Medicine and Health Sciences Commons^™

Mutation Signature Filtering Enables High-Fidelity Rna Structure Probing At All Four Nucleobases With Dms, David Mitchell, Jennifer Cotter, Irfana Saleem, Anthony M Mustoe

Faculty, Staff and Students Publications

Chemical probing experiments have transformed RNA structure analysis, enabling high-throughput measurement of base-pairing in living cells. Dimethyl sulfate (DMS) is one of the most widely used structure probing reagents and has played a pivotal role in enabling next-generation single-molecule probing analyses. However, DMS has traditionally only been able to probe adenine and cytosine nucleobases. We previously showed that, using appropriate conditions, DMS can also be used to interrogate base-pairing of uracil and guanines in vitro at reduced accuracy. However, DMS remained unable to informatively probe guanines in cells. Here, we develop an improved DMS mutational profiling (MaP) strategy that leverages …

The Difficulty In The Diagnosis And Management Of Antidepressant Discontinuation Syndrome, Sidney Charm D. Reyes

School of Medicine Publications

Background: Antidepressant discontinuation syndrome (ADS) is a condition that occurs in about 20% of patients following the abrupt reduction/stoppage of any antidepressant medication that has been taken continuously for at least one month.

Case Presentation: We present a 36-year-old Hispanic woman who initially presented for evaluation of flu-like symptoms (subjective fever, rhinorrhea) and worsening body aches, trouble sleeping, and headaches for the past three days. She also reported recent exposure to a sick co-worker. Rapid flu, strep, and COVID tests came back negative. Pt was diagnosed with a viral URI and was discharged with counseling on supportive treatment. The patient …

Clustering Microbiome Data Using Mixtures Of Logistic Normal Multinomial Models, Yuan Fang, Sanjeena Subedi

Pharmacy Faculty Scholarship

Discrete data such as counts of microbiome taxa resulting from next-generation sequencing are routinely encountered in bioinformatics. Taxa count data in microbiome studies are typically high-dimensional, over-dispersed, and can only reveal relative abundance therefore being treated as compositional. Analyzing compositional data presents many challenges because they are restricted to a simplex. In a logistic normal multinomial model, the relative abundance is mapped from a simplex to a latent variable that exists on the real Euclidean space using the additive log-ratio transformation. While a logistic normal multinomial approach brings flexibility for modeling the data, it comes with a heavy computational cost …

Coronavirus Update 9-7-23, The Coronavirus Planning Team

University Briefings & Virtual Events

Many of you are already aware that a new strain has caused an uptick in COVID cases across the nation. In the interest of everyone’s health and safety, we want to remind you please not to go to class or work if you are feeling sick.

Large-Scale Functional Hyperconnectivity Patterns In Trauma-Related Dissociation: An Rs-Fmri Study Of Ptsd And Its Dissociative Subtype, Saurabh B. Shaw, Braeden A. Terpou, Maria Densmore, Jean Theberge, Pau Frewen, Margaret C. Mckinnon, Ruth A. Lanius

Department of Medicine Publications

The dissociative subtype of post-traumatic stress disorder (PTSD) is a distinct PTSD phenotype characterized by trauma-related dissociation, alongside unique patterns of functional connectivity. However, disparate findings across multiple scales of investigation have highlighted the need for a cohesive understanding of dissociative neurobiology. We took a step towards this goal by conducting one of the broadest region of interest (ROI)-to-ROI analyses performed on a PTSD population to date. In this retrospective study, we investigated resting-state functional MRI data collected from a total of 192 participants, 134 of whom were diagnosed with PTSD. Small functional connectivity differences (maximum effect size 0.27) were …

A Narrative Review Of The Many Psychiatric Manifestations Of Neurosyphilis: The Great Imitator, Baneet Kaur, Deepesh Khanna

HPD Articles

Neurosyphilis is an infection of the central nervous system caused by the spirochete, Treponema pallidum. New syphilis infections have been increasing around the world each year. This disease was much of a concern in the pre-penicillin era, where when left untreated many cases progressed to tertiary syphilis which can commonly manifest as neurosyphilis. Of particular interest, neurosyphilis has been linked to masquerading itself as various psychiatric conditions. This narrative review focuses on exploring psychiatric manifestations of neurosyphilis as well as the importance of screening in psychiatric settings and clinicians maintaining high clinical suspicion of the disease. A systematic search …

