Medicine and Health Sciences Commons^™

Pressing Need Of Precision Care In Her2-Positive Colorectal Cancer: The Elephant In The Room, Kanwal P S Raghav, Jonathan M Loree, Scott Kopetz

Faculty, Staff and Student Publications

Although dual HER2 inhibition has shown promising clinical activity in patients with RAS wild-type HER2-positive metastatic colorectal cancer, predictive biomarkers of response/resistance are less well characterized. Activating HER2/RTK/MAPK genomic alterations appears to blunt the clinical benefit of dual anti-HER2 therapy and may hold a potential albeit partial role in patient selection. See related article by Randon et al., p. 436.

Cdk4/6 Inhibition Sensitizes Intracranial Tumors To Pd-1 Blockade In Preclinical Models Of Brain Metastasis, Naema Nayyar, Magali A De Sauvage, Jane Chuprin, Emily M Sullivan, Mohini Singh, Consuelo Torrini, Britney S Zhang, Sushobhana Bandyopadhyay, Keith A Daniels, Christopher Alvarez-Breckenridge, Ashish Dahal, Michael A Brehm, Priscilla K Brastianos

Faculty, Staff and Student Publications

PURPOSE: Brain metastases are associated with high morbidity and are often resistant to immune checkpoint inhibitors. We evaluated whether CDK4/6 inhibitor (CDKi) abemaciclib can sensitize intracranial tumors to programmed cell death protein 1 (PD-1) inhibition in mouse models of melanoma and breast cancer brain metastasis.

EXPERIMENTAL DESIGN: Treatment response was evaluated in vivo using immunocompetent mouse models of brain metastasis bearing concurrent intracranial and extracranial tumors. Treatment effect on intracranial and extracranial tumor-immune microenvironments (TIME) was evaluated using immunofluorescence, multiplex immunoassays, high-parameter flow cytometry, and T-cell receptor profiling. Mice with humanized immune systems were evaluated using flow cytometry to study …

Regulation Of Tissue Factor Activity By Interaction With The First Pdz Domain Of Magi1, Mohammad A. Mohammad, Sophie Featherby, Camille Ettelaie

School of Medicine Faculty Publications

Background; Tissue factor (TF) activity is stringently regulated through processes termed encryption. Post-translational modification of TF and its interactions with various protein and lipid moieties allows for a multi-step de-encryption of TF and procoagulant activation. Membrane-associated guanylate kinase-with inverted configuration (MAGI) proteins are known to regulate the localisation and activity of a number of proteins including cell-surface receptors. Methods; The interaction of TF with MAGI1 protein was examined as a means of regulating TF activity. MDA-MB-231 cell line was used which express TF and MAGI1, and respond well to protease activated receptor (PAR)2 activation. Proximity ligation assay (PLA), co-immunoprecipitation and …

Nonhormonal Pharmacotherapies For The Treatment Of Postmenopausal Vasomotor Symptoms, Taylor Witten, Julia Staszkiewicz, Logan Gold, Mallory A. Granier, Rachel J. Klapper, Gabriel Lavespere, Bradley Dorius, Varsha Allampalli, Shahab Ahmadzadeh, Sahar Shekoohi, Alan D. Kaye, Giustino Varrassi

School of Medicine Faculty Publications

An average of 60-80% of all menopausal women experience bothersome vasomotor symptoms (VMSs), such as flushing and sweating, within the first seven years of onset. However, despite increasing prevalence, these hot flashes remain hard to treat and have a negative effect on the quality of life. Though hormone replacement therapy is commonly utilized as a standard treatment for VMSs, this therapy is not recommended for all women. Specifically, the oral form of hormone replacement therapy is associated with several contraindications, including a history of thromboembolic disease, migraine headache with aura, liver failure, heart disease, and hormone-dependent cancers. For women with …

Disruption Of The Arabidopsis Acyl-Activating Enzyme 3 Impairs Seed Coat Mucilage Accumulation And Seed Germination, Ninghui Cheng, Paul A Nakata

