyehu RR, Singh AK, Ruiz J, Hines S, Alghanim F, Deepak J. Military exposures and lung cancer in United States veterans. Semin Oncol 2022; 49:S0093-7754(22)00050-1. [PMID: 35882571 DOI: 10.1053/j.seminoncol.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/24/2022] [Accepted: 06/25/2022] [Indexed: 11/11/2022]
Abstract
Lung cancer screening begins at age 50, with yearly low dose computed tomography (LDCT) scans until age 80, for patients determined to be high risk due to tobacco smoking. Veterans serving from World War II to the Gulf War are now at the age where LDCT is recommended. This recommendation from the United States Preventative Service Task Force includes patients who have a 20-pack year tobacco history and currently smoke or quit within the last 15 years. This recommendation does not consider additional risk factors such as exposures to lung carcinogens. We discuss unique operational and occupational exposures encountered while serving in the armed forces, which may potentially increase the risk of lung cancers in the Veteran population. The additional risk of lung cancer due to military exposure history is unclear and more work is needed to identify and quantify risk at an individual level. Increasing awareness at the provider level regarding the carcinogenic exposures encountered may allow a larger population of Veterans, not meeting traditional LDCT criteria, to benefit from lung cancer screening.
Collapse
Affiliation(s)
- William Grier
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Maryland Medical Center, Baltimore, MD, United States
| | - Hatoon Abbas
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Maryland Medical Center, Baltimore, MD, United States
| | - Rediet Regassa Gebeyehu
- Department of Medicine (Hematology & Oncology), Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Ankur Kumar Singh
- Department of Medicine (Hematology & Oncology), Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Jimmy Ruiz
- Department of Medicine (Hematology & Oncology), Wake Forest School of Medicine, Winston-Salem, NC, United States; Department of Medicine, W.G. (Bill) Hefner Veteran Administration Medical Center, Cancer Center, Salisbury, NC, United States
| | - Stella Hines
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Maryland Medical Center, Baltimore, MD, United States; Baltimore VA Medical Center, Department of Medicine, Baltimore, MD, United States
| | - Fahid Alghanim
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Maryland Medical Center, Baltimore, MD, United States
| | - Janaki Deepak
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Maryland Medical Center, Baltimore, MD, United States; Baltimore VA Medical Center, Department of Medicine, Baltimore, MD, United States.
| |
Collapse
|
11
|
Alghanim F, Li KZ, An M, Verceles AC, Grier WR, Abbas H, Deepak J. Exploring the effects of racial and socioeconomic factors on timeliness of lung cancer diagnosis and treatment in Baltimore Veterans. Semin Oncol 2022; 49:S0093-7754(22)00055-0. [PMID: 35927100 DOI: 10.1053/j.seminoncol.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/30/2022] [Accepted: 07/01/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To characterize the effect of racial and socioeconomic factors on the timeliness of lung cancer diagnosis and treatment in a single-center Veterans Affair Medical Center (VAMC) pulmonary nodule clinic. METHODS We conducted a single-center retrospective review of all patients seen at the Baltimore VAMC pulmonary nodule clinic between 2013 and 2019 to identify key demographic factors, measures of neighborhood socioeconomic disadvantage, cancer staging and histopathologic information, and time elapsed between diagnosis and treatment. We excluded patients with pulmonary nodules undergoing active surveillance, prior history of lung cancer, metastases of a different primary origin, insufficient followup, or who had received care outside the VHA system. RESULTS Median times to diagnosis and treatment of lung cancer were 28 and 73 days. There were no statistically significant differences in overall timeliness of diagnosis and treatment when stratified by race or measures of neighborhood socioeconomic disadvantage. CONCLUSIONS The authors found no differences in timeliness of lung cancer care by race and socioeconomic status within the system. Despite general adherence to national standards in timeliness of care, there continues to be a need for improvements in the operational workflows to reduce time to diagnosis and treatment for all Veterans.
Collapse
Affiliation(s)
- Fahid Alghanim
- Veterans Affairs Maryland Health Care System, Baltimore VA Medical Center, Baltimore, MD, USA; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kevin Z Li
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Max An
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Avelino C Verceles
- Veterans Affairs Maryland Health Care System, Baltimore VA Medical Center, Baltimore, MD, USA; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - William R Grier
- Veterans Affairs Maryland Health Care System, Baltimore VA Medical Center, Baltimore, MD, USA; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Hatoon Abbas
- Veterans Affairs Maryland Health Care System, Baltimore VA Medical Center, Baltimore, MD, USA; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Janaki Deepak
- Veterans Affairs Maryland Health Care System, Baltimore VA Medical Center, Baltimore, MD, USA; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
| |
Collapse
|
12
|
Kumar AJ, Tran DH, Sivasailam B, Nagaria Z, Patel J, Verceles AC, Deepak J. The Effect of a Dedicated Lung Mass Clinic on Lung Nodule Follow Up. APHE 2022; 1. [PMID: 35994029 PMCID: PMC9387331 DOI: 10.33552/aphe.2022.01.000524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Introduction: With the increased use of computed tomography (CT) imaging, lung nodules are found yearly requiring tracking and guideline directed follow up imaging. We describe the structure of a clinic dedicated to lung nodule tracking, patient education and the outcomes of lung nodule follow up. Methods: Patient electronic medical record charts were reviewed for lung nodules requiring tracking to determine if a follow up study was ordered, completed by the patient, and completed in an appropriate time frame. Patients were grouped based on referral to pulmonary clinic, lung mass clinic, or no subspecialty clinic. 700 CT reports were extracted from the electronic medical record of which 350 (50%) had lung nodules reported on CT, and 111 (15.9%) were lung nodules that additionally recommended discrete follow up in the radiologist report at the Veterans Health Administration hospital in Baltimore. Of these 111 patients, 95% were male and 5% were female. The mean age of the population was 66.3 ± 7.7 years. Results and Discussion: Patients seen in the lung mass clinic had a statistically significant higher rate of the follow up study being ordered by the provider. The lung mass clinic also had a higher percentage of patients who completed the study and completed the study within the recommended time frame, however, this was not statistically significant. Conclusion: A dedicated lung mass clinic should be considered as a method of improving lung nodule tracking with the added benefit of patient education and multidisciplinary care.
