Ibrahim Tawhari - Academia.edu (original) (raw)

Papers by Ibrahim Tawhari

Transplantation Proceedings

Baylor University Medical Center Proceedings

Pseudohyponatremia is an often misdiagnosed condition that needs to be managed by addressing the ... more Pseudohyponatremia is an often misdiagnosed condition that needs to be managed by addressing the underlying cause. Treatment of hyponatremic patients with intravenous fluids without ruling out pseudohyponatremia may aggravate a patient's hyponatremia and result in adverse outcomes. In a patient whose sodium is deteriorating, it is critical to diagnose pseudohyponatremia early in the course and acquire necessary consultations, even if the patient is asymptomatic. We discuss a case of a man in his 20s with a history of liver transplantation who presented with unexplained dangerously low sodium while being asymptomatic. The case illustrates an uncommon cause of pseudohyponatremia due to lipoprotein-X hypercholesterolemia in a patient with cholestatic liver disease.

Cureus, 2022

Background Patients with end-stage kidney disease (ESKD) are disproportionately vulnerable to COV... more Background Patients with end-stage kidney disease (ESKD) are disproportionately vulnerable to COVID-19 and its complications due to the older age and significant burden of comorbid conditions. Data about the impact of COVID-19 on the ESKD population in the Kingdom of Saudi Arabia is scarce, and this study aims to bridge this gap. Method This is a retrospective cohort study that included ESKD patients who were receiving either in-center hemodialysis (HD) or peritoneal dialysis (PD) for at least three months and were hospitalized due to COVID-19 at King Abdulaziz Medical City in Riyadh (KAMC) between March 2020 and March 2021. Of note, the incenter hemodialysis means that the patients come to the dialysis center three times per week to receive their dialysis sessions, as home hemodialysis is not available at our center. Multivariate logistic regression was performed to explore the association of clinical characteristics and laboratory parameters with ICU admission and mortality. Results A total of 104 patients were included in the analysis. The mean age was 62.6 (SD=17.4) years, 101 (97%) were on HD, predominantly through a central venous catheter (72%), and 53 patients (51%) were male. Patients with COVID-19 were either asymptomatic (42%) or had mild symptoms (37%), mainly cough and fever. At the time of admission, 37 patients (36%) had extrapulmonary symptoms, and 13 patients (12%) had altered mental status. Normal chest X-ray (48%), followed by bilateral lung infiltrates (24%), and unilateral lung infiltrate (11%) were the most common radiological findings. We did not observe any thromboembolic events. Twenty patients (19%) required ICU admission and 19 patients (18%) died during hospitalization. Predictors for in-hospital mortality were: 1) the need for inotropes (adjusted OR: 53.01, p=0.006), 2) age (adjusted OR: 1.07, p=0.019), and 3) C-reactive protein (CRP) level on admission (adjusted OR: 1.02, p=0.04). We did not find any strong predictor for ICU admission. Conclusion Our study demonstrated that COVID-19 carries significant mortality and morbidity in the ESKD population. Age, inotropic support requirement and elevated CRP on admission predicted mortality in our population. The high rate of adverse outcomes of COVID-19 among ESRD patients calls for strict implementation of preventive measures, including vaccination, social distancing, and universal masking at the level of both the healthcare providers and patients. Further studies are needed to assess the association of COVID-19 and hypercoagulability ESKD population.

BMJ case reports, Jan 8, 2015

Gastrointestinal endoscopy clinics of North America, 2011

There is increasing concern regarding a possible adverse interaction between proton pump inhibito... more There is increasing concern regarding a possible adverse interaction between proton pump inhibitors (PPIs) and clopidogrel that could lead to reduced cardiovascular protection by clopidogrel. We performed a literature search for relevant original studies and systematic reviews. PPIs likely affect the antiplatelet activity of clopidogrel as measured in vitro, and this may be a class effect. We conclude that the pharmacodynamic effect has not been translated into any clinically meaningful adverse effect. PPI cotherapy reduces the incidence of recurrent peptic ulcer and of upper gastrointestinal bleeding among patients on clopidogrel.

