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Papers by hammad bhatti

The clinical respiratory journal, Jan 10, 2015

Non-invasive Positive Pressure Ventilation (NIPPV) is employed for the management of acute respir... more Non-invasive Positive Pressure Ventilation (NIPPV) is employed for the management of acute respiratory failure and studies have shown that it can prevent the need for endotracheal intubation, mechanical ventilation and associated complications. Given limited studies evaluating the factors, other than those related patient or underlying disease severity, that may lead to NIPPV failure, we performed this study to gain insight into current practices in terms of utilization of NIPPV and operator dependent factors that may possibly contribute to failure of NIPPV. After institutional board review approval a retrospective chart review was performed of consecutive patients who were initiated on and failed NIPPV between January 2009 and December 2009. Data was recorded regarding baseline demographics, admission diagnosis, indications for NIPPV, presence of contraindications, type of NIPPV and initial settings, ABG analysis before and after initiation, whether a titration of the settings was ...

International Journal of Critical Illness and Injury Science, 2013

C45. BRONCHOSCOPY: DIAGNOSTIC DILEMMAS AND PROCEDURES, 2011

CHEST Journal, 2013

INTRODUCTION: Sjogren's Syndrome (SS) is known to cause lymphocytopenia, and there have been case... more INTRODUCTION: Sjogren's Syndrome (SS) is known to cause lymphocytopenia, and there have been cases of opportunistic infections described in patients with Sjogren's disease without evidence of AIDS(1) .To our knowledge, there has been no report describing MAC infection due to chronic lymphocytopenia induced by Sjogren's syndrome. CASE PRESENTATION: A 38F with insignificant medical history presented to ER with complaints of fever, dyspnea, and productive cough for 6 months. She was initially hospitalized at another facility 3 months prior with same complaints and discharged on azithromycin. She was later notified that she had grown mycobacterium avium complex from respiratory cultures. She was offered treatment but was unable to afford. HIV testing done at outside hospital as well as repeat testing at our institution were negative. During hospitalization at our institute, she had sputum that was positive for AFB however, TB PCR returned negative. CT chest showed severe bilateral upper cavitary lung disease (Fig;1). She was started on ethambutol, rifabutin and clarithromycin. Autoimmune testing revealed positive SSA (RO) antibody. Blood flow cytometric analysis did not reveal evidence of myeloproliferative disorder however, absolute CD4 helper T cells was 95/ul. DISCUSSION: US Centers for Disease Control (CDC) defines idiopathic CD4+ T lymphocytopenia (ICL) as: prolonged (at least 2) low counts of <300/mm3 or <20% CD4+ without HIV infection or other known causes of immunosuppression. The association between SS and ICL has already been observed previously. Pulmonary MAC is an AIDS defining illness and commonly presents in HIV positive patients with low CD4 counts. In our patient, susceptibility was due to a profound and persistent depletion of CD4+ T cells. No infection, therapy, malnutrition or defined immunodeficiency could be implicated. Opportunistic infections

CHEST Journal, 2012

Background: The purpose of this study was to evaluate the diagnostic yield of endobronchial ultra... more Background: The purpose of this study was to evaluate the diagnostic yield of endobronchial ultrasound with realtime-guided transbronchial needle aspiration (EBUS-TBNA), endobronchial forceps biopsy (EBBx), and 2D fluoroscopic-guided transbronchial forceps biopsy (TBLBx) for centrally located peribronchial lung lesions. Methods: A retrospective chart review of consecutive patients who underwent EBUS-TBNA of centrally located peribronchial lesions, that is, medial margin of the mass within inner third of hemithorax by computerized tomography scan. Patients who underwent EBUS-TBNA for lymph node sampling were excluded. Results: Thirty-two cases met the inclusion criteria. The mean age was 69 ± 12 years. Sixteen (50%) were male patients. Of the 32 EBUS-TBNA cases, 13 underwent concomitant TBLBx (group 1), 8 had concomitant EBBx (group 2), and 11 had EBUS-TBNA alone (group 3). In group 1, the diagnostic yield of EBUS-TBNA was 95% (n = 12/13), whereas the yield of TBLBx was 61% (n = 8/13). In group 2, the diagnostic yield of EBUS-TBNA was 100% (n = 8/8), whereas EBBx was positive in 75% (n = 6/8). In group 3, the diagnostic yield of EBUS-TBNA was 91% (n = 10/11). Overall diagnostic yield of EBUS-TBNA of centrally located peribronchial lung lesions was 94% (n = 30/32). Conclusion: Where available, EBUS-TBNA of centrally located peribronchial lung lesions should be given a strong consideration given its high diagnostic yield.