13 results on '"Sheila Asghar"'
Search Results
2. COVID-19 Infection Presents as Acute Cerebellar Ataxia (P6-10.003)
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Alexander Carvajal-Gonzalez, Michelle Benjamin, and Sheila Asghar
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- 2023
3. 0810 Management of Narcolepsy In A Patient With Severe Chronic Iron Deficiency: The Importance of Addressing Nutritional Deficiencies In The Treatment of Narcolepsy and Hypersomnias
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Scott Baldridge, Yousaf Khan, Naomi Ghildiyal, Brittany Monceaux, Sheila Asghar, Cesar Liendo, and Oleg Chernyshev
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Physiology (medical) ,Neurology (clinical) - Abstract
Introduction Since iron is a cofactor used in the synthesis of CNS dopamine, some of which is then converted into norepinephrine, CNS iron deficiency will have an impact on the availability of dopamine and norepinephrine. Medications for narcolepsy and hypersomnia, such as stimulants and wakefulness medications, are dependent on the availability of these neurotransmitters to achieve their clinical response. Unrecognized and untreated nutritional deficiencies may contribute to inadequate responses to treatment of these sleep disorders. Report of Cases: A 26-year-old female with a history of iron deficiency since her pre-kindergarten health evaluation had a history of inadequate responses to stimulants and wakefulness medications. Additional labs were drawn to evaluate for nutritional deficiencies that could be contributing to the combination of fatigue and hypersomnolence. These revealed continued severe iron deficiency along with vitamin B6, B12, and D deficiencies. The treatment plan then expanded to include treatment of the nutritional deficiencies and a trial of pitolisant, which works to increase histamine levels in the brain. Sadly, pitolisant resulted in intolerable headaches, so it was discontinued. Conclusion This author feels that patients with hypersomnia warrant a broader approach that includes evaluating for nutritional deficiencies which may contribute to fatigue and hypersomnolence. In this case, the plan was to address the patient’s nutritional deficiencies and switch to pitolisant which mediates increased CNS histamine levels. This was unsuccessful due to the side effect of increased frequency and intensity of headaches related to pitolisant. Treating her iron deficiency with iron infusions should increase CNS synthesis of dopamine and norepinephrine. She may now have a better response to stimulants or wakefulness medications which depend on the availability of these neurotransmitters. She may also benefit from combination therapy by adding sodium oxybate to one of these medications. Support (If Any)
- Published
- 2022
4. 833 Evolution of sleep disordered breathing types in heart failure
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Rupa Koothirezhi, Cesar Liendo, Oleg Chernyshev, Minh Tam Ho, Sheila Asghar, Brittany Monceaux, Pratibha Anne, and Ugorji Okorie
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medicine.medical_specialty ,business.industry ,Physiology (medical) ,Heart failure ,Internal medicine ,Sleep disordered breathing ,Cardiology ,Medicine ,Neurology (clinical) ,business ,medicine.disease - Abstract
Introduction Central sleep apnea is commonly seen in patients with heart failure. Here we present a case demonstrating shifting of predominant apneic events from central to obstructive type after placement of left ventricular assist device (LVAD) in end stage heart failure patient. Report of case(s) Case Presentation: 66 year-old African American male has past medical history of chronic congestive heart failure diabetes, hypertension, paroxysmal atrial fibrillation, anemia, hypothyroidism, chronic kidney disease and sleep apnea. Prior to his LVAD placement, his left ventricular ejection fraction (EF) was Conclusion This case report highlights not only the improvement of the sleep apnea in CHF treated with LVAD but also shows the shift of apneic events from predominantly central to obstructive type post LVAD. Support (if any) 1. Henein MY, Westaby S, Poole-Wilson PA, Cowie MR, Simonds AK. Resolution of central sleep apnoea following implantation of a left ventricular assist device. Int J Cardiol. 2010 Feb 4;138(3):317–9. PMID: 18752859. 2. Köhnlein T, Welte T, Tan LB, Elliott MW. Central sleep apnoea syndrome in patients with chronic heart disease: a critical review of the current literature. Thorax. 2002 Jun;57(6):547–54. PMID: 12037232 3. Monda C, Scala O, Paolillo S, Savarese G, Cecere M, D’Amore C, Parente A, Musella F, Mosca S, Filardi PP. Apnee notturne e scompenso cardiaco: fisiopatologia, diagnosi e terapia [Sleep apnea and heart failure: pathophysiology, diagnosis and therapy]. G Ital Cardiol (Rome). 2010 Nov;11(11):815–22. Italian. PMID: 21348318.
