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Alkaabi S, Alzidjali A, Pathare A, Alghaithi I, Alkhabori M, Elshinawy M, Fawzy H, Subhi TA, Elshinawy N, Wasifuddin M, Abdelhakem E, Al-Mulaabed S, AlRawas A, Wali Y. Spectrum, clinical characteristics and outcome of von Willebrand disease in Oman. Haemophilia 2024. [PMID: 38738970 DOI: 10.1111/hae.15029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/02/2024] [Accepted: 04/15/2024] [Indexed: 05/14/2024]
Affiliation(s)
- Shamsa Alkaabi
- Pediatric Resident, Oman Medical Specialty Board, Muscat, Oman
| | - Aala Alzidjali
- Pediatric Resident, Oman Medical Specialty Board, Muscat, Oman
| | - Anil Pathare
- Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Ibrahim Alghaithi
- Pediatric Hematology and Oncology Department, Royal Hospital, Muscat, Oman
| | - Murtadha Alkhabori
- Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Mohamed Elshinawy
- Child Health Department, Sultan Qaboos University Hospital, Muscat, Oman
- Department of Pediatrics, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Hanan Fawzy
- Child Health Department, Sultan Qaboos University Hospital, Muscat, Oman
- Department of Pediatrics, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Taimoora Al Subhi
- Department of Basic Health Science, Oman College of Health Science, Muscat, Oman
| | - Noor Elshinawy
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mustafa Wasifuddin
- Department of Internal Medicine, Brookdale University Hospital, New York, USA
| | - Esraa Abdelhakem
- Department of Pediatrics, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Sharef Al-Mulaabed
- Department of Pediatrics, Presbyterian Medical Group, Albuquerque, New Mexico, USA
| | - Abdulhakim AlRawas
- Child Health Department, Sultan Qaboos University Hospital, Muscat, Oman
| | - Yasser Wali
- Child Health Department, Sultan Qaboos University Hospital, Muscat, Oman
- Department of Pediatrics, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Wasifuddin M, Ilerhunmwuwa NP, Becerra H, Hakobyan N, Wasifuddin S, Asadi HA, Wang JC. Review of real-world experience with lurbinectedin in relapsed/refractory small cell lung cancer. J Chemother 2024:1-6. [PMID: 38234179 DOI: 10.1080/1120009x.2024.2302736] [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: 06/07/2023] [Accepted: 01/03/2024] [Indexed: 01/19/2024]
Abstract
Lurbinectedin, a novel antineoplastic agent, was granted the orphan drug designation by the United States Food and Drug Administration (US FDA) and approved for use in relapsed/refractory small cell lung cancer in June 2020. The approval was granted after its efficacy was demonstrated in a multicenter open-label, multi-cohort study enrolling 105 participants. Since then, real-world studies have examined the efficacy and safety profiles of lurbinectedin in clinical practice. By examining these outcomes, this review aims to provide clinicians with the tools necessary to make informed clinical decisions.
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Affiliation(s)
- Mustafa Wasifuddin
- Department of Internal Medicine, One Brooklyn Health/Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Nosakhare Paul Ilerhunmwuwa
- Department of Internal Medicine, One Brooklyn Health/Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Henry Becerra
- Department of Internal Medicine, One Brooklyn Health/Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Narek Hakobyan
- Department of Internal Medicine, One Brooklyn Health/Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Saad Wasifuddin
- Department of Life Sciences, University of Toronto, Toronto, Canada
| | - Hayder Al Asadi
- Department of Medicine, National University of Science and Technology, Muscat, Oman
| | - Jen Chin Wang
- Department of Hematology and Oncology, One Brooklyn Health/Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
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Wasifuddin M, Ilerhunmwuwa NP, Becerra H, Wang JC. Characteristics and survival outcomes of patients with T cell prolymphocytic leukemia in the United States: 2011-2020 analysis of the SEER database. Leuk Lymphoma 2023; 64:2051-2053. [PMID: 37531079 DOI: 10.1080/10428194.2023.2243354] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 07/25/2023] [Indexed: 08/03/2023]
Affiliation(s)
- Mustafa Wasifuddin
- Department of Internal Medicine, Brookdale University Hospital and Medical Center, Brooklyn, NY, USA
| | | | | | - Jen C Wang
- Department of Hematology/Oncology, Brookdale University Hospital and Medical Center, Brooklyn, NY, USA
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Hakobyan N, Yadav R, Pokhrel A, Wasifuddin M, John MJ, Yadav S, Boris A. Miller-Fisher Syndrome Unveiled in the Presence of Cholangiocarcinoma. Cureus 2023; 15:e49016. [PMID: 38111454 PMCID: PMC10727167 DOI: 10.7759/cureus.49016] [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] [Accepted: 11/17/2023] [Indexed: 12/20/2023] Open
Abstract
Miller-Fisher syndrome (MFS) is a rare variant of Guillain-Barré syndrome, characterized by ataxia, areflexia, ophthalmoplegia, and possible facial, swallowing and limb weakness alongside respiratory failure. Variations within MFS may include respiratory and limb weakness and Bickerstaff brainstem encephalitis (BBE), marked by altered consciousness, ataxia, ophthalmoparesis, and paradoxical hyperreflexia. MFS can emerge in both children and adults, often following bacterial or viral illness. While autoimmune-driven nerve damage occurs, most MFS patients recover within six months without specific treatment, with a low risk of lasting neurological deficits or relapses. Rarely fatal, MFS's co-occurrence with cholangiocarcinoma (CCA) presents unique management challenges. CCA, primarily affecting bile ducts, has a bleak prognosis; surgical resection offers limited cure potential due to late-stage detection and high recurrence rates. Advances in CCA's molecular understanding have led to novel diagnostic and therapeutic approaches, requiring a comprehensive interdisciplinary care approach for optimal MFS and CCA management outcomes. Herein, we present a 50-year-old male with a complex medical history who was admitted to the hospital due to abdominal discomfort, nausea, vomiting, and ascites. Imaging revealed pneumonia and secondary bacterial peritonitis. Later, he developed neurological symptoms, including weakness, gait abnormalities, and brainstem symptoms, leading to the diagnosis of MFS. Despite treatment efforts, his condition deteriorated, leading to acute liver failure and unexplained anasarca. N-acetyl cysteine was initiated for liver issues. Neurologically, he showed quadriparesis and areflexia. Intravenous immunoglobulin (IVIG) treatment improved his neurological symptoms but worsened gastrointestinal issues, including ileus and elevated CA19-9 levels, suggesting a potential carcinoma. A liver biopsy was performed. After IVIG treatment, he experienced widespread discomfort, emotional unresponsiveness, swallowing difficulties, and aspiration risk, ultimately leading to his demise.