Faculty, Staff and Students Publications

The Acyl-activating enzyme (AAE) 3 gene encodes an oxalyl-CoA synthetase that catalyzes the conversion of oxalate to oxalyl-CoA as the first step in the CoA-dependent pathway of oxalate catabolism. Although the role of this enzyme in oxalate catabolism has been established, its biological roles in plant growth and development are less understood. As a step toward gaining a better understanding of these biological roles, we report here a characterization of the Arabidopsis thaliana aae3 (Ataae3) seed mucilage phenotype. Ruthidium red (RR) staining of Ataae3 and wild type (WT) seeds suggested that the observed reduction in Ataae3 …

Post-Exposure Intranasal Ifnα Suppresses Replication And Neuroinvasion Of Venezuelan Equine Encephalitis Virus Within Olfactory Sensory Neurons, Matthew D Cain, N Rubin Klein, Xiaoping Jiang, Hamid Salimi, Qingping Wu, Mark J Miller, William B Klimstra, Robyn S Klein

2020-Current year OA Pubs

BACKGROUND: Venezuelan Equine Encephalitis virus (VEEV) may enter the central nervous system (CNS) within olfactory sensory neurons (OSN) that originate in the nasal cavity after intranasal exposure. While it is known that VEEV has evolved several mechanisms to inhibit type I interferon (IFN) signaling within infected cells, whether this inhibits virologic control during neuroinvasion along OSN has not been studied.

METHODS: We utilized an established murine model of intranasal infection with VEEV and a repository of scRNAseq data from IFN-treated OSN to assess the cellular targets and IFN signaling responses after VEEV exposure.

RESULTS: We found that immature OSN, which …

Molecular Mechanisms In Pathophysiology Of Mucopolysaccharidosis And Prospects For Innovative Therapy, Yasuhiko Ago, Estera Rintz, Krishna Sai Musini, Zhengyu Ma, Shunji Tomatsu

Department of Pediatrics Faculty Papers

Mucopolysaccharidoses (MPSs) are a group of inborn errors of the metabolism caused by a deficiency in the lysosomal enzymes required to break down molecules called glycosaminoglycans (GAGs). These GAGs accumulate over time in various tissues and disrupt multiple biological systems, including catabolism of other substances, autophagy, and mitochondrial function. These pathological changes ultimately increase oxidative stress and activate innate immunity and inflammation. We have described the pathophysiology of MPS and activated inflammation in this paper, starting with accumulating the primary storage materials, GAGs. At the initial stage of GAG accumulation, affected tissues/cells are reversibly affected but progress irreversibly to: (1) …

Draft Genomes Of 12 Bifidobacterium Isolates From Human Ibd Fecal Samples, Cole E Souza, Nicole E Jacobson, Michelle A An, Lindsay Droit, Alejandro A Vega, Mariel Rosales, Kathie A Mihindukulasuriya, Karina Pastrana, Scott A Handley, Miles Parkes, Joanna Rimmer, David Wang, Elizabeth A Dinsdale, Robert A Edwards, Anca M Segall

2020-Current year OA Pubs

Twelve

The Etiology Of Nurse Educator Shortages: Replenishing And Flourishing The Profession, Kara R. Delafosse

The Journal of Advancing Education Practice

Nursing shortages nationwide have been exemplified since the global pandemic demanding an examination of contributing factors crippling the profession. The United States Bureau of Labor Statistics estimates that 200,000 annual vacant registered nurse positions for the next decade, are problematic due to the mass exodus of individuals serving in the occupation (Gaines, 2022). A study of approximately 900 nursing schools in the country indicates two vacancies exist per establishment illuminating the critical shortages of educators (Morris, 2023). A growing phenomenon is the challenge to maintain and replenish leaders in nurse education necessary to train and prepare students enrolled in nursing …

Fibromyxoid Sarcoma Of The Breast: An Atypical Presentation Of A Rare Mesenchymal Tumor, Aaron I. Dadzie, Yossef Alsabawi, Lois C. Akpati, Valentine S. Alia, Roger Galindo

