Medicine and Health Sciences Commons^™

The Significant Impacts Of Interleukin-8 Genotypes On The Risk Of Colorectal Cancer In Taiwan, Chia-Wen Tsai, Wen-Shin Chang, Te-Cheng Yueh, Yun-Chi Wang, Yu-Ting Chin, Mei-Due Yang, Yi-Chih Hung, Mei-Chin Mong, Ya-Chen Yang, Jian Gu, Da-Tian Bau

Faculty, Staff and Student Publications

Interleukin-8 (IL-8), a pro-inflammatory cytokine, is upregulated in CRC and plays an important role in its development and progression. Genetic variants in the IL-8 gene may impact the risk of CRC by modulating IL-8 levels. Our primary objective was to investigate the role of IL-8 genotypes in the development of CRC. To accomplish this, we employed the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method to analyze the genotypes of IL-8 rs4017, rs2227306, rs2227543, and rs1126647 in 362 CRC patients and 362 controls. Additionally, we evaluated the interactions between these genotypes and factors such as age, gender, smoking, alcohol consumption, …

Nasal Iodophor Antiseptic Vs Nasal Mupirocin Antibiotic In The Setting Of Chlorhexidine Bathing To Prevent Infections In Adult Icus: A Randomized Clinical Trial, Susan S Huang, Edward J Septimus, Ken Kleinman, Lauren T Heim, Julia A Moody, Taliser R Avery, Laura Mclean, Syma Rashid, Katherine Haffenreffer, Lauren Shimelman, Whitney Staub-Juergens, Caren Spencer-Smith, Selsebil Sljivo, Ed Rosen, Russell E Poland, Micaela H Coady, Chi Hyun Lee, Eunice J Blanchard, Kimberly Reddish, Mary K Hayden, Robert A Weinstein, Brandon Carver, Kimberly Smith, Jason Hickok, Karen Lolans, Nadia Khan, S Gwynn Sturdevant, Sujan C Reddy, John A Jernigan, Kenneth E Sands, Jonathan B Perlin, Richard Platt

Faculty, Staff and Student Publications

IMPORTANCE: Universal nasal mupirocin plus chlorhexidine gluconate (CHG) bathing in intensive care units (ICUs) prevents methicillin-resistant Staphylococcus aureus (MRSA) infections and all-cause bloodstream infections. Antibiotic resistance to mupirocin has raised questions about whether an antiseptic could be advantageous for ICU decolonization.

OBJECTIVE: To compare the effectiveness of iodophor vs mupirocin for universal ICU nasal decolonization in combination with CHG bathing.

DESIGN, SETTING, AND PARTICIPANTS: Two-group noninferiority, pragmatic, cluster-randomized trial conducted in US community hospitals, all of which used mupirocin-CHG for universal decolonization in ICUs at baseline. Adult ICU patients in 137 randomized hospitals during baseline (May 1, 2015-April 30, 2017) …

Dendritic Cells As Shepherds Of T Cell Immunity In Cancer, Mikael J Pittet, Mauro Di Pilato, Christopher Garris, Thorsten R Mempel

Faculty, Staff and Student Publications

In cancer patients, dendritic cells (DCs) in tumor-draining lymph nodes can present antigens to naive T cells in ways that break immunological tolerance. The clonally expanded progeny of primed T cells are further regulated by DCs at tumor sites. Intratumoral DCs can both provide survival signals to and drive effector differentiation of incoming T cells, thereby locally enhancing antitumor immunity; however, the paucity of intratumoral DCs or their expression of immunoregulatory molecules often limits antitumor T cell responses. Here, we review the current understanding of DC-T cell interactions at both priming and effector sites of immune responses. We place emerging …

Paired Liver:Plasma Pfas Concentration Ratios From Adolescents In The Teen-Labs Study And Derivation Of Empirical And Mass Balance Models To Predict And Explain Liver Pfas Accumulationn, Brittney O Baumert, Fabian C Fischer, Flemming Nielsen, Philippe Grandjean, Scott Bartell, Nikos Stratakis, Douglas I Walker, Damaskini Valvi, Rohit Kohli, Thomas Inge, Justin Ryder, Todd Jenkins, Stephanie Sisley, Stavra Xanthakos, Sarah Rock, Michele A La Merrill, David Conti, Rob Mcconnell, Lida Chatzi

