Medical Specialties Commons^™

Multiplex Pcr Pathogen Detection In Acute Gastroenteritis Among Hospitalized Us Children Compared With Healthy Controls During 2011-2016 In The Post-Rotavirus Vaccine Era., Christopher J. Harrison, Ferdaus Hassan, Brian R. Lee, Julie Boom, Leila C. Sahni, Coreen Johnson, James Dunn, Daniel C. Payne, Mary E. Wikswo, Umesh Parashar, Rangaraj Selvarangan

Manuscripts, Articles, Book Chapters and Other Papers

Background: Despite vaccine-induced decreases in US rotavirus (RV) disease, acute gastroenteritis (AGE) remains relatively common. We evaluated AGE pathogen distribution in hospitalized US children in the post-RV vaccine era.

Methods: From December 2011 to June 2016, the New Vaccine Surveillance Network (NVSN) conducted prospective, active, population-based surveillance in hospitalized children with AGE. We tested stools from 2 NVSN sites (Kansas City, Houston) with Luminex x-TAG Gastrointestinal Pathogen Panels (Luminex GPP) and analyzed selected signs and symptoms.

Results: For 660 pediatric AGE inpatients and 624 age-matched healthy controls (HCs), overall organism detection was 51.2% and 20.6%, respectively (P < .001). Among AGE subjects, GPP polymerase chain reaction detected >1 virus …

Patient-Derived Ipscs Link Elevated Mitochondrial Respiratory Complex I Function To Osteosarcoma In Rothmund-Thomson Syndrome, Brittany E Jewell, An Xu, Dandan Zhu, Mo-Fan Huang, Linchao Lu, Mo Liu, Erica L Underwood, Jun Hyoung Park, Huihui Fan, Julian A Gingold, Ruoji Zhou, Jian Tu, Zijun Huo, Ying Liu, Weidong Jin, Yi-Hung Chen, Yitian Xu, Shu-Hsia Chen, Nino Rainusso, Nathaniel K Berg, Danielle A Bazer, Christopher Vellano, Philip Jones, Holger K Eltzschig, Zhongming Zhao, Benny Abraham Kaipparettu, Ruiying Zhao, Lisa L Wang, Dung-Fang Lee

Faculty, Staff and Student Publications

Rothmund-Thomson syndrome (RTS) is an autosomal recessive genetic disorder characterized by poikiloderma, small stature, skeletal anomalies, sparse brows/lashes, cataracts, and predisposition to cancer. Type 2 RTS patients with biallelic RECQL4 pathogenic variants have multiple skeletal anomalies and a significantly increased incidence of osteosarcoma. Here, we generated RTS patient-derived induced pluripotent stem cells (iPSCs) to dissect the pathological signaling leading to RTS patient-associated osteosarcoma. RTS iPSC-derived osteoblasts showed defective osteogenic differentiation and gain of in vitro tumorigenic ability. Transcriptome analysis of RTS osteoblasts validated decreased bone morphogenesis while revealing aberrantly upregulated mitochondrial respiratory complex I gene expression. RTS osteoblast metabolic assays …

Pre-Exposure Prophylaxis With Various Doses Of Hydroxychloroquine Among Healthcare Personnel With High-Risk Exposure To Covid-19: A Randomized Controlled Trial, Fibhaa Syed, Muhammad Hassan, Mohammad Ali Arif, Sadia Batool, Rauf Niazi, Ume E Laila, Sadia Ashraf, Junaid Arshad

Faculty, Staff and Student Publications

Objective This trial aimed to evaluate the safety and efficacy of pre-exposure prophylaxis (PrEP) with various hydroxychloroquine (HCQ) doses against a placebo among healthcare personnel (HCP) with high-risk exposure to coronavirus disease 2019 (COVID 19). Methods A phase II, randomized, placebo-controlled trial was conducted including 200 subjects with no active or past severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (antibody testing and reverse transcription-polymerase chain reaction (RT-PCR) were taken at the time of enrollment). Subjects of experimental groups one to three received HCQ in various doses and the control group received a placebo. The study outcomes in terms of …

Mission-Based Filters In The Electronic Residency Application Service: Saving Time And Promoting Diversity, Jennifer L Swails, Sasha Adams, Mark Hormann, Emma Omoruyi, Omowunmi Aibana

Faculty, Staff and Student Publications

BACKGROUND: Holistic review promotes diversity, but widespread implementation remains limited.

