Immune System Diseases Commons^™

Telemedicine For Rheumatology Patients In Covid-19 Pandemic: Perspectives Of Patients, Muhammad Mehmood Riaz, Saad Bin Zafar Mahmood, Noreen Nasir

Section of Internal Medicine

Telemedicine use for patients with autoimmune rheumatic conditions during the pandemic mandates better characterization. We conducted a telephonic survey on patients who consulted rheumatologists remotely to determine their attitudes toward telemedicine. The study was conducted at Aga Khan University Hospital, a tertiary care hospital in Pakistan which is a lower-middle-income country. Descriptive analyses were performed. Fifty patients visited tele-rheumatology clinic, 35 (70.0%) were female with a mean (SD) age of 47.6 (18.1) years. Majority (27, 54.0%) learned about telemedicine from hospital website and outpatient clinic desk or helpline. Lack of examination was the biggest concern with teleconsultation (18, 22.2%). Most …

A Proposed Treatment Of Mixed Connective Tissue Disease By Competitive Inhibition Of Autoantibodies, Thomas Russell

Senior Honors Theses

Mixed Connective Tissue Disease is an autoimmune disease characterized by Raynaud’s phenomenon and arthritis among other symptoms. It is primarily caused by antibodies that target the U1-RNP 70K peptide. The treatment proposed in this paper uses competitive inhibition to prevent the binding of the anti-U1-RNP 70K antibodies with the U1-RNP 70K peptide. A method for testing the designed treatment in silico is proposed using AutoDock Vina docking software.

The Response To Covid-19 Among Drug Retail Outlets In Indonesia: A Cross-Sectional Survey Of Knowledge, Attitudes, And Practices, Yusuf Ari Mashuri, Luh Putu Lila Wulandari, Mishal Khan, Astri Ferdiana, Ari Probandari, Tri Wibawa, Neha Batura, Marco Liverani, Richard Day, Stephen Jan

Community Health Sciences

Background: Pharmacists have been at the frontline of the COVID-19 response in Indonesia, providing medicines, advice, and referral services often in areas with limited healthcare access. This study aimed to explore their knowledge, attitudes, and practices during the pandemic, so that we can be better prepared for future emergencies.
Methods: A cross-sectional online survey of community pharmacists and pharmacy technicians in Indonesia was conducted between July and August 2020. The dataset was analysed descriptively, and logistic regression was used to explore willingness to participate in COVID-19 interventions.
Findings: 4716 respondents participated in the survey. Two-thirds (66·7%) reported knowing only "a …

Viral Hepatitis - The Road Traveled And The Journey Remaining, Ghulam Fareed Malik, Noval Zakaria, Muhammad Ibrahim Majeed, Faisal Wasim Ismail

Section of Gastroenterology

Hepatitis is defined as inflammation of the liver and is commonly due to infection with The hepatotropic viruses - hepatitis A, B, C, D and E. Hepatitis carries one of the highest disease burdens globally and has caused significant morbidity and mortality among different patient populations. Clinical presentation varies from asymptomatic or acute flu-like illness to acute liver failure or chronic liver disease, characterized by jaundice, hepatomegaly and ascites among many other signs. Eventually, this can lead to fibrosis (cirrhosis) of the liver parenchyma and carries a risk of development into hepatocellular carcinoma. Hepatitis B and C are most notorious …

Age-Associated Gut Dysbiosis, Marked By Loss Of Butyrogenic Potential, Correlates With Altered Plasma Tryptophan Metabolites In Older People Living With Hiv., Smita Ghare, Richa Singhal, Vaughn Bryant, Sabina Gautam, Chanakya Charan Tirumala, Praneet Kumar Srisailam, Andrea Reyes-Vega, Dushan Ghooray, Craig J. Mcclain, Kristi Hoffman, Joseph Petrosino, Kendall Bryant, Varand Govind, Ronald Cohen, Robert L. Cook, Shirish Barve

Faculty and Staff Scholarship

Background:

Imbalance in tryptophan (TRP) metabolism and its neuroactive metabolites, serotonin and kynurenine (KYN), is a known pathogenic mechanism underlying neurocognitive impairment. Gut microbiota plays an important role in TRP metabolism, and the production of these neuroactive molecules affects neurocognitive function. Although both HIV infection and normal aging independently induce gut dysbiosis and influence TRP metabolism, their interactive effects on compositional/functional changes in gut microbiota and consequent alterations in TRP metabolites remain largely undetermined.