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Affiliation(s)
- Narek Hakobyan
- Internal Medicine, Brookdale University Hospital and Medical Center, Brooklyn, USA
| | - Ruchi Yadav
- Hematology and Oncology, Brookdale University Hospital and Medical Center, Brooklyn, USA
| | - Akriti Pokhrel
- Internal Medicine, Brookdale University Hospital and Medical Center, Brooklyn, USA
| | - Mustafa Wasifuddin
- Internal Medicine, Brookdale University Hospital and Medical Center, Brooklyn, USA
| | - Michaela J John
- Internal Medicine, St. George's University School of Medicine, Brooklyn, USA
| | - Siddharth Yadav
- School of Health Sciences, The Bronx High School of Science, Bronx, USA
| | - Avezbakiyev Boris
- Hematology and Oncology, Brookdale University Hospital and Medical Center, Brooklyn, USA
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Ilerhunmwuwa NP, Inyang L, Wasifuddin M, Aiwuyo H, Tahir M, Hakobyan N, Ankah P, Torere BE, Amaechi UM, Rayapureddy AK, Wang JC. Demographics and outcomes of hemoglobin genotype in hospitalized patients with COVID-19 and sickle cell disease in the United States. Eur J Haematol 2023; 111:611-619. [PMID: 37477175 DOI: 10.1111/ejh.14054] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/06/2023] [Accepted: 07/10/2023] [Indexed: 07/22/2023]
Abstract
INTRODUCTION Coronavirus disease 2019 (COVID-19) is associated with poor outcomes in sickle cell disease (SCD) patients. However, there is a paucity of data comparing hemoglobin (Hb) genotypes in SCD and infection outcomes. METHODS The National Inpatient Sample was used to identify the record of hospitalizations with COVID-19 and SCD in 2020 using the International Classification of Disease, Tenth Revision codes. Study outcomes (invasive mechanical ventilation, extracorporeal membrane oxygenation, shock, vasopressor use, measures of resource utilization, and in-hospital mortality) were compared between hemoglobin SS, SC, and S-beta thalassemia (Sβ). RESULTS Of the 102 975 COVID-19 hospitalizations with SCD, 87.26% had HbSS, 7.16% had HbSC, and 5.58% had HbSβ. Younger patients were more likely to have HbSS, while older patients were likely to have HbSC and HbSβ. HbSS was more frequent with Blacks, while HbSβ was more prevalent with Whites and Hispanics. Though measures of resource utilization were higher in HbSS, there was no significant difference in in-hospital outcomes between the three genotypes. CONCLUSION There is no difference in COVID-19 outcomes among Hb genotypes in SCD. Further studies are needed to explore the reasons for this observation.
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Affiliation(s)
- Nosakhare Paul Ilerhunmwuwa
- Department of Internal Medicine, One Brooklyn Health/Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Lawrence Inyang
- Department of Internal Medicine, One Brooklyn Health/Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Mustafa Wasifuddin
- Department of Internal Medicine, One Brooklyn Health/Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Henry Aiwuyo
- Department of Internal Medicine, One Brooklyn Health/Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Muhammad Tahir
- Department of Internal Medicine, One Brooklyn Health/Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Narek Hakobyan
- Department of Internal Medicine, One Brooklyn Health/Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Paul Ankah
- Department of Internal Medicine, One Brooklyn Health/Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Beatrice E Torere
- Department of Internal Medicine, North Mississippi Medical Center, Tupelo, Mississippi, USA
| | - Uchenna M Amaechi
- Department of Internal Medicine, Lagos University Teaching Hospital, Surulere, Nigeria
| | | | - Jen Chin Wang
- Department of Hematology and Oncology, One Brooklyn Health/Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
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Wasifuddin M, Gomez D' Aza DJ, Pokhrel A, Manvar K, Wang JC. Recurrent Left Renal Fossa Clear Cell Renal Cell Carcinoma With Pancreatic Tail Invasion Presenting as Intestinal Obstruction. Cureus 2023; 15:e47953. [PMID: 38034254 PMCID: PMC10685987 DOI: 10.7759/cureus.47953] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Distant renal cell carcinoma (RCC) metastatic disease is mostly seen in the lungs, bones, and lymph nodes. The incidence of local recurrences within the ipsilateral retroperitoneum (RFR) is very low. We report a case of a 79-year-old male with recurrent left renal fossa RCC with pancreatic tail invasion who presented with large bowel obstruction. To the best of our knowledge, no cases have been reported of recurrent left renal fossa RCC initially presenting as extrinsic large bowel obstruction.