An Evolutionary Pathway For Coping With Emerging Infectious Disease, Scott Lyell Gardner, Daniel R. Brooks, Walter A. Boeger, Eric P. Hoberg

Zea E-Books Collection

Emerging infectious disease (EID) represents an existential threat to humanity. EIDs are increasing in frequency and impact because of climate change and other human activities. We are losing the battle against EIDs because of improper assessment of the risk of EID. This stems from adherence to a failed paradigm of pathogen-host associations that suggests EIDs ought to be both unpredictable and rare. That, in turn, leads to policies suggesting that crisis response is the best we can do. Real-time and phylogenetic assessments show EIDs to be neither rare nor unpredictable—this is the parasite paradox that shows the failures of the …

The Public Health Impact Of Paxlovid Covid-19 Treatment In The United States, Yuan Bai, Zhanwei Du, Lin Wang, Eric H. Y. Lau, Isaac Fung, Petter Holme, Ben Cowling, Alison Galvani, Robert Krug, Lauren Ancel Meyers

Biostatistics, Epidemiology & Environmental Health Sciences: Faculty Publications

The antiviral drug Paxlovid has been shown to rapidly reduce viral load. Coupled with vaccination, timely administration of safe and effective antivirals could provide a path towards managing COVID-19 without restrictive non-pharmaceutical measures. Here, we estimate the population-level impacts of expanding treatment with Paxlovid in the US using a multi-scale mathematical model of SARS-CoV-2 transmission that incorporates the within-host viral load dynamics of the Omicron variant. We find that, under a low transmission scenario (Re∼1.2) treating 20% of symptomatic cases would be life and cost saving, leading to an estimated 0.26 (95% CrI: 0.03, 0.59) million hospitalizations averted, 30.61 (95% …

Continuous Glucose Monitors To Reduce Ed Burden, Aneka Khilnani, Kevin Cho

URGENT Matters

No abstract provided.

Astrocytes In Stroke-Induced Neurodegeneration: A Timeline, Eileen Collyer, Elena Blanco-Suarez

Farber Institute for Neuroscience Faculty Papers

Stroke is a condition characterized by sudden deprivation of blood flow to a brain region and defined by different post-injury phases, which involve various molecular and cellular cascades. At an early stage during the acute phase, fast initial cell death occurs, followed by inflammation and scarring. This is followed by a sub-acute or recovery phase when endogenous plasticity mechanisms may promote spontaneous recovery, depending on various factors that are yet to be completely understood. At later time points, stroke leads to greater neurodegeneration compared to healthy controls in both clinical and preclinical studies, this is evident during the chronic phase …

A Rare Case Of Recurrent Parathyroid Adenomas After Initial Parathyroidectomy, Grant N. Schalet, Luke Vincent, Carl Eguez, Gerardo Diaz, Mark S. Shachner

HPD Articles

Hyperparathyroidism usually presents asymptomatically with elevated levels of calcium and parathyroid hormone; this biochemical imbalance establishes the diagnosis. In 80-85% of cases of primary hyperparathyroidism, singular parathyroid adenomas occur. In rare cases, this problem occurs due to multiple adenomas, multiglandular hyperplasia, or parathyroid carcinoma. Recurrent primary hyperparathyroidism (R-PHPT), as demonstrated in this case, is defined as hypercalcemia that arises after six months of normocalcemia following initial surgery for PHPT. The aim of this report is to describe the diagnosis and management of three parathyroid adenomas in a patient, two of which occurred after an initial partial parathyroidectomy.

Cocaine-Induced Four-Extremity Ischemia Caused By A Hypercoagulable State, Victoria Echevarria, Alexandra C. Echevarria, Damian Casadesus

HPD Articles

The use of cocaine is associated with serious complications including coronary vasospasm and myocardial, renal, intestinal, and neurological ischemia. Among these feared complications lies limb ischemia which is a rare potential side effect of chronic cocaine use. We present the case of a 50-year-old female with an extensive history of cocaine use who developed ischemia in all four limbs. Imaging studies revealed pulmonary emboli, multisystem thromboses, and microhemorrhages in the brain. Laboratory studies were significant for leukocytosis, thrombocytopenia, schistocytes on blood smear, and normal rheumatologic and hematologic studies. The patient was diagnosed with cocaine-induced thrombotic microangiopathy and she was treated …

