Digital Commons Network^™

Risk Of Major Adverse Cardiovascular Events And Major Hemorrhage Among White And Black Patients Undergoing Percutaneous Coronary Intervention, Anping Cai, Chrisly Dillon, William B. Hillegass, Mark Beasley, Brigitta C. Brott, Vera A. Bittner, Gilbert J. Perry, Ganesh V. Halade, Sumanth D. Prabhu, Nita A. Limdi

Internal Medicine Faculty Publications

Background: Data on racial disparities in major adverse cardiovascular events (MACE) and major hemorrhage (HEM) after percutaneous coronary intervention are limited. Factors contributing to these disparities are unknown. Methods and Results: PRiME-GGAT (Pharmacogenomic Resource to Improve Medication Effectiveness–Genotype-Guided Antiplatelet Therapy) is a prospective cohort. Patients aged ≥18 years undergoing percutaneous coronary intervention were enrolled and followed for up to 1 year. Racial disparities in risk of MACE and HEM were assessed using an incident rate ratio. Sequential cumulative adjustment analyses were performed to identify factors contributing to these disparities. Data from 919 patients were included in the analysis. Compared with …

Bone Benefits Of Fish Oil Supplementation Depend On Its Epa And Dha Content, Haissam Abou-Saleh, Allal Ouhtit, Ganesh V. Halade, Md Mizanur Rahman

Internal Medicine Faculty Publications

Licensee MDPI, Basel, Switzerland. The preventive effect of high-dose (9%) regular-fish oil (FO) against bone loss during aging has been demonstrated, but the effects of a low-dose (1%–4%) of a highly purified concentrated FO (CFO) has not been elucidated. The aim of this study was to determine the dose-dependent effect of a CFO against bone loss in C57BL/6 female mice during aging. Twelve-month old mice were fed with 1% and 4% CFO and 4% safflower oil (SFO) diets, including a group with a 4% regular-FO diet and a group with a lab chow diet for 12 months. Bone mineral density …

Inhibition Of Fpr2 Impaired Leukocytes Recruitment And Elicited Non-Resolving Inflammation In Acute Heart Failure, Vasundhara Kain, Jeevan Kumar Jadapalli, Bochra Tourki, Ganesh V. Halade

Internal Medicine Faculty Publications

Lifestyle or age-related risk factors over-activate the inflammation that triggers acute heart failure (HF)-related mortality following myocardial infarction (MI). Post-MI activated leukocytes express formyl peptide receptor 2 (FPR2) that is essential for inflammation-resolution and in cardiac healing. However, the role of FPR2 in acute HF is incomplete and remain of interest. Here, we aimed to determine whether pharmacological inhibition of FPR2 perturb leukocyte trafficking in acute HF. Male C57BL/6 (8–12 weeks) mice were subjected to acute HF (MI-d1) using permanent coronary artery ligation that develops irreversible acute and chronic heart failure. FPR2 antagonist WRW4 (1 μg/kg/day) was subcutaneously injected 3 …

Immune Responsive Resolvin D1 Programs Peritoneal Macrophages And Cardiac Fibroblast Phenotypes In Diversified Metabolic Microenvironment, Vasundhara Kain, Ganesh V. Halade

Internal Medicine Faculty Publications

Bioactive lipid mediators derived from n-3 and n-6 fatty acids are known to modulate leukocytes. Metabolic transformation of essential fatty acids to endogenous bioactive molecules plays a major role in human health. Here we tested the potential of substrates; linoleic acid (LA) and docosahexaenoic acid (DHA) and their bioactive products; resolvin D1 (RvD1) and 12- S-hydroxyeicosatetraenoic acids (HETE) to modulate macrophage plasticity and cardiac fibroblast phenotype in presence or absence of lipid metabolizing enzyme 12/15-lipoxygenase (LOX). Peritoneal macrophages and cardiac fibroblasts were isolated from wild-type (C57BL/6J) and 12/15LOX −/− mice and treated with DHA, LA, 12(S)-HETE, and RvD1 for 4, …

