Mohammed Munavvar - Academia.edu (original) (raw)

Papers by Mohammed Munavvar

European Respiratory Journal, Sep 1, 2012

Body: Background: Endobronchial ultrasound (EBUS) guided transbronchial needle aspiration (TBNA) ... more Body: Background: Endobronchial ultrasound (EBUS) guided transbronchial needle aspiration (TBNA) allows safe and reliable sampling of mediastinal and hilar lymph nodes with excellent specificity and good sensitivity. It is a well established technique in the diagnosis and staging of lung cancer including pathologic sub-typing and recent studies have shown that the samples may also be adequate for molecular testing. Aim: To evaluate the adequacy of EBUS TBNA samples used for epidermal growth factor receptor (EGFR) mutation screening. Methods: Retrospective study of 46 consecutive EBUS-TBNA samples obtained from lymph nodes > 5mm short-axis and central lung parenchymal lesions. Fisher's exact test was used to compare the 2 groups. Results: Of the 46 EBUS TBNA samples sent for EGFR testing, 38 were obtained from lymph nodes (19 subcarinal, 9 right paratracheal, 4 left paratracheal, 10 right hilar and 4 left hilar) and 8 from central lung parenchymal masses. In the lymph node group, 35 (92%) samples were negative for EGFR mutation, 3(8%) failed testing and none were positive for EGFR; 30 had adenocarcinoma, 1 adenosquamous, 2 squamous and 5 NSCLC-NOS(not otherwise specified). In the central lung mass group (n=8), one positive with exon19 deletion, 6 negative and one failed testing or was inadequate; 3 had adenocarcinoma, 3 NSCLC-NOS, 1 squamous and 1 adenosquamous. The overall EBUS-TBNA adequacy from both lymph nodes and central lung masses was 91% and there was no difference between the groups. Conclusion: Molecular testing of EBUS TBNA samples obtained from mediastinal and hilar lymph nodes is feasible and our study shows a higher proportion of 92% adequacy. The common reason for failed testing was paucicellular specimen and degraded DNA.

Clinical Medicine, Apr 1, 2009

ERJ Open Research

BackgroundChylothorax is an uncommon medical condition for which limited data are available regar... more BackgroundChylothorax is an uncommon medical condition for which limited data are available regarding the contemporary aetiology, management and outcomes. The goal of this study was to better define these poorly characterised features.MethodsThe medical records of adult patients diagnosed with chylothorax at 12 centres across Europe, America and South Africa from 2009–2021 were retrospectively reviewed. Descriptive and inferential statistics were performed.Results77 patients (median age 69 years, male to female ratio 1.5) were included. Subacute dyspnoea was the most typical presenting symptom (66%). The commonest cause of chylothorax was malignancy (68.8%), with lymphoma accounting for 62% of these cases. Other aetiologies were trauma (13%), inflammatory/miscellaneous conditions (11.7%) and idiopathic cases (6.5%). At the initial thoracentesis, the pleural fluid appeared milky in 73%, was exudative in 89% and exhibited triglyceride concentrations >100 mg·dL−1in 88%. Lymphangiogr...

Trials

Aim To inform the oversight of future clinical trials during a pandemic, we summarise the experie... more Aim To inform the oversight of future clinical trials during a pandemic, we summarise the experiences of the Data Monitoring Committee (DMC) for the Randomised Evaluation of COVID therapy trial (RECOVERY), a large-scale randomised adaptive platform clinical trial of treatments for hospitalised patients with COVID-19. Methods and findings During the first 24 months of the trial (March 2020 to February 2022), the DMC oversaw accumulating data for 14 treatments in adults (plus 10 in children) involving > 45,000 randomised patients. Five trial aspects key for the DMC in performing its role were: a large committee of members, including some with extensive DMC experience and others who had broad clinical expertise; clear strategic planning, communication, and responsiveness by the trial principal investigators; data collection and analysis systems able to cope with phases of very rapid recruitment and link to electronic health records; an ability to work constructively with regulators ...

