Medical Specialties Commons^™

New Onset Seizures Evolving Into Refractory Status Epilepticus In The Setting Of Covid-19: A Case Report, Mahira Mushtaq, Zuha Amin, Shafaq Saleem, Fowzia Siddiqui

Pakistan Journal of Neurological Sciences (PJNS)

The novel Coronavirus disease (COVID-19) has been shown to involve the nervous system (both central and peripheral), with or without respiratory involvement in multiple ways. Although not much is known about this disease yet, seizures and status epilepticus which may evolve into refractory status epilepticus have been associated with it along with other manifestations like encephalopathy, neuropathies etc. The mechanism for development of seizures with COVID-19 related disease is not entirely known however it can be the consequence of “cytokine release syndrome” or “cytokine storm” which has been associated with this virus. Patients with COVID-19 infection who develop resistant status …

Pakistan Ischemic Stroke Guidelines, Anjum Farooq, Maria Khan, Ayesha Zafar, Husnain Hashim, Fozan Khan, Abdul Malik, Ayeesha Kamran Kamal Aga Khan University, Karachi, Mohammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

Stroke is the second leading cause of death and disability. Mortality related to stroke is very high in low- and middle-income countries. Stroke imposes a great socioeconomical burden in Pakistan. It is important to take important steps for prevention and proper management of stroke in country. Purpose of developing stroke guidelines is to improve stroke care in Pakistan. Guidelines are designed to help neurologists and general practitioners for treating stroke. American stroke guidelines, NICE guidelines, Canadian guidelines and multiple important articles including those emphasizing stroke care in low- and middle-income countries were studied, and these current guidelines were designed in …

How Does 2 Level Cervical Disc Replacement Compare To Single Level?, Pierce Nunley, Brian Perry, Celeste Abjornson, Ashvin Patel, Faheem Sandhu, Armen Khachatryan, Jad Khalil

Conference Presentation Abstracts

Introduction: Anterior Cervical Discectomy and Fusion (ACDF) is highly successful at a single level with greater than 90% fusion rates and high patient satisfaction. However, multi-level ACDF surgery, though still successful, has diminishing results with increasing levels. With many Investigational Device Exemption (IDE) clinical trials for the treatment of Symptomatic Cervical Disc Disease (SCDD) at a single level and recent IDE clinical trials for two contiguous levels, these trials offer the opportunity to compare clinical outcomes utilizing the same motion sparing technology mechanisms of action (MOA). The hypothesis is that cervical total disc replacement (cTDR) maintains its clinical benefits from …

Nicotine Cessation, Children's Mercy Kansas City

Clinical Pathways

No abstract provided.

Comparison Of Two Learning Methodologies: Virtual Reality And Osce Simulation, Connor Blackwell, Tabor Mcgee

Doctoral Projects

Anesthesia education has evolved immensely over the past twenty years, and with the new virtual reality (VR) simulations created by SIMVANA, the exponential growth can continue. The anesthesia program at The University of Southern Mississippi (USM) currently utilizes an educational platform known as the Objective Structured Clinical Examination (OSCE) for their students’ clinical curriculum. With the development of technology and education models, the purpose of the doctoral project is to determine if VR simulation can produce more effective learning than the OSCE modules. To determine the effectiveness, pharmacologic lessons for intraoperative hypotension were administered through both platforms and then tested …

Polarimetry Terahertz Imaging Of Human Breast Cancer Surgical Specimens, Nikita Gurjar, Keith Bailey, Magda O. El-Shenawee

Electrical Engineering and Computer Science Faculty Publications and Presentations

Purpose

We investigate terahertz (THz) polarimetry imaging of seven human breast cancer surgical specimens. The goal is to enhance image contrast between adjacent tissue types of cancer, healthy collagen, and fat in excised breast tumors. Based on the biological perception of random growth of cancer and invasion of surrounding healthy tissues in the breast, we hypothesize that cancerous cells interact with the THz electric field in a different manner compared with healthy cells. This difference can be best captured using multiple polarizations instead of single polarization.

