Medicine and Health Sciences Commons^™

Timigp: An R Package To Depict The Tumor Microenvironment From Bulk Transcriptomics, Chenyang Li, Jianjun Zhang, Chao Cheng

Faculty, Staff and Students Publications

Exploring the clinical relevance of diverse immune cell types within the tumor microenvironment is pivotal for unraveling cancer intricacies and developing treatments. Here, we present a protocol for using tumor immune microenvironment illustration based on gene pairs, an R package to deduce cell-cell interactions, unveiling the association between immune cell relative abundance and patient prognoses from bulk gene expression and survival data. We describe steps for harnessing cell-type markers derived from single-cell RNA sequencing data to map the tumor immune microenvironment across a spectrum of cancer types. For complete details on the use and execution of this protocol, please refer …

Bayesian Longitudinal Tensor Response Regression For Modeling Neuroplasticity, Suprateek Kundu, Alec Reinhardt, Serena Song, Joo Han, M Lawson Meadows, Bruce Crosson, Venkatagiri Krishnamurthy

Faculty, Staff and Student Publications

A major interest in longitudinal neuroimaging studies involves investigating voxel-level neuroplasticity due to treatment and other factors across visits. However, traditional voxel-wise methods are beset with several pitfalls, which can compromise the accuracy of these approaches. We propose a novel Bayesian tensor response regression approach for longitudinal imaging data, which pools information across spatially distributed voxels to infer significant changes while adjusting for covariates. The proposed method, which is implemented using Markov chain Monte Carlo (MCMC) sampling, utilizes low-rank decomposition to reduce dimensionality and preserve spatial configurations of voxels when estimating coefficients. It also enables feature selection via joint credible …

Experiences Of Black American Millennials: A Qualitative Study Of Internalized And Externalized Coping In The Face Of Racial Trauma, Natalia Angelique Giles

Doctoral Dissertations

The experiences Black Americans have faced when standing against racial trauma have impacted the Black community for generations. Though previous generations faced overt styles of racism throughout the eras of slavery and Jim Crow, the invalidation and discrimination have remained consistent within the experiences of the Black American millennial (BAM) generation. Current experiences BAMs face are a combination of both overt and covert styles of racism, which increase mental exhaustion, reduce motivation, and leave the individual psychologically defenseless. The purpose of this qualitative study was to examine the experiences of BAMs in the face of racial trauma. This qualitative research …

Combining The Tyrosine Kinase Inhibitor Cabozantinib And The Mtorc1/2 Inhibitor Sapanisertib Blocks Erk Pathway Activity And Suppresses Tumor Growth In Renal Cell Carcinoma, Yige Wu, Siqi Chen, Xiaolu Yang, Kazuhito Sato, Preet Lal, Yuefan Wang, Andrew T Shinkle, Michael C Wendl, Tina M Primeau, Yanyan Zhao, Alanna Gould, Hua Sun, Jacqueline L Mudd, Jeremy Hoog, R Jay Mashl, Matthew A Wyczalkowski, Chia-Kuei Mo, Ruiyang Liu, John M Herndon, Sherri R Davies, Di Liu, Xi Ding, Yvonne A Evrard, Bryan E Welm, David Lum, Mei Yee Koh, Alana L Welm, Jeffrey H Chuang, Jeffrey A Moscow, Funda Meric-Bernstam, Ramaswamy Govindan, Shunqiang Li, James Hsieh, Ryan C Fields, Kian-Huat Lim, Cynthia X Ma, Hui Zhang, Li Ding, Feng Chen

Faculty, Staff and Student Publications

Current treatment approaches for renal cell carcinoma (RCC) face challenges in achieving durable tumor responses due to tumor heterogeneity and drug resistance. Combination therapies that leverage tumor molecular profiles could offer an avenue for enhancing treatment efficacy and addressing the limitations of current therapies. To identify effective strategies for treating RCC, we selected ten drugs guided by tumor biology to test in six RCC patient-derived xenograft (PDX) models. The multitargeted tyrosine kinase inhibitor (TKI) cabozantinib and mTORC1/2 inhibitor sapanisertib emerged as the most effective drugs, particularly when combined. The combination demonstrated favorable tolerability and inhibited tumor growth or induced tumor …

Plants As Vectors For Environmental Prion Transmission, Christina M Carlson, Samuel Thomas, Matthew W Keating, Paulina Soto, Nicole M Gibbs, Haeyoon Chang, Jamie K Wiepz, Annabel G Austin, Jay R Schneider, Rodrigo Morales, Christopher J Johnson, Joel A Pedersen

