Internal Medicine Commons^™

Effect Of Nintedanib In Patients With Systemic Sclerosis-Associated Interstitial Lung Disease And Risk Factors For Rapid Progression, Dinesh Khanna, Toby M Maher, Elizabeth R Volkmann, Yannick Allanore, Vanessa Smith, Shervin Assassi, Michael Kreuter, Anna-Maria Hoffmann-Vold, Masataka Kuwana, Christian Stock, Margarida Alves, Steven Sambevski, Christopher P Denton

Faculty, Staff and Student Publications

Objective: To investigate the rate of decline in forced vital capacity (FVC), and the effect of nintedanib on the rate of decline in FVC, in subjects with systemic sclerosis-associated interstitial lung disease (SSc-ILD) who had risk factors for rapid decline in FVC.

Methods: The SENSCIS trial enrolled subjects with SSc and fibrotic ILD of ≥10% extent on high-resolution CT. The rate of decline in FVC over 52 weeks was analysed in all subjects and in those with early SSc (< 18 months since first non-Raynaud symptom), elevated inflammatory markers (C reactive protein ≥6 mg/L and/or platelets ≥330×109/L) or significant skin fibrosis (modified Rodnan skin score (mRSS) 15-40 or mRSS ≥18) at baseline.

Results: In the placebo group, the rate of decline in FVC was numerically greater in subjects with < 18 months since first non-Raynaud symptom (-167.8 mL/year), elevated inflammatory markers (-100.7 mL/year), mRSS 15-40 (-121.7 mL/year) or mRSS ≥18 (-131.7 mL/year) than in all subjects (-93.3 mL/year). Nintedanib reduced the rate of FVC decline across subgroups, with a numerically greater effect in patients with these risk factors for rapid FVC decline.

Conclusion: In the …

Eosinophils Protect Against Acetaminophen-Induced Liver Injury Through Cyclooxygenase-Mediated Il-4/Il-13 Production, Long Xu, Yang Yang, Jiali Jiang, Yankai Wen, Jong-Min Jeong, Christoph Emontzpohl, Constance L Atkins, Kangho Kim, Elizabeth A Jacobsen, Hua Wang, Cynthia Ju

Faculty, Staff and Student Publications

BACKGROUND AND AIMS: A better understanding of the underlying mechanism of acetaminophen (APAP)-induced liver injury (AILI) remains an important endeavor to develop therapeutic approaches. Eosinophils have been detected in liver biopsies of patients with APAP overdose. We recently demonstrated a profound protective role of eosinophils against AILI; however, the molecular mechanism had not been elucidated.

APPROACH AND RESULTS: In agreement with our previous data from experiments using genetic deletion of eosinophils, we found that depletion of eosinophils in wild-type (WT) mice by an anti-IL-15 antibody resulted in exacerbated AILI. Moreover, adoptive transfer of eosinophils significantly reduced liver injury and mortality …

A Delicate Balance Between Antibody Evasion And Ace2 Affinity For Omicron Ba275, Jiandong Huo, Aiste Dijokaite-Guraliuc, Chang Liu, Daming Zhou, Helen M Ginn, Raksha Das, Piyada Supasa, Muneeswaran Selvaraj, Rungtiwa Nutalai, Aekkachai Tuekprakhon, Helen M E Duyvesteyn, Alexander J Mentzer, Donal Skelly, Thomas G Ritter, Ali Amini, Sagida Bibi, Sandra Adele, Sile Ann Johnson, Neil G Paterson, Mark A Williams, David R Hall, Megan Plowright, Thomas A H Newman, Hailey Hornsby, Thushan I De Silva, Nigel Temperton, Paul Klenerman, Eleanor Barnes, Susanna J Dunachie, Andrew J Pollard, Teresa Lambe, Philip Goulder, Optic Consortium, Isaric4c Consortium, Elizabeth E Fry, Juthathip Mongkolsapaya, Jingshan Ren, David I Stuart, Gavin R Screaton

