Medicine and Health Sciences Commons^™

Monoclonal Immunoglobulin-Associated Glomerulopathy: Single Health Center Experience With 16 Cases, Brandon Metcalf, Yazan A. Al-Othman, James Huang, Wei Li, Hassan D. Kanaan, Ping L. Zhang

Conference Presentation Abstracts

Context: In addition to monoclonal cryoglobulinemic glomerulopathy, nonorganized monoclonal immunoglobulin (Ig) can deposit in glomeruli, causing either proliferative glomerulonephritis or membranous glomerulopathy. We present our experience related to this phenomenon.

Design: Sixteen cases of monoclonal immunoglobulin-associated glomerulopathy (MIAGN) from 14 patients were identified during the past 13 years and their pathologic and clinical features were collected and presented.

Results: One case of membranous glomerulopathy with monoclonal immunoglobulin deposits (MGNMID) (also called membranous glomerulopathy with light-chain–restricted deposits) was found. The patient was a 71-year-old woman with serum creatinine at 0.7 mg/dL and nephrotic syndrome (urine protein to creatinine ratio at 5.41), …

Igm-Dominant Immune Complex-Mediated Glomerulonephritis Should Be Classified As Membranoproliferative Glomerulonephritis, Igm Subtype, Sarang Khan, Brandon Metcalf, Wei Li, Hassan Kanaan, Ping L. Zhang

Conference Presentation Abstracts

Context: Immunoglobulin M (IgM) glomerulopathy usually presents as drug-resistant nephrotic syndrome and is characterized by diffuse effacement of foot processes and scattered mesangial IgM deposits, which is considered within the spectrum of minimal change disease and primary focal segmental glomerulosclerosis. However, IgM-dominant immune complex–mediated glomerulonephritis (IgM-ICMGN) is a rare renal entity and usually characterized by a membranoproliferative pattern with light microscopy; dominant IgM staining by immunofluorescent staining; and subendothelial, mesangial, and occasional subepithelial deposits by electron microscopy.

Design: We report our experience of 5 IgM-ICMGN cases with their pathologic phenotypes and clinical scenarios.

Results: Patient ages ranged from 47 to …

Combined Smad4 And Imp3 Immunohistochemical Stains To Increase The Probability Of Diagnosing Pancreatic Adenocarcinomas In Fine-Needle Biopsies, Reenal Patel, Ashbita Pokharel, Ping L. Zhang, Zhenhong H. Qu

Conference Presentation Abstracts

Context: SMAD4 and IMP3 are useful stains in diagnosing pancreatic cancer but not perfect to reach that goal individually. We attempted to determine if using both SMAD4 and IMP3 can increase the diagnostic specificity of fine-needle biopsies (FNBs) for pancreatic adenocarcinomas, as FNBs often showed limited tissue for the morphologic evaluation.

Design: Fifteen FNBs with or without prior cytology were evaluated with both SMAD4 and IMP3 stains. Nuclear loss of SMAD4 was graded as 0 (no loss), 1–2+ (partial loss), and 3+ (total loss), whereas IMP3 was graded 0–3+ by staining intensity. Staining results were correlated with morphologic changes for …

Doac Therapy Associated With Macroscopic Hematuria: Investigation Of The Underlying Urologic Etiologies, Catherine Xie, Mary Wyrzykowski, Subhash Edupuganti, Ming Xie

Conference Presentation Abstracts

Context: Direct oral anticoagulants (DOACs) have gained wide use in prevention and treatment of thromboembolic diseases. Both major and nonmajor bleeding events have been reported. Hematuria is a common bleeding complication in patients receiving DOACs.

Design: This study retrospectively investigates the underlying urologic etiologies responsible for DOAC therapy–related macroscopic hematuria. During a 1-year period, hospitalized patients with prolonged PTT and DOAC therapy–related hemorrhage were identified. Medical chart review focused on urology consult and related laboratory and imaging findings.

