Medical Specialties Commons^™

Cryptococcus Neoformans And Streptococcus Pneumoniae Co-Infection In Post-Traumatic Meningitis In A Patient With Unknown Hiv Status, Faryal Saleem, Naima Fasih, Afia Zafar

Department of Pathology and Laboratory Medicine

Meningitis is a serious disease associated with considerable morbidity and mortality. Mixed meningeal infections due to bacteria and fungi are exceptionally rare. Here we report a case of meningeal co-infection with cryptococcus neoformans and streptococcus pneumoniae in a patient with unknown human immunodeficiency virus status. Because of the rarity of such cases, stringent screening of every cerebrospinal fluid specimen to exclude the presence of multiple pathogens is imperative. Assessment of patients for immunodeficiencies in case of isolation of an opportunistic organism like cryptococcus is also needed.

Hospital Preparedness In Community Measles Outbreaks-Challenges And Recommendations For Low-Resource Settings, Sadia Shakoor, Fatima Mir, Anita Zaidi, Afia Zafar

Department of Pathology and Laboratory Medicine

We have reviewed various strategies involved in containment of measles in healthcare facilities during community outbreaks. The strategies that are more applicable to resource-poor settings, such as natural ventilation, mechanical ventilation with heating and air-conditioning systems allowing unidirectional air-flow, and protection of un-infected patients and healthcare workers (HCWs), have been examined. Ventilation methods need innovative customization for resource-poor settings followed by validation and post-implementation analysis for impact. Mandatory vaccination of all HCWs with two doses of measles-containing vaccine, appropriate post-exposure prophylaxis of immunocompromised inpatients, and stringent admission criteria for measles cases can contribute toward reduction of nosocomial and secondary transmission …

Clinical Isolates Of Salmonella Enterica Serovar Agona Producing Ndm-1 Metallo-Beta-Lactamase: First Report From Pakistan, Seema Irfan, Erum Khan, Kauser Jabeen, Pushpa Bhawan, Katie L. Hopkins, Martin Day, Amna Nasir, Daniele Meunier, Neil Woodford

Department of Pathology and Laboratory Medicine

We report two cases of infantile diarrhea due to multidrug-resistant, NDM-1 metallo-beta-lactamase-producing Salmonella enterica serovar Agona from Pakistan. This study alerts toward possible risk of NDM-1 transmission to enteric fever pathogens and encourages microbiologists to consider active screening of carbapenem resistance in nontyphoidal Salmonella isolates.

Gastrointestinal Stromal Tumors: A Clinicopathologic And Risk Stratification Study Of 255 Cases From Pakistan And Review Of Literature, Nasir Ud Din, Zubair Ahmad, Huma Arshad, Romana Idrees, Naila Kayani

Department of Pathology and Laboratory Medicine

Purpose:
To describe the clinicopathological features of gastrointestinal stromal tumors (GIST) diagnosed in our section and to perform risk stratification of our cases by assigning them to specific risk categories and groups for disease progression based on proposals by Fletcher et al and Miettinen and Lasota.
Material and Results:
We retrieved 255 cases of GIST diagnosed between 2003 and 2014. Over 59% were male. The age range was 16 to 83 years with a mean of 51 years. Over 70% occurred between 40 and 70 years of age. Average diameter of tumors was 10 cms. The stomach was the most …

“Looks Can Be Deceiving”: Adrenal Teratoma Causing Diagnostic Difficulty, Mehwash Nadeem, Muhammad Hammad Ather, M Nasir Sulaiman, Shahid Pervez

Department of Pathology and Laboratory Medicine

Teratomas are unusual tumours that derived from totipotent cells with their origin from more than one or usually all three germ cells. Here authors are presenting a case of primary retroperitoneal tumour that is a rare clinical entity. A 19-year-old male presented with right lumbar pain and was found to have complex cyst with large calcification in right adrenal gland on imaging. Intraoperatively, he was found to have a solid mass with areas of soft consistency, which was excised en bloc. On gross examination, the cyst contained pieces of bone, few teeth, and hairs entangled in mucinous material. On histological …