Circulation: Cardiovascular Imaging, 2011

Background— Endocardial fibrous tissue (FT) deposition is a hallmark of endomyocardial fibrosis (... more Background— Endocardial fibrous tissue (FT) deposition is a hallmark of endomyocardial fibrosis (EMF). Echocardiography is a first-line and the standard technique for the diagnosis of this disease. Although late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) allows FT characterization, its role in the diagnosis and prognosis of EMF has not been investigated. Methods and Results— Thirty-six patients (29 women; age, 54±12 years) with EMF diagnosis after clinical evaluation and comprehensive 2-dimensional Doppler echocardiography underwent cine-CMR for assessing ventricular volumes, ejection fraction and mass, and LGE-CMR for FT characterization and quantification. Indexed FT volume (FT/body surface area) was calculated after planimetry of the 8 to 12 slices obtained in the short-axis view at end-diastole (mL/m 2 ). Surgical resection of FT was performed in 16 patients. In all patients, areas of LGE were confined to the endocardium, frequently as a continuous stre...

Acta Dermato Venereologica, 2013

Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN) and drug reaction with eosinophi... more Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN) and drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome, are severe cutaneous adverse reactions (SCARs), which can be fatal if not treated promptly. These 2 entities have phenotypically and pathophysiologically distinct features (1). However, there are clinical similarities between them, which can cause confusion in diagnosis, leading to delays in proper management. We report here a case of ethambutol-induced DRESS with early features resembling SJS. CASE REPORT A 68-year-old woman was admitted to our emergency department with maculopapular rashes on her trunk and extremities and painful erosions on her oral mucosa (Fig. 1a). On physical examination, prominent targetoid lesions were observed, with blisters and positive Nikolsky's sign (Fig. 1b). The patient had a high fever (39.6ºC) and acute conjunctivitis. Laboratory tests showed the following: C-reactive protein (CRP) 12.9 mg/dl (normal 0-0.5 mg/dl); leukocytes 3,810/mm 3 (4,000-10,000/ mm 3); eosinophils 220/mm3 (< 500/mm 3); aspartate aminotransferase (AST) 35 IU/l (0-40 IU/l); alanine aminotransferase (ALT) 12 IU/l (0-40 IU/l); and serum creatinine 0.7 mg/dl (0.7-1.4 mg/dl). Culture and serological tests were negative for bacteria, HIV, and hepatitis A, B and C virus. Her medication history revealed that she had started anti-tuberculosis drugs (isoniazid, rifampicin, ethambutol and levofloxacin) for tuberculous pericarditis 7 weeks earlier. As a diagnosis of SJS was suspected, anti-tuberculous medications were discontinued and systemic corticosteroid was started (methylprednisolone 1 mg/kg/day). Her skin rash and oral mucosal lesions subsequently improved gradually. By hospital day 9, her fever had resolved and CRP decreased to 3.5 mg/dl, therefore the dose of methylprednisolone was tapered down to 0.5 mg/kg/day. However, on hospital day 11, she suddenly began to deteriorate, with maculopapular eruptions combined with painful cervical lymphadenopathy. Notably, her cutaneous manifestations at this time were quite different in nature from the initial findings that had suggested SJS, such as targetoid lesion or blister formation. Laboratory tests revealed leukocytosis (13,020/mm 3) with hypereosinophilia (2,734/mm 3), atypical lymphocytosis (10%; normal < 1%), elevated ALT (63 IU/l), and acute renal dysfunction (serum creatinine 4.7 mg/dl). Immunoglobulin M against cytomegalovirus and Epstein-Barr virus tested on hospital day 12 were negative. Five days later, AST/ ALT increased to 95/118 IU/l and serum creatinine peaked at 5.4 mg/dl. The total score on the RegiSCAR scoring system was