Collapse
Affiliation(s)
- Avnee J Kumar
- Division of Pulmonary and Critical Care Medicine, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Dena H Tran
- Department of Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, MD, USA
| | - Barathi Sivasailam
- Department of Medicine, University of Maryland Medical Center and Baltimore VA, Baltimore, MD, USA
| | - Zain Nagaria
- Division of Pulmonary and Critical Care Medicine, University of Maryland Medical Center and Baltimore VA, Baltimore, MD, USA
| | - Jigar Patel
- Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Center Baltimore, MD, USA
- Imaging Services, VA Maryland Health Care System, Baltimore, MD, USA
| | - Avelino C Verceles
- Division of Pulmonary and Critical Care Medicine, University of Maryland Medical Center and Baltimore VA, Baltimore, MD, USA
| | - Janaki Deepak
- Division of Pulmonary and Critical Care Medicine, University of Maryland Medical Center and Baltimore VA, Baltimore, MD, USA
| |
Collapse
|
13
|
Cho A, Amirahmadi R, Ajmeri A, Deepak J. Pulmonary talcosis in the setting of cosmetic talcum powder use. Respir Med Case Rep 2021; 34:101489. [PMID: 34401315 PMCID: PMC8348924 DOI: 10.1016/j.rmcr.2021.101489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/02/2021] [Revised: 06/16/2021] [Accepted: 07/23/2021] [Indexed: 11/28/2022] Open
Abstract
Pulmonary talcosis is a rare pneumoconiosis that is difficult to diagnose and may progress to debilitating lung disease. Four types of talcosis are described in literature: talc-silicosis and talc-asbestosis secondary to inhalation in industry workers and talc-emboli in intravenous drug users that self-inject talc-containing oral tablets. Although found in common household products, talc is overlooked as a cause of pneumoconiosis. Talcosis caused by cosmetic face powder is even rarer. Here we discuss a woman in her 50s who developed talcosis from inhalation of cutaneous cosmetics two years prior, and how comprehensive history may be crucial in diagnosing this rare disease.
Collapse
Affiliation(s)
- Alvin Cho
- University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Aamir Ajmeri
- University of Maryland Medical Center, Baltimore, MD, USA
| | - Janaki Deepak
- University of Maryland Medical Center & Baltimore VA Medical Center, Baltimore, MD, USA
| |
Collapse
|
14
|
Glick DR, Galvin JR, Deepak J. Complex obstructive lung disease - A diagnostic and management conundrum. Respir Med Case Rep 2020; 31:101283. [PMID: 33209580 PMCID: PMC7658492 DOI: 10.1016/j.rmcr.2020.101283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 07/08/2020] [Revised: 10/23/2020] [Accepted: 11/02/2020] [Indexed: 10/26/2022] Open
Abstract
Rheumatoid arthritis (RA) is a common autoimmune disease most well-known for its inflammatory, destructive polyarthropathy. Extraarticular manifestations of the disease may involve the respiratory system, including interstitial lung disease, pleural disease, pulmonary vascular abnormalities, and airways disease. Smoking is highly prevalent in the RA population, and may even have a synergistic effect in disease development and progression. In the diagnosis of pulmonary disease, this presents a unique diagnostic and therapeutic challenge. We present a case of a woman in her 50s who presented for evaluation of dyspnea and was found to have obstructive lung disease. In addition to RA, she had a significant smoking history and also owned pet birds, making definitive diagnosis difficult. Ultimately, chest imaging was crucial in identifying RA-related lung disease as the root cause of her symptoms, leading to successful treatment and symptom management.
Collapse
Affiliation(s)
- Danielle R Glick
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jeffrey R Galvin
- Department of Diagnostic Radiology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Janaki Deepak
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.,Baltimore Veterans Affairs Medical Center, Baltimore, MD, USA
| |
Collapse
|
15
|
Azhar M, Munawar I, Korzan S, Deepak J, Britt E. HYPOXEMIA IN A PATIENT WITH PATENT FORAMEN OVALE IN THE ABSENCE OF PULMONARY HYPERTENSION. Chest 2020. [DOI: 10.1016/j.chest.2020.08.260] [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] [Indexed: 11/25/2022] Open
|
16
|
Melamed J, Deepak J. INTEGRATING TOBACCO HEALTH INTO MAINSTREAM PULMONARY CLINIC: A NOVEL APPROACH. Chest 2020. [DOI: 10.1016/j.chest.2020.08.2015] [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] [Indexed: 11/25/2022] Open
|
17
|
Stankiewicz J, Verceles A, Deepak J. EVALUATING PULMONARY/CRITICAL CARE FELLOWS’ PRACTICE HABITS REGARDING NICOTINE USE AFTER IMPLEMENTING A NOVEL INTERNET-BASED EDUCATIONAL SERIES. Chest 2020. [DOI: 10.1016/j.chest.2020.08.2009] [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] [Indexed: 11/24/2022] Open
|
18
|
Cassady SJ, Lasso-Pirot A, Deepak J. Phenotypes of Bronchopulmonary Dysplasia in Adults. Chest 2020; 158:2074-2081. [PMID: 32473946 DOI: 10.1016/j.chest.2020.05.553] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/06/2020] [Accepted: 05/24/2020] [Indexed: 11/30/2022] Open
Abstract
Bronchopulmonary dysplasia (BPD), first described by Northway in 1967, is a process of neonatal lung injury that is most strongly associated with prematurity. The "old" form of the disease associated with the oxidative damage and volutrauma from perinatal mechanical ventilation has been increasingly supplanted by a "new" form resulting from interrupted growth of the lung at earlier stages of fetal development. Given the significant improvement in the survival of children with BPD since the 1980s, many more of these patients are living into adulthood and are being seen in adult pulmonary practices. In this review, we present three brief vignettes of patients from our practice to introduce three of the major patterns of disease seen in adult survivors of BPD, namely, asthma-like disease, obstructive lung disease, and pulmonary hypertension. Additional factors shown to affect the lives of adult BPD survivors are also discussed. Finally, we discuss insights into the process of transitioning these complex patients from pediatric to adult pulmonary practices. As survivors of BPD enter adulthood and continue to require specialty pulmonary care, awareness of the disease's varied manifestations and responses to treatment will become increasingly important.
Collapse
Affiliation(s)
- Steven J Cassady
- Division of Pulmonary & Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD.
| | - Anayansi Lasso-Pirot
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD
| | - Janaki Deepak
- Division of Pulmonary & Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD
| |
Collapse
|
19
|
Mehta AK, Khan Z, Deepak J. An 81-Year-Old Man With Shortness of Breath After Chemotherapy and Radiation Therapy for Lung Cancer. Chest 2020; 156:e63-e67. [PMID: 31511162 DOI: 10.1016/j.chest.2019.04.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/10/2019] [Accepted: 04/12/2019] [Indexed: 10/26/2022] Open
Abstract
CASE PRESENTATION An 81-year-old man was admitted for evaluation of progressive dyspnea over the previous 4 weeks. He initially noticed dyspnea when walking briskly, but this progressed to dyspnea after only walking several feet. He also endorsed a dry cough without hemoptysis. Review of systems revealed a history of intermittent low-grade fevers, malaise, and nonexertional chest pain. He had been treated for a urinary tract infection twice over the past 3 weeks with prolonged courses of levofloxacin; while his urinary symptoms improved, his respiratory symptoms did not. Medical history was pertinent for lung adenocarcinoma stage IIIb status post right upper lobectomy 10 years prior with recurrence of lung adenocarcinoma in the right lower lobe and was recently diagnosed with stage 1 primary pancreatic adenocarcinoma. He had been a longstanding tobacco smoker but quit two decades ago. Treatment of his recurrent lung adenocarcinoma included four cycles of carboplatin-pemetrexed over the preceding 5 months and intensity-modulated radiation therapy totaling 60 Gy over 30 fractions to his right lower lobe 2 months prior to presentation. He also received stereotactic body radiation therapy totaling 45 Gy over five fractions to his pancreas.