Mitoquinone Ameliorates Pressure Overload-Induced Cardiac Fibrosis And Left Ventricular Dysfunction In Mice, Kah Yong Goh, Li He, Jiajia Song, Miki Jinno, Aaron J. Rogers, Palaniappan Sethu, Ganesh Halade, Rajasekaran N. Soorappan, Xiaoguang Liu, Sumanth D. Prabhu, Victor Darley-Usmar, Adam R. Wende, Lufang Zhou

Internal Medicine Faculty Publications

Increasing evidence indicates that mitochondrial-associated redox signaling contributes to the pathophysiology of heart failure (HF). The mitochondrial-targeted antioxidant, mitoquinone (MitoQ), is capable of modifying mitochondrial signaling and has shown beneficial effects on HF-dependent mitochondrial dysfunction. However, the potential therapeutic impact of MitoQ-based mitochondrial therapies for HF in response to pressure overload is reliant upon demonstration of improved cardiac contractile function and suppression of deleterious cardiac remodeling. Using a new (patho)physiologically relevant model of pressure overload-induced HF we tested the hypothesis that MitoQ is capable of ameliorating cardiac contractile dysfunction and suppressing fibrosis. To test this C57BL/6J mice were subjected to …

Pretreatment Of Carprofen Impaired Initiation Of Inflammatory- And Overlapping Resolution Response And Promoted Cardiorenal Syndrome In Heart Failure, Veena Krishnan, David Booker, Gabrielle Cunningham, Jeevan Kumar Jadapalli, Vasundhara Kain, Amanda B. Pullen, Ganesh V. Halade

Internal Medicine Faculty Publications

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) are commonly used to control pain, inflammation, and limit the cardinal signs of injury in humans. However, prolonged use of NSAIDs increases the risk of heart attack (myocardial infarction; MI) and the subsequent risk of heart and renal failure. The molecular and cellular mechanism of action for this adverse effect, particularly along the cardiorenal network, is incomplete. To define the mechanism, carprofen (CAP), an NSAID was administered at the dose of 5 mg/kg to C57BL/6 male mice for two weeks. After last dose of CAP treatment mice were subjected to permanent occlusion of coronary artery that …

Precision Delivery Of Ras-Inhibiting Sirna To Kras Driven Cancer Via Peptide-Based Nanoparticles, Matthew S. Strand, Bradley A. Krasnick, Hua Pan, Xiuli Zhang, Ye Bi, Candace Brooks, Christopher Wetzel, Narendra Sankpal, Timothy Fleming, S. Peter Goedegebuure, David G. Denardo, William E. Gillanders, William G. Hawkins, Samuel A. Wickline, Ryan C. Fields

Internal Medicine Faculty Publications

Over 95% of pancreatic adenocarcinomas (PDACs), as well as a large fraction of other tumor types, such as colorectal adenocarcinoma, are driven by KRAS activation. However, no direct RAS inhibitors exist for cancer therapy. Furthermore, the delivery of therapeutic agents of any kind to PDAC in particular has been hindered by the extensive desmoplasia and resultant drug delivery challenges that accompanies these tumors. Small interfering RNA (siRNA) is a promising modality for anti-neoplastic therapy due to its precision and wide range of potential therapeutic targets. Unfortunately, siRNA therapy is limited by low serum half-life, vulnerability to intracellular digestion, and transient …

Distinct Effects Of Acute Versus Chronic Corticosterone Exposure On Zebra Finch Responses To West Nile Virus, Lynn B. Martin, Meredith E. Kernbach, Thomas R. Unnasch

