Pahnwat Tonya Taweesedt, MD

All Publications

• Pharmacological management of sleep apnea and obesity, a new frontier. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine Taweesedt, P. T., Orakpo, N., Pelayo, R. 2025

  View details for DOI 10.5664/jcsm.11798

  View details for PubMedID 40476603

• SLEEP-RELATED HYPOVENTILATION IN CYSTIC FIBROSIS: THE SILENT DANGER Alla, R., Taweesedt, P. OXFORD UNIV PRESS INC. 2025: A630

  View details for DOI 10.1093/sleep/zsaf090.1470

  View details for Web of Science ID 001490488400013

• The impact of brain-systemic oxygenation coupling in sleep-disordered breathing on cognitive function in elderly. Scientific reports Kawai, M., Hosseini, S. M., Buck, C., Karna, R., Parker-Fong, K. A., Taweesedt, P. T. 2025; 15 (1): 1523

  Abstract

  Intermittent hypoxia, a consequence of sleep-disordered breathing (SDB), may contribute to an increased risk of cognitive decline. However, the association between SDB and cognition remains highly variable.Fifty-two community-dwelling healthy older adults (28 women) were recruited. All participants underwent neuropsychiatric evaluations, simultaneous ambulatory polysomnography (PSG), and near-infrared spectroscopy (NIRS) recordings. We quantified the average coherence between oxy-Hb and SpO2 signals during SDB events to determine whether it could predict cognitive outcomes in healthy older adults, where higher coherence indicates reduced protection against systemic hypoxia.The mean (SD) coherence of oxy-Hb and SpO2 was 0.16 (0.07). Linear regression analysis showed a significant association between mean coherence and worse Stroop Color Word Test scores (t=-0.304, p = .004). In contrast, oxy-Hb reduction alone and conventional SDB parameters did not show a significant association with cognition.This is the first report to demonstrate an association between a novel parameter of brain-systemic oxygenation coherence in SDB and cognition in older adults. A higher coherence rate of cortical oxy-Hb and systemic SpO2 during SDB may reflect a loss of compensatory mechanisms against systemic hypoxia and could help stratify older adults with a higher risk for cognitive decline.

  View details for DOI 10.1038/s41598-024-84305-3

  View details for PubMedID 39789019

  View details for PubMedCentralID 3639722

• Carbon ion radiation therapy in prostate cancer: The importance of dosage. World journal of radiology Treechairusame, T., Taweesedt, P. T. 2024; 16 (11): 696-699

  Abstract

  In this article, we comment on the article by Ono et al. We focus specifically on the carbon ion radiotherapy studies and the method to calculate the dosing schedule. While photon hypofractionated radiotherapy in prostate cancer has demonstrated improvement in tumor control with reduced gastrointestinal toxicity compared to conventional radiotherapy, carbon ion radiotherapy (CIRT) offers additional physical and biological advantages. Recent findings, including those from Ono et al, have established new dose constraints of CIRT for prostate cancer treatment and risk factors for rectal bleeding. Due to limited data on CIRT dosing, this study underscores the need for more research to refine dose calculation methods and better understand their effects on clinical outcomes.

  View details for DOI 10.4329/wjr.v16.i11.696

  View details for PubMedID 39635316

  View details for PubMedCentralID PMC11612798

• Impact of sleep on gastrointestinal cancer. World journal of clinical oncology Lo, J., Taweesedt, P. T., Kawai, M. 2024; 15 (6): 677-683

  Abstract

  Sleep problems have become a significant public health concern, affecting a large portion of the global population and have been linked to increased morbidity and mortality. The incidence of gastrointestinal (GI) cancers continues to rise, posing a substantial burden on healthcare systems worldwide. This editorial aims to delve into the impact of sleep on GI cancers, including esophageal, gastric, colorectal, hepatobiliary, and pancreatic cancer. Recent literature investigating the potential connections between GI cancers and sleep was reviewed. We considered aspects such as sleep duration, sleep disorders, and circadian rhythmicity, in order to explore the underlying mechanisms that can contribute to the development of GI cancers and propose avenues for future research.

  View details for DOI 10.5306/wjco.v15.i6.677

  View details for PubMedID 38946837

  View details for PubMedCentralID PMC11212604

• From macro to micro: slow-wave sleep and its pivotal health implications Ishii, T., Taweesedt, P. T., Chick, C., O’Hara, R., Kawai, M. Frontiers. 2024
• Impact of Antifibrotic Treatment on Postoperative Complications in Patients with Interstitial Lung Diseases Undergoing Lung Transplantation: A Systematic Review and Meta-Analysis. Journal of clinical medicine Taweesedt, P., Lertjitbanjong, P., Eksombatchai, D., Charoenpong, P., Moua, T., Thongprayoon, C., Tangpanithandee, S., Petnak, T. 2023; 12 (2)

  Abstract

  Antifibrotic treatment has been approved for reducing disease progression in fibrotic interstitial lung disease (ILD). As a result of increased bleeding risk, some experts suggest cessation of antifibrotics prior to lung transplantation (LT). However, extensive knowledge regarding the impact of antifibrotic treatment on postoperative complications remains unclear. We performed a comprehensive search of several databases from their inception through to 30 September 2021. Original studies were included in the final analysis if they compared postoperative complications, including surgical wound dehiscence, anastomosis complication, bleeding complications, and primary graft dysfunction, between those with and without antifibrotic treatment undergoing LT. Of 563 retrieved studies, 6 studies were included in the final analysis. A total of 543 ILD patients completing LT were included, with 161 patients continuing antifibrotic treatment up to the time of LT and 382 without prior treatment. Antifibrotic treatment was not significantly associated with surgical wound dehiscence (RR 1.05; 95% CI, 0.31-3.60; I2 = 0%), anastomotic complications (RR 0.88; 95% CI, 0.37-2.12; I2 = 31%), bleeding complications (RR 0.76; 95% CI, 0.33-1.76; I2 = 0%), or primary graft dysfunction (RR 0.87; 95% CI, 0.59-1.29; I2 = 0%). Finally, continuing antifibrotic treatment prior to LT was not significantly associated with decreased 1-year mortality (RR 0.80; 95% CI, 0.41-1.58; I2 = 0%). Our study suggests a similar risk of postoperative complications in ILD patients undergoing LT who received antifibrotic treatment compared to those not on antifibrotic therapy.