Research Symposium

Background: Low-grade Fibromyxoid Sarcoma (LGFMS) is a rare soft-tissue sarcoma with an incidence rate of 0.18 per million, first introduced into the literature by Harry L. Evans in 1987 [1]. This tumor, of mesenchymal origin, has a predilection for young adults and is most commonly found in the upper and lower extremities of deep soft tissues [1,2,3,4,5]. LGFMS has been described as having multiple variants, often presenting histologically as alternating fibrous and myxoid areas containing bland spindle and stellate cells arranged in a swirling, whorled appearance [6]. The predominant chromosomal abnormality of LGFMS has a FUS-CREB3L2 fusion gene with a …

Small Cell Carcinoma Of The Bladder: A Rare Case, Simita Gaglani, James Sander

Research Symposium

In this case report, we explore a case of small cell bladder carcinoma in a 75-year-old man with a history of smoking. This is a unique, aggressive subtype of bladder cancer which, in this patient, presented with gross hematuria. Workup included cystoscopy and transurethral resection of the bladder tumor, and pathological confirmation of the diagnosis elicited a referral to oncology for staging CT and potential chemotherapeutic measures. While the small cell carcinoma was successfully identified, it had already invaded the detrusor muscle on presentation, prompting the question of how to go about diagnosing and treating this subtype of bladder cancer …

Rare Presentation Of Oral Squamous Cell Carcinoma Of The Tongue With Ectopic Β-Hcg Secretion: A Case Report And Literature Review, Taha Al Hassan, Rachel A. Giese

Research Symposium

Background: Oral squamous cell carcinoma is the most common form of cancer in the oral cavity and pharynx, comprising more than 90% of all cases, with approximately half presenting with regional lymph node spread at the time of diagnosis. Pathogenesis includes various stages of progression encompassing multiple genetic and cellular events that ultimately lead to the malignant transformation of the squamous cells and invasion into surrounding tissues. Given the multistep nature of disease progression, recent studies have investigated potential prognostic indicators and screening markers through immunohistochemical staining and few studies suggest that human chorionic gonadotropin may be one marker that …

Cost Effective Treatment Options For Uninsured Patients With Diabetes, Sidney Selva, Ryan Bialaszewski, Elizabeth Althaus, Pamela Campos, Shuaibahmed M. Arab, Chelsea Chang

Research Symposium

Background: Approximately 37.3 million people in the United States have diabetes, accounting for 14.7% of the US population. Additionally, an estimated 2 million adults with diabetes have no health insurance coverage, which can contribute to chronic co-morbidities and increase all-cause mortality. Given the economic challenges these uninsured patients may face, it is important for healthcare providers to understand the cost-effective treatment options available to improve long-term outcomes. Therefore, this abstract aims to provide a cost-effective treatment algorithm for uninsured patients with diabetes.

Case Presentation: Our patient was a 47-year-old uninsured Hispanic female with uncontrolled type 2 diabetes mellitus. The …

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

Research Symposium

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 1 month. The difficulty of diagnosing ADS lies in the fact that the symptoms tend to be mistaken for other illnesses. Symptoms are commonly variable per individual, and the staggered presentation of symptoms can contribute to the difficulty in diagnosing ADS.

Case Presentation: We present a 36-year-old Hispanic woman who comes for evaluation of worsening, generalized body aches for the past 3 days. Associated signs and symptoms included rhinorrhea, …

Case Report: Kidney Transplant Pyelonephritis, Shuchita Jhaveri, Ruayda Bouls, Duc Khiem Ngo, Laura E. Garcia

Research Symposium

Background: Individuals with end-stage kidney disease (ESKD), and especially those who have received kidney transplants, are at an increased risk of developing urinary tract infection (UTI). UTI, especially recurrent UTI, is a common problem occurring in >75% of kidney transplant (KTX) recipients. Progression of infection can have significant consequences on the functioning of the transplanted kidney. It may be challenging to distinguish complicated UTI from acute or chronic rejection when patients present with fever and abdominal pain at the transplanted location. In this case study, we present the clinical scenario of a patient with a history of hypertension and ESKD …

Exploration Of Treatment Options For A Hispanic Patient With Obesity Class Iii And Multiple Comorbidities, Shuaibahmed M. Arab, Elizabeth Althaus, Pamela Campos, Sidney Selva, Ryan Bialaszewski, Chelsea Chang

