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Mahmood, Kamran

Positions:

Assistant Professor of Medicine

Medicine, Pulmonary, Allergy, and Critical Care Medicine
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.B.B.S. 1995

M.B.B.S. — King Edward Medical University

M.P.H. 2005

M.P.H. — University of Illinois

Grants:

AminoIndex

Administered By
Medicine, Pulmonary, Allergy, and Critical Care Medicine
AwardedBy
Ajinomoto Co., Inc.
Role
Principal Investigator
Start Date
July 31, 2016
End Date
July 31, 2017

Publications:

The Changing Role for Tracheostomy in Patients Requiring Mechanical Ventilation.

Tracheostomy is performed in patients who require prolonged mechanical ventilation or have upper airway instability. Percutaneous tracheostomy with Ciaglia technique is commonly used and rivals the surgical approach. Percutaneous technique is associated with decreased risk of stomal inflammation, infection, and bleeding along with reduction in health resource utilization when performed at bedside. Bronchoscopy and ultrasound guidance improve the safety of percutaneous tracheostomy. Early tracheostomy decreases the need for sedation and intensive care unit stay but may be unnecessary in some patients who can be extubated later successfully. A multidisciplinary approach to tracheostomy care leads to improved outcomes.

Authors
Mahmood, K; Wahidi, MM
MLA Citation
Mahmood, K, and Wahidi, MM. "The Changing Role for Tracheostomy in Patients Requiring Mechanical Ventilation." Clinics in chest medicine 37.4 (December 2016): 741-751. (Review)
PMID
27842753
Source
epmc
Published In
Clinics in Chest Medicine
Volume
37
Issue
4
Publish Date
2016
Start Page
741
End Page
751
DOI
10.1016/j.ccm.2016.07.013

Safety of hyperbaric oxygen therapy for management of central airway stenosis after lung transplant.

Central airway stenosis (CAS) is common after lung transplantation and causes significant post-transplant morbidity. It is often preceded by extensive airway necrosis, related to airway ischemia. Hyperbaric oxygen therapy (HBOT) is useful for ischemic grafts and may reduce the development of CAS.The purpose of this study was to determine whether HBOT could be safely administered to lung transplant patients with extensive necrotic airway plaques. Secondarily, we assessed any effects of HBOT on the incidence and severity of CAS. Patients with extensive necrotic airway plaques within 1-2 months after lung transplantation were treated with HBOT along with standard care. These patients were compared with a contemporaneous reference group with similar plaques who did not receive HBOT.Ten patients received HBOT for 18.5 (interquartile range, IQR 11-20) sessions, starting at 40.5 (IQR 34-54) days after transplantation. HBOT was well tolerated. Incidence of CAS was similar between HBOT-treated patients and reference patients (70% vs 87%, respectively; P=.34), but fewer stents were required in HBOT patients (10% vs 56%, respectively; P=.03).This pilot study is the first to demonstrate HBOT safety in patients who develop necrotic airway plaques after lung transplantation. HBOT may reduce the need for airway stent placement in patients with CAS.

Authors
Mahmood, K; Kraft, BD; Glisinski, K; Hartwig, MG; Harlan, NP; Piantadosi, CA; Shofer, SL
MLA Citation
Mahmood, K, Kraft, BD, Glisinski, K, Hartwig, MG, Harlan, NP, Piantadosi, CA, and Shofer, SL. "Safety of hyperbaric oxygen therapy for management of central airway stenosis after lung transplant." Clinical transplantation 30.9 (September 2016): 1134-1139.
PMID
27410718
Source
epmc
Published In
Clinical Transplantation
Volume
30
Issue
9
Publish Date
2016
Start Page
1134
End Page
1139
DOI
10.1111/ctr.12798

Effect of Endobronchial Coils vs Usual Care on Exercise Tolerance in Patients With Severe Emphysema: The RENEW Randomized Clinical Trial.

Preliminary clinical trials have demonstrated that endobronchial coils compress emphysematous lung tissue and may improve lung function, exercise tolerance, and symptoms in patients with emphysema and severe lung hyperinflation.To determine the effectiveness and safety of endobronchial coil treatment.Randomized clinical trial conducted among 315 patients with emphysema and severe air trapping recruited from 21 North American and 5 European sites from December 2012 through November 2015.Participants were randomly assigned to continue usual care alone (guideline based, including pulmonary rehabilitation and bronchodilators; n = 157) vs usual care plus bilateral coil treatment (n = 158) involving 2 sequential procedures 4 months apart in which 10 to 14 coils were bronchoscopically placed in a single lobe of each lung.The primary effectiveness outcome was difference in absolute change in 6-minute-walk distance between baseline and 12 months (minimal clinically important difference [MCID], 25 m). Secondary end points included the difference between groups in 6-minute walk distance responder rate, absolute change in quality of life using the St George's Respiratory Questionnaire (MCID, 4) and change in forced expiratory volume in the first second (FEV1; MCID, 10%). The primary safety analysis compared the proportion of participants experiencing at least 1 of 7 prespecified major complications.Among 315 participants (mean age, 64 years; 52% women), 90% completed the 12-month follow-up. Median change in 6-minute walk distance at 12 months was 10.3 m with coil treatment vs -7.6 m with usual care, with a between-group difference of 14.6 m (Hodges-Lehmann 97.5% CI, 0.4 m to ∞; 1-sided P = .02). Improvement of at least 25 m occurred in 40.0% of patients in the coil group vs 26.9% with usual care (odds ratio, 1.8 [97.5% CI, 1.1 to ∞]; unadjusted between-group difference, 11.8% [97.5% CI, 1.0% to ∞]; 1-sided P = .01). The between-group difference in median change in FEV1 was 7.0% (97.5% CI, 3.4% to ∞; 1-sided P < .001), and the between-group St George's Respiratory Questionnaire score improved -8.9 points (97.5% CI, -∞ to -6.3 points; 1-sided P < .001), each favoring the coil group. Major complications (including pneumonia requiring hospitalization and other potentially life-threatening or fatal events) occurred in 34.8% of coil participants vs 19.1% of usual care (P = .002). Other serious adverse events including pneumonia (20% coil vs 4.5% usual care) and pneumothorax (9.7% vs 0.6%, respectively) occurred more frequently in the coil group.Among patients with emphysema and severe hyperinflation treated for 12 months, the use of endobronchial coils compared with usual care resulted in an improvement in median exercise tolerance that was modest and of uncertain clinical importance, with a higher likelihood of major complications. Further follow-up is needed to assess long-term effects on health outcomes.clinicaltrials.gov Identifier: NCT01608490.

