Immune System Diseases Commons^™

Telehealth In Emergency Medicine Residency Training: A Model Curriculum, Laura Oh, Rahul Bhat, Michael J Carr, Aditi U Joshi, Bruce M Lo, Ashley C Rider, Lulu Wang, Michael C Wadman, Samuel D Luber

Faculty, Staff and Student Publications

Emergency physicians are well‐positioned to take a leadership role in telehealth, particularly in emerging categories such as triage, direct acute unscheduled care, and virtual observation. However, the growth of telehealth has outpaced curricular development in emergency medicine (EM) residency programs. This manuscript presents a model longitudinal telehealth curriculum, developed by the consensus of education experts, including representatives from the telehealth interest groups from EM's two primary specialty societies: the American College of Emergency Physicians and the Society for Academic Emergency Medicine. The curriculum describes overarching goals and components that may serve as a foundation for individual institutions seeking to train …

Etanercept, Methotrexate, Or Combined Therapy For Improving Rheumatoid Arthritis Symptoms, Ajith Dupati

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using:

van der Heijde D, Klareskog L, Rodriguez-Valverde V, et al. Comparison of etanercept and methotrexate, alone and combined, in the treatment of rheumatoid arthritis: two-year clinical and radiographic results from the TEMPO study, a double-blind, randomized trial. Arthritis Rheum. 2006;54(4):1063-1074. https://doi.org/10.1002/art.21655

for a patient with rheumatoid arthritis.

Nosebleed No More: Recognizing And Diagnosing Factor Viii Inhibitor, Salam Harb, Leidy Huie Martinez Md, Jose Alvarado Md, Ajit Koli Do, Hazem Nasef Ms4

HCA-NSU MD Research Day

Acquired hemophilia is a condition characterized by the unexpected onset of severe bleeding due to an issue with coagulation factors. Typically, this disorder results from the production of autoantibodies against the Factor VIII coagulation factor. Although acquired hemophilia is an extremely rare condition, with an annual incidence of just 1.5 cases per million, it is crucial to recognize and understand it. This is because diagnosing this disorder is intricate, and if left undiagnosed and untreated, it can lead to high levels of morbidity and mortality. This case stands out as the condition typically targets older adults, with around 80% of …

Using A Rabbit Model To Understand The Impact Of Oral Versus Intravenous Transmission Of Epstein-Barr Virus, Meera Mohammed Al Ameri

Thesis/ Dissertation Defenses

The isolation of Epstein-Barr Virus (EBV) in 1964 from a case of Burkitt lymphoma prompted a surge in research on the biology of this oncogenic virus and its role in the pathogenesis of associated malignancies. Over half a century later, a number of pertinent questions on the dynamics of EBV and the cellular targets of primary infection remain poorly defined. One major obstacle in EBV research has been the lack of a suitable small animal model. EBV is a highly human tropic virus. We have recently established a novel rabbit model of EBV infection that appears to mimic natural infection …

A Case Of Cecal Volvulus In The Setting Of Multiple Sclerosis, S. Jiaming Lin, Paige M. Kieper, Michael Mullinax, Jake W. Vogel, Kimberly Syres

Advances in Clinical Medical Research and Healthcare Delivery

This case report describes a patient with a history of multiple sclerosis (MS) and optic neuritis, who presented with acute onset of generalized abdominal pain. The patient was ultimately diagnosed with cecal volvulus requiring emergent laparotomy and right hemicolectomy. This case highlights the relationship between neurogenic bowel dysfunction (NBD) associated constipation in patients with MS and intestinal volvulus. Additionally, this case demonstrates the importance of NBD associated constipation management through various modalities including laxative regimens, behavioral and diet modification, and reduction of polypharmacy, with an emphasis on individualized patient management.

Experiences Of Midwestern Obstetric Clinicians During The Coronavirus Disease 2019 Pandemic, Drishti D Sinha, Megan Foeller, Abigail S Bell, Anthony J Nixon, Darrell Hudson, Aimee S James, Amy R Scheffer, Ana A Baumann, Emily Diveley, Ebony B Carter, Nandini Raghuraman, Indira U Mysorekar, Jeannie C Kelly

Faculty, Staff and Students Publications

BACKGROUND: The Coronavirus disease 2019 (COVID-19) pandemic led to healthcare system changes aimed at minimizing disease transmission that impacted experiences with obstetric healthcare.