Dry Needling For Myofascial Trigger Point Pain: A Clinical Commentary, Casey Unverzagt, Kathleen Berglund, J J. Thomas

Faculty Publications

Sports and orthopaedic physical therapists have long used a multitude of techniques in order to address pain and dysfunction associated with myofascial trigger points. One technique in particular has recently received overwhelming attention: trigger point dry needling (DN). Despite its efficacy and low risk, questions remain as to its effectiveness, safety, and whether the technique is within the scope of practice of physical therapists. Therefore, the purpose of this clinical commentary is to summarize the current literature related to the associated mechanisms of action of DN, the safety of DN, as well as to discuss relevant scope of practice concerns.

Dancing Around Infertility: The Use Of Metaphors In A Complex Medical Situation, Angela L. Palmer-Wackerly, Janice L. Krieger

Department of Communication Studies: Faculty Publications

People use metaphors to cognitively frame their experiences as well as to explain those experiences to others, especially in complex medical situations. However, previous research has not fully explored the extent to which metaphors may be helpful or harmful to achieving well-being. This investigation fills this gap by identifying and explaining metaphor use in the context of infertility. Guided by self-determination theory, in-depth interviews were conducted with 22 women and men who had experienced an inability to conceive a child. Analysis of participant narratives yielded 10 prominent metaphors that reflect how participants’ need for competence, autonomy, and relatedness were (and …

Comprehension Of Randomization And Uncertainty In Cancer Clinical Trials Decision Making Among Rural, Appalachian Patients, Janice L. Krieger, Angela L. Palmer-Wackerly, Phokeng M. Dailey, Jessica L. Krok-Schoen, Nancy E. Schoenberg, Electra D. Paskett

Department of Communication Studies: Faculty Publications

Comprehension of randomization is a vital, but understudied, component of informed consent to participate incancer randomized clinical trials(RCTs). Thisstudy examines patient comprehension of the randomization process as well as sources of ongoing uncertainty that may inhibit a patient’s ability to provide informed consent to participate in RCTs. Cancer patients living in rural Appalachia who were offeredanopportunitytoparticipateinacancertreatmentRCT completed in-depth interviews and a brief survey. No systematic differences in randomization comprehension between patients who consented and those who declined participation in a cancer RCT were detected. Comprehension is conceptually distinct from uncertainty, with patients who had both high and low comprehension experiencing …

Role Of Cellular Senescence And Nox4-Mediated Oxidative Stress In Systemic Sclerosis Pathogenesis., Sonsoles Piera-Velazquez, Sergio A. Jimenez

Department of Dermatology and Cutaneous Biology Faculty Papers

Systemic sclerosis (SSc) is a systemic autoimmune disease characterized by progressive fibrosis of skin and numerous internal organs and a severe fibroproliferative vasculopathy resulting frequently in severe disability and high mortality. Although the etiology of SSc is unknown and the detailed mechanisms responsible for the fibrotic process have not been fully elucidated, one important observation from a large US population study was the demonstration of a late onset of SSc with a peak incidence between 45 and 54 years of age in African-American females and between 65 and 74 years of age in white females. Although it is not appropriate …

Characterization Of Cd8+ T Cell Differentiation Following Sivδnef Vaccination By Transcription Factor Expression Profiling, James M. Billingsley, Premeela A. Rajakumar, Michelle A. Connole, Nadine C. Salisch, Sama Adnan, Yury V. Kuzmichev, Henoch S. Hong, R. Keith Reeves, Hyung-Joo Kang, Wenjun Li, Qingsheng Li, Ashley T. Haase, R. Paul Johnson

