Medicine and Health Sciences Commons^™

Epidemiological Algorithm And Early Molecular Testing To Prevent Covid-19 Outbreaks In A Mexican Oncologic Center, Moises González-Escamilla, Diana C. Peréz-Ibave, Carlos H. Burciaga-Flores, Vanessa N. Ortiz-Murillo, Genaro A. Ramírez-Correa, Patricia Rodríguez-Niño, Rafael Piñeiro-Retif, Hazyadee F. Rodríguez-Gutiérrez, Orlando D. Solis-Coronado, Juan F. González-Guerrero, Oscar Vidal-Gutiérrez, María Lourdes Garza-Rodríguez

Research Symposium

Introduction: Prevention strategies and detection of latent COVID-19 infections in oncology staff and oncologic patients are essential to prevent outbreaks in a cancer center. In this study, we used two statistical predictive models in oncology staff and patients from the radiotherapy area to prevent outbreaks and detect COVID-19 cases.

Methods: Staff and patients answered a questionnaire (electronic and paper surveys, respectively) with clinical and epidemiological information. The data was collected through two online survey tools: Real-Time Tracking (R-Track) and Summary of Factors (S-Facts). According to the algorithm's models, cut-off values were established. SARS-CoV-2 qRT-PCR tests confirmed the algorithm's positive individuals. …

Effect Of Igf-1 On Post-Translational Modifications (Ptms) On A Model Of Diabetes-Induced Cardiac Hypertrophy In H9c2 Cardiomyoblast Cell Line, Andres Medina, Lizbeth Trevino, Alejandra Salinas, Yadira Chaires, Erick Rodriguez

Research Symposium

Background: Diabetic cardiomyocytes alter their post-translational modification levels, especially in OGlcNAcylation and Phosphorylation. Insulin-like growth factor 1 (IGF-1) is a peptide known to induce favorable cardiovascular effects in patients with heart failure. Here, we focus on the downstream effects of IGF-1 as a potential DCM treatment.

Methods: H9c2 cells were cultured in DMEM-10% FBS at 80% of confluence. As a cellular model of cardiac hypertrophy, we used a high-glucose medium (30 mM glucose) in the presence or absence of 10 µmol/L of IGF-1 (HG and HG+IGF-1). As control groups, we used cells cultured in low-glucose DMEM (glucose 5mM) in the …

Effect Of Chitosan And Hydroxypropyl Methylcellulose On Size And Antibacterial Activity Of Copper Nanoparticles, Tippabattini Jayaramudu, John Amalraj

Research Symposium

Background: Nanomaterials exhibit better antibacterial activity because of their distinct structural/ morphological characteristics. The particle size and shape of the nanomaterials are the two significant parameters which affect the resultant antibacterial property. Different biopolymers have been explored to prepare capped metal nanoparticles with controlled/desired particle size and morphology.

Methods: The present research work explains the effect of chitosan (CH) and hydroxypropyl methylcellulose (HPMC) on the shape and size of the copper nanoparticles (Cu NPs) and their antibacterial activity. The CH-Cu and HPMC-Cu NPs were achieved by facile precipitation technique using ascorbic acid as a nucleating agent.

Results …

Dosimetric And Volumetric Analysis In Endobronchial Brachytherapy Treatment Of Carcinoma Lung Patients: A Pilot Study, Ravi Kant, Meenu Gupta, Jyoti Bisht, Vipul Nautiyal, Viney Kumar, Rishabh Dobhal, Mushtaq Ahmed, Sunil Saini

Research Symposium

Background: To analyze the radiation doses received by Organ at Risk (OAR) nearby the target volume and volumetric changes in the target volume in carcinoma lung patients irradiated in three treatment session of endobronchial brachytherapy (EBBT).

Methods: Dosimetric analysis was conducted on patients of carcinoma Lung received three session of Endobronchial brachytherapy treatment in High Dose Rate brachytherapy unit with Ir-192 source. A flexible Lumencare catheter was inserted into the bronchus and positioned catheter tip at the tumor. Length of the implanted catheter was measured with the source position simulator device. Acquired three dimensional CT image data set with …

Differential Gene Expression Between African American And Caucasian American Prostate Cancer, Daniel L. Shen, Gregory T. Maclennan, Sanjay Gupta

Research Symposium

Background: African-American (AA) men have higher incidence and mortality from prostate cancer compared to Caucasian-American (CA) men. Increasing evidence suggests that genetic and molecular alterations play important roles. We identified a 5 gene panel viz. p-Akt (Ser473), chemokine (C-X-C motif) receptor 4 (CXCR4), fatty acid synthase (FASN), interleukin-6 (IL-6) and matrix metallopeptidase 9 (MMP-9) highly expressed in prostate cancer and analyzed their expression in AA and CA cohorts.