Research Symposium

Introduction: The prevalence of obesity has reached epidemic proportions worldwide, presenting a significant challenge to public health systems and clinicians alike. The CDC published new statistics for the prevalence of obesity in the United States, with numbers reaching 41.9% from 2017-2020. Morbid obesity, indicated by a body mass index (BMI) of 40 kg/m² or higher, is associated with an increased risk of numerous comorbidities, including cardiovascular disease, type 2 diabetes, hypertension, and musculoskeletal disorders. This case report aims to explore the available treatment options for a Hispanic female with Obesity Class III and multiple comorbidities while keeping insurance coverage and …

Simultaneous Brachial Artery Injury And Ulnar Nerve Palsy: A Case Study Of An Atv Accident Survivor, Ryan Bialaszewski, Sidney Selva, Shuaibahmed M. Arab, Pamela Campos, Elizabeth Althaus, Chelsea Chang

Research Symposium

Background: All-terrain vehicle (ATV) accidents are a common cause of traumatic elbow injuries due to outstretched arms accepting contact at greater forces. However, their complexity and clinical significance often go unrecognized upon initial evaluation, especially in patients without acute fractures. Sequelae of such injuries can include neurovascular deficits, leading to chronic pain, limb ischemia, and paresthesias. This article aims to present a case study detailing a post-traumatic elbow injury with chronic neurovascular deficits following an ATV accident. Additionally, we address common clinical findings in post-traumatic concomitant brachial artery and ulnar nerve injuries, their evaluation, and respective management plans.

Case Presentation: …

Mycotic Aneurysms In Fungal Meningitis: The Management In A Case Of Fusarium Solani Meningitis, Ruayda Bouls, Duc Khiem Ngo, Jose E. Campo Maldonado

Research Symposium

Introduction:

We present a 31 y.o previously healthy woman who developed Fusarium solani fungal meningitis after undergoing cosmetic surgeries in Mexico. Fungal meningitis and particularly F. solani meningitis is very rare, and little is known about the extent and frequency of neurovascular complications in patients with this condition. To our knowledge, previous reports of fungal meningitis don’t recognize or emphasize enough the importance and extension of neurovascular complications noticed in our patient.

Case Presentation: A 31-year-old female presented with severe headaches and intermittent fever, two weeks after receiving epidural anesthesia during cosmetic surgery near the Texas-Mexico border. Lab results showed …

Avoiding A Perfect Storm: Delving Into The Consequences Of A Complex Case Of Superimposed Cellulitis After A Herpes Zoster Infection, Ruayda Bouls, Ed Wong Alvarado, Daniel Ibarias Paz, Yuri Cuellar De La Cruz

Research Symposium

Introduction: Cellulitis is an acute bacterial infection causing inflammation affecting the deep dermis layer as well as the surrounding subcutaneous tissue that does not contain an abscess. In this case study we aim to describe the clinical presentation of a middle aged Hispanic woman who developed a superimposed cellulitis infection following a flare-up of a zoster infection. Herpes Zoster is typically considered a typically benign infection but in immunocompromised individuals severe complications of the infection include bacterial superinfections, coagulopathies including disseminated intravascular coagulation, and central nervous system manifestations including encephalopathy with long term detrimental outcomes [1]. Management of Herpes Zoster …

Comatose Deception, Benzodiazepine Masquerade Of Myxedema Coma, Roy Subash Kondapavuluru, Sabhi Gull, Hemaswini Kakarla, Reshmanth Prathipati, Andres Suarez Parraga

Research Symposium

Introduction: Myxedema coma is a life:-threatening condition due to severe hypothyroidism or long-standing untreated hypothyroidism. This condition can be triggered by factors such as infection, exposure to certain medications, or other stressors on the body. Symptoms of myxedema coma include hypothermia, altered mental status, and fluid accumulation. This condition can be life threatening and requires immediate medical attention.

