Internal Medicine Commons^™

Assessment Of Symptom, Disability, And Financial Trajectories In Patients Hospitalized For Covid-19 At 6 Months, Andrew J Admon, Theodore J Iwashyna, Lee A Kamphuis, Stephanie J Gundel, Sarina K Sahetya, Ithan D Peltan, Steven Y Chang, Jin H Han, Kelly C Vranas, Kirby P Mayer, Aluko A Hope, Sarah E Jolley, Ellen Caldwell, Max L Monahan, Katrina Hauschildt, Samuel M Brown, Neil R Aggarwal, B Taylor Thompson, Catherine L Hough

Faculty, Staff and Student Publications

IMPORTANCE: Individuals who survived COVID-19 often report persistent symptoms, disabilities, and financial consequences. However, national longitudinal estimates of symptom burden remain limited.

OBJECTIVE: To measure the incidence and changes over time in symptoms, disability, and financial status after COVID-19-related hospitalization.

DESIGN, SETTING, AND PARTICIPANTS: A national US multicenter prospective cohort study with 1-, 3-, and 6-month postdischarge visits was conducted at 44 sites participating in the National Heart, Lung, and Blood Institute Prevention and Early Treatment of Acute Lung Injury Network's Biology and Longitudinal Epidemiology: COVID-19 Observational (BLUE CORAL) study. Participants included hospitalized English- or Spanish-speaking adults without severe prehospitalization …

Cellular Factors That Shape The Activity Or Function Of Nitric Oxide-Stimulated Soluble Guanylyl Cyclase, Iraida Sharina, Emil Martin

Faculty, Staff and Student Publications

NO-stimulated guanylyl cyclase (SGC) is a hemoprotein that plays key roles in various physiological functions. SGC is a typical enzyme-linked receptor that combines the functions of a sensor for NO gas and cGMP generator. SGC possesses exclusive selectivity for NO and exhibits a very fast binding of NO, which allows it to function as a sensitive NO receptor. This review describes the effect of various cellular factors, such as additional NO, cell thiols, cell-derived small molecules and proteins on the function of SGC as cellular NO receptor. Due to its vital physiological function SGC is an important drug target. An …

Renal Cell Carcinoma Presenting With Upper Gastrointestinal Bleeding: A Case Report, James Mega, Rene Roberts, Mohamed M Shahin, Ahmed Kamel Abdel Aal

Faculty, Staff and Student Publications

Renal cell carcinoma (RCC) is increasing in incidence as more cross sectional imaging is performed with approximately 20%-30% of cases presenting with metastasis at the time of diagnosis. Small bowel metastatic disease is rare, with RCC to the small bowel being exceptionally rare. We present a case report of metastatic RCC that initially presented as upper gastrointestinal bleeding at time of diagnosis. We also provide a brief discussion of small bowel metastatic RCC disease and literature review.

Rapid Clinical Expansion And The Fate Of The Hospitalist Educator, Julia B Caton, Shannon K Martin, Marisha Burden, Zaven Sargsyan, Michelle Brooks, Daniel N Ricotta

Faculty, Staff and Students Publications

No abstract provided.

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 …

Impacts Of Dietary Lysine And Crude Protein On Performance, Hepatic And Renal Functions, Biochemical Parameters, And Histomorphology Of Small Intestine, Liver, And Kidney In Broiler Chickens, Mohamed A Mousa, Ahamed S Asman, Reham M J Ali, Ramy K A Sayed, Kamlah A Majrashi, Khloud G Fakiha, Rashed A Alhotan, Shaimaa Selim

Faculty, Staff and Student Publications

The present study aimed to investigate the effects of increasing dietary lysine (Lys) levels with an adequate dietary crude protein (CP) content, as well as the effects of a reduction in dietary CP content with the recommended amino acid (AAs) level, on the performance, blood biochemical parameters, and histomorphology of the duodenum, liver, and kidney in broiler chickens. A total of 500 broiler chickens were randomly distributed into five dietary treatment groups, following a completely randomized design, where, at the beginning, the control group (C) was fed a diet containing the standard CP and Lys levels: 23% CP with 1.44% …

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.

Supplementing Glycine And N-Acetylcysteine (Glynac) In Older Adults Improves Glutathione Deficiency, Oxidative Stress, Mitochondrial Dysfunction, Inflammation, Physical Function, And Aging Hallmarks: A Randomized Clinical Trial, Premranjan Kumar, Chun Liu, James Suliburk, Jean W Hsu, Raja Muthupillai, Farook Jahoor, Charles G Minard, George E Taffet, Rajagopal V Sekhar

Faculty, Staff and Students Publications

BACKGROUND: Elevated oxidative stress (OxS), mitochondrial dysfunction, and hallmarks of aging are identified as key contributors to aging, but improving/reversing these defects in older adults (OA) is challenging. In prior studies, we identified that deficiency of the intracellular antioxidant glutathione (GSH) could play a role and reported that supplementing GlyNAC (combination of glycine and N-acetylcysteine [NAC]) in aged mice improved GSH deficiency, OxS, mitochondrial fatty-acid oxidation (MFO), and insulin resistance (IR). To test whether GlyNAC supplementation in OA could improve GSH deficiency, OxS, mitochondrial dysfunction, IR, physical function, and aging hallmarks, we conducted a placebo-controlled randomized clinical trial.