Results: Among 93 patients with DOAC therapy–related hemorrhage, 15 had macroscopic hematuria (16%), including 11 men and 4 women with a median …

Using An Artificial Intelligence (Ai) Tool (Chatgpt) To Identify The Main Indications And Side Effects Of Drugs In Patient Medical Records, Mai Elzieny, Zhenhong Qu

Conference Presentation Abstracts

Context: Drug history is important clinical information for the correct histologic diagnosis of a wide variety of nonneoplastic diseases, such as hepatitis, gastritis, and colitis. As pathologists, however, keeping a strong knowledge of all drugs (and variations of drug names) can be challenging. Using online databases to find relevant drug information one at a time is very time-consuming.

Design: Sixty-seven drugs were collected from the medical records of 5 randomly selected patients. ChatGPT (https://chat.openai.com/chat) was instructed to identify (1) the main clinical indications, and (2) the major side effects of each drug, using the prompt “List the major indications and …

“It's So Expensive And Isn’T Any Better! Or Is It?” A Comparative Analysis Of Price Per Ecmo Hour, Intracranial Hemorrhage, And Survival Rates In Neonates On Bivalirudin Vs. Heparin, Johanna I. Orrick, Jessie Charbonneau, Kari L. Davidson, Alexandra Oschman, John M. Daniel Iv

Posters

Background: Heparin has been the anticoagulant of choice for Neonatal ECMO for the past thirty years. It has the benefit of being well studied and having a low production cost. As bivalirudin is a newer anticoagulant, it has not been as widely studied and has a higher production cost, many centers are concerned about changing to a newer, more expensive agent. Bivalirudin has been studied from both an efficacy and cost perspective in adult patients (Sun et al 2021) and pediatric VAD populations (Burnstein et al 2023). While some safety and efficacy data exist for neonates, there are few if …

A Shorter Door-In-Door-Out Time Is Associated With Improved Outcome In Large Vessel Occlusion Stroke., Adam Sigal, Derek L Isenberg, Chadd K Kraus, Daniel Ackerman, Joseph Herres, Ethan S Brandler, Alexander Kuc, Jason T Nomura, Derek R Cooney, Michael T Mullen, Huaqing Zhao, Nina T Gentile

Einstein Health Papers

Introduction: Endovascular thrombectomy (EVT) significantly improves outcomes in large vessel occlusion stroke (LVOS). When a patient with a LVOS arrives at a hospital that does not perform EVT, emergent transfer to an endovascular stroke center (ESC) is required. Our objective was to determine the association between door-in-door-out time (DIDO) and 90-day outcomes in patients undergoing EVT. Methods: We conducted an analysis of the Optimizing Prehospital Stroke Systems of Care-Reacting to Changing Paradigms (OPUS-REACH) registry of 2,400 LVOS patients treated at nine ESCs in the United States. We examined the association between DIDO times and 90-day outcomes as measured by the …

Antiviral Susceptibility Of Clade 2.3.4.4b Highly Pathogenic Avian Influenza A(H5n1) Viruses Isolated From Birds And Mammals In The United States, 2022, Ha T. Nguyen, Anton Chesnokov, Juan De La Cruz, Philippe Noriel Q. Pascua, Vasiliy P. Mishin, Yunho Jang, Joyce Jones, Han Di, Andrei A. Ivashchenko, Mary Lea Killian, Mia K. Torchetti, Kristina Lantz, David E. Wentworth, Charles T. Davis, Alexandre V. Ivachtchenko, Larisa V. Gubareva

United States Department of Agriculture Wildlife Services: Staff Publications

Clade 2.3.4.4b highly pathogenic avian influenza (HPAI) A(H5N1) viruses that are responsible for devastating outbreaks in birds and mammals pose a potential threat to public health. Here, we evaluated their susceptibility to influenza antivirals. Of 1,015 sequences of HPAI A(H5N1) viruses collected in the United States during 2022, eight viruses (∼0.8%) had a molecular marker of drug resistance to an FDA-approved antiviral: three adamantane-resistant (M2-V27A), four oseltamivir-resistant (NA-H275Y), and one baloxavir-resistant (PA-I38T). Additionally, 31 viruses contained mutations that may reduce susceptibility to inhibitors of neuraminidase (NA) (n = 20) or cap-dependent endonuclease (CEN) (n = 11). A panel of 22 …

Toxic Vs. Visionary Leaders, Michelle C. Dziurgot Dds

The Journal of the Michigan Dental Association

This reviews characteristics of toxic and visionary leadership styles. This article is an installment of the MDA Journal’s monthly Editorial department.