Faculty, Staff and Students Publications

Animal studies have pointed at the liver as a hotspot for per- and polyfluoroalkyl substances (PFAS) accumulation and toxicity, however, these findings have not been replicated in human populations. We measured concentrations of seven PFAS in matched liver and plasma samples collected at the time of bariatric surgery from 64 adolescents in the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study. Liver:plasma concentrations ratios were perfectly explained (r2 > 0.99) in a multi-linear regression (MLR) model based on toxicokinetic (TK) descriptors consisting of binding to tissue constituents and membrane permeabilities. Of the seven matched plasma and liver PFAS concentrations compared in this …

Opposing Roles For The Α Isoform Of The Catalytic Subunit Of Protein Phosphatase 1 In Inside-Out And Outside-In Integrin Signaling In Murine Platelets, Tanvir Khatlani, Subhashree Pradhan, Kimberly Langlois, Deepika Subramanyam, Rolando E Rumbaut, K Vinod Vijayan

Faculty, Staff and Students Publications

Platelet activation during hemostasis and thrombosis is facilitated by agonist-induced inside–out and integrin αIIbβ3-initiated outside–in signaling via protein kinases and phosphatases. Pharmacological inhibitor studies suggest that the serine/threonine protein phosphatase 1 (PP1) promotes platelet activation. However, since phosphatase inhibitors block all the isoforms of the catalytic subunit of PP1 (PP1c), the role of specific PP1c isoform in platelet signaling remains unclear. Here, we employed a platelet-specific PP1cα−/− mice to explore the contribution of a major PP1 isoform in platelet functions. Loss of PP1cα moderately decreased activation of integrin αIIbβ3, binding of soluble fibrinogen, and aggregation to low-dose thrombin, ADP, and …

Subventricular Zone Cytogenesis Provides Trophic Support For Neural Repair In A Mouse Model Of Stroke, Michael R Williamson, Stephanie P Le, Ronald L Franzen, Nicole A Donlan, Jill L Rosow, Mathilda S Nicot-Cartsonis, Alexis Cervantes, Benjamin Deneen, Andrew K Dunn, Theresa A Jones, Michael R Drew

Faculty, Staff and Students Publications

Stroke enhances proliferation of neural precursor cells within the subventricular zone (SVZ) and induces ectopic migration of newborn cells towards the site of injury. Here, we characterize the identity of cells arising from the SVZ after stroke and uncover a mechanism through which they facilitate neural repair and functional recovery. With genetic lineage tracing, we show that SVZ-derived cells that migrate towards cortical photothrombotic stroke in mice are predominantly undifferentiated precursors. We find that ablation of neural precursor cells or conditional knockout of VEGF impairs neuronal and vascular reparative responses and worsens recovery. Replacement of VEGF is sufficient to induce …

Comparative Analysis Of Conformational Dynamics And Systematic Characterization Of Cryptic Pockets In The Sars-Cov-2 Omicron Ba.2, Ba.2.75 And Xbb.1 Spike Complexes With The Ace2 Host Receptor: Confluence Of Binding And Structural Plasticity In Mediating Networks Of Conserved Allosteric Sites, Mohammed Alshahrani, Grace Gupta, Sian Xiao, Peng Tao, Gennady M. Verkhivker

Mathematics, Physics, and Computer Science Faculty Articles and Research

In the current study, we explore coarse-grained simulations and atomistic molecular dynamics together with binding energetics scanning and cryptic pocket detection in a comparative examination of conformational landscapes and systematic characterization of allosteric binding sites in the SARS-CoV-2 Omicron BA.2, BA.2.75 and XBB.1 spike full-length trimer complexes with the host receptor ACE2. Microsecond simulations, Markov state models and mutational scanning of binding energies of the SARS-CoV-2 BA.2 and BA.2.75 receptor binding domain complexes revealed the increased thermodynamic stabilization of the BA.2.75 variant and significant dynamic differences between these Omicron variants. Molecular simulations of the SARS-CoV-2 Omicron spike full-length trimer complexes …

Use Of Point Of Care Ultrasound In The Pre-Op Evaluation Of Dialysis Patients Needing Creation Of Permanent Arteriovenous Access – Preliminary Study, Urvashi Mathur, Sotero Peralta

Research Colloquium

Background: Non-invasive ultrasound evaluation is part of the preoperative evaluation of patients needing creation of arteriovenous access. This study requires patients to return for an additional visit for imaging or visit an outpatient imaging facility. These visits produce delays in surgery and increase costs in healthcare. Point of care ultrasound examination at the same time of initial physician visit, allows to decrease cost, improvement of anatomical planning, and decrease timing of surgery.

