Muzzammil Waheed Ahmadzada

All Publications

• Psychosis in the Deaf Population: Prevalence, Phenomenology, and Diagnostic Challenges: A Narrative Review. Cureus Sarwar, H., Hamoudeh, K., Ahmadzada, M., Dhingra, M., Batmaz, E., Adnan, M., Nichols, C., Seikunas, J. 2025; 17 (11): e96140

  Abstract

  Deaf and hard-of-hearing (DHH) individuals face unique challenges in psychiatric assessment, particularly in the diagnosis and treatment of psychotic disorders. Communication barriers, cultural misunderstandings, and clinician unfamiliarity with deaf language and norms may contribute to misdiagnosis, diagnostic uncertainty, and inadequate care. This narrative review synthesizes current literature on the prevalence, phenomenology, and diagnostic challenges of psychotic disorders in the deaf population, aiming to identify trends, gaps, and future research needs. A comprehensive search was conducted in three databases - PubMed, EBSCO Open Dissertations, and ScienceDirect - between April 1, 2025, and April 20, 2025. Keywords and MeSH terms related to psychosis, hallucinations, delusions, and deafness were used. Inclusion criteria encompassed peer-reviewed studies that investigated the prevalence, symptomatology, or diagnostic complexities of psychosis in DHH populations. Studies involving only hearing individuals, those without psychosis-related outcomes, or those lacking comparative or baseline data were excluded. Data were extracted independently by two reviewers and synthesized narratively. Nine studies were included, encompassing a total of 827 participants. The reported prevalence of psychotic disorders in deaf populations ranged from 28% to 58%. Schizoaffective disorder and schizophrenia were the most common diagnoses. Distinct phenomenological patterns emerged, with visual, tactile, and non-verbal auditory hallucinations frequently reported. High rates of diagnostic ambiguity, including overuse of psychotic disorder Not Otherwise Specified (NOS), were observed. Language dysfluency, cognitive impairment, and systemic barriers further complicated diagnostic accuracy. Psychotic disorders are prevalent in deaf psychiatric populations, yet cultural, linguistic, and systemic challenges often hinder assessment. Future research should focus on culturally adapted diagnostic tools, large-scale multisite prevalence studies, and qualitative investigations into deaf experiences of psychosis. Similar approaches should be extended to other sensory-impaired populations to uncover potential diagnostic disparities and inform equitable psychiatric care.

  View details for DOI 10.7759/cureus.96140

  View details for PubMedID 41357028

  View details for PubMedCentralID PMC12680440

• A novel discovery of elevated risk of neuroendocrine tumors in patients with myotonic dystrophy. Journal of the neurological sciences Hameed, B., Ahmadzada, M., McNeel, T. S., DiCapua, D. B., Gadalla, S. M. 2025; 478: 123722

  Abstract

  OBJECTIVE: Cancer risk is higher in patients with myotonic dystrophy (DM) compared to the general population. We aimed to determine the frequency, types and associated risk of cancers in patients with myotonic dystrophy type 1 and type 2 and to evaluate possible associations with cardiovascular phenotypes.METHODS: We retrospectively studied 211 patients with DM at Yale New Haven Hospital from 1/1/2013 to 5/31/2023 and calculated Standardized Incidence Ratio of cancers by anatomic site comparing DM patients to the general population using Connecticut cancer registry. Novel findings were validated using the SEER-Medicare database.RESULTS: 167 patients had DM type 1 (DM1), and 44 patients had DM type 2 (DM2). We ascertained 53 cancers in 44 patients (28 of DM1 and 16 of DM2). We observed increased risk of gastrointestinal (GI) neuroendocrine tumors (NETs; N=4; p<.001) and thyroid cancers (N=4; p=.05) in patients with DM1 and of hematologic malignancies (N=9; p=.002) in patients with DM2, compared to the general population. In SEER-Medicare analysis, the odds of NETs versus adenocarcinoma were higher in 69 patients with DM and GI cancer than SEER population with GI cancers (odds ratio, OR=2.6, p=.007). The length of repeat expansion or presence of cardiovascular phenotype were not associated with the cancer.CONCLUSION: The noted increased risk of certain cancers in DM1 and DM2 strengthens the likelihood that myotonic dystrophy is a cancer susceptibility syndrome. The association between DM1 and neuroendocrine tumors is novel and calls for assessing GI symptoms in DM patients with a possibility of cancer.

