Medicine and Health Sciences Commons^™

Sickle Cell Anemia In Hispanic-Americans In South Texas: Two Case Reports, Ashika A. Chacko, Shadi Jafari-Esfahani, Nevin A. Varghese

Research Colloquium

Introduction: Sickle cell anemia and traits are well described in the African-American population. Hispanic Americans are an underappreciated community affected by Sickle cell disease, where it affects about every 1 in 16300 live births compared to 1 in every 365 African-American births.Hence, it is essential to acknowledge the incidence in Latin American origin people to provide competent and specific care to these populations.

Case Description: Case 1: A 28-year-old Latin-American lady with sickle cell anemia, multiple transfusions, and exchange transfusion in the past presented with complaints of lower back and lower extremity pain. The patient got admitted with acute sickle …

Antibiotic Stewardship In Skin And Soft Tissue Infections, Shah Z. Ali, Stephen Gore, Jose E. Campo Maldonado

Research Colloquium

Introduction: Skin and soft tissue infections (SSTIs) are characterized by microbial invasion of the skin layers and are common in various healthcare settings. A study conducted between 2005-2010 in the United States, found a combined total of 2.3 million cases of SSTIs in ambulatory and inpatient settings. This was higher than the rates of pneumonia and urinary tract infections during the same time period. Another study found that between 2000 and 2012, there was a 40% increase (2.4 million to 3.3 million) in cases of SSTIs. Our aim is to study the primary uses of vancomycin and piperacillin/tazobactam and their …

Impact Of Multimedia Interventions For Musculoskeletal Health Amidst Covid-19 Pandemic, Kevin J. Orellana, Tarek Yamout, Guillermo Ramirez, Paul Treviño, Erick M. Santos, Letitia Bradford

Research Colloquium

Lower extremity joint pain is a leading cause of disability and immobility in the United States. Movement is Life seeks to educate and empower patients to break the cycle that immobility starts in efforts to improve musculoskeletal and overall emotional and physical wellbeing. Studies in the past have described the correlation that exists between using Movement is Life education materials as well as a home exercise program to improve lower extremity pain and overall health short term but did not account for confounding factors during the COVID-19 pandemic. The effect of the COVID-19 pandemic on health goes beyond patients that …

Femoral Neck Fracture Management In The Young Patient: A Case Review, Luis Berrios, Kevin J. Orellana, Michael Lago, Frank Gerold

Research Colloquium

Introduction:The optimal management of femoral neck fractures in the young patient remains controversial. Although there are universally accepted principles, there remains some variability in the optimal timing of surgery and method of fixation. In general, surgery should be performed on an urgent or emergent basis when feasible to decrease peri-operative complications, length of stay, and most importantly the ultimate likelihood of avascular necrosis. However, it is important to note that the preference toward a specific method of fixation remains heterogeneous among orthopedic surgeons.(1)

The purpose of this study is to present our preferred technique for treatment of displaced femoral …

A Puzzling Case Of Glutamic Acid Decarboxylase 65 (Gad65) Neurologic Syndrome, Areeb Masood, Nina Appareddy, Raul Tovar Castro, Zan Shareef, Laura Garcia

Research Colloquium

Autoimmune encephalitis (AE) is a rare group of neurological disorders in which antibodies are directed against intracellular or surface antigens. The incidence of AE ranged from between 0.4-1.2 per 100,000 person-years between 1995 and 2015. A subset of these autoimmune encephalitides that target glutamic acid decarboxylase (GAD) are termed anti-GAD related neurological disorders. GAD is the rate-limiting enzyme involved in the synthesis of GABA from glutamate, and is expressed in neurons of the cerebral cortex, cerebellum, and hippocampus. In addition, it is found in the B-islets of the pancreas, epithelial cells of the fallopian tube, and spermatocytes of the testes. …

Rare Case Of Prosthetic Joint Infection Caused By Salmonella Enterica - A Case Report, Carlos Ramos, Shyama Appareddy, Peter J. Gonzalez

Research Colloquium

Introduction: Collectively, over 1 million total knee arthroplasties (TKA) and total hip arthroplasties (THA) are performed in the United States each year. In 2010 it was estimated that 1.58% of the United States general population has received a TKA. Prosthetic joint infections (PJI) are the most common indication for a TKA revision1 . In total, S. aureus is responsible for about 50% of all prosthetic joint infections, and about 15% are caused by gram negative pathogens2 .

