About

Mariam Zakher is a Clinical Assistant Professor of Medicine (Clinician Educator) at the Keck School of Medicine of USC. Her clinical and research work focuses on thyroid-related conditions, including hypothyroidism and thyroid nodules, as evidenced by her publications on the clinical features and outcomes of myxedema coma, the evaluation of sonographic features of thyroid nodules, and other thyroid-related clinical studies. She contributes to advancing understanding in these areas through her research and clinical practice, supporting the education of future healthcare professionals in the field of medicine.

Research topics

• Internal medicine
• Medicine
• Surgery
• Anesthesia
• Emergency medicine
• Intensive care medicine
• Pediatrics
• Urology

Selected publications

• Clinical Features and Outcomes of Myxedema Coma in Patients Hospitalized for Hypothyroidism: Analysis of the United States National Inpatient Sample

  Thyroid · 2024 · 14 citations

  • Medicine
  • Pediatrics
  • Emergency medicine

  In summary, MC remains a clinically significant diagnosis in the modern era, independently associated with high mortality and health care costs. This continued burden demonstrates a need for further efforts to prevent, identify, and optimize treatment for patients with MC.

  PublisherDOI

• 8810 Improvement in bone mineral density in tertiary hyperparathyroidism after renal transplant treated with parathyroidectomy

  Journal of the Endocrine Society · 2024

  1st authorCorresponding
  • Medicine
  • Urology
  • Surgery

  Abstract Disclosure: M. Zakher: None. 55 year old man with past medical history of end-stage renal disease (ESRD) and alcoholic cirrhosis who underwent simultaneous liver-kidney transplant (SLKT) seven months prior to presentation to endocrinology who was referred for management of hypophosphatemia as low as 1.0 mg/dl. Prior to the transplant, he had hyperphosphatemia and hyperparathyroidism with phosphate and parathyroid hormone (PTH) levels as high as 8.2 mg/dL and 682 pg/mL, respectively. PTH remained elevated at 244 pg/mL and vitamin D was 35 ng/mL the week of the initial endocrinology visit. Initial DXA scan six months after SLKT showed osteoporosis of the lumbar spine, total left proximal femur, and left femoral neck with T-scores of -3.4, -4.9, -5.6, respectively. Alendronate was started three weeks prior to the initial visit. Urine studies confirmed phosphate wasting with urinary phosphate excretion significantly higher than 100 mg/24h, FEPO4 greater than 70%, and TmP/GFR less than 2 mg/dL. Increased urinary excretion of phosphate was consistent with hyperparathyroidism. The extremely low urinary calcium in the setting of normocalcemia and the history of renal transplant suggested a tertiary hyperparathyroidism. Alendronate was discontinued eight months after the initial visit to reduce the risk of post-parathyroidectomy hypocalcemia and post-parathyroidectomy bone remodeling inhibition.One year after the initial visit, the patient had a bilateral neck exploration with total parathyroidectomy and auto transplantation of the parathyroid. Pathology showed hypercellular parathyroid tissue. He was hospitalized one week after surgery for symptomatic hypolcalcemia (calcium 5.8 mg/dL). He was taking one tablet of calcium carbonate three times daily at home instead of three tablets three times daily as prescribed. He was discharged on calcitriol 0.5 mcg once daily, magnesium oxide 800 mg twice daily, calcium carbonate 1 g three times daily, and cholecalciferol 5000 units once daily. He remained on these for eleven months as well as calcitriol for fifteen months with dose adjustments during visits. Calcitriol was discontinued when calcium was found to be 8.9 mg/dL and the patient was asymptomatic. Repeat DXA scan two years after the baseline DXA showed osteoporosis of the left femoral neck with a T score of -2.5. There was a tremendous improvement from the baseline DXA scan from +20% in the total lumbar spine to +170% in the left femoral neck. DXA scan four years after the baseline DXA scan showed osteopenia of the lumbar spine, total left proximal femur, and left femoral neck with T-scores of -1.7, -2.4, -1.9.This is a 55 year old man who underwent SLKT seven months prior to presentation to endocrinology who was referred for management of hypophosphatemia as low as 1.0 mg/dL found with tertiary hyperparathyroidism who underwent a parathyroidectomy that resulted in significant improvement in bone mineral density test. Presentation: 6/2/2024

  PublisherOA PDFDOI

• Diaphragmatic Inspiratory Time and Lung Ultrasound Score Are Novel Point of Care Tests to Assess Acute Respiratory Failure in Covid-19 Pneumonia

  2021

  • Medicine
  • Anesthesia
  • Internal medicine

  Rationale:Acute respiratory failure (ARF) is the leading cause of intensive care admission for patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Noninvasive respiratory support devices assist select patients with worsening ARF. However, delaying intubation may be associated with an increased mortality rate which stems from cardiovascular complications and volume induced lung injury.Prior research has shown correlations between point of care ultrasound measurements and success or failure of weaning intubated patients. There is a paucity of data analyzing the relationship between ultrasound measurements and the requirement of intubation in patients on non-invasive respiratory support. This study evaluates whether ultrasound measurements of diaphragm movement (diaphragm inspiratory time (TI), diaphragm excursion time index (E-t index)) and lung ultrasound score (LUS) among SAR-CoV-2 patients on non-invasive respiratory support would identify those at risk for failure necessitating intubation. Method: Prospective single center observational study. Recruitment was considered for patients with SAR-CoV-2 on noninvasive respiratory support: non-rebreather face mask (NRB), high flow nasal cannula (HFNC), or noninvasive positive pressure ventilation (NIPPV). Independent observers measured E-t index, TI and LUS. The clinical care team was blinded to the involvement of the patient in the study. Welch's two-sample t-tests detected differences in the lung ultrasound parameters distribution between the intubated and non-intubated groups. Association between lung ultrasound parameters and intubation events were evaluated by using a multivariable logistic regression analysis and fitting the lung ultrasound parameters and time component on the likelihood of intubation. Results were statistically significant if p<0.05. Result: 89 LUS and diaphragm measurements were performed from March 2020 to May 2020. Patients requiring intubation had higher mean LUS but lower mean inspiratory time (TI) and lower mean E-T index. (Table 1). Higher LUS was associated with higher odds of being intubated by a factor of 1.17. Conversely, a higher TI was associated with lower odds of intubation. Area under curve for a receiver operator curve of 0.85 with a sensitivity of 86% and specificity of 75% for TI and LUS. Conclusion: Our data shows that among SAR-CoV-2 infected patients with ARF, a reduced E-t index and TI and an elevated LUS are associated with intubation. A lower TI is independently associated with intubation. Among the intubated, the mean LUS was higher than those who were not. LUS more than or equal to15 predicted receipt of invasive ventilation with a sensitivity of 92% and a specificity of 45 % (AUC = 0.72).

  PublisherDOI

Frequent coauthors

• Sung‐Jong Hong

  Incheon National University

  1 shared

• Michael Bender

  1 shared

• Carolina Hurtado

  Los Angeles Medical Center

  1 shared

• Aitzaz Rai

  1 shared

• Sanchit Chawla

  1 shared

• Andrew Y. Chang

  Stanford University

  1 shared

• Monica Malviya

  Island Hospital

  1 shared

• Trevor E. Angell

  Keck Hospital of USC

  1 shared