Papers by Tashfeen Mahmood
Chest, Dec 1, 2013
A 39-year-old Hispanic man was admitted for the third time with a few days’ history of fever, sho... more A 39-year-old Hispanic man was admitted for the third time with a few days’ history of fever, shortness of breath, cough, and hemoptysis. The patient’s initial presentation was 5 weeks earlier. At that time, he was diagnosed with community-acquired pneumonia and was discharged on oral moxifl oxacin. He was admitted again 3 weeks prior to this current admission for the same symptoms. He was diagnosed with health-careassociated pneumonia and treated accordingly. During that admission, TB and HIV infections were ruled out. His medical history was negative, and he had no history of smoking. The patient was born in Mexico and immigrated to the United States 18 years ago. He worked at a local slaughterhouse for 10 years. He had no contact with live cattle; the animals were slaughtered, skinned, and washed with treated water before arriving at his workstation where he cut out parts to be packed. None of his family members had similar symptoms. Every time, his complaints resolved promptly after hospitalization to recur once he went back to work. Some of his coworkers complained of eye irritation and cough but none became as sick. Physical Examination Findings
Clinical Case Reports, Dec 26, 2013
We describe a case of pneumococcal round pneumonia in an elderly smoker and it demonstrates the r... more We describe a case of pneumococcal round pneumonia in an elderly smoker and it demonstrates the role of inflammatory biomarkers and follow-up imaging in ruling out more ominous diagnoses.
Canadian Respiratory Journal, 2014
The authors of this manuscript attest that the content here within represents the views of the au... more The authors of this manuscript attest that the content here within represents the views of the authors, and that neither the corresponding author nor the coauthors have submitted duplicate or overlapping manuscripts elsewhere. A written informed consent has been obtained from the patients presented in this case. Key Clinical Message We describe a case of pneumococcal round pneumonia in an elderly smoker and it demonstrates the role of inflammatory biomarkers and follow-up imag-ing in ruling out more ominous diagnoses.
Infection, 2014
The aim of this study was to examine the safety and efficacy of antibiotic de-escalation in patie... more The aim of this study was to examine the safety and efficacy of antibiotic de-escalation in patients admitted with bacteremic urinary tract infection (UTI). Methods A retrospective chart review of patients admitted to a community-hospital in West Texas with bacteremic UTI during the year 2008. Antibiotic de-escalation was defined as changing the intravenous empiric antibiotic regimen to a culture-directed single agent, given intravenously or orally, with a narrower spectrum than the original empiric regimen. Results Ninety-seven patients were admitted with bacteremic UTI. Thirty-two patients were not eligible for deescalation. Among the 65 patients who were eligible for de-escalation, the treating physicians failed to de-escalate antibiotics in 31 cases (47.7 %). Fluoroquinolones' resistance, bacteria other than Escherichia coli and discharge to long-term care facilities predicted failure to de-escalate antibiotics. On multivariate analysis, discharge to long-term care facility was the only risk factor that predicted failure to de-escalate antibiotics. The difference between mean hospital length of stay and mortality between the above two groups was not statistically significant. Conclusion Antibiotic de-escalation is under-recognized and sporadically practiced. In patients admitted with bacteremic UTI, empiric antibiotic regimen can be changed to a culture-directed single antibiotic without an increase in hospital length of stay or patients' mortality.
Metronidazole is a known but uncommon cause of acute pancreatitis. The reported cases were mild t... more Metronidazole is a known but uncommon cause of acute pancreatitis. The reported cases were mild to moderate in severity with moderate enzyme elevation. Only two cases so far had diagnostic imaging confirming the presence of pancreatic inflammation. In all the eight cases reported, the discontinuation of metronidazole resulted in rapid recovery both clinically and enzymatically. Interestingly all reported cases are females. Although uncommon, metronidazole use should be considered as a potential precipitant in patients presenting with acute pancreatitis.
Sleep, Apr 1, 2018
Report of Case: A 43 year-old previously healthy female with family history of sarcoidosis and lu... more Report of Case: A 43 year-old previously healthy female with family history of sarcoidosis and lupus, presented for evaluation in 2006 after acute onset of initially painful and, then painless, vision loss in her left eye (OS). Extensive neuro-ophthalmologic, immunologic, and rheumatologic workup was negative for other causes of optic neuropathy. She continued having recurrent, intermittent optic neuritis due to CRION, developed complete OS blindness in 2014, despite aggressive management with oral prednisone as outpatient as well as frequent hospitalizations for intravenous steroids, rituximab, and plasma exchange (PLEX). In September 2017, the patient was admitted for blurred vision in the right eye (OD), she presented with OD painless, optic neuropathy due to CRION, she was treated with methylprednisolone, and ofatumumab with no change in vision loss. The extensive work up was repeated and was negative for other causes of optic neuropathy. During hospital admission, sleep medicine was consulted for witnessed nocturnal apneic events. She complained of snoring, gasping, fatigue, and non-restorative sleep for 15 years. STOP-BANG 3. Physical exam revealed facial malocclusion class 3, Mallampati class IV, macroglossia with lateral scalloping, high-arched palate and neck measured 15 inches. She underwent in-lab split-night polysomnogram, which revealed an AHI of 28.1/hour, and was prescribed Auti BIPAP 15/6 cmH2O, PS-4 due to CPAP intolerance. Outpatient follow up with Sleep Medicine in December 2017 did not reveal any new symptoms, and no worsening in eye exam. Excellent subjective and objective BIPAP compliance was reported. Conclusion: We report the case of CRION progression with co-existing OSA. Although, most of the cases of optic neuropathy in OSA patients were related to non-arteritic anterior ischemic optic neuropathy (NAION), there are no existing reports establishing the relationship between OSA and CRION progression. While no doubt exists that this relationship needs to be further evaluated, patients with CRION may benefit from OSA evaluation and management.
