Salim R. Surani

By Salim Surani

Part of the book: Modern Pacemakers

By Jorge F. Velazco, Shekhar Ghamande and Salim Surani

Part of the book: Current Issues and Recent Advances in Pacemaker Therapy

By Mauricio Rodriguez and Salim R. Surani

Multidrug-resistant (MDR) pneumonia can be problematic and challenging to treat in an era of increasing resistance and limited treatment armamentarium. Multidrug-resistant pathogens are associated with increased morbidity and mortality, thus early empiric appropriate antibiotics are critical for survival. Many factors play a role in the selection, optimization, and duration of therapy that should be made on an individual basis. New technologies such as “rapid diagnostics” may provide the clinician with early phenotypic or genotypic result, thus improving early appropriate therapy. The increasing antibiotic resistance is a global threat to patients worldwide and is an economic burden. In the United States, drug-resistant bacteria cause approximately 2 million cases of illnesses and contribute to 23,000 deaths each year. The inappropriate use of antibiotics has contributed to the healthcare burden that ranges from $27 to $42 billion annually. As a result, several governmental agencies have placed forth regulatory mandates to enforce antimicrobial stewardship programs in acute care hospitals. Education will be vital across all healthcare disciplines to ultimately ensure optimal prescribing and reduce the emergence of resistance.

Part of the book: Contemporary Topics of Pneumonia

By Venkat Rajasurya and Salim Surani

Legionella bacteria are aerobic, pleomorphic, gram negative bacilli found in fresh water environments and are usually transmitted through inhalation aerosols from contaminated water or soil. Legionnaire’s disease is a severe form of pneumonia caused by legionella species and can be community acquired or hospital acquired. The reported incidence of Legionnaires’ disease is approximately 1.4–1.8 cases per 100,000 persons and immunocompromised state is a very important risk factor. Some of the other important risk factors include old age, impaired cellular immunity, hematologic malignancies, solid organ transplantation, splenectomy, tumor necrosis factor-alpha inhibitors, chronic respiratory disease, diabetes and end stage renal disease. Legionella pneumophila serotype 1 is the most commonly reported cause of human Legionella infections. The pathogenesis of legionnaire’s disease involves invasion of alveolar macrophages and cell mediated immunity is the primary means of immune control. The prevalence of Legionnaires disease has risen possibly from increased awareness and reporting. The symptoms of the disease are nonspecific requiring a high index of suspicion in vulnerable hosts, as effective treatment could be life-saving. Sensitivity of urinary antigen testing is lower in immunocompromised patients because of higher likelihood of infections caused non L. pneumophila species. Extrapulmonary manifestations and higher mortality are particularly more common in immunocompromised patients than in immunocompetent hosts.

Part of the book: Hospital Acquired Infection and Legionnaires' Disease

By Salim Surani

Part of the book: Hospital Acquired Infection and Legionnaires' Disease

By Kejal Gandhi, Pahnwat Taweesedt, Munish Sharma, Dweep Barbhaya and Salim Surani

Abdominal compartment syndrome and intra-abdominal hypertension (IAH) has been widely studied in surgical and trauma patients, even though the incidence of IAH in medical intensive care unit (MICU) remains high. Studies have shown that the time to decision making regarding diagnosis and management of IAH is twice in MICU compared to the corresponding surgical side. MICU patients often require large volume resuscitation such as in sepsis, hemorrhage, or an inflammatory condition such as acute pancreatitis, which increases the risk of development of IAH. It is often underdiagnosed and undertreated in MICU due to a lack of awareness of the consequences and mortality associated with it. Elevated intra-abdominal pressure has systemic effects causing atelectatic lungs, decreased cardiac output, and renal insufficiency. IAH, if not recognized early, can quickly progress to compartment syndrome causing multiorgan failure and death. Approach to ACS management between medical and surgical intensivists varies largely because of lack of experience with surgical decompression. This article provides an overview of definitions, incidence, pathophysiology, clinical presentation, diagnosis, and management of IAH and abdominal compartment syndrome in critically in medical patients.

