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Au S.,University of Illinois at Chicago | Fancher W.,University of Illinois at Chicago | Scribner J.,University of Illinois at Chicago | Scribner J.,James vell Federal Health Care Center
Dermatology Online Journal | Year: 2016

There has been increasing interest in minimally invasive approaches to treat pyogenic granulomas. We report successful treatment of a pyogenic granuloma in a pediatric patient on a functionally and cosmetically sensitive area using the 1064nm Nd:YAG laser. © 2016, Dermatology Online Journal. All rights reserved.


Nadeem R.,James vell Federal Health Care Center | Nadeem R.,Rosalind Franklin University of Medicine and Science | Molnar J.,Rosalind Franklin University of Medicine and Science | Madbouly E.M.,James vell Federal Health Care Center | And 5 more authors.
Journal of Clinical Sleep Medicine | Year: 2013

Study Objectives: Obstructive sleep apnea (OSA) has been linked to and is associated with increased cardiovascular and cerebrovascular morbidity. Ongoing inflammatory responses play an important role in this association. Multiple small size studies addressing the profile of the inflammatory markers in OSA are available therefore we performed a meta-analysis. Methods: Systematic review of medical literature was conducted using PubMed, Cochrane, and EMBASE databases from 1968 to 2011 by utilizing the key words obstructive sleep apnea, C-Reactive protein, tumor necrosis factor alpha (TNF-α), interleukin 6 (IL-6), interleukin 8 (IL-8), intercellular adhesion molecule (ICAM), vascular cell adhesion molecule (VCAM) and Selectins. Inclusion criteria were: full text English articles; studies with adult population; reported values for at least one of the markers of interest; with at least two separate groups (subjects with OSA and control group); OSA was defined as AHI of ≥ 5/h. Results: Five hundred and twelve studies were reviewed for inclusion with 51 studies pooled for analysis (30 studies for CRP, 19 studies for TNF-α, 8 studies for ICAM, 18 studies for IL-6, six studies for VCAM and 5 studies for Selectins). The levels of inflammatory markers were higher in patients with OSA compared to control group. Standardized pooled Mean differences were calculated to be 1.77 for CRP, 1.03 for TNF-α, 2.16 for IL-6, 4.22 for IL-8, 2.93 for ICAM, 1.45 for Selectins and 2.08 for VCAM. Conclusions: In this meta-analysis, the levels of systemic inflammatory markers were found to be higher in OSA patients compared to control subjects.


Nadeem R.,James vell Federal Health Care Center | Rishi M.A.,Rosalind Franklin University of Medicine and Science | Srinivasan L.,Rosalind Franklin University of Medicine and Science | Copur A.S.,Rosalind Franklin University of Medicine and Science | Naseem J.,James vell Federal Health Care Center
Respiratory Care | Year: 2013

BACKGROUND: CPAP is considered to be the cornerstone of therapy for obstructive sleep apnea. However, adherence to this treatment is frequently poor, which may lead to ongoing symptoms, including daytime sleepiness and poor cognitive function. We aimed to determine the efficacy of showing patients their raw graphic polysomnography (PSG) data in increasing their CPAP adherence. METHODS: The subjects were patients with obstructive sleep apnea (n = 37, diagnosed on prior PSG), who were prospectively randomized into an experimental arm or a control arm. The patients in the experimental arm (n = 18) were shown detailed PSG data, including graphic data from PSG prior to prescription of CPAP. The patients in the control arm (n = 19) were shown the non-graphic paper report of the PSG. Adherence data, collected using CPAP devices with internal microprocessors (adherence cards), was read at 4 weeks after treatment initiation. RESULTS: There was no difference in age (57.3 ± 11.8 y vs 55.5 ± 11.6 y, P =.64), body mass index (BMI) (32.7 ± 6.3 kg/m2 vs 32.3 ± 6.6 kg/m2, P =.85), and apnea-hypopnea index (36.0 ± 27.8 events/h vs 30.5 ± 19.1 events/h, P =.48) between the experimental and control arms. There was no difference in percent of days CPAP was used (58% vs 64%, P =.59) and average number of hours each night CPAP was used (3.9 ± 2.1 h vs 4.1 ± 2.5 h, P =.76) between the experimental and control arms, respectively. In multi logistic regression models, which included age, BMI > 30 kg/m2, apnea-hypopnea index, and experimental intervention, only BMI was found to increase likelihood of improved adherence (odds ratio = 13.3, P =.007). CONCLUSIONS: Showing patients raw graphic PSG data does not seem to improve adherence to CPAP. BMI is a very strong predictor of CPAP adherence. © 2013 Daedalus Enterprises.