OBJECTIVE: To explore experiences of clinicians providing obstetric care during the COVID-19 pandemic.

STUDY DESIGN: Qualitative, in-depth, semi-structured interviews were conducted with five nurse practitioners and 16 obstetrical physicians providing a mix of outpatient and inpatient obstetric care during the COVID-19 pandemic in a mid-sized, Midwestern city in the United States. Interviews elucidated challenges and facilitators of obstetric care provision and vaccination of pregnant patients against COVID-19 during the pandemic. Transcripts were coded inductively then deductively using …

Hepatotoxicity Induced By Immune Checkpoint Inhibitors, Flaviu Muresan, Olga Hilda Orasan, Angela Cozma, Madalina Daiana Bancos, Lorena Ciumarnean, Mircea Vasile Milaciu, Tinca Codruta Pocol, Nicoleta Valentina Leach, Teodora Gabriela Alexescu, Ovidiu Vasile Fabian, George Ciulei, Mirela Georgiana Perne

Journal of Mind and Medical Sciences

Immune checkpoint inhibitors (ICIs) are an effective immunotherapeutic approach for cancers affecting the lung, skin, kidney, mammary gland, or certain hematologic malignancies. Regarding the prognosis of these oncological conditions, treatments with ICIs open new therapeutic perspectives with benefits for both patients and healthcare providers. A drawback of immune checkpoint inhibition is the occurrence of immune-related adverse events that can involve a wide range of organs, such as the liver. Given widespread usage of immunotherapy, the number of patients who suffer from this unwanted condition has increased. Hepatopathy induced by ICIs can be severe and can even lead to death. Detecting …

The Role Of Peptides In Combatting Hiv Infection: Applications And Insights, Naiera M. Helmy, Keykavous Parang

Pharmacy Faculty Articles and Research

Peptide-based inhibitors represent a promising approach for the treatment of HIV-1, offering a range of potential advantages, including specificity, low toxicity, and the ability to target various stages of the viral lifecycle. This review outlines the current state of research on peptide-based anti-HIV therapies, highlighting key advancements and identifying future research directions. Over the past few years, there has been significant progress in developing synthetic peptide-based drugs that target various stages of the viral life cycle, including entry and replication. These approaches aim to create effective anti-HIV therapies. Additionally, peptides have proven valuable in the development of anti-HIV vaccines. In …

The Price Of Prevention: Spain And Italy's Approach To National Prep, Jon Burkart

Claremont-UC Undergraduate Research Conference on the European Union

While recent advancements in antiretroviral therapy (ART) continue to improve the outlook for people living with HIV (PLHIV), new infections remain a concern for health authorities around the world. A clinically proven intervention holds the potential to dramatically reduce new infections: Pre-exposure prophylaxis (PrEP) is a once-daily pill for high-risk populations, including men who have sex with men (MSM), that substantially reduces HIV infection risk. However—much like rates of new infection—public provision of PrEP varies considerably among OECD countries. This case study thus seeks to answer the question: What might explain the disparate timeline of adopting public reimbursement for PrEP …

A Tale Of Two Bills: Lessons Learned In Expanding Pharmacist-Led Hiv Pre-Exposure And Post-Exposure Prophylaxis, Jennifer M. Cocohoba, Jerika Lam, Maria Lopez, Betty J. Dong

Pharmacy Faculty Articles and Research

"In December 2023, JACCP published a content analysis of state legislative bills focused on expanding pharmacist scope of practice to provide human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP).¹ All states permit pharmacists to prescribe under a collaborative practice agreement with approximately half of the states granting HIV PrEP and post-exposure prophylaxis (PEP) authority to prescribe either via legislation, standing orders, or statewide protocols.^2-4 New York was the first state to expand pharmacists' specific authority for HIV prevention in 2017; however, California was the first state to pass legislation with Senate Bill 159 …