Detroit Mercy Dental: Empowering Leaders And Igniting Change, Mert N. Aksu Dds, Jd, Mhsa, Cert. Dph

The Journal of the Michigan Dental Association

This article is a review/recap of activities at the University of Detroit Mercy School of Dentistry over the past year, including information on community service programs, diversity and inclusion, research, faculty and staff accomplishments, student life, and demographic information.

Mda Foundation: How Foundation Grants Assist Dei Efforts At Detroit Mercy, U-M, Anne Berquist

The Journal of the Michigan Dental Association

This article provides information on the diversity, equity, and inclusion programs at Michigan’s two dental schools and details how the MDA Foundation is supporting these programs. This article is an installment of the MDA Journal’s monthly MDA Foundation department.

What Does Professionalism Mean To You? Part Ii, Michael G. Maihofer Dds

The Journal of the Michigan Dental Association

This article is a continuation of a similar article in the August 2023 (Vol. 105, No. 8) Journal of the Michigan Dental Association in which a grouping of new dentists across the state of Michigan was asked to define what “professionalism” meant to them. An introduction to the article is provided by Michael Maihofer, DDS, who compiled the comments.

Perio Presentation - The Gummy Smile

Journal of the Macomb Dental Society

Presentation summary: Ninety-two attendees ranging from dental specialists, generalists, and hygienists gathered at Andiamos as a team to learn treatment modalities for “Gummy Smiles.” Beautifully documented and photographed cases were shared. Classifications of “Gummy Smile” patients were reviewed. Dental teams can feel confident discussing treatment options concerning high smile lines thanks to Drs. Kinaia and Hasso.

Karen Burgess Remembered: Thoughts And Memories From Mda Leaders

The Journal of the Michigan Dental Association

This article is a collection of memories and remembrances of Karen Burgess, who served as Michigan Dental Association CEO/executive director from 2014 until her death on July 18, 2023.

Kneiffiella Palmae: A Non-Aspergillus Fungal Infection Isolated From A Pulmonary Nodule In A Child With Chronic Granulomatous Disease, Bianca E. Ituarte, Connie Canete-Gibas, Nathan P. Wiederhold, Liset Olarte

Manuscripts, Articles, Book Chapters and Other Papers

We report the first known human case of Kneiffiella palmae in the medical literature. K. palmae was isolated from a pulmonary nodule in a 7-year-old male with chronic granulomatous disease. The mold was identified as K. palmae at a national reference laboratory, where 17 other human respiratory samples tested positive for K. palmae from 2013 to 2021. Optimal antimicrobial treatment is unknown, but azoles and amphotericin B demonstrated in vitro activity against each tested isolate.

Validation Of A Clinical Prediction Rule For Distinguishing Bacterial And Aseptic Meningitis In Pediatric Patients, Amelia L Gurley, Matt Fukuda, Ashwin Sharma, Ethan Lee, Erica Junqueira, Michael Kang, Tommy Y Kim

Children’s Nutrition Research Center Staff Publications

Introduction

The treatments and prognosis of bacterial meningitis differ greatly from those of aseptic meningitis, making early identification and differentiation essential. Several different clinical prediction rules have been developed to distinguish bacterial meningitis from aseptic meningitis. We sought to validate one clinical prediction rule for pediatric patients utilizing a centralized data warehouse that collects daily data from 184 hospitals across the United States.