Methods: IHC of p-Akt, CXCR4, FASN, IL-6 and MMP-9 were evaluated in RRP specimens (n=20) from each ethnic group exhibiting Gleason scores ranging from 6 through 9.

Results: Low to medium staining …

Definitive Chemoradiation In Non Metastatic Squamous Cell Carcinoma Anal Canal: A Single Institution Experience, Viney Kumar, Saurab Bansal, Amit Badola, Vipul Nautiyal, Meenu Gupta, Mushtaq Ahmad, Sunil Saini

Research Symposium

Background: To analyze the oncological outcomes in anal canal squamous cell carcinoma treated with concurrent chemoradiotherapy.

Materials and Methods: A single centre retrospective hospital based study with sample size of 51 patients of anal canal Squamous cell carcinoma treated with concurrent chemoradiotherapy with mitomycin @10mg/m² and 5FU based. Disease free survival (DFS), Colostomy free survival (CFS) and Overall survival (OS) rates were calculated by Kaplan-Meier method.

Results: Among 51 eligible patients, after a median follow up of 46 months (range 10-68 months). The 3year Disease free survival (DFS) was 73.9%. 3patients developed locoregional recurrence while 1patient developed distant …

Development And Evaluation Of A Nanofiber Membrane In Vitro As A Therapeutic Alternative For The Post Treatment In Breast Cancer Cell In A Murine Model, Bruno A. Valades-Aguilar, Diana Ginette Zarate-Triviño, José Raúl Rángel-López, Moises Armides Franco-Molina, Jorge Luis Menchaca-Arredondo, María Cristina Rodríguez-Padilla

Research Symposium

Worldwide female breast cancer is the most commonly diagnosed cancer, with an estimated 2.3 million new cases in 2020, reason for the need of targeted therapies that can maximize treatment success and minimize toxicity. Nanoparticles of gold (AuNps) exhibit cytotoxic properties against certain types of cancer cell lines. Nanofibers have been use in the drug delivery systems due to its degradability and high surface area. We proposed a membrane with nanometric fibers using polivinilic alcohol (PVA) and chitosan (Qts) loaded with AuNps and Doxorubicin (Doxo) with the purpose of diminish tumor regression.

PVA-Qts membrane was develop with electrospinning, the injection, …

Developing An Assay For Easy And Rapid Detection Of Als Biomarker(S): A Hypothesis, Swati Dhasmana, Anupam Dhasmana, Meena Jaggi, Murali M. Yallapu, Subhash C. Chauhan

Research Symposium

Background: Death of motor neurons is the key pathology underlying neurodegenerative diseases such as amyotrophic lateral sclerosis (ALS). Biomarkers are chemical changes in the biological fluids. Biomarkers serving as a diagnostic tool should be specific to the concerned disease. Biomarkers indicating disease progression should be very sensitive to demonstrate changes during the disease process as well as therapeutics development. Biomarkers proposed for ALS include poly (GP) repeats in C9orf72, neurofilaments, miRNAs, glutathione and 4HNE in CSF, SOD1/TDP43 protein, poly (GP) repeats in C9orf72, neurofilaments, T regulatory cells, CRP, chitotriosidase, creatinine, creatinine kinase, miRNAs, glutamate, albumin, uric acid, glutathione, ferritin, …

Cyclophosphamide And Epirubicin Induce Apoptotic Cell Death In Microglia Cells, Rafael De La Hoz-Camacho

Research Symposium

Background. Chemotherapy Related Cognitive Impairment’s (CRCI), diminish patient’s quality life, being breast cancer (BC) patients the most affected. Microglia is described to play a major role in CRCI; hence, the aim of this research was to describe the cytotoxicity of cyclophosphamide (CTX) and Epirubicin (EPI), on microglia (SIM-A9), compared to BC cells (4T1).

