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Search Results: 1 - 10 of 273 matches for " Jahan Porhomayon "
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Pneumothorax and subcutaneous emphysema secondary to blunt chest injury
Jahan Porhomayon, Ralph Doerr
International Journal of Emergency Medicine , 2011, DOI: 10.1186/1865-1380-4-10
Abstract: A 49-year-old male presented to the trauma service 10 h after blunt chest injury. Initial presentation included respiratory failure with a respiratory rate of 26 beats per minute, a pulse rate of 110 beats per minute, and blood pressure of 150/80 mmHg. He complained of dysphonia and facial swelling.Physical examination revealed inspiratory dyspnea and crepitations suggestive of subcutaneous emphysema of the face, neck, and upper portion of his chest. Pharyngeal examination revealed swollen mucosa with crepitations on palpation (Figure 1a). Chest X-ray indicated extensive subcutaneous emphysema apparent in part as a group of muscles in the upper chest wall, but with no obvious pneumothorax (Figure 1c). Computed tomography of the chest confirmed subcutaneous and submucosal emphysema involving the pharynx. It also revealed obvious pneumomediastinum associated with left pneumothorax from rib fractures (Figure 1b and 1d). Physical examination and bronchoscopy ruled out laryngotracheal mucosal rupture. The patient remained dyspneic after placement of a chest tube. Twenty-four hours later, inspiratory dyspnea, dysphonia, and submucosal emphysema had resolved. Subcutaneous emphysema resolved in 4 days. The patient's recovery was uneventful.Subcutaneous emphysema can occur in critically ill patients after blunt trauma to the chest and result in a pressure gradient between the intra-alveolar and perivascular interstitial space [1,2]. The chest radiograph cannot exclude pneumothorax or pneumomediastinum. A CT scan is often needed for assessment of these conditions. Oropharyngeal subcutaneous emphysema has been described with dental surgery or spontaneous rupture of oropharyngeal or bronchial mucosa [3,4]. The association of submucosal emphysema with pneumothorax is rare. However, anatomical correlation among fascial planes of the cervical area, mediastinum, and retroperitoneum can explain this relationship [1] (Figure 2a and 2b).The authors do not have any financial and person
Failed Weaning from Mechanical Ventilation and Cardiac Dysfunction
Jahan Porhomayon,Peter Papadakos,Nader D. Nader
Critical Care Research and Practice , 2012, DOI: 10.1155/2012/173527
Abstract: Failure to transition patient from controlled mechanical ventilation to spontaneous breathing trials (SBTs) in a timely fashion is associated with significant morbidity and mortality in the intensive care unit. In addition, weaning failures are common in patients with limited cardiac reserves. Recent advances in cardiac echocardiography and laboratory measurement of serum biomarkers to assess hemodynamic response to SBT may provide additional information to guide clinicians to predict weaning outcome. 1. Introduction Weaning critically ill patients from mechanical ventilation (MV) is a gradual and challenging process. Discontinuation of MV should be considered when patient is able to follow commands and maintain appropriate minute ventilation. In addition, protective airway reflexes should be intacts and patient clinical status must have improved. Clinical bedside assessment tools are crucial during the weaning trial (WT) so that ventilator requirements are met as the disease course is corrected. In April 2005, an international consensus conference sponsored by five major scientific societies was held in Budapest, Hungary to provide recommendations regarding the management of weaning process. The main recommendations were as follows: weaning should be considered as early as possible, patients should be divided to three categories (simple, difficult, prolonged weaning), a spontaneous breathing trial (SBT) is the major diagnostic test to determine whether patients can be successfully extubated, the initial trial should last 30 minutes and consist of either tracheal tube (T-Piece) breathing or low levels of pressure support, pressure support or assist-control ventilation modes should be favored in patients failing an initial trial/trials, and noninvasive ventilation techniques should be considered in selected patients to shorten the duration of intubation