Jeffrey Miskoff - Academia.edu (original) (raw)

Papers by Jeffrey Miskoff

Advancements in Case Studies, 2019

Background: Measles remains one of the leading causes of death among children around the world. E... more Background: Measles remains one of the leading causes of death among children around the world. Encephalitis is the most serious complication of measles virus infection. Case presentation: We report two measles-induced encephalitis who was admitted to to Kyiv City Pediatric Infectious Clinical Hospital. One patient had postinfectious variant of measles encephalitis that occurred 6 days after primary measles infection onset. Disease had benign course with substantial improvement during hospital stay. Another patient presented with subacute sclerosing panencephalitis. Neurological symptoms started 10 years after measles infection. Disease characterized by progredient course and unfavorable outcome. Conclusion: Measles encephalitis is rare but serious and often deadliest complication. It should be considered in differential diagnostic of CNS infection among pediatric patients.

Cureus, May 27, 2020

Amiodarone is a class III antiarrhythmic agent that inhibits adrenergic stimulation by blocking a... more Amiodarone is a class III antiarrhythmic agent that inhibits adrenergic stimulation by blocking alpha and beta receptors. It prolongs action potential and refractory period in myocardial tissue. Its remarkably long half-life is associated with a myriad of adverse events. Here, we present an 85-year-old male patient who was started on amiodarone for atrial flutter. After three oral doses, he developed fulminant hepatic failure and acute renal failure, which resolved after stopping amiodarone. While fulminant hepatic failure is rare, it has been seen in less than 2% of patients. Alternative theories behind susceptibility to amiodarone-induced hepatic injury and acute kidney injury are discussed here.

Medicine, May 1, 2020

Rationale: Novel coronavirus 2019 (COVID-19) also known as severe acute respiratory syndrome coro... more Rationale: Novel coronavirus 2019 (COVID-19) also known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an enveloped, non-segmented positive-sense RNA virus belonging to the beta-coronaviridae family. This virus is known to cause severe bilateral pneumonia and acute respiratory distress syndrome (ARDS) which can lead to difficulty breathing requiring mechanical ventilation and intensive care unit management. Patient concerns: A 77-year-old female with a history of hypertension and hyperlipidemia who presented as a transfer to our hospital facility with worsening fevers, cough, and respiratory distress. Diagnosis: Chest X-rays revealed bilateral infiltrates worse at the lung bases and CT scan of the chest showed bilateral groundglass opacities consistent with COVID-19. While our testing revealed a negative COVID-19 result at our institution, the result at a previous hospital returned a positive result. Interventions: She was being treated aggressively in the intensive care unit with high dose intravenous ascorbic acid, hydroxychloroquine, and anti-interleukin-6 monoclonal antibody. She also received a loading dose of remdesivir however was unable to complete the course due to organ failure and requirement of vasopressors for hemodynamic stability. Outcomes: She remained critically ill and was eventually placed on comfort care as per the family's wishes and passed away. Lessons: With a rapidly growing death rate and more than 200,000 confirmed cases worldwide, COVID-19 has become a global pandemic and major hit to our healthcare systems. While several companies have already begun vaccine trials and healthcare facilities have been using a wide-range of medications to treat the virus and symptoms, there is not yet an approved medication regimen for COVID-19 infections. The alarming increase in cases per day adds additional pressure to find a cure and decrease the global health burden and mortality rate. Abbreviations: ARDS = acute respiratory distress syndrome, CoV = coronavirus, COVID-19 = novel coronavirus 2019, CVVHD = continuous veno-venous hemodialysis, ED = emergency department, FiO2 = fraction of inspired oxygen, ICU = intensive care unit, MERS-CoV = Middle East respiratory syndrome coronavirus, PCR = polymerase chain reaction, PEEP = positive end-expiratory pressure, RSV = Respiratory syncytial virus, SARS-CoV = severe acute respiratory syndrome coronavirus, SARS-CoV-2 = severe acute respiratory syndrome coronavirus 2.

