Medicine and Health Sciences Commons^™

Targeting Ribosome Biogenesis Is A Novel Approach For The Management Of Pancreatic Cancer, Mudassier Ahmad, Haider Ahsan, Carlos Perez, Muhammad Bangash, Andrew Massey, Emmanuel Anning, Manish Tripathi, Dae Kim, Subhash C. Chauhan, Bilal Bin Hafeez

Research Colloquium

Pancreatic ductal adenocarcinoma is the third leading cause of cancer-related deaths in the United States with limited therapeutic options available. Gemcitabine, a deoxycytidine nucleoside analog is currently considered the most effective therapy for PanCa. However, it shows only a marginal survival benefit of six months. Aberrant ribosome biogenesis occurs in most tumor types. We observed that PanCa cells are addicted to ribosome biogenesis, which supports their highly aggressive metastatic phenotypes. Thus, strategically targeting ribosome biogenesis process could be one of the ideal strategies for the prevention and treatment of PanCa. In this study, we elucidated the molecular mechanisms of POLR1A …

Unexpected Biliary Duct Dilation, A Wise Decision-Making Case., Mario A. Trujillo, Mathew R. Peynado, Muhammad Ali Siddiqui, Laura P. Ackerman

Research Colloquium

Background: Common bile duct dilation is expected in certain healthy populations with specific factors like age or post procedure status. When a size larger than expected is found in an acute setting further investigation is required. In the setting of acute abdominal pain in a patient with past medical history of cholelithiasis, the study protocol for patients with more than expected enlarged common bile duct and no apparently underlying disease in the biliary tree is not well elucidated.

Case: A 68-year-old female with past medical history but not limited to cholelithiasis, hypertension, type 2 diabetes mellitus, end stage renal …

Viral Party Gone Wrong: Polyviral Pericarditis Masquerading As Gastritis, Maria Eugenia Torres Perez, Joan Beatrice Capellan, Deanna Yamamura

Research Colloquium

Background: Acute pericarditis is a rapid inflammatory condition of the pericardium with both infectious and non-infectious etiologies. Diagnosis is usually based on clinical criteria with typical symptoms including chest pain that worsens with deep inspiration and decreases by leaning forward, and distinctive electrocardiographic changes. Pericarditis is typically self-limiting however, complications like pericardial effusion and cardiac tamponade may arise.

Case presentation: A 31-year-old male presented to the emergency department due to severe epigastric pain radiating to the right upper abdomen; the pain was associated with subjective fever and inability to eat due to its severity. His physical exam revealed tachycardia …

Obsessive Compulsive Disorder And Other Specified Anxiety Disorder In An 8-Year-Old Post-Respiratory Infection: A Case Report, Michael Tran, Alcides Amador, Sofia Camacho Bermudez

Research Colloquium

Background: This case report presents the diagnosis and management of Obsessive Compulsive Disorder (OCD) and Other Specified Anxiety Disorders in an 8-year-old male. The importance lies in the development of psychiatric symptoms after multiple respiratory infections and the subsequent diagnosis of Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS). It highlights a potential connection between infections and psychiatric manifestations in pediatric patients. PANDAS is an immune-mediated neuropsychiatric disorder that occurs after a Group A Strep (GAS) infection, characterized by the sudden onset or worsening of obsessive-compulsive disorder and tic disorder. While pathophysiology is not fully understood, evidence indicates that …

Stealthy Intrusion: Multivalve Culture-Negative Infective Endocarditis, Jennifer Rojas Huen, Carlos Luis Alejos Aguero, Duc Khiem Ngo, Maria E. Torres Perez

Research Colloquium

Introduction: Infective endocarditis (IE) typically targets a single valve, with involvement of more valves being rare. Timely targeted therapy hinges on identifying the responsible microorganism through blood culture. However, blood culture-negative endocarditis (BCNE), representing 5% of all endocarditis cases, poses diagnostic challenges and is associated with higher long-term mortality rates compared to blood culture-positive endocarditis (BCPE).