Objective: This is a case report which describes the presentation and clinical course of a 59-yearold female with Salmonella enterica septic arthritis of …

Factor V Leiden And Its Association With Vascular Disease And Treatment In A Latino Patient, Adriana Saavedra-Simmons, Daniel Aragon, Irma Huayanay, Brandon Cantazaro

Research Colloquium

Introduction: Factor V Leiden (FVL) is the most common hereditary thrombophilia, and a single amino acid mutation renders Factor V resistant to inactivation by Activated Protein C resulting in a prothrombotic state. The association between FVL and vascular disease has been reported and debated. We present a case of a patient with FVL and its repercussion on medical treatment.

Case Description: A 64-year old Hispanic man with a past medical history of coronary artery bypass grafting, Type 2 diabetes mellitus, hypertension and severe peripheral vascular disease with history of left above the knee amputation presented to the emergency department with …

Renal Artery Stenosis As A Cause Of Acute Kidney Injury In A Post-Kidney Transplant Patient, Nghia Nguyen, Mourad M. Alsabbagh, Brandon Cantazaro

Research Colloquium

Introduction: The most common complication of kidney transplantation is allograft dysfunction, which can present as acute kidney injury (AKI). Here, we report a case of transplant renal artery stenosis (TRAS) presenting with acute elevation in creatinine in concomitant with resistant hypertension.

Case Presentation: A 69-year-old African American male with history of end stage renal disease status post living unrelated kidney transplant presented for evaluation of worsening kidney function. Past medical history included hypertension, diabetes mellitus type 2, coronary artery disease. Physical exam was significant for blood pressure 164/85, bilateral crackles, lower extremities edema. Blood work showed creatinine 3..8 mg/dL (up …

Case Report: Recurrent Bell’S Palsy And Genetics, Dakota Bigham, Adam Kvinta, Heriberto Cantu

Research Colloquium

Background: Bell’s palsy, also known as Idiopathic Facial Paralysis (IFP), is a generally common condition, occurring up to 20-30 cases per 100,000 individuals in the general population. Its occurrence can be influenced by a variety of factors such as exposure, immunocompromised states and genetic susceptibility. While uncommon, Bell’s Palsy can recur spontaneously in up to 15% of patients. Here, we present a case of chronically recurrent Bell’s palsy in an individual, and explore the possibility of a genetic component.

Case Presentations: Our case involves a 39 year old woman with no significant past medical history who presented with a one …

Case Report: Levamisole-Induced Vasculitis After Cocaine Ingestion, Dakota Bigham, Adam Kvinta

Research Colloquium

Background: Levamisole, a common anthelmintic, is estimated to be present in up to 70% of the cocaine found in the United States. The exact mechanism of interaction between Levimasole and cocaine use is unknown. One such complication of ingestion of Levimasole contaminated cocaine is Levimasole Vasculitis. Here we report a case of the clinical presentation of Levimasole Vasculitis, and the emphasis on proper and thorough history taking when arriving at a diagnosis.

Case Presentation: Our case begins with a 71-year-old male with a history of COPD, hyperthyroidism, and polysubstance abuse who presented to the hospital with weakness, neck stiffness, chest …

Prevalence Of Liver Cirrhosis And Its Association With Obesity Among Mexican Americans: An Evidence Synthesis, Alexa Perlick, Abaigeal Thompson, Colton Wayne, Angel Rendon, Jose E. Campo Maldonado

Research Colloquium

Introduction: Chronic liver disease is the 6^th and 7^th leading cause of death in Hispanic men and Hispanics, respectively.¹ In contrast to other causes of liver disease, the prevalence of nonalcoholic liver disease has been growing as is diabetes and obesity.²

Objective: There is a paucity of data regarding the prevalence of cirrhosis for Mexican Americans in South Texas. The aim of this evidence synthesis is to investigate the prevalence of cirrhosis in Hispanic populations and its relationship with obesity.