Benzodiazepines are often prescribed to address various conditions such as anxiety, sedation, and seizures. However, they have significant side effects including drowsiness, sedation, low blood pressure, and slow heart rate. These side effects can mimic symptoms of other conditions such as myxedema …

When Medications Collide: Demystifying Drug-Induced Hyponatremia In A Complex Medical Case, Roy Kondapavuluru, Jian Garcia Cruz, Manaswini Kakarla, Ram Maganti, Akshay Pingilati, Andres Suarez Parraga

Research Symposium

Introduction: Hyponatremia, defined as serum sodium below 135mEq/L( normal range:136-145mEq/l), is a medical emergency associated with various complications. Sodium is an important electrolyte that helps regulate fluid balance and nerve/muscle function. Severe hyponatremia may not show obvious symptoms initially but can eventually manifest as nausea, vomiting, fatigue, impaired movement, and in extreme cases, seizures, coma, respiratory failure, or even death.

Thiazide diuretics have been associated with hyponatremia with a sodium level as low as 99mEq/L. In our case, the patient was on bumetanide, a loop diuretic and she developed hyponatremia which worsened with additional metolazone treatment to a sodium level …

“Blood, Blood Everywhere”: A Case Of Buried Bumper Syndrome Presenting As Melena And Hematochezia, Roy Subash Kondapavuluru, Baron S. Ekeledo, Jian Garcia Cruz, Eunbee Cho, Balakrishna Ravella, Sudheer K. Kanumari

Research Symposium

Gastrostomy tubes are frequently placed for a variety of conditions that cause interference with oral intake or gastric decompression and are used for enteral feeding, hydration, and medication administration in patients who are likely to have prolonged inadequate oral intake. Buried bumper syndrome is an extremely rare, but major complication of gastrostomy tubes which results due to tight apposition of the external bumper against the abdominal wall and erosion of the internal bumper of the gastrostomy tube against the gastric wall. The overall incidence has been reported to be 0.3 to 2.6 % of all patients with gastrostomy tubes. We …

Tick-Borne Illness In A Guatemalan Migrant, Radhika Mehta, Bareera Akhtar

Research Symposium

Abstract: Migration is a complex phenomenon that involves numerous physical and psychological challenges, particularly for individuals undertaking long and arduous journeys. In the case of this 39 year old Guatemalan man, his perilous 25-day journey crossing forests to reach the United States resulted in severe health consequences, including dehydration, acute kidney injury and a possible tick-borne illness. This case report aims to shed light on the healthcare needs of migrants and emphasizing the importance of providing comprehensive care.

A 39 year old male from Guatemala presented to the emergency department with diffuse abdominal pain associated with nausea, vomiting and a …

Clinical Management Of Larsen Syndrome In Inpatient Rehabilitation: A Case Report, Philippe J. Dentino

Research Symposium

Background: Larsen Syndrome is a rare osteochondrodysplasic disorder associated with Filamin 1 (FLN) gene mutations and clinically presents with frequent large joint dislocations, osseous disturbances, and craniofacial abnormalities. To date, no studies have assessed the medical and rehabilitative management of an individual living with Larsen Syndrome in an inpatient rehabilitation care setting.

Case Presentation: A 30 year-old biological female presented to the emergency department after developing worsening right-sided low back pain while bending forward. The patient’s past medical and surgical history was significant for Larsen Syndrome complicated by chronic hip, knee, and back pain, Celiac disease, major depressive disorder, post-traumatic …

Mystery Case: An Effort To Diagnose A Patient With A Decade Of Relapsing And Remitting Neurologic Symptoms With A Comprehensive Medical Approach, Pamela Campos, Sidney Selva, Ryan Bialaszewski, Elizabeth Althaus, Shuaibahmed M. Arab, Chelsea Chang

Research Symposium

Background: Muscle weakness and numbness are prevalent complaints amongst patients and can have a varying range of diagnoses from benign inconsequential to life-threatening causes. The pattern and intensity of weakness, accompanying symptoms, medication use, and family history assist the physician in determining if a patient's presentation is caused by infectious, neurologic, metabolic, inflammatory, psychiatric, or drug-induced condition.