Case Presentation: A 53-year-old male with a history of congestive heart failure (CHF), end stage renal disease on peritoneal dialysis, and 30- years of cocaine use presented with an abnormal echocardiogram. The patient reported a two-week history of chills, sweat, generalized weakness, and exertional …

Microglia In Post-Mortem Hippocampal Brain Tissue Of Male And Female Neonates After Hie, Kassandra M. Pulido, Angela N. Viaene, Amelia J. Eisch, Danielle G. Barber

Research Colloquium

Background: Hypoxic-ischemic encephalopathy (HIE) is the second-leading cause of neonatal morbidity and mortality worldwide. There are sex differences in the pathophysiology of HIE, particularly in microglia, which are critical in the immune response. Prior work highlights microglial aggregation in the hippocampus of human infants as a marker for HIE, but it is unknown whether this differs by sex.

Aim: We compare the microglial response in post-mortem hippocampal tissue from male and female neonates diagnosed with HIE vs. Controls who expired from other causes.

Methods: Using a retrospective cohort design, we reviewed medical records of neonates with hippocampal tissue in the …

Houston, We Have A Problem: Diagnostic Difficulties In The Aids Patient With Tuberculosis Infection, Hector D. Preciado, Maria E. Torres, Muhammad A. Siddiqui, Liza Salloum, Lee Gelpi, Jose E. Campo Maldonado

Research Colloquium

Background: Tuberculosis (TB) is the leading cause of infectious death worldwide with 1.5 million deaths annually and nearly 1/4th of the world’s population (1.7 billion) infected with latent tuberculosis infection (LTBI) in 2014. Its diagnosis conventionally relies on tuberculin skin testing (TST), and Interferon-Gamma Release Assay (IGRA) which relies on the production of Interferon Gamma (IFN-y) in response to Mycobacterium tuberculosis (MTB) specific antigens. IGRA is a useful tool for detecting latent TB disease, and can be used as an adjunct for the diagnosis of active TB cases. Increases in IFN-y levels might support the diagnosis of a new TB …

Comorbidity Of Mood Disorders And Upper Airway Resistance Syndrome: A Case Report, Abhishekh Pokhrel, Alexa Lissete Zarate, Alcides Amador

Research Colloquium

Background: The comorbidity of mood disorders and Upper Airway Resistance Syndrome (UARS) presents a significant challenge, especially in pediatric populations. UARS, characterized by increased upper airway resistance during sleep, often leads to disrupted sleep and daytime symptoms such as fatigue and cognitive impairment. Studies estimate UARS affects 15-30% of patients undergoing polysomnography for suspected sleep-disordered breathing. Mood & Anxiety Disorders are prevalent in patients with sleep-disordered breathing, with higher rates than in the general population.

Case Presentation: 16-year-old female, with psychiatric history of Bipolar II Disorder current episode depressed, ADHD, and Other Specified Anxiety Disorder presents for a follow-up. Since …

Navigating Economic Constraints In The Management Of Hfref - A Case Study Of An Uninsured Patient, Vamsikalayan Borra, Diana Othon Martinez, Barbara Malaga-Espinoza, Martha Solis, Nestor Gerardo Astorga, Prakhar Jain, Cesar Gutierrez

Research Colloquium

Background: Heart failure (HF) is a significant health concern, resulting in more than 500,000 new cases, 1.9 million hospitalizations, and a cost of $31 billion in the US. HF treatment aims to decrease hospitalizations, improve quality of life, and extend survival through GDMT. Social determinants of health (SoDH) have been associated with poor outcomes and higher readmission rates in HF patients. Addressing SoDH is crucial for achieving health equity and improving overall population health outcomes, per the CMS Framework for Health Equity 2022-2023. In the Rio Grande Valley, immigration is a common SoDH. It is estimated that 100,000 people are …

Heart Failure In The Setting Of Cocaine Abuse… Cause Or Progression? A Case Report., Diana Othon Martinez, Kashif Ali, Elimar Gonzalez Morales, Barbara Malaga-Espinoza, Jian Garcia, Cesar Gutierrez

Research Colloquium

Background: 1 out of 3 substance abuse emergency department visits are related to cocaine. In the US (United States), >5.5 million people consume cocaine. Hospitalizations for heart failure have a similar amount, with 5.7 million. Cocaine's cardiovascular adverse effects arise secondary to sympathetic nervous system stimulation, including decreased myocardial oxygen supply, coronary vasoconstriction, acceleration of atherosclerosis and thrombus formation. Studies have demonstrated contradictory information regarding cardiac anatomical changes (dilation/hypertrophy) secondary to chronic cocaine use. Cocaine cessation and guideline- directed medical therapy (GDMT) for HF are mainstay management. We present a case of a patient with HF and cocaine abuse.