Internal Medicine Faculty Publications

Wild animals are exposed to both short- (acute) and long-term (chronic) stressors. The glucocorticoid hormones, such as corticosterone (CORT), facilitate coping with such stressors, but these hormones can have quite distinct effects contingent on the duration of their elevation. Previously, we found that experimental elevation of CORT for 2 days (via implantation) affected zebra finch (Taeniopygia guttata) responses to West Nile virus (WNV). CORT-elevated birds had higher viremia for at least 2 days longer than controls, and West Nile virus (WNV)-associated mortality occurred only in CORT-elevated birds. Here, we queried how acute elevations of CORT, via injection an …

Directional Transmission Of Ultra-High Frequency Acoustic Signals Based On Metamaterial Structure, Jianning Han, Peng Yang, Jing-Zhi Wu, Tao Wang, Jing Wang

Internal Medicine Faculty Publications

Cell photoacoustic detection of acoustic signals has serious problems of transmission loss and difficulty in acquisition. Based on the acoustic transmission characteristics of acoustic supermaterials, the acoustic wave directional transmission model is designed using COMSOL software, and a finite element simulation experiment was carried out. Experiments show that the model designed in this paper has good sound wave focusing and acoustic wave directional transmission effects. According to the specific application in different environments, this paper designs a variety of transmission models with different structures and carries out comparative experiments to verify the influence of complex model structures on the directional …

The Utility Of Double Balloon Urinary Catheter In Reducing Rates Of Catheter-Associated Urinary Tract Infections In A Tertiary Care Teaching Hospital, Ju Hee Katzman, Cristina Vanessa Garcia, Seetha Lakshmi, Peggy Thompson, Lennox Archibald

Internal Medicine Faculty Publications

Background: Catheter-associated urinary tract infections (CAUTI) have been shown to increase hospital length of stay, healthcare costs, morbidity, and mortality. Studies that evaluate the role of urinary catheter design in preventing CAUTI are lacking. One such design is the double-balloon (DB) urinary catheter that has a second distal balloon; this design is aimed at reducing mucosal injury and inhibiting coiling of the in situ catheter. We carried out a comparative study to (a) determine whether CAUTI rates differ for different types of urinary catheters, and (b) identify risk factors associated with the acquisition of CAUTI in patients with DB vs. …

Comparison Of Access And Linkage To Care Among People Living With Human Immunodeficiency Virus When Enrolled In Florida Aids Drug Assistance Program (Adap), Greg Matthew E Teo, Nisha Sunku, Suraj Nagaraj, Sadaf Aslam, Rahul Mhaskar, Liwei Chen, Zhi Zhou, Robert L. Cook, Jamie P. Morano, Charurut Somboonwit

Internal Medicine Faculty Publications

Background: The Southeast region of the United States contains nine out of the 10 states with the most severe syndemic of poverty and HIV infection.1 The Florida AIDS Drug Assistance Program (FL-ADAP) and Ryan White network are crucial for linkage to care services. Data from FL-ADAP are available but seldom published; thus this study quantifies this program’s impact on Florida PLWH access and linkage to care.

Methods: Data were obtained from the Florida Cohort, an ongoing cross-sectional survey among health clinics across the State of Florida from 2015 to 2018. Chi-square and binomial multivariate logistic regression analyses correlated anti-retroviral therapy …

Recurrent Pancreatitis Induced By Uncontrolled Type V Hyperlipoproteinemia, Bianshly Rivera Rivero, Laura Oben Perez, Carlos Pla, Natalia Weare-Regales

Internal Medicine Faculty Publications

Background: Type V Hyperlipoproteinemia is a rare disease characterized by increased chylomicron and very low-density lipoprotein (VLDL) plasma levels. No official guidelines for treatment or monitoring of this disorder have been established due to the scarcity of cases. We present a patient with recurrent episodes of pancreatitis and diffuse eruptive xanthomas associated with uncontrolled type V hyperlipoproteinemia requiring recurrent Intensive Care Unit (ICU) admissions for management of his condition. Clinical Case: A 28 y/o male with Type V Hyperlipoproteinemia, Hypertension, uncontrolled Type 2 Diabetes Mellitus (DM2) and history of non-compliance, presented with epigastric pain and increased xanthoma formation. Family history …