  View details for DOI 10.3390/jcm12020655

  View details for PubMedID 36675583

• Obstructive Sleep Apnea: New Perspective. Medicina (Kaunas, Lithuania) Surani, S., Taweesedt, P. 2022; 59 (1)

  Abstract

  Obstructive sleep apnea (OSA) is one of the most common sleep disorders globally [...].

  View details for DOI 10.3390/medicina59010075

  View details for PubMedID 36676699

• Patient-Centered Therapy for Obstructive Sleep Apnea: A Review. Medicina (Kaunas, Lithuania) Taweesedt, P., Najeeb, H., Surani, S. 2022; 58 (10)

  Abstract

  Obstructive sleep apnea (OSA) is one of the most common sleep problems defined by cessation or decreased airflow despite breathing efforts. It is known to be related to multiple adverse health consequences. Positive airway pressure (PAP) is considered an effective treatment that is widely used. Various modes of PAP and other emerging treatment options are now available. A multidisciplinary approach, understanding diverse phenotypes of OSA, and shared decision-making are necessary for successful OSA treatment. Patient-centered care is an essential modality to support patient care that can be utilized in patients with OSA to help improve outcomes, treatment adherence, and patient satisfaction.

  View details for DOI 10.3390/medicina58101338

  View details for PubMedID 36295499

  View details for PubMedCentralID PMC9612386

• Characterizing sleep-wake patterns in mothers and children in an agrarian community: results from the Ghana Randomized Air Pollution and Health Study. Sleep Kundel, V., Agyapong, P. D., Parekh, A., Kaali, S., Prah, R. K., Taweesedt, P., Tawiah, T., Ayappa, I., Mujtaba, M. N., Agyei, O., Jack, D., Osei, M., Kwarteng, A. A., Lee, A., Asante, K. P. 2022; 45 (8)

  Abstract

  Several studies have examined sleep patterns in rural/indigenous communities, however little is known about sleep characteristics in women of reproductive age, and children within these populations. We investigate sleep-wake patterns in mothers and children (ages 3-5 years) leveraging data from the Ghana Randomized Air Pollution and Health Study (GRAPHS).The GRAPHS cohort comprises of rural/agrarian communities in Ghana and collected multiday actigraphy in a subset of women and children to assess objective sleep-wake patterns. Data were scored using the Cole-Kripke and Sadeh algorithms for mothers/children. We report descriptive, baseline characteristics and objective sleep measures, compared by access to electricity/poverty status.We analyzed data for 58 mothers (mean age 33 ± 6.6) and 64 children (mean age 4 ± 0.4). For mothers, mean bedtime was 9:40 pm ± 56 min, risetime 5:46 am ± 40 min, and total sleep time (TST) was 6.3 h ± 46 min. For children, median bedtime was 8:07 pm (interquartile range [IQR]: 7:50,8:43), risetime 6:09 am (IQR: 5:50,6:37), and mean 24-h TST 10.44 h ± 78 min. Children with access to electricity had a reduced TST compared to those without electricity (p = 0.02). Mean bedtime was later for both mothers (p = 0.05) and children (p = 0.08) classified as poor.Mothers in our cohort demonstrated a shorter TST, and earlier bed/risetimes compared to adults in postindustrialized nations. In contrast, children had a higher TST compared to children in postindustrialized nations, also with earlier sleep-onset and offset times. Investigating objective sleep-wake patterns in rural/indigenous communities can highlight important differences in sleep health related to sex, race/ethnicity, and socioeconomic status, and help estimate the impact of industrialization on sleep in developed countries.

  View details for DOI 10.1093/sleep/zsac033

  View details for PubMedID 35143676

  View details for PubMedCentralID PMC9366631

• Diagnostic accuracy of interferon-gamma release assays for diagnosis of smear-negative pulmonary tuberculosis: a systematic review and meta-analysis. BMC pulmonary medicine Petnak, T., Eksombatchai, D., Chesdachai, S., Lertjitbanjong, P., Taweesedt, P., Pornchai, A., Thongprayoon, C., Prokop, L. J., Wang, Z. 2022; 22 (1): 219