Case …

Unique Considerations In The Management Of Healthcare Among Fertile Women A Case Report On Chronic Myeloid Leukemia And Pregnancy, Hermione Yamyo Monie, Taha Al Hassan, Salomon Pardo Roca, Uchechi Ehiemua, Ramiro Leal

Research Colloquium

Background: With the overturning of Roe v. Wade, the management of women who are family planning has become more complex, highlighting the necessity for comprehensive and informed healthcare. This case report underscores the importance of holistic, interdisciplinary care for women with chronic conditions like Chronic Myeloid Leukemia (CML) who are planning for pregnancy. The novelty lies in the interplay between oncological treatment and reproductive health under current legal constraints.

Case Presentation: We present the case of a 32-year-old woman, G2P0010, with a history of CML and a previous spontaneous abortion. Initially believed to be in remission, she was started …

Recurrent Atrial Myxoma And Transient Ischemic Atack, Abdel Martinez Borrego, Benito Moran Herrera, Eduardo Flores

Research Colloquium

Background: Myxomas are the most common primary cardiac neoplasms and are predominantly located in the left atrium, accounting for approximately 80% of cases. Clinical manifestations can vary widely, ranging from asymptomatic to severe, with potential embolic or obstructive symptoms. Diagnosis is typically made through echocardiography, although CT and MRI can also be useful diagnostic tools. The primary treatment is surgical resection; however, long-term follow-up is essential due to the risk of recurrence, which may occur up to 10 years after the initial surgery.

Case presentation: A 54-year-old female patient with a history of a 5x3x2 cm left atrial …

Integrating Artificial Intelligence With Electrocardiograms: A New Era In Cardiac Care, Abdel Martinez Borrego, Eduardo Flores

Research Colloquium

Background: The integration of artificial intelligence with electrocardiography has significantly transformed contemporary medical practice, representing a major advancement in cardiac care. These algorithms have enhanced the detection of subtle ECG patterns, improving the diagnosis of conditions such as arrhythmias and providing a more accurate diagnostic environment. However, challenges such as data privacy, algorithm transparency, and clinical integration remain. AI holds substantial potential for improving diagnostic accuracy, with several FDA-approved devices now available in the market aimed at enhancing patient outcomes. Future efforts should focus on further validation, implementation, and research to fully realize AI's capabilities in this field.

Methods: This …

Systematic Review And Meta-Analysis Of Total Elbow Arthroplasty In Outpatient Versus Inpatient Settings, Blake Martin, Yolanda V. Gutierrez, Joshua Nwose, Robert H. Ablove, Juan Lopez-Alvarenga

Research Colloquium

Introduction: Total joint arthroplasties (TJA), including total elbow arthroplasty (TEA), are growing in number, shifting towards a younger age group, and moving more towards the outpatient setting. We are conducting this study to summarize the current knowledge about the outcomes of TEA in outpatient versus inpatient settings to allow for the best possible care when performing this procedure. We believe that outpatient TEA will have better outcomes with lower complication rates compared to inpatient TEA.

Methods: We conducted a systematic review and meta-analysis using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) framework. Electronic database searches were performed …

Clearance Of Recalcitrant Prosthetic Fungal Infection Utilizing Administration Of Voriconazole Through Intra-Articular Catheters Of The Knee, Blake Martin, Matthew Hnatow, Emma Herrera

Research Colloquium

Background: Prosthetic joint infection is a high cost and high morbidity complication of total joint arthroplasty accounting for about 1-2% of all joint replacements. Rarely fungal infections may complicate treatment and lower the rate of clearance of infection with rates as low as 50% or less in the literature. Intra-articular antibiotics have drawn more interest recently and may be a promising intervention for challenging prosthetic joint infections. We present a novel case utilizing voriconazole via intra-articular catheters with successful clearance of a recalcitrant fungal prosthetic joint infection with 2 year follow up.