- Published
- 2021
5. A Comprehensive Review of Neurologic Manifestations of COVID-19 and Management of Pre-existing Neurologic Disorders in Children
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Sarah A. Walser, Yunsung Kim, Rohit Jain, Sheila Asghar, Ashutosh Kumar, and Gayatra Mainali
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Nervous system ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Adolescent ,Neurotropism ,Encephalopathy ,Neuroimmunology ,03 medical and health sciences ,0302 clinical medicine ,Pandemic ,medicine ,Humans ,030212 general & internal medicine ,Intensive care medicine ,Child ,Children ,Pediatric ,Topical Review Articles ,business.industry ,SARS-CoV-2 ,Age Factors ,Infant, Newborn ,COVID-19 ,Infant ,medicine.disease ,Treatment ,medicine.anatomical_structure ,El Niño ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Neurological ,Encephalitis ,Neurology (clinical) ,Nervous System Diseases ,business ,030217 neurology & neurosurgery - Abstract
Since the first reports of SARS-CoV-2 infection from China, multiple studies have been published regarding the epidemiologic aspects of COVID-19 including clinical manifestations and outcomes. The majority of these studies have focused on respiratory complications. However, recent findings have highlighted the systemic effects of the virus, including its potential impact on the nervous system. Similar to SARS-CoV-1, cellular entry of SARS-CoV-2 depends on the expression of ACE2, a receptor that is abundantly expressed in the nervous system. Neurologic manifestations in adults include cerebrovascular insults, encephalitis or encephalopathy, and neuromuscular disorders. However, the presence of these neurologic findings in the pediatric population is unclear. In this review, the potential neurotropism of SARS-CoV-2, known neurologic manifestations of COVID-19 in children, and management of preexisting pediatric neurologic conditions during the COVID-19 pandemic are discussed.
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- 2020
6. 845 Progressive external ophthalmoplegia in sleep apnea presenting as floppy eyelid syndrome
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Minh Tam Ho, Oleg Chernyshev, Rupa Koothirezhi, Cesar Liendo, Brittany Monceaux, Pratibha Anne, Ugorji Okorie, and Sheila Asghar
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Floppy eyelid syndrome ,medicine.medical_specialty ,business.industry ,Physiology (medical) ,Ophthalmology ,External ophthalmoplegia ,medicine ,Sleep apnea ,Neurology (clinical) ,medicine.disease ,business - Abstract
Introduction Floppy eye lid syndrome (FES) is known to be associated with Obstructive sleep apnea (OSA) and chronic progressive external ophthalmoplegia (CPEO) is a rare genetic disorder with mitochondrial myopathy that may present with isolated eye lid ptosis in the initial stages. In a patient with loud snoring and obesity, treating obstructive sleep apnea may improve Floppy eyelid syndrome. Report of case(s) 52-year-old African – American male with past medical history of Hypertension, obesity, glaucoma, CPEO status bilateral blepharoplasty with failed surgical treatment. Patient was referred to Sleep medicine team to rule out Obstructive Sleep Apnea aa a cause of possible underlying FES and residual ptosis. On exam, patient was noted to have bilateral brow and eyelid ptosis and mild ataxic gait. MRI brain with and without contrast was unremarkable. Deltoid muscle biopsy was suggestive of possible congenital myopathy and mild denervation atrophy. Polysomnogram showed severe OSA with AHI of 74.1 per hour and patient was initiated on Auto CPAP at a pressure setting of 7–20 cm H2O. CPAP treatment improved snoring, OSA and subjective symptoms of excessive day time sleepiness but did not improve the residual ptosis. Conclusion Treatment of severe OSA in a patient previously diagnosed with CPEO and failed surgical treatment with bilateral blepharoplasty, did not alter the course of residual ptosis/ floppy eyelids even though his other sleep apnea symptoms have improved. Support (if any) 1. McNab AA. Floppy eyelid syndrome and obstructive sleep apnea. Ophthalmic Plast Reconstr Surg. 1997 Jun;13(2):98–114. doi: 10.1097/00002341-199706000-00005. PMID: 9185193.