Nebraska Center for Virology: Faculty Publications

The onset of protective immunity against pathogenic SIV challenge in SIVΔnef-vaccinated macaques is delayed for 15-20 weeks, a process that is related to qualitative changes in CD8⁺ T cell responses induced by SIVΔnef. As a novel approach to characterize cell differentiation following vaccination, we used multi-target qPCR to measure transcription factor expression in naïve and memory subsets of CD8+⁺ T cells, and in SIV-specific CD8⁺ T cells obtained from SIVΔnef-vaccinated or wild type SIVmac239-infected macaques. Unsupervised clustering of expression profiles organized naïve and memory CD8⁺ T cells into groups concordant with cell surface phenotype. Transcription factor …

Escherichia Coli Surface Display Of Single-Chain Antibody Vrc01 Against Hiv-1 Infection, Lin-Xu Wang, Michael Mellon, Dane Bowder, Meghan Quinn, Danielle Shea, Charles Wood, Shi-Hua Xiang

Nebraska Center for Virology: Faculty Publications

Human immunodeficiency virus type 1 (HIV-1) transmission and infection occur mainly via the mucosal surfaces. The commensal bacteria residing in these surfaces can potentially be employed as a vehicle for delivering inhibitors to prevent HIV-1 infection. In this study, we have employed a bacteria-based strategy to display a broadly neutralizing antibody VRC01, which could potentially be used to prevent HIV-1 infection. The VRC01 antibody mimics CD4-binding to gp120 and has broadly neutralization activities against HIV-1. We have designed a construct that can express the fusion peptide of the scFv-VRC01 antibody together with the autotransporter β-barrel domain of IgAP gene from …

Evidence For Placental Hpv Infection In Both Hiv Positive And Negative Women, Chrispin Chisanga, Dawn Eggert, Charles D. Mitchell, Charles Wood, Peter C. Angeletti

Nebraska Center for Virology: Faculty Publications

Human papillomaviruses (HPVs) have previously been reported to infect epithelial trophoblast cells of the placenta. To investigate this possibility, 200 placental samples from Zambian women were separated into HIV+ and HIV− groups and tested for HPV by redundant primer PCR, using GP5+/GP6+ and CPI/CPII primer sets. Three HPV genotypes (HPV6, 16 and 90) were detected in placental samples. Whereas, 20 different HPV genotypes were detected in vaginal sampling of the same patients, suggesting that compartment specific sub-populations of HPV may exist. The incidence of HPV16 in placental samples was almost 2-fold greater in HIV+ women compared to HIV− (p = …

The Hippo/Yap Pathway Interacts With Egfr Signaling And Hpv Oncoproteins To Regulate Cervical Cancer Progression, Chunbo He, Dagan Mao, Guohua Hua, Xiangmin Lv, Xingcheng Chen, Peter C. Angeletti, Jixin Dong, Steven W. Remmenga, Kerry J. Rodabaugh, Jin Zhou, Paul F. Lambert, Peixin Yang, John S. Davis, Cheng Wang

Nebraska Center for Virology: Faculty Publications

The Hippo signaling pathway controls organ size and tumorigenesis

through a kinase cascade that inactivates Yes-associated

protein (YAP). Here, we show that YAP plays a central role in

controlling the progression of cervical cancer. Our results suggest

that YAP expression is associated with a poor prognosis for cervical

cancer. TGF-α and amphiregulin (AREG), via EGFR, inhibit the Hippo

signaling pathway and activate YAP to induce cervical cancer cell

proliferation and migration. Activated YAP allows for up-regulation

of TGF-α, AREG, and EGFR, forming a positive signaling loop to

drive cervical cancer cell proliferation. HPV E6 protein, a major

etiological molecule of …

Kaposi’S Sarcoma At The University Teaching Hospital, Lusaka, Zambia In The Antiretroviral Therapy Era, Owen Ngalamika, Veenu Minhas, Charles Wood

Nebraska Center for Virology: Faculty Publications

With great interest, we read the recent publication “Kaposi’s sarcoma in HIV-infected patients in South Africa: Multicohort study in the antiretroviral therapy era” by Bohlius et al. We congratulate the authors for their contribution to this field. In this study the authors observed a decrease in incidence of Kaposi’s sarcoma (KS) in patients treated with anti-retroviral therapy (ART) when compared to patients who are not on ART. These results are encouraging because of the ongoing HIV epidemic in sub-Saharan Africa where KS is still one of the most prevalent cancers. Also, it is a relevant topic to study in …