Faculty, Staff and Student Publications

Prions cause fatal neurodegenerative diseases and exhibit remarkable durability, which engenders a wide array of potential exposure scenarios. In chronic wasting disease of deer, elk, moose, and reindeer and in scrapie of sheep and goats, prions are transmitted via environmental routes and the ability of plants to accumulate and subsequently transmit prions has been hypothesized, but not previously demonstrated. Here, we establish the ability of several crop and other plant species to take up prions via their roots and translocate them to above-ground tissues from various growth media including soils. We demonstrate that plants can accumulate prions in above-ground tissues …

A Mixed Methods Study Of Physical Activity In The Intensive Care Unit And Post-Intensive Care Unit Hospital Stay: Patient Characteristics, Symptom Burden, And Experiences Of Postoperative Adults, Christina Bach

Theses & Dissertations

Background: Physical activity (PA) beginning early in the intensive care unit (ICU) can reduce adverse outcomes commonly experienced by individuals after ICU discharge. Patient-centered approaches to PA in the ICU and reliable activity evaluations are essential for understanding PA's impact on patient outcomes.

Objective: This dissertation sought to evaluate patient-related factors associated with PA in the ICU and post-ICU hospital stay.

Methods: The purpose of the dissertation was to conduct: 1) a concept analysis to define ICU survivorship and identify critical care aspects important for patient recovery; 2) an integrative literature review to assess early mobility (EM) interventions with physical, …

Impacts Of Perinatal Oxycodone Exposed Offspring In Early Adolescence, Adrian Flores

Theses & Dissertations

The Opioid Epidemic has been a point of public health interest for the last twenty years. In this time, use of prescription opioids has grown exponentially, including use by pregnant women. The initial crisis has been focused on mitigating immediate problems such as lowering the significant loss of life in overdoses and providing support to cessation. Despite these advancements a separate phenomenon is on the rise: The rise in neonatal opioid withdrawal syndrome in neonatal care and associated challenges for these children as they age.

Currently preclinical research and epidemiological data suggests that exposed children are at risk for experiencing …

Maternal- Child Malnutrition In Nepal: A Policy Analysis, Garima Pokhrel

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

Abstract

Background: The United States Agency for International Development (USAID 2021) data finds that in Nepal 17 percent of women between the ages of 15-49 and 30 percent of adolescent girls of age 15-19 years are underweight; and 36 percent of children under the age of 5 were stunted in Nepal in 2016.

Objective: To review Nepal’s current National Nutrition Policy and provide evidence-based recommendations to amend the policy in order to improve nutritional outcomes of the prenatal population and children under the age of 5 years.

Methods: Bardach’s Eightfold Path to Policy Analysis Methodology and the Sustainable Diet …

Using Clinical Staff-Initiated Protocols In The Urgent Care Setting To Improve Throughput, Holly S. Mason

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

One of the goals and purposes of the urgent care setting is to provide quality patient care within a timely fashion. This process improvement project was designed to improve patient visit times in the urgent care setting, thus improving throughput. In this project, testing/imaging protocols were developed, agreed upon by the office healthcare providers, and utilized by clinical staff for patients who presented with complaints of 1) dysuria, 2) sore throat with an accompanying fever, 3) upper respiratory symptoms without an accompanying fever, 4) upper respiratory symptoms with an accompanying fever, and 5) an orthopedic injury known as a FOOSH …

Implementing A Standard Work Process For Food Insecurity Screening, Referral, And Connection Tracking In A Safety-Net Clinic, Aisha Keplinger

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

Social determinants of health (SDOH) screening and referral programs are crucial to achieving health equity, fundamental to providing the best care, and are critical to the United States’ pursuit of the Institute for Healthcare Improvement’s (IHI) Triple Aim (Berwick et al., 2008). Employing the PRECEDE-PROCEED model, a systematic screening and referral program was implemented at a safety-net clinic to increase SDOH screening and referral rates, and to identify the number of patients who connect with community resources. The program was guided by the IHI Triple Aim framework and evaluated using the Institute of Medicine (IOM) Six Aims of Healthcare Quality …

Evaluating Utilization And Outcomes For An Outpatient Oncology Urgent Care Center, Melody D. Noble

