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COPD in Smoking and Non-Smoking Community Members Exposed to the World Trade Center Dust and Fumes

Baba, Ridhwan Y; Zhang, Yian; Shao, Yongzhao; Berger, Kenneth I; Goldring, Roberta M; Liu, Mengling; Kazeros, Angeliki; Rosen, Rebecca; Reibman, Joan
BACKGROUND:The characteristics of community members exposed to World Trade Center (WTC) dust and fumes with Chronic Obstructive Pulmonary Disease (COPD) can provide insight into mechanisms of airflow obstruction in response to an environmental insult, with potential implications for interventions. METHODS:We performed a baseline assessment of respiratory symptoms, spirometry, small airway lung function measures using respiratory impulse oscillometry (IOS), and blood biomarkers. COPD was defined by the 2019 GOLD criteria for COPD. Patients in the WTC Environmental Health Center with <5 or ≥5 pack year smoking history were classified as nonsmoker-COPD (ns-COPD) or smoker-COPD (sm-COPD), respectively. MAIN RESULTS/RESULTS:= 0.007). CONCLUSIONS:Spirometry findings and small airway measures, as well as inflammatory markers, differed between patients with ns-COPD and sm-COPD. These findings suggest potential for differing mechanisms of airway injury in patients with WTC environmental exposures and have potential therapeutic implications.
PMCID:8999000
PMID: 35409931
ISSN: 1660-4601
CID: 5192332

Characterization of Persistent Uncontrolled Asthma Symptoms in Community Members Exposed to World Trade Center Dust and Fumes

Reibman, Joan; Caplan-Shaw, Caralee; Wu, Yinxiang; Liu, Mengling; Amin, Milan R; Berger, Kenneth I; Cotrina-Vidal, Maria L; Kazeros, Angeliki; Durmus, Nedim; Fernandez-Beros, Maria-Elena; Goldring, Roberta M; Rosen, Rebecca; Shao, Yongzhao
The destruction of the World Trade Center (WTC) towers on the 11th of September, 2001 released a vast amount of aerosolized dust and smoke resulting in acute and chronic exposures to community members as well as responders. The WTC Environmental Health Center (WTC EHC) is a surveillance and treatment program for a diverse population of community members, including local residents and local workers with WTC dust exposure. Many of these patients have reported persistent lower respiratory symptoms (LRS) despite treatment for presumed asthma. Our goal was to identify conditions associated with persistent uncontrolled LRS despite standard asthma management. We recruited 60 patients who were uncontrolled at enrollment and, after a three-month run-in period on high-dose inhaled corticosteroid and long acting bronchodilator, reassessed their status as Uncontrolled or Controlled based on a score from the Asthma Control Test (ACT). Despite this treatment, only 11 participants (18%) gained Controlled status as defined by the ACT. We compared conditions associated with Uncontrolled and Controlled status. Those with Uncontrolled symptoms had higher rates of upper airway symptoms. Many patients had persistent bronchial hyper-reactivity (BHR) and upper airway hyper-reactivity as measured by paradoxical vocal fold movement (PVFM). We found a significant increasing trend in the percentage of Controlled with respect to the presence of BHR and PVFM. We were unable to identify significant differences in lung function or inflammatory markers in this small group. Our findings suggest persistent upper and lower airway hyper-reactivity that may respond to standard asthma treatment, whereas others with persistent LRS necessitate additional diagnostic evaluation, including a focus on the upper airway.
PMID: 32933057
ISSN: 1660-4601
CID: 4592962

Clinical Evaluation of Sarcoidosis in Community Members with World Trade Center Dust Exposure