OBJECTIVE: We aimed to develop a practical approach to incorporate holistic review principles in screening applicants in the Electronic Residency Application Service (ERAS) and to assess the impact on diversity.

METHODS: Three residency programs (internal medicine [IM], pediatrics, and surgery) at McGovern Medical School developed filters to identify applicants with experiences/attributes aligned with the institutional mission. These filters were retroactively applied to each program's 2019-2020 applicant pool using built-in ERAS capabilities to group applicants by user-defined features. We compared the demographics of applicants reviewed during the cycle with those identified …

Resistin Levels Decrease As Insulin Resistance Increases In A Mexican-American Cohort, Absalon D Gutierrez, Carlos A Flores, Sapna Naik, Minjae Lee, Parisa Asgarisabet, Masha Resman, Miryoung Lee, Joseph B Mccormick, Susan P Fisher-Hoch

Faculty, Staff and Student Publications

AIMS: Links between resistin, insulin resistance (IR), and resistin-stimulated cytokine signaling remain unknown in Mexican-Americans. A Mexican-American cohort was examined to determine (1) relationships between circulating resistin and IR, (2) resistin's associations with cytokines and demographic and anthropometric variables, and (3) similar measurements with other adipokines.

METHODS: For cross sectional analyses, 953 adults (367 males and 586 females) in the Cameron County Hispanic Cohort (CCHC) were stratified into three groups: normal glucose tolerance, prediabetes, and diabetes mellitus. Differences in resistin and other adipokine levels were examined using linear regression via unadjusted model (Model 1), model adjusted for cytokines (Model 2), …

Giant Abdominal Aortic Aneurysms, Joshua I Ng, Tuong Nguyen, Anand Tarpara, Dawn Salvatore, Paul J Dimuzio, Babak Abai

Department of Surgery Faculty Papers

Giant abdominal aortic aneurysms (AAAs) are defined as AAAs >10 to 13 cm in the maximum transverse diameter. We have described a case of a patient who had presented for open repair of an 18-cm AAA and a review of reported cases of giant AAAs >10 cm in the maximum transverse diameter. Forty cases were compiled. The average maximum AAA diameter was 14.5 ± 4.1 cm. The AAA was ruptured on presentation in 12 patients (30%). Of the 40 cases, 34 (85%) were repaired with open surgery. The reported mortality was 15%. Despite the case complexity, five endovascular repairs were …

Effectiveness Of Simulation-Based Clinical Skills Training For Medical Students In Respiratory Medicine: A Pilot Study, Russell S. Martins, Saniya Sabzwari, Meesha Iqbal

Medical College Documents

Objective: To assess the effectiveness of high-fidelity simulation-based medical education (HF-SBME) in teaching and learning respiratory clinical examination in medical students.
Study design: Quasi-experimental pilot study.
Place and duration of study: The Aga Khan University, Karachi, from November 2018 to January 2020. Methodology: This study was conducted amongst third year medical students at the University. Students were assigned to intervention (IG) or control groups (CG). The IG underwent training for the respiratory clinical examination on a high-fidelity simulator mannequin, while the CG received the conventional practice session on standardised patients. Students were assessed on their respiratory clinical examination skills in …

Augmentation Of Pedicle Screws Using Bone Grafting In Patients With Spinal Osteoporosis, Andrey Evgenievich Bokov, Anatoliy Bulkin, I S. Bratsev, Svetlana Ya Kalinina, Sergey G. Mlyavykh, David G. Anderson