Approach

Time domain pulsed signals are experimentally collected from each pixel of the specimen …

Apoa2 Increases Cholesterol Efflux Capacity To Plasma Hdl By Displacing The C-Terminus Of Resident Apoa1, Snigdha Sarkar, Jamie Morris, Youngki You, Hannah Sexmith, Scott E. Street, Stephanie M. Thibert, Isaac K. Attah, Chelsea M. Hutchinson Bunch, Irina V. Novikova, James E. Evans, Amy S. Shah, Scott M. Gordon, Jere P. Segrest, Karin E. Bornfeldt, Tomas Vaisar, Jay W. Heinecke, W. Sean Davidson, John T. Melchior

Saha Cardiovascular Research Center Faculty Publications

Abstract The ability of high-density lipoprotein (HDL) to promote cellular cholesterol efflux is a more robust predictor of cardiovascular disease protection than HDL-cholesterol levels in plasma. Previously, we found that lipidated HDL containing both apolipoprotein A-I (APOA1) and A-II (APOA2) promotes cholesterol efflux via the ATP-binding cassette transporter (ABCA1). In the current study, we directly added purified, lipid-free APOA2 to human plasma and found a dose-dependent increase in whole plasma cholesterol efflux capacity. APOA2 likewise increased the cholesterol efflux capacity of isolated HDL with the maximum effect occurring when equal masses of APOA1 and APOA2 coexisted on the particles. Follow-up …

Untargeted Lipidomics Reveals Novel Hdl Metabotypes And Lipid-Clinical Correlates, Peer W. F. Karmaus, Scott M. Gordon, Marcus Y. Chen, Alison A. Motsinger-Reif, Rodney W. Snyder, Timothy R. Fennell, Suramya Waidyanatha, Reshan A. Fernando, Alan T. Remaley, Michael B. Fessler

Saha Cardiovascular Research Center Faculty Publications

Plasma high-density lipoprotein (HDL), originally studied for its role in lipid transport, is now appreciated to have wide-ranging biological functions that become defective during disease. While >200 lipids have collectively been detected in HDL, published HDL lipidomic analyses in different diseases have commonly been targeted to prespecified subsets of lipids. Here, we report the results of untargeted lipidomic analysis of HDL isolated from 101 subjects referred for computed tomographic coronary imaging for whom multiple additional clinical and lipoprotein metadata were measured. Unsupervised clustering of the total HDL lipidome revealed that the subjects fell into one of two discrete groups, herein …

Tissue Plasminogen Activator Associated Pulmonary Hemorrhage In Patient With Acta2-Associated Arteriopathy, Travis G. Hughes, Mark A. Wurth, Mary Burchett Sheppard

Saha Cardiovascular Research Center Faculty Publications

Pulmonary hemorrhage after administration of tissue plasminogen activator (tPA) is a rare complication. We present a 15- year-old boy with a heterozygous pathogenic variant in ACTA2 who presented with right brachial artery aneurysm thrombosis treated initially with tPA, resulting in pulmonary hemorrhage. We hypothesize that the underlying pulmonary abnormalities caused by the pathogenic ACTA2 variant may be a risk factor for pulmonary hemorrhage after tPA administration. (J Vasc Surg Cases Innov Tech 2024;10:101558.)

Ten-Year Review Of St-Segment Elevation Myocardial Infarction (Stemi) In Tanzania: A Single Center Retrospective Review, Nadeem Kassam, Mohamed Varwani, Mzee Ngunga, Jeilan Mohamed, Mangaro Mabusi, James Orwa, Salim Surani, Robert Mvungi, Nasiruddin Jamal

Internal Medicine, East Africa

Introduction: Ischemic Heart Disease (IHD) is an emerging epidemic in sub-Saharan Africa (SSA). Although the true burden may be underreported in the African continent, it still remains one of the leading causes of death among adults aged above 60 years. ST-Segment Elevation Myocardial Infarction (STEMI) is a clinically time-sensitive fatal sequela of IHD with timely reperfusion by primary Percutaneous Coronary Intervention (PCI) being the gold standard of care. There has been steady progress in coronary care services in Tanzania, alongside a rise in IHD-related risk factors. However, data on this is limited. This study aimed to examine trends in …

Quality Of Life After Myocardial Infarction In The Pakistani Population – Insights From A Single-Center Cohort Study, Javerya Hassan, Manzar Abbas, Hajra Arshad, Angelina Jessani, Izza Tahir, Shiza Qazi, Jasmit Shah, Zul Merali, Zainab Samad

Brain and Mind Institute

Background Health-related Quality of life (HRQoL) assessment is essential for optimizing patient care, treatment adjustments, and medical decision-making, particularly in post-Myocardial Infarction (MI) patients, but limited data exists on HRQOL post-MI from Pakistan. This study aimed to assess HRQoL and its determinants in the Pakistani population.