Frontiers in Immunology, Dec 19, 2022

Background: Belatacept (Bela) was developed to reduce nephrotoxicity and cardiovascular risk that... more Background: Belatacept (Bela) was developed to reduce nephrotoxicity and cardiovascular risk that are associated with the chronic use of Calcineurin inhibitors (CNIs) in kidney transplant recipients. The use of Bela with early steroid withdrawal (ESW) and simultaneous CNI avoidance has not been formally evaluated. Methods: At 3 months post-transplant, stable kidney transplant recipients with ESW on Tacrolimus (Tac) + mycophenolate (MPA) were randomized 1:1:1 to: 1) Bela+MPA, 2) Bela+low-dose Tac (trough goal <5 ng/mL), or 3) continue Tac +MPA. All patients underwent surveillance graft biopsies at enrollment and then at 12, and 24 months post-transplant. Twenty-seven recipients were included; 9 underwent conversion to Bela+MPA, 8 to Bela+low-dose Tac and 10 continued Tac+MPA. Serial blood samples were collected for immune phenotyping and gene expression analyses. Results: The Bela+MPA arm was closed early due to high rate of biopsy proven acute rejection (BPAR). The incidence of BPAR was 4/9 in Bela+MPA, 0/8 in Bela +low dose Tac and 2/10 in Tac+MPA, P= 0.087. The Bela+low-dose Tac regimen was associated with +8.8 mL/min/1.73 m 2 increase in eGFR compared to-0.38 mL/min/1.73 m 2 in Tac+MPA, P= 0.243. One graft loss occurred in the Bela+MPA group. Immunophenotyping of peripheral blood monocyte count (PBMC) showed that CD28 + CD4 + and CD28 + CD8 + T cells were higher in Bela+MPA patients with acute rejection compared to patients without rejection, although the difference did not reach statistical significance. Conclusions: Our data indicate that, in steroid free regimens, low-dose Tac maintenance is needed to prevent rejection when patients are converted to Bela, at least when the maneuver is done early after transplant.

Journal of The American Society of Nephrology, 2020

Kidney International Reports, 2020

Clinical Medicine Insights: Cardiology, 2020

Aim: To evaluate the effectiveness of using a smartphone-based electrocardiography (ECG) monitori... more Aim: To evaluate the effectiveness of using a smartphone-based electrocardiography (ECG) monitoring device (ECG Check) on the frequency of clinic or emergency room visits in patients who underwent ablation of atrial fibrillation (AF). Methods: Two groups of patients were identified and compared: The conventional monitoring group (CM group) included patients who were prescribed conventional event monitoring or Holter monitoring systems. The ECG Check group (EC group) included patients who were prescribed the ECG Check device for continuous monitoring in addition to conventional event monitoring. The primary outcome was the number of patient visits to clinic or emergency room. The feasibility, accuracy, and detection rate of mobile ECG Check were also evaluated. Results: Ninety patients were studied (mean age: 66.2 ± 11 years, 64 males, mean CHA2DS2-VASc score: 2.6 ± 2). In the EC group, forty-five patients sent an average of 52.8 ± 6 ECG records for either routine monitoring or sympt...

Journal of Investigative Medicine High Impact Case Reports, 2019

Haemophilus influenzae is serologically classified into two main categories based on the presence... more Haemophilus influenzae is serologically classified into two main categories based on the presence or absence of the polysaccharide capsule. Strains that possess polysaccharide capsules are identified as typeable Haemophilus influenzae, whereas strains that do not have capsules are identified as non-typeable Haemophilus influenza. Only on very rare occasions, Haemophilus influenzae affects adult joints, and almost 95% of cases have been identified as type b serotypes. Coexistence of gouty and septic arthritis is rare but has been reported. We herein report a case of polyarticular septic arthritis caused by non-typeable Haemophilus influenzae in an adult with concomitant new-onset gouty arthritis. The case was successfully treated with surgical debridement and a 4-week course of ceftriaxone.

Journal of the American Society of Nephrology, 2020

BackgroundStudies have documented AKI with high-grade proteinuria in patients with severe acute r... more BackgroundStudies have documented AKI with high-grade proteinuria in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In some patients, biopsies have revealed collapsing glomerulopathy, a distinct form of glomerular injury that has been associated with other viruses, including HIV. Previous patient reports have described patients of African ancestry who developed nephrotic-range proteinuria and AKI early in the course of disease.MethodsIn this patient series, we identified six patients with coronavirus disease 2019 (COVID-19), AKI, and nephrotic-range proteinuria. COVID-19 was diagnosed by a positive nasopharyngeal swab RT-PCR for SARS-CoV-2 infection. We examined biopsy specimens from one transplanted kidney and five native kidneys. Three of the six patients underwent genetic analysis of APOL1, the gene encoding the APOL1 protein, from DNA extracted from peripheral blood. In addition, we purified genomic DNA from paraffin-embedded tissue and per...