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

Patients receiving cancer care in the outpatient setting may often require unscheduled, acute management of symptoms. An oncology urgent care clinic (UCC) was implemented to provide symptom management for these patients outside of the emergency department (ED) at an academic medical center. A program evaluation was performed to assess the impact of the UCC on ED utilization and patient outcomes. The project methodology is the Predisposing, Reinforcing and Enabling Constructs in Educational Diagnosis-Policy, Regulatory and Organizational Constructs in Educational and Environmental Development (PRECEDE/PROCEED) method of program evaluation with additional evaluation of outcomes via the Institutes of Healthcare Improvement (IHI) triple …

Implementing Audiovisual Education To Improve Quality And Patient Experience For Outpatient Colorectal Cancer Screening Patients, Stephanie Armstrong

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

Colorectal cancer continues to be the second most deadly cancer in the United States, with thousands of new cases being diagnosed each year. Comprehension of bowel preparation education is an important factor in ensuring patients follow purgative and diet instructions. Inadequate bowel preparations lead to longer procedure lengths, decreased cancer screening capabilities, and decrease patient satisfaction. Audiovisual education has been shown to positively impact patient comprehension and instruction adherence, when compared to the standard written education. The goal of this quality improvement project was to implement audiovisual education and identify whether it improved bowel preparation adequacy and patient satisfaction. The …

Differences In Set-Based Tests For Sparse Alternatives When Testing Sets Of Outcomes Compared To Sets Of Explanatory Factors In Genetic Association Studies, Ryan Sun, Andy Shi, Xihong Lin

Faculty, Staff and Student Publications

Set-based association tests are widely popular in genetic association settings for their ability to aggregate weak signals and reduce multiple testing burdens. In particular, a class of set-based tests including the Higher Criticism, Berk-Jones, and other statistics have recently been popularized for reaching a so-called detection boundary when signals are rare and weak. Such tests have been applied in two subtly different settings: (a) associating a genetic variant set with a single phenotype and (b) associating a single genetic variant with a phenotype set. A significant issue in practice is the choice of test, especially when deciding between innovated and …

Dna Methylation-Based Epigenetic Biomarkers In Cell-Type Deconvolution And Tumor Tissue Of Origin Identification, Ze Zhang

Dartmouth College Ph.D Dissertations

DNA methylation is an epigenetic modification that regulates gene expression and is essential to establishing and preserving cellular identity. Genome-wide DNA methylation arrays provide a standardized and cost-effective approach to measuring DNA methylation. When combined with a cell-type reference library, DNA methylation measures allow the assessment of underlying cell-type proportions in heterogeneous mixtures. This approach, known as DNA methylation deconvolution or methylation cytometry, offers a standardized and cost-effective method for evaluating cell-type proportions. While this approach has succeeded in discerning cell types in various human tissues like blood, brain, tumors, skin, breast, and buccal swabs, the existing methods have major …

Diversity And Dissemination Of Viruses In Pathogenic Protozoa, Senne Heeren, Ilse Maes, Mandy Sanders, Lon-Fye Lye, Vanessa Adaui, Jorge Arevalo, Alejandro Llanos-Cuentas, Lineth Garcia, Philippe Lemey, Stephen M Beverley, James A Cotton, Jean-Claude Dujardin, Frederik Van Den Broeck

2020-Current year OA Pubs

Viruses are the most abundant biological entities on Earth and play a significant role in the evolution of many organisms and ecosystems. In pathogenic protozoa, the presence of viruses has been linked to an increased risk of treatment failure and severe clinical outcome. Here, we studied the molecular epidemiology of the zoonotic disease cutaneous leishmaniasis in Peru and Bolivia through a joint evolutionary analysis of Leishmania braziliensis and their dsRNA Leishmania virus 1. We show that parasite populations circulate in tropical rainforests and are associated with single viral lineages that appear in low prevalence. In contrast, groups of hybrid parasites …

Combining The Tyrosine Kinase Inhibitor Cabozantinib And The Mtorc1/2 Inhibitor Sapanisertib Blocks Erk Pathway Activity And Suppresses Tumor Growth In Renal Cell Carcinoma, Yige Wu, Siqi Chen, Xiaolu Yang, Kazuhito Sato, Preet Lal, Andrew T Shinkle, Michael C Wendl, Tina M Primeau, Yanyan Zhao, Alanna Gould, Hua Sun, Jacqueline L Mudd, Jeremy Hoog, R Jay Mashl, Matthew A Wyczalkowski, Chia-Kuei Mo, Ruiyang Liu, John M Herndon, Sherri R Davies, Di Liu, Xi Ding, Ramaswamy Govindan, Shunqiang Li, James Hsieh, Ryan C Fields, Kian-Huat Lim, Cynthia X Ma, Li Ding, Feng Chen, Et Al.