A Mixed Methods Evaluation Of Pharmacists' Readiness To Provide Long-Acting Injectable Hiv Pre-Exposure Prophylaxis In California, Raiza Beltran, Lauren A. Hunter, Laura J. Packel, Loriann De Martini, Ian W. Holloway, Betty J. Dong, Jerika Lam, Sandra I. Mccoy, Ayako Miyashita Ochoa

Pharmacy Faculty Articles and Research

Background:

Pre-exposure prophylaxis (PrEP) uptake remains low among people who could benefit, some of whom may prefer alternatives to oral PrEP, such as long-acting injectable pre-exposure prophylaxis (LAI-PrEP). We evaluated the potential for LAI-PrEP provision in pharmacies through a mixed methods study of pharmacists in California, where Senate Bill 159 enables pharmacists to independently provide oral PrEP.

Methods:

In 2022–2023, we conducted an online cross-sectional survey of California pharmacists and pharmacy students (n = 919) and in-depth interviews with pharmacists (n = 30), both of which included modules assessing attitudes about PrEP provision. Using log-binomial regression, we estimated prevalence ratios …

At A Crossroads: The Crucial Role Of Pharmacists In Healthcare Teams To End The Hiv Epidemic, Jerika Lam, Jennifer M. Cocohoba

Pharmacy Faculty Articles and Research

"Therapeutic advances in treatment and prevention have slowed the human immunodeficiency virus (HIV) epidemic, yet the virus and complications related to it still claim an alarming 630,000 lives globally every year.^1,2 The United States’ goals for the Ending the HIV Epidemic (EHE) initiative include reducing new infections by 90% by the year 2030 and advancing health equity through key treatment and prevention initiatives.³ Multiple agencies, professions, and patient groups are working diligently to achieve the EHE goals. Pharmacists have long recognized that our profession is a key resource in ending the HIV epidemic. We demonstrate this in the …

Providing End-Of-Life Counseling: A Narrative Inquiry, Carol Hecht, Sibyl West

Adultspan Journal

This qualitative study aimed to address the gap in the research related to end-of-life counseling by exploring the experiences of counselors working with clients at end of life. While counseling literature and education are lacking regarding end of life, many counselors will work alongside clients approaching death. The purpose of this study was twofold: (a) to better understand the nuanced experiences of counselors providing end-of-life counseling and (b) to explore the supports and preparations helpful for counselors to provide end-of-life counseling. A narrative approach, using the Listening Guide (Gilligan, 2015), was employed to analyze and present the stories of three …

Considerations Of Medicare Telehealth Services With Older Adults, Sonah Kho, Amanda Dediego

Adultspan Journal

The onset of the COVID-19 pandemic set in motion a rapid expansion of mental health services offered via telehealth. With this rapid expansion came the need to examine how policy and practice should be shaped in a future where telehealth is considered common in counseling practice. For counselors to understand how to support older adult clients in using telehealth services, they must understand telehealth policy. Following the eligibility of licensed counselors to participate in Medicare, counselors need to stay abreast of regulatory changes regarding restrictions and regulations on use of telehealth for mental and behavioral health services, including video and …

The Impact Of Electronic Messaging On Hiv In A Medically Underserved Population, Blake Martin, Smaran Marupudi, Justin Heckman, Russell Wiggins

Research Colloquium

Introduction: HIV in the United States has affected all types of demographics and has been growing by 50,000 new infections each year. Healthy people 2030 states that their objectives of both reducing new HIV cases and increasing knowledge of the disease has had little to no change. We intend to decrease both short-term incidence of HIV contracture and long-term incidence of disease progression to AIDS via utilization of an electronic health messaging and outreach system.

Methods: Individuals will be registered for text alerts at their next AHEC medical appointment. The practitioner, utilizing an HIV Risk Assessment Tool would ask high-risk …

Prognostic Utility Of The Lactate/Pyruvate Ratio For Mortality In Patients With Sepsis: An Observational Study, Edgar G. Dorsey-Trevino, Olga G. Cantu-Rodriguez, Jose A. Hawing-Zarate, Grecia A. Gonzalez-Cantu, David Gomez-Almaguer, Cesar H. Gutierrez-Aguirre