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Affiliation(s)
- Mustafa Wasifuddin
- Internal Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA
| | | | - Akriti Pokhrel
- Internal Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Kapilkumar Manvar
- Hematology and Medical Oncology, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Jen Chin Wang
- Hematology and Oncology, Brookdale University Hospital Medical Center, Brooklyn, USA
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Ilerhunmwuwa NP, Wasifuddin M, Becerra H, Rayapureddy AK, Wang JC. Characteristics and survival outcomes of patients with atypical chronic myeloid leukemia in the United States: A SEER-based analysis. Leuk Res Rep 2023; 20:100383. [PMID: 37592940 PMCID: PMC10428056 DOI: 10.1016/j.lrr.2023.100383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/19/2023] [Accepted: 08/05/2023] [Indexed: 08/19/2023] Open
Affiliation(s)
- Nosakhare Paul Ilerhunmwuwa
- Department of Internal Medicine, One Brooklyn Health/Brookdale University Hospital and Medical Center, Brooklyn, New York, United States of America
| | - Mustafa Wasifuddin
- Department of Internal Medicine, One Brooklyn Health/Brookdale University Hospital and Medical Center, Brooklyn, New York, United States of America
| | - Henry Becerra
- Incoming resident, Department of Internal Medicine, One Brooklyn Health/Brookdale University Hospital and Medical Center, Brooklyn, New York, United States of America
| | - Aditya Keerthi Rayapureddy
- Department of Internal Medicine, One Brooklyn Health/Interfaith Medical Center, Brooklyn, New York, United States of America
| | - Jen Chin Wang
- Department of Hematology and Oncology, One Brooklyn Health/Brookdale University Hospital and Medical Center, Brooklyn, New York, United States of America
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Sedeta E, Ilerhunmwuwa NP, Hindu Pahlani R, Aiwuyo H, Wasifuddin M, Uche I, Hakobyan N, Perry J, Terebelo S. A Diagnostic Dilemma: A Case of Neurosarcoidosis Without Systemic Sarcoidosis. Cureus 2023; 15:e42844. [PMID: 37664296 PMCID: PMC10472481 DOI: 10.7759/cureus.42844] [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] [Accepted: 08/02/2023] [Indexed: 09/05/2023] Open
Abstract
Sarcoidosis is a multisystem granulomatous disorder of unknown etiology characterized by non-caseating granulomas in involved organs. Approximately 10% of patients with sarcoidosis exhibit central nervous system involvement. However, the occurrence of isolated neurosarcoidosis without concurrent systemic signs is very rare, affecting less than 1% of patients. We report a case of isolated neurosarcoidosis in a previously healthy patient who initially presented with a single episode of seizure and loss of consciousness. Brain MRI showed T2/fluid-attenuated inversion recovery (FLAIR) hyperintense extra-axial soft tissue mass over the left cerebral convexity measuring approximately 14 mm in maximum depth. Excisional biopsy of the brain mass showed chronic non-caseating granulomatous inflammation with epitheloid cells that was consistent with sarcoidosis. Treatment with high dose-steroids led to significant clinical improvement. At a two-year follow-up, there were no signs of systemic disease or recurrence of the meningeal mass. This case emphasizes the rarity of such presentation, diagnostic difficulties, and the importance of high suspicion and timely management to prevent debilitating neurologic complications.
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Affiliation(s)
- Ephrem Sedeta
- Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA
| | | | | | - Henry Aiwuyo
- Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA
| | | | - Ifeanyi Uche
- Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Narek Hakobyan
- Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Jamal Perry
- Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Sima Terebelo
- Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA
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Ilerhunmwuwa NP, Adeniran O, Inyang L, Wasifuddin M, Hakobyan N, Perry JC, Abdul Khader AHS, Tahir M, Wang JC. Prevalence and outcomes of pulmonary embolism with sickle cell disease: Analysis of the Nationwide Inpatient Sample, 2016-2020. Eur J Haematol 2023. [PMID: 37293798 DOI: 10.1111/ejh.14025] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/26/2023] [Accepted: 05/30/2023] [Indexed: 06/10/2023]
Abstract
INTRODUCTION The outcomes of pulmonary embolism (PE) in sickle cell disease (SCD) are poorly established in the literature. This study examined the prevalence and outcomes of patients with PE and SCD. METHODS The National Inpatient Sample was used to identify patients' data with a diagnosis of PE and SCD in the United States from 2016 to 2020 using the International Classification of Disease, 10th Revision codes. Logistic regression was used to compare outcomes between those with and without SCD. RESULTS Of the 405 020 patients with PE, 1504 (0.4%) had SCD, and 403 516 (99.6%) did not have SCD. The prevalence of PE with SCD was stable. Patients in the SCD group were more likely to be female (59.5% vs. 50.6%; p < .0001), Black (91.7% vs. 54.4%; p < .0001), with a lower rate of comorbidities. The SCD group had higher in-hospital mortality (odds ratio [OR] = 1.41, 95% confidence interval [CI]:1.08-1.84; p = .012) but lower catheter-directed thrombolysis (OR = 0.23, 95% CI: 0.08-0.64; p = .005), mechanical thrombectomy (OR = 0.59, 95% CI: 0.41-0.64; p < .0029), and inferior vena cava filter placement (OR = 0.47, 95% CI: 0.33-0.66; p < .001). CONCLUSION In-hospital mortality remains high in PE with SCD. A proactive approach, including maintaining a high index of suspicion for PE, is needed to reduce in-hospital mortality.