2020-Current year OA Pubs

UNLABELLED: Current treatment approaches for renal cell carcinoma (RCC) face challenges in achieving durable tumor responses due to tumor heterogeneity and drug resistance. Combination therapies that leverage tumor molecular profiles could offer an avenue for enhancing treatment efficacy and addressing the limitations of current therapies. To identify effective strategies for treating RCC, we selected ten drugs guided by tumor biology to test in six RCC patient-derived xenograft (PDX) models. The multitargeted tyrosine kinase inhibitor (TKI) cabozantinib and mTORC1/2 inhibitor sapanisertib emerged as the most effective drugs, particularly when combined. The combination demonstrated favorable tolerability and inhibited tumor growth or induced …

T1 And Flair Signal Intensities Are Related To Tau Pathology In Dominantly Inherited Alzheimer Disease, Farzaneh Rahmani, Matthew R Brier, Brian A Gordon, Nicole Mckay, Shaney Flores, Sarah Keefe, Russ Hornbeck, Beau Ances, Nelly Joseph-Mathurin, Chengjie Xiong, Guoqiao Wang, Cyrus A Raji, Jorge J Libre-Guerra, Richard J Perrin, Eric Mcdade, Alisha Daniels, Celeste Karch, John C Morris, Randall J Bateman, Tammie L S Benzinger, Et Al.

2020-Current year OA Pubs

Carriers of mutations responsible for dominantly inherited Alzheimer disease provide a unique opportunity to study potential imaging biomarkers. Biomarkers based on routinely acquired clinical MR images, could supplement the extant invasive or logistically challenging) biomarker studies. We used 1104 longitudinal MR, 324 amyloid beta, and 87 tau positron emission tomography imaging sessions from 525 participants enrolled in the Dominantly Inherited Alzheimer Network Observational Study to extract novel imaging metrics representing the mean (μ) and standard deviation (σ) of standardized image intensities of T1-weighted and Fluid attenuated inversion recovery (FLAIR) MR scans. There was an exponential decrease in FLAIR-μ in mutation …

Towards A Mode Of Action For The Anti-Schistosomal Aryl Hydantoins, Thomas Schulze

Theses & Dissertations

Schistosomiasis is a significant human disease caused by the helminth parasite Schistosoma mansoni. Praziquantel remains the only clinically used treatment, yet it is rapidly metabolized and only effective against the adult stage worm infection. Ro 13-3978 (AR02) is a potent antischistosomal compound with activity against multiple S. mansoni life stages; however, it manifests anti-androgenic activity. Additionally, the mechanism of action for worm clearance remains unknown. The structure of Ro 13-3979 was used to generate optimized derivatives, including AR102, that show increased potency towards worms, reduced off-target anti-androgen effects, and extended half-life thereby increasing the feasibility for a single-dose curative treatment. …

A Community-Based Participatory Research Approach To Addressing Pediatric Asthma Disparities In Douglas County, Nebraska, Aislinn Rookwood

Theses & Dissertations

Pediatric asthma is the leading chronic disease among children in the United States, and the incidence of pediatric asthma is increasing every year. Nebraska has an asthma prevalence comparable to the United States average; however, the state has significant disparities by county, race, and geographic location, with prevalence rates much higher than the national average. Douglas County is a hot spot for increased pediatric asthma rates, with further differences in rates by race and geographic location within the county. The University of Nebraska Medical Center, in partnership with Healthy Housing Omaha and the Nebraska Asthma Coalition, collaborated to conduct this …

Applications Of The Re-Aim Framework In Health Promotion, Emiliane L. Pereira

Theses & Dissertations

This dissertation applied a variety of methods under the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework and provided a valuable and relevant contribution to the field of the dissemination and implementation (D&I) science. In the first study, we applied the RE-AIM framework to evaluate interventions and summarize the literature on breastfeeding promotion programs on the Black population (Chapter 1). The study results provide meaningful findings by bridging the gap on the literature of reporting breastfeeding supporting services and resources available to ensure breastfeeding continuation, as well as the need for a better reporting on the individual-level and setting representativeness, …

