Internal Medicine Commons^™

Deeper Seated Than Skin Deep: Report Of A Rare Case Of Follicular Occlusion Tetrad And A Literature Review, Yilen K. Ng-Wong, Blesset Alexander, Mery Bartl, Christine E. Loftis, Dina Hammad, Emilia C. Dulgheru, Mauricio De La Garza, Aidee C. Nunez

School of Medicine Publications

Follicular occlusion tetrad (FOT) is a clinical syndrome consisting of hidradenitis suppurativa (HS), acne conglobata (AC), dissecting cellulitis of the scalp (DCS), and pilonidal cyst (PC). These entities typically occur independently, but occasionally present simultaneously comprising FOT. The four components share similar pathophysiology affecting the apocrine glands, follicular hyperkeratinization being the hallmark of each entity.Understanding shared similarities of each disease is paramount for the treatment approach as the relapsing and chronic nature of this syndrome can be burdening to patients. We present the case of a 22- year-old obese Hispanic man with a history of tobacco use who presented with …

Tapped Twice: A Case Of A Rapidly Re-Accumulating Hepatic Hydrothorax In A Patient With Spontaneous Bacterial Empyema, Amir Khalil, Suma Alzouhayli, Silvia Novakova, Saad Shams, Ahmad Baiyasi, Maria Khalil, Mohammed Uddin, Aryan Shiari, Kareem Bazzy

The University of Louisville Journal of Respiratory Infections

Hepatic hydrothorax (HH) is a complication of decompensated liver cirrhosis that only occurs in about 5–6% of cirrhosis patients, defined as a pleural fluid in the setting of known liver disease, with the absence of any other cardiopulmonary etiology. Infected HH is a rare complication, designated as spontaneous bacterial empyema (SBEM), found in only 13–16% of patients with HH. This case follows a patient with SBEM who developed a recurrent pleural effusion minutes after thoracentesis. Our patient is a 56-year-old female with a history of alcoholic cirrhosis with pleuritic pain found to have right-sided pleural effusion with decompensation. She had …

A Phase 2 Study Of Nivolumab Combined With Ibrutinib In Patients With Diffuse Large B-Cell Richter Transformation Of Cll, Nitin Jain, Jayastu Senapati, Beenu Thakral, Alessandra Ferrajoli, Philip Thompson, Jan Burger, Sreyashi Basu, Tapan Kadia, Naval Daver, Gautam Borthakur, Marina Konopleva, Naveen Pemmaraju, Erin Parry, Catherine J Wu, Joseph Khoury, Carlos Bueso-Ramos, Naveen Garg, Xuemei Wang, Wanda Lopez, Ana Ayala, Susan O'Brien, Hagop Kantarjian, Michael Keating, James Allison, Padmanee Sharma, William Wierda

Faculty, Staff and Student Publications

Richter transformation (RT) is a rare complication of chronic lymphocytic leukemia (CLL) that has dismal outcomes. Upregulation of PD-1/PD-L1 drives immunological evasion in patients with RT. We hypothesized that combining nivolumab, a PD-1 blocking antibody, with the BTK inhibitor (BTKi) ibrutinib could potentiate tumor-cell killing. We conducted an investigator-initiated phase 2 clinical trial to assess the efficacy of combined nivolumab and ibrutinib in patients with diffuse large B-cell lymphoma (DLBCL) RT and CLL. Patients included were ≥18 years of age with adequate hepatic and renal function. Patients received nivolumab every 2 weeks of a 4-week cycle for a maximum of …

Rare Autoimmune Disease Caused By Not-So Rare Virus, Tiffany Marchewka, Acho Bernard, Molly Kempa, Kathryn Heal, Joseph M. Fullmer

Conference Presentation Abstracts

No abstract provided.