Methods A single-center cross-sectional study was conducted at a tertiary care hospital in Karachi, Pakistan. Patients≥18 years old with a primary diagnosis of acute MI (ICD-9 codes: 410.0-410.9 and ICD-10 codes: 121.0- 121.9) discharged from the Cardiology Service from January 2019 to December 2020 who could be contacted and consented to participate were included. …

Endovascular Thrombectomy For Childhood Stroke (Save Childs Pro): An International, Multicentre, Prospective Registry Study, Peter B. Sporn, Kartik Bhatia, Todd Abruzzo, Lisa Pabst, Stuart Fraser, Melissa G. Chun, Warren Lo, Ahmed Othman, Sebastian Steinmetz, Ameer E. Hassan

School of Medicine Publications

Background

Emerging evidence suggests that endovascular thrombectomy is beneficial for treatment of childhood stroke, but the safety and effectiveness of endovascular thrombectomy has not been compared with best medical treatment. We aimed to prospectively analyse functional outcomes of endovascular thrombectomy versus best medical treatment in children with intracranial arterial occlusion stroke.

Methods

In this prospective registry study, 45 centres in 12 countries across Asia and Australia, Europe, North America, and South America reported functional outcomes for children aged between 28 days and 18 years presenting with arterial ischaemic stroke caused by a large-vessel or medium-vessel occlusion who received either endovascular …

Cryoablation Of Primary Breast Cancer Tumors Induces A Systemic Abscopal Effect Altering Time (Tumor Immune Microenvironment) In Distant Tumors, Flávia Sardela De Miranda, Dalia Martinez-Marin, Rachel L. Babcock, Maribel Castro, Geetha P. Boligala, Sonia Y. Khan, Kathryn L. Furr, Isabel Castro-Piedras, Nicholas Wagner, Dakota E. Robison

School of Medicine Publications

Introduction: Despite recent advances, triple-negative breast cancer (TNBC) patients remain at high risk for recurrence and metastasis, which creates the need for innovative therapeutic approaches to improve patient outcomes. Cryoablation is a promising, less invasive alternative to surgical resection, capable of inducing tumor necrosis via freeze/thaw cycles. Necrotic cell death results in increased inflammatory signals and release of preserved tumor antigens, which have the potential to boost the local and systemic anti-tumor immune response. Thus, compared to surgery, cryoablation enhances the activation of T cells leading to an improved abscopal effect, defined as the occurrence of a systemic response after …

Focused Ultrasound: A New Era In Tremor Control, Sajid Hameed

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Pregnancy Outcomes After Covid-19 Infection, Angela M. Blanco Guertin, Arvinder Singh, Arianna Tapia, Emily Dickinson

Nursing & Health Sciences Research Journal

Background: Since the onset of the Coronavirus 19 (COVID-19) pandemic in 2020, the medical community has raced to keep up with the continued healthcare sequelae of the virus. During this time, pregnant women and newborns have been of particular concern. A higher incidence of pregnancy-related complications was seen among women during the pandemic. This study aimed to assess the relationship between COVID-19 and pregnancy complications among women. Methods: This retrospective study analyzed records of pregnant women with active COVID-19 or a history of COVID-19 during pregnancy, admitted to a South Florida hospital between March 2020 and December 2021. Patients’ charts …

Examining Anxiety And Coping Strategies With Persons With Parkinson's Disease (Pwpd) Who Routinely Exercise, Ashlynn Milburn, Angela Labrie Blackwell, Karen Aranha, Maggie Abbott

Fall 2024 OTD Capstone Symposium

Forty to 50% of the PwPD are reported to experience anxiety (Kwok et al., 2019). Anxiety is psychological distress characterized by excessive worry, and apprehension about future events (Khatri et al., 2020). Psychological distress with this population is secondary to care dependency, poor work and social function, increased physical and cognitive decline, increased dementia risk, and high mortality rate (Kwok et al., 2019).Exercise and meditation have been found to be useful coping strategies to manage one’s physical condition as well as psychosocial factors such as anxiety, with PD (Mantri et al., 2021).Although these coping strategies have the potential to reduce …