Authors
Sciurba, FC; Criner, GJ; Strange, C; Shah, PL; Michaud, G; Connolly, TA; Deslée, G; Tillis, WP; Delage, A; Marquette, C-H; Krishna, G; Kalhan, R; Ferguson, JS; Jantz, M; Maldonado, F; McKenna, R; Majid, A; Rai, N; Gay, S; Dransfield, MT; Angel, L; Maxfield, R; Herth, FJF; Wahidi, MM; Mehta, A; Slebos, D-J
MLA Citation
Sciurba, FC, Criner, GJ, Strange, C, Shah, PL, Michaud, G, Connolly, TA, Deslée, G, Tillis, WP, Delage, A, Marquette, C-H, Krishna, G, Kalhan, R, Ferguson, JS, Jantz, M, Maldonado, F, McKenna, R, Majid, A, Rai, N, Gay, S, Dransfield, MT, Angel, L, Maxfield, R, Herth, FJF, Wahidi, MM, Mehta, A, and Slebos, D-J. "Effect of Endobronchial Coils vs Usual Care on Exercise Tolerance in Patients With Severe Emphysema: The RENEW Randomized Clinical Trial." JAMA 315.20 (May 15, 2016): 2178-2189.
PMID
27179849
Source
epmc
Published In
JAMA : the journal of the American Medical Association
Volume
315
Issue
20
Publish Date
2016
Start Page
2178
End Page
2189
DOI
10.1001/jama.2016.6261

Development of a Tool to Assess Basic Competency in the Performance of Rigid Bronchoscopy.

Rigid bronchoscopy is increasingly used by pulmonologists for the management of central airway disorders. However, an assessment tool to evaluate the competency of operators in the performance of this technique has not been developed. We created the Rigid Bronchoscopy Tool for Assessment of Skills and Competence (RIGID-TASC) to serve as an objective, competency-oriented assessment tool of basic rigid bronchoscopic skills, including rigid bronchoscopic intubation and central airway navigation.To assess whether RIGID-TASC scores accurately distinguish the basic rigid bronchoscopy skills of novice, intermediate, and expert operators, and to determine whether RIGID-TASC has adequate interrater reliability when used by different independent testers.At two academic medical centers in the United States, 30 physician volunteers were selected in three categories: 10 novices at rigid bronchoscopy (performed at least 50 flexible, but no rigid, bronchoscopies), 10 operators with intermediate experience (performed 5-20 rigid bronchoscopies), and 10 experts (performed ≥100 rigid bronchoscopies). Participants included pulmonary and critical care fellows, interventional pulmonology fellows, and faculty interventional pulmonologists. Each subject then performed rigid bronchoscopic intubation and navigation on a manikin, while being scored independently by two testers, using RIGID-TASC.Mean scores for three categories (novice, intermediate, and expert) were 58.10 (±4.6 [SE]), 78.15 (±3.8), and 94.40 (±1.1), respectively. There was significant difference between novice and intermediate (20.05, 95% confidence interval [CI] = 7.77-32.33, P = 0.001), and intermediate and expert (16.25, 95% CI = 3.97-28.53, P = 0.008) operators. The interrater reliability (intraclass correlation coefficient) between the two testers was high (r = 0.95, 95% CI = 0.90-0.98).RIGID-TASC showed evidence of construct validity and interrater reliability in this setting and group of subjects. It can be used to reliably and objectively score and classify operators from novice to expert in basic rigid bronchoscopic intubation and navigation.

Authors
Mahmood, K; Wahidi, MM; Osann, KE; Coles, K; Shofer, SL; Volker, EE; Davoudi, M
MLA Citation
Mahmood, K, Wahidi, MM, Osann, KE, Coles, K, Shofer, SL, Volker, EE, and Davoudi, M. "Development of a Tool to Assess Basic Competency in the Performance of Rigid Bronchoscopy." Annals of the American Thoracic Society 13.4 (April 2016): 502-511.
PMID
26989810
Source
epmc
Published In
Annals of the American Thoracic Society
Volume
13
Issue
4
Publish Date
2016
Start Page
502
End Page
511
DOI
10.1513/annalsats.201509-593oc

Hypoxic Gene Expression of Donor Bronchi Linked to Airway Complications after Lung Transplantation.