Methods

We retrospectively collected data on all patients aged 29 days to 14 years who presented to Hospital Corporation of America (HCA) Healthcare hospitals from January 1, 2016, to May 31, 2021, with a diagnosis of meningitis. …

Mda Services: Why Dental Cpas Are Warning About Potential Employee Dishonesty, Reva Darling

The Journal of the Michigan Dental Association

This article details scenarios in which embezzlement and employee dishonesty can occur in a dental office and the need to employ a dental CPA. The article also describes two vendors endorsed by the Michigan Dental Association for accounting and protection against embezzlement. This article is an installment of the MDA Journal’s bi-monthly MDA Services department.

U-M School Of Dentistry: A New Leader, But The Same Longstanding Commitment To Advancing Dental Education And Oral Health Sciences, Jacques E. Nör Dds, Ms, Phd

The Journal of the Michigan Dental Association

This article is a review/recap of activities at the University of Michigan School of Dentistry over the past year, including introducing the new dean of the school, Dr. Jacques Nör, the mission of the school, student demographic information, community outreach, faculty news, student achievement, and research.

Knowledge And Use Of Paced Bottle-Feeding Among Mothers Of Young Infants, Alison K. Ventura, Vivian M. Drewelow

Kinesiology and Public Health

Objective: To describe mothers’ awareness and use of paced bottle-feeding (PBF) and to investigate whether the use of PBF was associated with maternal characteristics and infant feeding practices.

Methods: Cross-sectional, online survey. Participants were mothers of infants < 12 months of age (n =197). Participants self-reported their awareness and use of PBF, demographic characteristics, and infant feeding practices.

Results: Of the 41% of participants who indicated they had or maybe had heard of PBF, 23% used PBF and 35% sometimes used PBF. Use of PBF was not associated with mother or infant characteristics. Participants who used PBF were significantly less likely to encourage their infant to finish the bottle (odds ratio,0.04; 95% confidence interval, 0.01−0.79).

Conclusions and Implications: Paced bottle-feeding was …

Stop-Bang Questionnaire For Screening Obstructive Sleep Apnea Syndrome Among Hypertensive Patients In Kenya, Salim Abdallah, Jasmit Shah, Jumaa Bwika, Sayed Karar

Internal Medicine, East Africa

Introduction: Obstructive sleep apnea (OSA) is a type of breathing problem during sleep caused by the blockage of the upper airway, which can cause cessation of airflow. There is limited research on the prevalence of OSA in hypertensive patients in sub-Saharan Africa (SSA). The study aimed to describe the prevalence and clinical characteristics of OSA among hypertensive patients at a tertiary hospital in Nairobi, Kenya.

Methods: This cross-sectional study was conducted at the Aga Khan University Hospital in Nairobi, Kenya. Two hundred and fifty-one hypertensive patients were screened for OSA risk using the STOP-Bang questionnaire (SBQ). Patients with a SBQ …

Kenyan Palliative Care Providers’ And Leaders’ Perceptions Of Palliative Care Research Needs And Support To Facilitate Rigorous Research, K. Cartmell, E. Doherty, Nancy Gikaara, Z. Ali, S. Qanungo, E. S. Melikam, R. A. Powell

Internal Medicine, East Africa

Background: Palliative care (PC) can reduce symptom distress and improve quality of life for patients and their families experiencing life-threatening illness. While the need for PC in Kenya is high, PC service delivery and research is limited. Qualitative research is needed to explore potential areas for PC research and support needed to enable that research. This insight is critical for informing a national PC research agenda and mobilizing limited resources for conducting rigorous PC research in Kenya.