METHODS: Twenty-four …

Fluorescence Angiography With Dual Fluorescence For The Early Detection And Longitudinal Quantitation Of Vascular Leakage In Retinopathy, Benjamin Pomeroy, Alexander W Venanzi, Wei Li, Abigail S Hackam, Midhat H Abdulreda

Faculty, Staff and Students Publications

BACKGROUND: Diabetic retinopathy (DR) afflicts more than 93 million people worldwide and is a leading cause of vision loss in working adults. While DR therapies are available, early DR development may go undetected without treatment due to the lack of sufficiently sensitive tools. Therefore, early detection is critically important to enable efficient treatment before progression to vision-threatening complications. A major clinical manifestation of early DR is retinal vascular leakage that may progress from diffuse to more localized focal leakage, leading to increased retinal thickness and diabetic macular edema (DME). In preclinical research, a hallmark of DR in mouse models is …

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 …

The “Evolving” Role Of Intravascular Imaging In Myocardial Infarction With Nonobstructive Coronary Arteries, D L Fischman, Vaikom S. Mahadevan, Eric R. Bates

Division of Internal Medicine Faculty Papers & Presentations

No abstract provided.

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 …

Diagnosis Of Amyotrophic Lateral Sclerosis By Respiratory Function Test, Francesca Polverino, Simone Sampaolo, Antonio Capuozzo, Marco Fasolino, Michele Aliberti, Ersilia Satta, Carlo Santoriello, Mario Polverino

Faculty, Staff and Students Publications

The diagnostic criterion for amyotrophic lateral sclerosis (ALS) based on the findings of concomitant clinical and electrophysiological evidence of upper and lower motor neuron involvement may remain unsatisfied for months and in some patients, even for years in the early stage of the disease. Since respiratory involvement is an onset symptom of ALS in only 1-3% of patients, pulmonary assessment has never been considered useful in the early diagnosis of ALS. However, studies on pulmonary function are lacking, especially in those early stages where neurologic tests are also inconclusive. In contrast to the scarcity of data in the early stages, …

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 …

Reply To The Letter To The Editor Titled “Before Blaming Legionella For Severe Rhabdomyolysis, Consider Alternative Triggers”, Harish Gopalakrishna, Ahmad Al-Abdouh, Gayatri Nair, Vinod Solipuram, Ammer Bekele

Journal of Community Hospital Internal Medicine Perspectives

No abstract provided.

Characteristics And Weight Loss Practices From A Cohort Of 20,000 Patients Using Direct-To-Consumer Telehealth: Observational Cross-Sectional Study, Deborah Bade Horn, Elizabeth Pash, Megan S Zhou, Lauren Broffman, Damian Bialonczyk, Tzvi Doron, Elaine Chiquette

Faculty, Staff and Student Publications

BACKGROUND: Despite the increasing prevalence of obesity, the use of pharmacotherapy treatment remains low. Telehealth platforms have the potential to facilitate access to pharmacotherapy interventions, but little is known about telehealth patients.

OBJECTIVE: This study describes a large patient population taking Plenity, an oral superabsorbent hydrogel (OSH) used in the treatment of excess weight or obesity (BMI 25-40 kg/m

METHODS: This was a cross-sectional assessment of a random sample of 20,000 telehealth patients who completed a structured, web-based visit and received at least one prescription of OSH. Patients were eligible to receive care via telehealth if they were adults, were …

Feasibility And Preclinical Efficacy Of Cd7-Unedited Cd7 Car T Cells For T Cell Malignancies, Norihiro Watanabe, Feiyan Mo, Rong Zheng, Royce Ma, Vanesa C Bray, Dayenne G Van Leeuwen, Juntima Sritabal-Ramirez, Hongxiang Hu, Sha Wang, Birju Mehta, Madhuwanti Srinivasan, Lauren D Scherer, Huimin Zhang, Sachin G Thakkar, Laquisa C Hill, Helen E Heslop, Chonghui Cheng, Malcolm K Brenner, Maksim Mamonkin

Faculty, Staff and Students Publications

Chimeric antigen receptor (CAR)-mediated targeting of T lineage antigens for the therapy of blood malignancies is frequently complicated by self-targeting of CAR T cells or their excessive differentiation driven by constant CAR signaling. Expression of CARs targeting CD7, a pan-T cell antigen highly expressed in T cell malignancies and some myeloid leukemias, produces robust fratricide and often requires additional mitigation strategies, such as CD7 gene editing. In this study, we show fratricide of CD7 CAR T cells can be fully prevented using ibrutinib and dasatinib, the pharmacologic inhibitors of key CAR/CD3ζ signaling kinases. Supplementation with ibrutinib and dasatinib rescued the …

Point And Counterpoint: Polatuzumab Vedotin In The Front-Line Therapy For Diffuse Large B- Cell Lymphoma, Colin Thomas, Sameep Thapa, Connor Mclaughlin, Molly Halloran, Porcu Pierluigi

Department of Medical Oncology Faculty Papers

No abstract provided.