Methods: PubMed was used to perform a thorough literature search on September10, 2020. The terms “liver …

Development And Validation Of A Predictive Model For Childhood Mortality After A Traumatic Brain Injury: Analysis Of The National Trauma Data Bank, Jooby Joy, Axel Moreira, Kevin Chorath, Karthik Rajasekaran, Alvaro Moreira

Research Colloquium

Introduction: Traumatic brain injury (TBI) is a significant cause of morbidity and mortality in children. While most TBI-related admissions are mild, identifying early predictors of poor outcome may assist clinicians with timely medical decisions and effective triage utilization.

Objective: We sought to develop and validate a clinical tool for predicting in-hospital death in children after a traumatic brain injury.

Methods: Data was collected for children (≤18 years) from the National Trauma Data Bank between the years of 2007 to 2015. We included children who sustained any TBI, defined as: (i) open and closed skull fractures, (ii) cerebellar, cortical, or brain …

A Natural Near-Infrared Fluorescent Probe For Cancer Cell Imaging, Benilde E. Adriano, Nycol M. Cotto, Neeraj Chauhan, Meena Jaggi, Subhash C. Chauhan, Murali M. Yallapu

Research Colloquium

Introduction: Near-Infrared (NIR) fluorescence-based imaging is a noteworthy and safer strategy for cancer cells/tissues imaging compared to radiological imaging. NIR fluorescence offers deep tissue penetration and have minimal obstruction by autofluorescence and photon scattering [1]. There are several NIR dyes including indocyanine green (ICG) [2] and IR-1061 [3] that allow high-resolution tissue imaging. However, these dyes possess some low-quality characteristics which limit their use, namely photo instability, toxicity, poor water solubility, and short half-lives [4]. Therefore, more efficient and effective alternatives are urgently required to provide the desired clinical outcomes. Chlorophyll (Chl) is a natural dietary NIR fluorescence emitting …

Aids-Associated Kaposi's Sarcoma Complicated With Covid-19, Adriana Saavedra-Simmons, Veronica Salazar

Research Colloquium

Introduction: Several studies have not found a significant increase in risk of poor outcomes in people with HIV (PWH) who are coinfected with COVID-19. However, the majority of PWH in the studies were stable with their highly active antiretroviral therapy (HAART) regimen. We present a case of AIDS-associated Kaposi’s sarcoma (KS) with superimposed COVID-19 infection.

Case Description: Our patient is a 21-year old Hispanic male with recent diagnosis of HIV-1 who presented to the ED with generalized facial swelling and right lower extremity edema associated with shortness of breath (SOB) and palpitations. He denied fever, chills, weight loss, chest pain, …

Development Of Targeted Drug Delivery System To Improve Immunotherapy In Pancreatic Cancer, Poornima Devi Shaji, Ana Martinez Bulnes, Nirnoy Dan, Subhash C. Chauhan, Sheema Khan, Murali M. Yallapu

Research Colloquium

Introduction: About 95% of tumor arises from epithelial cell lining ducts known to be pancreatic ductal adenocarcinomas, with less than 5-7% survival rate. Unfortunately, little progress has been seen in the outcomes of patients with PDAC as tumor develops high desmoplasia and chemo-resistance to chemotherapeutic drugs, such as gemcitabine (Gem). Immunotherapy has shown promising results in other cancers but limited response in pancreatic cancer due to desmoplasia and fibrotic tumor microenvironment. A recently identified mucin, MUC13 is aberrantly expressed in pancreatic tumors but not in normal pancreas. Due to its high membrane expression, MUC13 may serve as an excellent target …

Novel Therapy Targeting Mutant-Krasg12d And Galectin-1 In Pancreatic Cancer, Ana I. Martinez Bulnes, Nirnoy Dan, Poornima Devi Shaji, Swathi Holla, Murali M. Yallapu, Sheema Khan

Research Colloquium

Introduction: Although, surgical resection and chemotherapy are the gold standard for treating Pancreatic Ductal Adenocarcinoma (PDAC), low patient survival rate remains the problem. The activating point mutation of the KRAS on codon-12 is present in 70–95% of PDAC cases and so far, no success has been achieved to inhibit KRAS. KRASG12D regulates cell proliferation, differentiation, apoptosis. Recent preliminary and published studies show high Galectin-1 (Gal-1) levels in both pancreatic cancer and stromal cells, which modulate tumor microenvironment and metastasis. Additionally, genetic deletion of gal1 inhibits metastasis and improves survival in KRAS mouse model of PDAC (1). Therefore, our objective is …

