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1.  Association of bronchoalveolar lavage yield with chest computed tomography findings and symptoms in immunocompromised patients 
Annals of Thoracic Medicine  2013;8(3):153-159.
Fiber-optic bronchoscopy (FOB) with bronchoalveolar lavage (BAL) is a common procedure performed in immunocompromised patients with undiagnosed pulmonary pathology. Identifying patients with the highest potential diagnostic yield may help to avoid morbidity in patients unlikely to benefit from the procedure. We sought to determine which patient factors, specifically chest computed tomography (CT) findings, affected diagnostic yield of BAL.
Retrospective chart review of immunocompromised patients who underwent FOB with BAL from 01/01/2010 to 12/31/2011 at an academic medical center was performed. The lung lobe lavaged, characteristics of pulmonary infiltrate on radiograph, patient symptoms, and diagnostic yield were collected. A positive diagnostic yield was defined as a positive microbiological culture, finding on cytopathologic staining, diffuse alveolar hemorrhage, alveolar eosinophilia or a positive immunologic or nucleic acid assay.
The overall diagnostic yield was 52.6%. Infiltrates that were predominantly reticular or nodular by CT had a lower diagnostic yield than predominantly consolidated, ground-glass, or tree-in-bud infiltrates (36.5% vs. 61.2%, P = 0.0058). The diagnostic yield was significantly improved in patients with both fever and chest symptoms compared to patients without symptoms (61.3% vs. 29.6%, P = 0.0066).
CT findings of reticular and nodular infiltrates portend a worse diagnostic yield from BAL than those that are alveolar in nature. Symptomatic patients are more likely to have diagnostic FOB with BAL than asymptomatic patients.
PMCID: PMC3731857  PMID: 23922610
Bronchoscopy; computed tomography; immunodeficiency; respiratory infection; respiratory symptoms
2.  Hepcidin in anemia of chronic heart failure 
American journal of hematology  2011;86(1):107-109.
Anemia is a common finding among patients with chronic heart failure. Although co-morbidities, such as kidney failure, might contribute to the pathogenesis of anemia, many patients with heart failure do not have any other obvious etiology for their anemia. We investigated whether anemia in heart failure is associated with an elevation in hepcidin concentration.
We used time-of-flight mass spectrometry to measure hepcidin concentration in urine and serum samples of patients with heart failure and in control subjects. We found that the concentration of hepcidin was lower in urine samples of patients with heart failure compared to those of control subjects. Serum hepcidin was also reduced in heart failure but was not significantly lower than that in controls. There were no significant differences between hepcidin levels in patients with heart failure and anemia compared to patients with heart failure and normal hemoglobin. We concluded that hepcidin probably does not play a major role in pathogenesis of anemia in patients with chronic heart failure.
PMCID: PMC3076004  PMID: 21080339
Anemias; Cytokines; Iron
3.  An in vitro study comparing a peripherally inserted central catheter to a conventional central venous catheter: no difference in static and dynamic pressure transmission 
BMC Anesthesiology  2010;10:18.
Early goal directed therapy improves survival in patients with septic shock. Central venous pressure (CVP) monitoring is essential to guide adequate resuscitation. Use of peripherally inserted central catheters (PICC) is increasing, but little data exists comparing a PICC to a conventional CVP catheter. We studied the accuracy of a novel PICC to transmit static and dynamic pressures in vitro.
We designed a device to generate controlled pressures via a column of water allowing simultaneous measurements from a PICC and a standard triple lumen catheter. Digital transducers were used to obtain all pressure readings. Measurements of static pressures over a physiologic range were recorded using 5Fr and 6Fr dual lumen PICCs. Additionally, random repetitive pressure pulses were applied to the column of water to simulate physiologic intravascular pressure variations. The resultant PICC and control waveforms were recorded simultaneously.
Six-hundred thirty measurements were made using the 5 Fr and 6 Fr PICCs. The average bias determined by Bland-Altman plot was 0.043 mmHg for 5 Fr PICC and 0.023 mmHg for 6 Fr PICC with a difference range of 1.0 to -1.0. The correlation coefficient for both catheters was 1.0 (p-value < 0.001). Dynamic pressure waveforms plotted simultaneously between PICC and control revealed equal peaks and troughs.