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- 2021
7. 856 Sleep-writing, sleep-talking in uncontrolled REM-predominant obstructive sleep apnea
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Cesar Liendo, Minh Tam Ho, Rupa Koothirezhi, Brittany Monceaux, Ugorji Okorie, Sheila Asghar, Pratibha Anne, Oleg Chernyshev, and Naomi Ghildiyal
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Obstructive sleep apnea ,medicine.medical_specialty ,Physical medicine and rehabilitation ,business.industry ,Physiology (medical) ,medicine ,Neurology (clinical) ,medicine.disease ,business ,Sleep in non-human animals - Abstract
Introduction Abnormal movements and behaviors during sleep are part of a larger group of nocturnal events that may occur during the sleep-wake cycle and/or the transitions into and out of sleep. We are presenting the case of OSA-related confusional arousals associated with sleep-writing and sleep-talking during REM-sleep. Report of case(s) 46 year old female with history of CAD, HTN, RLS, Anxiety, Depression, and REM predominant OSA (AHI of 2.9 per hour of sleep, REM AHI of 40 per hour of sleep, and oxygen saturation nadir of 91%), noncompliant with PAP therapy, returned to reestablish sleep medicine care and restart PAP therapy. The patient reported worsening of her OSA symptoms while being without PAP therapy. In addition to traditional OSA symptoms (snoring, frequent nighttime awakenings, restless legs, daytime sleepiness/fatigue), she reported episodes of sleep-talking, sleep-writing with demonstrated evidence of these events in her personal diary. She maintains a collective diary that incorporates her blood pressure readings, her weight loss accounts with records of meals in a day, as well as a separate log of letters that she will write and mail. In this diary, she has noticed sleep writing instances in each field, with no recollections subsequently on the act of writing them. The patient reported that these episodes of sleep writing would occur 3–4 times in a week, during this period of PAP noncompliance. Last reported instance of her sleep writing was October 2020. After re-initiation of PAP therapy, the patient has not reported further episodes of sleep-writing or sleep-talking. Conclusion The sleep-writing is a very rare clinical symptom in the presentation of REM-predominant OSA as well as in REM/NREM parasomnias. We were not able to come across a case of it in the sleep literature review. Sleep-talking is a well-documented phenomenon. Confusional arousals may be responsible for symptoms of sleep-writing and sleep-talking in this case. We may repeat a sleep study with split protocol and parasomnia montage using AutoBipap if needed to investigate further. Further research should be done to explore the nature and correlation of sleep-writing in clinical practice. Support (if any) N/A
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- 2021
8. DNM1 Mutation in a child associated with progressive bilateral mesial temporal sclerosis
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Alexandra Lazzara, Sheila Asghar, T. Thomas Zacharia, and Debra Byler
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0301 basic medicine ,medicine.medical_specialty ,Pediatrics ,Neurology ,Case Report ,Status epilepticus ,Case Reports ,Gene mutation ,03 medical and health sciences ,0302 clinical medicine ,medicine ,In patient ,genetics ,neurosurgery ,pediatrics and adolescent medicine ,business.industry ,neurology ,General Medicine ,nervous system diseases ,030104 developmental biology ,nervous system ,Refractory epilepsy ,Mutation (genetic algorithm) ,Temporal sclerosis ,Neurosurgery ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
Key Clinical Message This case represents a novel association of a DNM1 gene mutation with status epilepticus and progressive bilateral mesial temporal sclerosis. This could have future implications for treatment in patients with DNM1 mutation and refractory epilepsy as the mesial temporal sclerosis may become bilateral, making the patient a poor surgical candidate.