Case Presentation: A case study is presented in …

Literature Review: Exploring The Efficacy Of Minimally Invasive Surgery (Mis) Techniques In Spinal Fusion For Degenerative Spondylolisthesis, Yolanda V. Gutierrez, Blake Martin, Joshua Nwose, Robert H. Ablove

Research Colloquium

Introduction: Spine diseases and degeneration of the spine are common causes of back pain. One common cause of back pain is spondylolisthesis which is the slipping of a vertebral body disc. A subtype of spondylolisthesis is degenerative spondylolisthesis which commonly occurs due to wasting of the intervertebral disc leading to an unstable spine. In patients with a lack of neurological issues, conservative treatment is recommended. If conservative treatment is ineffective, surgery is deemed the next step, involving decompression of and fusion of the vertebrae. Minimally invasive surgery (MIS) techniques have emerged in the last decade. This systematic literature review aims …

Pre-Hospital Stroke Time Intervals In The Rio Grande Valley, Kelsey Baker, Elio E. Garcia Sosa

Research Colloquium

Background and Introduction: Stroke continues to be a significant cause of mortality in the United States. Despite advancements in acute stroke treatments such as thrombolytic therapy and endovascular procedures, many patients remain unable to benefit from these interventions due to delays in receiving treatment. Healthcare professionals have made substantial efforts to improve 'door to needle' times, the interval between a patient's arrival at the hospital and the administration of thrombolytic therapy, yielding promising outcomes. However, a critical gap persists: the time interval from the onset of stroke symptoms to when patients actually present at a healthcare facility. This study aims …

Late Tamponade After Coronary Artery Bypass Grafting, Jian Garcia Cruz, Roy Kondapavuluru, Diana Othon Martinez, Julio Perez Rodriguez

Research Colloquium

Introduction: Pericardial effusion (PE) incidence can go up to 85% after cardiac procedures, however, not every pericardial effusion causes hemodynamic instability. Progression to Pericardial Tamponade (PT) occurs in 0.1 to 8.8% and may be either early (within 24 h post-cardiac surgery) or late (presenting within a week post-procedure). Both presentations may be attributed to anticoagulant use, inadequate mediastinal drainage, coagulopathy, post-pericardiotomy syndrome (recurrent pericardial effusion).

Patient presentation time might be misleading, as pericardial effusion’s clinical symptoms are varied, ranging from asymptomatic, to shortness of breath, chest pain or discomfort, hypotension, tachycardia, or other non-specific symptoms like cough, fever, and malaise. …

Multiple Intracardiac Thrombi In A Patient With Ischemic Cardiomyopathy, Jian Garcia Cruz, Julio Perez Rodriguez

Research Colloquium

Introduction: Ischemic cardiomyopathy is defined by the American Heart Association (AHA) as cardiomyopathy caused by ischemic heart disease. The most common complication of ischemic cardiomyopathy is systolic congestive heart failure. Heart failure patients are in a hypercoagulable state that predisposes them to develop intracardiac thrombus. The incidence of LV thrombus in patients with dilated cardiomyopathy and sinus rhythm is 13% with the clot in the left atrial appendage in 68% of these cases. The thrombus formation results from impaired blood flow within the 4 chambers of the heart and can present as a life-threatening complication of end stage heart failure. …

Cardiac Tamponade Secondary To Purulent Pericarditis With Mrsa, Jian Garcia Cruz, Julio Perez Rodriguez

Research Colloquium

Introduction: Methicillin resistant Staphylococcus aureus (MRSA) is a nosocomial pathogen that causes severe morbidity and mortality worldwide. MRSA pericarditis is a rare life-threatening condition that can cause purulent pericarditis with only 7 cases having been reported so far. Several reasons why a patient may develop MRSA pericarditis are healthcare-associated infection, weakened immune system, invasive procedures and spread from other infections. Although not typically associated with tamponade, if MRSA were to cause an infection in the pericardial space, it could potentially lead to inflammation and fluid accumulation, resulting in tamponade. We present a case of a woman that developed tamponade secondary …

Understanding Hip Pain Through Social Media: An Initial Overview Of An International Web-Based Survey, John M. Gaddis, Ryan Bialaszewski, Bretton Laboret, Erika Shults, Joel Wells

Research Colloquium

Aims: In the adult population hip pain is often triggered by mechanical anatomic differences including hip dysplasia, femoroacetabular impingement (FAI), Perthes disease and osteoarthritis. We aimed to understand the adult experience of hip pain and develop a comprehensive hip-pain survey using a web-based REDCap platform via social media. This paper outlines our survey and analyzes the demographic composition and characteristics of our sample population.