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Affiliation(s)
- Nosakhare Paul Ilerhunmwuwa
- Internal Medicine Department, One Brooklyn Health/Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Olayemi Adeniran
- Internal Medicine Department, One Brooklyn Health/Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Lawrence Inyang
- Internal Medicine Department, One Brooklyn Health/Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Mustafa Wasifuddin
- Internal Medicine Department, One Brooklyn Health/Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Narek Hakobyan
- Internal Medicine Department, One Brooklyn Health/Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Jamal Christopher Perry
- Internal Medicine Department, One Brooklyn Health/Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | | | - Muhammad Tahir
- Internal Medicine Department, One Brooklyn Health/Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Jen Chin Wang
- Department of Hematology and Oncology, One Brooklyn Health/Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
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Ilerhunmwuwa NP, Inyang L, Hakobyan N, Wasifuddin M, Tahir M, Aiwuyo H, Ankah P, Torere BE, Amaechi UM, Wang JC. Outcomes of COVID-19 hospitalizations in patients with sickle cell disease: A nationwide analysis. Eur J Haematol 2023. [PMID: 37290934 DOI: 10.1111/ejh.14024] [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: 04/20/2023] [Revised: 05/27/2023] [Accepted: 05/30/2023] [Indexed: 06/10/2023]
Abstract
INTRODUCTION There is a paucity of data on the outcomes of coronavirus disease 2019 (COVID-19) in patients with sickle cell disease (SCD) in the United States. We examined the outcomes of patients with COVID-19 and SCD. METHODS We utilized the National Inpatient Sample (NIS) to identify the data of patients diagnosed with COVID-19 and SCD in 2020 using the International Classification of Disease, Tenth Revision codes. In-hospital outcomes (invasive mechanical ventilation and mortality) were compared between SCD and non-SCD groups. RESULTS Of the 1 057 550 COVID-19 hospitalizations, 2870 (0.3%) had SCD. The median age of the SCD group was 42 (IQR: 31) vs. 66 (IQR: 23) in the non-SCD group (p < .0001). Patients with SCD were likely to be females (62.02% vs. 37.98%, p < .0001), Blacks (87.81% vs. 12.19%, p < .0001), and in the lowest income quartile (50.62% vs. 11.15%, p < .0001). There was no difference in the outcomes between the two groups. There were increased odds of invasive mechanical ventilation and in-hospital mortality in COVID-19 in Asians, Hispanics, Native Americans, and Blacks (except for in-hospital mortality) compared to Whites. CONCLUSION In-hospital mortality and invasive mechanical ventilation outcomes in SCD are comparable to that in non-SCD patients hospitalized with COVID-19.
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Affiliation(s)
- Nosakhare Paul Ilerhunmwuwa
- Department of Internal Medicine, One Brooklyn Health/Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Lawrence Inyang
- Department of Internal Medicine, One Brooklyn Health/Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Narek Hakobyan
- Department of Internal Medicine, One Brooklyn Health/Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Mustafa Wasifuddin
- Department of Internal Medicine, One Brooklyn Health/Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Muhammad Tahir
- Department of Internal Medicine, One Brooklyn Health/Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Henry Aiwuyo
- Department of Internal Medicine, One Brooklyn Health/Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Paul Ankah
- Department of Internal Medicine, One Brooklyn Health/Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Beatrice E Torere
- Department of Internal Medicine, North Mississippi Medical Center, Tupelo, Mississippi, USA
| | - Uchenna M Amaechi
- Department of Internal Medicine, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Jen Chin Wang
- Department of Hematology and Oncology, One Brooklyn Health/Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
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Hakobyan N, Ilerhunmwuwa N, Wasifuddin M, Jamal F, Zagoruychenko T. An Unusual Source of Cerebral Embolism Caused by Lambl's Excrescences. Cureus 2023; 15:e40910. [PMID: 37496536 PMCID: PMC10366472 DOI: 10.7759/cureus.40910] [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] [Accepted: 06/24/2023] [Indexed: 07/28/2023] Open
Abstract
Lambl's excrescences (LEs) are delicate filiform strands formed by connective tissue located along the valve closure lines within the cardiovascular system. Most cases of these excrescences manifest without discernible symptoms, and the exact etiological factors contributing to their formation remain unknown. These excrescences may embolize to the brain, causing strokes. It is essential that all other possible causes of stroke be eliminated prior to identifying Lambl's excrescences as the cause of the stroke. Herein, we present a case of a patient who suffered a stroke, and all conventional testing for common causes of embolic strokes was ruled out. In pursuit of a comprehensive evaluation encompassing the classification of the stroke as cryptogenic, a transesophageal echocardiogram (TEE) was performed, which effectively disclosed the existence of LEs situated on the aortic valve leaflets. The patient was treated with anticoagulation and discharged with close follow-up monitoring. To culminate, the inclusion of this case within our study augments the currently scarce pool of instances that exhibit such characteristic cardioembolic phenomena, thereby accentuating the necessity for additional prospective investigations to substantiate the existence of a causative association linking LEs and cardioembolic strokes.