Methods: We reviewed the UTRGV Vascular Surgery Database from January to December 2020, for patients who has elective outpatient arteriovenous access creation, in which has pre-operative evaluation with …

Building The “Crypt” Through Non-Compliance: A Case Of Cryptococcal Meningitis In An Aids Patient, Rodolfo Singleterry, Khairiya Haj-Yahya

Research Colloquium

According to the World Health Organization (WHO), over 10-25% of hospital admissions result from patient noncompliance. This is a complex issue that has vast ripple effects as it not only worsens outcomes for patients but places a strain on the healthcare system entirely. In patients with HIV/AIDS, compliance with Antiretroviral therapy (ART) is necessary to prevent a host of potentially lethal infections.

A 33-year-old female with AIDS, presented to the ED complaining of nausea and vomiting for seven days. Throughout her hospital stay, the patient was regarded as medically noncompliant with daily episodes of refusing medications, hiding pills in her …

Effects Of Social Determinants Of Health On Disease Burden In A Case Of Takayasu Arteritis, Rodolfo Singleterry, Khairiya Hay-Yahya

Research Colloquium

Texas houses the largest uninsured population in the US with an estimated 5 million residents lacking healthcare. In the Rio Grande Valley, the combination of poverty, limited access to care, and lack of insurance poses a great barrier to healthcare management.

Patient is a 27-year-old female with a past medical history of Takayasu arteritis, migraine headaches, complete heart block with pacemaker placement, heart failure with reduced EF of 20%, and rheumatic heart disease s/p mitral valve replacement. Patient presented to the ED with a one-day history of a headache located on the right side of her head and face, described …

Steps On Establishing A Faculty Development Curriculum For Health Science Educators In A New Medical School, Beatriz Tapia, Karina Madrigal, Robert Nelson

Research Colloquium

Purpose: New Medical Schools need health science educators, to teach throughout the medical education continuum from basic science to clinical years. The need to establish a defined faculty development curriculum for health science educators will aid in standardizing best teaching practices and build a potential master teacher to move the curriculum toward active learning and innovation. The UTRGV SoM is a distributed campus, to achieve increase outreach we will offer synchronous and asynchronous online faculty development during the pandemic. This poster will share our progress to date.

Methods: A pilot, faculty development program, was established from faculty needs assessment data, …

Murine For A Bad Time: Prehospital Factor Associations With Murine Typhus Related Icu Admission, Russell H. Moreland Iii, Ayesha Khan, Denisse Ramirez, Salman Bangash, Azucena Del Real, Adriana Betancourth Alvarenga, Natalia Pinto, Chelsea H. Chang

Research Colloquium

Introduction: Across South Texas rates of murine typhus related hospitalization have been on the rise (1). Murine typhus is flea borne febrile illness caused by the bacterium Rickettsia typhi. Murine typhus is easily treated with doxycycline but is commonly underdiagnosed (2). Rarely murine typhus can cause hospitalization and ICU admission (3). To gain a greater understanding of the clinical course of severe murine typhus, our team has set out to identify novel clinical findings associated severe murine typhus courses.

Methods: Medical records were obtained from adults with suspected murine typhus admitted to Doctor’s Hospital at Renaissance in Edinburg, Texas, …

Establishing A Mentoring Program For Health Science Educators In A New Medical School, Karina Madrigal, Beatriz Tapia, Robert Nelson

Research Colloquium

Purpose: New Medical Schools need mentoring programs to enhance the personal and professional development of mentees and mentors. The need to establish a mentoring support mechanism is critical. This poster will share our progress to date.

Methods: A pilot mentoring program was established for junior faculty. These faculty members were paired with an associate professor or professor to serve as mentors for career development and engage in a focused scholarly project over a nine-month period.

Typically, the junior faculty is within the first three years of appointment and hold the rank of assistant professor. Each mentee will have 10% protected …

Ut Health Rgv Covid-19 Testing Report, Jefferson T. R. Chandler, Beatriz Tapia

Research Colloquium

Purpose: This health surveillance project's goal was to organize de-identified data received from UT Health RGV with the intent to provide timely reporting to testing sites and health affairs directors. We aimed to explore how testing rates differ between counties, testing sites and age groups from March 30 through August 7, 2020. We looked at different demographics and compared the positivity rates for each testing site. For this report, we will detail information for the pediatric population (ages 0-18).