Methods:

Older people living with HIV infection (PLWH, aged 50–70 years, n = 22) were enrolled in this cross-sectional pilot study. Metagenomic analysis of fecal microbiome …

Adult Pulmonary Langerhans Cell Histiocytosis With Osseous Involvement: Understanding This Rare Mimic Of Malignancy, Samantha A. Smith Ms Iii, Adam M. Franks Md, William Rollyson Ms Iv, Doreen Griswold, Tammy Bannister Md

Marshall Journal of Medicine

Langerhans cells are dendritic cells that form the antigenic barrier of the human body. They occur in nearly any tissue but are most prevalent in the skin, submucosa of the bronchial tree, and other mucosae. Langerhans Cell Histiocytosis (LCH) develops when these cells damage the tissues in which they reside through a combination of inflammatory and monoclonal stimulation. The pulmonary variant of LCH involves the lung parenchyma and creates a wide variety of disturbances: pulmonary hypertension and both obstructive and restrictive lung disease. Osseous involvement, in addition to the pulmonary variant, presents with pulmonary masses and lytic bone lesions, which …

Clinical Outcomes Of Immunomodulatory Therapies In The Management Of Covid-19: A Tertiary-Care Experience From Pakistan, Noreen Nasir, Salma Tajuddin, Sarah Khaskheli, Naveera Khan, Hammad Niamatullah, Nosheen Nasir

Section of Internal Medicine

The pharmacological management of COVID-19 has evolved significantly and various immunomodulatory agents have been repurposed. However, the clinical efficacy has been variable and a search for cure for COVID-19 continues. A retrospective cohort study was conducted on 916 patients hospitalized with polymerase chain reaction (PCR)-confirmed COVID-19 between February 2020 and October 2020 at a tertiary care academic medical center in Karachi, Pakistan. The median age was 57 years (interquartile range (IQR) 46–66 years). The most common medications administered were Methylprednisolone (65.83%), Azithromycin (50.66%), and Dexamethasone (46.6%). Majority of the patients (70%) had at least two or more medications used in …

Fever Of Unknown Origin: A Grave Diagnosis, Ryan Miller, Richard Allen

South Atlantic Division GME Research Day 2022

No abstract provided.

The Role Of Emergency Departments For Antimicrobial Stewardship In Covid-19 Pandemic; The Time Is Now, Madiha Ismail, Nazeer Najeeb Kapadia, Sara Usman

Department of Emergency Medicine

No abstract provided.

Plethora Of Cranial Nerve Palsies: A Problematic Presentation Of Myasthenia Gravis, Nichole Birdsong, Sean Gibbs, Jerry Banks

South Atlantic Division GME Research Day 2022

No abstract provided.

The Effects Of Glucocorticoids And Immunosuppressants On Cancer Outcomes In Checkpoint Inhibitor Therapy, Sebastian Bruera, Maria E Suarez-Almazor

Faculty, Staff and Students Publications

The emergence of checkpoint inhibitors has created a paradigm shift for the treatment of various malignancies. However, although these therapies are associated with improved survival rates, they also carry the risk of immune-related adverse events (irAEs). Moderate to severe irAEs are typically treated with glucocorticoids, sometimes with the addition of immunosuppressants as steroid-sparing therapy. However, it is unclear how glucocorticoids and immunosuppressants may impact cancer survival and the efficacy of immune checkpoint therapy on cancer. In this narrative review, we discuss the effects of glucocorticoids and immunosuppressants including methotrexate, hydroxychloroquine, azathioprine, mycophenolate mofetil, tumor-necrosis factor (TNF)-inhibitors, interleukin-6 inhibitors, interleukin-1 inhibitors, …

Evaluating The Efficacy Of Automated Smoking Treatment For People With Hiv: Protocol For A Randomized Controlled Trial, Damon J Vidrine, Thanh C Bui, Michael S Businelle, Ya-Chen Tina Shih, Steven K Sutton, Lokesh Shahani, Diana Stewart Hoover, Kristina Bowles, Jennifer I Vidrine

Faculty, Staff and Student Publications

BACKGROUND: Smoking prevalence rates among people with HIV are nearly 3 times higher than those in the general population. Nevertheless, few smoking cessation trials targeting smokers with HIV have been reported in the literature. Efforts to develop and evaluate sustainable, low-cost, and evidence-based cessation interventions for people with HIV are needed. Given the widespread proliferation of mobile phones, the potential of using mobile health apps to improve the reach and efficacy of cessation interventions is promising, but evidence of efficacy is lacking, particularly among people with HIV.