Aspirin And Nonaspirin Nonsteroidal Antiinflammatory Drug Use And Occurrence Of Colorectal Adenoma In Black American Women, Lauren E Barber, Kimberly A Bertrand, Shanshan Sheehy, Laura F White, Hemant K Roy, Lynn Rosenberg, Julie R Palmer, Jessica L Petrick

Faculty, Staff and Students Publications

Evidence suggests that aspirin use reduces the occurrence of colorectal neoplasia. Few studies have investigated the association among Black Americans, who are disproportionately burdened by the disease. We assessed aspirin use in relation to colorectal adenoma among Black women. The Black Women's Health Study is a prospective cohort of self-identified Black American women established in 1995. Participants reported regular aspirin use on baseline and follow-up questionnaires. Beginning in 1999, participants reported undergoing a colonoscopy or sigmoidoscopy, the only procedures through which colorectal adenomas can be diagnosed. Multivariable logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals …

A Case Of Filgrastim-Induced Neutrophilic Dermatosis Of The Dorsal Hands In A Patient With Felty Syndrome, Tejas P Joshi, Yelena Dokic, Gordana Verstovsek, Theodore Rosen

Faculty, Staff and Students Publications

Neutrophilic dermatosis of the dorsal hands (NDDH) is a variant of Sweet syndrome that presents with erythematous bullae, papules/plaques, or pustules on the dorsal hands. It is most commonly associated with hematologic and solid organ malignancies, though cases of NDDH associated with inflammatory bowel disease, rheumatologic disorders, and medication exposure have also been described in the literature. Felty syndrome is a rare complication of long-standing rheumatoid arthritis characterized by neuropathy, splenomegaly, and neutropenia. Granulocyte colony stimulating factors (e.g., filgrastim) can be utilized to rescue the neutropenia observed in Felty syndrome, but this treatment may subsequently cause Sweet syndrome. Herein, we …

Host-Microbiome Interactions In Distinct Subsets Of Preterm Labor And Birth, Jose Galaz, Roberto Romero, Jonathan M Greenberg, Kevin R Theis, Marcia Arenas-Hernandez, Yi Xu, Marcelo Farias-Jofre, Derek Miller, Tomi Kanninen, Valeria Garcia-Flores, Nardhy Gomez-Lopez

2020-Current year OA Pubs

Preterm birth, the leading cause of perinatal morbidity, often follows premature labor, a syndrome whose prevention remains a challenge. To better understand the relationship between premature labor and host-microbiome interactions, we conducted a mechanistic investigation using three preterm birth models. We report that intra-amniotic delivery of LPS triggers inflammatory responses in the amniotic cavity and cervico-vaginal microenvironment, causing vaginal microbiome changes and signs of active labor. Intra-amniotic IL-1α delivery causes a moderate inflammatory response in the amniotic cavity but increasing inflammation in the cervico-vaginal space, leading to vaginal microbiome disruption and signs of active labor. Conversely, progesterone action blockade by …

Cell-Free Rna Signatures Predict Alzheimer's Disease, Alejandro Cisterna-García, Aleksandra Beric, Muhammad Ali, Jose Adrian Pardo, Hsiang-Han Chen, Maria Victoria Fernandez, Joanne Norton, Jen Gentsch, Kristy Bergmann, John Budde, Joel S Perlmutter, John C Morris, Carlos Cruchaga, Juan A Botia, Laura Ibanez

2020-Current year OA Pubs

There is a need for affordable, scalable, and specific blood-based biomarkers for Alzheimer's disease that can be applied to a population level. We have developed and validated disease-specific cell-free transcriptomic blood-based biomarkers composed by a scalable number of transcripts that capture AD pathobiology even in the presymptomatic stages of the disease. Accuracies are in the range of the current CSF and plasma biomarkers, and specificities are high against other neurodegenerative diseases.