  Abstract

  The diagnosis of smear-negative pulmonary tuberculosis (SNPTB) is challenging. Interferon gamma-release assays (IGRAs) may be helpful in early diagnosis among these patients resulting in prompt treatment and favorable outcomes.We performed a comprehensive search from each databases' inception to April 5, 2021. The studies that provided sufficient data regarding the sensitivity and specificity of IGRAs included QuantiFERON-TB Gold In-Tube (QFT-GIT), T-SPOT.TB, or QuantiFERON-TB Gold Plus for diagnosis of SNPTB were included.Of 1,312 studies screened, 16 studies were included; 11 QFT-GIT, 2 T-SPOT.TB, and 3 QFT-GIT and T-SPOT.TB. For diagnosis of SNPTB, QFT-GIT had sensitivity of 0.77 (95% CI 0.71-0.82), specificity of 0.70 (95% CI 0.58-0.80), diagnostic odds ratio (DOR) of 8.03 (95% CI 4.51-14.31), positive likelihood ratio (LR) of 2.61 (95% CI 1.80-3.80), negative LR of 0.33 (95% CI 0.25-0.42), and area under receiver operating characteristic (AUROC) of 0.81 (95% CI 0.77-0.84). T-SPOT.TB had sensitivity of 0.74 (95% CI 0.71-0.78), specificity of 0.71 (95% CI 0.49-0.86), DOR of 6.96 (95% CI 2.31-20.98), positive LR of 2.53 (95% CI 1.26-5.07), negative LR of 0.36 (95% CI 0.24-0.55), and AUROC of 0.77 (95% CI 0.73-0.80). The specificity seemed lower in the subgroup analyses of studies from high tuberculosis burden counties compared to the studies from low tuberculosis burden.IGRAs do have insufficient diagnostic performance for SNPTB. However, the tests are still helpful to exclude tuberculosis among patients with low pre-test probability. Registry: PROSPERO: CRD42021274653.

  View details for DOI 10.1186/s12890-022-02013-y

  View details for PubMedID 35668411

  View details for PubMedCentralID PMC9169405

• Follow-up computed tomography scan in post-COVID-19 pneumonia. World journal of radiology Chohan, A., Choudhury, S., Dadhwal, R., Vakil, A. P., Franco, R., Taweesedt, P. T. 2022; 14 (4): 104-106

  Abstract

  The coronavirus disease 2019 (COVID-19) global pandemic can be a severe illness that leads to morbidity and mortality. With the increasing number of COVID-19 pneumonia survivors, several long-term changes may persist, including abnormal imaging of lung parenchyma. In addition to the clinical course, it is vital to follow up on pulmonary imaging during the post-infectious period, which is not routinely required in other common pulmonary diagnoses. Computed tomography (CT) scan of the chest is an effective and diagnostic tool for pneumonia which gives an insight into structural abnormalities within the lungs, complications, and possible progression of the disease. Several studies have monitored COVID-19 pneumonia and its complications using serial CT chest imaging from the initial phase of infection, hospitalization, and post-discharge. Nonetheless, long-term follow-up imaging data in post-COVID-19 is still limited. We have summarized the findings utilizing a systematic review of the literature regarding COVID-19 pneumonia imaging, including long-term follow-up.

  View details for DOI 10.4329/wjr.v14.i4.104

  View details for PubMedID 35646289

  View details for PubMedCentralID PMC9124981

• Call for a Global Vaccine Plan to Combat Current and Future Pandemics: One for ALL and ALL for One. The open respiratory medicine journal Surani, S., Taweesedt, P. T., Surani, S., Ratnani, I., Varon, J. 2022; 16: e187430642202040

  Abstract

  The emergence of SARS-CoV-2 in late December 2019 has taken the world by storm. In March 2020, the World Health Organization (WHO) named this virus COVID-19. To date, it has infected approximately 186 million people worldwide and is attributed as the cause of death of more than 5 million people (and this number is only increasing.) The global effort to develop vaccines and therapeutics occurred at the fastest pace yet, with several vaccines' approval under emergency authorization use. There are also several post-marketing side effects, including myocarditis, cerebral venous embolism, and Guillain Barre Syndrome. Global vaccine disparity complicates the control of pandemic challenges. Several highly infectious variants have emerged, and more variants are feared to emerge if global vaccination plans are not developed soon.

  View details for DOI 10.2174/18743064-v16-e2202040

  View details for PubMedID 37273957

  View details for PubMedCentralID PMC10156016

• A Case Report on Mycobacterium abscessus: An Emerging Pathogen. Cureus Chohan, A., Choudhury, S., Taweesedt, P. T., Dadhwal, R., Vakil, A. P., Ali, Z., Franco, R. 2022; 14 (3): e23072

  Abstract

  The incidence of infections by rapidly growing mycobacteria has increased in recent decades. nontuberculous mycobacteria(NTM) represent over 190 species and subspecies and can cause both pulmonary and extrapulmonary symptoms. The Mycobacterium abscessus complex (MABC)is among the most drug-resistant mycobacterial species, and prompt diagnosis and effective eradication are burdensome. We present the clinical course of a 55-year-old female who was diagnosed with M. abscessus and explore her clinical diagnosis and possible treatment options. This case report emphasizes the challenges clinicians face in the prompt diagnosis of M. abscessus and discusses the treatment options in light of the recent guidelines.

  View details for DOI 10.7759/cureus.23072

  View details for PubMedID 35419221

  View details for PubMedCentralID PMC8995077

• Applications of artificial intelligence in common pulmonary diseases Choudhury, S., Chohan, A., Dadhwal, R., Vakil, A. P., Franco, R., Taweesedt, P. T. Artif Intell Med Imaging. 2022
• Diagnosis of IPF Idiopathic Pulmonary Fibrosis Taweesedt, P. T., Gandhi, K., Shah, R., Surani, S. 2022
• Abnormal liver enzymes: A review for clinicians. World journal of hepatology Kalas, M. A., Chavez, L., Leon, M., Taweesedt, P. T., Surani, S. 2021; 13 (11): 1688-1698