Methods. We assessed cell viability (Resazurin) and cell death (AnnV), as well as nuclear damage with γ-H2AX, p53, p16 and cell cycle analysis (PI staining) by flow cytometry (FC). Furthermore, we evaluated ΔΨm (DIOC6), ROS (DCFDA) and NO (DAF-FM) production. Finally, caspase activation (TF2-VAD-FMK) and autophagy (CYTO-ID). …

Variant Of Fii Gene Plays A Critical Role In Coagulation Potential In Mexican-Americans, Hoang Anh T. Nguyen, Shuchita Vijay Jhaveri, Marcio A. Almeida, Vincent P. Diego, Satish Kumar, Juan M. Peralta, Joanne E. Curran, Bernadette W. Luu, Donna M. Lehman, Ralph A. Defronzo, Laura Almasy, Sarah Williams-Blangero, Ravi Duggirala, John Blangero, Tom Howard

Research Symposium

Background: Disruption in the balance between coagulation and bleeding can result in varying phenotypes such as hypercoagulability and can lead to the development of cardiovascular disease. In our study utilizing extended families of Mexican-Americans from South Texas, we performed a search for protein-altering variants influencing coagulation potential.

Methods: Mexican-Americans in the study were genotyped using Illumina-(human)-exome-24 chip to screen for protein-altering variants. Variants were analyzed for their association with FII activity, aPTT, and PT. Linear-mixed-model analysis was performed to estimate trait heritabilities and to interrogate single nucleotide variations (SNV) for evidence of genetic association. To control for multiple testing, associations …

Vitamin D Deficiency Among Children And Adolescents Living In Sunny South Texas, Yoscelina E. Martinez-Lopez, Margarita Faz, Beatriz Tapia, Juan C. Lopez-Alvarenga, Francisco J. Cervantes

Research Symposium

Background: Exposure to sunlight is essential to produce Vitamin D (ViD). Recent studies suggest obesity is associated with low ViD concentration. Living in South Texas with 220 sunny days a year should be enough to maintain adequate ViD levels. We aimed to analyze ViD levels and obesity in children and adolescents.

Methods: We included 1239 pediatric (1.5 to 18.8 years old) participants (primary care clinic from Laredo) with registered CDC percentiles of BMI (pBMI) and serum concentrations of ViD (Atellica™). Data are described as median (p25, p75), Loess correlation between pBMI and ViD, ANCOVA to adjust by age, sex, and …

Whole Genome Sequence Data Implicate Rbfox1 In Epilepsy Risk In Baboons, Mark Z. Kos, Melanie A. Carless, Lucy Blondell, Mary M. Leland, Koyle D. Knape, Harald H. H. Goring, Charles A. Szabo

Research Symposium

Background: Baboons exhibit a genetic generalized epilepsy (GGE) that resembles juvenile myoclonic epilepsy and may represent a suitable genetic model for human epilepsy. The genetic underpinnings of epilepsy were investigated in a baboon colony at the Southwest National Primate Research Center (San Antonio, TX) through the analysis of whole-genome sequence (WGS) data.

Methods: Baboon WGS data were obtained for 38 cases and 19 healthy controls from the NCBI Sequence Read Archive and, after standard QC filtering, two subsets of variants were examined: (1) 20,881 SNPs from baboon homologs of 19 candidate GGE genes; and (2) 36,169 protein-altering SNPs. Association tests …

Cucurbitacin D Ameliorates Benzo[A]Pyrene Induced Liver Injury Via Activation Of Nrf2 Antioxidant Pathway, Anyssa Rodriguez, Mohammed Sikander, Shabnam Malik, Fathi T. Halaweish, Meena Jaggi, Subhash C. Chauhan

Research Symposium

Background: Co-morbidity variables, such as smoking, are strongly linked to the development and progression of liver cancer. Further, benzo[a]pyrene, a major component of tobacco smoke, is highly carcinogenic and triggers liver damage. Cucurbitacin, a kind of triterpene, has a wide range of biological properties, including antioxidant, anti-inflammatory, and anti-cancer effects. However, the precise mechanism of its hepatoprotective effects is obscure.

Objective: The aim of this study is to investigate the cytoprotective effects of novel analog of cucurbitacin, cucurbitacin D, against benzo[a]pyrene-induced liver injury in HepG2 cells. Method: The cytoprotective efficacy of cucurbitacin D against benzo[a]pyrene-induced liver damage was …

Covid-19 And Chronic Diabetes: The Perfect Storm For Reactivation Tb?, Genesis P. Aguillón-Durán, Ericka Prieto-Martinez, Doris Ayala, Juan Garcia Jr, John M. Thomas, Juan I. Garcia, Jordi B. Torrelles, Eder Ledezma-Campos, Blanca I. Restrepo

Research Symposium

Background: The Coronavirus disease 2019 (COVID-19) pandemic is predicted to have a net negative effect on tuberculosis (TB) control, with an estimated excess of 6.3 million tuberculosis cases and 1.4 million deaths by 2025. Programmatic issues like the lockdown of TB services affect all patients, while biosocial factors have a differential impact on an individual’s risk for TB or adverse TB outcomes.