Hena, Kerry M; Murphy, Scarlett; Zhang, Yian; Shao, Yongzhao; Kazeros, Angeliki; Reibman, Joan
Background: Sarcoidosis is a granulomatous disease involving intrathoracic and extrathoracic organs. Genetic and environmental factors, such as exposure to World-Trade Center (WTC) dust after 9/11, may play a role in clinical presentation. Characterization of sarcoidosis in community members with exposure to the WTC dust can provide further insight into the relationship between environmental exposure and sarcoidosis. Methods: Patients with documented sarcoidosis were identified in the WTC Environmental Health Center (EHC), a treatment program for community members. Demographic and clinical data were collected from standardized questionnaires and chart review. Organ involvement was assessed with a standard instrument. Results: Among patients in the WTC EHC, 87 were identified with sarcoidosis after 9/11. Sarcoidosis cases were more likely African-American, local workers, and had more respiratory symptoms, compared with non-sarcoidosis WTC EHC patients. Many (46%) had ≥ Scadding stage 3 on chest imaging, and had reduced lung function measures. Extrathoracic involvement was identified in 33/87 (38%) with a diversity of organs involved. Conclusions: WTC-exposed sarcoidosis in community members is often characterized by severe pulmonary disease and a high rate of diverse extrathoracic involvement. Further analysis is required to characterize the course of disease progression or resolution.
PMCID:6480441
PMID: 30974916
ISSN: 1660-4601
CID: 3908692

A Unifying Diagnosis: IgG4-Related Disease

Broderick, Rachel; Kazeros, Angeliki; Beniaminovitz, Ainat; Fazlollahi, Ladan; Yi, Pauline; Brogno, David; Nickerson, Katherine G
PMID: 30075107
ISSN: 1555-7162
CID: 3217602

I went to new york city and all i got was a heimlich valve: conservative management of tb empyema with a bronchopleural fistula [Meeting Abstract]

Lam, J; Kazeros, A
INTRODUCTION: Tuberculous (TB) empyema with a bronchopleural fistula (BPF) is a late-stage presentation of active infection within the pleural space that is rare and difficult to treat. We report a case of a patient with TB empyema complicated by a BPF, which was managed conservatively with anti-TB medications and nonsurgical intervention. CASE PRESENTATION: A 45 year old male from Guyana with hypertension presented with shortness of breath and dyspnea on exertion. He denied fevers, chills, night sweats and cough but endorsed an unintentional weight loss of 20 lbs over the past month. He had a large left sided pleural effusion which drained a purulent fluid with a pH of 6.9, WBC 63120 Polys85%, RBC 1400. A chest tube was placed and he was started on broad spectrum antibiotics for empiric coverage. However, when AFB stains returned positive, he was given isoniazid, rifampin, pyrazinamide and ethambutol. Pleural fluid cultures grew mycobacterium tuberculosis. Multiple attempts were made to remove the chest tube by weaning suction and with clamp trials but an air leak persisted. A chest CT showed a thickened pleura and a clear BPF track which explained our findings at the bedside. The decision was made to manage the BPF conservatively with low suction and the eventual placement of a Heimlich valve. A follow-up CT scan was performed and the BPF was still present but the fistula track appeared to have diminished. Patient tolerated the Heimlich valve and was discharged from the hospital with recommendations for close follow-up with pulmonary and cardiothoracic surgery. DISCUSSION: In patients with difficult-to-treat TB empyema complicated by BPF, surgical interventions such as decortication, pneumonectomy and thoracoplasty can be attempted, but these are invasive procedures with variable outcomes. Conservative management with a Heimlich valve will likely not fully re-expand the lung given the thickened visceral pleura but may allow enough time for the fistula track to begin to heal, as seen in our patient, and hopefully close completely. CONCLUSIONS: A conservative approach may allow a patient with TB empyema and BPF to avoid more invasive procedures and may allow for an improved quality of life
EMBASE:619296911
ISSN: 1931-3543
CID: 2860142

Elevated C-reactive protein and posttraumatic stress pathology among survivors of the 9/11 World Trade Center attacks