Central airway stenosis (CAS) after lung transplantation has been attributed in part to chronic airway ischemia; however, little is known about the time course or significance of large airway hypoxia early after transplantation.To evaluate large airway oxygenation and hypoxic gene expression during the first month after lung transplantation and their relation to airway complications.Subjects who underwent lung transplantation underwent endobronchial tissue oximetry of native and donor bronchi at 0, 3, and 30 days after transplantation (n = 11) and/or endobronchial biopsies (n = 14) at 30 days for real-time polymerase chain reaction of hypoxia-inducible genes. Patients were monitored for 6 months for the development of transplant-related complications.Compared with native endobronchial tissues, donor tissue oxygen saturations (Sto2) were reduced in the upper lobes (74.1 ± 1.8% vs. 68.8 ± 1.7%; P < 0.05) and lower lobes (75.6 ± 1.6% vs. 71.5 ± 1.8%; P = 0.065) at 30 days post-transplantation. Donor upper lobe and subcarina Sto2 levels were also lower than the main carina (difference of -3.9 ± 1.5 and -4.8 ± 2.1, respectively; P < 0.05) at 30 days. Up-regulation of hypoxia-inducible genes VEGFA, FLT1, VEGFC, HMOX1, and TIE2 was significant in donor airways relative to native airways (all P < 0.05). VEGFA, KDR, and HMOX1 were associated with prolonged respiratory failure, prolonged hospitalization, extensive airway necrosis, and CAS (P < 0.05).These findings implicate donor bronchial hypoxia as a driving factor for post-transplantation airway complications. Strategies to improve airway oxygenation, such as bronchial artery re-anastomosis and hyperbaric oxygen therapy merit clinical investigation.

Authors
Kraft, BD; Suliman, HB; Colman, EC; Mahmood, K; Hartwig, MG; Piantadosi, CA; Shofer, SL
MLA Citation
Kraft, BD, Suliman, HB, Colman, EC, Mahmood, K, Hartwig, MG, Piantadosi, CA, and Shofer, SL. "Hypoxic Gene Expression of Donor Bronchi Linked to Airway Complications after Lung Transplantation." American journal of respiratory and critical care medicine 193.5 (March 2016): 552-560.
PMID
26488115
Source
epmc
Published In
American journal of respiratory and critical care medicine
Volume
193
Issue
5
Publish Date
2016
Start Page
552
End Page
560
DOI
10.1164/rccm.201508-1634oc

The Diagnostic Yield of Bronchoalveolar Lavage and Transbronchial Lung Biopsy in Pulmonary Lymphangitic Carcinomatosis

Authors
Rahmatullah, A; Mahmood, K
MLA Citation
Rahmatullah, A, and Mahmood, K. "The Diagnostic Yield of Bronchoalveolar Lavage and Transbronchial Lung Biopsy in Pulmonary Lymphangitic Carcinomatosis." Chest 148.4 (October 2015): 786A-786A.
Source
crossref
Published In
Chest
Volume
148
Issue
4
Publish Date
2015
Start Page
786A
End Page
786A
DOI
10.1378/chest.2270027

Therapeutic bronchoscopy for malignant central airway obstruction: success rates and impact on dyspnea and quality of life.

There is significant variation between physicians in terms of how they perform therapeutic bronchoscopy, but there are few data on whether these differences impact effectiveness.This was a multicenter registry study of patients undergoing therapeutic bronchoscopy for malignant central airway obstruction. The primary outcome was technical success, defined as reopening the airway lumen to > 50% of normal. Secondary outcomes were dyspnea as measured by the Borg score and health-related quality of life (HRQOL) as measured by the SF-6D.Fifteen centers performed 1,115 procedures on 947 patients. Technical success was achieved in 93% of procedures. Center success rates ranged from 90% to 98% (P = .02). Endobronchial obstruction and stent placement were associated with success, whereas American Society of Anesthesiology (ASA) score > 3, renal failure, primary lung cancer, left mainstem disease, and tracheoesophageal fistula were associated with failure. Clinically significant improvements in dyspnea occurred in 90 of 187 patients measured (48%). Greater baseline dyspnea was associated with greater improvements in dyspnea, whereas smoking, having multiple cancers, and lobar obstruction were associated with smaller improvements. Clinically significant improvements in HRQOL occurred in 76 of 183 patients measured (42%). Greater baseline dyspnea was associated with greater improvements in HRQOL, and lobar obstruction was associated with smaller improvements.Technical success rates were high overall, with the highest success rates associated with stent placement and endobronchial obstruction. Therapeutic bronchoscopy should not be withheld from patients based solely on an assessment of risk, since patients with the most dyspnea and lowest functional status benefitted the most.

Authors
Ost, DE; Ernst, A; Grosu, HB; Lei, X; Diaz-Mendoza, J; Slade, M; Gildea, TR; Machuzak, MS; Jimenez, CA; Toth, J; Kovitz, KL; Ray, C; Greenhill, S; Casal, RF; Almeida, FA; Wahidi, MM; Eapen, GA; Feller-Kopman, D; Morice, RC; Benzaquen, S; Tremblay, A; Simoff, M
MLA Citation
Ost, DE, Ernst, A, Grosu, HB, Lei, X, Diaz-Mendoza, J, Slade, M, Gildea, TR, Machuzak, MS, Jimenez, CA, Toth, J, Kovitz, KL, Ray, C, Greenhill, S, Casal, RF, Almeida, FA, Wahidi, MM, Eapen, GA, Feller-Kopman, D, Morice, RC, Benzaquen, S, Tremblay, A, and Simoff, M. "Therapeutic bronchoscopy for malignant central airway obstruction: success rates and impact on dyspnea and quality of life." Chest 147.5 (May 2015): 1282-1298.
PMID
25358019
Source
epmc
Published In
Chest
Volume
147
Issue
5
Publish Date
2015
Start Page
1282
End Page
1298
DOI
10.1378/chest.14-1526

Bronchomediastinal fistula caused by endobronchial aspergilloma.