Case presentation: We report three cases of incident TB after resolution of COVID-19 episodes.Coincidently, all cases shared a common risk factor: a chronic history poorly-controlled diabetes.

Conclusions: Our findings alert to the threat posed by …

Correlation Between Ct-Values And Symptoms Of Covid-19 Patients, Luis E. Fernández-Garza, A. Huitrón-Carrizales, Hugo A. Barrera-Saldaña, Raúl Rodríguez-Palacios

Research Symposium

Background: Currently available RT-PCR methods for the diagnosis of COVID-19 can give an estimate of the viral load. The cycle threshold value (Ct-value) of the PCR correlates inversely with the viral load; low Ct-values indicate high viral loads and vice versa. Higher viral loads have been seen to correlate with disease severity and infectivity. Therefore, we studied the correlation of the Ct-value of RT-PCR and the most common symptoms of COVID-19 individually.

Methods: A prospective and descriptive study was carried out with the subjects that attended our laboratory for a COVID-19 test from September 14, 2020, to January 30, 2021. …

Confusing Code Status In An 81-Year-Old Spanish-Speaking Woman: Addressing Barriers To Quality End-Of Life Care For Latinos, Vanessa E. Lopez, Chelsea H. Chang

Research Symposium

Background: End-of-life discussions present a challenge for many Hispanic families and physicians. Hesitancy to begin discussions and a language barrier hinder elderly Spanish-speaking patients and their families from making informed decisions about end-of-life care. We present a case of a confusing code status in an elderly Spanish-speaking woman with a rapidly declining condition.

Case presentation: An 81-year-old Hispanic Spanish-speaking female with a past medical history of hypertension, chronic kidney disease stage 3 and type 2 diabetes mellitus presents with generalized weakness, decreased appetite and a 10-pound weight loss over one month. She wished to be Do-Not-Intubate. Throughout her stay, she …

Comparison Of Five Commercial Kits For Sars Cov 2 Rt-Pcr Diagnosis., Carolina Rivera, Hugo A. Barrera-Saldaña, Marisol Ramirez

Research Symposium

Background: SARS-CoV-2 was identified as the causal agent of the COVID-19 pandemic. Its rapid spread and huge health and economic impact prompted the development of diagnostic tests to opportunely identify affected individuals as a prerequisite to quarantine them and avoid further spreading the infection.

Methods: The following commercial RT-PCR kits, approved by our National Institute of Diagnostics and Epidemiological Reference of InDRE (from the Spanish name) were tested: Vircell (Granda, Spain), Light Mix Roche (Berlin, Germany), Logix Smart (Utah, USA), 1 Copy (Korea Republic), and RIDA GENE (Darmstadt, Germany). RNA was isolated either manually or automatically (QIAmp Viral RNA and …

Colon Cancer Presenting With Deep Venous Thrombosis (Dvt) In A Hispanic Woman, Baron S. Ekeledo, Ashika Chacko, Fatimah Bello

Research Symposium

Introduction: Incidence of colon cancer in young adults with no family history has significantly increased, leading to reevaluation of screening age. Colon cancer presents in various forms, but this case report discusses DVT as an initial presentation.

Case report: A 46-year-old Hispanic woman with history of chronic anemia secondary to dysfunctional uterine bleeding, recently on oral contraception was evaluated outpatient for complaints of neck swelling after recent COVID vaccination. CT angiogram of the neck demonstrated a left internal jugular vein thrombus. The DVT was attributed to concomitant use of COVID vaccine in a patient on OCPs. The patient started oral …

Chronic Dvt In The Setting Of A Long-Term Ivc Filter, Protein C Deficiency, And Non-Compliance, Matthew N. Parvus, Karrar Al Gburi

Research Symposium

Introduction: Inferior vena cava filters are often placed with the intention of removal and IVC filters are a temporary intervention, so leaving them in long term can present with significant risk of complications. When combined with protein C deficiency, the patient is at even greater risk.

