Asif Saberi - Academia.edu (original) (raw)
Papers by Asif Saberi
Acute and Critical Care
Background: Coronavirus disease 2019 (COVID-19) infection is associated with significant morbidit... more Background: Coronavirus disease 2019 (COVID-19) infection is associated with significant morbidity and mortality. Some patients develop severe acute respiratory distress syndrome and kidney failure requiring the combination of extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT). Methods: Retrospective cohort study of 127 consecutive patients requiring combined ECMO and CRRT support in intensive care units at an ECMO center in Marietta, GA, United States. Results: Sixty and 67 patients with and without COVID-19, respectively, required ECMO-CRRT support. After adjusting for confounding variables, patients with COVID-19 had increased mortality at 30 days (hazard ratio [HR], 5.19; 95% confidence interval [CI], 2.51–10.7; P<0.001) and 90 days (HR, 6.23; 95% CI, 2.60–14.9; P<0.001). Conclusions: In this retrospective study, patients with COVID-19 who required ECMO-CRRT had increased mortality when compared to patients without COVID-19.
he Stinchfield test, a pain response caused by an increase in hip joint reactive force, is a valu... more he Stinchfield test, a pain response caused by an increase in hip joint reactive force, is a valuable test that distinguishes between intra-articular and extra-articular hip pathology causing groin, thigh, buttock, and even pretibial leg pain. Positive pain response to the Stinchfield test (Sidebar) is a simple way to confirm intra-articular pathology and is a marker of such disorders as arthritis, synovitis, occult femoral neck fracture, and prosthetic failure or loosening. The Stinchf ield test requires no special equipment, offers significant diagnostic yield, and may be performed in both the office and emergency department settings. HISTORIC PERSPECTIVE
upuytren’s contracture, a contracture of the palmar fascia that usually causes the ring and littl... more upuytren’s contracture, a contracture of the palmar fascia that usually causes the ring and little fingers to bend into the palm so they cannot be extended (Sidebar), has been described in medical literature for more than 700 years. Cases of Dupuytren’s contracture were recorded in the Orkney Islands and Iceland as early as the 12th century 1 and folklore sagas tell of miraculous cures of hands so crippled that all the fingers pulled into the palm. 2 Today, Dupuytren’s contracture is commonly described in association with such etiologies as chronic alcoholism, diabetes mellitus, phenytoin therapy, chronic vibration exposure (eg, work with a jackhammer), 3 polyvinyl chloride bagging and packing, trauma, HIV, 4 and hemodialysis. 5
Hospital Physician, 1999
... A study by Dickson and Imrie6 noted Cullen's sign in 2% of patients with acute pancreatit... more ... A study by Dickson and Imrie6 noted Cullen's sign in 2% of patients with acute pancreatitis. ... C Dr. Marinella is Assistant Clinical Professor of Internal Medicine, Wright State University School of Medicine, Dayton, OH, and a Hospitalist, Miami Valley Hospital, Dayton. Drs. ...
Argyll Robertson pupil, a miotic pupil that responds to an accommodation effort but fails to reac... more Argyll Robertson pupil, a miotic pupil that responds to an accommodation effort but fails to react to direct light, has been described in medical literature for more than a century. This pupillary reaction (Sidebar) is a simple way to confirm the integrity of the optic pathways and is a marker of such neurological disorders as neurosyphilis, neurosarcoidosis, and multiple sclerosis. The test requires no special equipment, holds great diagnostic yield, and takes less time to elicit than is needed to pronounce the eponym. the German ophthalmologist Von Graefe, the preemi-nent ophthalmologist of that era. 1 Robertson's first landmark contribution to ophthal-mology came in early 1863, when he reported the ocu-lar effects of the Calabar bean. 2 The active agent of the Calabar bean is physostigmine, a cholinesterase in-hibitor. Robertson showed the antagonistic property of the Calabar bean to atropine, and this agent became the first effective medication to treat glaucoma. Robertson f...
Hospital Pharmacy, 2019
Purpose: The purpose of this study was to evaluate the cost effectiveness of argatroban compared ... more Purpose: The purpose of this study was to evaluate the cost effectiveness of argatroban compared to heparin during extracorporeal membrane oxygenation (ECMO) therapy. Methods: This was a retrospective study of patients who received argatroban or heparin infusions with ECMO therapy at a community hospital between January 1, 2017 and June 30, 2018. Adult patients who received heparin or argatroban for at least 48 hours while on venovenous (VV) or venoarterial (VA) ECMO were included. Patients with temporary mechanical circulatory assist devices were excluded. Each continuous course of anticoagulant exposure that met the inclusion criteria was evaluated. The primary endpoint was the total cost of anticoagulant therapy for heparin versus argatroban, including all administered study drugs, blood or factor products, and associated laboratory tests. Secondary endpoints included safety and efficacy of anticoagulation with each agent during ECMO. Documentation of bleeding events, circuit clo...