Gram-Negative Rod Skin And Soft-Tissue Infections Following Breast Tissue Expander Surgery In Breast Cancer Patients, Ju Hee Katzman, Sadaf Aslam, Donna Mae M Pate, Nicole Guidish, Shelby Power, Clarissa Maravilla, Janelle Perkins, John Greene

Internal Medicine Faculty Publications

Background: Breast cancer patients who undergo tissue expander surgery (TES) are at an increased risk of developing gram-negative rod (GNR) skin and soft-tissue infection (SSIs) and its complications including prolonged antibiotic therapy, antibiotics side effects, and implant removal. Current perioperative antimicrobials focus mostly on gram-positive organisms, but the presence of a foreign body increases the risk of GNR SSI. We describe here the most common GNR bacteria and their susceptibility patterns that cause SSI after TES among breast cancer patients. Methods: We conducted a retrospective cohort study at Moffitt Cancer Center, Tampa, FL from January 2016, to January 2018, on …

The Epidemiology, Demographics, And Geographical Distribution Of Human Non-Tuberculosis Mycobacteria (Ntm) Disease In The Endemic Central Florida Region, Cristina Vanessa, Greg Matthew E. Teo, Jamie P. Morano, Beata Casanas, Sadaf Aslam, Jose Montero, Kristen Zeitler, Ripal Jariwala, Anthony Cannella

Internal Medicine Faculty Publications

Background: Of the >100,000 people in the United States infected yearly with non-tuberculosis mycobacteria (NTM), Florida has the highest yearly incidence and prevalence of NTM disease. However, little has been documented on the epidemiology and distribution of NTM disease within Central Florida. Methods: A retrospective case review study was conducted from January, 2011 to December, 2017 at a large tertiary acute care medical center in Tampa, Florida to identify all NTM infection cases. Demographics (age, sex at birth, ethnicity), comorbidities, HIV testing status, residential zip code, NTM species, and specimen sources were collected. Results: Of the 507 isolates, Mycobacterium abscessus …

Health Care Utilization And Mortality Associated With Heart Failure-Related Admissions Among Cancer Patients, Avirup Guha, Amit Kumar Dey, Merna Armanious, Katherine Dodd, Janice Bonsu, Hani Jneid, William Abraham, Michael G. Fradley, Daniel Addison

Internal Medicine Faculty Publications

Aims: Heart failure (HF) outcomes continue to improve with widespread use of new therapies. Concurrently, cancer survival has dramatically improved. Yet whether cancer patients share similar strategies and outcomes of inpatient HF treatment to those without HF is unknown. We sought to assess the contemporary impacts of cancer on inpatient HF outcomes over time.

Methods and results: The retrospective National Inpatient Sample (2003–15) and National Readmissions Database (2013–14) registries were queried for adults admitted for HF and stratified for cancer status, excluding cases of metastatic disease. Temporal trends in HF admissions, hospital charge rates, length of hospitalization, HF-related procedure utilization, …

Nocardia Bejingensis: A Novel Isolate Affecting Immunocompromised Patients In The United States, Shylah M. Moore-Pardo, Johonna Asquith, Sadaf Aslam, Cynthia Mayer, John Greene, Sally Alrabaa

Internal Medicine Faculty Publications

Background: Nocardia species can cause localized or disseminated disease in humans. Infection results from direct inoculation or inhalation. In recent years, several new species have been identified via molecular methods. Further speciation is crucial as each organism has its own spectrum of disease and unique antibiotic susceptibility patterns. Immunosuppression, alcoholism, and certain lung diseases are well-established risk factors for nocardiosis. In fact, cases have incremented in association with increasing population of immunocompromised hosts as well as improved methods for detection and identification. Thus, Nocardia species may be considered opportunistic pathogens.