OBJECTIVE: This study will consist of a 2-group randomized controlled trial to evaluate …

Apathy Is Not Associated With A Panel Of Biomarkers In Older Adults With Hiv Disease, Steven Paul Woods, Jennifer L Thompson, Michelle A Babicz, Lokesh Shahani, Gabriela Delevati Colpo, Natalia P Rocha, Erin E Morgan, Antonio L Teixeira

Faculty, Staff and Student Publications

OBJECTIVE: Apathy is prevalent in HIV disease and can significantly impact personal well-being; however, little is known about its neurobiological substrates in persons with HIV (PWH) disease.

METHODS: This cross-sectional, correlational study examined the association between apathy and several plasma biomarkers (tumor necrosis factor alpha, kynurenine, tryptophan, quinolinic acid, brain-derived neurotrophic factor, glial fibrillary acidic protein, neurofilament light chain, and phosphorylated tau at position threonine 181) in 109 PWH and 30 seronegative participants ages 50 and older. Apathy was measured with a composite score derived from subscales of the Frontal Systems Behavior Scale and the Profile of Mood States.

RESULTS: …

Balancing Science And Public Policy In Pakistan's Covid-19 Response, Zulfiqar Ahmed Bhutta, Faisal Sultan, Aamer Ikram, Adil H. Haider, Assad Hafeez, Muhammad Islam

Department of Paediatrics and Child Health

Background: Coronavirus disease 2019 (COVID-19) has affected the world in an unprecedented manner and South Asian countries were among the first to experience imported cases. Pakistan's response to COVID-19 has been under scrutiny for its granularity, reach and impact.
Aims: to evaluate objectively the chronology and depth of the response to COVID-19 in Pakistan.
Methods: We evaluated available national and subnational epidemiological and burden information on COVID-19 cases and deaths in Pakistan, including projection models available to the Government at an early stage of the pandemic.
Results: Pakistan, with a population of 215 million and considerable geographic diversity, experienced case …

Comparing Growth Velocity Of Hiv Exposed And Non-Exposed Infants: An Observational Study Of Infants Enrolled In A Randomized Control Trial In Zambia, Obvious Nchimunya Chilyabanyama, Roma Chilengi, Natasha Makabilo Laban, Masuzyo Chirwa, Michelo Simunyandi, Luiza Miyanda Hatyoka, Innocent Ngaruye, Najeeha Talat Iqbal, Samuel Bosomprah

Department of Paediatrics and Child Health

Background: Impaired growth among infants remains one of the leading nutrition problems globally. In this study, we aimed to compare the growth trajectory rate and evaluate growth trajectory characteristics among children, who are HIV exposed uninfected (HEU) and HIV unexposed uninfected (HUU), under two years in Zambia.
Method: Our study used data from the ROVAS II study (PACTR201804003096919), an open-label randomized control trial of two verses three doses of live, attenuated, oral RotarixTM administered 6 &10 weeks or at 6 &10 weeks plus an additional dose at 9 months of age, conducted at George clinic in Lusaka, Zambia. Anthropometric measurements …

Unveiling And Addressing Implementation Barriers To Routine Immunization In The Peri-Urban Slums Of Karachi, Pakistan: A Mixed-Methods Study, Amna Tanweer Yazdani, Ameer Muhammad, Muhammad Imran Nisar, Uzma Khan, Yasir Shafiq

Department of Paediatrics and Child Health

Background: Great disparities in immunization coverage exist in Pakistan between urban and rural areas. However, coverage estimates for large peri-urban slums in Sindh are largely unknown and implementation challenges remain unexplored. This study explores key supply- and demand-side immunization barriers in peri-urban slums, as well as strategies to address them. It also assesses immunization coverage in the target slums.
Methods: Conducted in four peri-urban slums in Karachi, this mixed-methods study consists of a baseline cross-sectional coverage survey of a representative sample of 840 caregivers of children aged 12-23 months, and 155 in-depth interviews (IDIs) through purposive sampling of respondents (caregivers, …

Acute Encephalitis, Myoclonus And Sweet Syndrome After Mrna-1273 Vaccine, Gabriel Torrealba-Acosta, Jennifer C Martin, Yve Huttenbach, Catherine R Garcia, Muhammad R Sohail, Sandeep Krishna Agarwal, Carina Wasko, Eric M Bershad, Mohammad I Hirzallah

Faculty, Staff and Students Publications

A patient presented with fever, generalised rash, confusion, orofacial movements and myoclonus after receiving the first dose of mRNA-1273 vaccine from Moderna. MRI was unremarkable while cerebrospinal fluid showed leucocytosis with lymphocyte predominance and hyperproteinorrachia. The skin evidenced red, non-scaly, oedematous papules coalescing into plaques with scattered non-follicular pustules. Skin biopsy was consistent with a neutrophilic dermatosis. The patient fulfilled the criteria for Sweet syndrome. A thorough evaluation ruled out alternative infectious, autoimmune or malignant aetiologies, and all manifestations resolved with glucocorticoids. While we cannot prove causality, there was a temporal correlation between the vaccination and the clinical findings.