Case Reports in Medicine, 2019
Goodpasture syndrome is a rare autoimmune disease comprising antiglomerular basement membrane (an... more Goodpasture syndrome is a rare autoimmune disease comprising antiglomerular basement membrane (anti-GBM) crescentic glomerulonephritis and pulmonary capillaritis with circulating anti-GBM antibodies. Rarely, antibody-negative cases have been described. We report a young, African American adult woman admitted with flank pain and hematuria with laboratory testing and kidney biopsy demonstrating anti-GBM crescentic glomerulonephritis with elevated anti-GBM antibody levels. She received treatment but remained dialysis-dependent. She was seronegative and clinically stable until she presented 8 months later with dyspnea and hemoptysis requiring mechanical ventilation. Bronchoscopy revealed diffuse alveolar hemorrhage. She was treated for relapse of Goodpasture syndrome. However, anti-GBM antibodies were undetectable. This case emphasizes prompt diagnosis and treatment of Goodpasture syndrome to preserve renal function. Additionally, clinical manifestations of Goodpasture syndrome and its ...
Patients in respiratory failure on VV ECMO may develop cardiovascular dysfunction necessitating a... more Patients in respiratory failure on VV ECMO may develop cardiovascular dysfunction necessitating additional hemodynamic support, while patients in cardiovascular failure on VA ECMO may require additional respiratory support for concurrent gas exchange abnormalities. A hybrid venoarterio-venous (VA-V) configuration provides both cardiac support via a traditional arterial reinfusion cannula and respiratory support via an additional venous reinfusion limb. We describe our single center experience using VA-V ECMO for patients (n = 14, median age 54) with combined cardiopulmonary failure or differential hypoxemia. Patients were treated with ECMO support for a median of 148.2 (IQR 122.6 – 174.4) hours, consisting of 0 (IQR 0 – 1.8) hours of VA and 92.4 (IQR 58 – 115) hours of VA-V followed by 46 (IQR 0 – 95.5) hours of VV support. Of these 14 patients, 11 survived to decannulation (79%) and 9 survived to hospital discharge (64%).
Acute and Critical Care
Background: Coronavirus disease 2019 (COVID-19) infection is associated with significant morbidit... more Background: Coronavirus disease 2019 (COVID-19) infection is associated with significant morbidity and mortality. Some patients develop severe acute respiratory distress syndrome and kidney failure requiring the combination of extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT). Methods: Retrospective cohort study of 127 consecutive patients requiring combined ECMO and CRRT support in intensive care units at an ECMO center in Marietta, GA, United States. Results: Sixty and 67 patients with and without COVID-19, respectively, required ECMO-CRRT support. After adjusting for confounding variables, patients with COVID-19 had increased mortality at 30 days (hazard ratio [HR], 5.19; 95% confidence interval [CI], 2.51–10.7; P<0.001) and 90 days (HR, 6.23; 95% CI, 2.60–14.9; P<0.001). Conclusions: In this retrospective study, patients with COVID-19 who required ECMO-CRRT had increased mortality when compared to patients without COVID-19.
he Stinchfield test, a pain response caused by an increase in hip joint reactive force, is a valu... more he Stinchfield test, a pain response caused by an increase in hip joint reactive force, is a valuable test that distinguishes between intra-articular and extra-articular hip pathology causing groin, thigh, buttock, and even pretibial leg pain. Positive pain response to the Stinchfield test (Sidebar) is a simple way to confirm intra-articular pathology and is a marker of such disorders as arthritis, synovitis, occult femoral neck fracture, and prosthetic failure or loosening. The Stinchf ield test requires no special equipment, offers significant diagnostic yield, and may be performed in both the office and emergency department settings. HISTORIC PERSPECTIVE
upuytren’s contracture, a contracture of the palmar fascia that usually causes the ring and littl... more upuytren’s contracture, a contracture of the palmar fascia that usually causes the ring and little fingers to bend into the palm so they cannot be extended (Sidebar), has been described in medical literature for more than 700 years. Cases of Dupuytren’s contracture were recorded in the Orkney Islands and Iceland as early as the 12th century 1 and folklore sagas tell of miraculous cures of hands so crippled that all the fingers pulled into the palm. 2 Today, Dupuytren’s contracture is commonly described in association with such etiologies as chronic alcoholism, diabetes mellitus, phenytoin therapy, chronic vibration exposure (eg, work with a jackhammer), 3 polyvinyl chloride bagging and packing, trauma, HIV, 4 and hemodialysis. 5
Hospital Physician, 1999
... A study by Dickson and Imrie6 noted Cullen's sign in 2% of patients with acute pancreatit... more ... A study by Dickson and Imrie6 noted Cullen's sign in 2% of patients with acute pancreatitis. ... C Dr. Marinella is Assistant Clinical Professor of Internal Medicine, Wright State University School of Medicine, Dayton, OH, and a Hospitalist, Miami Valley Hospital, Dayton. Drs. ...