European Respiratory Journal, 2021

BackgroundChest drain displacement is a common clinical problem that occurs in 9–42% of cases and... more BackgroundChest drain displacement is a common clinical problem that occurs in 9–42% of cases and results in treatment failure or additional pleural procedures conferring unnecessary risk. A novel chest drain with an integrated intrapleural balloon may reduce the risk of displacement.MethodsA prospective randomised controlled trial comparing the balloon drain to standard care (12 F chest drain with no balloon) with the primary outcome of objectively defined unintentional or accidental chest drain displacement.Results267 patients were randomised (primary outcome data available in 257, 96.2%). Displacement occurred less frequently using the balloon drain (displacement 5 of 128, 3.9%; standard care displacement 13 of 129, 10.1%) but this was not statistically significant (OR for drain displacement 0.36, 95% CI 0.13–1.0, Chi-squared 1 degree of freedom (df)=2.87, p=0.09). Adjusted analysis to account for minimisation factors and use of drain sutures demonstrated balloon drains were inde...

SUMMARYBackgroundREGEN-COV is a combination of 2 monoclonal antibodies (casirivimab and imdevimab... more SUMMARYBackgroundREGEN-COV is a combination of 2 monoclonal antibodies (casirivimab and imdevimab) that bind to two different sites on the receptor binding domain of the SARS-CoV-2 spike protein. We aimed to evaluate the efficacy and safety of REGEN-COV in patients admitted to hospital with COVID-19.MethodsIn this randomised, controlled, open-label platform trial, several possible treatments were compared with usual care in patients hospitalised with COVID-19. Eligible and consenting patients were randomly allocated (1:1) to either usual standard of care alone (usual care group) or usual care plus a single dose of REGEN-COV 8g (casirivimab 4g and imdevimab 4g) by intravenous infusion (REGEN-COV group). The primary outcome was 28-day mortality assessed first among patients without detectable antibodies to SARS-CoV-2 at randomisation (seronegative) and then in the overall population. The trial is registered with ISRCTN (50189673) andclinicaltrials.gov(NCT04381936).FindingsBetween 18 S...

Cochrane Database of Systematic Reviews, 2019

D22. CHRONIC OBSTRUCTIVE PULMONARY DISEASE: NOVEL OUTCOME MEASURES AND TREATMENTS, 2010

St. Pierre Hospital, Brussels, Belgium, University Hospital of Brescia, Brescia, Italy, LKH Natte... more St. Pierre Hospital, Brussels, Belgium, University Hospital of Brescia, Brescia, Italy, LKH Natters, Natters, Austria, Hannover Medical 1 2 3 4 ... School, Hannover, Germany, Clinica Universitaria de Navarra, Pamplona, Spain, Royal Preston Hospital, Preston, United Kingdom, 5

C102. WHAT'S NEW IN INTERVENTIONAL PULMONARY: EBUS AND MORE, 2010

A41. CHRONIC OBSTRUCTIVE PULMONARY DISEASE EXACERBATIONS: EPIDEMIOLOGY AND OUTCOMES, 2010

Journal of Bronchology & Interventional Pulmonology, 2010

Pleural effusion of undetermined etiology (PEUE), where blind pleural aspirate/biopsy fails to yi... more Pleural effusion of undetermined etiology (PEUE), where blind pleural aspirate/biopsy fails to yield an answer, often needs histologic study for a definitive diagnosis. Several studies have shown the potential utility of medical thoracoscopy (MT) in PEUE; results, however, are not uniform and a majority are available for rigid thoracoscopy. We sought to determine the diagnostic accuracy of the relatively new technique of semirigid thoracoscopy in PEUE through this systematic review. The electronic search was carried out in PubMed without language restriction. References of relevant records and abstracts were hand searched. Articles were selected based on the following criteria: (1) prospective study, (2) based on original research, (3) enrolled consecutive patients with PEUE, (4) full paper available in English, (5) MT carried out under local anesthesia (LA) using semirigid (flex-rigid) instrument, and (6) reported sufficient data to construct a 2∞2 contingency table. We assessed the study quality and extracted data independently and in duplicate using a standardized data extraction form. Five studies met the inclusion criteria, encompassing 154 patients. Pooled sensitivity (95% CI) was 0.97 (0.92-0.99), specificity (95% CI) was 1.00 (0.69-1.00), positive likelihood ratio (95% CI) was 5.47 (1.11-16.86) and negative likelihood ratio (95%CI) was 0.08 (0.04-0.18). No major complications or mortality was noted. Semirigid thoracoscopy seems to be a safe, simple, and accurate tool for undiagnosed pleural effusions. It is well tolerated and is devoid of major complications. Further studies with sound methodology will further help to define the future role of this procedure.