Case: This case presents a 35-year-old Hispanic woman who presented to the emergency department for a one-week history of pain and swelling of the right leg. Past medical history includes protein C deficiency, chronic DVT, IVC filter (twelve-years ago), and venous insufficiency. Due to non-compliance, and financial difficulties, the patient didn’t continue her treatment …

Chromium Picolinate, Biotin, And Sodium Bicarbonate Combination As A Dietary Supplement In The Treatment Of Type 2 Diabetes, Luis E. Fernández-Garza, Fernando J. Lavalle, Hugo A. Barrera-Saldaña

Research Symposium

Background: Type 2 diabetes mellitus (T2DM) is characterized by hyperglycemia due to insulin resistance, which can lead to micro and macrovascular complications. The importance of glycemic control for prevention demands the need to promote accessible and safe treatments among others in the form of scientifically proven nutritional supplements. Previous studies have suggested that the consumption of bicarbonate-rich mineral water altered blood metabolites and gut microbiome which has beneficial effects on patients with T2DM. Likewise, chromium picolinate and biotin have shown usefulness in glycemic control. The objective of our study was to evaluate the supplementation with chromium picolinate, biotin, and sodium …

Childhood Cancer Survival In The Highly Vulnerable Population Of South Texas: Persistent Challenges For Adolescents And Hispanic Ethnicity, Shenghui Wu, Y. N. Liu, M. Williams, C. Aguilar, A. G. Ramirez, R. Mesa, G. E. Tomlinson

Research Symposium

Background: This study examines childhood cancer survival rates and prognostic factors related to survival in the majority Hispanic population of South Texas (STX), whereas most other population studies in childhood cancer survival focus on populations with relatively few Hispanics.

Methods: The population-based cohort study used Texas Cancer Registry data (1995-2017) to examine survival and prognostic factors.

Results: The 5-year relative survival rate for STX cancer patients diagnosed at 0–19 years was 80.3% for all races/ethnicity. Hispanics had statistically significant lower 5-year relative survival rates than non-Hispanic Whites (NHW) for male and female together diagnosed at age ≥ 5 years. When …

Characterization Of Oral Cavity And Oropharyngeal Cancer In The Texas Rio Grande Valley, Jared A. Sperling, Rachel Giese

Research Symposium

Background: Cancers of the oral cavity (OC) and oropharynx (OP) account for 3% of cancers diagnosed in the United States each year. A primary cause of death among the Hispanic population in the United States is cancer, accounting for 20% of annual mortality. The Rio Grande Valley (RGV) is a medically-underserved area of South Texas with a large Hispanic population facing health disparities. In this study, we examine the incidence and mortality of OC and OP cancer in the RGV.

Methods: CDC population-level incidence and mortality rate per 100,000 of OC/OP cancer among patients in the RGV counties of Hidalgo …

Characterization Of Epithelial Growth Factor Transcripts Identified In Crotalus Atrox Venom, Ivan Lopez, Ying Jia

Research Symposium

Epithelial Growth Factor (EGF) is the primary source in regeneration and stimulation of essential fibroblasts cells commonly found in epithelium. Studies have shown that snake venom components are becoming a growing factor in treating illnesses such as cancer, muscular dystrophy, chronic pain, blood pressure, blood clotting, etc. EGF in human cells contains a promising quaternary structure that can bind to snake venom metalloproteinases, proposing a means of activating biochemical responses through protein-protein interactions to regulate unwanted cellular functions. This supports promising research in achieving a greater understanding of regulation along cellular pathways through ligands, increasing the likelihood of targeting unwanted …

Challenge Of Diagnosing And Treating A Mediastinal Mass In A Young Patient, Rosa Guedez-White, Christine E. Loftis, Ricardo Abreu

Research Symposium

Background: Germ cell tumors (GCT) are neoplasms arising in the testicles (1). Rarely these tumors can grow outside of the reproductive organs without involving them, acquiring the name of extragonadal GCT (2). Mediastinal extragonadal GCT is further divided into seminomatous, non-seminomatous (yolk sac tumor, choriocarcinoma and/or embryonal cell tumor), mature teratoma, and immature teratoma according to the histological pattern (2).

Case Presentation: 24-year-old-male patient presented to the ER with complaints of a persistent cough of one-month duration accompanied by orthopnea, pleuritic chest pain, and worsening shortness of breath. The patient denied weight loss, testicular pain, night sweats, fever, or hemoptysis. …

Cervical Cancer In Hispanic Women, Suneet Johal

Research Symposium

Background: Cervical cancer is the fourth most common cancer in women and although the number of cases in the United States has decreased significantly, it is estimated that 14,480 new cases of invasive cervical cancer will be diagnosed in the United States in 2021. With the Hispanic population being the fastest growing demographic group in the United States, Hispanic women are 40% more likely to be diagnosed with cervical cancer and 20% more likely to die from cervical cancer.