Nocardia bejingensis was first isolated in 2001 by Wang et …

Pyoderma Gangrenosum Following Pacemaker Implantation: A Case Report And Review Of Literature, Noura Ayoubi, Zaydi Javeed, Raymond Cutro, Brooke T. Baldwin

Internal Medicine Faculty Publications

Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis characterized by noninfectious, inflammatory, ulcerating lesions. Pathergy can be seen in these patients, whereby minor trauma or surgery can result in the development of PG ulcerations. Here, we present a case of PG following pacemaker implantation. A 76-year-old male with a history of rheumatoid arthritis presented to the cardiology team with symptomatic bradycardia. Indications for implantation were met, and the procedure was performed in a routine fashion. The patient returned to clinic for follow-up four days later, complaining of pain at the incision site, coupled with erythema and purulent drainage. Consultations with …

Comparison Between Signature Cytokines Of Nasal Tissues In Subtypes Of Chronic Rhinosinusitis, Dong-Kyu Kim, Kyoung Mi Eun, Min-Kyung Kim, Deuktae Cho, Sun A. Han, Sang-Yoon Han, Yuju Seo, Dong-Han Lee, Seong Ho Cho, Dae Woo Kim

Internal Medicine Faculty Publications

Purpose: Endotype in chronic rhinosinusitis (CRS) has been established in the last decade. However, the exact immunologic profile of CRS still has controversy because it has a considerable immunologic heterogeneity. Therefore, we investigated various inflammatory mediators according to different nasal tissues in chronic rhinosinusitis and compared them within the same subject. Methods: We collected uncinate process mucosa (UP) and nasal polyp (NP) tissues from controls, CRS without NP (CRSsNP) and CRS with NP (CRSwNP). Expression levels of 28 inflammatory mediators including T helper (Th) 1, Th2, Th17, proinflammatory cytokines and remodeling markers were determined by multiplex immunoassay and were analyzed …

Comparing Trends And Outcomes Among Hiv-Infected Vs. Hiv Uninfected Patients With Tuberculosis: A 5-Year Experience Within The Florida Department Of Health In Hillsborough County, Shylah M. Moore-Pardo, Anteneh Addisu, Tea Reljic, Sadaf Aslam, Beata Casanas

Internal Medicine Faculty Publications

Background: Although the rate of tuberculosis (TB) has significantly declined in the United States, elimination has plateaued. Florida is one of the states with the greatest number of cases. The majority of cases occur in foreign-born individuals. Human immunodeficiency virus (HIV) is also a major contributor. HIV-TB coinfection leads to reciprocal interactions with significant clinical impact. We aim to compare the risk factors, clinical findings, and outcomes among HIV-infected vs. HIV uninfected patients.

Methods: A retrospective cohort study of TB cases over a 5 year period (2012–2017) was conducted. All patients with HIV co-infection with age- and gender-matched HIV negative …

A Case Report Of Massive Acetaminophen Poisoning Treated With A Novel “Triple Therapy”: N-Acetylcysteine, 4-Methylpyrazole, And Hemodialysis, Emily A. Kiernan, Julie A. Fritzges, Kathryn A. Henry, Kenneth D. Katz

Internal Medicine Faculty Publications

Massive acetaminophen (N-acetyl-p-aminophenol; APAP) ingestion is characterized by a rapid onset of mitochondrial dysfunction, including metabolic acidosis, lactemia, and altered mental status without hepatotoxicity which may not respond to the standard doses of N-acetylcysteine (NAC). A 64-year-old woman without medical history presented comatose after an ingestion of 208 tablets of Tylenol PM™ (APAP 500 mg and diphenhydramine 25 mg). The initial APAP concentration measured 1,017 µg/mL (therapeutic range 10-30 µg/mL), and elevated anion gap metabolic acidosis, lactemia, and 5-oxoprolinemia were detected. High-dose intravenous (IV) NAC, 4-methylpyrazole (4-MP), and hemodialysis (HD) were initiated. She was transferred to a liver …