Collapse
Affiliation(s)
- Atul K Mehta
- Division of Pulmonary and Critical Care, University of Maryland School of Medicine, Baltimore, MD.
| | - Zulqarnain Khan
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Janaki Deepak
- Division of Pulmonary and Critical Care, University of Maryland School of Medicine, Baltimore, MD
| |
Collapse
|
20
|
Deepak J, Kenaa B. Caplan's Syndrome with a twist. Int J Clin Case Rep Rev 2020; 2:10.31579/2690-4861/007. [PMID: 34027516 PMCID: PMC8136599 DOI: 10.31579/2690-4861/007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Caplan's syndrome is seen in patients with rheumatoid arthritis (RA) and chronic silica inhalation. We present a patient with RA who presented with multiple pulmonary nodules. Biopsy of the nodules revealed silica crystals under polarized light. He continued treatment for RA and his pulmonary nodules remained stable. However, he subsequently developed renal failure with nephrotic range proteinuria. We discuss silica and the associated autoimmunity in patients with chronic occupational exposure. BACKGROUND Caplan's syndrome also known as rheumatoid pneumoconiosis is a disease entity that is seen in patients with rheumatoid arthritis (RA) exposed to chronic silica and inorganic dust [1,2]. Classically, they form peripheral well-defined pulmonary nodules with characteristic silica retained in the necrobiotic center. In addition, epidemiological data has shown some association with silica and autoimmunity [3]. We present a case of silica and asbestosis exposure in a patient with rheumatoid arthritis who developed rheumatoid pneumoconiosis and subsequent renal failure. We highlight this rare disease, progression as well as other associated complications.
Collapse
Affiliation(s)
- Janaki Deepak
- Division of Pulmonary and Critical Care Medicine, Baltimore VA Medical Health Center, Baltimore, MD 21201, USA
| | - Blaine Kenaa
- Division of Pulmonary and Critical Care Medicine, Baltimore VA Medical Health Center, Baltimore, MD 21201, USA
| |
Collapse
|
21
|
Amirahmadi R, Kumar AJ, Cowan M, Deepak J. Lung Cancer Screening in Patients with COPD-A Case Report. ACTA ACUST UNITED AC 2019; 55:medicina55070364. [PMID: 31336732 PMCID: PMC6681240 DOI: 10.3390/medicina55070364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 06/28/2019] [Accepted: 07/08/2019] [Indexed: 11/16/2022]
Abstract
We present two cases demonstrating the nuances that must be considered when determining if a patient could benefit from low dose computed tomography (LDCT) lung cancer screening. Our case report discusses the available literature, where it exists, on lung cancer screening with special attention to the impact of chronic obstructive pulmonary disease (COPD), and poor functional status. Patients with COPD and concurrent smoking history are at higher risk of lung cancer and may therefore benefit from lung cancer screening. However, this population is at increased risk for complications related to biopsies and lobar resections. Appropriate interventions other than surgical resection exist for COPD patients with poor pulmonary reserve. Risks and benefits of lung cancer screening are unique to each patient and require shared decision-making.
Collapse
Affiliation(s)
- Roxana Amirahmadi
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
| | - Avnee J Kumar
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Mark Cowan
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Janaki Deepak
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
- Division of Pulmonary and Critical Care Medicine, Baltimore VA Medical Health Center, Baltimore, MD 21201, USA
| |
Collapse
|
22
|
Holden VK, Wappel S, Verceles AC, Deepak J. Impact of an Onsite Endobronchial Ultrasound Program on the Time to Treatment of Cancer in Veterans. Ann Lung Cancer 2019; 3:66-74. [PMID: 31552396 PMCID: PMC6759328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Endobronchial ultrasound (EBUS) is commonly employed in the diagnostic evaluation of pulmonary nodules and for mediastinal staging of lung cancer. We hypothesized that the establishment of an onsite EBUS program would decrease the time to the diagnosis and treatment of detected malignancy in veterans seen in a dedicated pulmonary nodule clinic. METHODS We conducted a retrospective chart review of patients seen at the Baltimore Veterans Affairs Medical Center (BVAMC) pulmonary nodule clinic and required diagnostic evaluation. One hundred and fifty consecutive patients before and after implementation of an onsite EBUS program were screened. RESULTS Forty-nine patients from the pre-intervention group and 41 patients from the post-intervention group underwent diagnostic evaluation and were included in study analyses. There was no significant difference in the median number of days between CT chest and initial visit to the BVAMC Lung Mass Clinic (22 vs. 14 days, P = 0.06), CT chest to diagnostic procedure (47.5 vs. 37 days, P = 0.33), and CT chest to initial treatment of detected malignancy (103 vs. 88 days, P = 0.15). There was no significant difference in the lung cancer stages or 1-year mortality between groups. A total of 76 barriers to care were identified among the 90 patients. CONCLUSIONS There was a trend towards improving the time from the initial CT chest to the treatment of cancer with onsite availability of EBUS. More efforts need to be done to decrease the modifiable barriers to treatment to improve the overall lung cancer care for veterans.
Collapse
Affiliation(s)
- Van K. Holden
- VA Maryland Health Care System, Baltimore VA Medical Center, 10 N. Greene St., Baltimore, MD, USA 21201
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, 110 S. Paca St., 2 Floor, Baltimore, MD, USA 21201
| | - Stephanie Wappel
- VA Maryland Health Care System, Baltimore VA Medical Center, 10 N. Greene St., Baltimore, MD, USA 21201
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, 110 S. Paca St., 2 Floor, Baltimore, MD, USA 21201
| | - Avelino C. Verceles
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, 110 S. Paca St., 2 Floor, Baltimore, MD, USA 21201
| | - Janaki Deepak
- VA Maryland Health Care System, Baltimore VA Medical Center, 10 N. Greene St., Baltimore, MD, USA 21201
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, 110 S. Paca St., 2 Floor, Baltimore, MD, USA 21201
| |
Collapse
|
23
|
Abstract
A 64-year-old African American man, with a history of prostate adenocarcinoma treated in 2009 and a greater than 50-pack-year tobacco smoking history, presented with 2-3 weeks of non-productive cough, frontal headache and generalised myalgias and arthralgias. CT was positive for diffuse, miliary opacities in bilateral lung fields. He was diagnosed with stage four lung adenocarcinoma, negative for epidermal growth factor receptor (EGFR) gene mutation. The patient was unable to tolerate therapy and passed away approximately 4 months after his diagnosis. Previous case reports and research have suggested an association between EGFR gene mutation and miliary patterned lung metastases in non-small cell lung cancer. This case suggests that the mechanism by which miliary patterned metastases occur is more complex than purely mutation of the EGFR gene. Further study may elucidate novel molecular targets for treatment, especially in patients with rapidly progressive disease such as the patient we describe.