Braf V600e/Ras Mutations And Lynch Syndrome In Patients With Msi-H/Dmmr Metastatic Colorectal Cancer Treated With Immune Checkpoint Inhibitors, Raphael Colle, Sara Lonardi, Marine Cachanado, Michael J Overman, Elena Elez, Marwan Fakih, Francesca Corti, Priya Jayachandran, Magali Svrcek, Antoine Dardenne, Baptiste Cervantes, Alex Duval, Romain Cohen, Filippo Pietrantonio, Thierry André

Faculty, Staff and Student Publications

BACKGROUND: We pooled data from 2 cohorts of immune checkpoint inhibitors-treated microsatellite instability-high/mismatch repair-deficient (MSI/dMMR) metastatic colorectal cancer patients to evaluate the prognostic value of RAS/BRAFV600E mutations and Lynch syndrome (LS).

PATIENTS AND METHODS: Patients were defined as LS-linked if germline mutation was detected and as sporadic if loss of MLH1/PMS2 expression with BRAFV600E mutation and/or MLH1 promoter hypermethylation, or biallelic somatic MMR genes mutations were found. Progression-free survival (PFS) and overall survival (OS) were adjusted on prognostic modifiers selected on unadjusted analysis (P < .2) if limited number of events.

RESULTS: Of 466 included patients, 305 (65.4%) and 161 (34.5%) received, respectively, anti-PD1 alone and anti-PD1+anti-CTLA4 …

Atezolizumab For Advanced Alveolar Soft Part Sarcoma, Alice P Chen, Brian A Van Tine, Et Al.

2020-Current year OA Pubs

BACKGROUND: Alveolar soft part sarcoma (ASPS) is a rare soft-tissue sarcoma with a poor prognosis and no established therapy. Recently, encouraging responses to immune checkpoint inhibitors have been reported.

METHODS: We conducted an investigator-initiated, multicenter, single-group, phase 2 study of the anti-programmed death ligand 1 (PD-L1) agent atezolizumab in adult and pediatric patients with advanced ASPS. Atezolizumab was administered intravenously at a dose of 1200 mg (in patients ≥18 years of age) or 15 mg per kilogram of body weight with a 1200-mg cap (in patients <18 years of age) once every 21 days. Study end points included objective response, duration of response, and progression-free survival according to Response Evaluation Criteria in Solid Tumors (RECIST), version 1.1, as well as pharmacodynamic biomarkers of multistep drug action.

RESULTS: A total of 52 patients were evaluated. An objective response was observed in …

Nutrition-Related Experiences Of Women With Perinatal Depression During The Covid-19 Pandemic: A Qualitative Study, Dahlia Stott, Cynthia Klobodu, Lisa A. Chiarello, Bobbie Posmontier, Mona Egohail, Pamela A. Geller, June Andrews Horowitz, Brandy-Joe Milliron

College of Nursing Faculty Papers & Presentations

Women with perinatal depression are at a high risk for unhealthy dietary behaviors but whether the coronavirus disease 2019 (COVID-19) pandemic has exacerbated this risk is unknown. Here we report the findings of a qualitative study exploring the impact of the COVID-19 pandemic on nutrition-related experiences of women with perinatal depression. Using a qualitative descriptive approach, in-depth interviews were conducted with 18 women with a history of perinatal depression and 10 healthcare providers. A semistructured format elicited how food and nutrition-related behaviors of women with perinatal depression were affected by the COVID-19 pandemic. Thematic analysis identified 4 themes related to …

Paclitaxel With Or Without Cixutumumab As Second-Line Treatment Of Metastatic Esophageal Or Gastroesophageal Junction Cancer: A Randomized Phase Ii Ecog-Acrin Trial, Shannon Stockton, Paul Catalano, Steven J. Cohen, Barbara A, Burtness, Edith P. Mitchell, Efrat Dotan, Sam J. Lubner, Pankaj Kumar, Mary F. Mulcahy, George A. Fisher, Theodore L. Crandall, Al Benson

Department of Medical Oncology Faculty Papers

BACKGROUND: Patients with advanced esophageal cancer carry poor prognoses; limited data exist to guide second-line therapy in the metastatic setting. Paclitaxel has been used yet is associated with limited efficacy. There is preclinical evidence of synergy between paclitaxel and cixutumumab, a monoclonal antibody targeting insulin-like growth factor-1 receptor. We conducted a randomized phase II trial of paclitaxel (arm A) versus paclitaxel plus cixutumumab (arm B) in the second-line for patients with metastatic esophageal or gastroesophageal junction (GEJ) cancers.