Endobronchial aspergilloma is a rare condition affecting immunocompromised patients. We present three cases resulting in airway fistulae.A 68-year-old male with orthotopic heart transplantation presented with fatigue, cough, and dyspnea. A computerized tomography (CT) scan of the chest and bronchoscopy revealed an endobronchial right mainstem mass and airway fistula to the mediastinum. The mass was debrided and biopsy showed Aspergillus fumigatus. He was treated with antifungals and recovered. A 52-year-old male with acquired immunodeficiency syndrome presented with cough, dyspnea, and hypoxemia. Chest CT showed a bronchus intermedius mass and fistula to the mediastinum. Bronchoscopy revealed a necrotic endobronchial mass and pseudomembranes and confirmed the presence of a fistula. The mass was resected bronchoscopically and Aspergillus fumigatus was isolated. He was treated with antifungals and the fistula healed. A 63-year-old male with chronic lymphoid leukemia was admitted for dyspnea, cough, weakness, and dysphagia. Chest CT and bronchoscopy showed a mass causing obstruction of the subglottic trachea and a fistula to the mediastinum. Biopsy showed Aspergillus fumigatus and he was treated with antifungals. The sinus healed but the patient died of leukemia.Risk factors for airway aspergilloma include immune deficiency, mucosal damage, and ischemia. We report airway fistula formation as a complication of this infection, which has not been previously emphasized.Endobronchial aspergillomas may form fistulae to the mediastinum. Aggressive treatment with antifungals and bronchoscopic interventions are required.

Authors
Argento, AC; Wolfe, CR; Wahidi, MM; Shofer, SL; Mahmood, K
MLA Citation
Argento, AC, Wolfe, CR, Wahidi, MM, Shofer, SL, and Mahmood, K. "Bronchomediastinal fistula caused by endobronchial aspergilloma." Annals of the American Thoracic Society 12.1 (January 2015): 91-95.
PMID
25513736
Source
epmc
Published In
Annals of the American Thoracic Society
Volume
12
Issue
1
Publish Date
2015
Start Page
91
End Page
95
DOI
10.1513/annalsats.201406-247bc

Therapeutic bronchoscopy improves spirometry, quality of life, and survival in central airway obstruction.

Central airway obstruction (CAO) occurs in patients with primary or metastatic lung malignancy and nonmalignant pulmonary disorders and results in significant adverse effects on respiratory function and quality of life.The objective of this study was to assess the effect of therapeutic bronchoscopic interventions on spirometry, dyspnea, quality of life, and survival in patients with CAO.We prospectively studied patients who underwent therapeutic rigid bronchoscopy for CAO. Spirometry, San Diego Shortness of Breath questionnaire (SOBQ), and SF-36 questionnaire responses were obtained before the procedure and at follow-up 6-8 weeks after the procedure.Fifty-three patients (24 malignant and 29 nonmalignant CAO), who underwent successful rigid bronchoscopic intervention, were enrolled. Airway stent placement and various debulking techniques including mechanical debridement and heat therapy were used. After bronchoscopy, there was a significant increase in forced vital capacity (2.2 ± 0.91 l before, 2.7 ± 0.80 l after, p = 0.009) and forced expiratory volume at 1 s (1.4 ± 0.60 l before, 1.8 ± 0.67 l after, p = 0.002). The SOBQ score improved from 55.8 ± 30.1 before the procedure to 37.9 ± 27.25 after the procedure (p = 0.002). In the SF-36, there was an improvement in almost all domains, with statistically significant improvement seen in several domains. Benefits were seen independent of the etiology of CAO, site of intervention or stent placement. The patients with malignant CAO, in whom airway patency could not be achieved, had a poor survival.Alleviation of CAO with therapeutic rigid bronchoscopy results in improvement in spirometry, shortness of breath, quality of life, and survival.

Authors
Mahmood, K; Wahidi, MM; Thomas, S; Argento, AC; Ninan, NA; Smathers, EC; Shofer, SL
MLA Citation
Mahmood, K, Wahidi, MM, Thomas, S, Argento, AC, Ninan, NA, Smathers, EC, and Shofer, SL. "Therapeutic bronchoscopy improves spirometry, quality of life, and survival in central airway obstruction." Respiration; international review of thoracic diseases 89.5 (January 2015): 404-413.
PMID
25925488
Source
epmc
Published In
Respiration; international review of thoracic diseases
Volume
89
Issue
5
Publish Date
2015
Start Page
404
End Page
413
DOI
10.1159/000381103

High Dose Brachytherapy For Bronchial Stenosis In Lung Transplant Recipients

Authors
Ali, HA; Snyder, LD; Mahmood, K; Wahidi, MM; Argento, AC; Larrier, NA; Shofer, SL
MLA Citation
Ali, HA, Snyder, LD, Mahmood, K, Wahidi, MM, Argento, AC, Larrier, NA, and Shofer, SL. "High Dose Brachytherapy For Bronchial Stenosis In Lung Transplant Recipients." 2015.
Source
wos-lite
Published In
American journal of respiratory and critical care medicine
Volume
191
Publish Date
2015

Ablative therapies for central airway obstruction.

Central airway obstruction (CAO) is seen in malignant and nonmalignant airway disorders and can lead to significant morbidity and mortality. Endobronchial ablative therapies are used in conjunction with mechanical debridement to achieve hemostasis and restore airway patency. These therapies can be classified into modalities with immediate or delayed effect. Therapies with immediate effect include heat therapies (such as electrocautery, argon plasma coagulation, and laser) and cryorecanalization using a cryoprobe for tissue extraction. These modalities can be used in severe CAO for immediate relief of obstruction. Therapies with delayed effect include cryotherapy, brachytherapy, and photodynamic therapy. These modalities should not be used for acutely symptomatic CAO, and typically require follow-up bronchoscopy for removal of debris from the airway. Multimodality approach typically leads to better outcomes.