Materials and Methods: A codebook and database were created with information about COVID-19 test data to formulate reports to the testing …

Psychotropics Prescription In Primary Care, Ruthzaine Lopez Bolano

Research Colloquium

Background: The study aimed to measure the prevalence of psychotropic prescriptions in primary care at four UTRGV clinical sites. Based on the results, this paper serves to inform and educate primary care providers of their current practices and treatment options when diagnosing mental health disorders and prescribing psychotropics.

Methods: This study used EMR data from January to March 2021 in four primary care clinics affiliated with the UT Health RGV system. Primary care patients from January to March 2021 and who were diagnosed with mood disorders (including Depression, Anxiety, and Bipolar Disorder) were included in this quality improvement study.

Results: …

A Novel Approach To Target Tumor Immune Microenvironment And Improve Checkpoint Immunotherapies, Poornima Devi Shaji, Ana Martinez, Melida Flores Cantu, Anupam Dhasmana, Meena Jaggi, Stephen W. Behrman, Murali M. Yallapu, Subhash C. Chauhan, Sheema Khan

Research Colloquium

Background: Pancreatic cancer remains 3^rd deadliest disease, with less than 7-10% survival rate. Little progress has been seen in patient’s outcome due to high desmoplasia and chemo-resistance. Immunotherapy has shown promising results in cancers, except pancreatic cancer due to their characteristic fibrotic tumor microenvironment. The therapies are unable to penetrate fibrotic tumor leading to insufficient availability of therapeutic drugs at the tumor site. A recently identified mucin, MUC13 is aberrantly expressed in pancreatic tumors but not in normal pancreas, that makes it an excellent protein tumor target. This study is unique as it utilizes MUC13Ab for targeting the pancreatic …

Survival Disparities Between Border And Non-Border Counties In Colorectal Cancer Patients Using The Tcr, Michael Machiorlatti, Michael Brian Lapelusa

Research Colloquium

Along the US Texas Mexico border constant migration, developing medical infrastructure and income disparity leads to poorer access to healthcare and poorer health outcomes. Given 32 of the 254 counties in TX are on the border with roughly 9.8% of the Texas residing in these counties (2.8 million people), this represents a significant population susceptible to adverse health outcomes. We investigate comparisons between border and non-border counties as well as how sociodemographic and diagnostic criterion influence survival of colorectal cancer. Data was obtained from the Texas Department of State Health Service’s TCR. Patients were 18 or older and excluded for …

Case Report Of Chylothorax From Venous Cannulation, Maria Najam, Suneet Johal, Nevin Varghese

Research Colloquium

Background: Chylothorax is the accumulation of the lymphatic fluid in the pleural space. Diagnosis of chylothorax is confirmed with pleural fluid analysis demonstrating triglycerides greater than 110 and cholesterol level less than 200mg/dl. Rarely, chylothorax can occur from damage to the thoracic duct from central venous cannulation

Case Presentation: A 48-year-old female with presented with gradual onset of shortness of breath for five days. She was noted to be hypoxic on arrival and was placed on non-rebreather oxygen therapy. Physical exam revealed decreased breathing sounds on the right side and was also noted for the right internal jugular dialysis catheter. …

Outcomes After Rib Fracture In Elderly Patient Due To Blunt Trauma At Doctors Renaissance Hospital, Lord Crescens Mvoula, David Weaver, Monica Michelle Betancourt-Garcia, Jeffrey Skubic

Research Colloquium

Background: Blunt trauma remains the most common traumatic reason for presentation at a hospital. Despite their frequency, there remains high morbidity and mortality. This is particularly true amongst the elderly. About 16.5 percent of the American population was 65 years old or over in 2019. This number is projected to reach 22 percent in 2050.

Some clinical guidelines requiring admission to an intensive care setting in trauma centers for elderly patients with two or more rib fractures have been adopted by some trauma centers. Usage of these guidelines may lead to significant decreases in hospital stats, ICU stats, and use …

The Reality Of Virtual Undergraduate Medical Education: Hands-On Learning In A Hands-Free World, Layla Nejad, Paola Ibarra, Aleena Flores, Robert Nelson Jr.