Collapse
Affiliation(s)
- Seth A Hoffman
- Division of Internal Medicine, University Of Maryland School Of Medicine, Baltimore, Maryland, USA
| | - Scott Manski
- Division of Internal Medicine, University Of Maryland School Of Medicine, Baltimore, Maryland, USA
| | - Janaki Deepak
- Division of Pulmonary and Critical Care Medicine, University Of Maryland School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
24
|
Sameed M, Sullivan S, Marciniak ET, Deepak J. Chronic cough and cystic lung disease caused by Bordetella bronchiseptica in a patient with AIDS. BMJ Case Rep 2019; 12:12/4/e228741. [PMID: 30996069 DOI: 10.1136/bcr-2018-228741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 24-year-old man with a history of HIV and large B cell lymphoma (currently in remission) presented with fever, dry cough and dizziness. His CD4+ count was undetectable, and the HIV viral load was 109 295 cop/mL. Physical examination revealed fever, hypotension and tachycardia with coarse breath sounds in the middle and lower chest zones bilaterally. Chest imaging showed diffuse abnormal micronodular and patchy infiltrates, without focal consolidation. A cavitary lesion was noted measuring 5×2 cm in axial dimensions within the left lower lobe and multiple small cystic lesions in the background. Bronchoalveolar lavage fluid culture grew Bordetella bronchiseptica The patient was empirically treated with vancomycin and piperacillin-tazobactam for multifocal pneumonia with concerns for sepsis and was started on combined antiretroviral therapy (cART) with abacavir/dolutegravir/lamivudine. Symptoms improved after day 3 of therapy, and the patient was discharged home on 2 weeks of moxifloxacin, in addition to the cART and appropriate chemoprophylaxis.
Collapse
Affiliation(s)
- Muhammad Sameed
- Internal Medicine, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Scott Sullivan
- Pulmonary and Critical Care Medicine, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Ellen T Marciniak
- Pulmonary and Critical Care Medicine, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Janaki Deepak
- Pulmonary and Critical Care Medicine, University of Maryland Medical Center, Baltimore, Maryland, USA
| |
Collapse
|
25
|
Sivasailam B, Kumar A, Marciniak E, Deepak J. Acute Liver Failure Induced by Joss Paper Ingestion. Med Case Rep (Wilmington) 2019; 5:9. [PMID: 31633080 PMCID: PMC6800179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
We present a case of liver failure secondary to ingestion of Joss paper. A 44-year-old female initially presented with fever, nausea and vomiting and was subsequently diagnosed with acute liver failure. Prior to presentation she had consumed 1.3 gram of acetaminophen and 800 mg of ibuprofen. Her acetaminophen level was 18 mcg/mL initially and on repeat check was <10 mcg/ml and all viral hepatology antibodies and antigens were negative. History revealed that the patient ingested a ceremonial paper, Joss paper, daily, which is typically painted with heavy metals. Her mercury level was subsequently found to be elevated to 12 ug/L. Mercury can cause depletion of glutathione (GSH) through production of reactive oxygen species. Acetaminophen metabolism requires sufficient GSH to bind to a reactive metabolite to prevent cell death and hepatic injury. Daily exposure to mercury present in the Joss paper, likely accumulated in our patient's body and allowed hepatic injury from even therapeutic doses of acetaminophen.
Collapse
Affiliation(s)
| | | | | | - Janaki Deepak
- Corresponding author: Deepak J, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA, Tel: + 410-328-2488;
| |
Collapse
|
26
|
Wani SA, Munianjana NB, Jadhav V, Ramesh S, Gowrishankar BC, Deepak J. Urethral Duplication in Children: Experience of Twenty Cases. J Indian Assoc Pediatr Surg 2019; 24:275-280. [PMID: 31571759 PMCID: PMC6752076 DOI: 10.4103/jiaps.jiaps_164_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background and Objective Urethral duplication is a rare congenital anomaly having multiple anatomical variants and varied presentations. Multiple surgical techniques have been described for this anomaly, and no surgical technique is ideal. The aim of this study was to present our experience of twenty cases of urethral duplication in the management of this anomaly. Materials and Methods Retrospectively over a period of 10 years from 2006 to 2016, records of all urethral duplications were reviewed. All available records were evaluated for clinical presentation, imaging studies (micturating cystourethrogram, retrograde urethrogram, ultrasonography, and cystourethroscopy), and classified according to the Effmann's classification. The intraoperative details, outcome, and follow-up (including cystoscopy and contrast studies) were noted. Results There were 20 patients of urethral duplications. Age of patients ranged from 3 months to 9 years with a mean age of 4.6 years. The details of management, outcome, and follow-up were obtained. Conclusion Management varies with the symptoms and the severity of the anomaly. Y-type urethral duplication is more complex and challenging and requires extensive urethral reconstruction. Combined use of the bladder and buccal mucosa for reconstruction gives better results than bladder mucosa alone.
Collapse
Affiliation(s)
- Sajad Ahmad Wani
- Department of Paediatric Surgery, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
| | - Narendra Babu Munianjana
- Department of Paediatric Surgery, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
| | - Viney Jadhav
- Department of Paediatric Surgery, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
| | - S Ramesh
- Department of Paediatric Surgery, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
| | - B C Gowrishankar
- Department of Paediatric Surgery, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
| | - J Deepak
- Department of Paediatric Surgery, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
| |
Collapse
|
27
|
Kumar A, Sivasailam B, Marciniak E, Deepak J. EBUS-TBNA diagnosis of localised amyloidosis presenting as mediastinal lymphadenopathy. BMJ Case Rep 2018; 11:11/1/e226619. [PMID: 30567190 DOI: 10.1136/bcr-2018-226619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Amyloidosis is a unique disease of localised or systemic deposition of the abnormal extracellular fibril. Localised amyloidosis generally takes a benign course, while systemic requires treatment. Adenopathy, especially mediastinal adenopathy, is an unusual manifestation of localised amyloidosis and often requires mediastinoscopy or surgical resection for diagnosis. With the advent of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), there is potential for a less invasive diagnostic approach. We report a rare case of localised mediastinal amyloidosis diagnosed by EBUS-TBNA.
Collapse
Affiliation(s)
- Avnee Kumar
- Department of Medicine, University Of Maryland School Of Medicine, Baltimore, Maryland, USA
| | - Barathi Sivasailam
- Department of Medicine, University Of Maryland School Of Medicine, Baltimore, Maryland, USA
| | - Ellen Marciniak
- Department of Medicine, University Of Maryland School Of Medicine, Baltimore, Maryland, USA
| | - Janaki Deepak
- Department of Medicine, University Of Maryland School Of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
28
|
|
29
|
Erickson P, Gardner LD, Loffredo CA, St George DM, Bowman ED, Deepak J, Mitchell K, Meaney CL, Langenberg P, Bernat DH, Amr S, Ryan BM. Racial and Ethnic Differences in the Relationship between Aspirin Use and Non-Small Cell Lung Cancer Risk and Survival. Cancer Epidemiol Biomarkers Prev 2018; 27:1518-1526. [PMID: 30171037 DOI: 10.1158/1055-9965.epi-18-0366] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 06/25/2018] [Accepted: 08/22/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND African Americans (AA) experience higher incidence and mortality of lung cancer as compared with European Americans (EA). Inflammation is associated with lung cancer, many aspects of which differ between AA and EA. We investigated whether use, frequency, and duration of the anti-inflammatory drug aspirin were associated with lung cancer risk and survival, separately among AA and EA populations. METHODS Using data from the Maryland Non-Small Cell Lung Cancer (NSCLC) Case-Control Study (1,220 cases [404 AA and 816 EA] and 1,634 controls [1,004 EA and 630 AA]), we estimated the adjusted odds ratios (OR) and hazard ratios (HR) with 95% confidence intervals (CI) of the associations between aspirin use and NSCLC risk and survival, respectively. RESULTS Any aspirin use (OR: 0.66; 95% CI, 0.49-0.89), daily use of ≥ 1 tablet (OR: 0.68; 95% CI, 0.50-0.90), and use for ≥ 3 years (OR: 0.61; 95% CI, 0.44-0.85) was associated with lower NSCLC risk only among men, even after adjustment for covariates including body mass index and global genetic ancestry. These variables were also associated with improved survival, but only among AA (HR: 0.64; 95% CI, 0.46-0.91; HR: 0.61; 95% CI, 0.42-0.90; and HR: 0.60; 95% CI, 0.39-0.92, respectively). Tylenol and other NSAIDs were either associated with elevated or no NSCLC risk. CONCLUSIONS Aspirin use is associated with lower risk of NSCLC among men and improved survival among AA. IMPACT Preventive regular aspirin use could be considered among men and AA.