Department of Neurosurgery Faculty Papers

The aim of the study was to develop a new method of vertebral augmentation based on autologous and allogeneic bone chips to be used in pedicle screw fixation and to compare this method with the technique based on polymethyl methacrylate (PMMA). Materials and Methods. This prospective non-randomized study included 164 patients with degenerative pathologies or traumatic injuries of the lumbar spine and transitional thoracolumbar segments; 153 of the operated patients were followed up for 18 months. In these patients, radiodensity of the cancellous bone tissue was below 110 HU by the Hounsfield scale. Patients with degenerative spinal disorders underwent pedicle …

Outcomes Of Mechanical Thrombectomy For Patients With Stroke Presenting With Low Alberta Stroke Program Early Computed Tomography Score In The Early And Extended Window, Eyad Almallouhi, Sami Al Kasab, Zachary Hubbard, Eric C Bass, Guilherme Porto, Ali Alawieh, Reda Chalhoub, Pascal Jabbour, Robert M Starke, Stacey Q Wolfe, Adam S Arthur, Edgar Samaniego, Ilko Maier, Brian M Howard, Ansaar Rai, Min S Park, Justin Mascitelli, Marios Psychogios, Reade De Leacy, Travis Dumont, Michael R Levitt, Adam Polifka, Joshua Osbun, Roberto Crosa, Joon-Tae Kim, Walter Casagrande, Shinichi Yoshimura, Charles Matouk, Peter T Kan, Richard W Williamson, Benjamin Gory, Maxim Mokin, Isabel Fragata, Osama Zaidat, Albert J Yoo, Alejandro M Spiotta

Department of Neurosurgery Faculty Papers

Importance: Limited data are available about the outcomes of mechanical thrombectomy (MT) for real-world patients with stroke presenting with a large core infarct.

Objective: To investigate the safety and effectiveness of MT for patients with large vessel occlusion and an Alberta Stroke Program Early Computed Tomography Score (ASPECTS) of 2 to 5.

Design, setting, and participants: This retrospective cohort study used data from the Stroke Thrombectomy and Aneurysm Registry (STAR), which combines the prospectively maintained databases of 28 thrombectomy-capable stroke centers in the US, Europe, and Asia. The study included 2345 patients presenting with an occlusion in the internal carotid …

Combined Amplification And Sound Therapy For Individuals With Tinnitus And Coexisting Hearing Loss: A Retrospective Cohort Study, Purushothaman Ganesan, Hansapani Rodrigo, Jason Schmiedge, Rob Reiter, Simham Swapna, Vinaya Manchaiah

School of Mathematical & Statistical Sciences Faculty Publications

BACKGROUND: The heterogeneity of tinnitus perception and its impact necessitates a tailor-made management approach in everyone. The current study examined the effects of residual inhibition in combined amplification and sound therapy in individuals with tinnitus and coexisting hearing loss.

METHODS: A retrospective analysis was performed on patients with tinnitus and coexisting hearing loss between 2016 and 2019. A total of 72 patients provided with combined amplification and sound therapy were divided into 3 groups based on residual inhibition: (i) complete residual inhibition, (ii) partial residual inhibition, and (iii) negative residual inhibition. Tinnitus severity was measured using the Tinnitus …

The Disrupt: A Measure Of Parent Distraction With Phones And Mobile Devices And Associations With Depression, Stress, And Parenting Quality., Brandon T. Mcdaniel Phd

Health Services and Informatics Research

Abstract

The landscape of modern parenting has shifted as an increasing number of parents have and utilize smartphones and other mobile devices throughout the day. A validated measure of parent distraction with these devices is needed in the field. It is important to have a validated measure of parent distraction with mobile devices (e.g., phubbing, technoference), as this distraction can be common at times and could negatively impact the quality of parenting that children receive. In the current study, I developed a brief, parent-reported survey measure of parent distraction (DISRUPT), examined its reliability and validity (convergent, divergent) in two survey …