METHODS: The primary endpoint was progression-free survival (PFS); 87 patients (43 in arm A, 44 in arm B) were treated.

RESULTS: Median …

Evidence Of Neurovascular Water Exchange And Endothelial Vascular Dysfunction In Schizophrenia: An Exploratory Study, Eric L Goldwaser, Danny J J Wang, Bhim M Adhikari, Joshua Chiappelli, Xingfeng Shao, Jiaao Yu, Tong Lu, Shuo Chen, Wyatt Marshall, Alexa Yuen, Mark Kvarta, Yizhou Ma, Xiaoming Du, Si Gao, Osamah Saeedi, Heather Bruce, Patrick Donnelly, Hugh O'Neill, Alan R Shuldiner, Braxton D Mitchell, Peter Kochunov, L Elliot Hong

Faculty, Staff and Student Publications

BACKGROUND AND HYPOTHESIS: Mounting evidence supports cerebrovascular contributions to schizophrenia spectrum disorder (SSD) but with unknown mechanisms. The blood-brain barrier (BBB) is at the nexus of neural-vascular exchanges, tasked with regulating cerebral homeostasis. BBB abnormalities in SSD, if any, are likely more subtle compared to typical neurological insults and imaging measures that assess large molecule BBB leakage in major neurological events may not be sensitive enough to directly examine BBB abnormalities in SSD.

STUDY DESIGN: We tested the hypothesis that neurovascular water exchange (Kw) measured by non-invasive diffusion-prepared arterial spin label MRI (n = 27 healthy controls [HC], n = …

Five-Year Follow-Up Of Keynote-087: Pembrolizumab Monotherapy For Relapsed/Refractory Classical Hodgkin Lymphoma, Philippe Armand, Pier Luigi Zinzani, Hun Ju Lee, Nathalie A Johnson, Pauline Brice, John Radford, Vincent Ribrag, Daniel Molin, Theodoros P Vassilakopoulos, Akihiro Tomita, Bastian Von Tresckow, Margaret A Shipp, Alex F Herrera, Jianxin Lin, Eunhee Kim, Samhita Chakraborty, Patricia Marinello, Craig H Moskowitz

Faculty, Staff and Student Publications

Previous analyses of the phase 2 KEYNOTE-087 (NCT02453594) trial of pembrolizumab monotherapy demonstrated effective antitumor activity with acceptable safety in patients with relapsed or refractory (R/R) classical Hodgkin lymphoma (cHL). However, long-term response durability and outcome of patients who receive a second course after treatment discontinuation after complete response (CR) remain of clinical interest. We present KEYNOTE-087 data after >5 years of median follow-up. Patients with R/R cHL and progressive disease (PD) after autologous stem cell transplantation (ASCT) and brentuximab vedotin (BV; cohort 1), salvage chemotherapy and BV without ASCT (cohort 2), or ASCT without subsequent BV (cohort 3), received …

Prospective Assessment Of Inter-Rater Reliability Of A Neonatal Adverse Event Severity Scale., Thomas Salaets, Thierry Lacaze-Masmonteil, Isamu Hokuto, Cheri Gauldin, Amjad Taha, Anne Smits, Liesbeth Thewissen, Ilse Van Horebeek, Armuchou Shoraisham, Khorshid Mohammad, Manami Suzuki, Shiori Komachi, Kurt Michels, Mark A. Turner, Karel Allegaert, Tamorah Lewis

Manuscripts, Articles, Book Chapters and Other Papers

Introduction: To ensure the quality of clinical trial safety data, universal data standards are required. In 2019 the International Neonatal Consortium (INC) published a neonatal adverse event severity scale (NAESS) to standardize the reporting of adverse event (AE) severity. In this study the reliability of AE severity grading with INC NAESS was prospectively assessed in a real-world setting. Methods: Severity of AEs was assessed by two independent observers at each of four centers across the world. In each center two series of 30 neonatal adverse events were assessed by both observers: in a first phase with a generic (Common Terminology …

Early Exposure To Added Sugars Via Infant Formula May Explain High Intakes Of Added Sugars During Complementary Feeding Beyond Maternal Modeling., Adrianne K. Griebel-Thompson, Tera L. Fazzino, Emily Cramer, Rocco A. Paluch, Katherine S. Morris, Kai Ling Kong

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Research has shown that early exposure to added sugars from table food is related to increased intake of added sugars in later childhood. The earliest window of exposure to added sugars may be in infancy via infant formula. However, beyond the well-established factors of maternal lifestyle and modeling, there is a lack of research examining how exposure to added sugars from infant formula influences infant/toddler added sugar intakes from table foods and sugar sweetened beverages (SSB).