Medicine, 2020

Rationale: Novel coronavirus 2019 (COVID-19) also known as severe acute respiratory syndrome coro... more Rationale: Novel coronavirus 2019 (COVID-19) also known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an enveloped, non-segmented positive-sense RNA virus belonging to the beta-coronaviridae family. This virus is known to cause severe bilateral pneumonia and acute respiratory distress syndrome (ARDS) which can lead to difficulty breathing requiring mechanical ventilation and intensive care unit management. Patient concerns: A 77-year-old female with a history of hypertension and hyperlipidemia who presented as a transfer to our hospital facility with worsening fevers, cough, and respiratory distress. Diagnosis: Chest X-rays revealed bilateral infiltrates worse at the lung bases and CT scan of the chest showed bilateral groundglass opacities consistent with COVID-19. While our testing revealed a negative COVID-19 result at our institution, the result at a previous hospital returned a positive result. Interventions: She was being treated aggressively in the intensive care unit with high dose intravenous ascorbic acid, hydroxychloroquine, and anti-interleukin-6 monoclonal antibody. She also received a loading dose of remdesivir however was unable to complete the course due to organ failure and requirement of vasopressors for hemodynamic stability. Outcomes: She remained critically ill and was eventually placed on comfort care as per the family's wishes and passed away. Lessons: With a rapidly growing death rate and more than 200,000 confirmed cases worldwide, COVID-19 has become a global pandemic and major hit to our healthcare systems. While several companies have already begun vaccine trials and healthcare facilities have been using a wide-range of medications to treat the virus and symptoms, there is not yet an approved medication regimen for COVID-19 infections. The alarming increase in cases per day adds additional pressure to find a cure and decrease the global health burden and mortality rate. Abbreviations: ARDS = acute respiratory distress syndrome, CoV = coronavirus, COVID-19 = novel coronavirus 2019, CVVHD = continuous veno-venous hemodialysis, ED = emergency department, FiO2 = fraction of inspired oxygen, ICU = intensive care unit, MERS-CoV = Middle East respiratory syndrome coronavirus, PCR = polymerase chain reaction, PEEP = positive end-expiratory pressure, RSV = Respiratory syncytial virus, SARS-CoV = severe acute respiratory syndrome coronavirus, SARS-CoV-2 = severe acute respiratory syndrome coronavirus 2.

Cureus, 2020

Amiodarone is a class III antiarrhythmic agent that inhibits adrenergic stimulation by blocking a... more Amiodarone is a class III antiarrhythmic agent that inhibits adrenergic stimulation by blocking alpha and beta receptors. It prolongs action potential and refractory period in myocardial tissue. Its remarkably long half-life is associated with a myriad of adverse events. Here, we present an 85-year-old male patient who was started on amiodarone for atrial flutter. After three oral doses, he developed fulminant hepatic failure and acute renal failure, which resolved after stopping amiodarone. While fulminant hepatic failure is rare, it has been seen in less than 2% of patients. Alternative theories behind susceptibility to amiodarone-induced hepatic injury and acute kidney injury are discussed here.

Cureus, Jun 6, 2018

Mycobacterium chimaera is an indolent nontuberculous mycobacterium which is abundant in soil, dus... more Mycobacterium chimaera is an indolent nontuberculous mycobacterium which is abundant in soil, dust, and water. Although lacking recognition garnered by other mycobacteria (i.e., M. tuberculosis), it has been recognized as an emerging opportunistic threat to patients undergoing coronary bypass surgery and open heart procedures requiring extracorporeal devices. Here, we present a case of an individual initially seen in the inpatient setting without a history of such procedures or other risk factors commonly associated with mycobacteriumladen infections.

Cureus, Jul 18, 2022

Robinson et al. This is an open access article distributed under the terms of the Creative Common... more Robinson et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cureus, Jul 5, 2018

Low dose naltrexone (LDN) has been promising as a complementary medication for patients with a br... more Low dose naltrexone (LDN) has been promising as a complementary medication for patients with a broad range of medical disorders. Although not a proven cure, evidence from clinical trials supports LDN as being a valuable adjunct for disorders in which the immune system plays a centralized role. Additionally, clinical trials have proposed a unique mechanism(s) allowing LDN to affect tumors including non-small cell lung cancer (NSCLC) at the cellular level by augmenting the immune system. We present a case of a 50-year-old male with a prolonged survival and a past medical history of prostate and lung cancer.

Journal of Occupational and Environmental Medicine, 2004

The effects of exposure to the environment around the World Trade Center after the attack of Sept... more The effects of exposure to the environment around the World Trade Center after the attack of September 11, 2001, are not fully described. We evaluated 240 police first-responders; respiratory symptoms occurred in 77.5% but resolved or improved in around three fourths of subjects by the time of their evaluation (mean 69 days after the attack). Cough was the most common symptom (62.5%). Spirometric abnormalities were mild and occurred in 28.8%. Independent risk factors for abnormal spirometry were previous pulmonary disease or symptoms (adjusted odds ratio, 2.76) and intensity of exposure (AOR, 2.32). Previous pulmonary conditions were associated with obstructive defects (P<0.002). Exposure intensity was associated with a lower forced vital capacity (P<0.03) and a higher prevalence of abnormal spirometry (P<0.03). Officers with dyspnea, chest discomfort, or wheeze were more likely to have abnormal spirometry (P=0.04). A significant minority of officers had symptoms a few months after the exposure. Long-term effects of this respiratory tract exposure will need additional evaluation.