Assessment Of Pathogenic Changes In The Gut-Liver Axis In Plwh With Heavy Alcohol Drinking And Gut Dysbiosis Marked By Decreased Butyrogenic Potential., Smita Ghare, Vaughn Bryant, Richa Singhal, Sabina Gautam, Chanakya Charan Tirumala, Andrea Reyes-Vega, Craig J. Mcclain, Ronald Cohen, Varand Govind, Robert L. Cook, Shirish Barve

Faculty and Staff Scholarship

Purpose: People living with HIV infection (PLWH) experience increasing risk for non-AIDS diseases including liver dysfunction and injury. Both HIV-infection and heavy alcohol drinking (HAD) are known to cause gut microbial dysbiosis and systemic inflammation that may potentially contribute to altered Gut-Liver axis. However, the specific pathogenic features associated with combinatorial harmful effects of alcohol and HIV infection on gut-liver interactions are not completely understood. This study evaluate the pathogenic changes in the Gut-Liver axis in PLWH with HAD.

Diabetes Mellitus And Immunomodulation: A Double-Edged Sword., James Harte

International Undergraduate Journal of Health Sciences

Diabetes is an endocrinological disorder characterised by chronic hyperglycaemia due to abnormalities in insulin secretion, insulin action or a combination of both. According to the International Diabetes Federation, 463 million people worldwide are living with diabetes; 700 million people will be affected by 2045. The severity of the disease is dependent on the type and the stage of progression; when not correctly managed, diabetes can lead to potentially life-threatening micro- and macrovascular complications.

Prior to the discovery of insulin in 1922, the life expectancy of children with diabetes was short and the prognosis was very poor. The advocated treatment for …

Full Issue: The International Undergraduate Journal Of Health Sciences, Volume 1, Issue 1, June 2021, Iujhs Full Issue

International Undergraduate Journal of Health Sciences

The full June 2021 issue (Volume 1, Issue 1) of the International Undergraduate Journal of Health Sciences

Transient Leukopenia, Thrombocytopenia, And Severe Neutropenia Associated With Acute Sars-Cov-2 Infection, Austin Schatzman, Julia Vandenheuvel Md, Tibisay Villalobos Md, Kris Rooney Md

Department of Pediatrics

No abstract provided.

The Effect Of Carfilzomib And Bortezomib Based Regimes On Cardiotoxicity In Multiple Myeloma Patients At Cooper University Hospital, Ami Patel, Tulin Budak-Alpdogan, Stalam Tapati

Rowan-Virtua Research Day

Introduction

• Multiple myeloma (MM) is a cancer of plasma cells, which is a white blood cell that normally produces antibodies
• Treatment in patients younger than 65 years old is typically high dose chemotherapy, usually with bortezomib based regimens or lenalidomide dexamethasone, followed by a stem cell transplant
• For patients with relapsed myeloma, carfilzomib is usually the treatment of choice
• Carfilzomib is a highly selective, irreversible proteasome inhibitor that binds to the 20 S proteasome. Several studies have illustrated that carfilzomib has been associated with cardiovascular adverse events (CVAE).
• Current literature on the role and effect of bortezomib on cardiotoxicity is …

430— Ifnγ And 5-Aza Drug Effects On Hla Expression In Human Leukemia And Epidermoid Carcinoma, Nick Turnquist

GREAT Day Posters

Human Leukocyte Antigen (HLA) is a gene that codes for cell-surface proteins that are the basis of our bodies’ immune response, and are crucial for the combatting of pathogens or infections. For our experiment we observed two cell lines, a human Leukemia cell line (HL-60), and an epidermoid carcinoma cell line A-431. Our purpose for this experiment was to observe the effects of two drugs as well as the combination of them on the expression of HLA antigens in these cancerous cell lines. The drugs being used in this experiment are Gamma interferon, which is known to increase antigen presentation …

Association Of Vitamin D Deficiency And Disease Activity In Systemic Lupus Erythematosus Patients: Two-Year Follow-Up Study, Ainan Arshad, Saad Bin Zafar Mahmood, Ahmed Ayaz, Adil A. Manji, Akash Kumar Ahuja