Bending The Patient Safety Curve: How Much Can Ai Help?, David C Classen, Christopher Longhurst, Eric J Thomas

Faculty, Staff and Student Publications

This paper reviews the current state of patient safety and the application of artificial intelligence (AI) techniques to patient safety. This paper defines patient safety broadly, not just inpatient care but across the continuum of care, including diagnostic errors, misdiagnosis, adverse events, injuries, and measurement issues. It outlines the major current uses of AI in patient safety and the relative adoption of these techniques in hospitals and health systems. It also outlines some of the limitations of these AI systems and the challenges with evaluation of these systems. Finally, it outlines the importance of developing a proactive agenda for AI …

Bending The Patient Safety Curve: How Much Can Ai Help?, David C Classen, Christopher Longhurst, Eric J Thomas

Faculty, Staff and Student Publications

This paper reviews the current state of patient safety and the application of artificial intelligence (AI) techniques to patient safety. This paper defines patient safety broadly, not just inpatient care but across the continuum of care, including diagnostic errors, misdiagnosis, adverse events, injuries, and measurement issues. It outlines the major current uses of AI in patient safety and the relative adoption of these techniques in hospitals and health systems. It also outlines some of the limitations of these AI systems and the challenges with evaluation of these systems. Finally, it outlines the importance of developing a proactive agenda for AI …

Bending The Patient Safety Curve: How Much Can Ai Help?, David C Classen, Christopher Longhurst, Eric J Thomas

Faculty, Staff and Student Publications

This paper reviews the current state of patient safety and the application of artificial intelligence (AI) techniques to patient safety. This paper defines patient safety broadly, not just inpatient care but across the continuum of care, including diagnostic errors, misdiagnosis, adverse events, injuries, and measurement issues. It outlines the major current uses of AI in patient safety and the relative adoption of these techniques in hospitals and health systems. It also outlines some of the limitations of these AI systems and the challenges with evaluation of these systems. Finally, it outlines the importance of developing a proactive agenda for AI …

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 …

Functional Assessment Data: Current Status Of Federal Initiatives To Support Interoperability Among Post Acute Care Settings, Edgar Chou

Division of Internal Medicine Faculty Papers & Presentations

Health information needed along the transitions in care includes functional status such as self-care abilities assessments. Despite current federal efforts to support interoperability of functional status data, gaps still exist. Functional status assessments are included in data collection instruments widely used in four post acute care (PAC) settings, with each type of setting using a different standard instrument. These various instruments lack a shared standard for the content (meaning) of functional assessment items, necessitating mapping to a standard data terminology. Analysis indicates complete LOINC representation and incomplete SNOMED representation among functional status items and instruments. The new U.S. Core Data …

Radiofrequency Ablation Remodels The Tumor Microenvironment And Promotes Neutrophil-Mediated Abscopal Immunomodulation In Pancreatic Cancer, Erika Y Faraoni, Baylee J O'Brien, Lincoln N Strickland, Baron K Osborn, Victoria Mota, Jarod Chaney, Constance Lynn Atkins, Putao Cen, Julie Rowe, Jessica Cardenas, Kyle L Poulsen, Curtis J Wray, Nirav C Thosani, Jennifer M Bailey-Lundberg

Faculty, Staff and Student Publications

Pancreatic ductal adenocarcinoma (PDAC) presents a 5-year overall survival rate of 11%, despite efforts to improve clinical outcomes in the past two decades. Therapeutic resistance is a hallmark of this disease, due to its dense and suppressive tumor microenvironment (TME). Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) is a promising local ablative and potential immunomodulatory therapy for PDAC. In this study, we performed RFA in a preclinical tumor-bearing KrasG12D; Trp53R172H/+; Pdx1:Cre (KPC) syngeneic model, analyzed local and abscopal affects after RFA and compared our findings with resected PDAC specimens. We found that RFA reduced PDAC tumor progression in vivo and promoted strong …

Rapid Onset Hydralazine-Induced Antineutrophil Cytoplasmic Antibody (Anca) Associated Vasculitis Presenting With Hemoptysis And Kidney Failure: Case Report, Rachel E. Easter, Andinet Gizaw, Natalie Klein

Internal Medicine Publications

Hydralazine-induced vasculitis can be challenging to recognize and diagnose as presenting symptoms vary and can mimic other conditions or diseases, however, swift intervention and treatment is key in halting progression of the disease and providing patients with the best possible outcomes. A 71-year-old African American female presented to the emergency department with weakness, fatigue, anemia, blood-streaked sputum, fever, chills, and severe myalgias. Hydralazine was prescribed to treat resistant hypertension eight months prior to presentation. Hydralazine was discontinued on hospital day (HD) 4. Pertinent laboratory values showed elevated inflammatory markers, positive antinuclear antibody (ANA), negative rheumatoid factor (RF), normal complement levels, …

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.