Authors
Mahmood, K; Wahidi, MM
MLA Citation
Mahmood, K, and Wahidi, MM. "Ablative therapies for central airway obstruction." Seminars in respiratory and critical care medicine 35.6 (December 2, 2014): 681-692.
PMID
25463159
Source
epmc
Published In
Seminars in Respiratory and Critical Care Medicine
Volume
35
Issue
6
Publish Date
2014
Start Page
681
End Page
692
DOI
10.1055/s-0034-1395501

Ventilation and anesthetic approaches for rigid bronchoscopy.

Due to growing interest in management of central airway obstruction, rigid bronchoscopy is undergoing a resurgence in popularity among pulmonologists. Performing rigid bronchoscopy requires use of deep sedation or general anesthesia to achieve adequate patient comfort, whereas maintaining oxygenation and ventilation via an uncuffed and often open rigid bronchoscope requires use of ventilation strategies that may be unfamiliar to most pulmonologists. Available approaches include apneic oxygenation, spontaneous assisted ventilation, controlled ventilation, manual jet, and high-frequency jet ventilation. Anesthetic technique is partially dictated by the selected ventilation strategy but most often relies on a total intravenous anesthetic approach using ultra-short-acting sedatives and hypnotics for a rapid offset of action in this patient population with underlying respiratory compromise. Gas anesthetic may be used with the rigid bronchoscope, minimizing leaks with fenestrated caps placed over the ports, although persistent circuit leaks can make this approach challenging. Jet ventilation, the most commonly used ventilatory approach, may be delivered manually using a Sanders valve or via an automated ventilator at supraphysiologic respiratory rates, allowing for an open rigid bronchoscope to facilitate ease of moving tools in and out of the airway. Despite a patient population that often suffers from significant respiratory compromise, major complications with rigid bronchoscopy are uncommon and are similar among modern ventilation approaches. Choice of ventilation technique should be determined by local expertise and equipment availability. Appropriate patient selection and recognition of limitations associated with a given ventilation strategy are critical to avoid procedural-related complications.

Authors
Pathak, V; Welsby, I; Mahmood, K; Wahidi, M; MacIntyre, N; Shofer, S
MLA Citation
Pathak, V, Welsby, I, Mahmood, K, Wahidi, M, MacIntyre, N, and Shofer, S. "Ventilation and anesthetic approaches for rigid bronchoscopy." Annals of the American Thoracic Society 11.4 (May 2014): 628-634.
PMID
24635585
Source
epmc
Published In
Annals of the American Thoracic Society
Volume
11
Issue
4
Publish Date
2014
Start Page
628
End Page
634
DOI
10.1513/annalsats.201309-302fr

Learning experience of linear endobronchial ultrasound among pulmonary trainees.

BACKGROUND: Linear endobronchial ultrasound (EBUS) allows real-time guidance of transbronchial needle aspiration of thoracic structures and has become an increasingly important diagnostic tool for chest physicians. Little has been published about the learning experience of operators with this technology. The purpose of this study was to define the learning experience of EBUS-guided transbronchial needle aspiration (EBUS-TBNA) among pulmonary trainees. METHODS: This was a multicenter cohort study of fellows in pulmonary medicine over the first 2 years of their training. Prior to performing EBUS-TBNA, all participants had to complete 30 conventional bronchoscopies, an EBUS-specific didactic curriculum, and a simulation session with a plastic airway model. Each consecutive EBUS procedure was scored with a checklist that evaluated the ability to pass a bronchoscope through vocal cords, identify the appropriate node for sampling, acquire adequate ultrasound images, guide the bronchoscopy team through the technical steps of EBUS-TBNA, and obtain adequate tissue samples. RESULTS: Thirteen pulmonary trainees from three training programs were enrolled in the study and were observed over a 2-year period. The majority of trainees were able to perform all essential steps of EBUS-TBNA and obtain adequate tissue after performing an average of 13 (95% CI, 7-16) procedures. CONCLUSIONS: Pulmonary trainees needed an average of 13 procedures to achieve first independent successful performance of EBUS-TBNA following a training protocol that included a didactic curriculum and simulation-based practice. Our findings could guide pulmonary fellowship directors in planning EBUS training and establishing a reasonable juncture to assess EBUS skills with validated assessment tools.

Authors
Wahidi, MM; Hulett, C; Pastis, N; Shepherd, RW; Shofer, SL; Mahmood, K; Lee, H; Malhotra, R; Moser, B; Silvestri, GA
MLA Citation
Wahidi, MM, Hulett, C, Pastis, N, Shepherd, RW, Shofer, SL, Mahmood, K, Lee, H, Malhotra, R, Moser, B, and Silvestri, GA. "Learning experience of linear endobronchial ultrasound among pulmonary trainees." Chest 145.3 (March 2014): 574-578.
PMID
24114380
Source
epmc
Published In
Chest
Volume
145
Issue
3
Publish Date
2014
Start Page
574
End Page
578
DOI
10.1378/chest.13-0701

Hemorrhagic complications of thoracentesis and small-bore chest tube placement in patients taking clopidogrel.