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Affiliation(s)
- Narek Hakobyan
- Internal Medicine, Brookdale University Hospital Medical Center, New York City, USA
| | | | - Mustafa Wasifuddin
- Internal Medicine, Brookdale University Hospital Medical Center, New York City, USA
| | - Fares Jamal
- Internal Medicine, Brookdale University Hospital Medical Center, New York City, USA
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Ilerhunmwuwa NP, Wasifuddin M, Perry J, Hakobyan N, Inyang L, Zavgorodneva Z, Gasparyan L, Tahir M. Pituitary Metastases From Differentiated Thyroid Cancers: A Systematic Review. World J Oncol 2023; 14:165-173. [PMID: 37350806 PMCID: PMC10284638 DOI: 10.14740/wjon1593] [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: 04/06/2023] [Accepted: 05/12/2023] [Indexed: 06/24/2023] Open
Abstract
Background Pituitary metastasis (PM) from differentiated thyroid cancer (DTC) is extremely rare and may adversely affect outcomes. We aimed to assess the characteristics and outcomes of patients with PM from DTC. Methods We systematically reviewed the literature on publications on PM and the different DTC histologic types (papillary, follicular, and Hurthle cell cancers). Three databases (PubMed, Embase, and Scopus) were searched for articles published from 1967 to 2022. Survival time was estimated as the period from the first treatment of PM to the time of death or last follow-up. Results Twenty-five articles comprising 27 cases that met the eligibility criteria were identified using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The median age of the patients was 60 years (23 - 86). A preponderance of females (66.7%) with PM most commonly reported papillary thyroid cancer (55.6%). This was followed by follicular thyroid cancer (37.0%) and Hurthle cell cancer (7.4%). The most common presentations were headache, nausea, and vomiting, with visual symptoms in 44.4%. Diabetes insipidus was an infrequent finding (7.4%). The median time from diagnosis or first treatment of DTC to the diagnosis of PM was 3 years (0 - 25). The most common endocrine abnormality was hyperprolactinemia (63.2%), while the most frequently deficient hormone was luteinizing hormone (50%). The most common treatment modality for PM was a combination of radiotherapy and surgery with or without radio-iodine. At the end of the follow-up, 30% of the patients died. Only 33.3% of the patients achieved complete resolution of symptoms. The overall median survival time was 12 months (3 - 108). There was a moderate inverse correlation between the age of patients and survival, which was, however, not statistically significant (rs = -0.45, P = 0.103). Conclusion PM from DTC is extremely rare, and Hurtle cell cancer appears to be the least associated with PM. Diabetes insipidus is a rare initial manifestation of PM from DTC. Complete resolution of symptoms is less likely to be achieved in PM from DTC. Older age may confer an increased survival tendency, probably due to more intracranial space volume in older people compared to the younger population. Larger studies are needed to examine the relationship between age and survival in PM from DTC. Also, more observational data are required to determine the predictors of survival and compare the efficacy of the different treatment modalities in patients with PM from DTC.
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Affiliation(s)
| | - Mustafa Wasifuddin
- Internal Medicine Department, Brookdale Hospital Medical Center/One Brooklyn Health, Brooklyn, NY, USA
| | - Jamal Perry
- Internal Medicine Department, Brookdale Hospital Medical Center/One Brooklyn Health, Brooklyn, NY, USA
| | - Narek Hakobyan
- Internal Medicine Department, Brookdale Hospital Medical Center/One Brooklyn Health, Brooklyn, NY, USA
| | - Lawrence Inyang
- Internal Medicine Department, Brookdale Hospital Medical Center/One Brooklyn Health, Brooklyn, NY, USA
| | - Zhanna Zavgorodneva
- Internal Medicine Department, Brookdale Hospital Medical Center/One Brooklyn Health, Brooklyn, NY, USA
| | - Lilit Gasparyan
- Internal Medicine Department, Brookdale Hospital Medical Center/One Brooklyn Health, Brooklyn, NY, USA
| | - Muhammad Tahir
- Internal Medicine Department, Brookdale Hospital Medical Center/One Brooklyn Health, Brooklyn, NY, USA
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13
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Yadav R, Pokhriyal SC, Yadav V, Idries I, Berekashvili K, Panigrahi K, Wasifuddin M. The Role of Dual Antiplatelet Therapy (DAPT) vs Surgery in a Case of Moyamoya Disease: A Case Report and Review of the Literature. Cureus 2023; 15:e39694. [PMID: 37398791 PMCID: PMC10308803 DOI: 10.7759/cureus.39694] [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] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
Moyamoya disease (MMD) is a rare cerebrovascular disease characterized by non-atherosclerotic and non-inflammatory progressive narrowing of the intracranial part of the carotid artery and its proximal branches. The disease process is commonly associated with the development of weak, dilated collateral blood vessels at the base of the brain. This gives it a classic smoky appearance on cerebral angiograms and hence the name "Moyamoya" which means "puff of smoke" in Japanese. When a patient has similar vasculopathy in the setting of another disease then it is known as Moyamoya syndrome (MMS). The associated diseases are sickle cell anemia, neurofibromatosis, long-standing diabetes, uncontrolled hypertension, or chemotherapy. Despite being known as a disease of the East Asian population, the disease is no longer exclusive to Asians, as evidenced by the rising incidence among non-Asian groups such as Caucasians, Hispanics, and African Americans. Patients can remain asymptomatic or present with ischemic or hemorrhagic stroke, headache, seizures, or recurrent transient ischemic attacks. Conventional cerebral angiography is considered the gold standard for diagnosing MMD. Treatment may be supportive, medical, or surgical. We present the case of a 42-year-old African American woman with several comorbidities who presented with sudden onset of ischemic stroke and upon further workup was found to have MMD. Equally important is to identify the most effective therapeutic approaches based on individual patients to achieve better clinical outcomes. Our case report highlights the importance of surgery in symptomatic MMD with a lack of supporting evidence indicating the benefits of dual antiplatelet therapy (DAPT).