Case Presentation: 29-year-old Hispanic female with history of cervical cancer status post hysterectomy and chemotherapy presents with complaints of vaginal bleeding …

Biocidal Properties Of Hybrid Nanonanomaterial, Chandrasekaran Karthikeyan, Kokkarachedu Varaprasad

Research Symposium

Background: Cancer is one of the essential unpredictable diseases worldwide; simultaneously, complicated issues created are by the human health system. Especially, breast cancer is the most commonly occurring cancer in women and is increasing remarkably in developing countries. It is a leading cause of cancer death in women, and breast cancer incidence rates are growing globally. To diagnose and treat cancer cells, different methods such as Radiation Therapy, Surgery, and Chemotherapy. These methods are high risk, more side effects, and high costs. The advanced healthcare material was developed to overcome this problem, inexpensive tools, and diagnosis of less-toxic drugs with …

Biobanking In Ne Mexico For Biomedical Research And Clinical Needs, Raúl Rodríguez-Palacios, Nathalia L. Walle-Gloria, Hugo A. Barrera-Saldaña

Research Symposium

Background: The advancement of biomedicine demands tools that translate its achievements into services to both the scientific community and the pharma/biotech industry. Biobanks are powerful tools that collect, process, store, manage, and distribute biospecimens and their associated clinical/demographic data to users carrying out studies aimed at causing a real public health impact.

For our laboratory to offer pharma/biotech companies support for their projects with the highest quality possible biospecimens we adopted the Best Biobanking Practices from ISBER (https://www.isber.org/).

Methods: As a result of the pandemics, great effort has been dedicated to help the health ecosystem through a diagnostic service for …

Barriers To Applying Guidelines For Treatment Of Type 2 Diabetes Mellitus In The Rio Grande Valley, Carra G. Honderich, Chelsea Chang

Research Symposium

Background: Type 2 Diabetes Mellitus affects 29.6% of adults in the Rio Grande Valley and 54% are estimated to be uncontrolled. Established and new pharmacotherapy agents are available, and guidelines exist in individualization of glycemic targets and agent selection. We present a case facing various barriers in applying these guidelines.

Case Presentation: A 54-year-old uninsured woman with past medical history of uncontrolled type 2 diabetes mellitus, hypertension, chronic kidney disease stage 3, peripheral artery disease and bilateral below knee amputations presents for follow-up. She denies polyuria, polydipsia and weight changes. She reports compliance with medications and a fasting glucose range …

Bactrim, Spironolactone And Lisinopril. Stay Away! A Dangerous Cocktail For Hyperkalemia, Daniel Nwosuocha, Areeb Masood, Christian Abraham, Vanessa Sanchez, Cesar A. Peralta, Alberto E. Montalvo, Jose E. Campo Maldonado

Research Symposium

Introduction: Hyperkalemia is a potentially life-threatening complication of several medications, particularly in situations of polypharmacy. Trimethoprim/sulfamethoxazole (TMP-SMX) is a first line antibiotic for outpatient treatment of MRSA for skin and soft tissue infections that can enhance the hyperkalemic effects of spironolactone and Angiotensin receptor inhibitors (ACEI).

Case Presentation: A 53-year-old female with history of HTN, stage 3 CKD, CHF, hypercholesterolemia and DM II, chronic left foot ulcer presented to our local hospital with generalized malaise, severe lower extremity weakness and heaviness of 2 days duration. She normally uses a walker but has had increasing difficulty standing from a seated position. …

Bactrim Induced Brash Syndrome In Elderly Female: A Case Report, Pooja Maknoor, Ashika Chacko, Himabindu Kolli, Nevin A. Varghese

Research Symposium

Background: BRASH syndrome is a clinical entity comprising of bradycardia, renal failure, AV blockade, shock, and hyperkalemia. It is a vicious cycle in which AV nodal blockers and hyperkalemia act synergistically to precipitate bradycardia in patients with renal dysfunction resulting in cardiovascular collapse.

Case Presentation: 89-year-old lady with history of Stage 4 CKD, hypertension, and diabetes mellitus presented with worsening generalized body weakness. On medication review, she was recently started on bactrim for treatment of a foot ulcer. Other home medications included diltiazem, lisinopril and dulaglutide. Initial vitals were significant for pulse 34, BP 90/35 mmHg and RR 19. Patient …