Alicia Thomas

Obesity and Pulmonary Function in African Americans

Background Obesity prevalence in United States (US) adults exceeds 30% with highest prevalence being among blacks. Obesity is known to have significant effects on respiratory function and obese patients commonly report respiratory complaints requiring pulmonary function tests (PFTs). However, there is no large study showing the relationship between body mass index (BMI) and PFTs in healthy African Americans (AA). Objective To determine the effect of BMI on PFTs in AA patients who did not have evidence of underlying diseases of the respiratory system. Methods We reviewed PFTs of 339 individuals sent for lung function testing who had normal spirometry and lung diffusion capacity for carbon monoxide (DLCO) with wide range of BMI. Results Functional residual capacity (FRC) and expiratory reserve volume (ERV) decreased exponentially with increasing BMI, such that morbid obesity resulted in patients breathing near their residual volume (RV). However, the effects on the extremes of lung volumes, at total lung capacity (TLC) and residual volume (RV) were modest. There was a significant linear inverse relationship between BMI and DLCO, but the group means values remained within the normal ranges even for morbidly obese patients. Conclusions We showed that BMI has significant effects on lung function in AA adults and the greatest effects were on FRC and ERV, which occurred at BMI values < 30 kg/m2. These physiological effects of weight gain should be considered when interpreting PFTs and their effects on respiratory symptoms even in the absence of disease and may also exaggerate existing lung diseases.

Body Mass Index and Intensive Care Unit Outcomes in African American Patients

PURPOSE We sought to determine whether body mass index (BMI) is associated with worse intensive care unit (ICU) outcomes among Black patients. METHODS Patients admitted to the medical ICU during 2012 were categorized into six BMI groups based on the World Health Organization criteria. ICU mortality, ICU and hospital length of stay (LOS), need for and duration of mechanical ventilation and organ failure rate were assessed. RESULTS A total of 605 patients with mean age 58.9 ± 16.0 years were studied. Compared with those with normal BMI, obese patients had significant higher rates of hypertension, diabetes mellitus and obstructive sleep apnea diagnoses (P<.001 for all). A total of 100 (16.5%) patients died during their ICU stay. Obesity was not associated with increased odds of ICU mortality (OR=.58; 95% CI, .16-2.20). Moreover, improved survival was observed for class II obese patients (OR, .031; 95% CI, .001-.863). There were no differences in the need for and duration of mechanical ventilation between the BMI groups. However, ICU and hospital LOS were significantly longer in patients with obesity. CONCLUSION Obesity was not associated with increased ICU mortality; however, obesity was associated with increased comorbid illness and with significant longer ICU and hospital length of stay.

A Case of Large, Hemodynamically Significant Abdominal Wall Hematoma Following Paracentesis in a Cirrhotic Patient

Paracentesis is a safe procedure with severe bleeding occurring in less than 1% of cases. Paracentesis is often times performed as an outpatient procedure. Hemorrhagic complications can be rapidly fatal if not diagnosed and treated in a timely fashion. We present the case of a 55-year-old female with decompensated cirrhosis who developed hemodynamically significant bleeding post paracentesis. This case brings up the question whether certain patients who undergo paracentesis should be admitted for close observation for at least 24 hours after the procedure. It also identifies the need for more research into pre-operative risk factors in cirrhotics that predisposes them to severe bleeding.

Anoxic Brain Injury Presenting as Pseudosubarachnoid Hemorrhage in the Medical Intensive Care Unit

Anoxic encephalopathy is frequently encountered in the medical intensive care unit (ICU). Cerebral edema as a result of anoxic brain injury can result in increased attenuation in the basal cisterns and subarachnoid spaces on computerized tomography (CT) scans of the head. These findings can mimic those seen in acute subarachnoid hemorrhage (SAH) and are referred to as pseudosubarachnoid hemorrhage (pseudo-SAH). Pseudo-SAH is a diagnosis critical care physicians should be aware of as they treat and evaluate their patients with presumed SAH, which is a medical emergency. This lack of awareness could have important clinical implications on outcomes and impact management decisions if patients with anoxic brain injury are inappropriately treated for SAH. We describe three patients who presented to the hospital with anoxic brain injury. Subsequent CT head suggested SAH, which was subsequently proven to be pseudo-SAH.

Postpartum Tuberculosis: A Diagnostic and Therapeutic Challenge

Tuberculosis (TB) infection in pregnant women and newborn babies is always challenging. Appropriate treatment is pivotal to curtail morbidity and mortality. TB diagnosis or exposure to active TB can be emotionally distressing to the mother. Circumstances can become more challenging for the physician if the mothers TB status is unclear. Effective management of TB during pregnancy and the postpartum period requires a multidisciplinary approach including pulmonologist, obstetrician, neonatologist, infectious disease specialist, and TB public health department. Current guidelines recommend primary Isoniazid prophylaxis in TB exposed pregnant women who are immune-suppressed and have chronic medical conditions or obstetric risk factors and close and sustained contact with a patient with infectious TB. Treatment during pregnancy is the same as for the general adult population. Infants born to mothers with active TB at delivery should undergo a complete diagnostic evaluation. Primary Isoniazid prophylaxis for at least twelve weeks is recommended for those with negative diagnostic tests and no evidence of disease. Repeated negative diagnostic tests are mandatory before interrupting prophylaxis. Separation of mother and infant is only necessary when the mother has received treatment for less than 2 weeks, is sputum smear-positive, or has drug-resistant TB. This case highlights important aspects for management of TB during the postpartum period which has a higher morbidity. We present a case of a young mother migrating from a developing nation to the USA, who was found to have a positive quantiFERON test associated with multiple cavitary lung lesions and gave birth to a healthy baby.

Abstract 654: The effect of lung cancer screening awareness on smoking behavior among U.S. adults

Proceedings: AACR 103rd Annual Meeting 2012‐‐ Mar 31‐Apr 4, 2012; Chicago, IL Background: Emphasizing the risk of lung cancer can encourage smoking cessation, but use of spiral low-dose CT scans reduced lung cancer mortality in a recent randomized screening trial. It is unknown if awareness of lung cancer screening will influence smoking behavior. Aim: To evaluate the awareness of lung cancer screening and to determine if awareness of lung cancer screening affects smoking cessation-related behavior among current smokers. Methods: We identified 7,282 adult respondents who answered questions concerning their smoking-related behavior in the 2007 Health Information National Trends Survey (HINTS). We used logistic regression models to evaluate the association of smoking status with awareness of lung cancer screening and we also investigated the association of lung cancer screening awareness with smoking cessation behaviors among current smokers. Results: The mean age of responders was 54.1 years and 61.2% were females. There were 3,813 (52.4%) never smokers; 2,222 (30.5%) former smokers; and 1,247 (17.2%) current smokers. Overall, 2,183 (30.6%) of respondents had heard of a lung cancer screening test (29.6% never smokers, 33.4% former smokers, and 28.5% current smokers; P value = 0.002). Chest X-ray (64.4%) and CT scan (5.7%) were among the screening tests that they have heard of. Among current smokers, awareness of lung cancer screening had no effect on smoking cessation behavior after adjusting for age, sex, race, education, income and marital status (Table). Conclusion: Awareness of lung cancer screening tests did not affect smoking cessation behavior of current smokers. However, smoking cessation should be recommended for all current smokers and those with a history of smoking should be informed about lung cancer screening with CT scan. ![Figure][1] Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 654. doi:1538-7445.AM2012-654 [1]: pending:yes