RATIONALE: Clopidogrel is a commonly used antiplatelet medication. The risk of local hemorrhage associated with use of this drug during routine thoracentesis or small-bore chest tube placement is not well established. OBJECTIVES: We conducted a prospective cohort study to assess the risk of hemothorax in patients taking clopidogrel while undergoing either pleural procedure. METHODS: Twenty-five consecutive adult patients who were taking clopidogrel at the time they were offered thoracentesis or small-bore (14 Fr) chest tube placement consented to continue taking the drug through their procedure. A control group consisted of 50 patients undergoing these pleural procedures who were not taking clopidogrel at the time they consented to undergo either procedure. All of the pleural procedures were performed under ultrasound guidance by an interventional pulmonologist or a fellow under direct faculty supervision. Hospitalized patients were screened for hemothorax by observing for a post-procedure drop in blood hemoglobin content of 2 g/dl or reaccumulation of their pleural effusion within 24 hours of the procedure. Outpatients were called within 2 weeks after their procedure to determine whether they had any symptoms suggestive of hemothorax. MEASUREMENTS AND MAIN RESULTS: There was one case of hemothorax after thoracentesis in the clopidogrel group versus none in the control group. The one patient with hemothorax required transfusion with 2 units of packed red blood cells and small-bore chest tube placement, and clopidogrel was withheld. There were no other clinically apparent complications of either procedure. CONCLUSIONS: Considered in combination with other small previously published studies, this single-center, nonrandomized, controlled prospective cohort study suggests that the rate of clinically consequential hemorrhage after ultrasound-guided thoracentesis or chest tube placement in patients taking clopidogrel is sufficiently low to warrant a large, randomized clinical trial designed to determine the safety of performing these procedures without interrupting clopidogrel therapy.

Authors
Mahmood, K; Shofer, SL; Moser, BK; Argento, AC; Smathers, EC; Wahidi, MM
MLA Citation
Mahmood, K, Shofer, SL, Moser, BK, Argento, AC, Smathers, EC, and Wahidi, MM. "Hemorrhagic complications of thoracentesis and small-bore chest tube placement in patients taking clopidogrel." Ann Am Thorac Soc 11.1 (January 2014): 73-79.
PMID
24102190
Source
pubmed
Published In
Annals of the American Thoracic Society
Volume
11
Issue
1
Publish Date
2014
Start Page
73
End Page
79
DOI
10.1513/AnnalsATS.201303-050OC

Endobronchial fiducial to guide stereotactic body radiotherapy.

Optimal treatment for unresectable central airway tumors is not well established. Stereotactic body radiation therapy has shown efficacy for both peripheral and central lung lesions. However, the treatment of central tumors has been limited because of associated radiation toxicity. We report the use of an endobronchial fiducial to localize hypofractionated stereotactic body radiation therapy treatment of a limited central airways disease in a patient with recurrent metastatic squamous cell lung cancer. The fiducial was instrumental in designing the treatment field and minimizing related treatment toxicity. Future studies may take advantage of this technique in patients with unresectable central airways non-small cell lung cancers.

Authors
Shofer, SL; Dunphy, F; Mahmood, K; Wahidi, MM; Yoo, D
MLA Citation
Shofer, SL, Dunphy, F, Mahmood, K, Wahidi, MM, and Yoo, D. "Endobronchial fiducial to guide stereotactic body radiotherapy." J Bronchology Interv Pulmonol 20.3 (July 2013): 274-275.
PMID
23857206
Source
pubmed
Published In
Journal of Bronchology and Interventional Pulmonology
Volume
20
Issue
3
Publish Date
2013
Start Page
274
End Page
275
DOI
10.1097/LBR.0b013e31829dd690

Straightening out chest tubes: what size, what type, and when.

Although chest tube placement is one of the most common procedures in managing patients with pleural disease, it is not clear what size and type of chest tube is indicated for various conditions. Chest tubes can be divided into small- (≤14 French [Fr]) and large-bore (>14 Fr) and can be placed by blunt dissection, guidewire (Seldinger), or trocar guidance. Recently a trend has been seen toward using smaller chest tubes for most indications, given their relative ease and patient comfort. This article summarizes the rationale for using different chest tubes depending on the clinical scenario.

Authors
Mahmood, K; Wahidi, MM
MLA Citation
Mahmood, K, and Wahidi, MM. "Straightening out chest tubes: what size, what type, and when." Clin Chest Med 34.1 (March 2013): 63-71. (Review)
PMID
23411057
Source
pubmed
Published In
Clinics in Chest Medicine
Volume
34
Issue
1
Publish Date
2013
Start Page
63
End Page
71
DOI
10.1016/j.ccm.2012.11.007

Alendronate tracheobronchitis.

Authors
Mahmood, K; Koubar, S; Shofer, SL; Ninan, NA; Wahidi, MM
MLA Citation
Mahmood, K, Koubar, S, Shofer, SL, Ninan, NA, and Wahidi, MM. "Alendronate tracheobronchitis." Ann Am Thorac Soc 10.1 (February 2013): 64-66.
PMID
23509337
Source
pubmed
Published In
Annals of the American Thoracic Society
Volume
10
Issue
1
Publish Date
2013
Start Page
64
End Page
66
DOI
10.1513/AnnalsATS.201212-124OT

Association of gender with outcomes in critically ill patients.