BMC Pulmonary Medicine, 2021

Background Anti-synthetase syndrome (ASS) is an uncommon immune-mediated entity characterized by ... more Background Anti-synthetase syndrome (ASS) is an uncommon immune-mediated entity characterized by myositis, interstitial lung disease (ILD), non-erosive arthritis, and less common features such as fever, Raynaud’s phenomenon, and skin changes in association with anti-aminoacyl-transfer-RNA antibodies, most commonly anti-Jo-1 antibodies. Case presentation We present a challenging and rare case of ASS-associated ILD presenting with unexplained respiratory symptoms and bilateral infiltrates on chest imaging during the COVID-19 pandemic. High clinical suspicion for ASS with early appropriate therapy with corticosteroids and immunosuppressive agents led to marked clinical improvement. Conclusion High index of suspicion for ASS is mandated in patients with unexplained ILD. A comprehensive autoimmune work-up is important as an early treatment with corticosteroids with or without immunomodulators improves patient outcomes and survival in an otherwise poor prognostic disease.

Cureus, 2020

E-cigarette or vaping is an alternative to traditional cigarette use with potentially devastating... more E-cigarette or vaping is an alternative to traditional cigarette use with potentially devastating consequences. The most recent update from the Centers for Disease Control and Prevention reports a total of 2,561 cases of vaping associated pulmonary injury as of December 27, 2019. This case described a 41-year-old female who presented with a clinical picture suggesting of bronchitis; however, a diagnosis of e-cigarette or vaping product use-associated lung injury was made.

Cureus, 2019

Cryptogenic organizing pneumonia (COP), also known as idiopathic bronchiolitis obliterans organiz... more Cryptogenic organizing pneumonia (COP), also known as idiopathic bronchiolitis obliterans organizing pneumonia (BOOP), is a rare inflammatory condition. It often presents as sequelae of existing chronic inflammatory diseases such as rheumatoid arthritis, systemic lupus erythematosus, and various connective tissue conditions. This case describes a 28-year-old African American female who presented with a complex clinical picture involving chronic inflammatory processes and the pulmonary system. The initial evaluation suggested pneumonia to be the underlying cause of respiratory symptoms; however, ultimately, a diagnosis of BOOP with dermatomyositis was made.

Cureus, 2019

Diffuse parenchymal lung diseases (DPLD), also known as interstitial lung diseases (ILD), are a g... more Diffuse parenchymal lung diseases (DPLD), also known as interstitial lung diseases (ILD), are a group of lung disorders affecting alveolar epithelium, pulmonary capillary endothelium, and surrounding lung tissue. Over time due to injury, the tissue around the air sacs becomes fibrotic leading to poor oxygen exchange, eventually resulting in the patient experiencing shortness of breath. This case describes a 69-year old male who presented in 2017 with a complex clinical picture involving both cardiac and pulmonary systems. Drug toxicity was initially thought to be the cause of the patients interstitial lung process; however, ultimately, a diagnosis of UIP was made.

A39. DRUG RELATED CASE REPORTS, 2019

Nitrofurantoin is one of the most utilized antibiotics to treat bladder and urinary tract infecti... more Nitrofurantoin is one of the most utilized antibiotics to treat bladder and urinary tract infections (UTIs). Despite the clinical benefits, it requires vigilant monitoring, as it can cause damage to multiple organs, especially the lungs and the liver. This case is an example of clinical vigilance, which provided tremendous benefit for the patient.

A57. NTM: CASE REPORTS, 2019

Mycobacterium chimaera is an indolent nontuberculous mycobacterium which is abundant in soil, dus... more Mycobacterium chimaera is an indolent nontuberculous mycobacterium which is abundant in soil, dust, and water. Although lacking recognition garnered by other mycobacteria (i.e., M. tuberculosis), it has been recognized as an emerging opportunistic threat to patients undergoing coronary bypass surgery and open heart procedures requiring extracorporeal devices. Here, we present a case of an individual initially seen in the inpatient setting without a history of such procedures or other risk factors commonly associated with mycobacteriumladen infections.

