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Alviar, Carlos L.; Postelnicu, Radu; Pradhan, Deepak R.; Hena, Kerry M.; Chitkara, Nishay; Milland, Thor; Mukherjee, Vikramjit; Uppal, Amit; Goldberg, Randal I.; Divita, Michael; Asef, Fariha; Wan, Kah Loon; Vlahakis, Susan; Patel, Mansi; Mertola, Ma-Rosario; Stasolla, Vito; Bianco, Lauren; Nunemacher, Kayla M.; Yunaev, Victoria; Howe, William B.; Cruz, Jennifer; Bernard, Samuel; Bangalore, Sripal; Keller, Norma M.
ISSN: 0012-3692
CID: 5523002

Respiratory Mechanics and Association With Inflammation in COVID-19-Related ARDS

Bhatt, Alok; Deshwal, Himanshu; Luoma, Kelsey; Fenianos, Madelin; Hena, Kerry; Chitkara, Nishay; Zhong, Hua; Mukherjee, Vikramjit
BACKGROUND:The novel coronavirus-associated ARDS (COVID-19 ARDS) often requires invasive mechanical ventilation. A spectrum of atypical ARDS with different phenotypes (high vs low static compliance) has been hypothesized in COVID-19. METHODS:test, chi-square test, ANOVA test, and Pearson correlation was used to identify relationship between subject variables and respiratory mechanics. The primary outcome was duration of mechanical ventilation. Secondary outcomes were correlation between fluid status, C- reactive protein, PEEP, and D-dimer with respiratory and ventilatory parameters. RESULTS:= .02). CONCLUSIONS:In our cohort of mechanically ventilated COVID-19 ARDS subjects, high PEEP and D-dimer were associated with increase in physiologic dead space without significant effect on oxygenation, raising the question of potential microvascular dysfunction.
PMID: 34521759
ISSN: 1943-3654
CID: 5038882

PAP Adherence and Nasal Resistance: A Randomized Control Trial of CPAPFlex vs CPAP

Sunderram, Jag; Ayappa, Indu; Lu, Shou-En; Wang, Han; Black, Kathleen; Twumasi, Akosua; Sanders, Haley; Harrison, Denise; Udasin, Iris; Chitkara, Nishay; de la Hoz, Rafael E; Carson, Jeffrey L; Rapoport, David M
RATIONALE/BACKGROUND:) may reduce discomfort in those with high nasal resistance and improve adherence in this subgroup. OBJECTIVES/OBJECTIVE:improves adherence over CPAP in subjects with high nasal resistance. METHODS:versus CPAP in World Trade Center dust-exposed subjects with OSA stratified by nasal resistance measured by 4-Phase Rhinomanometry. RESULTS:(mean Δ hours (95% CI)) in subjects with low resistance (0.33h (-0.10, 0.76)) or high nasal resistance (0.26h (-0.14, 0.66)). No significant differences were observed in any of the secondary outcomes between PAP modes. CONCLUSIONS:than to CPAP in subjects with high or low nasal resistance, and, show clinically insignificant better adherence overall with CPAP. Clinical Trial registered with (NCT01753999).
PMID: 33202147
ISSN: 2325-6621
CID: 4672622

Clinical Outcomes in Critically Ill Coronavirus Disease 2019 Patients: A Unique New York City Public Hospital Experience

Mukherjee, Vikramjit; Toth, Alexander T; Fenianos, Madelin; Martell, Sarah; Karpel, Hannah C; Postelnicu, Radu; Bhatt, Alok; Deshwal, Himanshu; Kreiger-Benson, Elana; Brill, Kenneth; Goldlust, Sandra; Nair, Sunil; Walsh, B Corbett; Ellenberg, David; Magda, Gabriela; Pradhan, Deepak; Uppal, Amit; Hena, Kerry; Chitkara, Nishay; Alviar, Carlos L; Basavaraj, Ashwin; Luoma, Kelsey; Link, Nathan; Bails, Douglas; Addrizzo-Harris, Doreen; Sterman, Daniel H
To explore demographics, comorbidities, transfers, and mortality in critically ill patients with confirmed severe acute respiratory syndrome coronavirus 2.
PMID: 32885172
ISSN: 2639-8028
CID: 4583592

Chronic Rhinosinusitis Is an Independent Risk Factor for OSA in World Trade Center Responders