INTRODUCTION: The influence of gender on mortality and other outcomes of critically ill patients is not clear. Different studies have been performed in various settings and patient populations often yielding conflicting results. We wanted to assess the relationship of gender and intensive care unit (ICU) outcomes in the patients included in the Acute Physiology and Chronic Health Evaluation (APACHE) IV database (Cerner Corporation, USA). METHODS: We performed a retrospective review of the data available in the APACHE IV database. A total of 261,255 consecutive patients admitted to adult ICUs in United States from 1 January 2004 to 31 December 2008 were included. Readmissions were excluded from the analysis. The primary objective of the study was to assess the relationship of gender with ICU mortality. The secondary objective was to evaluate the association of gender with active therapy, mechanical ventilation, length of stay in the ICU, readmission rate and hospital mortality. The gender-related outcomes for disease subgroups including acute coronary syndrome, coronary artery bypass graft (CABG) surgery, sepsis, trauma and chronic obstructive pulmonary disease (COPD) exacerbation were assessed as well. RESULTS: ICU mortality was 7.2% for men and 7.9% for women, odds ratio (OR) for death for women was 1.07 (95% confidence interval (CI): 1.04 to 1.1). There was a statistically significant interaction between gender and age. In patients <50 years of age, women had a reduced ICU mortality compared with men, after adjustment for acute physiology score, ethnicity, co-morbid conditions, pre-ICU length of stay, pre-ICU location and hospital teaching status (adjusted OR 0.83, 95% CI: 0.76 to 0.91). But among patients ≥ 50 years of age, there was no significant difference in ICU mortality between men and women (adjusted OR 1.02, 95% CI: 0.98 to 1.06). CONCLUSIONS: Among the critically ill patients, women less than 50 years of age had a lower ICU mortality compared to men, while 50 years of age or older women did not have a significant difference compared to men. Women had a higher mortality compared to men after CABG surgery and lower mortality with COPD exacerbation. There was no difference in mortality in acute coronary syndrome, sepsis or trauma.

Authors
Mahmood, K; Eldeirawi, K; Wahidi, MM
MLA Citation
Mahmood, K, Eldeirawi, K, and Wahidi, MM. "Association of gender with outcomes in critically ill patients. (Published online)" Crit Care 16.3 (May 22, 2012): R92-.
PMID
22617003
Source
pubmed
Published In
Critical Care (UK)
Volume
16
Issue
3
Publish Date
2012
Start Page
R92
DOI
10.1186/cc11355

Re: Noninvasive repair of broken tunneled pleural catheters

Authors
Bower, C; Mahmood, K
MLA Citation
Bower, C, and Mahmood, K. "Re: Noninvasive repair of broken tunneled pleural catheters." Journal of Vascular and Interventional Radiology 22.2 (2011): 255-256.
PMID
21276918
Source
scival
Published In
JVIR: Journal of Vascular and Interventional Radiology
Volume
22
Issue
2
Publish Date
2011
Start Page
255
End Page
256
DOI
10.1016/j.jvir.2010.10.025

Treatment of infection associated with tunneled pleural catheters

Chronic indwelling tunneled pleural catheters are increasingly used for the treatment of malignant pleural effusions. Some common complications of these catheters include empyema and local site infection. Empyema is generally treated with the removal of the pleural catheter and the administration of systemic antibiotics. We propose a different and more conservative but effective method of the treatment of infected tunneled pleural catheters. © 2010 by Lippincott Williams & Wilkins.

Authors
Mahmood, K; Bower, C
MLA Citation
Mahmood, K, and Bower, C. "Treatment of infection associated with tunneled pleural catheters." Journal of Bronchology and Interventional Pulmonology 17.1 (2010): 69-72.
Source
scival
Published In
Journal of Bronchology and Interventional Pulmonology
Volume
17
Issue
1
Publish Date
2010
Start Page
69
End Page
72
DOI
10.1097/LBR.0b013e3181ca66c1

Oxaliplatin-induced eosinophilic pneumonia: A case report and review of the literature

Oxaliplatin is a platinum-based agent that is typically given with 5-fluorouracil and leucovorin in a combination known as FOLFOX to treat colorectal cancer. It has been associated with hypersensitivity reactions and pulmonary toxicity but is a rare cause of eosinophilic pneumonia. We present a case of oxaliplatin-induced eosinophilic pneumonia. A literature review showed only one other such report. © 2009 Elsevier Inc. All rights reserved.

Authors
Vu, K; Mahmood, K; Subramanian, S
MLA Citation
Vu, K, Mahmood, K, and Subramanian, S. "Oxaliplatin-induced eosinophilic pneumonia: A case report and review of the literature." Community Oncology 6.9 (2009): 422-424.
Source
scival
Published In
Community Oncology
Volume
6
Issue
9
Publish Date
2009
Start Page
422
End Page
424

Effects of vitamin D insufficiency on bone mineral density in African American men

In African American men serum, 25-hydroxyvitamin D (25-OHD) was below 30 ng/ml in 89% of subjects. In overall group, there was no correlation between 25-OHD and bone mineral density (BMD). A subgroup analysis of subjects with 25-OHD ≤ 15 ng/ml showed that serum 25-OHD was positively associated with BMD. Introduction: This study examined the effects of low serum 25-hydroxyvitamin D (25-OHD) on bone mineral density (BMD) in African American (AA) men from the general medicine clinic at an inner city Veteran Administration medical center. Methods: The data for 112 AA males who had both 25-OHD levels and BMD of spine and hip were extracted and analyzed using SAS software. Results: AA men were aged 38 to 85 years, with mean age of 62 years. Levels of 25-OHD ranged from 4 to 45 ng/ml, with mean 17.5 ng/ml, 24% and 89% of the subjects had 25-OHD below 10 and 30 ng/ml, respectively. In the overall group, there was no correlation between 25-OHD and BMD at any site. In a subgroup analysis of subjects with 25-OHD 15 ng/ml, in multiple adjusted models, 25-OHD was positively associated with BMD of spine (r∈=∈0.26, p∈=∈0.05), total hip (r∈=∈0.27, p∈<∈0.05), ward's triangle (r∈=∈0.25, p∈=∈0.05), and trochanter (r∈=∈0.30, p∈<∈0.05). Conclusions: The negative effect of vitamin D insufficiency on bone was observed only at very low levels of 25-OHD, suggesting that AA male skeleton is relatively resistant to the effects of secondary hyperparathyroidism. © 2008 International Osteoporosis Foundation and National Osteoporosis Foundation.