Benefits Of Occupational Therapy In Concussion Treatment For Professional Athletes, Alexandria Brown, Zeida Gutierrez Ph.D., Mhs, Otr/L, James Wersal Otd, Msot, Otr/L, Cbis, Drs, Dcs

Fall 2024 OTD Capstone Symposium

Concussions are a significant concern in sports, with an estimated 1.6 to 3.8 million cases in the U.S. annually, many of which go unreported. These traumatic brain injuries result from various impacts, causing symptoms like headaches, dizziness, and memory loss, which can disrupt an athlete's daily life. Recovery typically follows a staged protocol, with professional organizations implementing concussion management guidelines. Despite these measures, athletes often hesitate to report symptoms due to concerns about playing time or team expectations. There is a gap in treatment for concussions as activities of daily living and occupations are not addressed. Occupational therapy can help …

Adapting Classroom Activities To Increase Social Engagement, Ivie Hacker, Mary Jan Greer Ph.D., Otr

Fall 2024 OTD Capstone Symposium

This capstone program focuses on enhancing the development of children with disabilities through adaptive play strategies. It aims to create a supportive, engaging environment that accommodates the unique needs of children on the autism spectrum. By incorporating individualized play techniques, the program promotes social, emotional, and cognitive skills, fostering greater communication, creativity, and physical coordination. The project explores the role of adaptive play in improving social interactions, reducing sensory sensitivities, and building self-confidence, ultimately contributing to the overall well-being and development of children with autism.

Sex Education Program For Individuals With Disabilities, Kalynne Coates, Keisa Boykin

Fall 2024 OTD Capstone Symposium

The purpose of this project is to develop and implement a program to discuss the ADL of sex education with individuals with intellectual and developmental disabilities (IDD).

Association Of Common And Rare Variants With Alzheimer’S Disease In More Than 13,000 Diverse Individuals With Whole-Genome Sequencing From The Alzheimer’S Disease Sequencing Project, Wan-Ping Lee, Seung Hoan Choi, Margaret G Shea, Po-Liang Cheng, Beth A Dombroski, Achilleas N Pitsillides, Nancy L Heard-Costa, Hui Wang, Katia Bulekova, Amanda B Kuzma, Yuk Yee Leung, John J Farrell, Honghuang Lin, Brian W Kunkle, Adam Naj, Elizabeth E Blue, Frederick Nusetor, Dongyu Wang, Eric Boerwinkle, William S Bush, Xiaoling Zhang, Philip L De Jager, Josée Dupuis, Lindsay A Farrer, Myriam Fornage, Eden Martin, Margaret Pericak-Vance, Sudha Seshadri, Ellen M Wijsman, Li-San Wang, Alzheimer's Disease Sequencing Project, Gerard D Schellenberg, Anita L Destefano, Jonathan L Haines, Gina M Peloso

Center for Medical Ethics and Health Policy Staff Publications

Introduction: Alzheimer's disease (AD) is a common disorder of the elderly that is both highly heritable and genetically heterogeneous.

Methods: We investigated the association of AD with both common variants and aggregates of rare coding and non-coding variants in 13,371 individuals of diverse ancestry with whole genome sequencing (WGS) data.

Results: Pooled-population analyses of all individuals identified genetic variants at apolipoprotein E (APOE) and BIN1 associated with AD (p < 5 × 10-8). Subgroup-specific analyses identified a haplotype on chromosome 14 including PSEN1 associated with AD in Hispanics, further supported by aggregate testing of rare coding and non-coding variants in the region. Common variants in LINC00320 were observed associated with AD in Black individuals (p = 1.9 × 10-9). Finally, we observed rare non-coding variants in the promoter of TOMM40 distinct of APOE in pooled-population analyses (p = 7.2 × 10-8).

Discussion: We observed that complementary pooled-population and subgroup-specific analyses offered unique insights into the genetic architecture of AD.