  Abstract

  Liver biochemical tests are some of the most commonly ordered routine tests in the inpatient and outpatient setting, especially with the automatization of testing in this technological era. These tests include aminotransferases, alkaline phosphatase, gamma-glutamyl transferase, bilirubin, albumin, prothrombin time and international normalized ratio (INR). Abnormal liver biochemical tests can be categorized based on the pattern and the magnitude of aminotransferases elevation. Generally, abnormalities in aminotransferases can be classified into a hepatocellular pattern or cholestatic pattern and can be further sub-classified based on the magnitude of aminotransferase elevation to mild [< 5 × upper limit of normal (ULN)], moderate (> 5-< 15 × ULN) and severe (> 15 × ULN). Hepatocellular pattern causes include but are not limited to; non-alcoholic fatty liver disease/non-alcoholic steatohepatitis, alcohol use, chronic viral hepatitis, liver cirrhosis (variable), autoimmune hepatitis, hemochromatosis, Wilson's disease, alpha-1 antitrypsin deficiency, celiac disease, medication-induced and ischemic hepatitis. Cholestatic pattern causes include but is not limited to; biliary pathology (obstruction, autoimmune), other conditions with hyperbilirubinemia (conjugated and unconjugated). It is crucial to interpret these commonly ordered tests accurately as appropriate further workup, treatment and referral can greatly benefit the patient due to prompt treatment which can improve the natural history of several of the diseases mentioned and possibly reduce the risk of progression to the liver cirrhosis.

  View details for DOI 10.4254/wjh.v13.i11.1688

  View details for PubMedID 34904038

  View details for PubMedCentralID PMC8637680

• Hepatopulmonary syndrome: An update. World journal of hepatology Gandhi, K. D., Taweesedt, P. T., Sharma, M., Surani, S. 2021; 13 (11): 1699-1706

  Abstract

  Hepatopulmonary syndrome (HPS) is characterized by defects in oxygenation caused by intra-pulmonary vasodilation occurring because of chronic liver disease, portal hypertension, or congenital portosystemic shunts. Clinical implications of portal hypertension are very well-known, however, awareness of its effect on multiple organs such as the lungs are less known. The presence of HPS in chronic liver disease is associated with increased mortality. Medical therapies available for HPS have not been proven effective and definitive treatment for HPS is mainly liver transplantation (LT). LT improves mortality for patients with HPS drastically. This article provides a review on the definition, clinical presentation, diagnosis, and management of HPS.

  View details for DOI 10.4254/wjh.v13.i11.1699

  View details for PubMedID 34904039

  View details for PubMedCentralID PMC8637683

• Stethoscope - An essential diagnostic tool or a relic of the past? Hospital practice (1995) Qamar, S., Tekin, A., Taweesedt, P. T., Varon, J., Kashyap, R., Surani, S. 2021; 49 (4): 240-244

  Abstract

  Rene Laennec came up with the idea of a stethoscope in 1816 to avoid the embarrassment of performing immediate auscultation on women. Soon many doctors around the world started using this tool because of its increased accuracy and ease of use. Stethoscopes hold great significance in the medical community. However, is the importance placed on stethoscopes justified today? We now have devices like portable ultrasound machines that make it much easier to visualize the body. These devices offset their higher initial cost by reducing downstream costs due to their greater accuracy and their capability of detecting diseases at an earlier stage. Also, because of the COVID-19 pandemic, new ways are being investigated to reduce the transmission of diseases. Stethoscopes being a possible vector for infectious agents coupled with the advent of newer devices that can visualize the body with greater accuracy put into question the continued use of stethoscopes today. With that said, the use of stethoscopes to diagnose diseases is still crucial in places where buying these new devices is not yet possible. The stethoscope is a great symbol of medicine, but its use needs to be in line with what is best for the patient.

  View details for DOI 10.1080/21548331.2021.1949170

  View details for PubMedID 34180345

• Comparison of first and second waves of COVID-19 through severity markers in ICU patients of a developing country. Journal of community hospital internal medicine perspectives Asghar, M. S., Yasmin, F., Haris, A., Nadeem, A., Taweesedt, P. T., Surani, S. 2021; 11 (5): 576-584

  Abstract

  Background: Many countries are experiencing outbreaks of the second wave of COVID-19 infection. With these outbreaks, the severity of the disease is still ambiguously projected. Certain inflammatory markers are known to be associated with the severity of the disease and regular monitoring of these biomarkers in intensive care unit admissions is paramount to improve clinical outcomes.Objectives: This study was aimed to compare the severity markers of the patients infected during the first wave versus the second wave in an intensive care unit.Methods: We conducted a retrospective study obtaining patient's data from hospital records, admitted during the first wave in March-May 2020, and compared the data with those COVID-19 patients admitted during the second wave from October-November 2020. A descriptive comparison was done among the patients admitted to intensive care unit (ICU) during both waves of the pandemic.Results: 92 patients from first wave and 68 patients from second wave were included in the analysis, all admitted to ICU with equal gender distribution. Increased age and length of ICU stay was observed during the first wave. BMI, in-hospital mortality and invasive ventilation were statistically indifferent between both the waves. There was significantly higher APACHE-II during first wave (p = 0.007), but SOFA at day 1 (p = 0.213) and day 7 of ICU stay remain indifferent (p = 0.119). Inflammatory markers were less severe during second wave while only neutrophils and lymphocytes were found to peak higher.Conclusion: Most of the severity markers were less intense during the early analysis of second wave.