Activation And Degradation Of Open Reading Frame 45 By The Replication And Transcription Activator Of Kaposi's Sarcoma-Associated Herpesvirus, Ying Wang, Kai Yu, Xiuzhi Pei, Tiancheng Zhang, Yuying Guo, Charles Wood, Jinzhong Wang

Nebraska Center for Virology: Faculty Publications

The open reading frame 45 (ORF45) of the Kaposi's sarcoma-associated herpesvirus (KSHV) is an immediate-early phosphorylated tegument protein critical for viral escape from host immune surveillance. Its expression is upregulated by the viral replication and transcription activator (RTA), a key protein that controls the switch from latency to lytic replication. We report here that ORF45 expression was not only upregulated by RTA, but ORF45 could also be degraded by RTA in a proteasome-dependent manner. The ORF45 was activated by RTA via activation of the ORF45 promoter, and the promoter region from nt 69 271 to nt 69 026 was involved. …

Single-Dose Cpg Immunization Protects Against A Heterosubtypic Challenge And Generates Antigen-Specific Memory T Cells, Alexander J. Vogel, Deborah M. Brown

Nebraska Center for Virology: Faculty Publications

Despite extensive research, influenza A virus (IAV) remains a major cause of morbidity, mortality, and healthcare expenditure. Emerging pandemics from highly pathogenic IAV strains, such as H5N1 and pandemic H1N1, highlight the need for universal, crossprotective vaccines. Current vaccine formulations generate strain-specific neutralizing antibodies primarily against the outer coat proteins, hemagglutinin and neuraminidase. In contrast to these highly mutable proteins, internal proteins of IAV are more conserved and are a favorable target for developing vaccines that induce strong T cell responses in addition to humoral immunity. Here, we found that intranasal administration with a single dose of CpG and inactivated …

Long-Acting Parenteral Combination Antiretroviral Loaded Nano-Drug Delivery System To Treat Chronic Hiv-1 Infection: A Humanized Mouse Model Study, Subhra Mandal, Guobin Kang, Pavan Kumar Prathipati, Wenjin Fan, Qingsheng Li, Christopher J. Destache

Nebraska Center for Virology: Faculty Publications

Human immunodeficiency virus (HIV) patients are often diagnosed in the chronic stage of HIV/AIDS. Combination antiretroviral therapy (cART) has improved quality of life for HIV-infected patients. Present study describes a novel long-acting parenteral formulation of combination antiretroviral (cARV) loaded nano-drugs for treating chronic HIV-1 (cHIV) in a humanized-BLT (hu-BLT) mice model. The cARV (elvitegravir + tenofovir alafenamide + emtricitabine; EVG + TAF + FTC) drugs (mimicking marketed Genvoy® one-pill for HIV-treatment) were encapsulated in poly (lactic-co-glycolic acid) nanoparticles (NPs). To establish cHIV, hu-BLT mice were intravaginally challenged with HIV-1 and maintained for 15 weeks. Plasma viral load (pVL) was monitored …

Comparison Of Six Commercial Elisa Kits For Their Specificity And Sensitivity In Detecting Different Major Peanut Allergens, Shyamali Jayasena, Mieke Smits, Daniëlle Fiechter, Aard De Jong, Julie A. Nordlee, Joe Baumert, Steve L. Taylor, Raymond H. Pieters, Stef J. Koppelman

Department of Food Science and Technology: Faculty Publications

Six commercial peanut enzyme-linked immunosorbent assay kits were assessed for their ability to recover peanut from the standard reference material 2387 peanut butter and also for their specificity in detecting four major peanut allergens, Ara h 1, Ara h 2, Ara h 3, and Ara h 6. The percentage recovery of peanut from peanut butter differed across different kits as well as at different sample concentrations. The highest recovery was observed with the Romer and R-Biopharm kits, while four other kits were found to underestimate the protein content of the reference peanut butter samples. Five of the kits were most …

