Papers by Zulfiqar Hussain
Blood
3133 The human bone marrow is often evaluated in patients with various hematological disorders. M... more 3133 The human bone marrow is often evaluated in patients with various hematological disorders. Multiple bone marrow procedures are often required in patients with hematological malignancies to guide their treatment. The instrument customarily employed, the Jamshidi needle, which involves manual rotary insertion into the marrow cavity of the posterior aspect of the iliac bone produces both an aspirate and a biopsy. Bone marrow biopsy procedure has changed very little in the last 40 years and is regarded by patients and physicians alike as a painful and uncomfortable procedure. In addition, suboptimal specimens including dilute aspirates and small core biopsies are often obtained, limiting the diagnostic potential of the procedure. Initial clinical studies utilizing a new powered bone marrow (PBM) device (OnControl, Vidacare Corporation, Shavano Park, TX), indicated that it was faster and easier to use for bone marrow aspirations than the traditional method. While the duration of the...
Journal of medical case reports, Jan 7, 2017
Myxofibrosarcoma is an aggressive soft tissue neoplasm, classified as a variant of malignant fibr... more Myxofibrosarcoma is an aggressive soft tissue neoplasm, classified as a variant of malignant fibrous histiocytoma. Most often, it occurs in middle to late adult life peaking in the seventh decade and involving the lower extremities (77%), trunk (12%), and retroperitoneum or mediastinum (8%). We report the first case of thoracic myxofibrosarcoma presenting as a Pancoast tumor. A 48-year-old non-tobacco smoking African-American man presented with a slow-growing mass in his neck along with 11 kg weight loss over 9 months. A review of his systems was positive for hoarseness and lowgrade intermittent fever without any shortness of breath or cough. A physical examination revealed a mass on the left side of his neck superior to his sternoclavicular joint measuring 3 × 3 × 1 cm. He had ptosis and miosis of his left eye. His breath sounds were decreased and coarse at the left apex. A neurological examination revealed 3/5 strength in his left upper arm. The remainder of the physical examinati...
The American Journal of Medicine, Jun 1, 2009
BACKGROUND: Clinicians depend on history given by the patients when considering the diagnosis of ... more BACKGROUND: Clinicians depend on history given by the patients when considering the diagnosis of orthostatic hypotension. METHODS: Patients with a decrease in systolic blood pressure more than 60 mm Hg from baseline during a head-up tilt table test were included. They were classified according to their symptoms during the head-up tilt table test. Localization of the cause of orthostatic hypotension was sought in each of these groups. RESULTS: Eighty-eight (43%) patients had typical symptoms, 49 (24%) had atypical symptoms, and 68 (33%) were asymptomatic. The average decrease in systolic blood pressure was 88 mm Hg, 87.5 mm Hg, and 89.8 mm Hg in the typical, atypical, and asymptomatic groups, respectively (P ϭ .81). Patients reported severe dizziness with a similar frequency as lower extremity discomfort. Backache and headache also were common atypical complaints. Patients with peripheral cause of dysautonomia were able to sustain the longest upright position during the head-up tilt table test (21 minutes, compared with central dysautonomia [15 minutes]) (P ϭ .005). There was no correlation between the cause of dysautonomia and the occurrence of symptoms during the head-up tilt table test (P ϭ .58). CONCLUSION: A third of the patients with severe orthostatic hypotension are completely asymptomatic during the head-up tilt table test, and another quarter have atypical complaints that would not lead physicians toward the diagnosis of orthostatic hypotension. These findings suggest that they might not provide adequate information in diagnosing profound orthostatic hypotension in a subset of patients with this disorder.
The American Journal of the Medical Sciences, Jan 6, 2012
Portopulmonary hypertension (POPH) is a not infrequent but serious complication of liver cirrhosi... more Portopulmonary hypertension (POPH) is a not infrequent but serious complication of liver cirrhosis. Continuous intravenous epoprostenol infusion is a treatment option for this condition. Progressive splenomegaly with pancytopenia (hypersplenism) is associated with epoprostenol use in POPH. After recognizing a case of epoprostenol-induced hypersplenism that resolved upon stopping the drug, the authors retrospectively reviewed all patients treated with epoprostenol at the center for both POPH and pulmonary hypertension due to other causes. Five of 11 patients with POPH developed hypersplenism secondary to epoprostenol. In 1 patient, and possibly in a second, the hypersplenism resolved upon discontinuation of epoprostenol. None of 9 patients with pulmonary hypertension due to other causes developed splenomegaly. This report confirms hypersplenism as a complication of epoprostenol therapy for POPH. Furthermore, the authors demonstrate for the first time that hypersplenism may be reversed by stopping the medication and propose a mechanism for this phenomenon.