Cureus, 2019

Asthma and chronic obstructive pulmonary disease (COPD) can present as unique conditions or as a ... more Asthma and chronic obstructive pulmonary disease (COPD) can present as unique conditions or as a combination known as asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS). These condition(s) can be categorized as obstructive conditions, causing inflammation of small airways leading to decrease airflow, mucus production, and bronchoconstriction. Asthma and COPD affect every age, gender, ethnicity, and socioeconomic status, thus increasing mortality and morbidity burden in our society. Fractional exhaled nitric oxide (FeNO) is an endogenous gaseous molecule which can be measured in the human breath test because of airway inflammation. It has been studied extensively as a marker of inflammation and has been incorporated into an algorithm for asthma management. The purpose of this study was to investigate whether FeNO testing can lead to a change in the diagnosis. A retrospective chart review of 95 patients with asthma, COPD, and ACOS was performed, and FeNO levels were recorded. Out of 95 patients, 36%, 24%, and 22% of the patients had an initial diagnosis of asthma, COPD, and ACOS, respectively. After the FeNO testing, the number of patients with the final diagnosis of asthma and ACOS increased, and COPD decreased. Our results support the utility of FeNO as a viable marker in diagnosing and managing complex cases of asthma, COPD, and ACOS.

Cureus, 2019

Introduction Chronic obstructive pulmonary disease (COPD) is most commonly caused by smoking toba... more Introduction Chronic obstructive pulmonary disease (COPD) is most commonly caused by smoking tobacco or cigarettes. However, alpha-1 antitrypsin deficiency (AATD) is the only genetic disorder known to cause COPD and these patients often present with emphysema earlier in life and with more severe disease. Additionally, AATD patients are often misdiagnosed with other lung disorders, and the diagnosis is often delayed for up to a decade. Furthermore, several clinicians may see the patient before genetic testing is performed and an official diagnosis is made. We hypothesized that patients with radiographic emphysema on computed tomography (CT) scan of the chest would represent an enriched population of patients with a higher prevalence of alpha-1 antitrypsin (AAT) carrier or heterozygous state. Methods We evaluated 250 in-patients with chest computed tomography (CT) findings of emphysema, and per clinical guidelines, all were tested for AAT with Alphakit finger stick blood collection kits. Sampling 250 patients provided power to detect a carrier prevalence of 20% +/-1.0%. Results A total of 250 patients were recruited of which 53% were male, 91% Caucasian, 7% African American, and 16% active smokers. They smoked an average of 39 packs per year. The prevalence of carrier status (Pi*MS or Pi*MZ) was 6.8% (95% CI (4%, 11%)). The mean forced expiratory volume in one second (FEV-1) was 53%, predicted among Pi*MM patients (n=126) and not significantly different from the Pi*MS group (50%, n=13). 69% of Pi*MM were diagnosed with asthma or COPD, vs. 79% of Pi*MS (n=14) and 100% Pi*MZ (n=3), but the difference was not significant (p=0.4). Conclusion In the population studied, compared to a cohort of patients with abnormal pulmonary function tests (PFTs), radiographically evident emphysema did not identify patients at higher risk of being heterozygous or homozygous for AAT deficiency.

Cureus, 2019

Narcolepsy is a sleep disorder, which can manifest in childhood, or adolescence by causing excess... more Narcolepsy is a sleep disorder, which can manifest in childhood, or adolescence by causing excessive daytime sleepiness, hallucinations, sleep attacks or cataplexy. Although presentation can vary, nearly all patients present with excessive daytime sleepiness (EDS). There is often a significant delay in diagnosis, which may lead to a misdiagnosis. Timely diagnosis and management may dramatically improve quality of life and symptoms. If missed, a patient may be at risk of accidents at home, work or while operating motor vehicle or machinery. This particular case describes a 42-year-old male, taxicab driver, who has been living with this undiagnosed condition his entire life along with examining real life consequences of his condition due to his occupation.

D63. THORACIC ONCOLOGY CASE REPORTS III, 2019

Low dose naltrexone (LDN) has been promising as a complementary medication for patients with a br... more Low dose naltrexone (LDN) has been promising as a complementary medication for patients with a broad range of medical disorders. Although not a proven cure, evidence from clinical trials supports LDN as being a valuable adjunct for disorders in which the immune system plays a centralized role. Additionally, clinical trials have proposed a unique mechanism(s) allowing LDN to affect tumors including non-small cell lung cancer (NSCLC) at the cellular level by augmenting the immune system. We present a case of a 50-year-old male with a prolonged survival and a past medical history of prostate and lung cancer.