Hepatoprotective Role Of Cucurbitacin D On Benzo[A]Pyrene Induced Liver Injury, A. Rodriguez, Mohammed Sikander, Shabnam Malik, M. Vela, Fathi T. Halaweish, Meena Jaggi, Sumeet S. Chauhan

Research Colloquium

Background: Epidemiological findings show the strong correlation of co-morbidity factors including smoking with the development and progression of liver cancer. Moreover, benzo[a]pyrene, a main component of tobacco smoke, is extremely carcinogenic and contributes to liver injury as well. Cucurbitacin, chemically classified as triterpenes, have shown diverse biological activities including potent antioxidant, anti-inflammatory and anti-cancer activities. However, their hepatoprotective activities are not completely understood.

Objective: In the present study, we investigated the cytoprotective activity of novel analog of cucurbitacin, cucurbitacin D, against benzo[a]pyrene-induced liver injury in human HepG2 cells.

Method: Proliferation, clonogenicity, migration, invasion, Western blotting and qPCR analysis were conducted …

Pharmacological Restoration Of Pkd1: A Novel Strategy For Prostate Cancer Therapy, Mohammed Sikander, Shabnam Malik, A. Rodriguez, Aditya Ganju, Bilal B. Hafeez, Fathi T. Halaweish, Subhash C. Chauhan, Meena Jaggi

Research Colloquium

Background: Prostate cancer has poor prognosis owing to late diagnosis and ineffective multimodal clinical treatment. Extensive efforts are ongoing to establish methods that can resolve the expression of genes implicated in disease development and treatment. Previously, we reported that Protein Kinase D1 (PKD1), a serine threonine kinase, controls a number of tumor suppressor functions including cell aggregation, cell motility, cell proliferation, and cell invasion. Thus, PKD1 is considered as an emerging therapeutic target for prostate cancer treatment.

Objective: To investigate the restoration of PKD1 by a pharmacological modulator ormeloxifene, which showed well-defined PK/PD and safety profiles in humans.

Methods: Proliferation, …

Mucin 13 Expression Correlates With Tumor Development In Hepatocellular Carcinoma, Shabnam Malik, Mohammed Sikander, Deepshikha Pande Katare, S. Mishra, S. K. Jain, P. Khan, Subhash C. Chauhan, Meena Jaggi

Research Colloquium

Background: Hepatocellular carcinoma (HCC) has a poor prognosis due to ineffective therapeutic modality and lack of early diagnostic marker. Accumulating studies have shown that elevated expression of mucin 13 as potential oncogene and predictive biomarker for various cancer. However, very little is known about its expression and function for development and progression of HCC Objective: To investigate mucin 13 expression in chemically induced hepatocellular carcinoma model.

Methodology: Diethyl nitrosamine (DEN) and 2-Acetylaminofluorene (2-AAF) induced method was employed for the development of hepatocellular carcinoma in Male Wistar rats. Serum and tissues were collected at regular interval of time and routinely validated …

Severe Hypokalemia Secondary To Distal Renal Tubular Acidosis In A Hispanic Man, Aramide Mikhail Tijani, Himabindu Kolli, Suneet Johal, Maria Najam, Fatimah Bello, J. M. Paredes

Research Colloquium

Introduction: Renal tubular acidosis is a rare renal disorder that can cause severe electrolyte imbalances which can be life threatening.

Case: A 21-year-old man presented to the ED on account of generalized weakness and body aches of one day duration. He reported no past medical history other than a previous episode of similar symptoms with improvement after IV hydration and electrolytes replacements about 2 months prior. He was not taking any medications and denied vomiting, diarrhea nor any significant family history. He admitted to alcohol and marijuana use.