Research Colloquium

Introduction: Measurement of serum lactate remains pivotal in sepsis evaluation as it is closely related to tissue hypoxia and mortality.^{1, 2} Serum lactate, however, can be elevated due to a myriad of reasons beyond hypoperfusion.³ A proposed alternative to control for serum lactate’s inherent variability is to measure pyruvate concomitantly to calculate the lactate/pyruvate (L/P) ratio.^{4, 5} As pyruvate transforms into lactate in anaerobic conditions, its value decreases in serum, increasing the L/P ratio, hence indicating an actual tissue-perfusion mismatch.⁶ Despite its clinical utility, there is a paucity of evidence evaluating the role of the L/P …

A Presentation Of Myelin Oligodendrocyte Glycoprotein Antibody Associated Disease (Mogad) As Optic Neuritis, Kirhyn A. Stein, Laura Garcia, Sobia Memon, Hernan Guanajuato, Johanna Mora

Research Colloquium

Background: Myelin Oligodendrocyte Glycoprotein Antibody Associated Disease (MOGAD) is a relatively new and rare autoimmune disease that causes demyelination of the central nervous system. The pathogenicity of this disease is characterized by an immune reaction against myelin oligodendrocyte glycoprotein: a component of the myelin sheath that is also expressed on the surface of oligodendrocytes. The purpose of this glycoprotein is thought to be for construction and maintenance of myelin and cell to cell communication. The destruction of oligodendrocytes and myelin in the central nervous system affects the brain, spinal cord, and optic nerves, and can cause symptoms such as acute …

Streptococcus Pneumoniae Spinal Epidural Abscess In An Immunocompetent Patient, Salena Sinnasone, Michelle Blyth

School of Medicine Faculty Publications

Epidural abscesses are a rare diagnosis in immunocompetent patients. The most common risk factors linked with spinal epidural abscesses are intravenous drug use, diabetes mellitus, hepatitis, and iatrogenic factors like prior surgery and catheter usage. The thoracic and lumbar spine are the most common sites of these abscesses. Clinical presentation can include back pain, fever, and neurologic deterioration, with back pain occurring in almost two-thirds of patients. Staphylococcus aureus is the most common causative pathogen. We present a 50 male with no significant past medical or family history who presented with progressive back pain for greater than one week, chills …

Unveiling The Complexity Of Nocardia Septic Arthritis In An Immunocompromised Patient: A Case Report, Steven A. Kessler, Meghan R. Mansour, Ali Khreisat, Mamon Tahhan

HCA Healthcare Journal of Medicine

Background

Nocardiosis is the systemic manifestation of Nocardia infection, often found in immunocompromised individuals. Nocardia are transmitted via inhalation or skin wounds, disseminating hematogenously to organs and rarely, joints. We present a patient with immunosuppression who developed gout of the knee with superimposed Nocardial septic arthritis and a possible subsequent systemic infection.

Case Presentation

A 74-year-old man presented with left lower extremity swelling and pain. He was taking immunosuppressive medication for antineutrophilic cytoplasmic antibody-positive vasculitis. A week prior, an arthrocentesis test was positive for gout. He received prednisone without improvement. A repeat arthrocentesis was positive for Nocardia farcinica septic arthritis. …

Combination Therapy Of Ido1 Inhibition And Anti-Pd1 Mediates Anti-Tumor Immunity By Promoting Memory Immunity Development And Cytotoxicity Of Γδ T And Nk Cells Via Il-2 Signaling And By Overcoming Pro-Tumor Effects Of Tgf-Β Signaling, Hyuk Jee

Dartmouth College Master’s Theses

Cutaneous melanoma is the most aggressive form of skin cancer even though it takes only about 1% of all skin cancers. Even among all cutaneous melanomas, NRAS-mutant melanoma is more aggressive than any other, and about 10-25% of all cutaneous melanoma cases have mutations in NRAS. NRAS is a member of the RAS family of proto-oncogenic GTPase proteins, and it plays a key role in signal transduction pathways responsible for cellular survival, proliferation, and metabolism. Immunotherapy is the first line of defense against NRAS-mutant melanoma because, despite tremendous efforts made for decades, it has not been successful to develop small …

Understanding The Role Of Mastl In Colon Homeostasis And Colitis-Associated Cancer Development, Kristina Pravoverov

Theses & Dissertations

Colitis-associated cancer (CAC) is the most devastating complication of longstanding inflammatory bowel disease (IBD). Understanding the mechanisms underlying the switch from damage-repair to dysplasia in IBD is critical for identifying novel therapies to facilitate mucosal healing while mitigating CAC risk. Microtubule-associated serine-threonine kinase-like (MASTL), though crucial in cell growth and repair, is upregulated in sporadic colorectal cancer and CAC. This study sought to delineate the role of MASTL in colitis and CAC development.