Advancements in Case Studies, 2019

Background: Measles remains one of the leading causes of death among children around the world. E... more Background: Measles remains one of the leading causes of death among children around the world. Encephalitis is the most serious complication of measles virus infection. Case presentation: We report two measles-induced encephalitis who was admitted to to Kyiv City Pediatric Infectious Clinical Hospital. One patient had postinfectious variant of measles encephalitis that occurred 6 days after primary measles infection onset. Disease had benign course with substantial improvement during hospital stay. Another patient presented with subacute sclerosing panencephalitis. Neurological symptoms started 10 years after measles infection. Disease characterized by progredient course and unfavorable outcome. Conclusion: Measles encephalitis is rare but serious and often deadliest complication. It should be considered in differential diagnostic of CNS infection among pediatric patients.

Cureus, May 27, 2020

Amiodarone is a class III antiarrhythmic agent that inhibits adrenergic stimulation by blocking a... more Amiodarone is a class III antiarrhythmic agent that inhibits adrenergic stimulation by blocking alpha and beta receptors. It prolongs action potential and refractory period in myocardial tissue. Its remarkably long half-life is associated with a myriad of adverse events. Here, we present an 85-year-old male patient who was started on amiodarone for atrial flutter. After three oral doses, he developed fulminant hepatic failure and acute renal failure, which resolved after stopping amiodarone. While fulminant hepatic failure is rare, it has been seen in less than 2% of patients. Alternative theories behind susceptibility to amiodarone-induced hepatic injury and acute kidney injury are discussed here.

Medicine, May 1, 2020

Rationale: Novel coronavirus 2019 (COVID-19) also known as severe acute respiratory syndrome coro... more Rationale: Novel coronavirus 2019 (COVID-19) also known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an enveloped, non-segmented positive-sense RNA virus belonging to the beta-coronaviridae family. This virus is known to cause severe bilateral pneumonia and acute respiratory distress syndrome (ARDS) which can lead to difficulty breathing requiring mechanical ventilation and intensive care unit management. Patient concerns: A 77-year-old female with a history of hypertension and hyperlipidemia who presented as a transfer to our hospital facility with worsening fevers, cough, and respiratory distress. Diagnosis: Chest X-rays revealed bilateral infiltrates worse at the lung bases and CT scan of the chest showed bilateral groundglass opacities consistent with COVID-19. While our testing revealed a negative COVID-19 result at our institution, the result at a previous hospital returned a positive result. Interventions: She was being treated aggressively in the intensive care unit with high dose intravenous ascorbic acid, hydroxychloroquine, and anti-interleukin-6 monoclonal antibody. She also received a loading dose of remdesivir however was unable to complete the course due to organ failure and requirement of vasopressors for hemodynamic stability. Outcomes: She remained critically ill and was eventually placed on comfort care as per the family's wishes and passed away. Lessons: With a rapidly growing death rate and more than 200,000 confirmed cases worldwide, COVID-19 has become a global pandemic and major hit to our healthcare systems. While several companies have already begun vaccine trials and healthcare facilities have been using a wide-range of medications to treat the virus and symptoms, there is not yet an approved medication regimen for COVID-19 infections. The alarming increase in cases per day adds additional pressure to find a cure and decrease the global health burden and mortality rate. Abbreviations: ARDS = acute respiratory distress syndrome, CoV = coronavirus, COVID-19 = novel coronavirus 2019, CVVHD = continuous veno-venous hemodialysis, ED = emergency department, FiO2 = fraction of inspired oxygen, ICU = intensive care unit, MERS-CoV = Middle East respiratory syndrome coronavirus, PCR = polymerase chain reaction, PEEP = positive end-expiratory pressure, RSV = Respiratory syncytial virus, SARS-CoV = severe acute respiratory syndrome coronavirus, SARS-CoV-2 = severe acute respiratory syndrome coronavirus 2.