Collapse
Affiliation(s)
- Patricia Erickson
- George Washington University, Washington, District of Columbia
- Laboratory of Human Carcinogenesis, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Lisa D Gardner
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Christopher A Loffredo
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia
| | - Diane Marie St George
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Elise D Bowman
- Laboratory of Human Carcinogenesis, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Janaki Deepak
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Khadijah Mitchell
- Laboratory of Human Carcinogenesis, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Claire L Meaney
- Laboratory of Human Carcinogenesis, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Patricia Langenberg
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Debra H Bernat
- George Washington University, Washington, District of Columbia
| | - Sania Amr
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland.
- Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, Maryland
| | - Bríd M Ryan
- Laboratory of Human Carcinogenesis, Center for Cancer Research, NCI, NIH, Bethesda, Maryland.
| |
Collapse
|
30
|
Gardner LD, Loffredo PhD CA, Langenberg P, George DMS, Deepak J, Harris CC, Amr S. Associations between history of chronic lung disease and non-small cell lung carcinoma in Maryland: variations by sex and race. Ann Epidemiol 2018; 28:543-548. [PMID: 29778651 DOI: 10.1016/j.annepidem.2018.04.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 04/08/2018] [Accepted: 04/27/2018] [Indexed: 12/16/2022]
Abstract
PURPOSE Lung cancer is a multifactorial malignancy for which some risk factors, such as chronic lung diseases, their interactions with smoking, and how they differ by race and sex, are not fully understood. We investigated the associations between chronic inflammatory lung disease and non-small cell lung carcinoma (NSCLC) and how sex and race may affect such associations. METHODS Using logistic regression, we analyzed 1660 lung cancer cases and 1959 population controls and estimated adjusted odds ratios (AORs) and 95% confidence intervals (CIs). RESULTS Chronic lung disease was significantly associated with higher odds of having NSCLC in never (AOR = 1.99; 95% CI = 1.19-3.34), former (AOR = 1.68; 95% CI = 1.29-2.20), and current smokers (AOR = 2.40; 95% CI = 1.62-3.57), after adjustment for relevant covariates. For each 5-year increment in chronic lung disease duration, the risk of lung cancer increased only among females (AOR = 1.07; 95% CI = 1.02-1.13). Females, but not males, with asthma were at risk for NSCLC (AOR = 2.08; 95% CI = 1.40-3.10). CONCLUSIONS This study provides support for chronic lung inflammation as a potential contributing factor to lung cancer risk and possible sex difference in the inflammatory events underlying disease mechanisms.
Collapse
Affiliation(s)
- Lisa D Gardner
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | - Christopher A Loffredo PhD
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Patricia Langenberg
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | - Diane Marie St George
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | - Janaki Deepak
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Curtis C Harris
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Sania Amr
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD; Marlene and Stuart Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD.
| |
Collapse
|
31
|
Wappel S, Deepak J. A Case of Nodular Pulmonary Amyloidosis Presenting as Eccentrically Calcified Lung Masses. Chest 2017. [DOI: 10.1016/j.chest.2017.08.756] [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] [Indexed: 10/18/2022] Open
|
32
|
Leiter N, Deepak J. Solitary Pulmonary Nodules in Patients With Prior Extrapulmonary Neoplasms. Chest 2017. [DOI: 10.1016/j.chest.2017.08.695] [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] [Indexed: 10/18/2022] Open
|
33
|
Aihole JS, Lokanath H, Babu MN, Deepak J. Clitoral Choristoma: A Rare Case Report. J Indian Assoc Pediatr Surg 2017; 22:163-164. [PMID: 28694574 PMCID: PMC5473303 DOI: 10.4103/0971-9261.207642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Clitoral hypertrophy is usually seen as a congenital malformation, specifically during the stages of hormonal expressions in the disorders of sexual development. Acquired clitoral hypertrophy is a relatively rare condition. Clitoris can be the site of neoplastic lesions. Clitoral choristoma has not been reported so far in the literature.
Collapse
Affiliation(s)
| | | | - M Narendra Babu
- Department of Paediatric Surgery, IGICH, Bengaluru, Karnataka, India
| | - J Deepak
- Department of Paediatric Surgery, IGICH, Bengaluru, Karnataka, India
| |
Collapse
|
34
|
Weiler-Lisowski B, Deepak J, Twaddell W, Burke A. Rash and Pulmonary Infiltrates in a 37-Year-Old Woman. Chest 2016. [DOI: 10.1016/j.chest.2016.08.296] [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] [Indexed: 10/20/2022] Open
|
35
|
Deepak J, Aravind KL, Gowrishankar, Ramesh S. A Case of Rare Small Bowel Tumor in a Child and Review of Literature. Indian J Surg Oncol 2016; 6:292-5. [PMID: 27217683 DOI: 10.1007/s13193-015-0417-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 05/19/2015] [Indexed: 01/25/2023] Open
Affiliation(s)
- J Deepak
- Department of Pediatric Surgery, South Hospital Complex, Dharmaram College Post, Indira Gandhi Institute of Child Health, Near NIMHANS, Bangalore, 560029 India ; No.1247, 8th cross, Chandra layout, Vijayanagar Bangalore, 560040 India
| | - K L Aravind
- Department of Pediatric Surgery, South Hospital Complex, Dharmaram College Post, Indira Gandhi Institute of Child Health, Near NIMHANS, Bangalore, 560029 India
| | - Gowrishankar
- Department of Pediatric Surgery, South Hospital Complex, Dharmaram College Post, Indira Gandhi Institute of Child Health, Near NIMHANS, Bangalore, 560029 India
| | - S Ramesh
- Department of Pediatric Surgery, South Hospital Complex, Dharmaram College Post, Indira Gandhi Institute of Child Health, Near NIMHANS, Bangalore, 560029 India
| |
Collapse
|
36
|
Handu AT, Jadhav V, Deepak J, Aihole JS, Gowrishankar, Narendrababu M, Ramesh S, Srimurthy K. Laparoscopic pyloromyotomy: Lessons learnt in our first 101 cases. J Indian Assoc Pediatr Surg 2014; 19:213-7. [PMID: 25336803 PMCID: PMC4204246 DOI: 10.4103/0971-9261.142009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Aim: To analyze our experience with laparoscopic pyloromyotomy for infantile hypertrophic pyloric stenosis for the lessons that we learnt and to study the effect of learning curve. Materials and Methods: This is a retrospective analysis of case records of 101 infants who underwent laparoscopic pyloromyotomy over 6 years. The demographic characteristics, conversion rate, operative time, complications, time to first feed and post-operative hospital stay were noted. The above parameters were compared between our early cases (2007-2009) (n = 43) and the later cases (2010-2013) (n = 58). Results: 89 male and 12 female babies ranging in age from 12 days to 4 months (mean: 43.4 days) were operated upon during this period. The babies ranged in weight from 1.8 to 4.7 kg (mean: 3.1 kg). Four cases were converted to open (3.9%): three due to mucosal perforations and one due to technical problem. The mean operative time was 45.7 minutes (49.7 minutes in the first 3 years and 43.0 minutes in the next 3 years). There were 10 complications-4 mucosal perforations, 5 inadequate pyloromyotomies and 1 omental prolapse through a port site. All the complications were effectively handled with minimum morbidity. In the first 3 years of our experience the conversion rate was 9.3%, mucosal perforations were 6.9% and re-do rate was 2.3% as compared to 0%, 1.7% and 6.9%, respectively, in the next 3 years. Mean time for starting feeds was 21.4 hours and mean post-operative hospital stay was 2.4 days. Conclusion: Laparoscopic pyloromyotomy is a safe procedure with minimal morbidity and reasonable operative times. Conversion rates and operative times decrease as experience increases. Our rate of inadequate pyloromyotomy was rather high which we hope to decrease with further experience.