Bright Facet Sign And Its Association With Demographic And Clinical Variables, Gary Andrew Longmuir

Walden Dissertations and Doctoral Studies

Low back pain has a significant impact on global public health and economics. The bright facet sign (BFS), a common finding on magnetic resonance imaging (MRI) of the lumbar spine, is associated with low back pain. While degenerative joint disease (DJD) affects low back pain, its presence appears independent of the BFS at the disc and facet joints at the same spinal level. Increased BMI, considered a risk factor for DJD, has an inverse association with the BFS. The independent relationship of DJD and the BFS is poorly understood and may represent a previously unreported pain pathway. In this nested …

Survival Analysis Of Total Therapy 3 In Newly Diagnosed Multiple Myeloma, Scott Edward Bowman Miller

Walden Dissertations and Doctoral Studies

Multiple Myeloma (MM) is a hematologic malignancy that accounts for approximately 1% of all adult cancers. This study investigated the impact of patient distance traveled to MM care sites, which was not considered in previous research on any disease-specific staging or prognostic schema despite evidence suggesting that distance impacts patient outcome. This study investigated the impact of patient distance from the site of care on survival outcomes using a group of 480 clinical trial participants. Andersen's behavioral model of health services use functioned as the theoretical model for this study. The independent variable was patient travel distance, controlling for established …

Self-Management Education In Hispanic Women With Gestational Diabetes Mellitus (Gdm), Laura B. Hieronymus

DNP Projects

The purpose of this Practice Inquiry Project was to develop, implement, and evaluate the effectiveness of a diabetes self-management education intervention in a population of Hispanic women at risk for gestational diabetes mellitus within a CenteringPregnancy(R) model of care.

Measuring Adherence To Evidence-Based Practice Guidelines For The Management Of Hypertension In Women, Cristina M. Jorgensen

DNP Projects

Approximately 1 in 3 adults In the United States (U. S.) with approximately half being women have hypertension, a significant risk factor for cardiovascular disease (CVD) and stroke (Nwankwo, Yoon, Burt, & Gu, 2013). Nearly 70% of people who had a first heart attack, 80% of those who had a first stroke, and 75% of those who had congestive heart failure (CHF) have hypertension (Mozaffarian et al., 2013). Hypertension was the underlying or contributing cause of more than 375,000 deaths in 2011. Despite multiple publications of national hypertension guidelines, only 50% of adults with hypertension have their blood pressure under …

Primary Care Providers’ Knowledge And Experience With Pediatric Acute Watery Diarrhea And Hemolytic Uremic Syndrome, Krista Marie Cassel

DNP Projects

The purpose of this capstone is to investigate the potential for hemolytic uremic syndrome (HUS) risk reduction in children through the evaluation of current evidence as well as pediatric primary care providers' knowledge and experience with children at risk for HUS. The goals of this capstone are to 1) evaluate the current literature to determine best practice for prevention of HUS, 2) assess primary care provider knowledge of HUS and experience with children with acute watery, and 3) develop a guideline for the initial management and referral of these children at risk for HUS.

Improving Depression Care For Older Home Health Patients, Sarah R. Schirmer

DNP Projects

Rates of depression in older home healthcare (HH) patients are highly prevalent. Although depression in this population is associated with increased rates of re-hospitalization, falls, and suicides, it is frequently under diagnosed and under treated. This Capstone Report examined this problem through three interrelated manuscripts. The first manuscript explored the problem through a review of the literature. This review determined that while there are many barriers to adequate depression care, programs that train clinicians to screen for depression and connect patients to depression care encourage adequate evaluation and treatment and can result in clinically significant changes in depression scores. This …

Measuring Providers’ Adherence To The American Diabetes Association Screening Recommendation For Prevention Of Diabetic Nephropathy, Whitney R. Munroe

DNP Projects

Purpose: The purpose of this study was to evaluate provider adherence to the ADA’s recommendation for an annual screening urinary albumin excretion level to check for the presence of microalbuminuria. A secondary objective was to assess for adequate treatment (i.e. ACE inhibitor or ARB prescription) in those patients with microalbuminuria present.