Eradication Of Enterococcus Faecalis In Conventional Endodontic Retreatments (A Randomized Clinical Trial), Fadl H. Khaled, Roula S. Abiad, Khaled Abd El Galil, Essam Osman

BAU Journal - Creative Sustainable Development

Enterococcus faecalis is the most common bacteria isolated in conventional endodontic retreatments. Aim: To compare the impact of three irrigation modalities on the elimination of the isolated microbial strains of Enterococcus faecalis. Materials and Methods: Thirty patients requiring conventional endodontic retreatment for one of their mandibular premolars and tested positive for E. faecalis were chosen. Patients were randomly divided into three groups (n=10) according to the irrigation modality to be used; group I: syringe irrigation (NaOCl 2.625%), group II: NaOCl 2.625%+EndoActivator and group III: NaOCl 2.625%+diode laser. Before obturation, samples S2 were collected and PCR analysis was performed to identify …

Current And Future Directions Of Breast Mri, Margaret Houser, David Barreto, Anita Mehta, Rachel F. Brem

Radiology Faculty Publications

No abstract provided.

Covid-19 Newsletter (Vol. 97), Center For Disaster Medicine, New York Medical College

COVID-19 Newsletter

No abstract provided.

Impact Of Central Line Bundle Care On Reduction Of Central Line Associated-Infections: A Scoping Review, Alisha James-Scott Msn, Fnp-C, Rachel Savoy Msn, Fnp-Bc, Donna Lynch-Smith Dnp, Acnp-Bc, Apn, Ne-Bc, Cnl, Tracy Mcclinton Dnp, Ag-Acnp-Bc, Apn

Doctor of Nursing Practice Projects

Purpose/Background Central venous catheters (CVC) are typical for critically ill patients in the intensive care unit (ICU). Due to the invasiveness of this procedure, there is a high risk for central line-associated bloodstream infection (CLABSI). These infections have been known to increase mortality and morbidity, medical costs, and reduce hospital reimbursements. Evidenced-based interventions were grouped to assemble a central line bundle to decrease the number of CLABSIs and improve patient outcomes. This scoping review will evaluate the literature and examine the association between reduced CLABSI rates and central line bundle care implementation or current use.

Methods A literature review was …

Nutrition, Atherosclerosis, Arterial Imaging, Cardiovascular Risk Stratification, And Manifestations In Covid-19 Framework: A Narrative Review., Smiksha Munjral, Puneet Ahluwalia, Ankush D Jamthikar, Anudeep Puvvula, Luca Saba, Gavino Faa, Inder M Singh, Paramjit S Chadha, Monika Turk, Amer M Johri, Narendra N Khanna, Klaudija Viskovic, Sophie Mavrogeni, John R Laird, Gyan Pareek, Martin Miner, David W Sobel, Antonella Balestrieri, Petros P Sfikakis, George Tsoulfas, Athanasios Protogerou, Prasanna Misra, Vikas Agarwal, George D Kitas, Raghu Kolluri, Jagjit Teji, Mustafa Al-Maini, Surinder K Dhanjil, Meyypan Sockalingam, Ajit Saxena, Aditya Sharma, Vijay Rathore, Mostafa Fatemi, Azra Alizad, Vijay Viswanathan, P K Krishnan, Tomaz Omerzu, Subbaram Naidu, Andrew Nicolaides, Jasjit S Suri

Heart and Vascular Articles

Background: Atherosclerosis is the primary cause of the cardiovascular disease (CVD). Several risk factors lead to atherosclerosis, and altered nutrition is one among those. Nutrition has been ignored quite often in the process of CVD risk assessment. Altered nutrition along with carotid ultrasound imaging-driven atherosclerotic plaque features can help in understanding and banishing the problems associated with the late diagnosis of CVD. Artificial intelligence (AI) is another promisingly adopted technology for CVD risk assessment and management. Therefore, we hypothesize that the risk of atherosclerotic CVD can be accurately monitored using carotid ultrasound imaging, predicted using AI-based algorithms, and reduced …