Journal of Clinical Neuromuscular Disease, 2008
Gastroenterology and Hepatology
As the obesity epidemic spreads across the world, physicians of all specialties will be called on... more As the obesity epidemic spreads across the world, physicians of all specialties will be called on to participate in the management of this condition. Gastroenterologists are no exception and can expect, in the future, to play a major role in all aspects of the care of the obese patient. Thus, gastroenterologists must learn to recognize, prevent, and treat gastrointestinal disorders related to obesity, and they must have an understanding of the risks and benefits of various management strategies. Gastroenterologists may also be called upon to assist in the evaluation and management of liver and gastrointestinal problems that have developed following bariatric surgery. When treating these problems, a thorough understanding of the anatomic and physiologic perturbations associated with a given procedure is essential, as is the knowledge of which complications are linked to weight loss and which are linked to a specific surgical approach.
Gastroenterology & hepatology, 2007
As the obesity epidemic spreads across the world, physicians of all specialties will be called on... more As the obesity epidemic spreads across the world, physicians of all specialties will be called on to participate in the management of this condition. Gastroenterologists are no exception and can expect, in the future, to play a major role in all aspects of the care of the obese patient. Thus, gastroenterologists must learn to recognize, prevent, and treat gastrointestinal disorders related to obesity, and they must have an understanding of the risks and benefits of various management strategies. Gastroenterologists may also be called upon to assist in the evaluation and management of liver and gastrointestinal problems that have developed following bariatric surgery. When treating these problems, a thorough understanding of the anatomic and physiologic perturbations associated with a given procedure is essential, as is the knowledge of which complications are linked to weight loss and which are linked to a specific surgical approach.
Hematology Reports (formerly Hematology Reviews), 2011
The purpose of this study was to compare a novel bone marrow device with the standard marrow need... more The purpose of this study was to compare a novel bone marrow device with the standard marrow needle in a prospective, randomized study in a teaching hospital employing hematologists-in-training. The new device, the OnControl Bone Marrow (OBM) Biopsy System, utilizes a battery-powered drill to insert the needle. Fifty-four bone marrows (27 standard and 27 OBM) were performed by 11 fellows under the observation and supervision of 3 attending hematologists and 1 research technologist. The primary endpoint of the study, the mean length of the marrow biopsy specimens, a surrogate for marrow quality, was determined by a pathologist in a blinded manner. The mean length of the marrow biopsy specimens was significantly longer (56%) for the OBM group (15.3 mm) than for the standard bone marrow (SBM) group (9.8 mm), P<0.003. An objectively determined secondary endpoint; mean procedure time, skin-to-skin; also favored the OBM group (175 s) versus the SBM group (292 s), P<0.007. Several subjective secondary endpoints also favored the OBM group. Only minor adverse events were encountered in the OBM and SBM study groups. It was concluded that bone marrow procedures (BMPs) performed by hematologists-in-training were significantly faster and superior in quality when performed with the OBM compared to the SBM. These data suggest that the OBM may be considered a new standard of care for adult hematology patients. OBM also appears to be a superior method for training hematology fellows.
2010 International Conference on Wireless Communication and Sensor Computing (ICWCSC), 2010
ABSTRACT: Multi-Protocol Label Switching is a best technique for efficient utilization of network... more ABSTRACT: Multi-Protocol Label Switching is a best technique for efficient utilization of network resources, a small overhead labels. The Internet Protocol is the dominant protocol in computer networks today. MPLS adds the flavor of virtual circuits in computer networks. Which ...
Neurology, 2008
To determine the incidence, in-hospital mortality, and predictors of death in Guillain-Barré synd... more To determine the incidence, in-hospital mortality, and predictors of death in Guillain-Barré syndrome (GBS) in a large US cohort. Our cohort was identified from the Nationwide Inpatient Sample database, 2000 through 2004. We excluded patients younger than 18 years and those who presented with rapidly paralyzing conditions due to other causes. GBS patients who were transferred between hospitals were counted once. The incidence rate adjusted for 20% of the US census reported by the Census Bureau. A logistic regression model was used to identify predictors of death. After data cleansing, 4,954 patients were identified with a primary diagnosis of GBS. The adjusted incidence rate varied between 1.65 and 1.79 per 100,000 during the years included in this study. The in-hospital mortality rate was 2.58% (128/4,954) and did not change significantly over the study period. Eleven percent had variable pulmonary complications, and 9.1% received endotracheal intubation, which was a predictor of mortality (adjusted odds ratio 5.09, 95% CI 3.21-8.05). Other predictors of mortality included older age, composite comorbidity index, cardiac complications, and sepsis. The mortality rate in Guillain-Barré syndrome is low, and predictors of death are similar to those predicting poor disability outcome. The disease incidence was stable over the 5 years included in this study.