  View details for DOI 10.1016/j.jns.2025.123722

  View details for PubMedID 41100969

• Spectrum of Cancers and Their Prognosis Among Patients With Myotonic Dystrophy. JAMA network open Gadalla, S. M., McNeel, T. S., Wheeler, W., Alsaggaf, R., Hameed, B., Avantsa, S., Ahmadzada, M., Pfeiffer, R. M. 2025; 8 (8): e2526894

  View details for DOI 10.1001/jamanetworkopen.2025.26894

  View details for PubMedID 40802186

• A Literature Review and Pooled Case Analysis of Cardiofaciocutaneous Syndrome to Estimate Cancer Risk. Genetics in medicine : official journal of the American College of Medical Genetics Bess, J., Brown, T., Bhala, S., Faizer, A., Ahmadzada, M., Livinski, A. A., Pemov, A., Kim, J., Rosenberg, P. S., Ney, G. M., Stewart, D. R. 2025: 101423

  Abstract

  We quantified cancer risk in cardiofaciocutaneous syndrome (CFC), a rare RASopathy.From a comprehensive search, we reviewed articles from five databases and abstracted CFC cases with a clinical and/or molecular diagnosis to form a retrospective cohort. We collected information on BRAF, KRAS, MAP2K1, and MAP2K2 genetic variants when available. Genotype-phenotype (cancer) correlations, standardized incidence ratios (SIR) with age stratification, cumulative incidence and cause-specific hazard rates for cancer and cancer-free in CFC were calculated. A sensitivity analysis with molecular diagnoses only was also performed.This study included 198 publications reporting 690 individuals. Only 1.6% (11) had cancer, including acute lymphoblastic leukemia (ALL). Six individuals had cancer and harbored pathogenic variants within BRAF, MAP2K1, and MAP2K2. Cumulative incidence by age 10 was 5% for cancer or cancer-free death. Hazard Ratio (death) was 1-2% until age 3 and declined thereafter. Significant SIRs were found for all sites (SIR=4.96) and ALL (SIR=24.23).This is the largest investigation of cancer in CFC to date. Cancer risk in the CFC population was elevated but appears to be limited to younger than age three. However, modest case and cancer numbers limit accurate assessments of cancer risk in CFC and more studies are needed.

  View details for DOI 10.1016/j.gim.2025.101423

  View details for PubMedID 40196938

• Glycemic Management in Diabetic Foot Ulcers: A Comparative Analysis of Wound and Wound-free Periods in Adults With Type 1 and Type 2 Diabetes. Canadian journal of diabetes Bhat, S. Z., Al-Hajri, N., Kanbour, S., Ahmadzada, M., Borovoy, A., Abusamaan, M. S., Canner, J. K., Nass, C., Sherman, R. L., Hines, K. F., Hicks, C. W., Abularrage, C. J., Mathioudakis, N. 2024; 48 (8): 517-523.e2

  Abstract

  Our aim in this study was to determine whether there are differences in glycemia during wound and wound-free states among individuals with diabetes at a multidisciplinary diabetic foot and wound clinic from 2012 to 2019.We conducted a retrospective analysis of prospectively collected data over 7.4 years from the Johns Hopkins Multidisciplinary Diabetic Foot and Wound Clinic. Participants with diabetic foot ulcers were observed during at least one wound period and one wound-free period and had at least one glycated hemoglobin (A1C) measurement in both a wound period and a wound-free period. The A1C measurements were aggregated and summarized across wound and wound-free periods, and compared using the Wilcoxon matched-pairs signed rank test.Two hundred six eligible participants with a total of 623 wounds were included in this analysis. Participants were followed for a median period of 2.4 years (876 days). There were no significant differences in mean, minimum, and maximum A1C between the aggregate wound and wound-free periods, with median values of 7.6% (interquartile range [IQR] 6.6% to 9.1%) and 7.5% (IQR 6.6% to 9.1%) for mean A1C (p=0.43), 6.9% (IQR 6.0% to 8.0%) and 6.8% (6.0% to 8.1%) for minimum A1C (p=0.78), and 8.6% (IQR 7.1% to 10.9%) and 8.5% (IQR 7.0% to 10.7%) for maximum A1C (p=0.06) in the wound and wound-free periods, respectively.This retrospective study shows similar levels of A1C during wound and wound-free periods; however, given the limitations of missing A1C and small sample size, further studies leveraging continuous glucose monitoring are needed to determine whether glycemia worsens in the setting of a DFU.