but should not be routinely used as a tool for extubation failure [1]. In general, mechanical weaning parameters are poor at predicting weaning success because they do not take into account cardiac reserves [2]. Therefore it is necessary for clinicians to understand the cardiovascular response to weaning trials and utilize the available tools to guide the wean team. 2. Physiology of Spontaneous Breathing Trials MV weaning trial can be compared to a cardiac stress test where spontaneous ventilation is a form of an exercise [2], and therefore hemodynamic compromise can occur during weaning process in critically ill patients. The immediate transition from positive pressure mechanical ventilation to
A Rare Neurological Complication of Ranolazine
Jahan Porhomayon,Gino Zadeii,Alireza Yarahmadi
Case Reports in Neurological Medicine , 2013, DOI: 10.1155/2013/451206
Abstract: Myoclonus is not a known side effect of ranolazine. We report a case of myoclonus in a 72-year-old female who underwent cardiac catheterization for angina and was started on ranolazine after the procedure. Two days after ranolazine therapy on 1000?mg per day in divided doses, myoclonus developed, which severely impaired her normal activity. Her symptoms resolved 2 days after discontinuation of ranolazine. Ranolazine was resumed after discharge from hospital with recurrent myoclonus after two days of therapy. The causal relationship between ranolazine and myoclonus was suggested by cessation of myoclonus after ranolazine was discontinued. 1. Introduction Chronic angina is a debilitating condition affecting nearly 6 million Americans. Current standard therapy includes beta-blockers, calcium channel blockers, and long acting nitrates. Some patients may be intolerable to standard therapy due to their side effects [1]. Ranolazine is new agent introduced into clinical practice in 2006. It is an extended release antianginal drug and is intended to act without reducing heart rate or blood pressure. Ranolazine is specifically indicated for the treatment of chronic angina in patients that failed previous anti-ischemic therapy [2]. It is contraindicated in patients with QT prolongation [3]. It has a piperazine compound that belongs to a group known as partial fatty-acid oxidation inhibitors [4]. Initially, the main anti-anginal effects of ranolazine were thought to be related to the actions of ranolazine to shift adenosine triphosphate (ATP) production away from fatty-acid oxidation toward glycolysis [5, 6]. Recent evidence suggests that ranolazine is an inhibitor of the late sodium current which results in a reduction of the intracellular sodium and calcium overload in ischemic cardiac myocytes [7–9]. 2. Case Report This is a 72-year-old female who presented to the emergency department with history of chest pain and non-ST-segment elevation myocardial infarction (NSTEMI). Her past medical history was significant for intermittent chest pain. She underwent cardiac catheterization with placement of 2 drug eluding stents and was started on ranolazine for symptomatic relief of NSTEM with angina. Her medication list included atorvastatin 20?mg daily, clopidogrel 75?mg daily, aspirin 162?mg daily, diltiazam 60?mg four times a day, and ranolazine 500?mg twice daily. She presented 2 days after discharge with myoclonic jerks in her upper and lower extremities. She was readmitted in the hospital for evaluation of myoclonus. At the time of her hospitalization, ranolazine was
Isolated Interrupted Aortic Arch: Unexpected Diagnosis in a 63-Year-Old Male
Hassan Javadzadegan,Jahan Porhomayon,Alireza Sadighi,Mehrdad Yavarikia,Nader Nader
Case Reports in Critical Care , 2011, DOI: 10.1155/2011/989621
Abstract: A 63-year-old male with history of hypertension, dyspnea on exertion, and chronic chest pain was admitted for elective cardiac angiography. Arterial blood pressure was 160/90 mmHg in both arms. Femoral and popliteal pulses were extremely weak, and third (S3) and fourth (S4) heart sounds were audible. Aortography showed a mildly dilated aortic root with double brachiocephalic trunk and interruption of aortic arch at isthmus. Profuse and well-developed collaterals appeared at neck and thorax. The patient was recommended to take medical treatment for his hypertension and advanced heart failure. The aim of this paper, is to review the diagnostic and therapeutic options for treatment of the interrupted aortic arch.