Collapse
Affiliation(s)
- Abhilasha Tej Handu
- Department of Surgery, Bharti Hospital and Research Centre, Pune, Maharashtra, India
| | - Vinay Jadhav
- Department of Pediatric Surgery, Indira Gandhi Institute of Child Health, Bangalore, Karnataka, India
| | - J Deepak
- Department of Pediatric Surgery, Indira Gandhi Institute of Child Health, Bangalore, Karnataka, India
| | - Jayalaxmi S Aihole
- Department of Pediatric Surgery, Indira Gandhi Institute of Child Health, Bangalore, Karnataka, India
| | - Gowrishankar
- Department of Pediatric Surgery, Indira Gandhi Institute of Child Health, Bangalore, Karnataka, India
| | - M Narendrababu
- Department of Pediatric Surgery, Indira Gandhi Institute of Child Health, Bangalore, Karnataka, India
| | - S Ramesh
- Department of Pediatric Surgery, Indira Gandhi Institute of Child Health, Bangalore, Karnataka, India
| | - Kr Srimurthy
- Department of Pediatric Surgery, Indira Gandhi Institute of Child Health, Bangalore, Karnataka, India
| |
Collapse
|
37
|
Abstract
We present a rare case of mediastinal hemangioma in a 4-year-old child. The child presented with cough and fever and the chest radiograph revealed right pleural effusion. On further work-up with chest computed tomography mediastinal cystic mass occupying the right hemithorax was identified. The cystic mass was resected completely through a right thoracotomy. Histopathological examination established the final diagnosis of mediastinal capillary hemangioma.
Collapse
Affiliation(s)
- J Deepak
- Department of Paediatric Surgery, Indira Gandhi Institute of Child Health, Bangalore, Karnataka, India
| | - M Narendra Babu
- Department of Paediatric Surgery, Indira Gandhi Institute of Child Health, Bangalore, Karnataka, India
| | - B C Gowrishankar
- Department of Paediatric Surgery, Indira Gandhi Institute of Child Health, Bangalore, Karnataka, India
| | - S Ramesh
- Department of Paediatric Surgery, Indira Gandhi Institute of Child Health, Bangalore, Karnataka, India
| |
Collapse
|
38
|
Marciniak E, Choi J, Sachdeva A, Deepak J. EBUS Diagnosis of Granular Cell Tumor After Negative Mediastinoscopy. Chest 2013. [DOI: 10.1378/chest.1704789] [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] [Indexed: 11/01/2022] Open
|
39
|
Patel S, Barrett M, Pickering E, Deepak J. EBUS-TBNA Diagnosis of Mediastinal Amyloid Lymphadenopathy Presenting as a Solitary, Calcified Paratracheal Mass. Chest 2013. [DOI: 10.1378/chest.1702297] [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] [Indexed: 11/01/2022] Open
|
40
|
|
41
|
Deepak J, Agarwal P, Bagdi RK, Balagopal S, Madhu R, Balamourougane P, Khanday ZS. Laparoscopic appendicectomy is a favorable alternative for complicated appendicitis in children. J Indian Assoc Pediatr Surg 2011; 13:97-100. [PMID: 20011482 PMCID: PMC2788453 DOI: 10.4103/0971-9261.43797] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Aim: To evaluate the role of laparoscopy in complicated appendicitis in children. Materials and Methods: A total of 119 children were operated for appendicitis between October 2005 and May 2008 at SRMC, Chennai. Forty-one patients underwent open appendicectomy (OA), and 71 patients underwent laparoscopic appendicectomy (LA). Twenty-six cases among the LA group and 16 among the OA group had complicated appendicitis. Twenty-six cases were completed laparoscopically, and 2 needed conversion to OA. Results: Out of 26 patients in the LA group, 23 made an uneventful recovery without any complications. One had minor port site infection, and 2 had prolonged loose stools. Out of 16 in the OA group, 7 had complications. Three had wound infection, 2 had loose stools, 1 had fecal fistula and another required subsequent surgeries. Operative duration in LA was 86.7 min (range: 75 to 120 min) and 90.3 min (range: 70 to 150 min) in OA. Oral feed resumption in LA was done at average of 2.7 days and in OA at 4.3 days. IV antibiotics were administered for an average of 3.6 days in LA and 4.8 days in OA, parenteral analgesic for 2.7 days in LA and 4.2 days in OA. The length of hospital stay was 5.4 days in LA and 7.3 days in OA. Conclusion: LA is a favorable alternative in children with complicated appendicitis in view of less postoperative pain, fewer postoperative complications and quicker return to normal activity.