Thyroid Storm And Hypoparathyroidism Caused By Anaplastic Thyroid Carcinoma, Laura Oben Perez, Alejandro Ramirez, Jessica Betancourt, John Tourtelot

Internal Medicine Faculty Publications

Anaplastic Thyroid Carcinoma (ATC) has an incidence of ≤ 2/1,000,000 and mean diagnosis age of 65 years (1). Fewer than 10% are <50 years (2,3). Hypoparathyroidism secondary to destruction of the gland from malignant invasion is rare, accounting for ≤0.7% of all cases (4). The estimated incidence of thyroid storm is <0.2/100,000 per year (5). A 48-year-old woman presents with odynophagia, night sweats, exertional dyspnea, diarrhea and swelling of the neck. A CT shows a large solid mass with cystic pockets in the thyroid measuring 12.5 cm, and multiple lung nodules consistent with metastatic cancer. She is admitted with an initial Burch HB-Wartofsky Score (BWS) of 10. TSH is <0.01 mIU/L; free T4, 2.91 ng/dL; and T3, 6.44 pg/mL. Thyroid fine needle aspiration biopsy shows malignancy with a differential diagnosis of ATC versus metastatic squamous cell carcinoma. A subsequent core thyroid biopsy confirms ATC. The patient developed compressive dyspnea that resulted in hypoxic cardiac arrest followed by atrial fibrillation. She experienced persistent tachycardia, hyperthermia (101.7 F), and coma. She is diagnosed with thyroid storm (BWS of 50). Thyroid antibodies were negative. She responds to high-dose glucocorticoids, beta blockers, and propylthiouracil. Three days later, thyroid function tests, tachycardia, and fever improves, but coma persists. The ATC continues to enlarge rapidly. Fourteen days after admission, she develops hypocalcemia (5.2 mg/dL), and intact Parathyroid Hormone (iPTH) was 6.3 pg/mL. Phosphorus and magnesium are normal. Hypoparathyroidism is attributed to malignant infiltration and destruction of the parathyroid glands. She responds to enteral calcitriol and calcium citrate. Her family opts for comfort measures after 19 days of coma. Conclusion: ATC may present with thyrotoxicosis and progress to thyroid storm. Hypoparathyroidism may occur due to invasion of the parathyroid glands. References: 1. Burke JP, Hay ID, Dignan F, et al. Long-term trends in thyroid carcinoma: a population-based study in Olmsted County, Minnesota, 1935-1999. Mayo Clin Proc 2005; 80:753. 2. Kebebew E, Greenspan FS, Clark OH, et al. Anaplastic thyroid carcinoma. Treatment outcome and prognostic factors. Cancer 2005; 103:1330. 3. Nagaiah G, Hossain A, Mooney CJ, et al. Anaplastic thyroid cancer: a review of epidemiology, pathogenesis, and treatment. J Oncol 2011; 2011:542358. 4. Marcucci G, et al. HypoparaNet: A Database of Chronic Hypoparathyroidism Based on Expert Medical-Surgical Centers in Italy.

Relapsed Acute Lymphoblastic Leukemia Presenting As Acute Renal Failure, Ashley Rose, Samuel Slone, Eric Padron

Internal Medicine Faculty Publications

Acute lymphoblastic leukemia (ALL) is the second most common acute leukemia in adults. It is an aggressive hematologic neoplasm, with a bimodal age distribution typically presenting in childhood and the decade of life (Terwilliger and Abdul-Hay, 2017). Renal injury in ALL is common and can occur through many different mechanisms, such as prerenal acute kidney injury, acute tubular necrosis, renovascular disease, obstruction, glomerulonephritis, and parenchymal infiltration of tumor cells (Luciano and Brewster, 2014). Infiltration of kidneys by leukemia cells is common; however a resultant injury only occurs in about 1% of patients, and renal failure is even more rare (Luciano …