Hiv-1 Transmission Among Injecting Drug Users Is Principally Derived From Local Circulating Strains In Guangxi, China, Ping Cen, Hua Yue Liang, Yuan Yang, Fei Zhang, Shi Xiong Yang, Ju Cong Mo, Yi Feng, Jie Gang Huang, Chuan Yi Ning, Chun Yuan Huang, Yao Yang, Na Liang, Bing Yu Liang, Li Ye, Hao Liang

Faculty, Staff and Student Publications

OBJECTIVE: The mode of human immunodeficiency virus (HIV) transmission

METHODS: We performed a molecular epidemiological investigation of infections across Guangxi from 2009 to 2019. Phylogenetic and Bayesian time-geographic analyses of HIV-1 sequences were performed to confirm the characteristics of transmission between IDUs in combination with epidemiological data.

RESULTS: Among the 535 subjects, CRF08_BC (57.4%), CRF01_AE (28.4%), and CRF07_BC (10.7%) were the top 3 HIV strains; 72.6% of infections were linked to other provinces in the transmission network; 93.6% of sequence-transmitted strains were locally endemic, with the rest coming from other provinces, predominantly Guangdong and Yunnan; 92.1% of the HIV transmission …

Parent Perspectives Of School/Daycare Experiences In Young Children Newly Diagnosed With Diabetes, Alexa Stern, Brenda Duran, Randi Streisand, Christine H Wang, Carrie Tully, Lauren Clary, Katherine Gallagher, Fran Cogen, Lefkothea Karaviti, Maureen Monaghan, Marisa E Hilliard

Faculty, Staff and Students Publications

OBJECTIVE: A central part of family adjustment to a new diagnosis of type 1 diabetes (T1D) is integrating T1D management into the child's school/daycare. This may be particularly challenging for young children who rely on adults for their diabetes management. This study aimed to describe parent experiences with school/daycare during the first 1.5 years following a young child's T1D diagnosis.

METHODS: As part of a randomized controlled trial of a behavioral intervention, 157 parents of young children with new-onset (<2 >months) T1D reported on their child's school/daycare experience at baseline and at 9- and 15-month post-randomization. We used a mixed-methods …

Co-Delivery Of Therapeutics And Bioactive Gas Using A Novel Liposomal Platform For Enhanced Treatment Of Acute Arterial Injury, Shao-Ling Huang, Melanie R Moody, Xing Yin, David D Mcpherson, Hyunggun Kim

Faculty, Staff and Student Publications

Atherosclerosis is a complex, multi-stage disease characterized by pathological changes across the vascular wall. Endothelial dysfunction, inflammation, hypoxia, and vascular smooth muscle cell proliferation contribute to its progression. An effective strategy capable of delivering pleiotropic treatment to the vascular wall is essential to limit neointimal formation. Echogenic liposomes (ELIP), which can encapsulate bioactive gases and therapeutic agents, have the potential to deliver enhanced penetration and treatment efficacy for atherosclerosis. In this study, liposomes loaded with nitric oxide (NO) and rosiglitazone, a peroxisome proliferator-activated receptor agonist, were prepared using hydration, sonication, freeze-thawing, and pressurization. The efficacy of this delivery system was …

Blockchain-Enabled Immutable, Distributed, And Highly Available Clinical Research Activity Logging System For Federated Covid-19 Data Analysis From Multiple Institutions, Tsung-Ting Kuo, Anh Pham, Maxim E Edelson, Jihoon Kim, Jason Chan, Yash Gupta, Lucila Ohno-Machado

Faculty, Staff and Student Publications

OBJECTIVE: We aimed to develop a distributed, immutable, and highly available cross-cloud blockchain system to facilitate federated data analysis activities among multiple institutions.

MATERIALS AND METHODS: We preprocessed 9166 COVID-19 Structured Query Language (SQL) code, summary statistics, and user activity logs, from the GitHub repository of the Reliable Response Data Discovery for COVID-19 (R2D2) Consortium. The repository collected local summary statistics from participating institutions and aggregated the global result to a COVID-19-related clinical query, previously posted by clinicians on a website. We developed both on-chain and off-chain components to store/query these activity logs and their associated queries/results on a blockchain …

A Rare Cause Of Lymphadenopathy In A Young Hispanic Female: Unmasking Recurrent Nodal Rosai-Dorfman Disease, Blesset Alexander, Alfarooq Alshaikhli, Mery Bartl, Emilia Dulgheru