Applications of minimally invasive cardiac output monitors
Jahan Porhomayon, Gino Zadeii, Samuel Congello, Nader D Nader
International Journal of Emergency Medicine , 2012, DOI: 10.1186/1865-1380-5-18
Abstract: The ultimate goal of any hemodynamic monitoring system is to provide the clinicians with additional information on the underlying pathological condition and to guide fluid or vasopressor therapy. Cardiac output measurement and its response to therapeutic interventions are frequently used in critically ill patients. As the use of CO monitoring devices increases today, it is necessary to understand the application of such devices in different clinical settings. For many years pulmonary artery catheter (PAC) thermodilution cardiac output assessment was the monitor of choice for the management of critically ill patients. Thermodilution is a modification of the original indicator dilution techniques in which the injectate has a defined volume and temperature from which the thermodilution curve is generated [1]. As with the other indicator dilution techniques, CO is calculated from the area under the indicator thermodilution curve using the modified Stewart-Hamilton equation [2]. PAC was first used in dogs, and subsequently in humans 50 years later [2]. PAC provides valuable measurements, including right atrial pressure, right ventricular pressures, pulmonary artery pressures, pulmonary artery occlusive pressure, mixed venous saturation (SvO2), and CO. The derived hemodynamic variables are systemic and pulmonary vascular resistances. The major obstacle for the use of PAC has been the lack of demonstrating patient benefit and its level of invasiveness. Several prospective trials have demonstrated the lack of benefit from PACs. The PAC-man trial indicated that the routine placement of PACs had no effect on morbidity or mortality, and the ESCAPE trial found no difference in mortality or length of hospital stay when PAC parameters were compared with clinical assessment in the management of severe congestive heart failure patients [3-6]. Furthermore, for using PAC now, many physicians have lost the training, confidence, and familiarity with its use. PAC should probably be used
A Case of Prolonged Delayed Postdural Puncture Headache in a Patient with Multiple Sclerosis Exacerbated by Air Travel
Jahan Porhomayon,Gino Zadeii,Alireza Yarahamadi,Nader D. Nader
Case Reports in Anesthesiology , 2013, DOI: 10.1155/2013/253218
A Case of Prolonged Delayed Postdural Puncture Headache in a Patient with Multiple Sclerosis Exacerbated by Air Travel
Jahan Porhomayon,Gino Zadeii,Alireza Yarahamadi,Nader D. Nader
Case Reports in Anesthesiology , 2013, DOI: 10.1155/2013/253218
Abstract: The developments of new spinal needles and needle tip designs have reduced the incidence of postdural puncture headache (PDPH). Although it is clear that reducing the loss of CSF leak from dural puncture reduces the headache, there are areas regarding the pathogenesis, treatment, and prevention of PDPH that remain controversial. Air travel by itself may impose physiological alteration in central nervous system that may be detrimental to patients with PDPH. This case report highlights a case of a young female patient who suffered from a severe incapacitating PDPH headache during high-altitude flight with a commercial jet. 1. Introduction The first case report of postdural puncture headache (PDPH) was described in about 100 years ago by Bier and his assistant [1]. It was later postulated that PDPH is triggered by leakage of cerebrospinal fluid through the dural rent, but the cause of the pain is probably due to intracranial arterial and venous dilatation [2]. PDPH remains one of the major complications of spinal tap performed for diagnostic purposes. Other adverse events after lumbar puncture include dysesthesia, backache, nerve palsies, infectious processes, and bleeding disorders [3]. The patterns of development of PDPH depend on a number of procedure and nonprocedure-related risk factors. Knowledge of procedure-related factors supports interventions designed to reduce the incidence of PDPH. Despite the best preventive efforts, PDPH may still occur and be associated with significant morbidity [4, 5]. The potential risks for developing PDPH include female gender [6], young adults, repeated attempt with multiple dural punctures, and the size/type and orientation of the needle [7]. Gender is believed to be an independent risk factor for the development of PDPH as demonstrated by the recent meta-analysis by Wu et al. [6]. Clinical presentation of the PDPH or “spinal headache” is usually described as a severe, dull pain, usually frontal occipital, which is irritated in the upright position and decreased in the supine position. It may or may not be accompanied by nausea, vomiting, and visual/auditory disturbances. The onset of PDPH is between 2 to 72 hours, and latency period of up to 15 days has generally been described in the literature [8, 9]. 2. Case Report This is unique case of a young 23 years old middle Eastern female who developed an acute unilateral eye pain and generalized headache with visual disturbances associated with fatigue and weakness in lower extremities for two days. She presented to a local community hospital and was examined by a
Application of Dual Mask for Postoperative Respiratory Support in Obstructive Sleep Apnea Patient
Jahan Porhomayon,Gino Zadeii,Nader D. Nader,George R. Bancroft,Alireza Yarahamadi
Case Reports in Anesthesiology , 2013, DOI: 10.1155/2013/321054