Utility Of Blood Cellular Indices In The Risk Stratification Of Patients Presenting With Acute Pulmonary Embolism., Brett Slajus, Yevgeniy Brailovsky, Iman Darwish, Jawed Fareed, Amir Darki

Division of Cardiology Faculty Papers

Pulmonary embolism (PE) clinical manifestations vary widely, and that scope is not fully captured by current all-cause mortality risk models. PE is associated with inflammatory, coagulation, and hemostatic imbalances so blood cellular indices may be prognostically useful. Complete blood count (CBC) data may improve current risk models like the simplified pulmonary embolism severity index (sPESI) for all-cause mortality, offering greater accuracy and analytic ability. Acute PE patients (n = 228) with confirmatory diagnostic imaging were followed for all-cause mortality. Blood cellular indices were assessed for association to all-cause mortality and were supplemented into sPESI using multivariate logistic regression. Multiple blood …

Radioresistance In Prostate Cancer: Focus On The Interplay Between Nf-Κb And Sod, Sameera Kumar, Daret St. Clair

Toxicology and Cancer Biology Faculty Publications

Prostate cancer occurs frequently in men and can often lead to death. Many cancers, including prostate cancer, can be initiated by oxidative insult caused by free radicals and reactive oxygen species. The superoxide dismutase family removes the oxygen-derived reactive oxygen species, and increased superoxide dismutase activity can often be protective against prostate cancer. Prostate cancer can be treated in a variety of ways, including surgery, androgen deprivation therapy, radiation therapy, and chemotherapy. The clinical trajectory of prostate cancer varies from patient to patient, but more aggressive tumors often tend to be radioresistant. This is often due to the free-radical and …

The Role Of Decorin And Biglycan Signaling In Tumorigenesis, Valentina Diehl, Lisa Sophie Huber, Jonel Trebicka, Malgorzata Wygrecka, Renato V. Iozzo, Liliana Schaefer

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

The complex and adaptive nature of malignant neoplasm constitute a major challenge for the development of effective anti-oncogenic therapies. Emerging evidence has uncovered the pivotal functions exerted by the small leucine-rich proteoglycans, decorin and biglycan, in affecting tumor growth and progression. In their soluble forms, decorin and biglycan act as powerful signaling molecules. By receptor-mediated signal transduction, both proteoglycans modulate key processes vital for tumor initiation and progression, such as autophagy, inflammation, cell-cycle, apoptosis, and angiogenesis. Despite of their structural homology, these two proteoglycans interact with distinct cell surface receptors and thus modulate distinct signaling pathways that ultimately affect cancer …

Pharmacist-Directed Vancomycin Therapeutic Drug Monitoring In Pediatric Patients: A Collaborative-Practice Model, Kashif Hussain, Rahila Ikram, Gul Ambreen, Muhammad Sohail Salat

Department of Biological & Biomedical Sciences

Background: Therapeutic drug monitoring (TDM) of Vancomycin (VCM) is required to prevent inappropriate dosage-associated bacterial resistance, therapeutic failure, and toxicities in pediatrics. Anecdotal experience and studies show that many healthcare institutions confront barriers while implementing TDM services, this study aimed to assess a pharmacist-directed VCM-TDM service for optimizing patient care in our institution.
Materials and methods: Patients aged 1 month-18 years who received intravenous VCM were included in this quasi-experimental study. The pre-implementation phase (March-June 2018) consisted of retrospective assessment of pediatric patients, the interventional phase (July 2018 to February 2020) included educational programs and the post-implementation phase (March-June 2020) …

Bay Leaf Extract‐Based Near‐Infrared Fluorescent Probe For Tissue And Cellular Imaging, Benilde Adriano, Nycol Cotto, Neeraj Chauhan, Vinitha Karumuru, Meena Jaggi, Subhash C. Chauhan, Murali M. Yallapu