Baylor University Medical Center Proceedings
The Southwest Respiratory and Critical Care Chronicles
Rheumatoid arthritis is a multisystem autoimmune disease that can cause several lung diseases; it... more Rheumatoid arthritis is a multisystem autoimmune disease that can cause several lung diseases; it rarely presents initially in the lungs without obvious joint disease. The medications used to treat RA have adverse effects in the lungs, and it may be difficult to differentiate a progressive rheumatoid lung disease from a new drug-related side effect. 1,2 Treatment decisions critically depend on this distinction. In this review we consider the effects of rheumatoid disease modifying agents on the treatment of rheumatoid-associated lung disease and their potential to cause adverse drug-related complications in the lung. rheumatoId arthrItIs and Its effects on lungs One of the most frequent complications of RA involving the lungs is rheumatoid arthritis-related interstitial lung disease (RA-ILD) with an approximate incidence of 10% (Table 1). 3 Lee and colleagues reported that usual interstitial pneumonitis (UIP) is more frequent than nonspecific interstitial pneumonitis (NSIP) in these patients. 4 Pulmonary nodules also develop in RA patients. The exact incidence of nodules is uncertain; they are more common in patients who have long standing RA and who have subcutaneous nod-abstract Rheumatoid arthritis (RA) is a systemic inflammatory disease mainly affecting the joints. It has extra-articular manifestations, including lung disease, a major contributor to morbidity and mortality. Careful assessment of systemic signs and symptoms of patients presenting to a pulmonologist with unexplained respiratory symptoms is very important, since RA itself can present with initial pulmonary symptoms without articular manifestations. Several disease modifying agents and biologics have been introduced to treat RA and have been shown to improve the quality of life and slow down the disease progression itself. The possibility of pulmonary toxicity with these drugs has been raised but establishing a causal relationship is difficult. In some case reports stopping the drug in question has reversed radiological changes and decreased inflammatory markers and symptoms, suggesting drug-related toxicity. However, some experts suggest that evolving or increasing pulmonary toxicity usually represents failure of treatment and an indication to switch to a different biologic or disease modifying agent. In this review we evaluate the association between methotrexate, leflunomide, and newer biologic agents and lung disease in patients with rheumatoid arthritis.
Baylor University Medical Center Proceedings
Canadian Respiratory Journal, 2014
Pneumonia is a common diagnosis with significant morbidity and mortality. However, pneumonia is a... more Pneumonia is a common diagnosis with significant morbidity and mortality. However, pneumonia is a commonly overdiagnosed entity, with many similar-appearing conditions. A young, previously healthy woman was misdiagnosed with a variety of respiratory tract infections over the course of five months before establishing the correct diagnosis - chronic eosinophilic pneumonia.
Proceedings (Baylor University. Medical Center), 2015
Ornithine transcarbamoylase deficiency is the most common inherited urea cycle disorder. In adult... more Ornithine transcarbamoylase deficiency is the most common inherited urea cycle disorder. In adults, its phenotypes are diverse. In asymptomatic patients with late presentations, symptom onset is often associated with a precipitating factor. We present a case of a woman with urea cycle disorder diagnosed after an acute peptic ulcer bleed and fasting.
Canadian respiratory journal : journal of the Canadian Thoracic Society
Pneumonia is a common diagnosis with significant morbidity and mortality. However, pneumonia is a... more Pneumonia is a common diagnosis with significant morbidity and mortality. However, pneumonia is a commonly overdiagnosed entity, with many similar-appearing conditions. A young, previously healthy woman was misdiagnosed with a variety of respiratory tract infections over the course of five months before establishing the correct diagnosis - chronic eosinophilic pneumonia.
Clinical Case Reports, 2013
We describe a case of pneumococcal round pneumonia in an elderly smoker and it demonstrates the r... more We describe a case of pneumococcal round pneumonia in an elderly smoker and it demonstrates the role of inflammatory biomarkers and follow-up imaging in ruling out more ominous diagnoses.
Infection and Drug Resistance, 2014
Antibiotic de-escalation is a potential strategy advocated to conserve the effectiveness of broad... more Antibiotic de-escalation is a potential strategy advocated to conserve the effectiveness of broad-spectrum antibiotics. The aim of this study was to examine the safety and feasibility of antibiotic de-escalation in patients admitted with bacteremic pneumonia. A retrospective chart review was done for patients with bacteremic pneumonia admitted to Northwest Texas Hospital in Amarillo, TX, USA, during 2008. Antibiotic de-escalation was defined as changing the empiric antibiotic regimen to a culture-directed single agent with a narrower spectrum than the original regimen. Sixty-eight patients were admitted with bacteremic pneumonia. Eight patients were not eligible for de-escalation. Among the 60 patients who were eligible for de-escalation, the treating physicians failed to de-escalate antibiotics in 27 cases (45.0%). Discharge to a long-term care facility predicted failure to de-escalate antibiotics, while an infectious diseases consultation was significantly associated with antibiotic de-escalation. The average daily cost of antibacterial therapy in the de-escalation group was $25.7 compared with $61.6 in the group where de-escalation was not implemented. The difference in mean length of hospital stay and mortality between the two groups was not statistically significant. Antibiotic de-escalation is a safe management strategy but unfortunately is not widely adopted. Although bacterial resistance poses a significant threat and is rising, antimicrobial de-escalation has emerged as a potential intervention that can conserve the effectiveness of broad-spectrum antibiotics without compromising the patient's outcome. This practice is becoming important in the face of slow development of new anti-infective agents.
The American Journal on Addictions, 2012
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Papers by Tashfeen Mahmood