Faculty, Staff and Student Publications

Variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have caused successive global waves of infection. These variants, with multiple mutations in the spike protein, are thought to facilitate escape from natural and vaccine-induced immunity and often increase in affinity for ACE2. The latest variant to cause concern is BA.2.75, identified in India where it is now the dominant strain, with evidence of wider dissemination. BA.2.75 is derived from BA.2 and contains four additional mutations in the receptor-binding domain (RBD). Here, we perform an antigenic and biophysical characterization of BA.2.75, revealing an interesting balance between humoral evasion and ACE2 receptor …

Recurrent Cyanotic Spells In An Octogenarian, Chin Tong Kwok, Chun Kit Wong

Journal of the Hong Kong College of Cardiology

We report rare case of an octogenarian who, after years of diagnostic delay, was found to have a patent foramen ovale, and due to an ascending aortic aneurysm that anatomically facilitated right-to-left shunt, presenting with life-threatening cyanotic attacks. The characteristic orthodeoxia-platypnea syndrome and high alveolar arterial gradient hint to the diagnosis. She was eventually treated successfully with urgent percutaneous PFO closure. Routine ordering of a transthoracic echocardiogram, without agitated saline injection under provocation maneuvers, may not be sufficient to rule out shunts.

Approach To The Patient: Pharmacological Therapies For Fracture Risk Reduction In Adults With Osteogenesis Imperfecta, Winnie Liu, Brendan Lee, Sandesh C S Nagamani, Lindsey Nicol, Frank Rauch, Eric T Rush, V Reid Sutton, Eric Orwoll

Faculty, Staff and Students Publications

Context

Osteogenesis imperfecta (OI) is a genetic disorder characterized by increased bone fragility largely caused by defects in structure, synthesis, or post-translational processing of type I collagen. The effectiveness of medications used for fracture reduction in adults with OI is understudied and practice recommendations are not well established. Drugs currently used to improve skeletal health in OI were initially developed to treat osteoporosis. Oral and intravenous bisphosphonates have been shown to improve bone mineral density (BMD) in adults with OI and are commonly used; however, conclusive data confirming fracture protection are lacking. Similarly, teriparatide appears to increase BMD, an effect …

Posoleucel, An Allogeneic, Off-The-Shelf Multivirus-Specific T-Cell Therapy, For The Treatment Of Refractory Viral Infections In The Post-Hct Setting, Thomas Pfeiffer, Ifigeneia Tzannou, Mengfen Wu, Carlos Ramos, Ghadir Sasa, Caridad Martinez, Premal Lulla, Robert A Krance, Lauren Scherer, Daniel Ruderfer, Swati Naik, Claire Bocchini, Iain P Fraser, Badrish Patel, Dany Ward, Tao Wang, Helen E Heslop, Ann M Leen, Bilal Omer

Faculty, Staff and Students Publications

PURPOSE: Viral infections are a major cause of morbidity and mortality following allogeneic hematopoietic cell transplantation (allo-HCT). In the absence of safe and effective antiviral treatments, virus-specific T cells have emerged as a promising therapeutic option. Posoleucel is a multivirus-specific T-cell therapy for off-the-shelf use against six viral infections that commonly occur in allo-HCT recipients: adenovirus, BK virus (BKV), cytomegalovirus, Epstein-Barr virus, human herpes virus-6, and JC virus.

PATIENTS AND METHODS: We conducted an open-label, phase II trial to determine the feasibility and safety of posoleucel in allo-HCT recipients infected with one or more of these viruses. Infections were either …

Perspectives Of Health Care Staff On Predictors Of Success In A Food Prescription Program: A Qualitative Study, John Wesley Mcwhorter, Jennifer N Aiyer, Nalini Ranjit, Jack Toups, Esther Liew, Jemima C John, Shreela V Sharma

Faculty, Staff and Student Publications

Partnerships between food prescription programs and food banks can address food insecurity and support health; however, few studies have examined the experience and perceptions of health care partners about these programs. Our objective was to analyze secondary qualitative data from clinicians and clinic staff involved in implementing a food prescription program in Houston, Texas. We collected data from 17 health care clinics from May 2018 through March 2021 to learn how implementation of the food prescription program was perceived, and we received 252 responses. Principal themes were the importance of a value-based care strategy, patient and food pantry barriers to …