School of Medicine Publications

The development of fluorescence dyes for near‐infrared (NIR) fluorescence imaging has been a significant interest for deep tissue imaging. Among many imaging fluoroprobes, indocyanine green (ICG) and its analogues have been used in oncology and other medical applications. However, these imaging agents still experience poor imaging capabilities due to low tumor targetability, photostability, and sensitivity in the biological milieu. Thus, developing a biocompatible NIR imaging dye from natural resources holds the potential of facilitating cancer cell/tissue imaging. Chlorophyll (Chl) has been demonstrated to be a potential candidate for imaging purposes due to its natural NIR absorption qualities and its wide …

Case Study--Jimmy (Zero Balancing And Cst), Judith Sullivan

Journal of Transformative Touch

Jimmy started receiving Zero Balancing and CranioSacral Therapy when he was 11 months old for significant torticollis and scoliosis. In 7 sessions between the beginning of November and the beginning of February. His x-rays show changes within normal ranges.

Using Nature To Nurture: Breast Milk Analysis And Fortification To Improve Growth And Neurodevelopmental Outcomes In Preterm Infants, Katherine Marie Ottolini, Elizabeth V. Schulz, Catherine Limperopoulos, Nickie Andescavage

Pediatrics Faculty Publications

No abstract provided.

Technology-Enabled Health Care Collaboration In Pediatric Chronic Illness: Pre-Post Interventional Study For Feasibility, Acceptability, And Clinical Impact Of An Electronic Health Record–Linked Platform For Patient-Clinician Partnership, Shehzad Ahmed Saeed, Lisa Opipari-Arrigan, Dana M. H. Dykes, Sunny Thakkar, Lisa Burns, Barbara A. Chini, Gary L. Mcphail, Ian Eslick, Peter A. Margolis, Heather C. Kaplan

Pediatrics Faculty Publications

Background: Mobile health (mHealth) technology has the potential to support the Chronic Care Model's vision of closed feedback loops and patient-clinician partnerships. Objective: This study aims to evaluate the feasibility, acceptability, and short-term impact of an electronic health record-linked mHealth platform (Orchestra) supporting patient and clinician collaboration through real-time, bidirectional data sharing. Methods: We conducted a 6-month prospective, pre-post, proof-of-concept study of Orchestra among patients and parents in the Cincinnati Children's Hospital inflammatory bowel disease (IBD) and cystic fibrosis (CF) clinics. Participants and clinicians used Orchestra during and between visits to complete and view patient-reported outcome (PRO) measures …

A Role For Adipocytes And Adipose Stem Cells In The Breast Tumor Microenvironment And Regenerative Medicine, Courtney K. Brock, Katherine L. Hebert, Maria Artiles, Maryl K. Wright, Thomas Cheng, Gabrielle O. Windsor, Khoa Nguyen, Madlin S. Alzoubi, Bridgette M. Collins-Burow, Elizabeth C. Martin, Frank H. Lau, Bruce A. Bunnell, Matthew E. Burow

School of Medicine Faculty Publications

Obesity rates are climbing, representing a confounding and contributing factor to many disease states, including cancer. With respect to breast cancer, obesity plays a prominent role in the etiology of this disease, with certain subtypes such as triple-negative breast cancer having a strong correlation between obesity and poor outcomes. Therefore, it is critical to examine the obesity-related alterations to the normal stroma and the tumor microenvironment (TME). Adipocytes and adipose stem cells (ASCs) are major components of breast tissue stroma that have essential functions in both physiological and pathological states, including energy storage and metabolic homeostasis, physical support of breast …

Provider Perception And Office Practices Of The Initial Prenatal Visit Pre – Coronavirus 2019 Pandemic, Arlin Delgado, Emma Hale, Jay Schulkin, Charles Macri, Kimberly Fryer

Florida Public Health Review

Background Prenatal Care is a critical aspect of women’s health and current literature shows adequate care significantly reduces risk of adverse outcomes. With scientific advancement, the initial prenatal visit is increasingly tasked with more objectives that leave providers with barriers to provide appropriate and adequate care.