OBJECTIVE: While accounting factors previously associated with infant/toddler added sugar intakes and maternal SSB consumption (proximal measure of maternal modeling), this study aims …

Seamless Phase Ii/Iii Design: A Useful Strategy To Reduce The Sample Size For Dose Optimization, Liyun Jiang, Ying Yuan

Faculty, Staff and Student Publications

Background: The traditional more-is-better dose selection paradigm, originally developed for cytotoxic chemotherapeutics, can be problematic when applied to the development of novel molecularly targeted agents. Recognizing this issue, the US Food and Drug Administration initiated Project Optimus to reform the dose optimization and selection paradigm in oncology drug development, emphasizing the need for greater attention to benefit-risk considerations.

Methods: We identify different types of phase II/III dose-optimization designs, classified according to trial objectives and endpoint types. Through computer simulations, we examine their operating characteristics and discuss the relevant statistical and design considerations for effective dose optimization.

Results: Phase II/III dose-optimization …

Reducing Brain Kynurenic Acid Synthesis Precludes Kynurenine-Induced Sleep Disturbances, Katherine M. Rentschler, Snezana Milosavljevic, Annalisa M. Baratta, Courtney J. Wright, Maria V. Piroli, Zachary Tentor, Homayoun Valafar, Christian O'Reilly, Ana Pocivavsek

Publications

Patients with neurocognitive disorders often battle sleep disturbances. Kynurenic acid is a tryptophan metabolite of the kynurenine pathway implicated in the pathology of these illnesses. Modest increases in kynurenic acid, an antagonist at glutamatergic and cholinergic receptors, result in cognitive impairments and sleep dysfunction. We explored the hypothesis that inhibition of the kynurenic acid synthesising enzyme, kynurenine aminotransferase II, may alleviate sleep disturbances. At the start of the light phase, adult male and female Wistar rats received systemic injections of either: (i) vehicle; (ii) kynurenine (100 mg kg−1; i.p.); (iii) the kynurenine aminotransferase II inhibitor, PF-04859989 (30 mg kg−1; s.c.); …

3d-Cultured Blastoids Model Human Embryogenesis From Pre-Implantation To Early Gastrulation Stages, Rowan M Karvas, Joseph E Zemke, Syed Shahzaib Ali, Eric Upton, Eshan Sane, Laura A Fischer, Chen Dong, Kyoung-Mi Park, Brian Chew, Brittany Meyer, Chao Zhou, Sabine Dietmann, Thorold W Theunissen, Et Al.

2020-Current year OA Pubs

Naive human pluripotent stem cells have the remarkable ability to self-organize into blastocyst-like structures ("blastoids") that model lineage segregation in the pre-implantation embryo. However, the extent to which blastoids can recapitulate the defining features of human post-implantation development remains unexplored. Here, we report that blastoids cultured on thick three-dimensional (3D) extracellular matrices capture hallmarks of early post-implantation development, including epiblast lumenogenesis, rapid expansion and diversification of trophoblast lineages, and robust invasion of extravillous trophoblast cells by day 14. Extended blastoid culture results in the localized activation of primitive streak marker TBXT and the emergence of embryonic germ layers by day …

Heart Failure Burden In Oman As A Mid-East Exemplar Versus Global Perspectives: An Integrative Review, Maryam Alharrasi, Chandrani Isac, Joy Kabasindi Kamanyire

Journal of the Saudi Heart Association

Heart failure (HF), a clinical syndrome caused by a structural and functional cardiac abnormality and corroborated by elevated natriuretic peptide levels and pulmonary congestion. This study intends to investigate the state of heart failure (HF) in Oman and assess it in comparison of global trends. Ten published literatures from the past 20 years were included after a thorough search of databases (Arab World Research Source, EBSCOhost, Medline, and Google Scholar). These studies were reviewed considering the global literature. We have observed an increase in HF cases especially in older adults, over the past two decades in Oman. Acute coronary syndrome …

Medical School Watercooler Newsletter - September 6, 2023, Lindsey Lyle

Watercooler Newsletter

This is the September 6, 2023 edition of the Frederick P. Whiddon College of Medicine's newsletter - Watercooler.