Medicine, 2020

Rationale: Novel coronavirus 2019 (COVID-19) also known as severe acute respiratory syndrome coro... more Rationale: Novel coronavirus 2019 (COVID-19) also known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an enveloped, non-segmented positive-sense RNA virus belonging to the beta-coronaviridae family. This virus is known to cause severe bilateral pneumonia and acute respiratory distress syndrome (ARDS) which can lead to difficulty breathing requiring mechanical ventilation and intensive care unit management. Patient concerns: A 77-year-old female with a history of hypertension and hyperlipidemia who presented as a transfer to our hospital facility with worsening fevers, cough, and respiratory distress. Diagnosis: Chest X-rays revealed bilateral infiltrates worse at the lung bases and CT scan of the chest showed bilateral groundglass opacities consistent with COVID-19. While our testing revealed a negative COVID-19 result at our institution, the result at a previous hospital returned a positive result. Interventions: She was being treated aggressively in the intensive care unit with high dose intravenous ascorbic acid, hydroxychloroquine, and anti-interleukin-6 monoclonal antibody. She also received a loading dose of remdesivir however was unable to complete the course due to organ failure and requirement of vasopressors for hemodynamic stability. Outcomes: She remained critically ill and was eventually placed on comfort care as per the family's wishes and passed away. Lessons: With a rapidly growing death rate and more than 200,000 confirmed cases worldwide, COVID-19 has become a global pandemic and major hit to our healthcare systems. While several companies have already begun vaccine trials and healthcare facilities have been using a wide-range of medications to treat the virus and symptoms, there is not yet an approved medication regimen for COVID-19 infections. The alarming increase in cases per day adds additional pressure to find a cure and decrease the global health burden and mortality rate. Abbreviations: ARDS = acute respiratory distress syndrome, CoV = coronavirus, COVID-19 = novel coronavirus 2019, CVVHD = continuous veno-venous hemodialysis, ED = emergency department, FiO2 = fraction of inspired oxygen, ICU = intensive care unit, MERS-CoV = Middle East respiratory syndrome coronavirus, PCR = polymerase chain reaction, PEEP = positive end-expiratory pressure, RSV = Respiratory syncytial virus, SARS-CoV = severe acute respiratory syndrome coronavirus, SARS-CoV-2 = severe acute respiratory syndrome coronavirus 2.

Cureus, 2020

Amiodarone is a class III antiarrhythmic agent that inhibits adrenergic stimulation by blocking a... more Amiodarone is a class III antiarrhythmic agent that inhibits adrenergic stimulation by blocking alpha and beta receptors. It prolongs action potential and refractory period in myocardial tissue. Its remarkably long half-life is associated with a myriad of adverse events. Here, we present an 85-year-old male patient who was started on amiodarone for atrial flutter. After three oral doses, he developed fulminant hepatic failure and acute renal failure, which resolved after stopping amiodarone. While fulminant hepatic failure is rare, it has been seen in less than 2% of patients. Alternative theories behind susceptibility to amiodarone-induced hepatic injury and acute kidney injury are discussed here.

Cureus, Jun 6, 2018

Mycobacterium chimaera is an indolent nontuberculous mycobacterium which is abundant in soil, dus... more Mycobacterium chimaera is an indolent nontuberculous mycobacterium which is abundant in soil, dust, and water. Although lacking recognition garnered by other mycobacteria (i.e., M. tuberculosis), it has been recognized as an emerging opportunistic threat to patients undergoing coronary bypass surgery and open heart procedures requiring extracorporeal devices. Here, we present a case of an individual initially seen in the inpatient setting without a history of such procedures or other risk factors commonly associated with mycobacteriumladen infections.

Cureus, Jul 18, 2022

Robinson et al. This is an open access article distributed under the terms of the Creative Common... more Robinson et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cureus, Jul 5, 2018

Low dose naltrexone (LDN) has been promising as a complementary medication for patients with a br... more Low dose naltrexone (LDN) has been promising as a complementary medication for patients with a broad range of medical disorders. Although not a proven cure, evidence from clinical trials supports LDN as being a valuable adjunct for disorders in which the immune system plays a centralized role. Additionally, clinical trials have proposed a unique mechanism(s) allowing LDN to affect tumors including non-small cell lung cancer (NSCLC) at the cellular level by augmenting the immune system. We present a case of a 50-year-old male with a prolonged survival and a past medical history of prostate and lung cancer.

Journal of Occupational and Environmental Medicine, 2004

The effects of exposure to the environment around the World Trade Center after the attack of Sept... more The effects of exposure to the environment around the World Trade Center after the attack of September 11, 2001, are not fully described. We evaluated 240 police first-responders; respiratory symptoms occurred in 77.5% but resolved or improved in around three fourths of subjects by the time of their evaluation (mean 69 days after the attack). Cough was the most common symptom (62.5%). Spirometric abnormalities were mild and occurred in 28.8%. Independent risk factors for abnormal spirometry were previous pulmonary disease or symptoms (adjusted odds ratio, 2.76) and intensity of exposure (AOR, 2.32). Previous pulmonary conditions were associated with obstructive defects (P<0.002). Exposure intensity was associated with a lower forced vital capacity (P<0.03) and a higher prevalence of abnormal spirometry (P<0.03). Officers with dyspnea, chest discomfort, or wheeze were more likely to have abnormal spirometry (P=0.04). A significant minority of officers had symptoms a few months after the exposure. Long-term effects of this respiratory tract exposure will need additional evaluation.