Impact Of Availability Of Telehealth Programs On Documented Hiv Viral Suppression: A Cluster-Randomized Program Evaluation In The Veterans Health Administration, Michael E. Ohl, Kelly Richardson, Maria C. Rodriguez-Barradas, Roger Bedimo, Vincent Marconi, Jamie P. Morano, Michael P. Jones, Mary Vaughan-Sarrazin

Internal Medicine Faculty Publications

Background: Telehealth may improve care for people with HIV who live far from HIV specialty clinics. We conducted a cluster-randomized evaluation to determine the impact of availability of HIV telehealth programs on documented viral suppression in Veterans Administration clinics. Methods: In 2015–2016, people who previously traveled to HIV specialty clinics were offered telehealth visits in nearby primary care clinics. Patients were cluster-randomized to immediate telehealth availability (n = 925 patients in service areas of 13 primary care clinics offering telehealth) or availability 1 year later (n = 745 patients in 12 clinics). Measures during the evaluation year included telehealth use …

Recurrent Adrenal Crises In A Cytochrome P450 Ultra-Rapid Metabolizer, Gustavo Meyreles Chaljub, Losty Torres Potter, Pedro Troya, Madeline Candelario-Cosme, Natalia Weare-Regales

Internal Medicine Faculty Publications

Background The cytochrome P450s (CYPs) are a superfamily of oxidative enzymes of which the CYP3A subfamily is responsible for the metabolism of approximately 50% of all drugs. This includes exogenous and endogenous steroids. Over 20 polymorphisms of CYP3A4 have been described with three metabolic phenotypes: ultra-rapid, extensive and poor metabolizers. The CYP3A4*1B has an allelic frequency of 2-9% in Caucasians and is associated with increased enzymatic activity. Clinical Case This is a 49-year-old Caucasian female with a known history of Addison’s disease for 2 years, Hashimoto’s thyroiditis, Osteoporosis, Celiac disease, Vitamin D deficiency and Pernicious Anemia, who presented to the …

A Case Of Allergic Bronchopulmonary Aspergillosis (Abpa) In A Patient With A History Of Cocaine Use And Tuberculosis, Noura Ayoubi, Samuel Jalali, Nikesh Kapadia

Internal Medicine Faculty Publications

Aspergillosis refers to a spectrum of disorders that can occur due to colonization with the Aspergillus fungus. Allergic bronchopulmonary aspergillosis (ABPA) is an airway hypersensitivity reaction to the fungus that is almost exclusively seen in patients with cystic fibrosis or asthma. Here, we present a case of ABPA in a patient with a history of chronic cocaine use and tuberculosis and no history of asthma or cystic fibrosis. The patient had presented with progressively worsening dyspnea for three months as well as a 20-pound weight loss. Diagnosis was made with an elevated IgE against Aspergillus and chest CT findings, which …

Outcomes Of Extended-Spectrum Β-Lactamase-Producing Escherichia Coli Bloodstream Infection In Neutropenic Patients With Hematological Malignancies, Sadaf Aslam, James Denham, John Greene

Internal Medicine Faculty Publications

Background: Infections with extended-spectrum β-lactamase (ESBL) producing Enterobacteriaceae is an emerging problem leading to poor clinical outcomes and increased mortality. The purpose of this study was to determine the prevalence, risk factors and outcomes of ESBL-producing E. coli (EC) in bloodstream infections (BSIs) of neutropenic patients with hematological malignancies and compare the difference with Non-ESBL producing EC.

Methods: Through an IRB approved protocol, a retrospective cohort study was conducted at the H. Lee Moffitt Cancer Center from January, 2007 till October, 2017. Of the 310 records, who had +ive blood cultures for E. Coli, a total of 63 neutropenic patients …

The Impact Of Recent Incarceration On Post-Release Hiv Linkage To Care And Risk-Taking Behaviors In The Setting Of Enhanced Linkage To Care Policies In Florida, Greg Matthew E Teo, Suraj Nagaraj, Nisha Sunku, Sadaf Aslam, Rahul Mhaskar, Liwei Chen, Zhi Zhou, Robert L. Cook, Jamie P. Morano, Charurut Somboonwit

Internal Medicine Faculty Publications

Background: The United States has the largest incarcerated population in the world with 6.61 million adults in 2016.1 While incarceration is a known risk factor for difficulties in linkage to care2–3 and adverse health outcomes4–6, little is published on post-release incarcerated persons living with HIV (PLWH) in Florida.