Physical examination was significant for reduced muscle power, tone, and reflexes in …

Assessing The Mental Health Of Older Hispanic/Latinx Adults: Focus On The Impact Of The Hispanic Cultural Value Of Fatalismo On Depressive Symptomatology, Anna J. Prado, Amie Bostic, Mario Gil

Research Colloquium

Introduction: The impact of depression in older Hispanic/Latinx adults in the United States is poorly understood. The influence of the deeply embedded Hispanic/Latinx cultural value of fatalismo, referring to the belief that one’s future is predetermined and related to feelings of helplessness, has been found to negatively impact their psychological health [1, 2]. The present study explores the association between the Hispanic/Latinx cultural value of fatalismo and mental health.

Objective: To contribute to the identification and understanding of psycho-social-cultural determinants of depression in the Hispanic/Latinx population.

Methods: Using data from the Health and Retirement Study (HRS) …

A Preliminary Timeline Of The Midbrain Development In The Monodelphis Domestica Animal Model, Ismael Perez, John L. Vandeberg, Mario Gil

Research Colloquium

Introduction: The Brazilian short-tailed opossum (Monodelphis Domestica) is an understudied animal model compared to the Mus musculus that has been identified as a perfect candidate to study neurodevelopment (Baggott, L. & Moore, H., 1990). What makes the Monodelphis Domestica a perfect specimen for neurodevelopment is that the embryo develops outside the pouch of the mother providing easy noninvasive access to track changes across different developmental stages (Mate et al., 1994).

Objective: The objective of the study is to compare the area and volume in the development of the Monodelphis’s midbrain across three different developmental stages. Our research is beneficial because …

Assessing Morbidity In Patients With Greater Trochanteric Pain Syndrome (Gtps), Sonia Wadekar, Joel Wells

Research Colloquium

Introduction: Greater trochanteric pain syndrome (GTPS) continues to be a challenge among orthopedics to rid discomfort for their patients, especially since there are few studies on characterization of GTPS morbidity.

Objective: The purpose of this study is to characterize the morbidity of GTPS in order to aid orthopedics in providing an early diagnosis and better treatment/care options for their patients.

Methods: A total of 156 patients were included from January of 2016 to July of 2020. Refer to Figure 1 for a visual of inclusion criteria. All patient information was taken from first appointment notes, operative notes, chart reviews, and …

Severe Hyponatremia Associated With Partial Empty Sella Syndrome, Lily Chen, Shyama Appareddy, Laura Garcia

Research Colloquium

Hyponatremia, serum sodium concentration < 135 mmol/L, is further classified by patient volume status. Symptoms are dependent on the acuity of sodium loss. Acute onset hyponatremia can present with confusion, disorientation, headache, agitation, vomiting, and lethargy. Patients with hyponatremia warrant a thorough workup and can be a leading manifestation of hypopituitarism in the geriatric population. A 77 year old patient, history of pituitary adenoma, presented with generalized symptoms of fatigue, gait instability, poor appetite and confusion associated with severe hyponatremia and hypoglycemia. The patient has a history of pituitary adenoma treated with cabergoline, hypothyroidism treated with levothyroxine and gonadal insufficiency treated with testosterone, with no reported history of diuretic use. On admission, the patient had a sodium level of 116 mmol/L. While the patient reported improvement in symptoms, patient’s confusion was noted to persist despite appropriate correction of sodium and glucose. Patient had an AM cortisol of 4 mcg/dL. Cosyntropin test was conducted and noted to be negative. MRI Brain with Gadolinium revealed empty sella turcica with a small amount of enhancing pituitary tissue, which may indicate a response to previous cabergoline therapy. Despite negative cosyntropin results, the patient was suspected to have relative adrenal insufficiency due to multiple acute stressors including illness, hospitalization, disruption of routine and abrupt smoking cessation. Patient was given a trial of hydrocortisone with improvements noted in his mental status, strength and appetite. Thus, careful consideration should be given towards adrenal insufficiency secondary to hypopituitarism as an etiology for severe hyponatremia.