First, we examined whether MASTL is associated with colitis and recovery. Review of publicly available data found significant elevation of MASTL and interleukin (IL)-22 in biopsies from …

Analyzing Hiv/Aids Trends And Disparities In The Bronx: A Comparative Study With Nyc Boroughs, Caleb Adjei

CUNY Mexican Studies Institute

This study analyzes changes in reported HIV/AIDS cases over time in the Bronx, identifying the racial/ethnic groups and neighborhoods most affected by the disease. The Bronx consistently exhibits the highest rate of new HIV diagnoses among New York City’s boroughs, with Latino/Hispanic and Black populations being disproportionately impacted. Key neighborhoods like High Bridge-Morrisania, Crotona-Tremont, and Fordham-Bronx Park have the highest case concentrations. Despite advancements in healthcare and treatments like antiretroviral therapy, disparities persist. The findings highlight the need for targeted interventions to support the most affected communities and address the underlying social determinants contributing to the disparities in HIV/AIDS diagnoses.

In Vivo Examination Of Peripheral Drivers Of Alzheimer’S Disease, Celso Catumbela

Dissertations and Theses (Open Access)

Alzheimer’s disease (AD) is the leading cause of dementia worldwide, and predominantly affects elderly populations. This disease is well known for its effects on the brain, but a wealth of clinical reports show that dementia can also modify, or be modified by, various peripheral and systemic processes. Yet, the pathological contribution of peripheral comorbidities to AD remains to be fully understood. In an attempt to address some knowledge gaps, we characterized the cerebral and peripheral pathology in mice with history of either liver injury or sepsis. In the former subjects, we found that even in the absence of genetic risk …

Genomic Data Science Approaches For Understanding Human Diseases, Snehal Shah

All Dissertations

The intricate interplay of genetic predisposition, environmental influences, and lifestyle acts as the multifactorial landscape of diseases. Understanding this complexity presents a significant challenge. Molecular insights into disease mechanisms, particularly the interactions of DNA, RNA, and proteins with environmental and lifestyle factors, have revolutionized disease diagnosis, prognosis, and treatment. High-throughput technologies, such as next-generation sequencing, generate large amounts of molecular data, holding a wealth of knowledge. These datasets unveil the roles of genes and their interactions with various factors through analysis, shedding light on previously unknown molecular mechanisms underlying disease pathogenesis. Furthermore, they facilitate the discovery of biomarkers crucial for …

The Pneumothorax And Symptom Evaluation (Pase) Study: Bendopnoea In Patients With Pneumothorax, Bianca M. Iacopetta, Michaela Donaghy, Chloe Charlesworth, Carolyn J. Peddle-Mcintyre, Ai Ling Tan, Y. C.Gary Lee

Research outputs 2022 to 2026

Background: Pneumothorax can cause distressing breathlessness, however the effect of the accumulated air in the pleural space and its association with diaphragmatic function and symptoms of breathlessness is not well understood. Bendopnoea is an evolving clinical symptom that has been demonstrated as clinically useful in some heart and lung conditions. Whether bendopnoea is present in patients with pneumothorax, and its potential clinical usefulness has not yet been investigated. The PASE study is a pilot study to explore the incidence and clinical relevance of bendopnoea in patients with pneumothorax and may provide better understanding of pneumothorax related dyspnoea. Methods: PASE is …

A Presentation Of Acute On Chronic Pancreatitis Complicated By Pancreaticopleural Fistula Leading To Bilateral Exudative Pleural Effusions And Empyema, Ashruta Patel, Do, Ms