European Respiratory Journal, 2012

This multicentre, blinded, sham-controlled study was performed to assess the safety and effective... more This multicentre, blinded, sham-controlled study was performed to assess the safety and effectiveness of bronchial valve therapy using a bilateral upper lobe treatment approach without the goal of lobar atelectasis. Patients with upper lobe predominant severe emphysema were randomised to bronchoscopy with (n537) or without (n536) IBV Valves for a 3-month blinded phase. A positive responder was defined as having both a o4-point improvement in St George's Respiratory Questionnaire (SGRQ) and a lobar volume shift as measured by quantitative computed tomography. At 3 months, there were eight (24%) positive responders in the treated group versus none (0%) in the control group (p50.002). Also, there was a significant shift in volume in the treated group from the upper lobes (mean¡SD-7.3¡9.0%) to the non-treated lobes (6.7¡14.5%), with minimal change in the control group (p,0.05). Mean SGRQ total score improved in both groups (treatment:-4.3¡16.2; control:-3.6¡10.7). The procedure and devices were well tolerated and there were no differences in adverse events reported in the treatment and control groups. Treatment with bronchial valves without complete lobar occlusion in both upper lobes was safe, but not effective in the majority of patients.

British Journal of Ophthalmology, 2007

Diagnosing COVID-19 and treating its complications remains a challenge. This review reflects the ... more Diagnosing COVID-19 and treating its complications remains a challenge. This review reflects the perspective of some of the Dragon (IMI 2-call 21, #101005122) research consortium collaborators on the utility of bronchoalveolar lavage (BAL) in COVID-19. BAL has been proposed as a potentially useful diagnostic tool to increase COVID-19 diagnosis sensitivity. In both critically ill and non-critically ill COVID-19 patients, BAL has a relevant role in detecting other infections or in supporting alternative diagnosis, and can change management decisions in up to two-third of patients. BAL is used to guide steroid and immunosuppressive treatment and to narrow or discontinue antibiotic treatment reducing the use of unnecessary broad antibiotics. Moreover, cellular analysis and novel multi-omics techniques on BAL are of critical importance for the understanding of the microenvironment and interaction between epithelial cells and immunity revealing novel potential prognostic and therapeutic t...

Lung India, 2020

Chronic obstructive pulmonary disease is a prevalent and progressive disease. The recently develo... more Chronic obstructive pulmonary disease is a prevalent and progressive disease. The recently developed bronchoscopic lung volume reduction (BLVR) techniques offer personalized therapeutic options in subgroups of patients with severe emphysema. Endobronchial and intrabronchial valves (EBV/IBV) achieve lung volume reduction by lobar atelectasis. The lung volume reduction coils (LVRCs) and bronchoscopic thermal vapor ablation (BTVA) induce tissue compression, either mechanically or through inflammatory processes. While the effects of EBV/IBV are reversible by removing the implants, the effects of LVRC are partially reversible and that of BTVA is irreversible. The presence of interlobar collateral ventilation (CV) impacts on EBV/IBV treatment outcome due to its mechanism of action. Therefore, using radiological and endoscopic techniques to assess CV has a vital importance. Current evidence of BLVR demonstrates acceptable safety and short-term clinical efficacy. However, head-to-head trials are lacking, and further research is needed to establish long-term clinical benefit, durability, and cost-effectiveness of these techniques.