Objectives: To explore perceptions of priority areas for PC research and support needed to facilitate rigorous research from the perspective of Kenyan PC …

Gall Bladder Schistosomiasis Diagnosed Incidentally Post Laparoscopic Cholecystectomy: A Case Report, Willbroad Kyejo, Sajida Panjwani, Ally Zain Ismail, Blessing Mathew, Caroline Ngimba, Ally Mwanga

Internal Medicine, East Africa

Introduction and importance: Schistosomiasis is a neglected tropical disease caused by parasitic worms of the genus Schistosoma. It primarily affects the intestines, liver, and urinary tract however, rare cases have been reported where the parasite invades other organs. This case report presents an incidental finding of schistosomiasis, upon histopathology evaluation, in a patient who underwent laparoscopic cholecystectomy for symptomatic gallstone disease with recurrent attacks of cholecystitis.

Case presentation: We present the case of a 42-year-old female patient who presented to the emergency department with symptoms and signs suggestive of acute cholecystitis. She underwent conservative management with interval laparoscopic cholecystectomy …

Effect Of Instability Training On Compensatory Muscle Activation During Perturbation Challenge In Young Adults, Stephen C. Glass, Kamryn A. Wisneski

Open Access Publishing Support Funded Articles

Balance requires constant adjustments in muscle activation to attain force steadiness. Creating appropriate training can be challenging. The purpose of this study was to examine the effects of 2 weeks of front squat instability training using a water-filled training tube on force steadiness during an instability challenge. Control (CON, n = 13) and experimental (EXP, n = 17) subjects completed pre- and post-testing for EMG variability by completing one set of 10 repetitions with a stable and unstable training tube. Electrodes were placed bilaterally on the anterior deltoid, paraspinal, and vastus lateralis muscles. CON subjects completed 2 weeks of training …

Closing The Gap For Children With Ocd: A Staged-Care Model Of Cognitive Behavioural Therapy With Exposure And Response Prevention, Lara J Farrell, Allison M Waters, Eric A Storch, Gabrielle Simcock, Iain E Perkes, Jessica R Grisham, Katelyn M Dyason, Thomas H Ollendick

Center for Medical Ethics and Health Policy Staff Publications

Childhood obsessive-compulsive disorder (OCD) is among the most prevalent and disabling mental health conditions affecting children and adolescents. Although the distress and burden associated with childhood OCD are well documented and empirically supported treatments are available, there remains an unacceptable "treatment gap" and "quality gap" in the provision of services for youth suffering from OCD. The treatment gap represents the large number of children who never receive mental health services for OCD, while the quality gap refers to the children and young people who do access services, but do not receive evidence-based, cognitive behavioural therapy with exposure and response prevention …

Emotional Distress And Cardiovascular Disease Risk Among Participants Enrolled In The Glycemia Reduction Approaches In Diabetes: A Comparative Effectiveness (Grade) Study, Gladys Crespo-Ramos, Ionut Bebu, Heidi Krause-Steinrauf, Claire J Hoogendoorn, Ran Fang, Dominic Ehrmann, Caroline Presley, Aanand D Naik, Aimee Katona, Elizabeth A Walker, Andrea Cherrington, Jeffrey S Gonzalez

Faculty, Staff and Student Publications

AIMS: People with type 2 diabetes (T2DM) have an increased risk of cardiovascular disease (CVD). We examined depressive symptoms (DS) and diabetes distress (DD) in relation to the estimated 10-year risk of CVD in adults with T2DM enrolled in the GRADE Emotional Distress Substudy.

METHODS: Linear regression models examined the associations of baseline DS and DD with estimated 10-year risk of CVD using the Atherosclerotic Cardiovascular Disease (ASCVD) risk score, adjusting for age, sex, race/ethnicity, education, income, diabetes duration, diabetes-related complications, and HbA1c.

RESULTS: A total of 1,605 GRADE participants were included: 54% Non-Latino (NL) White, 18% Latino, 19% NL-Black, …

Prediagnostic Glycoprotein Acetyl Levels And Incident And Recurrent Flare Risk Accounting For Serum Urate Levels: A Population-Based, Prospective Study And Mendelian Randomization Analysis, Amit D Joshi, Natalie Mccormick, Chio Yokose, Bing Yu, Adrienne Tin, Robert Terkeltaub, Tony R Merriman, A Heather Eliassen, Gary C Curhan, Laura M Raffield, Hyon K Choi

Faculty, Staff and Student Publications

OBJECTIVE: To prospectively investigate population-based metabolomics for incident gout and reproduce the findings for recurrent flares, accounting for serum urate.