Sunderram, Jag; Weintraub, Michael; Black, Kathleen; Alimokhtari, Shahnaz; Twumasi, Akosua; Sanders, Haley; Udasin, Iris; Harrison, Denise; Chitkara, Nishay; de la Hoz, Rafael E; Lu, Shou-En; Rapoport, David M; Ayappa, Indu
BACKGROUND:Many respiratory conditions have been attributed to toxic dust and fume exposure in World Trade Center (WTC) rescue and recovery workers, who frequently report symptoms of OSA. We examined the prevalence of new-onset OSA and tested if the prevalence and severity of OSA are related to the presence of chronic rhinosinusitis (CRS). METHODS:) enrolled in the WTC Health Program, excluding those with significant pre-September 11, 2001, snoring or prior CRS, underwent two nights of home sleep testing. OSA was defined as Apnea Hypopnea Index 4% ≥ 5 events/h or respiratory disturbance index of ≥ 15 events/h. CRS was assessed using nasal symptom questionnaires. RESULTS:The prevalence of OSA was 75% (25% no OSA, 46% mild OSA, 19% moderate OSA, and 10% severe OSA), and the prevalence of CRS was 43.5%. Compared with no CRS, new and worsening CRS was a significant risk factor for OSA with an OR of 1.80 (95% CI, 1.18-2.73; P = .006) unadjusted and 1.76 (95% CI, 1.08-2.88; P = .02) after adjustment for age, BMI, sex, gastroesophageal reflux disorder, and alcohol use. CONCLUSIONS:The high prevalence of OSA in WTC responders was not explained fully by obesity and sex. Possible mechanisms for the elevated risk of OSA in subjects with CRS include increased upper airway inflammation and/or elevated nasal/upper airway resistance, but these need confirmation.
PMID: 30739642
ISSN: 1931-3543
CID: 3655972

Severe Obstructive Sleep Apnea is Associated with Alterations in the Nasal Microbiome and Increase in Inflammation

Wu, Benjamin G; Sulaiman, Imran; Wang, Jing; Shen, Nan; Clemente, Jose C; Li, Yonghua; Laumbach, Robert J; Lu, Shou-En; Udasin, Iris; Le-Hoang, Oanh; Perez, Alan; Alimokhtari, Shahnaz; Black, Kathleen; Plietz, Michael; Twumasi, Akosua; Sanders, Haley; Melacha, Patrick; Kapoor, Bianca; Scaglione, Benjamin D; Wang, Anbang; Blazoski, Cameron; Weiden, Michael D; Rapoport, David M; Harrison, Denise; Chitkara, Nishay; Vicente, Eugenio; Marin, José M; Sunderram, Jag; Ayappa, Indu; Segal, Leopoldo N
RATIONALE/BACKGROUND:Obstructive Sleep Apnea (OSA) is associated with recurrent obstruction, sub-epithelial edema, and airway inflammation. The resultant inflammation may influence or be influenced by the nasal microbiome. OBJECTIVES/OBJECTIVE:To evaluate whether the composition of the nasal microbiota is associated with obstructive sleep apnea and inflammatory biomarkers. METHODS:Two large cohorts were utilized: 1) a discovery cohort of 472 subjects from the WTCSNORE cohort; and 2) a validation cohort of 93 subjects from the Zaragoza Sleep cohort. Sleep apnea was diagnosed using home sleep tests. Nasal lavages were obtained from cohort subjects to measure: 1) microbiome composition (based on 16S rRNA gene sequencing); 2) biomarkers for inflammation (inflammatory cells, IL-8, and IL-6). Longitudinal 3 months samples were obtained in the validation cohort including post-CPAP treatment when indicated. RESULTS:In both cohorts, we identified that: 1) severity of OSA correlated with differences in microbiome diversity and composition; 2) the nasal microbiome of subjects with severe OSA were enriched with Streptococcus, Prevotella, and Veillonella; 3) the nasal microbiome differences were associated with inflammatory biomarkers. Network analysis identified clusters of co-occurring microbes that defined communities. Several common oral commensals (e.g., Streptococcus, Rothia, Veillonella, and Fusobacterium) correlated with apnea-hypopnea index. Three months of treatment with CPAP did not change the composition of the nasal microbiota. CONCLUSIONS:We demonstrate that the presence of an altered microbiome in severe OSA is associated with inflammatory markers. Further experimental approaches to explore causal links are needed.
PMID: 29969291
ISSN: 1535-4970
CID: 3186082


Bagchi, N.; Sanders, H.; Chen, Y.; Black, K.; Twumasi, A.; Udasin, I; Harrison, D.; Chitkara, N.; Rapoport, D. M.; Ayappa, I; Lu, S.; Sunderram, J.
ISSN: 1550-9109
CID: 3114262

Adherence to Continuous Positive Airway Pressure in World Trade Center Responders with Obstructive Sleep Apnea. Role of Nasal Pathology [Meeting Abstract]

Sunderram, J.; Lu, S.; Wang, H.; Twumasi, A.; Perez, A.; Black, K.; Nicholas, C.; Sanders, H.; Carson, J. A.; Udasin, I.; Harrison, D. J.; Chitkara, N.; Rapoport, D. M.; Ayappa, I. A.
ISSN: 1073-449x
CID: 3512792

Pulmonary Eosinophilia Secondary to Topiramate Use [Meeting Abstract]

Pillai, Ray; Doo, Kathleen; Chitkara, Nishay
ISSN: 0012-3692
CID: 3332632

Systemic Mastocytosis With Pulmonary Involvement [Meeting Abstract]

Pillai, Ray; Maehara, Darren; Chitkara, Nishay
ISSN: 0012-3692
CID: 3332642