Purpose The aim of this survey study was to determine clinical practices of the initial prenatal visit – regarding history taking, counseling, lab work and screening prior to the onset of COVID-19 Pandemic.

Methods A one-time anonymous provider survey was distributed electronically to all obstetrics providers in the Tampa Bay Region in Florida. Descriptive …

Editorial: Thrombotic Microangiopathies, Diagnostic And Therapeutic Advances, Robert W. Maitta, Hollie M. Reeves

Faculty Scholarship

Thrombotic microangiopathies (TMAs) as a disease group represent a diagnostic and clinical challenge to practitioners. Presentations, which at times have overlapping symptomatology or have undetermined etiologies, emphasize the need for a constant reassessment of what is known about this disease group in order to determine not only how to best treat patients but also to develop targeted approaches to test for a given etiology. Likewise, in those instances when excluding diagnoses is the only available option, timely adjustment of therapy due to lack of therapeutic response needs to be achieved in the most efficient way. It is with this in …

Resident-Led Physical Wellness Initiative Linked To Less Burnout For Emergency Physicians During Covid-19 Pandemic, Camila A. Calderón, Adeola A. Kosoko, Salil K. Bhandari, Jason A. Lesnick, Derek R. Herkes, Ryan M. Huebinger

Journal of Wellness

Introduction: The COVID-19 pandemic has taken a significant toll on societal, physical, and psychological health. Emergency physicians (EPs) are susceptible to burnout under ordinary circumstances and may be particularly vulnerable during the pandemic. To reduce pandemic-related burnout, we implemented a residency-led physical wellness initiative and evaluated the effect on burnout among EPs.

Methods: In the spring of 2020, we invited all resident and attending EPs in our department to participate in a four-week physical wellness initiative as part of a prospective study. After completing or opting out of this wellness initiative, EPs responded to an online survey comprised …

Igg4-Mediated Neurologic Autoimmunities: Understanding The Pathogenicity Of Igg4, Ineffectiveness Of Ivig, And Long-Lasting Benefits Of Anti-B Cell Therapies, Marinos Dalakas

Department of Neurology Faculty Papers

Background and objectives: Describe the unique functions of immunoglobulin G4 (IgG4) in IgG4-neurologic disorders (IgG4-ND) and explain why, in contrast to their IgG1-counterparts, they respond poorly to intravenous immune globulin (IVIg) but effectively to anti-B cell therapies.

Methods: The IgG4 structure and isotype switch, B cells and plasmablasts relevant to IgG4 production, and IgG4-induced disruption of the targeted antigens are reviewed and compared with IgG1-mediated autoimmune ND, where IVIg inhibits IgG1-triggered inflammatory effects.

Results: The main IgG4-ND include muscle-specific kinase myasthenia; nodal/paranodal chronic inflammatory demyelinating polyradiculoneuropathy with antibodies to neurofascin-155, contactin-1/caspr-1, or pan-neurofascins; antileucine-rich, glioma-inactivated-1 and contactin-associated protein-like 2 associated-limbic …

Case Report: Molecular Diagnosis Of Cystoisospora Belli In A Severely Immunocompromised Patient With Hiv And Kaposi Sarcoma, Roumen Borilov Iordanov, Lauren M Leining, Meng Wu, Galant Chan, Andrew R Dinardo, Rojelio Mejia

Faculty, Staff and Students Publications

Diarrhea in an immunocompromised patient has a broad infectious differential. Diagnosis is difficult despite advances in diagnostic modalities. We report a case of a 45-year-old Nigerian woman who immigrated to the United States 2 years ago. She presented to the hospital with gastrointestinal bleeding, newly diagnosed HIV, and disseminated Kaposi sarcoma. During hospitalization, the patient had an onset of watery diarrhea and high eosinophilia. Subsequent stool analysis using multi-parallel real-time quantitative polymerase chain reaction for 13 parasites was positive for Cystoisospora belli. The patient was treated with trimethoprim-sulfamethoxazole, but had relapsed disease when her antibiotics were stopped prematurely. After restarting …