Notch Blockade Specifically In Bone Marrow-Derived Fsp-1-Positive Cells Ameliorates Renal Fibrosis, Yongdong Wu, Ming Liang, Fengzhang Huang, Owen H Cheng, Xiaoguang Xiao, Tae Hoon Lee, Luan Truong, Jizhong Cheng

Faculty, Staff and Students Publications

Background: The infiltration of inflammatory cells during a kidney injury stimulates myofibroblast activation leading to kidney fibrosis. Fibroblast-specific protein 1 (FSP-1) positive cells have been reported as either myofibroblasts or monocytes during tissue fibrosis. The functions of FSP-1+ cells that are associated with the development of renal fibrosis and the signaling pathways that regulate FSP-1+ cell activation have not been well defined. Methods: In mice with unilateral ureteral obstruction (UUO), we characterized FSP-1+ cells and determined the role of the Notch signaling pathway in the activation of bone marrow-derived FSP-1+ cells during kidney fibrosis. Results: In kidneys from mice with …

Anti-Glomerular Basement Membrane Disease Presenting With Renal Failure And Extensive Deep Venous Thrombosis, Alec Rhodes, Zainab Shakir, Lakshmi Tatineni, Sivatej Sarva, Ramesh Kesavan

Gulf Coast Division GME Research Day 2023

No abstract provided.

Suspected Angioedema Caused By Gabapentin In A Young Patient: A Case Report, Andrew Kim, Elizabeth Benge, Cristian Valdez, Aaron Singh, Manish Kanakunta

Far West Division GME Research Day 2023

No abstract provided.

Unexpected Complications Involving A Subdermal Facial Piercing In A Patient With Tricuspid Endocarditis, A Case Report, Andrew Kim, Cristian Valdez, Tony Alarcon

Far West Division GME Research Day 2023

No abstract provided.

Metformin Induced Erythema Annulare Centrifugum Mimicking Community Acquired Mrsa Skin Infections, Emmanuel Garrastegui-Mercado, Suresh Antony

Central & West Texas GME Research Day 2023

No abstract provided.

An Interesting Case Of Libman-Sacks Endocarditis, Nam Tran, David Kenison, Hasan Seede, Julian Nguyen

Gulf Coast Division GME Research Day 2023

No abstract provided.

Lungs Of A Chronic Smoker: The Case Of Heroin Induced Emphysema In A 35-Year-Old Male, Neil Gerts, George Ishak, Ian Joel, Jasprit Takher

Far West Division GME Research Day 2023

No abstract provided.

Multiple Sclerosis In A 32-Year-Old Female With History Of Prolactinoma, Aleeza Ali, Jesse Simon, Adekunle Bamgboye

East Florida Division GME Research Day 2023

Among disorders affecting the central nervous system (CNS), excluding trauma, multiple sclerosis (MS) is the most common cause of permanent disability in young adults. This condition is characterized by IgG autoantibody-mediated destruction of oligodendrocytes in the brain and spinal cord. Although the origin of MS is not fully understood, some suggest that prolactin may be involved in the development of the disease process evidenced by the fact that it predominately affects women of childbearing age, and the diverse role of prolactin (PRL) as a peptide hormone, cytokine, and immune modulator. Here we review the case of a 32-year-old female with …

Severe Case Of Systemic Lupus Erythematosus In A 36-Year-Old Male, Aleeza Ali, Max Kaito, Stanley Dennison, Hanan Zisling, Esam Khalifa, John Romano

East Florida Division GME Research Day 2023

Systemic Lupus Erythematosus (SLE) is a multifactorial autoimmune disease that is capable of involving almost any organ in the body, leading to significant morbidity and mortality in affected patients. SLE is characterized by pathogenic autoantibodies that react with antigens and form immune complexes, resulting in tissue damage and a potential wide array of manifestations, including arthralgias, lupus nephritis, pleuritis, and delirium. Experts cite the effect of estrogens or factors related to the X chromosome as possible explanations regarding the increased prevalence of SLE in women over men, with ratios of up to 15:1. Here, we discuss the case of a …

Short Qt Syndrome (Sqts), George Shaker, Igbayilola Dosunmu, Jason Kim, Tiffany Guillen, Kevin Kuang

East Florida Division GME Research Day 2023

Please see supplemental content for full abstract.