Collapse
Affiliation(s)
- J Deepak
- Department of Pediatric Surgery, Sri Ramachandra Medical College and Research Institute, Chennai, India
| | | | | | | | | | | | | |
Collapse
|
42
|
Todd NW, Jeudy J, Lavania S, Franks TJ, Galvin JR, Deepak J, Britt EJ, Atamas SP. Centrilobular emphysema combined with pulmonary fibrosis results in improved survival. Fibrogenesis Tissue Repair 2011; 4:6. [PMID: 21324139 PMCID: PMC3055815 DOI: 10.1186/1755-1536-4-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Accepted: 02/15/2011] [Indexed: 12/21/2022]
Abstract
Background We hypothesized that, in patients with pulmonary fibrosis combined with emphysema, clinical characteristics and outcomes may differ from patients with pulmonary fibrosis without emphysema. We identified 102 patients who met established criteria for pulmonary fibrosis. The amount of emphysema (numerical score) and type of emphysema (centrilobular, paraseptal, or mixed) were characterized in each patient. Clinical characteristics, pulmonary function tests and patient survival were analysed. Results Based on the numerical emphysema score, patients were classified into those having no emphysema (n = 48), trivial emphysema (n = 26) or advanced emphysema (n = 28). Patients with advanced emphysema had a significantly higher amount of smoking in pack/years than patients with no emphysema or trivial emphysema (P < 0.0001). Median survival [1st, 3rd quartiles] of patients with advanced emphysema was 63 [36, 82] months compared to 29 [18, 49] months in patients without emphysema and 32 [19, 48] months in patients with trivial emphysema (P < 0.001). Median forced vital capacity (FVC) and total lung capacity (TLC) were higher in the advanced emphysema group compared to patients with no emphysema (P < 0.01 and P < 0.001, respectively), whereas median DLCO did not differ among groups and was overall low. Within the advanced emphysema group (n = 28), further characterization of the type of emphysema was performed and, within these subgroups of patients, survival was 75 [58, 85] months for patients with centrilobular emphysema, 75 [48, 85] months for patients with mixed centrilobular/paraseptal emphysema, and 24 [22, 35] months for patients with paraseptal emphysema (P < 0.01). Patients with advanced paraseptal emphysema had similar survival times to patients without emphysema. Conclusions Patients with pulmonary fibrosis combined with advanced centrilobular or mixed emphysema have an improved survival compared with patients with pulmonary fibrosis without emphysema, with trivial emphysema or with advanced paraseptal emphysema.
Collapse
Affiliation(s)
- Nevins W Todd
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA.
| | | | | | | | | | | | | | | |
Collapse
|
43
|
Deepak J, Agarwal P, Bagdi RK, Balagopal S, Madhu R, Balamourougane P. Pediatric cholelithiasis and laparoscopic management: A review of twenty two cases. J Minim Access Surg 2010; 5:93-6. [PMID: 20407567 PMCID: PMC2843131 DOI: 10.4103/0972-9941.59306] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2009] [Accepted: 11/07/2009] [Indexed: 01/06/2023] Open
Abstract
AIM To evaluate the role of laparoscopic cholecystectomy (LC) in the management of cholelithiasis in children. MATERIALS AND METHODS A retrospective review of our experience with LC for cholelithiasis at our institution, between April 2006 and March 2009 was done. Data points reviewed included patient demographics, clinical history, haematological investigations, imaging studies, operative techniques, postoperative complications, postoperative recovery and final histopathological diagnosis. RESULTS During the study period of 36 months, 22 children (10 males and 12 females) with cholelithiasis were treated by LC. The mean age was 9.4 years (range 3 to 18 years). Twenty-one children had symptoms of biliary tract disease and one child was incidentally detected with cholelithiasis during an ultrasonogram of the abdomen for an unrelated cause. Only five (22.7%) children had definitive etiological risk factors for cholelithiasis and the remaining 13(77.3%) cases were idiopathic. Twenty cases had pigmented gallstones and two had cholesterol gallstones. All the 22 patients underwent LC, 21 elective and one emergency LC. The mean operative duration was 74.2 minutes (range 50-180 minutes). Postoperative complications occurred in two (9.1%) patients. The average duration of hospital stay was 4.1 days (range 3-6 days). CONCLUSION Laparoscopic chloecystectomy is confirmed to be a safe and efficacious treatment for pediatric cholelithiasis. The cause for an increased incidence of pediatric gallstones and their natural history need to be further evaluated.
Collapse
Affiliation(s)
- J Deepak
- Department of Pediatric Surgery, Sri Ramachandra Medical College, Porur, Chennai - 600 116, India
| | | | | | | | | | | |
Collapse
|
44
|
Deepak J, Pradeep T, Waghmare UV. Interaction of small gold clusters with carbon nanotube bundles: formation of gold atomic chains. J Phys Condens Matter 2010; 22:125301. [PMID: 21389485 DOI: 10.1088/0953-8984/22/12/125301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
We use first-principles density functional theory to simulate the interaction of bundles of semiconducting (10, 0) and metallic (6, 6) carbon nanotubes (CNTs) with small gold clusters (Au(n), n = 3, 5) inserted in their interstitial spaces. We find that gold clusters spontaneously evolve to form atomic chains along the axis of nanotubes and induce weak metallicity in the semiconducting nanotubes through charge transfer. We further show that a similar structural evolution of Pt(3) clusters occurs in the interstitial spaces of a (10, 0) CNT bundle. Our calculations show that these structural changes, along with interesting changes in the electronic structure, occur at moderate pressures that are readily achievable in a laboratory, and should be relevant to devices that make use of gold-nanotube contacts.
Collapse
Affiliation(s)
- J Deepak
- Indian Institute of Technology Madras, Chennai 600 036, India
| | | | | |
Collapse
|
45
|
Zhou R, Liu Q, Todd NW, Deepak J, Liu Z, Stass SA, Edelman MJ, Katz RL, Jiang F. Evaluation of aldehyde dehydrogenase 1 (ALDH1) as a marker of non-small cell lung cancer (NSCLC) stem cells (SCs) and correlation with prognosis. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.11105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
11105 Background: ALDH1 is a cytosolic enzyme responsible for oxidizing intracellular aldehydes, and conversion of retinol to retinoic acid in SCs. ALDH1 has been previously demonstrated to be a marker for SCs in breast cancer (Ginestier C, et al., Cell Stem Cell. 2007 Nov; 1(5):555–67). The Aldefluor assay is based on conversion of a synthetic substrate BAAA, when passively infused into cytosol, to brightly fluorescent BAA by ALDH1. Combined with fluorescence-activated cell sorting (FACS), it has been used successfully in hematopoietic and breast cancer SCs isolation. ALDH1 is also found in NSCLC. We hypothesized that ALDH1 would be a marker for NSCLC SCs and a potential prognostic marker. Methods: NSCLC SCs were isolated from human NSCLC cell lines using the Aldefluor assay and FACS. ALDH1-positive cells were analyzed extensively for SC characteristics. ALDH1 expression in 303 NSCLC biopsy specimens from three independent cohorts of NSCLC patients was then analyzed by immunohistochemisty (IHC) using an ALDH1 antibody (Santa Cruz Biotechnology) and commercially available negative controls. Results: Isolated cancer cells with high ALDH1 activity displayed cancer SCs features, including capacities for proliferation, self-renewal, differentiation; resistance to chemotherapeutic agents including cisplatin, vinorelbine, gemcitabine and docetaxel; expression of the SC surface marker CD133, and high invasiveness. ALDH1-positive cells generated tumors in vivo recapitulating heterogeneity of parental cells. Xenograft tumors derived from ALDH1-positive cells (103 each) were 36±2.9 mm3 on average in size, with some of the cells having lost ALDH1 expression. Xenograft tumors derived from ALDH1-negative cells (105 each) were 4 mm3 on average in size, without ALDH1 reactivation. Statistical analysis of quantitative IHC and clinical data showed ALDH1 expression was correlated with higher stage and grade of NSCLC (p = 0.02). Expression of ALDH1 in stage I NSCLC patients was linked to decreased 5 year cancer-specific survival (62% vs. 96%, p = 0.006) and overall survival (32% vs. 72%, p = 0.009). Conclusions: 1. ALDH1 is a NSCLC SC-associated tumor marker. 2. ALDH1 expression is a negative prognostic marker in early stage NSCLC. No significant financial relationships to disclose.