The Journal of Integrated Primary Care

This case report highlights a rare but serious complication of acute pancreatitis, where pancreatic juice drains into the pleural space, causing bilateral exudative pleural effusions and potentially leading to empyema. The patient's history of alcohol abuse and splenic vein thrombosis likely contributed to the development of this complication. The clinical presentation, including progressive shortness of breath and pleuritic chest pain, along with findings on examination and imaging, prompted further investigation. The MRI findings of a pancreaticopleural fistula, along with a pseudocyst, were significant in diagnosing the condition. Treatment involved a multidisciplinary approach, including antibiotic therapy, chest tube placement to drain …

Tfeb Safeguards Trophoblast Syncytialization In Humans And Mice, Wanshan Zheng, Yue Zhang, Peiqun Xu, Zexin Wang, Xuan Shao, Chunyan Chen, Han Cai, Yinan Wang, Ming-An Sun, Wenbo Deng, Fan Liu, Jinhua Lu, Xueqin Zhang, Dunjin Cheng, Indira U Mysorekar, Haibin Wang, Yan-Ling Wang, Xiaoqian Hu, Bin Cao

Faculty, Staff and Students Publications

The formation of multinucleated syncytiotrophoblast (STB) through cell fusion of cytotrophoblast, also termed syncytialization, ensures the proper placental structure and functions. Nutrient insufficiency and inactivation of the mechanistic target of rapamycin complex 1 (mTORC1) in trophoblasts have been shown to enhance STB formation; however, the underlying mechanism remains elusive. Here, we showed that the deficiency of a mTORC1 downstream transcriptional factor, TFEB, significantly impaired STB formation in human trophoblasts and knock-out mice. TFEB conferred direct transcriptional activation of the fusogen ERVFRD-1 and thereby promoted trophoblast syncytialization. Additionally, TFEB expression positively correlated with the reinforced trophoblast syncytialization in human fetal growth …

Data-Driven Drug Repurposing For Immune System-Related Diseases, Sabyasachi Mohanty

Department of Biochemistry: Dissertations, Theses, and Student Research

In this research, we explore a data-driven approach for drug repurposing to enhance the immunomodulatory effect by integrating pattern-based search and genome-scale metabolic modeling. This research helps to find a solution to the preexisting problems of drug discovery which includes expenses and a high amount of time consumption. By leveraging the pre-existing data of the approved drugs to identify the major metabolic pathway changes, we can find new drugs with similar effects with less off-target effects.

The focus on the immune system modulating drugs is due to the high prevalence of immune system-involved diseases and the growing demand for effective …

Exploring The Experiences Of Hiv Positive Pregnant Women On Prevention Of Vertical Transmission Of Hiv/Aids In Rural Malawi, Gertrude Finyiza

Electronic Theses and Dissertations

Mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) continues to be the primary conduct that HIV is transmitted to children worldwide. The problem of HIV/acquired immunodeficiency syndrome (AIDS) is having a great impact on the world's children. The prevalence of HIV/AIDS in Malawi continues to be a serious public health issue, especially for expectant mothers. The health outcomes of mothers and children remain significantly threatened by vertical HIV transmission, even with improvements in preventive and treatment efforts. The purpose of this thesis was to explore the experiences of HIV-positive pregnant women in Malawi. I conducted semi structured interviews with thirteen …

The Third Pleural Effusion And Symptom Evaluation (Please-3) Study: Bendopnoea In Patients With Pleural Effusion, Bapti Roy, Bianca M. Iacopetta, Carolyn J. Peddle-Mcinytre, Michaela Donaghy, Matthew Ing, Ai Ling Tan, Y. C. Gary Lee

Research outputs 2022 to 2026

Background: Pleural effusions often cause disabling breathlessness, however the mechanism is unknown. Patients with pleural effusions are subjected to pleural fluid drainage on a ‘trial and error’ basis, as symptom relief varies. This population commonly complain of bendopnoea (breathlessness on bending forward) which has not been investigated. Our pilot data found bendopnoea was significantly associated with presence of pleural effusion. The PLEASE-3 study will evaluate bendopnoea as a screening test for effusion-related breathlessness, its predictive value of symptomatic benefits from fluid drainage and explore its underlying physiological mechanism. Methods: PLEASE-3 is a multi-centre prospective study. Eligible patients are assessed at …