Dina Alnabwani’s research while affiliated with Hackensack University Medical Center and other places

Pneumokoniose ist eine Berufskrankheit, die bei Arbeitern auftritt, die organischen und anorganischen Stäuben in der Umwelt ausgesetzt sind, wie im Bergbau, beim Sandstrahlen und Töpfern, bei Steinmetzarbeiten und in der Landwirtschaft. Die entzündliche Reaktion der Lunge auf lungengängigen Staub verursacht die Bildung von Makulae, Knötchen und Fibrose, und ein höherer Kieselsäuregehalt im eingeatmeten Staub ist mit einer erhöhten Fibrosierung verbunden. Die Mischstaubpneumokoniose (MDP) entsteht durch die Exposition gegenüber Staub, der 10–20% Kieselsäure enthält, und in der Lungenbildgebung zeigen sich unregelmäßige Trübungen. Die Histopathologie spielt bei der Diagnose der MDP eine entscheidende Rolle. Günstige Behandlungsergebnisse sind möglich, doch die MDP entwickelt sich langsam über viele Jahre konstanter Exposition und ist durch eine Verschlechterung von Dyspnoe und Husten gekennzeichnet, die allmählich zum Cor pulmonale fortschreiten. Die einzig wirksame Behandlung besteht darin, die Exposition zu beenden, weshalb es für ein günstiges Outcome unerlässlich ist, die Krankheit frühzeitig zu erkennen. Wir stellen einen Fall von Mischstaubpneumokoniose bei einem Bauern aus Südamerika vor, der an Asthma litt. Er stellte sich mit sich verschlimmernder Dyspnoe und multiplen Knötchen in beiden Lungen in der Bildgebung und einem Cor pulmonale vor. Es wurde eine umfassende diagnostische Abklärung durchgeführt, die Malignität und Tuberkulose ausschloss. Die Analyse von Biopsieproben aus der videoassistierten thorakoskopischen Chirurgie (VATS) bestätigte die Diagnose einer Staubpneumokoniose. Er hatte einen Zusammenfluss von unregelmäßigen Knoten in den oberen Lungenlappen, und der größte war 2,1 cm groß. Dies passt zur Definition der progressiven massiven Fibrose der Internationalen Arbeitsorganisation (ILO). Dies, zusammen mit seinem Cor pulmonale, ergibt eine schlechte Prognose, selbst nachdem er von der Staubexposition befreit wurde. Er erhielt Steroide, was zu einer symptomatischen Besserung führte, und er wurde zur weiteren Nachsorge beim Pneumologen entlassen.

La neumoconiosis es una enfermedad profesional que afecta a trabajadores con exposición ambiental a polvo orgánico e inorgánico, como en la minería, el granallado, la alfarería, la cantería y la agricultura. La respuesta inflamatoria del pulmón al polvo respirable provoca la formación de máculas, nódulos y fibrosis, y un contenido mayor de sílice en el polvo inhalado se asocia con un aumento en la fibrosis. La neumoconiosis mixta por polvo (MDP) se caracteriza por la exposición a polvos que contienen 10–20% de sílice, con imágenes pulmonares que muestran opacidades irregulares. La histopatología desempeña un papel vital en el diagnóstico de la MDP. Aunque tiene un pronóstico favorable, la enfermedad evoluciona lentamente, a lo largo de muchos años de exposición constante, y se caracteriza por un agravamiento de la disnea y la tos, que progresa gradualmente hasta convertirse en cor pulmonale. El único tratamiento eficaz es eliminar la fuente de exposición, por lo que es esencial reconocer la enfermedad de forma temprana para lograr un resultado favorable. Presentamos un caso de neumoconiosis mixta por polvo en un agricultor de Sudamérica que padecía asma. El paciente se presentó con agravamiento de la disnea y múltiples nódulos en ambos pulmones en el diagnóstico por imagen, y cor pulmonale. Tras un amplio estudio, se descartó cualquier neoplasia maligna y tuberculosis. El análisis de las muestras de biopsia de cirugía toracoscópica asistida por video (VATS) confirmó el diagnóstico de neumoconiosis mixta por polvo. El paciente presentaba una confluencia de nódulos irregulares en los lóbulos superiores de los pulmones, y el mayor medía 2.1 cm. Esto coincide con la definición de la Organización Internacional del Trabajo (OIT) de fibrosis masiva progresiva. Este hallazgo, junto con el cor pulmonale, indica un mal pronóstico, incluso luego de eliminar la exposición al polvo. Se administraron corticoides, que produjeron una mejoría sintomática, y se dio de alta al paciente para seguimiento con el neumólogo.