Methods: The survey link was active from October 1, 2023, to May 1, 2024, on social media platforms. Respondents consented to the study before beginning. Responses were anonymous and only unique surveys were analyzed. The comprehensive …

Unveiling The Impact Of Phosphate On Skeletal Muscle Dysfunction In Chronic Kidney Disease, Hiram Garcia, Sowmya Duddu, Erik Hinojosa, Model Zerfu, Nathaniel L. Alvarez, Alex Zuo, Mohammad Razzaque

Research Colloquium

Background: Chronic Kidney Disease (CKD) is characterized by progressive decline in renal function that ultimately culminates in the inability of the kidneys to effectively maintain homeostasis. The kidneys are a key regulator of phosphate, with other organs assisting in regulation including the skeletal system. In CKD, reduced kidney function leads to hyperphosphatemia. While its impact on the skeletal system is moderately studied, its effects on skeletal muscle are less reviewed.In our literature review, we aim to describe the effects of phosphate in the context of patients who have CKD while providing clinical context for this deserving population. We describe …

Periacetabular Osteotomy: An Analysis Of Social Media To Determine The Most Common Questions Asked By The Periacetabular Osteotomy Population, John M. Gaddis, Ryan Bialaszewski, Bretton Laboret, Joel Wells, Adina Stewart

Research Colloquium

Background: Social media has become an increasingly popular resource for patients and a platform to share one’s experiences. Patients undergoing periacetabular osteotomy (PAO) may gravitate towards social media for support, guidance and understanding. The aim of this study was to investigate Facebook, Instagram and Twitter to further understand what the most common preoperative and postoperative questions patients undergoing PAO are asking.

Methods: Facebook, Instagram and Twitter were queried consecutively from February 1, 2023 to November 23, 2011. Facebook was searched for the two most populated interest groups; “Periacetabular Osteotomy (PAO)” and “Periacetabular Osteotomy Australia”. Instagram and Twitter were queried for …

Unveiling The Neurological Aftermath: Pres After Cardiac Arrest, Oyinlola O. Fasehun, Jessica Daza, Sriharsha Koneru, Victor Tran, Eunbee Cho, Fatimah Bello

Research Colloquium

Background: Posterior Reversible Encephalopathy Syndrome (PRES), also known as ‘Reversible Posterior Leukoencephalopathy Syndrome (RPLS)’, is a clinical radiographic syndrome originally described by Hinchey et al in 1996. PRES has been significantly underdiagnosed due to difficulty in confirmation. As such, there is currently no epidemiological data regarding its incidence, but it has been diagnosed in all age groups with a preponderance in females. A variety of medical conditions have been implicated as causes of PRES, including severe hypertension, immunosuppressive therapy, sepsis, renal diseases and autoimmune disorders. The mechanism of PRES is thought to be related to disordered cerebral autoregulation and endothelial …

Pernicious Anemia Presenting With Pancytopenia And Hemolysis: A Case Report From South Texas, Yareli Durazo, Victor Tran, Sriharsha Koneru, Andres Suarez Parraga

Research Colloquium

Introduction: Pancytopenia is a commonly encountered hematologic entity with varying clinical presentations. It results from various disease processes ranging from simple to life-threatening. The most common cause of pancytopenia is megaloblastic anemia, and the most common causes of megaloblastic anemia are deficiencies of vitamin B9 or B12. Thus, folate and B12 deficiency should be high in the differential diagnosis when patients present with pancytopenia. Hemolytic anemia, anemia due to the shortened survival of circulating erythrocytes, often represents a more difficult diagnostic challenge for the clinician. While recognition of ongoing hemolysis is usually rapid and relatively simple, establishing the cause can …

Can We Predict Dominant Compensatory Curves In Congenital Scoliosis?, Myung-Jin Cha, William Elnemer, Paul D. Sponseller

Research Colloquium

Background: A complication in the natural evolution of congenital scoliosis is the development of a compensatory curve. Congenital curves are often focal and rigid, causing patients to develop a compensatory curve cranial and/or caudal to the congenital anomaly to achieve coronal balance. Therefore, surgeons are faced with the difficult choice of waiting for the patient to reach an appropriate age for surgery or correcting the congenital curve before a compensatory curve develops.