School of Medicine Publications

Rosai-Dorfman disease (RDD) is a rare histiocytic disorder that can present with painless bilateral symmetrical cervical lymphadenopathy, mimicking lymphomas. RDD is characterized by excessive tissue infiltration by dendritic cells, macrophages, or monocyte-derived cells, with a histopathologic diagnosis based on the presence of CD68+, CD163+, and S100+ histiocytes, which differentiate it from other histiocytic neoplasms. In this case report, we present a young Hispanic female with recurrent subcutaneous growths and lymphadenopathy, initially thought to be lymphoma, who was diagnosed with RDD after a significant diagnostic workup. Treatment initially consisted of surgical excision; however, due to recurrence, the patient was successfully treated …

Sarcopenia And Cardiovascular Diseases, Abdulla A Damluji, Maha Alfaraidhy, Noora Alhajri, Namit N Rohant, Manish Kumar, Christina Al Malouf, Samira Bahrainy, Min Ji Kwak, Wayne B Batchelor, Daniel E Forman, Michael W Rich, James Kirkpatrick, Ashok Krishnaswami, Karen P Alexander, Gary Gerstenblith, Peggy Cawthon, Christopher R Defilippi, Parag Goyal

Faculty, Staff and Student Publications

Sarcopenia is the loss of muscle strength, mass, and function, which is often exacerbated by chronic comorbidities including cardiovascular diseases, chronic kidney disease, and cancer. Sarcopenia is associated with faster progression of cardiovascular diseases and higher risk of mortality, falls, and reduced quality of life, particularly among older adults. Although the pathophysiologic mechanisms are complex, the broad underlying cause of sarcopenia includes an imbalance between anabolic and catabolic muscle homeostasis with or without neuronal degeneration. The intrinsic molecular mechanisms of aging, chronic illness, malnutrition, and immobility are associated with the development of sarcopenia. Screening and testing for sarcopenia may be …

Apolipoprotein E Dyslipidemia And Nephrotic Syndrome: A Rare Connection, Sahana Tito, Avica Atri, Shivaraj Patil, Saima Dean, Sweta Carpenter

Einstein Health Papers

Severe hyperlipidemia warrants an extensive evaluation. We report a case of a 25-year-old man of Chinese descent seen in the cardiology-lipid clinic. He was found to have a serum low-density lipoprotein cholesterol of 12.12 mmol/L (468 mg/dL) and serum triglycerides of 2.29 mmol/L (203 mg/dL) during routine screening. Work-up revealed nephrotic-range proteinuria, and renal biopsy showed dilated glomerular capillary loops with lipid deposits, pathognomonic of lipoprotein glomerulopathy. Genetic studies showed apolipoprotein E3/E4 phenotype. He was treated with a high-intensity statin and fibrate therapy, which resulted in a marked improvement in dyslipidemia and proteinuria.

Gastrointestinal Bleeding As Initial Manifestation Of Injection Drug Use-Associated Amyloidosis, Mohammed Rifat Shaik, Nishat Anjum Shaikh, Elvina Yunasan, Erika Wheeler, Robert T Chow

Journal of Community Hospital Internal Medicine Perspectives

Systemic amyloidosis has been reported in the context of injection drug use, usually related to ongoing chronic inflammation and persistent cutaneous infections. The kidneys are almost always the first organs affected in that setting. Involvement of the gastrointestinal tract is less common and rarely the initial site of presentation. We present a case of systemic amyloidosis that primarily manifested in the gastrointestinal tract, occurring in the setting of chronic injection drug use. The patient's hemoglobin level dropped progressively over time due to ongoing, slow gastrointestinal bleeding, prompting an endoscopic examination that ultimately confirmed the presence of gastrointestinal amyloidosis. As the …

Prevalence And Impact Of Gastrointestinal Manifestations In Covid-19 Patients: A Systematic Review, Bassam Hossain, Shoreh Qazi, Sumair Ahmad, Atif Saleem, Amanke Oranu, Fahad Malik