Nadeem R.,Rosalind Franklin University of Medicine and Science | Sharieff A.,Rosalind Franklin University of Medicine and Science | Tanna S.,Rosalind Franklin University of Medicine and Science | Sidhu H.,Rosalind Franklin University of Medicine and Science | And 2 more authors.
Journal of Stroke and Cerebrovascular Diseases | Year: 2015

Background Atrial fibrillation (AF) is a potent risk factor for ischemic cerebrovascular accident (ICVA). Inflammation is a potential pathogenic factor for atherosclerosis and ICVA. Chronic obstructive pulmonary disease (COPD) is associated with increased inflammatory markers. Subjects who frequently experience COPD and AF together may have higher risk of ICVA. The objective of the study is to compare the prevalence of ICVA in patients with atrial fibrillation and COPD together versus atrial fibrillation alone. Methods Subjects diagnosed with COPD, AF, and ICVA were categorized into 3 groups: COPD, AF, and COPD plus AF. Prevalence of ICVA was compared. Confounding factors affecting ICVA risk were recorded: age, diabetes, hypertension, peripheral vascular disease, dyslipidemia, and congestive cardiac failure. Results Total charts reviewed were 500: COPD alone 244, AF alone 188, and both together 68. ICVA was documented in 132 (26.4%) subjects. Prevalence of ICVA was 11.8% (COPD alone), 29.8% (AF alone), and 39.7% (AF plus COPD). COPD plus AF group had ICVA 2.05 (95% confidence interval [CI], 1.203-3.94; P =.007) times compared with others. ICVA was also higher in patients with AF only versus COPD only (P <.001). Logistic regression showed AF plus COPD was a stronger predictor of ICVA (P =.001) than AF only (P =.07) or COPD only (P =.8). Odds ratio for ICVA was 2.85 (CI, 1.57-5.16; P =.001) for AF plus COPD versus 1.81 (CI,.94-3.47; P =.71) for AF only and 1.08 (CI,.58-2.10; P =.8) for COPD only. Conclusions COPD may increase the risk of ischemic stroke in subjects with AF. Presence of COPD may increase the risk of ischemic stroke in subjects with AF. © 2015 National Stroke Association.


Nadeem R.,Rosalind Franklin University of Medicine and Science | Nadeem R.,James vell Federal Health Care Center | Harvey M.,Rosalind Franklin University of Medicine and Science | Singh M.,Rosalind Franklin University of Medicine and Science | And 7 more authors.
International Journal of Vascular Medicine | Year: 2013

Background. Obstructive sleep apnea (OSA) is associated with coronary artery disease. Intermittent hypoxia associated with OSA increases sympathetic activity and may cause systemic inflammation, which may contribute to atherosclerosis leading to an increase in the size of carotid intima media thickness (CIMT). Methods. PubMed and Cochrane library were reviewed by utilizing different combinations of key words: sleep apnea, carotid disease, intima media thickness, and carotid atherosclerosis. Inclusion criteria were English articles; studies with adult population with OSA and without OSA; CIMT recorded by ultrasound in mean and standard deviation or median with 95% confidence interval; and OSA defined as apnea hypopnea index of ≥5/h. A total of 95 studies were reviewed for inclusion, with 16 studies being pooled for analysis. Results. Ninety-five studies were reviewed, while 16 studies were pooled for analysis; since some studies have more than one data set, there were 25 data sets with 1415 patients being pooled for meta-analysis. All studies used ultrasound to measure CIMT. CIMT standardized difference in means ranged from -0.883 to 8.01. The pooled standardized difference in means was 1.40 (lower limit 0.996 to upper limit 1.803, (P < 0.0001). Conclusion. Patients with OSA appear to have increased CIMT suggestive of an atherosclerotic process. © 2013 Rashid Nadeem et al.

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