METHODS: We conducted a prediagnostic metabolome-wide analysis among 105,615 UK Biobank participants with nuclear magnetic resonance metabolomic profiling data (168 total metabolites) from baseline blood samples collected 2006-2010 in those without history of gout. We calculated hazard ratios (HRs) for incident gout, adjusted for gout risk factors, excluding and including serum urate levels, overall and according to fasting duration before sample collection. Potential causal effects were tested with 2-sample Mendelian randomization. Poisson regression was used to calculate rate ratios (RRs) …

Exceptional Responses To Selpercatinib In Ret-Fusion Driven Metastatic Pancreatic Cancer, Deepak Bhamidipati, Sireesha Yedururi, Jason Huse, Sri Veda Chinapuvvula, Jie Wu, Vivek Subbiah

Faculty, Staff and Student Publications

No abstract provided.

Ras Gtpases And Interleaflet Coupling In The Plasma Membrane, Junchen Liu, Neha Arora, Yong Zhou

Faculty, Staff and Student Publications

RAS genes are frequently mutated in cancer. The primary signaling compartment of wild-type and constitutively active oncogenic mutant RAS proteins is the inner leaflet of the plasma membrane (PM). Thus, a better understanding of the unique environment of the PM inner leaflet is important to shed further light on RAS function. Over the past few decades, an integrated approach of superresolution imaging, molecular dynamic simulations, and biophysical assays has yielded new insights into the capacity of RAS proteins to sort lipids with specific headgroups and acyl chains, to assemble signaling nanoclusters on the inner PM. RAS proteins also sense and …

Cancer In Louisiana: 2016-2020, Volume 38, Louisiana Tumor Registry, Lauren Maniscalco, Mei-Chin Hsieh, Christina Lefante, Yong Yi, Lisa Pareti, Brent Mumphrey, Mary Anne Lynch, Xiao-Cheng Wu, Simon Zulu

Policy & Position Papers

Mission:

To collect and report complete, high-quality, and timely population-based cancer data in Louisiana to support cancer research, control, and prevention.

Vision:

To reduce suffering and death from cancer using information collected by the Louisiana Tumor Registry.

History:

Cancer registration in Louisiana began in 1947 at the Charity Hospital Tumor Registry in New Orleans. In 1974, as part of its Surveillance, Epidemiology and End Results (SEER) Program, the National Cancer Institute provided funds for a population-based cancer incidence and survival registry covering Jefferson, Orleans, and St. Bernard parishes. Five years later, the Louisiana Tumor Registry (LTR) was transferred to the …

Epigenome-Wide Dna Methylation Association Study Of Circulating Ige Levels Identifies Novel Targets For Asthma, Kathryn Recto, Priyadarshini Kachroo, Tianxiao Huan, David Van Den Berg, Gha Young Lee, Helena Bui, Dong Heon Lee, Jessica Gereige, Chen Yao, Shih-Jen Hwang, Roby Joehanes, Scott T Weiss, George T O'Connor, Daniel Levy, Dawn L Demeo

Faculty, Staff and Student Publications

BACKGROUND: Identifying novel epigenetic signatures associated with serum immunoglobulin E (IgE) may improve our understanding of molecular mechanisms underlying asthma and IgE-mediated diseases.

METHODS: We performed an epigenome-wide association study using whole blood from Framingham Heart Study (FHS; n = 3,471, 46% females) participants and validated results using the Childhood Asthma Management Program (CAMP; n = 674, 39% females) and the Genetic Epidemiology of Asthma in Costa Rica Study (CRA; n = 787, 41% females). Using the closest gene to each IgE-associated CpG, we highlighted biologically plausible pathways underlying IgE regulation and analyzed the transcription patterns linked to IgE-associated CpGs …