Methods: A retrospective chart review was conducted on 60 randomly selected patients seen within a primary care practice in an urban university setting between January 1^st, 2014 and December 31^st, 2014. Inclusion criteria included age ≥ 18 years and an active diagnosis of type 2 …

Are Type 2 Diabetes Patients Receiving Diabetes Self-Management Education In The Primary Care Setting?, Erica Mahone

DNP Projects

Diabetes is a growing health concern in the United States, with approximately 1.7 million new cases diagnosed yearly. A management option to help patients gain glycemic control is the participation in diabetes self-management education (DSME). DSME aims to teach patients how and why they need to perform self-care, and not solely rely on medications to manage diabetes. A literature review of 10 studies between 2007 and 2014 was conducted and found favorable health outcomes for participants of DSME. Patients who participated in DSME had improved glycemic control, achieved blood pressure and cholesterol goals, and lost weight. An analysis of the …

Foster Parents' Perceptions And Beliefs About Social Emotional Development In Infants And Toddlers, Susan R. Noel

DNP Projects

Infants and toddlers placed in foster care are at increased risk for social-emotional (SE) development dysregulation. Foster parents, as surrogate parents, play a critical role in a young child having the potential for healthy SE development. The transactional model supports the complex and intricate interplays and transactions of the child, the foster parent, and the environment that influences a healthy SE development. This qualitative descriptive study explored foster parent knowledge, behavioral cue recognitions, and role perception regarding a young child's SE development. Although the sample size was small, the study provides relevant information, from the on-going experiences of foster parents, …

An Evaluation To The Adherence Of A Sepsis Protocol At A Central Kentucky Community Hospital, Somer K. Robinson

DNP Projects

Background: Sepsis is defined as a “systemic response to an active infectious process in the host” and “represents the systemic inflammatory response to the presence of infection” (American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference, 1992, p.865). In 2008, an estimated 727,000 patients were hospitalized with a diagnosis of sepsis, an increase from 326,000 in 2000, or a 55% increase in prevalence over the eight-year period (Hall, Williams, DeFrances, & Golosinskiy, 2011). Early identification of sepsis with early and effective management strategies has been shown to improve patient outcomes and decrease mortality and prevent organ dysfunction (Levy …

Polypharmacy Practice Inquiry Project, Mary T. Skinner

DNP Projects

“The impending crisis, which has been foreseen for decades, is now upon us.The nation needs to act now to prepare the health care workforce to meet the care needs of older adults.” Institute of Medicine.

Given the rising tide of people over the age of 65, taking multiple medications or polypharmacy is a becoming more prevalent in older adults. Unfortunately, there are many negative consequences associated with polypharmacy. Specifically, this burden has been associated with greater health care costs and an increased risk of adverse drug events, drug-interactions, medication non-adherence, reduced functional capacity and multiple geriatric syndromes including cognitive impairment. …

Case 213: Primary Spenic Angiosarcoma, John J. Krol, Vera V. Krol, Adrian Dawkins, Halemane S. Ganesh

Radiology Faculty Publications

A 75-year-old woman with a medical history of gastroesophageal reflux disease and type II diabetes presented to the hospital with a 3-month history of gradually worsening headaches, vague upper abdominal pain, and lower back pain. The patient denied fevers, night sweats, contact with sick individuals, occupational exposure to infection, bleeding, immunodeficiency, intravenous drug use, alcohol or tobacco abuse, history of malignancy, family history of genetic disorders, and international travel. Physical examination revealed a skin-colored mass protruding from the right side of her forehead, but there were no other notable abnormalities. Her diabetes was managed with diet, and the only prescription …