Highlights: We determine the association of genetic variants with Alzheimer's disease (AD) using …

Tocilizumab In The Management Of Neuromyelitis Optica Spectrum Disorder: A Narrative Review Of Literature And Critical Appraisal, Salman Mansoor, Samar Iltaf Mairajuddin, Saqib Gul

Pakistan Journal of Neurological Sciences (PJNS)

Background and objective

Neuromyelitis Optica Spectrum disorder (NMOSD) mostly affects the spinal cord and optic nerves. This manuscript aims to explore the treatment potential of tocilizumab, a monoclonal antibody that targets the interleukin-6 (IL-6) receptor and regulates inflammatory cytokines implicated in the pathophysiology of NMOSD. Methods

A thorough search of the pertinent literature was done for this research utilising electronic databases, specifically PubMed, Cochrane Library, and Embase, which contained studies published from 2016 to 2024.

Results Clinical studies show that tocilizumab improves clinical outcomes and lowers recurrence rates in people with NMOSD, especially those who don't respond to traditional treatments. …

Chorea As A Rare Manifestation Of Neuropsychiatric Systemic Lupus Erythematosus: A Case Report, Qurat Ul Ain, Ashfeen Ishfaq, Farzana Kouser, Rabia Rasool

Pakistan Journal of Neurological Sciences (PJNS)

Systemic lupus erythematosus (SLE) is a systemic autoimmune disease with multisystemic involvement. It has variable clinical presentations and a relapsing and remitting course. Clinical manifestations are broad, ranging from mild mucocutaneous involvement to major organ involvement. We present a case of a 32-year-old female with repeated movements of the right arm, and confusion with a background of pains in multiple joints. She was diagnosed as a case of Neuropsychiatric Systemic Lupus Erythematosus (NPSLE). She was managed with pulse therapy of cyclophosphamide (CYC) along with other supportive medications. After six months of intensive immunosuppressive therapy, she remained well and continued maintenance …

A Sticky Mess—Are Moisturizers Overused In Dermatitis Care?, Susan Nedorost

Faculty Scholarship

Microbial dysbiosis is increasingly understood to influence allergic sensitization and skin barrier defects in dermatitis. Occlusion, such as from moisturizers, fosters microbial dysbiosis, and increases itch in many patients with dermatitis. Nevertheless, use of moisturizers in dermatitis remains part of dermatologic guidelines. This is a review of the evidence of benefits and adverse effects of moisturizers in dermatitis and a proposal for moderation in their clinical use.

Investing In Limb Preservation: A Case Report In Avoiding Bilateral Amputation In A Vasculopathy Patient, Nikita Gambhir, Heather V. Tran, Craig J. Verdin, Stephanie N. Campbell, Cyaandi Dove

School of Podiatric Medicine Publications

Limb salvage and prosthetics play vital roles in restoring function and mobility for patients with severe injuries or metabolic conditions. Limb salvage involves surgical techniques aimed at preserving a limb rather than resorting to amputation, while prosthetics provide artificial devices to replace lost limbs. Key considerations for limb salvage include restoring a functional foot, maintaining patient independence, minimizing hospitalizations, and avoiding bilateral lower limb amputations. Aggressive measures in wound care and surgery are needed for patients already at single-limb status with PAD and coronary artery disease (CAD).

The Effects Of Mosaicism On Biological And Clinical Markers Of Alzheimer's Disease In Adults With Down Syndrome, Laura Xicota, Lam-Ha T. Dang, Alice Lee, Sharon Krinsky-Mchale, Deborah Pang, Lisa Melilli, Sid E. O’Bryant, Rachel L. Henson, Charles Laymon, Florence Lai, H. Diana Rosas, Beau Ances, Ira Lott, Christy Hom, Bradley Christian, Sigan Hartley, Shahid Zaman, Elizabeth Head, Mark Mapstone, Zhezhen Jin, Wayne Silverman, Nicole Schupf, Benjamin Handen, Joseph H. Lee, Alzheimer’S Biomarker Consortium – Down Syndrome (Abc-Ds)

Neurology Faculty Publications

Background Individuals with Down syndrome (DS) are at high risk of early-onset Alzheimer’s disease (AD); yet, some 20 percent do not develop any signs of dementia until after 65 years or in their lifetime. Mosaicism could contribute to this phenotypic variation, where some disomic cells could lead to lower levels of gene products from chromosome 21.