In vitro, no static or dynamic pressure differences were found between the PICC and a conventional CVP catheter. Clinical studies are required to assess whether the novel PICC has bedside equivalence to conventional catheters when measuring central venous pressures.
PMCID: PMC2964716  PMID: 20939919
4.  Phytoliths in woody plants from the Miombo woodlands of Mozambique 
Annals of Botany  2009;104(1):91-113.
Background and Aims
There are no descriptions of phytoliths produced by plants from the ‘Zambezian’ zone, where Miombo woodlands are the dominant element of the largest single phytochorion in sub-Saharan Africa. The preservation of phytoliths in fossil records of Africa makes phytoliths a tool to study early plant communities. Paleo-ethnobotanical interpretation of phytoliths relies on the comparison of ancient types with morphotypes extracted from living reference collections.
Phytoliths were extracted from plant samples representing 41 families, 77 genera and 90 species through sonic cleaning, dry ashing and acid treatment; and phytoliths thus extracted were quantified. For each species, an average of 216 phytoliths were counted. The percentage of each morphotype identified per species was calculated, and types were described according to the descriptors from the International Code for Phytolith Nomenclature. Phytolith assemblages were subject to discriminant analysis, cluster analysis and principal component analysis.
Key Results
Phytoliths were grouped into 57 morphotypes (two were articulated forms and 55 were discrete shapes), and provide a reference collection of phytolith assemblages produced by Miombo woody species. Common and unique morphotypes are described and taxonomic and grouping variables are looked into from a statistical perspective.
The first quantitative taxonomy of phytoliths from Miombos is presented here, including new types and constituting the most extensive phytolith key for any African ecoregion. Evidence is presented that local woody species are hypervariable silica producers and their phytolith morphotypes are highly polymorphic. The taxonomic significance of these phytoliths is largely poor, but there are important exceptions that include the morphotypes produced by members from >10 families and orders. The typical phytolithic signal that would allow scientists to identify ancient woodlands of ‘Zambezian’ affiliation comprises only half of the original number of phytoliths originally produced and might favour the more resilient blocky, cylindroid, globular and tabular forms.
PMCID: PMC2706725  PMID: 19429923
Africa; Mozambique; Niassa; Miombo; phytolith analysis; reference collection; quantitative methods; principal component analysis; cluster analysis; discriminant analysis
5.  Convalescent Pulmonary Dysfunction Following Hantavirus Pulmonary Syndrome in Panama and the United States 
Lung  2010;188(5):387-391.
The objective of this study was to document persistent pulmonary symptoms and pulmonary function abnormalities in adults surviving hantavirus pulmonary syndrome (HPS). Acute infection by most hantaviruses result in mortality rates of 25–35%, while in Panama the mortality rate of 10% is contrasted by an unusually high incidence. In all types of HPS, the viral prodrome, cardiopulmonary phase due to massive pulmonary capillary leak syndrome, and spontaneous diuresis are followed by a convalescent phase with exertional dyspnea for 3–4 weeks, but the frequency of persistent symptoms is not known. In this observational study of a convenience sample, 14 survivors of HPS caused by Choclo virus infection in Panama and 9 survivors of HPS caused by Sin Nombre virus infection in New Mexico completed a questionnaire and pulmonary function tests up to 8 years after infection. In both groups, exertional dyspnea persisted for 1–2 years after acute infection in 43% (Panama) and 77% (New Mexico) of survivors surveyed. Reduction in midexpiratory flows (FEF25–75%), increased residual volume (RV), and reduced diffusion capacity (DLCO/VA) also were common in both populations; but the severity of reduced expiratory flow did not correlate with exertional dyspnea. Symptoms referable to previous hantavirus infection had resolved within 3 years of acute infection in most but not all patients in the Panama group. Temporary exertional dyspnea and reduced expiratory flow are common in early convalescence after HPS but resolves in almost all patients.
PMCID: PMC2939327  PMID: 20524006
Hantavirus; Pneumonia; Pulmonary function test

Results 1-5 (5)