Research Colloquium

Background & Purpose: In the wake of the current COVID-19 pandemic, medical education has been forced to rely on virtual experiences including skills workshops, patient interactions, and oral exams. The virtual reality (VR) technology that currently exists has the potential to enhance undergraduate medical learning by improving information retention, clinical skills, and communication; however, most undergraduate medical education (UME) curricula lack its integration and use. Introducing VR to the UTRGV School of Medicine (SOM) could incorporate all existing learning styles and update the virtual world where medical students live and learn, leading to more versatile future-physicians.

Methods: We have explored …

A Case Of Disseminated Cryptococcosis, Suneet Johal, Shadi Jafari-Esfahani, Maria Najam, Luis Rosas

Research Colloquium

Background: Cryptococcus is an invasive fungal infection, typically acquired through inhalation. It is found in soil contaminated with bird droppings and it can disseminate to the lungs, meninges, and skin. In the United States, the incidence of cryptococcosis is estimated to be about 0.4-1.3 cases per 100,000 population with the most common species being Cryptococcus Neoformans and Cryptococcus Gatti. Cryptococcosis is commonly seen in HIV patients, however, immunocompromised individuals with cancer, solid organ transplants, or chronic glucocorticoid therapy are also at high risk.

Case Presentation: A 69-year-old male with history of polymyositis and granulomatosis polyangiitis on chronic steroids presents to …

Long-Term Survival After Stage Iiib Gallbladder Adenocarcinoma, Shiv Govindji, Rohan Jeyarajah, Shankar Logarajah

Research Colloquium

Patients with gallbladder adenocarcinomas are rare but present with low five-year survival rates. However, there are patients that survive long after their diagnosis with late-stage gallbladder cancer. The objective of this clinical case report is to highlight factors which may have contributed to this patient’s current 15-year survival to provide further insight on the prognosis of aggressive gallbladder adenocarcinomas.

A 43-year-old woman presented to the clinic with back pain. She had an ultrasound which showed dilated bile ducts and a filling defect with endoscopic retrograde cholangiopancreatography. A gall bladder mass was found and biopsied. Biopsy concluded the mass to be …

Uterine Serous Carcinoma: A Rare Presentation Of An Uncommon Type Of Cancer, Shadi Jafari-Esfahani, Fatimah Bello

Research Colloquium

Introduction: Endometrial adenocarcinoma is the most common type of uterine cancer and is divided into two types; type 1 includes 80 percent of the cases while type 2 comprises 10 to 20 percent, with latter being more aggressive. Type 2 endometrial cancer is of serous or clear cell histology and abnormal uterine bleeding is the most common clinical presentation. This case portrays an infrequent presentation of uterine cancer.

Case Presentation: A 73-year-old woman with past medical history of hypertension and diabetes mellitus type 2 presents to the emergency room with chief complaint of nausea and abdominal bloating for 2 months, …

Analysis Of Secondary Neurodegeneration In Spinal Cord Mri In Post-Stroke Patients, Sarvani Uppati, Sravani Mannuru, Kelsey Baker

Research Colloquium

Background: Stroke, also termed cerebral infarction, results in neurodegeneration and neuroinflammation in the brain at area of the infarct and peri-infarct regions. It has also been established that damage in the motor pathways including the corticospinal tract contribute to motor deficits in post-stroke patients. Recent research has recognized the involvement of alternate sensorimotor pathways in the spinal cord that underline disease progression and the degree of functional recovery post-stroke. Evaluating the role of alternate sensorimotor pathways in the brain can be challenging, since the pathways remained crossed until they reach the spinal cord. Although MRI has been used to examine …

A Case Of Cannabis Smoking Induced Leukocytosis, Ramiro A. Rodriguez Jr., Rukayat Akande, Nevin Varghese

Research Colloquium

Background: Leukocytosis relates to infections, malignancies, stress response, and multiple intoxicants. Like other intoxicants, cannabis smoking can result in a persistent leukocytosis. Here we report a case of cannabis-induced leukocytosis.