Section of Internal Medicine

Objectives: This study aims to determine the prevalence of vitamin D deficiency in Pakistani systemic lupus erythematosus (SLE) patients and the effect of vitamin D deficiency on the severity and outcomes of SLE.
Patients and methods: This retrospective study evaluated SLE patients presenting to our hospital between January 2009 and December 2018. A total of 98 patients (13 males, 85 females; mean age 39.8±14.9 years; range, 16 to 73 years) with vitamin D levels available at the time of diagnosis were included in the study. Disease activity was measured using SLE disease activity score at the time of diagnosis and …

The Utility Of Hyperbaric Oxygen Therapy In Post-Transplant Cyclophosphamide-Induced Hemorrhagic Cystitis: A Case Report And Review Of The Literature., Moayed Ibrahim, Kshama Bhyravabhotla, Basil Khalaf, Keith Van Meter, Nakhle S Saba, Hana Safah, Francisco Socola

School of Medicine Faculty Publications

Background: To date, there are only a few case reports of cyclophosphamide (Cy)-induced hemorrhagic cystitis (HC) in adult or pediatric allogeneic stem cell transplant (SCT) patients treated successfully with hyperbaric oxygen (HBO). In all the reported cases, Cy was used as a part of the conditioning regimen, rather than post-transplant for graft-versus-host-disease (GVHD) prophylaxis. More recently, the risk of HC in allogeneic SCT is further increased by the widespread use of post-transplantation cyclophosphamide (PTCy) as a highly effective strategy for GVHD prophylaxis. This is the first case reported of PTCy-induced HC successfully treated with HBO to the best of our …

The Intellectual Property Of Covid-19, Ana Santos Rutschman

All Faculty Scholarship

The response to COVID-19 is indissolubly tied to intellectual property. In an increasingly globalized world in which infectious disease pathogens travel faster and wider than before, the development of vaccines, treatments and other forms of medical technology has become an integral part of public health preparedness and response frameworks. The development of these technologies, and to a certain extent the allocation and distribution of resulting outputs, is informed by intellectual property regimes. These regimes influence the commitment of R&D resources, shape scientific collaborations and, in some cases, may condition the widespread availability of emerging technologies. As seen throughout this chapter, …

Intrapulmonary Administration Of Purified Neil2 Abrogates Nf-Κb-Mediated Inflammation, Nisha Tapryal, Shandy Shahabi, Anirban Chakraborty, Koa Hosoki, Maki Wakamiya, Gobinda Sarkar, Gulshan Sharma, Victor J Cardenas, Istvan Boldogh, Sanjiv Sur, Gourisankar Ghosh, Tapas K Hazra

Faculty, Staff and Students Publications

Aberrant or constitutive activation of nuclear factor kappa B (NF-κB) contributes to various human inflammatory diseases and malignancies via the upregulation of genes involved in cell proliferation, survival, angiogenesis, inflammation, and metastasis. Thus, inhibition of NF-κB signaling has potential for therapeutic applications in cancer and inflammatory diseases. We reported previously that Nei-like DNA glycosylase 2 (NEIL2), a mammalian DNA glycosylase, is involved in the preferential repair of oxidized DNA bases from the transcriptionally active sequences via the transcription-coupled base excision repair pathway. We have further shown that Neil2-null mice are highly sensitive to tumor necrosis factor α (TNFα)- and lipopolysaccharide-induced …

A Rare Case Of C3 Glomerulonephritis Presenting As Pulmonary Renal Syndrome, Gerardo Mederos, Harsh Patel, Menalee Hapuarachchi, Machaiah Madhrira, Ranjit Nair, Dana Ciobanu

HCA Healthcare Journal of Medicine

C3 glomerulonephritis (C3GN) is a rare disease that falls under the umbrella of C3 glomerulopathy (C3G). Classic manifestations of C3G include acute renal failure, proteinuria, and hematuria. In some cases, extrarenal manifestations can include ocular drusen. Until recent reports, C3G manifesting with pulmonary symptoms has not been reported. In this report, we describe a patient that initially presented with hemoptysis and acute renal failure, eventually leading to a diagnosis of pulmonary renal syndrome. Renal biopsy showed C3GN. The patient’s symptoms improved with pulse dose steroids, plasmapheresis and mycophenolate mofetil. C3G presenting with pulmonary symptoms is rare. Further research is needed …

Applying Immuno-Epidemiology Principles To Violence, Anna H. Sisk, Nina H. Fefferman, Judy Day, Patricia Bamwine

Annual Symposium on Biomathematics and Ecology Education and Research

No abstract provided.

Idiopathic Hypertrophic Pachymeningitis In The Setting Of Chronic Cutaneous Lupus Erythmatosus: A Case Report, Andrew Cappiello, Seba Issa, Sana Khan, Kenneth Crager

Rheumatology

No abstract provided.