BMC Pulmonary Medicine, 2021

Background Anti-synthetase syndrome (ASS) is an uncommon immune-mediated entity characterized by ... more Background Anti-synthetase syndrome (ASS) is an uncommon immune-mediated entity characterized by myositis, interstitial lung disease (ILD), non-erosive arthritis, and less common features such as fever, Raynaud’s phenomenon, and skin changes in association with anti-aminoacyl-transfer-RNA antibodies, most commonly anti-Jo-1 antibodies. Case presentation We present a challenging and rare case of ASS-associated ILD presenting with unexplained respiratory symptoms and bilateral infiltrates on chest imaging during the COVID-19 pandemic. High clinical suspicion for ASS with early appropriate therapy with corticosteroids and immunosuppressive agents led to marked clinical improvement. Conclusion High index of suspicion for ASS is mandated in patients with unexplained ILD. A comprehensive autoimmune work-up is important as an early treatment with corticosteroids with or without immunomodulators improves patient outcomes and survival in an otherwise poor prognostic disease.

Cureus, 2020

E-cigarette or vaping is an alternative to traditional cigarette use with potentially devastating... more E-cigarette or vaping is an alternative to traditional cigarette use with potentially devastating consequences. The most recent update from the Centers for Disease Control and Prevention reports a total of 2,561 cases of vaping associated pulmonary injury as of December 27, 2019. This case described a 41-year-old female who presented with a clinical picture suggesting of bronchitis; however, a diagnosis of e-cigarette or vaping product use-associated lung injury was made.

Cureus, 2019

Cryptogenic organizing pneumonia (COP), also known as idiopathic bronchiolitis obliterans organiz... more Cryptogenic organizing pneumonia (COP), also known as idiopathic bronchiolitis obliterans organizing pneumonia (BOOP), is a rare inflammatory condition. It often presents as sequelae of existing chronic inflammatory diseases such as rheumatoid arthritis, systemic lupus erythematosus, and various connective tissue conditions. This case describes a 28-year-old African American female who presented with a complex clinical picture involving chronic inflammatory processes and the pulmonary system. The initial evaluation suggested pneumonia to be the underlying cause of respiratory symptoms; however, ultimately, a diagnosis of BOOP with dermatomyositis was made.

Cureus, 2019

Diffuse parenchymal lung diseases (DPLD), also known as interstitial lung diseases (ILD), are a g... more Diffuse parenchymal lung diseases (DPLD), also known as interstitial lung diseases (ILD), are a group of lung disorders affecting alveolar epithelium, pulmonary capillary endothelium, and surrounding lung tissue. Over time due to injury, the tissue around the air sacs becomes fibrotic leading to poor oxygen exchange, eventually resulting in the patient experiencing shortness of breath. This case describes a 69-year old male who presented in 2017 with a complex clinical picture involving both cardiac and pulmonary systems. Drug toxicity was initially thought to be the cause of the patients interstitial lung process; however, ultimately, a diagnosis of UIP was made.

A39. DRUG RELATED CASE REPORTS, 2019

Nitrofurantoin is one of the most utilized antibiotics to treat bladder and urinary tract infecti... more Nitrofurantoin is one of the most utilized antibiotics to treat bladder and urinary tract infections (UTIs). Despite the clinical benefits, it requires vigilant monitoring, as it can cause damage to multiple organs, especially the lungs and the liver. This case is an example of clinical vigilance, which provided tremendous benefit for the patient.

A57. NTM: CASE REPORTS, 2019

Mycobacterium chimaera is an indolent nontuberculous mycobacterium which is abundant in soil, dus... more Mycobacterium chimaera is an indolent nontuberculous mycobacterium which is abundant in soil, dust, and water. Although lacking recognition garnered by other mycobacteria (i.e., M. tuberculosis), it has been recognized as an emerging opportunistic threat to patients undergoing coronary bypass surgery and open heart procedures requiring extracorporeal devices. Here, we present a case of an individual initially seen in the inpatient setting without a history of such procedures or other risk factors commonly associated with mycobacteriumladen infections.