  View details for DOI 10.1080/20009666.2021.1949793

  View details for PubMedID 34567444

  View details for PubMedCentralID PMC8462838

• Role of proning and positive end-expiratory pressure in COVID-19. World journal of critical care medicine Gandhi, K. D., Sharma, M., Taweesedt, P. T., Surani, S. 2021; 10 (5): 183-193

  Abstract

  The novel coronavirus, which was declared a pandemic by the World Health Organization in early 2020 has brought with itself major morbidity and mortality. It has increased hospital occupancy, heralded economic turmoil, and the rapid transmission and community spread have added to the burden of the virus. Most of the patients are admitted to the intensive care unit (ICU) for acute hypoxic respiratory failure often secondary to acute respiratory distress syndrome (ARDS). Based on the limited data available, there have been different opinions about the respiratory mechanics of the ARDS caused by coronavirus disease 2019 (COVID-19). Our article provides an insight into COVID-19 pathophysiology and how it differs from typical ARDS. Based on these differences, our article explains the different approach to ventilation in COVID-19 ARDS compared to typical ARDS. We critically analyze the role of positive end-expiratory pressure (PEEP) and proning in the ICU patients. Through the limited data and clinical experience are available, we believe that early proning in COVID-19 patients improves oxygenation and optimal PEEP should be titrated based on individual lung compliance.

  View details for DOI 10.5492/wjccm.v10.i5.183

  View details for PubMedID 34616655

  View details for PubMedCentralID PMC8462021

• Obstructive Sleep Apnea in Adults: What Primary Care Physicians Need to Know. Cureus Arredondo, E., Udeani, G., Panahi, L., Taweesedt, P. T., Surani, S. 2021; 13 (9): e17843

  Abstract

  Obstructive sleep apnea (OSA) remains a prominent disease state characterized as the recurrent collapse of the upper airway while sleeping and is estimated to plague 936 million adults globally. Although the initial clinical presentation of OSA appears harmless, it increases the risk of cardiovascular diseases such as heart failure, stroke, and hypertension; metabolic disorders; and an overall decrease in quality of life, in addition to increasing mortality. Current treatment of OSA includes lifestyle changes, behavioral modification, mandibular advancement devices, surgical treatment, and continuous positive airway pressure, which remains the gold standard. It is crucial to identify OSA early on and initiate treatment to mitigate the adverse health risks it imposes. This review will discuss the pathophysiology, epidemiology, management strategies, and medical treatment of OSA.

  View details for DOI 10.7759/cureus.17843

  View details for PubMedID 34660049

  View details for PubMedCentralID PMC8501746

• Current state of medical tourism involving liver transplantation-the risk of infections and potential complications. World journal of hepatology Neupane, R., Taweesedt, P. T., Anjum, H., Surani, S. 2021; 13 (7): 717-722

  Abstract

  Liver transplant has been shown to significantly improve mortality and quality of life in various liver diseases such as acute liver failure, end-stage liver disease, and liver cancer. While the organ transplant demand is continuing to rise, the organ donation supply remains unmatched. The organ shortage, high cost, and long waiting lists have stimulated a desire for routes that may be unethical. This process which is named transplant tourism is the term used to describe traveling to another country to purchase an organ for transplant. Liver transplant tourism has been associated with post-transplant complications and higher mortality compared to a domestic liver transplant. Improper pre-and post-transplant infectious screening, inadequate opportunistic infection prophylaxis, and loss to follow-up were noted in patients who travel abroad for a liver transplant. It is crucial to understand the risk of transplant tourism to prevent morbidity and mortality.

  View details for DOI 10.4254/wjh.v13.i7.717

  View details for PubMedID 34367493

  View details for PubMedCentralID PMC8326159

• Severe Photosensitivity Reaction After Pirfenidone Use. Cureus Choudhury, S., Taweesedt, P. T., Dadhwal, R., Surani, S. 2021; 13 (7): e16626

  Abstract

  Idiopathic pulmonary fibrosis is a chronic and progressive disease with a significant mortality rate. Pirfenidone is one of two oral antifibrotic therapies approved to treat idiopathic pulmonary fibrosis (IPF). Pirfenidone helps decrease disease progression in patients with IPF and reduces vital capacity. This has led to widespread use of this medication in recent years. In this case report, we present a 60-year-old male who started treatment with pirfenidone for IPF and had severe skin reactions after initiation of therapy.

  View details for DOI 10.7759/cureus.16626

  View details for PubMedID 34458037

  View details for PubMedCentralID PMC8384726

• Utilizing Artificial Intelligence in Critical Care: Adding A Handy Tool to Our Armamentarium. Cureus Sharma, M., Taweesedt, P. T., Surani, S. 2021; 13 (6): e15531

  Abstract

  We have witnessed rapid advancement in technology over the last few decades. With the advent of artificial intelligence (AI), newer avenues have opened for researchers. AI has added an entirely new dimension to this technological boom. Researchers in medical science have been excited about the tantalizing prospect of utilizing AI for the benefit of patient care. Lately, we have come across studies trying to test and validate various models based on AI to improve patient care strategies in critical care medicine as well. Thus, in this review, we will attempt to succinctly review current literature discussing AI in critical care medicine and analyze its future utility based on prevailing evidence.

  View details for DOI 10.7759/cureus.15531

  View details for PubMedID 34268051

  View details for PubMedCentralID PMC8266146

• Mediastinal lymphadenopathy in COVID-19: A review of literature. World journal of clinical cases Taweesedt, P. T., Surani, S. 2021; 9 (12): 2703-2710

  Abstract

  A novel coronavirus disease 2019 (COVID-19) is a progressive viral disease that affected people around the world with widespread morbidity and mortality. Patients with COVID-19 infection typically had pulmonary manifestation but can also present with gastrointestinal, cardiac, or neurological system dysfunction. Chest imaging in patients with COVID-19 commonly show bilateral lung involvement with bilateral ground-glass opacity and consolidation. Mediastinal lymphadenopathy can be found due to infectious or non-infectious etiologies. It is commonly found to be associated with malignant diseases, sarcoidosis, and heart failure. Mediastinal lymph node enlargement is not a typical computer tomography of the chest finding of patients with COVID-19 infection. We summarized the literature which suggested or investigated the mediastinal lymph node enlargement in patients with COVID-19 infection. Further studies are needed to better characterize the importance of mediastinal lymphadenopathy in patients with COVID-19 infection.