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Affiliation(s)
- Ruchi Yadav
- Hematology and Oncology, Brookdale University Hospital Medical Center, New York, USA
| | | | - Vivek Yadav
- Pulmonary and Critical Care, State University of New York Downstate Health Sciences University, New York, USA
| | - Iyad Idries
- Internal Medicine, Brookdale University Hospital Medical Center, New York, USA
| | | | | | - Mustafa Wasifuddin
- Internal Medicine, Brookdale University Hospital Medical Center, New York, USA
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14
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Hakobyan N, Ilerhunmwuwa N, Wasifuddin M, Tasnim A, Boris A. COVID-19-Associated Disseminated Intravascular Coagulopathy Presenting As Inferior ST-Segment Elevation Myocardial Infarction. Cureus 2023; 15:e39308. [PMID: 37346198 PMCID: PMC10281741 DOI: 10.7759/cureus.39308] [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] [Accepted: 05/21/2023] [Indexed: 06/23/2023] Open
Abstract
Disseminated intravascular coagulopathy (DIC) is infrequently associated with COVID-19 infection. COVID-19 infection can predispose to thrombotic events through inflammation and microvascular injury. DIC is rarely associated with coronary artery disease, especially myocardial infarction (MI). In this case report, we present an uncommon case of a patient with concurrent DIC and MI in the setting of COVID-19 infection. A 73-year-old male patient with no known cardiovascular risk factor presented with syncope. Assessment in the field by emergency medical service (EMS) showed the patient had a third-degree atrioventricular block and a heart rate of 40 beats per minute. He was given atropine and transcutaneously paced. Upon admission, he was found to have an inferior wall ST-elevation myocardial infarction (STEMI) and tested positive for COVID-19. Cardiac catheterization was performed urgently and revealed triple vessel disease. Attempts to revascularize the vessels were unsuccessful. He subsequently developed cardiogenic shock. He was started on multiple pressor support. Laboratory workup was suggestive of DIC, and he later developed multiorgan failure. Continuous renal replacement therapy was initiated but failed due to persistent thrombosis of the dialysis access. Despite all measures, the patient developed cardiac arrest and passed away on the third day of hospitalization. Our understanding of COVID-19 and its complications has grown exponentially since the beginning of the pandemic. The pro-inflammatory state induced by the disease creates a hypercoagulable state that may result in thrombotic complications, including MI. In severe cases, a consumptive coagulopathy may develop, leading to DIC. This unique case report seeks to highlight the importance of staying vigilant about the potential complications of MI and DIC induced by COVID-19 so that prompt diagnosis can be made to reduce morbidity and mortality in these patients.
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Affiliation(s)
- Narek Hakobyan
- Internal Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA
| | | | - Mustafa Wasifuddin
- Internal Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Anika Tasnim
- Internal Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Avezbakiyev Boris
- Hematology/Oncology, Brookdale University Hospital Medical Center, Brooklyn, USA
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15
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Wasifuddin M, Ilerhunmwuwa N, Hakobyan N, Sedeta E, Uche I, Aiwuyo HO, Perry JC, Heravi O, Boris A. Malignant Pleural Effusion As the Initial Presentation of Renal Cell Carcinoma: A Case Report and Literature Review. Cureus 2023; 15:e37128. [PMID: 37153237 PMCID: PMC10159591 DOI: 10.7759/cureus.37128] [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] [Accepted: 04/03/2023] [Indexed: 05/09/2023] Open
Abstract
Renal cell carcinoma is the most common renal neoplasm. Its presentation is often very occult, and it may be discovered incidentally. It may present with the classic symptoms of back pain, flank pain, hematuria, or hypertension. Renal cell carcinoma may also present with malignant pleural effusion at diagnosis; however, it is very rare. In this case report and literature review, we describe a 77-year-old male who was diagnosed with renal cell carcinoma after presenting with a malignant pleural effusion - an extremely rare phenomenon. An analysis of the literature yielded 13 case reports, including ours, where the diagnostic presentation of renal cell carcinoma was a malignant pleural effusion. Our patient presented with left-sided chest pain. Imaging was suggestive of pleural effusion. CT and MRI imaging demonstrated masses in the upper and lower poles of the right kidney suggestive of renal cell carcinoma. CT imaging also showed lung nodules that were suggestive of pulmonary metastases. Biopsy and immunostaining of pleural tissue were positive for clear cell renal cell carcinoma. Therapeutic thoracentesis was performed. Despite this, the patient developed recurrent large-volume pleural effusions requiring drainage and placement of a pleural catheter. Our patient's extremely rare presentation of malignant pleural effusion as the diagnostic presentation of renal cell carcinoma along with recurrent, large-volume effusions requiring drainage has only been reported in the form of case reports in the literature.