Journal of Clinical Neuromuscular Disease, 2008
To determine the patterns of hospital utilization of plasma exchange (PE), intravenous immunoglob... more To determine the patterns of hospital utilization of plasma exchange (PE), intravenous immunoglobulin (IVIG), or combination therapy in Guillain-Barré syndrome in a large US cohort. Guillain-Barré syndrome patients, older than 18 years, were identified from the Nationwide Inpatient Sample database for the years 2000 through 2005. Patients with documented immunotherapy during hospitalization were included. We used the Cochran-Armitage test to assess the trend of hospital utilization of the type of immune intervention over time. Binomial logistic regression model was used to identify the association between patient and hospital demographics and hospital- associated complications with the type of therapy administered during hospitalization. After data cleansing, 1657 patients were included. There is a decreasing trend in PE utilization and an increasing trend in IVIG use over the 6 years included in this study (P < 0.0001). Patients who received PE were older (mean age of 50.8 +/- 18.5 versus 42.2 +/- 24.2, P < 0.0001) and had higher complication rates including respiratory failure (18.9% versus 7.56%, P < 0.0001) and sepsis (2.85% versus 0.61%, P = 0.003). In addition, the mortality rate is lower in the group treated with IVIG when compared with PE (0.45% versus 3.3%, P < 0.0001). Conversely, 61% of patients treated with IVIG group were discharged to home compared with 42% of patients treated with PE. The trend analysis supports an increasing use of IVIG over PE. Older population and those with pulmonary or sepsis complications were likely treated with PE. The mortality rate was higher in patients treated with PE.
The American Journal of the Medical Sciences, 2012
Portopulmonary hypertension (POPH) is a not infrequent but serious complication of liver cirrhosi... more Portopulmonary hypertension (POPH) is a not infrequent but serious complication of liver cirrhosis. Continuous intravenous epoprostenol infusion is a treatment option for this condition. Progressive splenomegaly with pancytopenia (hypersplenism) is associated with epoprostenol use in POPH. After recognizing a case of epoprostenol-induced hypersplenism that resolved upon stopping the drug, the authors retrospectively reviewed all patients treated with epoprostenol at the center for both POPH and pulmonary hypertension due to other causes. Five of 11 patients with POPH developed hypersplenism secondary to epoprostenol. In 1 patient, and possibly in a second, the hypersplenism resolved upon discontinuation of epoprostenol. None of 9 patients with pulmonary hypertension due to other causes developed splenomegaly. This report confirms hypersplenism as a complication of epoprostenol therapy for POPH. Furthermore, the authors demonstrate for the first time that hypersplenism may be reversed by stopping the medication and propose a mechanism for this phenomenon.
The American Journal of Medicine, 2009
BACKGROUND: Clinicians depend on history given by the patients when considering the diagnosis of ... more BACKGROUND: Clinicians depend on history given by the patients when considering the diagnosis of orthostatic hypotension. METHODS: Patients with a decrease in systolic blood pressure more than 60 mm Hg from baseline during a head-up tilt table test were included. They were classified according to their symptoms during the head-up tilt table test. Localization of the cause of orthostatic hypotension was sought in each of these groups. RESULTS: Eighty-eight (43%) patients had typical symptoms, 49 (24%) had atypical symptoms, and 68 (33%) were asymptomatic. The average decrease in systolic blood pressure was 88 mm Hg, 87.5 mm Hg, and 89.8 mm Hg in the typical, atypical, and asymptomatic groups, respectively (P ϭ .81). Patients reported severe dizziness with a similar frequency as lower extremity discomfort. Backache and headache also were common atypical complaints. Patients with peripheral cause of dysautonomia were able to sustain the longest upright position during the head-up tilt table test (21 minutes, compared with central dysautonomia [15 minutes]) (P ϭ .005). There was no correlation between the cause of dysautonomia and the occurrence of symptoms during the head-up tilt table test (P ϭ .58). CONCLUSION: A third of the patients with severe orthostatic hypotension are completely asymptomatic during the head-up tilt table test, and another quarter have atypical complaints that would not lead physicians toward the diagnosis of orthostatic hypotension. These findings suggest that they might not provide adequate information in diagnosing profound orthostatic hypotension in a subset of patients with this disorder.
Alimentary Pharmacology and Therapeutics, 2006
Complementary and alternative medical therapies and practices are widely employed in the treatmen... more Complementary and alternative medical therapies and practices are widely employed in the treatment of the irritable bowel syndrome.
Cell Cycle, 2014
Esophageal adenocarcinoma (EAC) is one of the fastest growing malignancies in the US and needs ne... more Esophageal adenocarcinoma (EAC) is one of the fastest growing malignancies in the US and needs newer therapeutic and diagnostic strategies. Chronic inflammation plays a role in the pathogenesis of EAC and contributes to the dysplastic conversion of normal esophageal epithelium to Barrett's esophagus and frank adenocarcinoma. Chemokines play important roles in mediating inflammation and recent evidence implicates these ligands and their receptors in the development and spread of various tumors. We demonstrated that the chemokines IL8, CXCL1 and CXCL3 are significantly overexpressed during esophageal carcinogenesis and accompanied by amplification and demethylation of the chr4q21 gene locus. We also demonstrated that IL8 levels can be detected in serum of patients with EAC and can serve as potential biomarkers. We now demonstrate that inhibition of IL8 receptor, CXCR2, leads to decreased invasiveness of esophageal adenocarcinoma derived cells without affecting cellular proliferation. Taken together, these studies reveal the important roles that chemokines play in development of esophageal cancer and demonstrate that these pathways can serve as potential therapeutic targets.
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Papers by Zulfiqar Hussain