Argyll Robertson pupil, a miotic pupil that responds to an accommodation effort but fails to reac... more Argyll Robertson pupil, a miotic pupil that responds to an accommodation effort but fails to react to direct light, has been described in medical literature for more than a century. This pupillary reaction (Sidebar) is a simple way to confirm the integrity of the optic pathways and is a marker of such neurological disorders as neurosyphilis, neurosarcoidosis, and multiple sclerosis. The test requires no special equipment, holds great diagnostic yield, and takes less time to elicit than is needed to pronounce the eponym. the German ophthalmologist Von Graefe, the preemi-nent ophthalmologist of that era. 1 Robertson's first landmark contribution to ophthal-mology came in early 1863, when he reported the ocu-lar effects of the Calabar bean. 2 The active agent of the Calabar bean is physostigmine, a cholinesterase in-hibitor. Robertson showed the antagonistic property of the Calabar bean to atropine, and this agent became the first effective medication to treat glaucoma. Robertson f...
Hospital Pharmacy, 2019
Purpose: The purpose of this study was to evaluate the cost effectiveness of argatroban compared ... more Purpose: The purpose of this study was to evaluate the cost effectiveness of argatroban compared to heparin during extracorporeal membrane oxygenation (ECMO) therapy. Methods: This was a retrospective study of patients who received argatroban or heparin infusions with ECMO therapy at a community hospital between January 1, 2017 and June 30, 2018. Adult patients who received heparin or argatroban for at least 48 hours while on venovenous (VV) or venoarterial (VA) ECMO were included. Patients with temporary mechanical circulatory assist devices were excluded. Each continuous course of anticoagulant exposure that met the inclusion criteria was evaluated. The primary endpoint was the total cost of anticoagulant therapy for heparin versus argatroban, including all administered study drugs, blood or factor products, and associated laboratory tests. Secondary endpoints included safety and efficacy of anticoagulation with each agent during ECMO. Documentation of bleeding events, circuit clo...
Case Reports in Medicine, 2019
Goodpasture syndrome is a rare autoimmune disease comprising antiglomerular basement membrane (an... more Goodpasture syndrome is a rare autoimmune disease comprising antiglomerular basement membrane (anti-GBM) crescentic glomerulonephritis and pulmonary capillaritis with circulating anti-GBM antibodies. Rarely, antibody-negative cases have been described. We report a young, African American adult woman admitted with flank pain and hematuria with laboratory testing and kidney biopsy demonstrating anti-GBM crescentic glomerulonephritis with elevated anti-GBM antibody levels. She received treatment but remained dialysis-dependent. She was seronegative and clinically stable until she presented 8 months later with dyspnea and hemoptysis requiring mechanical ventilation. Bronchoscopy revealed diffuse alveolar hemorrhage. She was treated for relapse of Goodpasture syndrome. However, anti-GBM antibodies were undetectable. This case emphasizes prompt diagnosis and treatment of Goodpasture syndrome to preserve renal function. Additionally, clinical manifestations of Goodpasture syndrome and its ...
Patients in respiratory failure on VV ECMO may develop cardiovascular dysfunction necessitating a... more Patients in respiratory failure on VV ECMO may develop cardiovascular dysfunction necessitating additional hemodynamic support, while patients in cardiovascular failure on VA ECMO may require additional respiratory support for concurrent gas exchange abnormalities. A hybrid venoarterio-venous (VA-V) configuration provides both cardiac support via a traditional arterial reinfusion cannula and respiratory support via an additional venous reinfusion limb. We describe our single center experience using VA-V ECMO for patients (n = 14, median age 54) with combined cardiopulmonary failure or differential hypoxemia. Patients were treated with ECMO support for a median of 148.2 (IQR 122.6 – 174.4) hours, consisting of 0 (IQR 0 – 1.8) hours of VA and 92.4 (IQR 58 – 115) hours of VA-V followed by 46 (IQR 0 – 95.5) hours of VV support. Of these 14 patients, 11 survived to decannulation (79%) and 9 survived to hospital discharge (64%).