  View details for DOI 10.12998/wjcc.v9.i12.2703

  View details for PubMedID 33969053

  View details for PubMedCentralID PMC8058669

• Cocaine-Induced Bronchial Laceration: A Rare Incidence. Cureus Dadhwal, R., Bulathsinghala, C. P., Choudhry, I., Taweesedt, P. T., Surani, S. 2021; 13 (4): e14252

  Abstract

  Tracheobronchial injuries are either traumatic or iatrogenic but can be lethal in a high dependency setting if not managed promptly. There are few reported cases of cocaine-induced airway damage and barotrauma due to thermal or ischemic injury and increased intra-alveolar pressure. We present a sui generis case of cocaine-induced bronchial laceration with pneumomediastinum which was challenging to diagnose based on the patient's recent history of hospitalization, as well as the patient's reluctance to share the history of cocaine use. The patient was successfully managed conservatively. Here, we discuss the mechanism involved and the various treatment options available, along with the role of early involvement of the multidisciplinary team to deliver the best possible outcome.

  View details for DOI 10.7759/cureus.14252

  View details for PubMedID 33959440

  View details for PubMedCentralID PMC8093120

• Foreign Body Aspiration Getting Weird: Crack Pipe Aspiration. Cureus Bulathsinghala, C. P., De Silva, P. R., Dadhwal, R., Taweesedt, P. T., Surani, S. 2021; 13 (2): e13267

  Abstract

  Inhalation of cocaine derivatives is associated with a number of pulmonary and systemic complications. We report a case of less recognized complication, the aspiration of a metallic object used as a screen for crack cocaine abuse. A 42-year-old female presented with a two-day history of gradually worsening cough and a history of "food aspiration." Her lung examination revealed wheezing and fine crackles with diminished air entry at the left base. A chest X-ray revealed an 8 mm radiopaque foreign body overlying the region of the left lower lobe bronchus, with a confirmatory computed tomography scan of the chest. An urgent bronchoscopy revealed a metallic foreign body impacted into the left lower lobe bronchus proper, soon after the takeoff of the superior segment, which was removed with forceps. The patient signed out against medical advice soon after. Though relatively uncommon, this case highlights a possible complication associated with crack cocaine abuse that may require emergent intervention.

  View details for DOI 10.7759/cureus.13267

  View details for PubMedID 33728203

  View details for PubMedCentralID PMC7948311

• Hemothorax After a Renal Biopsy With Ablation, a Rare Complication: A Case Report and Review of the Literature. Cureus Taweesedt, P. T., Anjum, H., Dadhwal, R., Surani, S. 2021; 13 (1): e12439

  Abstract

  Renal biopsy is an important diagnostic test which is used to extract kidney tissue with the help of a biopsy needle. It is frequently performed under ultrasonography or CT guidance. As with every other procedure, renal biopsy also carries some risks. Common complications of renal biopsy are damage to adjacent organs. Hemothorax is an exceedingly rare complication of renal biopsy. We report a case of a middle-aged female who developed a left-sided hemothorax after undergoing percutaneous renal biopsy with ablation and conducted a literature review of this rare complication.

  View details for DOI 10.7759/cureus.12439

  View details for PubMedID 33552758

  View details for PubMedCentralID PMC7854316

• COVID-19 and the Mental Health Dilemma: How Mental Health Influences the Population during the Pandemic Mominkhawaja, A., Taweesedt, P. T., Surani, S. Acta Scientific Medical Sciences. 2021
• Abdominal compartment syndrome among medical patients A Comprehensive Review of Compartment Syndrome Gandhi, K., Taweesedt, P. T., Sharma, M., Barbhaya, D., Salim, S. 2021
• Pulmonary complications of vasculitis Vasculitis: From diagnosis to treatment Taweesedt, P. T., Bayati, J., Yasmin, F., Sharma, M., Surani, S. 2021
• Bruxism: From diagnosis to management Advances in health and disease Taweesedt, P. T., Yasmin, F., Salim, S., Ramar, K. 2021
• An Intriguing Case of Pneumoperitoneum In a Patient With COVID-19: Do All Pneumoperitoneum Cases Need Surgery? Cureus Sharma, M., Ojha, P., Taweesedt, P. T., Ratnani, I., Surani, S. 2020; 12 (12): e12279

  Abstract

  Pneumoperitoneum is pneumatosis in the potential space of the abdominal cavity. It is generally considered a surgical emergency and is mostly due to perforated hollow viscus. Rarely, pneumoperitoneum might occur even in the absence of bowel perforation. We hereby present a case of pneumoperitoneum in a patient with COVID-19 pneumonia and pneumomediastinum, which was managed non-surgically.

  View details for DOI 10.7759/cureus.12279

  View details for PubMedID 33510986

  View details for PubMedCentralID PMC7828748

• A Complicated Case of a Paravalvular Leak Following Mitral Valve Replacement. Cureus Khan, K., Taweesedt, P. T., Venkatachalam, S., Surani, S. 2020; 12 (12): e11897

  Abstract

  Paravalvular leaks (PVL) are an uncommon sequelae of valve replacement but can be seen as a complication of both mechanic and prosthetic valves. Patients with PVL may remain asymptomatic or have detrimental complications, which include heart failure, hemodynamically significant hemolysis, and endocarditis. Management depends on the clinical presentation and the degree of the valvular leak. We hereby present a case report of a patient with a complicated clinical course secondary to a PVL of the mitral valve. The patient had a recent mitral valve replacement and presented with symptoms of heart failure that was refractory to standard medical therapy. Valvular abnormality was not seen with initial trans-thoracic echocardiogram (TTE), but with high clinical suspicion, a trans-esophageal echocardiogram (TEE) was done confirming a PVL. The patient's condition continued to deteriorate; he became hemodynamically unstable with end-organ damage. Cardiothoracic surgery was consulted for surgical repair of the PVL. The patient, however, remained too unstable for surgery and the family opted for comfort measures per the patient's wishes.