Authors
Akhter, N; Sinnott, B; Mahmood, K; Rao, S; Kukreja, S; Barengolts, E
MLA Citation
Akhter, N, Sinnott, B, Mahmood, K, Rao, S, Kukreja, S, and Barengolts, E. "Effects of vitamin D insufficiency on bone mineral density in African American men." Osteoporosis International 20.5 (2009): 745-750.
PMID
18820989
Source
scival
Published In
Osteoporosis International
Volume
20
Issue
5
Publish Date
2009
Start Page
745
End Page
750
DOI
10.1007/s00198-008-0746-4

Prevalence of type 2 diabetes in patients with obstructive sleep apnea in a multi-ethnic sample

Study Objectives: Relationship of obstructive sleep apnea (OSA) with insulin resistance and type 2 diabetes in Caucasians has been studied, but this association has not been investigated in Hispanic and African-Americans. The objective of this study is to determine the prevalence of type 2 diabetes in patients evaluated for OSA in a predominantly African American and Hispanic sample. The secondary objective is to evaluate the relationship of REM related OSA and type 2 diabetes. Methods: 1008 consecutive patients who had a comprehensive polysomnography were evaluated. OSA was defined as an obstructive apnea-hypopnea index (AHI) of ≥ 5 per hour. REM AHI of ≥ 10 was considered to indicate REM related OSA. Results: The prevalence of type 2 diabetes was 30.1% in the group with OSA compared to 18.6% in those without OSA. The subjects with OSA had significantly increased odds of type 2 diabetes compared with those without OSA (odds ratio = 1.8, 95% confidence interval: 1.3-2.6) but this association became non-significant when controlled for confounding variables and covariates (odds ratio = 1.3, 95% confidence interval: 0.9-2.0). Middle-aged participants with OSA had 2.8 times higher odds for type 2 diabetes, when compared to younger or middle aged without OSA, controlling for covariates. Finally, the odds of type 2 diabetes were 2.0 times higher in patients with REM AHI of ≥ 10/h independent of confounding variables. Conclusions: OSA is not independently associated with type 2 diabetes in a predominantly African American and Hispanic sample. However, the relationship of REM related OSA with type 2 diabetes may be statistically significant.

Authors
Mahmood, K; Akhter, N; Eldeirawi, K; Önal, E; Christman, JW; Carley, DW; Herdegen, JJ
MLA Citation
Mahmood, K, Akhter, N, Eldeirawi, K, Önal, E, Christman, JW, Carley, DW, and Herdegen, JJ. "Prevalence of type 2 diabetes in patients with obstructive sleep apnea in a multi-ethnic sample." Journal of Clinical Sleep Medicine 5.3 (2009): 215-221.
PMID
19960641
Source
scival
Published In
Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine
Volume
5
Issue
3
Publish Date
2009
Start Page
215
End Page
221

Thoracic splenosis: The scar is the clue

Thoracic splenosis is a rare condition resulting from autotransplantation of splenic tissue into the left hemithorax after remote splenic trauma. It is usually incidentally detected on chest radiography or thoracic computed tomography. A history of splenic trauma in a patient with left-sided, pleural nodules on imaging studies suggests the diagnosis. The diagnosis of splenosis may be confirmed with 99mTc sulfur colloid, 111I-labeled platelet, or 99mTc heat-damaged erythrocyte studies. We present a patient noninvasively diagnosed with thoracic splenosis 17 years after a gunshot wound that had resulted in splenectomy. Early recognition of thoracic splenosis can prevent unnecessary interventions, such biopsy or surgery. © 2008 by Lippincott Williams & Wilkins.

Authors
Atia, A; Khiani, A; Kanneganti, V; Bower, C; Mahmood, K
MLA Citation
Atia, A, Khiani, A, Kanneganti, V, Bower, C, and Mahmood, K. "Thoracic splenosis: The scar is the clue." Clinical Pulmonary Medicine 15.6 (2008): 363-366.
Source
scival
Published In
Clinical Pulmonary Medicine
Volume
15
Issue
6
Publish Date
2008
Start Page
363
End Page
366
DOI
10.1097/CPM.0b013e31818cd923

Audible implantable cardioverter defibrillator alarms detect intermittent conductor discontinuity

The lead conductor integrity of implantable cardioverter defibrillator devices is inferred from impedance measurements; however, intermittent discontinuity can be difficult to detect or confirm. Newer devices can perform daily lead impedance self-testing, and some even have audible alarms that promptly warn patients of anomalies. In the present case, the audible alarms were solely responsible for the timely identification of an intermittent, otherwise clinically nonreproducible, form of potentially fatal implantable cardioverter defibrillator system failure.

Authors
Sheth, N; Mahmood, K; Singh, B; Carter-Adkins, D; Pachulski, SRT
MLA Citation
Sheth, N, Mahmood, K, Singh, B, Carter-Adkins, D, and Pachulski, SRT. "Audible implantable cardioverter defibrillator alarms detect intermittent conductor discontinuity." Canadian Journal of Cardiology 18.4 (2002): 430-432.
PMID
11992137
Source
scival
Published In
Canadian Journal of Cardiology
Volume
18
Issue
4
Publish Date
2002
Start Page
430
End Page
432
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