Part of the book: A Comprehensive Review of Compartment Syndrome

By Pahnwat T. Taweesedt, Kejal Gandhi, Reena Shah and Salim Surani

Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive interstitial lung fibrosis with an unknown cause commonly seen in the elderly. Obtaining histories such as past medical history, exposure history, occupational history, and family history can be crucial parts to help to find other pulmonary fibrosis causes. Not only that, but thorough physical examination can rule out pulmonary fibrosis related to other diseases. Several diagnostic modalities have helped to improve the IPF assessment, including computer tomographic scan, histopathology, bronchoscopy lavage, serological testing, and serum biomarkers. Diagnostic of exclusion is required. The consensus from multidisciplinary IPF experts’ discussion from various societies recommends the clinical practice for IPF diagnosis to help define this condition. In this book chapter, we will discuss the evidence for each of the diagnostic techniques for IPF.

Part of the book: Idiopathic Pulmonary Fibrosis

By Anthony Wilks, Ladan Panahi, George Udeani and Salim Surani

Acid suppressive therapy (AST) has been the primary mechanism to provide gastroesophageal reflux disease (GERD) symptomatic relief and prevent complications in many individuals with GERD. Many AST options exist, but proton pump inhibitors (PPIs) have developed popularity in symptomatic relief for refractory GERD patients. To help reduce persistent symptoms, the use of AST therapy optimization is imperative and involves timing doses appropriately and increasing the dose and dosing frequency. Recently, more data has become available regarding the safety profile of AST, specifically PPI use. This data has raised awareness about its potential for toxicity with long-term use. This chapter focuses on the pharmacological management of GERD with a focus on the current updates regarding AST safety and efficacy.

Part of the book: Gastroesophageal Reflux Disease

By Muhammad K. Hayat Syed, Shehabaldin Alqalyoobi, Hillary Vaughan and Salim Surani

Extracorporeal membrane oxygenation (ECMO) has advanced significantly in the last few decades. Although not FDA-approved in the United States for respiratory insufficiency, it is widely used to support cardiac and pulmonary function via Venoarterial (VA) and Venovenous (VV) ECMO, respectively. In the patient with worsening respiratory failure VV-ECMO is considered a salvaging therapy that gives patients’ lungs time to heal or as a bridge to lung transplant. Clinicians use tools like the Murray score to initiate a referral for VV-ECMO using indices like oxygen requirement, pulmonary compliance, and bilateral opacities. Early referral for VV-ECMO within 7 days of intubation has shown better results. Important factors that are considered in ECMO candidacy are patients’ age, comorbid conditions, and chronic conditions that would affect patients’ overall longevity. Extracorporeal life support organization (ELSO) gets data from ECMO centers worldwide and has general recommendations for centers guiding treatment and management. During the COVID pandemic, there was a huge surge in acute respiratory distress syndrome (ARDS) and rampant use of VV-ECMO for COVID-ARDS. Data from various centers have helped us understand the appropriate use of VV-ECMO for ARDS and other causes of hypoxic and hypercapnic respiratory failure. Early referral and careful screening for the patient for ECMO are of paramount importance for a better outcome.

Part of the book: Respiratory Insufficiency

By Farah Yasmin, Muhammad Umar Janjua, Hala Najeeb, Pragya Aastha, Hayat Syed Muhammad, Munish Sharma and Salim R. Surani

This chapter explores the clinical manifestations and initial diagnostic findings associated with pulmonary hypertension (PHTN) at different stages. The definition of PHTN, as proposed in the 6th World Symposium, considers a mean pulmonary arterial pressure at rest (mPAP) of greater than 20 mmHg (previously 25 mmHg) and a pulmonary vascular resistance equal to or exceeding 3 WU. PHTN is clinically classified into five groups: Group 1 includes idiopathic, hereditary, and other forms; Group 2 comprises PHTN due to left heart disease; Group 3 consists of PHTN associated with pulmonary diseases or hypoxia; Group 4 pertains to PHTN caused by pulmonary artery obstruction; and Group 5 encompasses cases with unclear or multifactorial etiologies. The classification of PHTN into these groups holds significant clinical value as it contributes to determining survival rates and treatment responses. The chapter elaborates on the clinical features observed throughout various stages of PHTN and highlights the abnormalities detected during initial diagnostic assessments. The in-depth details will also be outlined in subsequent chapters of the book.

Part of the book: New Insights on Pulmonary Hypertension [Working title]