Abstract: In some conditions continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BIPAP) therapy alone fails to provide satisfactory oxygenation. In these situations oxygen (O2) is often being added to CPAP/BIPAP mask or hose. Central sleep apnea and obstructive sleep apnea (OSA) are often present along with other chronic conditions, such as chronic obstructive pulmonary disease (COPD), congestive heart failure, pulmonary fibrosis, neuromuscular disorders, chronic narcotic use, or central hypoventilation syndrome. Any of these conditions may lead to the need for supplemental O2 administration during the titration process. Maximization of comfort, by delivering O2 directly via a nasal cannula through the mask, will provide better oxygenation and ultimately treat the patient with lower CPAP/BIPAP pressure. 1. Introduction Obstructive sleep apnea (OSA) is a complex medical disorder, characterized by repetitive upper airway collapse during sleep. The disease affects individuals of all ages and predisposes to multiple comorbidities, including increased risk of cardiovascular disease [1]. Perioperative apneas appear to be multifactorial in nature. Sedatives and anesthetics have been shown to decrease pharyngeal muscle tone and therefore predispose to apnea [2]. Meanwhile, the patient’s normal arousal responses and reflexes are also compromised by anesthetics [3]. This predisposes to apneic episodes which can be more severe than those associated with natural sleep. While many patients present for surgery with undiagnosed OSA, it is currently recommended that patients who receive ambulatory CPAP preoperatively should continue to have CPAP administered in the perioperative period. Otherwise, the optimal management of OSA in the perioperative period has yet to be elucidated [4]. 2. Case Report A 51-year-old obese male, with a history of daytime fatigue, presented to the anesthesia holding area for urgent appendectomy. He had previously undergone a sleep study several months before with apnea/hypopnea index (AHI) of 35 and a maximum desaturation to the low 60’s. Patient vital signs included a blood pressure of 140/85?mm/Hg, heart rate of 95 beats per minute and respiratory rate of 16 per minute with a temperature of 38 centigrade. His pulse oximetry (SaO2) reading was 91% with 2 liters/minute of nasal oxygen flow. Chest radiography did not show any pathology. He was brought to operating room, and anesthesia was induced with propofol and succinylcholine in a rapid sequence technique. The trachea was intubated with the aid of a GlideScope.
Human Resources Information System (HRIS): A Theoretical Perspective  [PDF]
Sabrina Sabrina Jahan
Journal of Human Resource and Sustainability Studies (JHRSS) , 2014, DOI: 10.4236/jhrss.2014.22004
Abstract: HRIS is one of the major modern HR tools. In developed countries, it became popular since the be-ginning of this century. In Bangladesh, corporate organizations have started to implement HRIS in last 5 years. But still its implementation is limited within the big corporate houses. Small corporate houses and public organizations have failed to realize the benefits of HRIS and taken hardly any initiative to implement the system. The major barrier to success of HRIS is the lack of management commitment. The major limitation is the high cost. But the benefits of the HRIS are more than the limitations. Once it is implemented in any organization, employees and management have accepted and realized the benefits. But to get it implemented is a challenge. This study is an attempt to provide a theoretical analysis of the HRIS implementation with analysis of benefits, limitations and barriers. A case study was prepared to provide a better understanding of the topic in a real life context.
An Innovative Approach to Mitigate Vehicular Emission through Roadside Greeneries: A Case Study on Arterial Roads of Dhaka City  [PDF]
Meher Nigar Neema, Jinat Jahan
Journal of Data Analysis and Information Processing (JDAIP) , 2014, DOI: 10.4236/jdaip.2014.21005

With the surge of human population, the need for transportation of goods and people also concomitantly increases, resulting in urban air pollution through emission from motorized traffic especially in developing countries. The extent of environmental pollution in an urban setting is significantly influenced by the pollutants of vehicular fuel combustion. Many effective measures are required in cities to sequester carbon thereby helping to reduce automobile pollution. Roadside greeneries can serve as ecological elements which reduce the concentration of pollutants from vehicular emissions by their direct involvement in absorbing vehicular emitted carbon. In this context, in this study an attempt has been taken to assess contribution of roadside greeneries in absorbing vehicular carbon dioxide emission. A case study has been conducted on arterial roads of mega city Dhaka to quantify the vehicular carbon emission and correlate it with roadside trees to absorb the emitted carbon dioxide. It is noted that in Dhaka city, carbon dioxide is accounted for more than ninety percent of air pollution. To achieve our goals, two busiest arterial roads (namely Mirpur Road and Rokeya Shoroni Road) were taken into account to quantify vehicular carbon emission as well as assess carbon absorption by roadside greeneries. Carbon absorption by different sizes of trees has been quantified using the amount of woody biomass. In addition, absorption by grass-shrubs-herbs has been quantified by the area they cover. The results thus obtained show that indeed the road with more side greeneries absorbs more vehicular emitted carbon dioxide. It is therefore evident that plantation of more roadside trees is an effective measure of reducing air pollution and consequently turning a city to become healthier and more suitable for living.

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