Rosen, Rebecca L; Levy-Carrick, Nomi; Reibman, Joan; Xu, Ning; Shao, Yongzhao; Liu, Mengling; Ferri, Lucia; Kazeros, Angeliki; Caplan-Shaw, Caralee E; Pradhan, Deepak R; Marmor, Michael; Galatzer-Levy, Isaac R
BACKGROUND: Systemic inflammation has emerged as a promising marker and potential mechanism underlying post-traumatic stress disorder (PTSD). The relationship between posttraumatic stress pathology and systemic inflammation has not, however, been consistently replicated and is potentially confounded by comorbid illness or injury, common complications of trauma exposure. METHODS: We analyzed a large naturalistic cohort sharing a discrete physical and mental health trauma from the destruction of the World Trade Center (WTC) towers on September 11, 2001 (n = 641). We evaluated the relationship between multiple physical and mental health related indices collected through routine evaluations at the WTC Environmental Health Center (WTC EHC), a treatment program for community members exposed to the disaster. C-Reactive Protein (CRP), a marker of systemic inflammation, was examined in relation to scores for PTSD, PTSD symptom clusters (re-experiencing, avoidance, negative cognitions/mood, arousal), depression and anxiety, while controlling for WTC exposures, lower respiratory symptoms, age, sex, BMI and smoking as potential risks or confounders. RESULTS: CRP was positively associated with PTSD severity (p < 0.001), trending toward association with depression (p = 0.06), but not with anxiety (p = 0.27). CRP was positively associated with re-experiencing (p < 0.001) and avoidance (p < 0.05) symptom clusters, and trended toward associations with negative cognitions/mood (p = 0.06) and arousal (p = 0.08). CONCLUSIONS: In this large study of the relationship between CRP and posttraumatic stress pathology, we demonstrated an association between systemic inflammation and stress pathology (PTSD; trending with depression), which remained after adjusting for potentially confounding variables. These results contribute to research findings suggesting a salient relationship between inflammation and posttraumatic stress pathology.
PMID: 28135632
ISSN: 1879-1379
CID: 2425042

Paresthesias Among Community Members Exposed To The World Trade Center Disaster

Marmor, Michael; Shao, Yongzhao; Bhatt, D Harshad; Stecker, Mark M; Berger, Kenneth I; Goldring, Roberta M; Rosen, Rebecca L; Caplan-Shaw, Caralee; Kazeros, Angeliki; Pradhan, Deepak; Wilkenfeld, Marc; Reibman, Joan
OBJECTIVE: Paresthesias can result from metabolic disorders, nerve entrapment following repetitive motions, hyperventilation pursuant to anxiety, or exposure to neurotoxins. We analyzed data from community members exposed to the World Trade Center (WTC) disaster of September 11, 2001, to evaluate whether exposure to the disaster was associated with paresthesias. METHODS: Analysis of data from 3141 patients of the WTC Environmental Health Center. RESULTS: Fifty-six percent of patients reported paresthesias at enrollment 7 to 15 years following the WTC disaster. After controlling for potential confounders, paresthesias were associated with severity of exposure to the WTC dust cloud and working in a job requiring cleaning of WTC dust. CONCLUSIONS: This study suggests that paresthesias were commonly associated with WTC-related exposures or post-WTC cleaning work. Further studies should objectively characterize these paresthesias and seek to identify relevant neurotoxins or paresthesia-inducing activities.This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0.
PMCID:5374747
PMID: 28157767
ISSN: 1536-5948
CID: 2437202

A Case Of A Rare Isoniazid Related Neurotoxicity [Meeting Abstract]

Andriotis, A; Ahmed, N; Kazeros, A
ISI:000400372505815
ISSN: 1535-4970
CID: 2591272

Progressive Restrictive Pulmonary Dysfunction As An Effect Of Small-Airway Destruction: The Ongoing Havoc Of 9/11/2001 [Meeting Abstract]

Riggs, J; Hossain, T; Goldring, RM; Shao, Y; Liu, M; Kazeros, A; Caplan-Shaw, CE; Oppenheimer, BW; Reibman, J; Berger, KI
ISI:000400372501707
ISSN: 1535-4970
CID: 2590962

Sleep Disordered Breathing Characteristics In Patients In The World Trade Center Program For Community Members [Meeting Abstract]

Ahuja, SB; Zhu, Z; Shao, Y; Reibman, J; Berger, KI; Goldring, RM; Caplan-Shaw, CE; Kazeros, A; Ahmed, O
ISI:000400372503396
ISSN: 1535-4970
CID: 2591042