Normal intra-abdominal pressure (IAP) ranges from 0 to 5, and abdominal compartment syndrome (ACS)occurs when a sustained IAP >20 mmHg causes organ dysfunction. ACS mainly occurs in patients who are critically ill. It occurs due to an injury or disease in the abdomen or pelvic area, including trauma, abdominal surgery, acute pancreatitis, pancreatic ileus, volvulus, fecal impaction, and ruptured abdominal aortic aneurysm. If not recognized early, ACS leads to multiorgan dysfunction, shock, and sepsis and has high morbidity and mortality. Our patient was brought to the emergency department (ED) following cardiac arrest and resuscitation and was diagnosed with sigmoid volvulus (SV) and ACS. SV is seen in older men, and its presentation is often insidious and leads to bowel gangrene and ACS. The patient's delay in presenting to the hospital and the severity of his condition leads to a poor outcome despite surgery. A delay in recognizing ACS can lead to a worse outcome.

Pneumoconiosis is an occupational disease found in workers with environmental exposure to organic and inorganic dust, as in mining, sandblasting, pottery, stone masonry, and farming. The inflammatory response of the lung to respirable dust causes the formation of macules, nodules, and fibrosis, and higher silica content in inhaled dust is associated with increased fibrosis. Mixed dust pneumoconiosis (MDP) is characterized by exposure to dust containing 10-20% silica, and its lung imaging show irregular opacities. Histopathology plays a vital role in the diagnosis of MDP. Though it has a favorable outcome, it evolves slowly over many years of constant exposure and is characterized by worsening dyspnea and cough gradually progressing to cor pulmonale. The only effective treatment is removing exposure, which makes it essential to recognize the disease early for a favorable outcome. We present a case of mixed dust pneumoconiosis in a farmer from South America who had asthma. He presented with worsening dyspnea and multiple nodules in both lungs on imaging and cor pulmonale. An extensive workup was done, and it ruled out any malignancy and tuberculosis. Analysis of video-assisted thoracoscopic surgery (VATS) biopsy samples confirmed the diagnosis of mixed dust pneumoconiosis. He had a confluence of irregular nodes in the upper lobes of the lungs, and the largest was 2.1 cm. This fits the International Labour Organization (ILO) definition of progressive massive fibrosis. This, along with cor pulmonale present in him, gives it a poor prognosis even after he is removed from dust exposure. He received steroids, which led to symptomatic improvement, and he was discharged to follow up with the pulmonologist.

Gout is inflammatory arthritis and is easily recognizable by healthcare providers by its typical clinical presentation of acute gout flare or by the presence of chronic tophaceous deposits. However, chronic gouty arthropathy can be more challenging to diagnose in some cases, especially in the absence of a previous history of gout and other characteristic findings on exam. We present a case of chronic gouty arthropathy with features mimicking rheumatoid arthritis involving multiple small joints of hands and feet and other large joints. He had high serum uric acids and a dual-energy CT (DECT) scan of the feet and ankles was obtained which showed polyarticular gout. He was started on pegloticase in view of joint erosions, and severe limitations in activity which resulted in a lowering of monosodium urate crystals and symptomatic improvement.

Background: Lower gastrointestinal bleeds (LGIB) is a very common inpatient condition in the United States. Gastrointestinal bleeds have a variety of presentations, from minor bleeding to severe hemorrhage and shock. Although previous studies investigated the efficacy of colonoscopy in hospitalized patients with LGIB, there is limited research that discusses disparities in colonoscopy utilization in patients with LGIB in urban and rural settings. Aim: To investigate the difference in utilization of colonoscopy in lower gastrointestinal bleeding between patients hospitalized in urban and rural hospitals. Methods: This is a retrospective cohort study of 157748 patients using National Inpatient Sample data and the Healthcare Cost and Utilization Project provided by the Agency for Healthcare Research and Quality. It includes patients 18 years and older hospitalized with LGIB admitted between 2010 and 2016. This study does not differentiate between acute and chronic LGIB and both are included in this study. The primary outcome measure of this study was the utilization of colonoscopy among patients in rural and urban hospitals admitted for lower gastrointestinal bleeds; the secondary outcome measures were in-hospital mortality, length of stay, and costs involved in those receiving colonoscopy for LGIB. Statistical analyses were all performed using STATA software. Logistic regression was used to analyze the utilization of colonoscopy and mortality, and a generalized linear model was used to analyze the length of stay and cost. Results: Our study found that 37.9% of LGIB patients at rural hospitals compared to approximately 45.1% at urban hospitals received colonoscopy, (OR = 0.730, 95%CI: 0.705-0.7, P > 0.0001). After controlling for covariates, colonoscopies were found to have a protective association with lower in-hospital mortality (OR = 0.498, 95%CI: 0.446-0.557, P < 0.0001), but a longer length of stay by 0.72 d (95%CI: 0.677-0.759 d, P < 0.0001) and approximately $2199 in increased costs. Conclusion: Although there was a lower percentage of LGIB patients that received colonoscopies in rural hospitals compared to urban hospitals, patients in both urban and rural hospitals with LGIB undergoing colonoscopy had decreased in-hospital mortality. In both settings, benefit came at a cost of extended stay, and higher total costs.