Case Presentation: A 20-year-old Hispanic female with a history of anxiety disorder presented with 3-days of nausea, vomiting, and colicky abdominal pain. She endorsed heavy marijuana smoking as self-medication and compulsive hot showers for symptom relief. She was admitted for oral intake intolerance, concerning for cannabis hyperemesis syndrome. Her history demonstrated multiple admission for cannabis hyperemesis syndrome during which she demonstrated a leukocytosis which improved with abstinence of marijuana. Her …

Mallory-Weiss Syndrome In The Setting Of Multiple Seizures, Pooja Maknoor, Himabindu Kolli, Nestor Gerardo Astorga, Timothy Heath

Research Colloquium

Background: Mallory-Weiss syndrome is a longitudinal mucosal laceration in the distal esophagus and proximal stomach, usually associated with forceful retching or vomiting. Here, we present a case of Mallory Weiss syndrome in the setting of multiple seizures without any retching or vomiting.

Case Presentation: A 64-year-old man with history of epilepsy on anticonvulsant medications presented to the emergency department with complaints of multiple seizures. During the initial evaluation, he was alert, in no acute distress and was answering questions appropriately. He denied any trauma, loss of consciousness, nausea, vomiting, retching, tongue biting or incontinence. On examination, blood pressure was 92/53 …

Hepatic Chylothorax, A Rare Finding In A Patient With Subacute Hepatic Hydrothorax, Oscar Rodrigo Zamudio Herrera, Shadi Jafari-Esfahani, Fatimah Bello

Research Colloquium

Background: The presence of chyle in the pleural space is termed chylothorax. Etiologies include traumatic (iatrogenic, blunt, or penetrating injury) and non-traumatic (non-malignant and malignant). Liver cirrhosis is a rare cause of non-traumatic, nonmalignant chylothorax. We describe a case of a transudative chylothorax in a patient with cirrhosis and hepatic hydrothorax.

Case presentation: A 72-year-old woman presents with complaints of shortness of breath for 7 days, altered mental status, and abdominal distention. Patient has past medical history of diabetes, hypertension, and liver cirrhosis. On arrival, vital signs demonstrated T 96.2 F°, HR 75, RR 16, BP 143/68, and SO2 97%. …

A Case Of Device Lead Induced Severe Tricuspid Regurgitation And Right-Sided Heart Failure, Nina Shyama Appareddy, Michaela Iglesia, Ayman Khaddam, Henry Kwang, Eduardo D. Flores

Research Colloquium

Background: Interference of device leads with closure of the tricuspid leaflets can cause severe tricuspid regurgitation (TR) and right-sided heart failure, as can heart failure with reduced LV function (HfrEF), and left sided valve disease.

Case Presentation: A 78-year-old male with history of coronary artery disease s/p remote coronary bypass, ischemic cardiomyopathy with left ventricular ejection fraction 35-40%, and inducible ventricular tachycardia status post defibrillator presented with worsening dyspnea on exertion, easy fatigue, lower extremity pitting edema, anasarca, abdominal bloating and new systolic murmurs at the right upper and left lower sternal borders. An Echocardiogram demonstrated severe aortic stenosis with …

A Case Of Pericardial Effusion: Aid Of Bedside Ultrasound In Clinical Decision Making, Nestor G. Astorga, Aramide M. Tijani, Nevin A. Varghese

Research Colloquium

Background: In life-threatening conditions, such as cardiac tamponade, we need to recognize signs of impending decompensation in a timely manner. Point of care ultrasound is non-invasive and is readily available, particularly in a resource limited setting. In this case, we present a patient with worsening pericardial effusion and the importance of bedside cardiac ultrasound.

Case presentation: A 76-year-old male with stage IV adenocarcinoma of the lung was admitted for worsening dysphagia for 3 days and decreased oral intake. He was normotensive but was tachycardic with muffled heart sounds. CT of the chest demonstrated a significant pericardial effusion. Bedside ultrasound to …

Pneumocystis Jirovecii Pneumonia In A Newly Diagnosed Aids Geriatric Patient, Ashley Sareen, Nathan Tanner, James Fahey

Research Colloquium

Background: Approximately 40% of new HIV infections originate from people who are unaware of their diagnosis. Median time from infection to diagnosis was 3 years in 2015. Cases of newly diagnosed HIV in the geriatric population are rare.

Case Presentation: 71 year old Hispanic man with history of diabetes and anemia presenting to the hospital with generalized weakness, presyncopal episodes, shortness of breath, loose stools, and falls for past two weeks. He is a poor historian so wife contacted to provide detailed history. Patient with 100 pound weight loss in 6 months. Intravenous drug use 30 years ago, and blood …