Contents Include:

• Meet a Med Student: Cana Brown
• USA scientists awarded national grant to study body's innate immune response to infection
• Medical student to present tick transmission research at national conference

Multidisciplinary Team Approach To Reduce Unplanned Extubations In The Nicu: Going Back To Basics, Jessica M. Dalton Bsn, Rn, Ccrn, Andrea Konno Msn, Rn, C-Elbw, Rnc-Nic, Dolores T. Suzansky Msn, Rnc-Nic

Department of Pediatrics

No abstract provided.

Exploring The Lived Experiences Of Dental Hygiene Faculty Using Simulation With Dental Manikin Head Devices To Teach Local Anesthesia, Allison Castro

Doctor of Education Program Dissertations

This study employed a qualitative phenomenological methodology to explore the lived experiences of dental hygiene faculty using simulation with dental manikin head devices to teach local anesthesia. This study aimed to address the gap in the literature given the lack of discussion regarding dental manikin head simulation use in teaching local anesthesia within dental hygiene education. The purpose extended to explore if educators could guide students and ease anxieties by incorporating simulation in the development of treatment skills on a manikin before applying these skills to real-life interactions. John Dewey’s (1938) concept of interconnectedness between education and experience and David …

An Electronic Origin Of Charge Order In Infinite-Layer Nickelates, Hanghui Chen, Yi-Feng Yang, Guang-Ming Zhang, Hongquan Liu

Faculty, Staff and Student Publications

A charge order (CO) with a wavevector [Formula: see text] is observed in infinite-layer nickelates. Here we use first-principles calculations to demonstrate a charge-transfer-driven CO mechanism in infinite-layer nickelates, which leads to a characteristic Ni1+-Ni2+-Ni1+ stripe state. For every three Ni atoms, due to the presence of near-Fermi-level conduction bands, Hubbard interaction on Ni-d orbitals transfers electrons on one Ni atom to conduction bands and leaves electrons on the other two Ni atoms to become more localized. We further derive a low-energy effective model to elucidate that the CO state arises from a delicate competition between Hubbard interaction on Ni-d …

Integrating Participant Feedback And Concerns To Improve Community And Individual Level Chemical Exposure Assessment Reports, Samantha M Samon, Michael Barton, Kim Anderson, Abiodun Oluyomi, Melissa Bondy, Georgina Armstrong, Diana Rohlman

Faculty, Staff and Students Publications

BACKGROUND: As exposure assessment has shifted towards community-engaged research there has been an increasing trend towards reporting results to participants. Reports aim to increase environmental health literacy, but this can be challenging due to the many unknowns regarding chemical exposure and human health effects. This includes when reports encompass a wide-range of chemicals, limited reference or health standards exist for those chemicals, and/or incompatibility of data generated from exposure assessment tools with published reference values (e.g., comparing a wristband concentration to an oral reference dose).

METHODS: Houston Hurricane Harvey Health (Houston-3H) participants wore silicone wristbands that were analyzed for 1,530 …

Hyperferritinemic Sepsis, Macrophage Activation Syndrome, And Mortality In A Pediatric Research Network: A Causal Inference Analysis, Zhenziang Fan, John C Lin, Allan Doctor, Et Al.

2020-Current year OA Pubs

BACKGROUND: One of five global deaths are attributable to sepsis. Hyperferritinemic sepsis (> 500 ng/mL) is associated with increased mortality in single-center studies. Our pediatric research network's objective was to obtain rationale for designing anti-inflammatory clinical trials targeting hyperferritinemic sepsis.

METHODS: We assessed differences in 32 cytokines, immune depression (low whole blood ex vivo TNF response to endotoxin) and thrombotic microangiopathy (low ADAMTS13 activity) biomarkers, seven viral DNAemias, and macrophage activation syndrome (MAS) defined by combined hepatobiliary dysfunction and disseminated intravascular coagulation, and mortality in 117 children with hyperferritinemic sepsis (ferritin level > 500 ng/mL) compared to 280 children with sepsis …