Methods We examined longitudinal neuropsychological and biomarker data from two large studies of DS: the Alzheimer Biomarker Consortium–Down syndrome study (ABC-DS) (n = 357); and a legacy study (n = 468). We assessed mosaicism using karyotyping or GWAS data. Participants had data on plasma …

Targeted Long-Read Sequencing To Quantify Methylation Of The C9orf72 Repeat Expansion, Evan Udine, Nicole Finch, Mariely Dejesus-Hernandez, Jazmyne L. Jackson, Matthew C. Baker, Siva Arumugam Saravanaperumal, Eric Wieben, Mark T. W. Ebbert, Jaimin Shah, Leonard Petrucelli, Rosa Rademakers, Björn Oskarsson, Marka Van Blitterswijk

Neurology Faculty Publications

Background The gene C9orf72 harbors a non-coding hexanucleotide repeat expansion known to cause amyotrophic lateral sclerosis and frontotemporal dementia. While previous studies have estimated the length of this repeat expansion in multiple tissues, technological limitations have impeded researchers from exploring additional features, such as methylation levels.

Methods We aimed to characterize C9orf72 repeat expansions using a targeted, amplification-free long-read sequencing method. Our primary goal was to determine the presence and subsequent quantification of observed methylation in the C9orf72 repeat expansion. In addition, we measured the repeat length and purity of the expansion. To do this, we sequenced DNA extracted from …

An Innovative Community‐Led Education And Recruitment Program To Increase Clinical Research Participation Among Black Americans, Bahar Niknejad, Ethlyn Mcqueen Gibson, Travonia Brown-Hughes, Katie Mcdonough, Ebony Andrews, Deborah Hudson, Hamid Okhravi

Glennan Center for Geriatrics and Gerontology Faculty Publications

Background: Previous studies attest to a lack of awareness about Alzheimer’s Disease (AD) and limited participation of Black Americans in AD clinical trials. The AHEAD Study is a multicenter trial focused on preventing AD by evaluating the effectiveness and safety of Lecanemab in individuals with preclinical AD. The study aims to recruit at least 15% from underrepresented populations, including Black Americans. To achieve this goal, our study site utilizes a community-based participatory research (CBPR) approach and developed a Community Education and Recruitment Program (CERP) designed to increase the participation of Black individuals in the AHEAD Study.

Method: In a collaborative …

Analysis Of Impulsive Differential Equation Models Of Cell Populations Undergoing Radiation Therapy, Abigail D'Ovidio Long

Dissertations and Doctoral Documents, University of Nebraska-Lincoln, 2023–

Radiation therapy is a mode of treatment which is implemented for approximately 50% of cancer patients. Treatment needs to be able to kill cancer cells, but also do minimal damage to surrounding healthy tissue. We propose two main impulsive differential equation models of radiation therapy to capture the periodic nature of the treatment. These models build off of previous studies using clinical data to ensure biological relevance. The first model incorporates only cancer cell populations, and we provide parameter relationships which theoretically ensure treatment outcomes of cancer eradication, cancer approaching a carrying capacity, and cancer approaching a periodic solution. We …

Enhancement Of Zika Virus Infection By West Nile And Dengue Virus Antibody Positive Cord-Blood Samples From Mothers In El Paso-Texas, Jeanette Orbegozo

Open Access Theses & Dissertations

The recent Zika virus (ZIKV) outbreak and its association with microcephaly cases and other neurological syndromes are important public health concerns. A phenomenon known as antibody-dependent enhancement (ADE) involves preexisting flavivirus antibodies to a specific flavivirus that enhances the severity of a second infection with a different flavivirus. Since ZIKV is related to flaviviruses like West Nile virus (WNV) and dengue virus (DENV), prior exposure to these viruses could elicit cross-reactive antibodies that may enhance a subsequent ZIKV infection. Therefore, this study aimed to determine if WNV and DENV antibodies from cord blood enhanced ZIKV infection in vitro. Initially, a …

Novel Therapuetic Approaches For Chagas Disease, Juan Carlos Silva

Open Access Theses & Dissertations

Chagas disease (CD) is caused by the hemoflagellate protozoan Trypanosoma cruzi. This disease is considered one of the 20 neglected tropical diseases (NTD), and it is estimated that 6 to 8 million people worldwide are diagnosed with CD. In the United States, Chagas infection is not reported in all states; however, most reported CD cases are chronic infections. Chagas infection is characterized by two phases: an acute and a chronic phase. Until this present moment, no prophylactic or therapeutic human vaccine is available. However, in a recent study in a murine model, our group showed that the synthetic 20-merpeptide (DAENPGGEVFNDNKKGLSRV) …