Papers by Ghassan Jamaleddine
Critical Care, 2009
Introduction There is considerable uncertainty about the reproducibility of the various instrumen... more Introduction There is considerable uncertainty about the reproducibility of the various instruments used to measure dyspnea, their ability to reflect changes in symptoms, whether they accurately reflect the patient's experience and if its evolution is similar between acute heart failure syndrome patients and nonacute heart failure syndrome patients. URGENT was a prospective multicenter trial designed to address these issues. Methods Patients were interviewed within 1 hour of first physician evaluation, in the emergency department or acute care setting, with dyspnea assessed by the patient using both a five-point Likert scale and a 10-point visual analog scale (VAS) in the sitting (60º) and then supine (20º) position if dyspnea had not been considered severe or very severe by the sitting versus decubitus dyspnea measurement. Results Very good agreements were found between the five-point Likert and VAS at baseline (0.891, P <0.0001) and between changes (from baseline to hour 6) in the five-point Likert and in VAS (0.800, P <0.0001) in acute heart failure (AHF) patients. Lower agreements were found when changes from baseline to H6 measured by Likert or VAS were compared with the seven-point comparative Likert (0.512 and 0.500 respectively) in AHF patients. The worse the dyspnea at admission, the greater the amplitude of improvement in the first 6 hours; this relationship is stronger when dyspnea is measured with VAS (Spearman's rho coefficient = 0.672) than with the five-point Likert (0.272) (both P <0.0001) in AHF patients. By the five-point Likert, only nine patients (3% (1% to 5%)) reported an improvement in their dyspnea, 177 (51% (46% to 57%)) had no change, and 159 (46% (41% to 52%)) reported worse dyspnea supine compared with sitting up in AHF patients. The PDA test with VAS was markedly different between AHF and non-AHF patients. Conclusions Both clinical tools five-point Likert and VAS showed very good agreement at baseline and between changes from baseline to tests performed 6 hours later in AHF patients. The PDA test with VAS was markedly different between AHF and non-AHF patients. Dyspnea is improved within 6 hours in more than threequarters of the patients regardless of the tool used to measure the change in dyspnea. The greater the dyspnea at admission, the greater the amplitude of improvement in the first 6 hours.
Respiratory care, 2003
We report a case of brainstem infarction resulting in apneustic breathing, which was alleviated w... more We report a case of brainstem infarction resulting in apneustic breathing, which was alleviated with buspirone. We discuss apneusis, review the literature, and speculate about the benefit of serotonin 1A receptor agonists in the treatment of apneusis and other respiratory disorders.
Clinical Rheumatology, 2006
Relapsing polychondritis is characterized by recurrent inflammation and destruction of the cartil... more Relapsing polychondritis is characterized by recurrent inflammation and destruction of the cartilage and connective tissue. Respiratory complications are frequently severe during the course of the disease and usually signal a poor prognosis. We report a case of a 47-year-old man with known relapsing polychondritis who presented with bilateral narrowing of the airways complicated by refractory cavitary Pseudomonas aeruginosa pneumonia. Despite an aggressive antibiotic regimen, the patient's pneumonia did not improve until bronchial stenting 4 months later.
Lung, 2007
The aim of this study was to evaluate the value of pulmonary function tests performed before an a... more The aim of this study was to evaluate the value of pulmonary function tests performed before an autologous peripheral stem cell transplant (APSCT) in identifying patients who are at risk for developing post-transplant pulmonary complications. This retrospective study included patients who underwent autologous peripheral stem cell transplantation from January 1997 to December 2006. The total sample consisted of 43 patients with 24 patients (55.8%) having multiple myeloma, 9 patients (20.9%) having Hodgkin&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s lymphoma, and 10 patients (23.3%) having non-Hodgkin&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s lymphoma. The patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; average age at the time of diagnosis and at the time of APSCT was 41.8 +/- 14.6 and 43.1 +/- 14.2 years, respectively. After APSCT, 8 patients (18.6%) had pulmonary complications all of which were infectious pneumonia. The mean pretransplant forced midexpiratory flow (FEF(25-75%)) in the patients who developed post-transplant pulmonary complications was significantly lower than the mean pretransplant FEF(25-75%) in the patients who did not develop post-transplant pulmonary complications (75.5 +/- 19.9% vs. 104.3 +/- 24.5%, p = 0.004). There were no other differences in the pretransplant pulmonary function test parameters between the patients who developed post-transplant pulmonary complications and the patients who did not develop post-transplant pulmonary complications. Our results showed that patients with decreased pretransplant FEF(25-75%) are at risk for developing pulmonary complications in the post autologous stem cell transplantation period.
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Papers by Ghassan Jamaleddine