A Single C-Terminal Residue Controls Sars-Cov-2 Spike Trafficking And Incorporation Into Vlps, Debajit Dey, Enya Qing, Yanan He, Yihong Chen, Benjamin Jennings, Whitaker Cohn, Suruchi Singh, Lokesh Gakhar, Nicholas J Schnicker, Brian G Pierce, Julian P Whitelegge, Balraj Doray, John Orban, Tom Gallagher, S Saif Hasan

2020-Current year OA Pubs

The spike (S) protein of SARS-CoV-2 is delivered to the virion assembly site in the ER-Golgi Intermediate Compartment (ERGIC) from both the ER and cis-Golgi in infected cells. However, the relevance and modulatory mechanism of this bidirectional trafficking are unclear. Here, using structure-function analyses, we show that S incorporation into virus-like particles (VLP) and VLP fusogenicity are determined by coatomer-dependent S delivery from the cis-Golgi and restricted by S-coatomer dissociation. Although S mimicry of the host coatomer-binding dibasic motif ensures retrograde trafficking to the ERGIC, avoidance of the host-like C-terminal acidic residue is critical for S-coatomer dissociation and therefore incorporation …

The Effect Of Covid-19 On Antibiotic Resistance, Debra A. Woo Dds, Ma, Karen A. Schulze Dds, Phd, Mali K. Mcguire Dds, Ms

Pacific Journal of Health

Over three years have passed since the beginning of the COVID-19 pandemic. During these times we have experienced significant changes in all areas of our life. In healthcare, more attention was focused on COVID-19 than other concerns. An unexpected consequence of the pandemic was a silent progression of an increased spread of multi-resistant pathogens. While antibiotic use during the pandemic varied across healthcare settings, antibiotics were prescribed for COVID-19 patients, even though antibiotics are known not to be effective against viruses.¹ In dentistry, antibiotics were prescribed to prevent potential dental infections, since many dental offices were not open. Antimicrobial …

End Of Life In The Ed – Brain Death And Organ Transplantation, Madison Cohen, Donald Penney

The Journal of Integrated Primary Care

Every year thousands of Americans die awaiting an organ transplant. While our knowledge and experience with organ transplantation has only improved, organ availability continues to be a major issue due to a lack of suitable donor organs. A large population of organ donors are those who have been clinically diagnosed as brain dead. Brain death is defined as the irreversible loss of all brain and brainstem functions. Despite brainstem functions being lost, mechanical ventilation and perfusion techniques allow for proper organ maintenance. This gives brain-dead individuals a unique opportunity to serve as multiple organ donors. However, due to mistrust of …

Recovery Capital, Mental Health And Substance Use Among Individuals Initiating Office-Based Buprenorphine Treatment For Opioid Use Disorder, Hannah R. Callahan, Karen Dugosh, Emily Hurstak, Patty Mccarthy, Emily Garber, Daniel Dejoseph, Julia Dejoseph, Michelle R. Lent

The Journal of Integrated Primary Care

Recovery capital refers to the internal and external resources available to support an individual in their recovery from substance use disorders. Using data from an ongoing trial, the current study examined recovery capital among 225 individuals initiating office-based buprenorphine treatment for opioid use disorder (OUD) at Federally Qualified Health Centers in the mid-Atlantic region. At baseline, participants completed the Brief Assessment of Recovery Capital-10 (BARC-10), a validated measure assessing the 4 major domains of recovery capital and completed a urine toxicology screening. Participants reported BARC-10 scores of 49.22 on average (SD = 8.14). Average scores were highest for the …

Differential Diagnostic Considerations In A Patient With New Onset Apathy: A Case Study On Frontal Lobe Glioblastoma Multiforme, Joy Zarandy, Sarah Yoon, Sharnikha Saravanan, Sanjana Das, Sarah Thomas

The Journal of Integrated Primary Care

This case study involves a 50 year-old previously healthy female presenting with a two-week history of clinically significant apathy. The patient and her family assume her symptoms are due to a potential underlying psychiatric condition; however, neurologic and systemic disorders should also be considered when evaluating a patient with sudden personality change. After a thorough history and physical exam, further evaluation with neuroimaging is performed due to suspicion of neurological etiology. A sizable ring-enhancing lesion in the frontal lobe is noted on MRI, and a diagnosis of glioblastoma multiforme (GBM) is confirmed with biopsy. GBM, or grade 4 astrocytoma, is …

In Great Health: Basal Cell Carcinoma And Denial Of Progressive Disease In The Elderly, Yusur Alsalihi, Alexa Truong, Patrick Golden

The Journal of Integrated Primary Care

Basal Cell Carcinoma (BCC) is the most common skin cancer across the world and occurs predominantly on sun-exposed or sun-damaged skin, particularly on the head, face, and neck. Slow-growing and unremoved lesions can become destructive and progress to the rare Giant Basal Cell Carcinoma subtype that occurs in a very small subset of patients (