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- 2018
9. 1240 Obstructive Sleep Apnea Management in Weill-Marchesani Syndrome: A Case Report
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Megan Smalley, Edmond Roberts, Sheila Asghar, Cesar Liendo, Ugorji Okorie, Oleg Chernyshev, and Brittany Monceaux
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Obstructive sleep apnea ,Pediatrics ,medicine.medical_specialty ,business.industry ,Physiology (medical) ,medicine ,Neurology (clinical) ,medicine.disease ,business ,Weill–Marchesani syndrome - Abstract
Introduction Weill-Marchesani Syndrome (WMS) is a rare systemic genetic connective tissue disorder which usually presents with symptoms of short stature, limited joint movement, and eye problems such as glaucoma and microspherophakia. This genetic condition is associated with fibrous tissue hyperplasia. WMS is inherited as autosomal dominant or autosomal recessive patterns in families leading to a variability in presenting phenotype. Few papers have been written on airway management during anesthesia but as far as we know, this is the first case report on obstructive sleep apnea management in a patient with WMS. Report of Case A 9 year old boy with a past medical history of Methylene THF Reductase deficiency, von Willebrand’s Disease, seizure disorder, premature birth, developmental delays and Weill-Marchesani syndrome was referred to Sleep Medicine due to tonsillar hypertrophy (3+), snoring and witnessed apneas. Upon physical examination, patient had mid-facial hypoplasia, retropositioning of the mandible, high arched palate, Mallampti class IV, maxillary hypoplasia and mandibular hypoplasia. He had been evaluated by ENT which determined the patient to be too high risk due to his medical conditions for T&A. The patient had a polysomnogram in 2018 indicating OSA with an apnea-hypopnea index of 4.2 and a minimum oxygen saturation of 91%. After a CPAP titration study, the patient was started on Auto CPAP of 5-15 cmH2O and has shown improvement in symptoms based on subjective and objective compliance report. Patient has been able to tolerate PAP therapy well with 100% compliance greater than 4 hours per night. Conclusion This case is the first illustrating OSA in a patient with Weill-Marchesani Syndrome. In WMS, the causes of OSA are not only due to tonsillar hypertrophy, but multifactorial, including craniofacial abnormalities. Given the high risk of surgical complications in WMS patients, PAP therapy appears to be a reasonable option for OSA management.
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- 2020
10. Spinal cord lesions in a pediatric patient with chronic kidney disease and review of literature: Answers
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Michael A. Freeman, Sheila Asghar, Himadri Patel, Harmanpreet Tiwana, and Ashutosh Kumar
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Nephrology ,Pediatrics ,medicine.medical_specialty ,business.industry ,MEDLINE ,medicine.disease ,Spinal cord ,Pediatric patient ,medicine.anatomical_structure ,Internal medicine ,Pediatrics, Perinatology and Child Health ,medicine ,business ,Kidney disease - Published
- 2018
11. Spinal cord lesions in a pediatric patient with chronic kidney disease and review of literature: Questions
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Harmanpreet Tiwana, Himadri Patel, Sheila Asghar, Ashutosh Kumar, and Michael Freeman
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Nephrology ,Pediatrics, Perinatology and Child Health - Published
- 2018
12. A Comprehensive Review of Tourette Syndrome and Complementary Alternative Medicine
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Sheila Asghar, Gayatra Mainali, Debra Byler, Laura Duda, and Ashutosh Kumar
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medicine.medical_specialty ,Tic ,Phonic Tic ,business.industry ,Alternative medicine ,Tourette's Syndrome (TS Zeiger, Section Editor) ,medicine.disease ,Tourette syndrome ,Complementary alternative medicine (CAM) ,03 medical and health sciences ,Psychiatry and Mental health ,0302 clinical medicine ,Developmental Neuroscience ,030225 pediatrics ,Tourette syndrome (TS) ,Developmental and Educational Psychology ,medicine ,Integrative medicine ,Psychiatry ,business ,030217 neurology & neurosurgery - Abstract
Purpose of Review Tourette syndrome (TS) is a neuropsychiatric condition defined by both motor and phonic tics over a period of at least 1 year with the onset before 18 years of age. The purpose of this article is to review the use of complementary alternative medicine (CAM) in children and adults with Tourette syndrome with emphasis on recent research. Recent Findings Most patients do not tell their physician about the use of CAM unless if specifically asked. Of the studies reviewed, description of the treatment and the frequency of use were most often reported. Few studies examine the role or effectiveness of CAM in the treatment of TS specifically. Summary Practitioners should be aware of current research regarding various CAM modalities used for TS patients, including efficacy, potential adverse effects, and interactions with medications. Robust data about the use of CAM, efficacy, and potential side effects is lacking and requires further research to clarify optimal use.
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- 2018
13. Unique presentation of rapidly fluctuating symptoms in a child with congenital myasthenic syndrome due to RAPSN mutation
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Sheila Asghar, Matthew Wicklund, Robert Kavanagh, and Ashutosh Kumar
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Pediatrics ,medicine.medical_specialty ,Physiology ,business.industry ,Congenital myasthenic syndrome ,medicine.disease ,RAPSN ,03 medical and health sciences ,Cellular and Molecular Neuroscience ,0302 clinical medicine ,030225 pediatrics ,Physiology (medical) ,Mutation (genetic algorithm) ,medicine ,Neurology (clinical) ,Presentation (obstetrics) ,business ,030217 neurology & neurosurgery - Published
- 2018
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