  View details for DOI 10.1016/j.jcjd.2024.08.007

  View details for PubMedID 39260687

• A Systematic Review and Meta-Analysis to Assess the Impact of Pre-existing Comorbidities on the 30-Day Readmission after Lower Extremity Bypass Surgery for Peripheral Artery Occlusive Disease. Annals of vascular surgery Zil-E-Ali, A., Ahmadzada, M., Calisi, O., Holcomb, R. M., Patel, A., Aziz, F. 2023; 91: 10-19

  Abstract

  Unplanned hospital readmissions after surgical operations are considered a marker for suboptimal care during index hospitalizations and are associated with poor patient outcomes and increased healthcare resource utilization. Patients undergoing lower extremity bypass (LEB) operations for severe peripheral arterial disease (PAD) have one of the highest readmission rates, among all the vascular and nonvascular surgical operations. This review is meant to evaluate the impact of pre-existing comorbidities (diabetes mellitus (DM), chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), hypertension (HTN), and coronary artery disease (CAD))-on the 30-day readmission rates among patients who underwent LEB for severe PAD.The review protocol was registered to the PROSPERO database (CRD42021261067). A systematic review of the English literature was performed using PubMed, Scopus, and the Cochrane Library databases from inception till April 2022. The review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and included only studies reporting on 30-day readmission following LEB for occlusive PAD. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach and was reported as high, moderate, or low. The risk of bias was evaluated utilizing the Risk of Bias in Nonrandomized Studies - of Interventions (ROBINS-I) tool. A pooled odds ratio (OR) for each study was computed, and a P-value of <0.05 was designated as statistically significant. Interstudy heterogeneity was evaluated by Q-metric and quantified using Higgins I2 statistics.Five studies reported data on 30-day readmission after LEB for occlusive PAD. A total of 19,739 patients were included. Readmission occurred among 3,559 (18%) patients. DM and COPD were reported by all 5 selected studies, and CHF and HTN were reported by 4 studies. CAD was least reported among the selected 5 pre-existing conditions, with only 2 studies mentioning it. HTN (OR, 1.35; 95% confidence interval (CI), 1.10-1.64; P ≤ 0.001; I2 = 52.20%), DM (OR, 1.52; 95% CI, 1.30-1.79; P ≤ 0.001; I2 = 74.51%), and CHF (OR, 1.85; 95% CI, 1.51-2.25; P ≤ 0.001; I2 = 50.48%) were all found to be associated with an increased risk of 30-day readmission, while the presence of COPD (OR, 1.16; 95% CI, 0.98-1.36; P = 0.09; I2 = 61.93%) and CAD (OR, 1.30; 95% CI, 0.94-1.78; P = 0.11; I2 = 51.01%) was not associated with early readmission on meta-analysis of the available studies.The pre-existing comorbidities HTN, DM, and CHF increase the risk of 30-day readmission after LEB for occlusive PAD. The identification of these risk factors can help stratify the patients and further guide in understanding the variety of factors that contribute in hospital readmissions.