Cureus, 2019

Asthma and chronic obstructive pulmonary disease (COPD) can present as unique conditions or as a ... more Asthma and chronic obstructive pulmonary disease (COPD) can present as unique conditions or as a combination known as asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS). These condition(s) can be categorized as obstructive conditions, causing inflammation of small airways leading to decrease airflow, mucus production, and bronchoconstriction. Asthma and COPD affect every age, gender, ethnicity, and socioeconomic status, thus increasing mortality and morbidity burden in our society. Fractional exhaled nitric oxide (FeNO) is an endogenous gaseous molecule which can be measured in the human breath test because of airway inflammation. It has been studied extensively as a marker of inflammation and has been incorporated into an algorithm for asthma management. The purpose of this study was to investigate whether FeNO testing can lead to a change in the diagnosis. A retrospective chart review of 95 patients with asthma, COPD, and ACOS was performed, and FeNO levels were recorded. Out of 95 patients, 36%, 24%, and 22% of the patients had an initial diagnosis of asthma, COPD, and ACOS, respectively. After the FeNO testing, the number of patients with the final diagnosis of asthma and ACOS increased, and COPD decreased. Our results support the utility of FeNO as a viable marker in diagnosing and managing complex cases of asthma, COPD, and ACOS.

Cureus, 2019

Introduction Chronic obstructive pulmonary disease (COPD) is most commonly caused by smoking toba... more Introduction Chronic obstructive pulmonary disease (COPD) is most commonly caused by smoking tobacco or cigarettes. However, alpha-1 antitrypsin deficiency (AATD) is the only genetic disorder known to cause COPD and these patients often present with emphysema earlier in life and with more severe disease. Additionally, AATD patients are often misdiagnosed with other lung disorders, and the diagnosis is often delayed for up to a decade. Furthermore, several clinicians may see the patient before genetic testing is performed and an official diagnosis is made. We hypothesized that patients with radiographic emphysema on computed tomography (CT) scan of the chest would represent an enriched population of patients with a higher prevalence of alpha-1 antitrypsin (AAT) carrier or heterozygous state. Methods We evaluated 250 in-patients with chest computed tomography (CT) findings of emphysema, and per clinical guidelines, all were tested for AAT with Alphakit finger stick blood collection kits. Sampling 250 patients provided power to detect a carrier prevalence of 20% +/-1.0%. Results A total of 250 patients were recruited of which 53% were male, 91% Caucasian, 7% African American, and 16% active smokers. They smoked an average of 39 packs per year. The prevalence of carrier status (Pi*MS or Pi*MZ) was 6.8% (95% CI (4%, 11%)). The mean forced expiratory volume in one second (FEV-1) was 53%, predicted among Pi*MM patients (n=126) and not significantly different from the Pi*MS group (50%, n=13). 69% of Pi*MM were diagnosed with asthma or COPD, vs. 79% of Pi*MS (n=14) and 100% Pi*MZ (n=3), but the difference was not significant (p=0.4). Conclusion In the population studied, compared to a cohort of patients with abnormal pulmonary function tests (PFTs), radiographically evident emphysema did not identify patients at higher risk of being heterozygous or homozygous for AAT deficiency.

Cureus, 2019

Narcolepsy is a sleep disorder, which can manifest in childhood, or adolescence by causing excess... more Narcolepsy is a sleep disorder, which can manifest in childhood, or adolescence by causing excessive daytime sleepiness, hallucinations, sleep attacks or cataplexy. Although presentation can vary, nearly all patients present with excessive daytime sleepiness (EDS). There is often a significant delay in diagnosis, which may lead to a misdiagnosis. Timely diagnosis and management may dramatically improve quality of life and symptoms. If missed, a patient may be at risk of accidents at home, work or while operating motor vehicle or machinery. This particular case describes a 42-year-old male, taxicab driver, who has been living with this undiagnosed condition his entire life along with examining real life consequences of his condition due to his occupation.

D63. THORACIC ONCOLOGY CASE REPORTS III, 2019

Low dose naltrexone (LDN) has been promising as a complementary medication for patients with a br... more Low dose naltrexone (LDN) has been promising as a complementary medication for patients with a broad range of medical disorders. Although not a proven cure, evidence from clinical trials supports LDN as being a valuable adjunct for disorders in which the immune system plays a centralized role. Additionally, clinical trials have proposed a unique mechanism(s) allowing LDN to affect tumors including non-small cell lung cancer (NSCLC) at the cellular level by augmenting the immune system. We present a case of a 50-year-old male with a prolonged survival and a past medical history of prostate and lung cancer.