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Affiliation(s)
- Mustafa Wasifuddin
- Internal Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA
| | | | - Narek Hakobyan
- Internal Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Ephrem Sedeta
- Internal Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Ifeanyi Uche
- Internal Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Henry O Aiwuyo
- Internal Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Jamal C Perry
- Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Omid Heravi
- Oncology, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Avezbakiyev Boris
- Hematology/Oncology, Brookdale University Hospital Medical Center, Brooklyn, USA
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16
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Wasifuddin M, Ilerhunmwuwa N, Uche I, Aiwuyo HO, Hakobyan N, Sedeta E, Perry JC, Torere BE, Abowali HA, Mararenko L. Malignant Pleural Effusion Due to Uterine Serous Carcinoma: An Unusual Presentation. Cureus 2023; 15:e34354. [PMID: 36874745 PMCID: PMC9974524 DOI: 10.7759/cureus.34354] [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] [Accepted: 01/29/2023] [Indexed: 01/31/2023] Open
Abstract
Endometrial cancer is the most common cancer of the female genital tract. It can rarely metastasize to the pleura and present as a malignant pleural effusion. Here we present the case of a 61-year-old female with two primary malignancies, breast and endometrium, who presented to us with shortness of breath. Imaging was suggestive of a malignant pleural effusion. Diagnostic and therapeutic thoracentesis were performed that were initially suggestive of a breast source. However, final pleural fluid studies showed endometrial serous carcinoma as the source of the effusion. The patient received pembrolizumab and lenvatinib treatment and continues to be followed up in our clinic.
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Affiliation(s)
- Mustafa Wasifuddin
- Internal Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA
| | | | - Ifeanyi Uche
- Internal Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Henry O Aiwuyo
- Internal Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Narek Hakobyan
- Internal Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Ephrem Sedeta
- Internal Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Jamal C Perry
- Internal Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA
| | | | - Hesham Ali Abowali
- Hematology and Oncology, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Larisa Mararenko
- Internal Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA
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17
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Wasifuddin M, Sabzposh H, Sun L, Wu R, Wang JC. Recurrence of T-Cell Prolymphocytic Leukemia With a Rare Presentation as Diffuse Generalized Skin Lesion. J Investig Med High Impact Case Rep 2023; 11:23247096231176223. [PMID: 37219076 DOI: 10.1177/23247096231176223] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Abstract
T-cell prolymphocytic leukemia (T-PLL) is a rare and aggressive neoplasm that originates from mature post-thymic T-cells. Cutaneous manifestations are a common presentation in T-PLL but rarely are a presentation in the recurrent setting. Here, we describe the case of a 75-year-old female with a history of T-PLL-who at the time of initial diagnosis did not exhibit any rash-presenting with diffuse rash, facial swelling, sore throat, and dysphagia 7 months later and was found to have recurrent T-PLL. She had diffuse lymphadenopathy and diffuse skin lesions. Biopsy of the skin lesions also confirmed infiltration with T-PLL cells. After review of the literature, no previously reported cases of recurrent T-PLL presented as diffuse skin lesions. This case demonstrates that recurrent T-PLL may present with diffuse rash, respiratory distress, and anasarca. It is important to stay vigilant in patients with history of T-PLL to recognize signs of recurrent disease to allow prompt diagnosis and treatment.
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Affiliation(s)
- Mustafa Wasifuddin
- Department of Medicine, Brookdale University Hospital and Medical Center, Brooklyn, NY, USA
| | - Hafsa Sabzposh
- Department of Medicine, Brookdale University Hospital and Medical Center, Brooklyn, NY, USA
| | - Lishi Sun
- Division of Hematology and Oncology, Department of Medicine, Brookdale University Hospital and Medical Center, Brooklyn, NY, USA
| | - Richard Wu
- Division of Pathology, Brookdale University Hospital and Medical Center, Brooklyn, NY, USA
| | - Jen C Wang
- Division of Hematology and Oncology, Department of Medicine, Brookdale University Hospital and Medical Center, Brooklyn, NY, USA
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18
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Muacevic A, Adler JR, Aiwuyo HO, Sedeta E, Uche I, Wasifuddin M, Perry JC. Breast Cancer Complicated by Cardiac Tamponade in a Patient With Neurofibromatosis Type 1. Cureus 2023; 15:e34095. [PMID: 36843810 PMCID: PMC9946274 DOI: 10.7759/cureus.34095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2023] [Indexed: 01/24/2023] Open
Abstract
Pericardial effusion may occur as a result of malignant pericarditis, which may in turn result in cardiac tamponade. This paper reports on a rare case of cardiac tamponade that occurred in an African American patient with breast cancer and neurofibromatosis. Herein, we present a case of a 38-year-old woman with neurofibromatosis type 1 (NF1) and breast cancer. She presented with sudden shortness of breath and hypotension. Computed tomography of the chest and an echocardiogram confirmed the presence of cardiac tamponade. Symptomatic relief was obtained following an emergency pericardiocentesis. The patient experienced a recurrence of symptomatic pleuro-pericardial effusion, requiring repeat therapeutic pericardiocentesis and thoracocentesis. To eliminate accumulating fluid, an indwelling drain was placed. The clinical condition of the patient, however, continued to deteriorate and she expired a few days after admission. When patients with breast cancer present with dyspnea, clinicians should maintain a high index of suspicion of cardiac tamponade; urgent imaging should be performed to exclude tamponade. Further research is needed to identify the factors that predict cardiac tamponade in breast cancer patients as well as the optimal treatment for the condition. It is also necessary to examine the relationship between a history of neurofibromatosis and cardiac tamponade.