  View details for DOI 10.7759/cureus.11897

  View details for PubMedID 33415049

  View details for PubMedCentralID PMC7781868

• Pulmonary arteriovenous malformation and follow-up imaging. The Pan African medical journal Taweesedt, P. T., Surani, S. 2020; 37: 294

  View details for DOI 10.11604/pamj.2020.37.294.27100

  View details for PubMedID 33623630

  View details for PubMedCentralID PMC7881932

• Septic Shock and Purpura Fulminans Due to Streptococcus pneumoniae Bacteremia in an Unvaccinated Immunocompetent Adult: Case Report and Review. The American journal of case reports Djurdjevic, N., Taweesedt, P. T., Paulson, M., LaNou, A., Radovanovic, M., Patel, J. N., Veselinovic, M., McDermott, W. R., Dumic, I. 2020; 21: e923266

  Abstract

  BACKGROUND Despite proven efficacy of vaccinations against Streptococcus pneumoniae in preventing infection, only 70% of eligible individuals receive the vaccine in the United States. Pneumococcal bacteremia represents a form of invasive pneumococcal disease and is associated with high mortality, especially in immunocompromised patients and the elderly. Purpura fulminans is a rare complication and manifestation of disseminated intravascular coagulation and sepsis. It is exceedingly rare in the setting of pneumococcal bacteremia, particularly in immunocompetent individuals. CASE REPORT We report a generally healthy 67-year-old male with schizophrenia who refused pneumococcal vaccination. He had an intact and functional spleen with a functional immune system. The patient presented with fever and diarrhea. He subsequently progressed to develop purpura fulminans and septic shock due to S. pneumoniae bacteremia. Despite an extensive search for the primary source of infection, none could not be identified. Due to timely initiation of appropriate antibiotic therapy and aggressive supportive care in an intensive care unit, he recovered despite multi-organ failure that developed throughout his hospitalization. CONCLUSIONS We present a rare manifestation of a potentially preventable disease and emphasize the importance of pneumococcal vaccination in order to decrease the risk of developing invasive pneumococcal disease. Furthermore, we discuss etiology, diagnosis, differential diagnosis, and evidence-based management of purpura fulminans and invasive pneumococcal disease with a literature review. Purpura fulminans due to S. pneumoniae is exceedingly rare in immunocompetent patients and an unusual clinical manifestation of pneumococcal bacteremia.

  View details for DOI 10.12659/AJCR.923266

  View details for PubMedID 32513908

  View details for PubMedCentralID PMC7304654

• Splenic Complications of Babesia microti Infection in Humans: A Systematic Review. The Canadian journal of infectious diseases & medical microbiology = Journal canadien des maladies infectieuses et de la microbiologie medicale Dumic, I., Madrid, C., Rueda Prada, L., Nordstrom, C. W., Taweesedt, P. T., Ramanan, P. 2020; 2020: 6934149

  Abstract

  Splenic complications of acute Babesia microti infection include splenomegaly, splenic infarct, and splenic rupture. These complications are relatively rarely reported, and the aim of this research was to synthetize data on this topic according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using the PubMed database. In this review, we find that unlike other severe complications of babesiosis, splenic infarct and rupture occur in younger and immunocompetent patients, and they do not correlate with parasitemia level. Furthermore, admission hemoglobin of 10 mg/dl or less, platelet count of 50 × 10⁹/L or less, presence of hemodynamic instability, and splenic rupture were associated independently with an increased risk of requiring splenectomy. As babesiosis is an emerging tick-borne zoonosis, we hope that this review will help to raise awareness among clinicians regarding this rare but potentially life-threatening complication.

  View details for DOI 10.1155/2020/6934149

  View details for PubMedID 32566058

  View details for PubMedCentralID PMC7275217

• Early use of tranexamic acid in gastrointestinal bleed ACTA Scientific Medical Sciences Taweesedt, P. T., Surani, S. 2020
• Pulmonary Manifestations of Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome: A Systematic Review. BioMed research international Taweesedt, P. T., Nordstrom, C. W., Stoeckel, J., Dumic, I. 2019; 2019: 7863815