  View details for DOI 10.1016/j.avsg.2022.12.072

  View details for PubMedID 36549476

• Adherence to a Federal Hospital Price Transparency Rule and Associated Financial and Marketplace Factors. JAMA Haque, W., Ahmadzada, M., Janumpally, S., Haque, E., Allahrakha, H., Desai, S., Hsiehchen, D. 2022; 327 (21): 2143-2145

  Abstract

  This study evaluates US hospitals’ disclosure of standard service charges as mandated by a federal price transparency rule and hospital characteristics among acute care hospitals.

  View details for DOI 10.1001/jama.2022.5363

  View details for PubMedID 35670796

  View details for PubMedCentralID PMC9175070

• Transparency, Accessibility, and Variability of US Hospital Price Data. JAMA network open Haque, W., Ahmadzada, M., Allahrakha, H., Haque, E., Hsiehchen, D. 2021; 4 (5): e2110109

  Abstract

  This cross-sectional study evaluates the compliance of hospitals with a Centers for Medicare & Medicaid Services ruling mandating that hospital chargemasters be publicly available in a machine-readable file.

  View details for DOI 10.1001/jamanetworkopen.2021.10109

  View details for PubMedID 33988709

  View details for PubMedCentralID PMC8122228

• Teledermatology after COVID-19: key challenges ahead. Dermatology online journal Haque, W., Chandy, R., Ahmadzada, M., Rao, B. 2021; 27 (4)

  Abstract

  Teledermatology has been leveraged during the COVID-19 pandemic as a means of adopting novel ways to treat patients while reducing the risk of viral transmission. Although teledermatology offers benefits related to patient convenience and improved access to care, key challenges in the areas of reimbursement, licensure, and diagnostic accuracy remain. In this commentary, we discuss these three obstacles and potential solutions.

  View details for PubMedID 33999576

• Factors associated with disease severity and mortality among patients with COVID-19: A systematic review and meta-analysis. PloS one Chidambaram, V., Tun, N. L., Haque, W. Z., Majella, M. G., Sivakumar, R. K., Kumar, A., Hsu, A. T., Ishak, I. A., Nur, A. A., Ayeh, S. K., Salia, E. L., Zil-E-Ali, A., Saeed, M. A., Sarena, A. P., Seth, B., Ahmadzada, M., Haque, E. F., Neupane, P., Wang, K. H., Pu, T. M., Ali, S. M., Arshad, M. A., Wang, L., Baksh, S., Karakousis, P. C., Galiatsatos, P. 2020; 15 (11): e0241541

  Abstract

  Understanding the factors associated with disease severity and mortality in Coronavirus disease (COVID-19) is imperative to effectively triage patients. We performed a systematic review to determine the demographic, clinical, laboratory and radiological factors associated with severity and mortality in COVID-19.We searched PubMed, Embase and WHO database for English language articles from inception until May 8, 2020. We included Observational studies with direct comparison of clinical characteristics between a) patients who died and those who survived or b) patients with severe disease and those without severe disease. Data extraction and quality assessment were performed by two authors independently.Among 15680 articles from the literature search, 109 articles were included in the analysis. The risk of mortality was higher in patients with increasing age, male gender (RR 1.45, 95%CI 1.23-1.71), dyspnea (RR 2.55, 95%CI 1.88-2.46), diabetes (RR 1.59, 95%CI 1.41-1.78), hypertension (RR 1.90, 95%CI 1.69-2.15). Congestive heart failure (OR 4.76, 95%CI 1.34-16.97), hilar lymphadenopathy (OR 8.34, 95%CI 2.57-27.08), bilateral lung involvement (OR 4.86, 95%CI 3.19-7.39) and reticular pattern (OR 5.54, 95%CI 1.24-24.67) were associated with severe disease. Clinically relevant cut-offs for leukocytosis(>10.0 x109/L), lymphopenia(< 1.1 x109/L), elevated C-reactive protein(>100mg/L), LDH(>250U/L) and D-dimer(>1mg/L) had higher odds of severe disease and greater risk of mortality.Knowledge of the factors associated of disease severity and mortality identified in our study may assist in clinical decision-making and critical-care resource allocation for patients with COVID-19.

  View details for DOI 10.1371/journal.pone.0241541

  View details for PubMedID 33206661

  View details for PubMedCentralID PMC7673562