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19
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Muacevic A, Adler JR, Wasifuddin M, Hakobyan N, Aiwuyo HO, Perry JC, Uche I, Okhawere K, Torere BE, Burak E, Omid H, Wang JC. Cardiac Tamponade in Patients With Breast Cancer: A Systematic Review. Cureus 2022; 14:e33123. [PMID: 36721600 PMCID: PMC9884404 DOI: 10.7759/cureus.33123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2022] [Indexed: 12/31/2022] Open
Abstract
Cardiac tamponade is a rare presentation in breast cancer and may be associated with poor prognosis. In this article, we reviewed the characteristics and survival outcomes of patients with breast cancer who developed cardiac tamponade. Three databases (PubMed, EMBASE and SCOPUS) were searched for relevant articles published from 1978 to 2022 and 16 articles were identified comprising 64 cases. The median age of the cases was 52 years. Cardiac tamponade was diagnosed with echocardiogram or computerized tomography of the chest or both in 91.9%, 1.6% and 6.5% of the cases, respectively. Cytology of the pericardial fluid was done in 90.5% of the cases while biopsy in addition to cytology was done in 9.5% of cases. Tamponade was proven to be malignant in 97.4% of the cases. The initial treatment for tamponade was pericardiocentesis. Adjunct therapies ranged from the insertion of a pericardial window, pericardiectomy, radiotherapy and chemotherapy. The median time from the first treatment of breast cancer to the onset of tamponade was 24 months while the median survival following diagnosis of tamponade was 13 months. There was no significant correlation (spearman rank-sum correlation coefficient= 0.35, p = 0.165) between time to tamponade (interval time from the first diagnosis of breast cancer and the onset of cardiac tamponade) and survival. Cardiac tamponade may adversely affect survival in patients with breast cancer. Early diagnosis with echocardiogram and cytology may guide management and expectations. Further observational studies are needed to determine the predictors of cardiac tamponade and optimal treatment in patients with breast cancer.
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20
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Muacevic A, Adler JR, Ilerhunmwuwa N, Raza HM, Tan J, Belousova T, Wasifuddin M. A Rare Case of Metastatic Gastric Signet Ring Cell Adenocarcinoma in a 23-Year-Old Female Presenting as Malignant Pleural Effusion. Cureus 2022; 14:e33085. [PMID: 36726911 PMCID: PMC9886370 DOI: 10.7759/cureus.33085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2022] [Indexed: 12/30/2022] Open
Abstract
Signet ring cell carcinoma (SRCC) is a poorly differentiated mucin-producing adenocarcinoma with greater than 50% signet ring cells. It commonly arises from the gastrointestinal (GI) tract and rarely from extraintestinal organs. This is a rare case of a young African American female who presented with metastatic spread of signet ring cell gastric cancer (pleural and lymph nodal involvement) as the initial presentation of SRCC. Knowledge of the various clinical manifestations of SRCC can help with its early diagnosis, and there is a high need for detailed physical examination, early referral, and prompt treatment in patients with SRCC.
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21
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Muacevic A, Adler JR, Hakobyan N, Sedeta E, Uche I, Wasifuddin M, Torere BE, Perry JC, Rafii SE. BRASH Syndrome Presenting With Idioventricular Escape Rhythm in a Patient With Trifascicular Block. Cureus 2022; 14:e32217. [PMID: 36620804 PMCID: PMC9812229 DOI: 10.7759/cureus.32217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2022] [Indexed: 12/12/2022] Open
Abstract
Bradycardia, renal failure, atrioventricular (AV) nodal disease, shock, and hyperkalemia (BRASH) syndrome is a well-recognized constellation of distinct clinicopathologic entities comprising bradycardia, renal failure, AV nodal disease, shock, and hyperkalemia. Our patient is an 89-year-old female with a past medical history significant for hypertension and diabetes, who was newly started on labetalol and had recent gastroenteritis; she presented to our Emergency Department with bradycardia and shock. Upon presentation, she showed physical signs of volume depletion, and her blood pressure was 50 mmHg systolic and heart rate was 25 beats per minute. The initial electrocardiogram showed an idioventricular rhythm. The laboratory workup revealed hyperkalemia. The patient was given repeated doses of atropine with no significant response. She was resuscitated with isotonic fluids. The patient improved clinically, her blood pressure stabilized, her potassium level, renal function, and heart rate were normalized, and normal sinus rhythm was restored with a narrow QRS complex. A diagnosis of BRASH syndrome was made retrospectively. Overall, the treatment of this syndrome is largely symptomatic. Hemodynamic support with fluid and treatment of hyperkalemia remains the goal of care. The overall prognosis is good if identified early and managed appropriately.
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