Case Presentation: Our patient is a 37-year-old female who presents to the clinic for a follow-up. The patient has a past medical history of Major Depressive Disorder (MDD), Generalized Anxiety Disorder (GAD), and an undiagnosed neuromuscular weakness for approximately 10 years. The weakness …

New Onset Bilateral Pleural Effusion: An Uncommon Presentation Of Subclinical Hypothyroidism Or A Premature Closure Diagnosis Error?, Molly Chapman, Andrea Soto Abarca, Duc Khiem Ngo, Carlos T. Ramos

Research Symposium

Background: Subclinical hypothyroidism is biochemically defined with normal serum-free T4 in the presence of an elevated serum TSH. Common symptoms of an underactive thyroid can include fatigue, weakness, cold intolerance, weight gain despite poor appetite, hair loss, constipation, and depression. Pleural effusions have also been recognized as a clinical sequelae in the literature, where up to 25% of patients can develop a pleural fluid collection in the setting of hypothyroidism. Although not well understood, a mechanism includes an increased capillary permeability that leads to the retention of fluid in pleural cavities and other tissues.

Case presenting: A 66-year-old woman …

A Rare Case Of Acute Pancreatitis Associated With Cannabinoids Consumption, Mays Abdulazeez, Michael Perez, Alejandro Hidalgo Parada, Rani Rabah, Greity Dominguez, Rowel Perez Vargas, Jose Cano, Jesus Garza-Tamez, Sunand Kallumadanda

Research Symposium

Introduction: Acute pancreatitis is an inflammatory condition of the pancreas characterized by abdominal pain and elevated levels of pancreatic enzymes in the blood. Acute pancreatitis is a leading gastrointestinal cause of hospitalization in the United States. Several conditions are associated with acute pancreatitis, of which gallstones and chronic alcohol use disorder account for approximately two-thirds of the cases. Others, including smoking, hypertriglyceridemia, infections, trauma, drugs, malignancy, scorpion stings, hypercalcemia, endoscopic retrograde cholangiopancreatography (ERCP), opioids, angiotensin-converting enzyme (ACE) inhibitors, macrolides, diuretics, statins, and cannabis have also been associated with acute pancreatitis. Cannabis is the most widely used recreational drug worldwide, with …

From Carious To Salivarius: A Case Of Streptococcus Salivarius Infective Endocarditis, Maria E. Torres Perez, Ed Wong Alvarado, Cecilia Salinas Domene, Jennifer Rojas Huen, Sara G. Mojica, C. Garza, Usman Sheriff

Research Symposium

Background: Streptococcus salivarius forms part of the Viridans family which accounts for almost 40% of all endocarditis cases. However, S.salivarius is only attributed to 2% of those cases. In the most common setting, S.salivarius is a commensal bacterium of both the oral mucosa and the gut, but it has proven to have infective potential. S.salivarius accounts as an easily missed and commonly misdiagnosed Viridians strep species, but has been implicated as a rare cause of infective endocarditis.

Case presentation: We present the case of a 43-year-old male who presented with worsening fatigue, chest pain, shortness of breath, and subjective fever. …

Sudden Cardiac Death Due To Pharmacological Cardioversion Of Atrial Fibrillation, Manlio F. Lara Duck, Juan Rosales-Martínez, Netzahualcoyotl Mayek Pérez

Research Symposium

Introduction: Atrial fibrillation (AF) is the most common cardiac arrhythmia. The global prevalence of AF is 0.51% of the world population (37.5 million people) and has increased 33% in the last 20 years. AF may be associated with increased risk of sudden cardiac death (SCD); as well as ischemic stroke or coagulopathies. Coronary heart disease and heart failure are the two most common substrates of SCD. Therefore, the relationship between AF and SCD is particularly difficult to address. AF may have a shared molecular basis with ventricular fibrillation (VF; the most common arrhythmia underlying SCD), as both involve cellular …

Use Of Translational Science, Continuous Glucose Monitoring In The Primary Care Setting For Management Of Nesidioblastosis. A Case Report, Karuna Manandhar, Othman Farahneh, Gerardo Munoz-Monaco

Research Symposium

Background: Nesidioblastosis is a term used to describe histologic changes in the pancreatic cell defined by beta cell hypertrophy and formation of ductoinsular complexes. It is a disease previously most extensively identified in neonates and is a rare cause of endogenous hypoglycemia in the adult population. However, with increasing numbers of gastric bypass surgeries for management of obesity in recent years, there has been a growing number of populations with post gastric bypass surgery related nesidioblastosis.

Case Description: Our case report follows a 60-year-old female with previous history of Roux-en-Y gastric bypass surgery who initially presented to an acute-care hospital …