A Covid-19-Inspired Comprehensive Approach To Resident Wellness And 360-Degree Approach To Pandemic Preparedness And Disinfection Practices, Preet Gudimella, Unnam Nasir, Heidi Pareja

Research Colloquium

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak that had led to the coronavirus disease 2019 (COVID-19) pandemic caused stress for medical residents on the frontline. This motivated our team to implement changes in our residency program’s inpatient service. We approached resident wellness in a comprehensive manner. The changes we implemented at our site had crucial benefits for our inpatient teams. Not only did we implement conventional best practices on infection prevention, we also executed additional safety measures, addressed mental and physical health, and had COVID-19-specific skills training. Consequently, our residents were less stressed, better prepared, and more focused …

Suicide Risk In Patients With Type Ii Diabetes, Ruthzaine Lopez Bolano, Michael Machiorlatti

Research Colloquium

Introduction: The comorbidity of mental and physical disorders represents a major challenge for health care worldwide. The comorbidity of depression and diabetes can be seen as a prototypical example of mental/physical comorbidity. The prevalence of both conditions is growing, with depression twice as frequent in people with diabetes compared with those without diabetes. [1] The prevalence of depressive disorders in diabetics is the general range of 10% to 15%, which is approximately twice as high as the prevalence of depression in non-diabetics. [1] For instance, diabetic patients, and during the course of the disease, are most likely to experience …

A Systematic Review And Meta-Analysis Of Empathy Changes In Medical Students During Medical Education, Sahar Panjwani, Jiyun Lim, Matthew Hidalgo, Michael Machiorlatti, Minerva Angelica Romero Arenas

Research Colloquium

Introduction: Reduction in empathy has been explored in medical students (MS). Questions remain on whether significant changes in empathy occur during MS education.

Objective: Focusing on studies using the Jefferson Scale of Empathy medical student version (JSE-S), the authors aimed to quantify and assess reported changes across reviewed literature.

Methods: A systematic review and meta-analysis were performed using PRISMA guidelines. Criteria for inclusion were articles 1) written in English, 2) pertained to human subjects, and 3) written in the previous ten years (2009-2019). Exclusion criteria were those that 1) did not assess MS, 2) did not utilize the JSE-S, 3) …

Stem Cell Technology For Age Related Macular Degeneration Intervention, Laura Valdez

Research Colloquium

The main focus of this thesis is to study induced pluripotent stem cell derived Retinal Pigmented Epithelium (RPE) cells in various physiological conditions mimicking RPE transplantation rejection. Retinal pigmented epithelium (RPE) cells are located between the choroid and photoreceptors within the eye and are essential to provide nutrients from blood to rods and cones, as well retinoids of the visual cycle. Vision loss and various ocular diseases are attributable to the degeneration or dysfunction of the RPE cells, leading to blindness. One of the major ocular problem from RPE dysfunction is macular degeneration. Age-related macular degeneration (AMD) can be frequently …

Antifungal Prophylaxis And Risk For Invasive Mold Infections In Children With Hematologic Malignancies, Ashley Ikwuezunma, Ankhi Dutta, Maria I. Castellanos, Hana Paek, Debra L. Palazzi, Karen R. Rabin, Michael E. Scheurer, Maria M. Gramatges

Research Colloquium

Introduction: Invasive mold infections (IMI) are a leading cause of mortality in immunocompromised hosts. Children diagnosed with hematologic malignancies experience profound, prolonged neutropenia following intensive chemotherapy, and are at increased risk for infection-related outcomes. Depending on the anticipated therapeutic intensity, antimicrobial prophylaxis may be employed to mitigate risk for infection. We conducted a retrospective review of children diagnosed with acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), or lymphoma between 2006-2015 and determined the incidence of IMI to be 4.8% (47/976), with an exceptionally high incidence observed in patients with AML (8.1%). This observation prompted a change in clinical practice …

Exploration Of Potential Risk Factors For Texas County Covid-19 Infection Rates, Keren Kahsai, Michael Machiorlatti

Research Colloquium

There have been over 2 million COVID-19 cases within the United States. When considering where infections take place, there appears to be variability between states and even between counties (Gardner 2020). To understand the reasons underlying this phenomenon, we used Texas county data on Covid-19 infection rates and utilized auxiliary data such as age, race, gender, diabetes and obesity rates, temperature, humidity, median household income, metropolitan or rural designation, and poverty rates to see what confers greater risk for higher total infection at a county level. Our study found a positive relationship between diabetes and obesity rates and COVID-19 infection …