Collapse
Affiliation(s)
- R. Zhou
- University of Maryland Greenebaum Cancer Center, Baltimore, MD; University of Maryland School of Medicine, Baltimore, MD; University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Q. Liu
- University of Maryland Greenebaum Cancer Center, Baltimore, MD; University of Maryland School of Medicine, Baltimore, MD; University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - N. W. Todd
- University of Maryland Greenebaum Cancer Center, Baltimore, MD; University of Maryland School of Medicine, Baltimore, MD; University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - J. Deepak
- University of Maryland Greenebaum Cancer Center, Baltimore, MD; University of Maryland School of Medicine, Baltimore, MD; University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Z. Liu
- University of Maryland Greenebaum Cancer Center, Baltimore, MD; University of Maryland School of Medicine, Baltimore, MD; University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - S. A. Stass
- University of Maryland Greenebaum Cancer Center, Baltimore, MD; University of Maryland School of Medicine, Baltimore, MD; University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - M. J. Edelman
- University of Maryland Greenebaum Cancer Center, Baltimore, MD; University of Maryland School of Medicine, Baltimore, MD; University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - R. L. Katz
- University of Maryland Greenebaum Cancer Center, Baltimore, MD; University of Maryland School of Medicine, Baltimore, MD; University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - F. Jiang
- University of Maryland Greenebaum Cancer Center, Baltimore, MD; University of Maryland School of Medicine, Baltimore, MD; University of Texas M. D. Anderson Cancer Center, Houston, TX
| |
Collapse
|
46
|
Xie Y, Todd NW, Liu Z, Zhan M, Fang H, Peng H, Alattar M, Deepak J, Stass SA, Jiang F. Altered miRNA expression in sputum for diagnosis of non-small cell lung cancer. Lung Cancer 2009; 67:170-6. [PMID: 19446359 DOI: 10.1016/j.lungcan.2009.04.004] [Citation(s) in RCA: 248] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2009] [Accepted: 04/11/2009] [Indexed: 12/28/2022]
Abstract
UNLABELLED Analysis of molecular genetic markers in biological fluids has been proposed as a useful tool for cancer diagnosis. MicroRNAs (miRNAs) are small regulatory RNAs that are frequently dysregulated in lung cancer and have shown promise as tissue-based markers for its prognostication. The aim of this study was to determine whether aberrant miRNA expression can be used as a marker in sputum specimen for the diagnosis of non-small cell lung cancer (NSCLC). EXPERIMENTAL DESIGN expressions of mature miRNAs, mir-21 and mir-155, were examined by real-time reverse transcription polymerase chain reaction (RT-PCR) and normalized to that of control miRNA, U6B, in sputum of 23 patients with NSCLC and 17 cancer-free subjects. The data was compared with conventional sputum cytology for the diagnosis of lung cancer. All endogenous miRNAs were present in sputum in a remarkably stable form and sensitively and specifically detected by real-time RT-PCR. Mir-21 expression in the sputum specimens was significantly higher in cancer patients (76.32+/-9.79) than cancer-free individuals (62.24+/-3.82) (P<0.0001). Furthermore, overexpression of mir-21 showed highly discriminative receiver-operator characteristic (ROC) curve profile, clearly distinguishing cancer patients from cancer-free subjects with areas under the ROC curve at 0.902+/-0.054. Detection of mir-21 expression produced 69.66% sensitivity and 100.00% specificity in diagnosis of lung cancer, as compared with 47.82% sensitivity and 100.00% specificity by sputum cytology. The measurement of altered miRNA expression in sputum could be a useful noninvasive approach for the diagnosis of lung cancer.
Collapse
Affiliation(s)
- Ying Xie
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Jiang F, Qiu Q, Khanna A, Todd NW, Deepak J, Xing L, Wang H, Liu Z, Su Y, Stass SA, Katz RL. Aldehyde dehydrogenase 1 is a tumor stem cell-associated marker in lung cancer. Mol Cancer Res 2009; 7:330-8. [PMID: 19276181 PMCID: PMC4255559 DOI: 10.1158/1541-7786.mcr-08-0393] [Citation(s) in RCA: 601] [Impact Index Per Article: 40.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Tumor contains small population of cancer stem cells (CSC) that are responsible for its maintenance and relapse. Analysis of these CSCs may lead to effective prognostic and therapeutic strategies for the treatment of cancer patients. We report here the identification of CSCs from human lung cancer cells using Aldefluor assay followed by fluorescence-activated cell sorting analysis. Isolated cancer cells with relatively high aldehyde dehydrogenase 1 (ALDH1) activity display in vitro features of CSCs, including capacities for proliferation, self-renewal, and differentiation, resistance to chemotherapy, and expressing CSC surface marker CD133. In vivo experiments show that the ALDH1-positive cells could generate tumors that recapitulate the heterogeneity of the parental cancer cells. Immunohistochemical analysis of 303 clinical specimens from three independent cohorts of lung cancer patients and controls show that expression of ALDH1 is positively correlated with the stage and grade of lung tumors and related to a poor prognosis for the patients with early-stage lung cancer. ALDH1 is therefore a lung tumor stem cell-associated marker. These findings offer an important new tool for the study of lung CSCs and provide a potential prognostic factor and therapeutic target for treatment of the patients with lung cancer.
Collapse
Affiliation(s)
- Feng Jiang
- Department of Pathology, Greenbaum Cancer Center, University of Maryland School of Medicine, Baltimore, Maryland 21201-1192, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Abstract
Internal hernia may be either congenital or acquired. Its incidence has been reported to be 1-2%. Herniation may be persistent or intermittent. Internal hernia is a rare cause of small bowel obstruction with a reported incidence of 0.2-0.9%. The most common type is paraduodenal. Less common types include mesocolic hernia, which occurs following abdominal surgery. We report mesocolic hernias in two young patients, which presented as small bowel obstruction without any prior abdominal surgery.
Collapse
Affiliation(s)
- L F Tauro
- Department of Surgery, Father Muller Medical College Hospital, Mangalore, Karnataka, India.
| | | | | | | | | | | | | |
Collapse
|
49
|
|
50
|
Deepak J, Comer J, Bowling M, Dobbs J, Aldenderfer PH, Fish DC, Bandyopadhyay K. Simultaneous purification of RNA-dependent DNA polymerase and gs-antigen from Rauscher leukemia virus. Biochem Biophys Res Commun 1975; 63:400-8. [PMID: 47745 DOI: 10.1016/0006-291x(75)90702-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|