  Abstract

  The syndrome of drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare, yet potentially fatal hypersensitivity reaction, most commonly associated with anticonvulsants, sulfonamides, and allopurinol. The reaction commonly manifests as a febrile skin eruption with lymphadenopathy and malaise between two and eight weeks following drug exposure. Internal organ involvement occurs in close to 90 percent of patients, and multiple organs may be involved in approximately half of those affected (most commonly the liver, kidney, and lung). Its long latency period and its variable clinical pattern of presentation have earned it the moniker of "the great mimicker," with delays in diagnosis leading to higher morbidity and mortality. Although less commonly affected in DRESS syndrome, lung involvement is associated with more severe clinical course and potentially worse outcome. Pulmonary symptoms may precede development of the other more common symptoms and signs of the syndrome, or they might develop later in the course of the disease. Lung involvement in DRESS presents with a plethora of manifestations from mild cough or dyspnea with nonspecific interstitial changes on chest imaging to acute respiratory distress syndrome (ARDS) with life-threatening hypoxic respiratory failure.We performed a systematic review of literature from the PubMed database and selected cases of definite DRESS syndrome as defined by the European Registry of Severe Cutaneous Adverse Reactions (RegiSCAR) with a score of 6 or more who also had pulmonary involvement. Demographic data, pattern of lung involvement, culprit medication, latency period, laboratory findings, therapy, and outcome were described and compared with the literature.The most common pulmonary radiographic findings in DRESS were interstitial infiltrates in 50% of cases, followed by acute respiratory distress syndrome (ARDS) 31%. Symptoms of cough and shortness of breath (SOB) were present in 72% of patients at the time of presentation. SOB was the more common presenting symptom (81%) compared to cough (19%). In 95% of cases, another visceral organ was involved (most commonly liver or kidneys). 45% of cases were initially misdiagnosed as pneumonia and were treated with empiric antimicrobials. In a multivariate regression, a latency of 30 days or less and an age of 60 or less were associated with development of ARDS. Gender and eosinophil count were not associated with severity of pulmonary manifestations. All patients recovered, and in the vast majority of cases (95%), parenteral steroids were used for treatment in addition to supportive care and symptomatic management.Albeit rare, DRESS is a potentially life-threatening syndrome which may present with a myriad of pulmonary signs and symptoms. Pulmonary manifestations are less common but are typically seen in more severe cases. Pulmonary manifestations may be a presenting sign of DRESS, and timely recognition is important in order to stop offending medication and decrease morbidity and mortality.

  View details for DOI 10.1155/2019/7863815

  View details for PubMedID 31662996

  View details for PubMedCentralID PMC6778864

• Arousal perception/misperception and total sleep time misperception in subjects with sleep disorders International Journal of Medicine and Medical Sciences Khan, Z., Bachan, M., Taweesedt, P. T., Rath, M., Kumar, D., Siegal, R., Lund, S., Freeman, J. 2019
• Hyperparathyroidism and increased fractional excretion of phosphate predict allograft loss in long-term kidney transplant recipients. Clinical and experimental nephrology Prakobsuk, S., Sirilak, S., Vipattawat, K., Taweesedt, P. T., Sumethkul, V., Kantachuvesiri, S., Disthabanchong, S. 2017; 21 (5): 926-931

  Abstract

  After kidney transplantation, fibroblast growth factor-23 (FGF-23) normally returns to baseline within 1 year whereas hyperparathyroidism persists in most kidney transplant (KT) recipients. As a result, serum phosphate remains relatively low in association with increased serum calcium and urinary phosphate excretion when compared to chronic kidney disease patients. The relationship between mineral metabolism and outcomes in long-term KT recipients has not been extensively studied. This study investigated whether the alteration in mineral metabolism influenced graft survival in long-term KT recipients.This study included 273 KT recipients after 1 year of transplantation. Mineral parameters were obtained at the time of enrolment and patients were followed prospectively for an average of 71 months.Graft loss (death-censored) occurred in 41 (15%) patients. In univariate analysis, deceased donor transplantation, decreased serum albumin and estimated glomerular filtration rate, increased serum phosphate, parathyroid hormone (PTH), FGF-23 and fractional excretion of phosphate (FePi) predicted future allograft loss. After adjustments for cardiovascular disease risk factors, donor type, dialysis vintage, serum albumin and allograft function, only increased PTH and FePi remained associated with the outcome. Relationships between increased serum phosphate and FGF-23 with graft survival were lost after adjustments. Adjusted survival curves revealed the association between PTH > 90 pg/mL and FePi > 20% with worse graft survival.Hyperparathyroidism and increased FePi predicted allograft loss in long-term KT recipients.

  View details for DOI 10.1007/s10157-016-1370-9

  View details for PubMedID 27981393

• Mineral and bone disorder after kidney transplantation. World journal of transplantation Taweesedt, P. T., Disthabanchong, S. 2015; 5 (4): 231-42

  Abstract

  After successful kidney transplantation, accumulated waste products and electrolytes are excreted and regulatory hormones return to normal levels. Despite the improvement in mineral metabolites and mineral regulating hormones after kidney transplantation, abnormal bone and mineral metabolism continues to present in most patients. During the first 3 mo, fibroblast growth factor-23 (FGF-23) and parathyroid hormone levels decrease rapidly in association with an increase in 1,25-dihydroxyvitamin D production. Renal phosphate excretion resumes and serum calcium, if elevated before, returns toward normal levels. FGF-23 excess during the first 3-12 mo results in exaggerated renal phosphate loss and hypophosphatemia occurs in some patients. After 1 year, FGF-23 and serum phosphate return to normal levels but persistent hyperparathyroidism remains in some patients. The progression of vascular calcification also attenuates. High dose corticosteroid and persistent hyperparathyroidism are the most important factors influencing abnormal bone and mineral metabolism in long-term kidney transplant (KT) recipients. Bone loss occurs at a highest rate during the first 6-12 mo after transplantation. Measurement of bone mineral density is recommended in patients with estimated glomerular filtration rate > 30 mL/min. The use of active vitamin D with or without bisphosphonate is effective in preventing early post-transplant bone loss. Steroid withdrawal regimen is also beneficial in preservation of bone mass in long-term. Calcimimetic is an alternative therapy to parathyroidectomy in KT recipients with persistent hyperparathyroidism. If parathyroidectomy is required, subtotal to near total parathyroidectomy is recommended. Performing parathyroidectomy during the waiting period prior to transplantation is also preferred in patients with severe hyperparathyroidism associated with hypercalcemia.

  View details for DOI 10.5500/wjt.v5.i4.231

  View details for PubMedID 26722650

  View details for PubMedCentralID PMC4689933