Methods: Data were acquired from the Florida Cohort, an ongoing, longitudinal, cross-sectional study of PLWH recruited across HIV clinics in the state of Florida, from 2014 to 2018. Chi-square and multiple regression analyses correlated recent incarceration (within last 12 months) with demographics, HIV care adherence, perceived barriers to care, and self-reported high-risk …

Incorporating Electronic Medical Record Hard Stops To Reduce Inappropriate Clostridioides Difficile Testing At An Academic Medical Center: A Quality Improvement Study, Seetha Lakshmi, Kimberly Atrubin, Andrew Myers, Jonathan Teter, Ripal Jariwala, Kristen Zeitler, Laura Haubner, Terri Ashmeade, Maya Balakrishnan

Internal Medicine Faculty Publications

Background:

Clostridioides difficile is the most common pathogen causing healthcare-associated infections. This study highlights the multi-disciplinary efforts to reduce C. difficile infections (CDI) at a large, tertiary care teaching facility. Methods:

A quality improvement study was performed between March 2017 and April 2018, using six Plan-Do-Study-Act cycles that included transmission prevention, diagnostic stewardship, education, and antimicrobial stewardship. Process measures included hand hygiene, isolation precautions, low-level disinfection compliance, number of tests ordered, lab cancelation of tests, and compliance with the Electronic Medical Record (EMR) hard stop for patients with laxative use, and negative C.difficile test in the past 7 days. Results: …

Epigenetic Reader Complexes Of The Human Malaria Parasite, Plasmodium Falciparum, Wieteke Anna Maria Hoeijmakers, Jun Miao, Sabine Schmidt, Christa Geeke Toenhake, Sony Shrestha, Jeron Venhuizen, Rob Henderson, Jakob Birnbaum, Sonja Ghidelli-Disse, Gerard Drewes, Liwang Cui, Hendrik Gerard Stunnenberg, Tobias Spielmann, Richárd Bártfai

Internal Medicine Faculty Publications

Epigenetic regulatory mechanisms are central to the development and survival of all eukaryotic organisms. These mechanisms critically depend on the marking of chromatin domains with distinctive histone tail modifications (PTMs) and their recognition by effector protein complexes. Here we used quantitative proteomic approaches to unveil interactions between PTMs and associated reader protein complexes of Plasmodium falciparum, a unicellular parasite causing malaria. Histone peptide pull-downs with the most prominent and/or parasite-specific PTMs revealed the binding preference for 14 putative and novel reader proteins. Amongst others, they highlighted the acetylation-level-dependent recruitment of the BDP1/BDP2 complex and identified an PhD-finger protein (PHD …

Demographic Characteristics And Management Of Uninsured Patients With A History Of Melanoma, Noura Ayoubi, Abu-Sayeef Mirza, Mohammad Ayoub, Justin Swanson

Internal Medicine Faculty Publications

Aims and Objectives: Patients diagnosed with malignant melanoma often undergo regular follow-up care and skin checks to reduce the likelihood of recurrence. Yearly exams are more inconsistent and likely to be missed due to a lack of healthcare access and resources among the uninsured population. This study determined demographic characteristics of uninsured patients with a history of malignant melanoma. Follow-up was assessed in order to improve and ensure the highest quality of long-term care.

Methods: Demographics and chronic disease diagnoses were extracted from 8,857 patients managed at eight free-clinics from the Tampa Bay Area during 2016 and 2017. Patients diagnosed …