Short QT syndrome (SQTS) is a rare inherited arrhythmogenic disorder characterized by abnormally short QT interval on electrocardiogram (ECG) secondary to a cardiac channelopathy in the absence of structural heart disease.3 Defective function of the potassium-calcium ion channels in SQTS patients facilitates an increased risk of ventricular and atrial arrhythmias, which can lead to symptoms such as syncope or cardiac arrest.2 In this report, we present a 24-year-old male with a past medical history SQTS with prior cardiac arrest and ventricular fibrillation, status post ICD placement and cardiac sympathectomy, who presented with increased …

Shocking Side Effect: Hypophosphatemia Induced By Hydrochlorothiazide, Kenneth Salu

Gulf Coast Division GME Research Day 2023

No abstract provided.

A Case Of Embolic Stroke Due To Native Mitral Valve Pasteurella Multocida Infective Endocarditis, Alexia Foy-Crowder, Omar Kandah, Mohamed Faris

South Atlantic Division GME Research Day 2023

No abstract provided.

Performance Of Amiodarone As A First-Line Pharmacologic Agent To Treat New Onset Atrial Fibrillation In Patients With Sepsis And Septic Shock: A Retrospective Cohort Study In A Large U.S. Hospital System, Blerina Asllanaj, Elizabeth Benge, Don Pepito

Far West Division GME Research Day 2023

No abstract provided.

Renal Dysfunction Due To Mitral Valve Repair-Induced Hemosiderosis With Partial Recovery After Corrective Surgery, Nicole Fernandez, Gilad Guez, Abdelaziz Elsanjak, Christine Vanbeek

Capital Division GME Research Day 2023

No abstract provided.

Confusion, Pruritus, And Purple Skin: A Case Of Hypereosinophilic Syndrome, Blane Alost, Asha Kurian

Central & West Texas GME Research Day 2023

No abstract provided.

Mycotic Aortic Abdominal Aneurysm: A Rare Case, Jazmine Duran, Judy Jin, Skyler Westerfeld

Central & West Texas GME Research Day 2023

No abstract provided.

Covid-19 Vaccine Induced Rhabdomyolysis In A 53 Year-Old Female, Akash Hazari, Jack Chien, Daniel Nunez, Saurabh Pande

Central & West Texas GME Research Day 2023

No abstract provided.

A Case Of Acquired Acrodermatitis Enteropathica Associated With Inflammatory Bowel Disease And Amyloidosis, Laura Landis, Mitalie Gupta, Ricardo Estrada, Kathryn Hall, Adam Gomez

Central & West Texas GME Research Day 2023

No abstract provided.

Left Atrial Enlargement In Primary Cryptogenic Strokes Without Atrial Fibrillation, Hytham Rashid, Jonathan Brown, Negar Niknam, Tusharkumar Pansuriya, Sivatej Sarva, Syed Danyal Raza

Gulf Coast Division GME Research Day 2023

No abstract provided.

Free-Floating Thrombus In The Right Coronary Artery Complicating Unstable Angina, Marc Lozano, Andrew Sephien, Qitan Huang, Aakash Patel

West Florida Division GME Research Day 2023

No abstract provided.

Metformin-Induced Giant Cell Arteritis: An Uncommon Case Of Drug-Induced Vasculitis, Christine Angeles, Wendy Lee

South Atlantic Division GME Research Day 2023

No abstract provided.

Development Of A Prediction Model For Atrial Fibrillation In Patients With Heart Failure And Preserved Ejection Fraction: Secondary Analysis Of Treatment Of Preserved Cardiac Function Heart Failure With An Aldosterone Antagonist (Topcat) Trial, Khaled Elkholey, Stavros Stavrakis

TriStar Division Research Day 2023

No abstract provided.

Myocarditis With Concurrent Monkeypox: More Than An Association?, Anwar Alshaakh Moh'd Mari, Jorge Restrepo, Minh Q. Ho, Mohammed Ahmed

North Florida Division GME Research Day 2023

No abstract provided.