Methods: By searching the Pediatric Spine Study Group database, we identified 307 pediatric patients (age <18) with congenital scoliosis who had preoperative radiographs taken during at least 2 years of natural growth (without bracing or surgery). Of these patients, 17 (5.5%) had a dominant compensatory curve, and 290 had no compensatory curve or one that was smaller than the congenital curve. Of those 290 patients, we randomly selected 100 to serve as a control group, referred to as the nondominant curve cohort. We extracted data on the type of congenital anomaly and its vertebral level, as well as the Cobb angles of the congenital and compensatory curves at initial and latest follow-up. We compared vertebral level and type of congenital anomaly via chi-squared test between the dominant and nondominant curve group.

Results: The congenital anomaly was located at L4 or more caudal in 18% …

Gastrointestinal Bleed In The Context Of Hemophilia A In An Incarcerated Patient In The Rio Grande Valley, Cameron B. Caldwell, Hector Trejo, Andres Suaez-Parraga

Research Colloquium

Background: Hemophilia A, the most common X-linked hereditary hemostasis disorder, has an incidence of approximately 1 in 5600 male live births worldwide. It results from a deficiency of clotting factor VIII, crucial for fibrin generation in the coagulation cascade, leading to inadequate fibrin generation and defective secondary hemostasis. Hemophilia can cause life-threatening bleeding, characterized as severe (<1% factor VIII activity), moderate (2-5%), or mild (6-40%). Social determinants of health pose significant challenges in managing hemophilia in underserved populations. This case presents gastrointestinal bleeding in a mild hemophilia A patient in the Rio Grande Valley.

Case Presentation: A 24-year-old Hispanic male with mild hemophilia A presented with a three-day history of melena, headaches, dizziness, and mild abdominal discomfort. Despite recent normal colonoscopy and EGD results, he had a history of intermittent black stool episodes. On admission, …

Utilization Of Pap Smears And Cervicovaginal Fluid For Early Ovarian Cancer Screening & Detection, Natasha Bell, Subhash C. Chauhan

Research Colloquium

Background: Ovarian cancer (OC) remains the gynecologic cancer with the highest mortality due to late-stage diagnosis, lack of effective screening tools, and nonspecific symptoms. This literature review evaluates the use of Pap smears and cervicovaginal fluids for early OC detection. This review explores their potential for detecting OC-specific biomarkers, mutations, proteomics, and methylation patterns from Pap smears and cervicovaginal fluids to investigate their effectiveness and utility as screening and diagnostic tools for OC.

Methods: A systematic PubMed search was conducted using keywords related to ovarian cancer diagnosis, Pap smears, early detection, cervical swabs, mutations, and methylation. Eligibility criteria focused on …

Orthopedic Surgery Residency Trends 2019-2023: Insights And Dynamics, Zayd M. Ayas, Hassan Abou Adma, Juan C. Lopez Alvarenga, Michael Sander

Research Colloquium

Background: Historically, the Step 1 exam served as a major factor in the residency selection process. We aim to analyze how the shift of Step 1 to pass/fail impacts residency applications in terms of number of applicants and application criteria, such as research experiences, step 2 CK scores, etc.

We also aim to analyze how the shift in criteria will impact the quality of orthopedic surgery residents. Using the Orthopedic in Training Examination (OITE) which provides valuable insights into the performance and preparedness of orthopedic surgery residents.

Methods: We began by analyzing the data from the AAMC Report on Residents …

Cultural And Socioeconomic Determinants Of Hip And Knee Arthroplasty In The Rio Grande Valley Community, Blake Martin, John M. Gaddis, Jared Hensley, Juan Lopez Alvarenga, Kelsey Baker

Research Colloquium

Background: Joint arthroplasty is one of the most common procedures performed worldwide and the volume of these operations are on the rise. In this study we aimed to discover if there were differences in the demographics and social factors associated with individuals undergoing total knee arthroplasty (TKA) and total hip arthroplasty (THA) in the Rio Grande Valley. We hypothesized that women would have increased risk of THA whereas individuals who are older and have higher BMI would have increased risk of TKA.

Methods: We conducted a retrospective chart review using the UTRGV UTHealth electronic database from January 1, 2018 through …