Journal of Community Hospital Internal Medicine Perspectives

Background and Objective: The aim of this study is to systematically analyze and summarize the implications of COVID-19 on the digestive system by quantitatively evaluating the prevalence of gastrointestinal symptoms such as nausea, vomiting, abdominal pain, constipation, diarrhea, anorexia. reported in COVID-19 cases. We simultaneously investigated other variables to determine the association of such symptoms in COVID-19 patients which can potentially influence the disease prognosis and outcome. This systematic review presents an updated literature on the issue as it requires more scientific discussion in order to better inform the medical community and authorities so that appropriate measures can be taken …

Home Oxygen And Monitoring For Covid-19 Patients: A Multidisciplinary Team Approach, Mahta Salehi, Shehrose Chaudry, Rebecca B. Newman, Josette Hartnett, Suzanne J. Rose, Forugh Homayounrooz

Journal of Community Hospital Internal Medicine Perspectives

Introduction: During the initial COVID-19 pandemic peak, Stamford Hospital implemented a home oxygen program (HOP) to create a comprehensive, multi-disciplinary outpatient initiative without sacrificing a safe discharge. Primary care physicians monitored program participants, whose only indication for remaining admitted was an oxygen requirement. We retrospectively examined participant co-morbidities and outcomes, including death and readmission rates to evaluate HOP safety.

Methods: A retrospective analysis of program participants discharged between April 2020-Janurary 2021 was performed. Variables included demographics, oxygen requirement, days enrolled in the HOP, and major comorbidities such as cardiovascular disease (CVD), diabetes (DM), hypertension (HTN), obesity, chronic kidney disease, malignancies …

Confidence-Based Laboratory Test Reduction Recommendation Algorithm, Tongtong Huang, Linda T Li, Elmer V Bernstam, Xiaoqian Jiang

Faculty, Staff and Student Publications

BACKGROUND: We propose a new deep learning model to identify unnecessary hemoglobin (Hgb) tests for patients admitted to the hospital, which can help reduce health risks and healthcare costs.

METHODS: We collected internal patient data from a teaching hospital in Houston and external patient data from the MIMIC III database. The study used a conservative definition of unnecessary laboratory tests, which was defined as stable (i.e., stability) and below the lower normal bound (i.e., normality). Considering that machine learning models may yield less reliable results when trained on noisy inputs containing low-quality information, we estimated prediction confidence to assess the …

Functional Neuronal Circuits Promote Disease Progression In Cancer, Anthony C Restaino, Austin Walz, Samuel J Vermeer, Jeffrey Barr, Attila Kovács, Robin R Fettig, Daniel W Vermeer, Hunter Reavis, Caitlin S Williamson, Christopher T Lucido, Tuany Eichwald, Dalia K Omran, Euihye Jung, Lauren E Schwartz, Maria Bell, Desirae M Muirhead, Jody E Hooper, William C Spanos, Ronny Drapkin, Sebastien Talbot, Paola D Vermeer

Faculty, Staff and Student Publications

The molecular and functional contributions of intratumoral nerves to disease remain largely unknown. We localized synaptic markers within tumors suggesting that these nerves form functional connections. Consistent with this, electrophysiological analysis shows that malignancies harbor significantly higher electrical activity than benign disease or normal tissues. We also demonstrate pharmacologic silencing of tumoral electrical activity. Tumors implanted in transgenic animals lacking nociceptor neurons show reduced electrical activity. These data suggest that intratumoral nerves remain functional at the tumor bed. Immunohistochemical staining demonstrates the presence of the neuropeptide, Substance P (SP), within the tumor space. We show that tumor cells express the …

A Multimodal Intervention Treatment Plan For Adults With Generalized Anxiety Disorder In Primary Care, Morgan Cullings

Evidence-Based Practice Project Reports

Generalized anxiety disorder (GAD) is a debilitating psychological condition that affects 3.1% of the American population and is one of the leading causes of disability (Anxiety and Depression Association of America, 2022; Baxter, 2014). The purpose of this evidence-based practice project was to implement a multimodal intervention to decrease GAD symptoms in adults in the primary care setting. The PICOT question that guided this project was: In adults, over the age of 18, who have been diagnosed with generalized anxiety disorder (GAD), does the combination of digital cognitive behavioral therapy (CBT) through a smartphone application, lifestyle modification education, and pharmacotherapy …

Cord Blood Transplantation For Nonmalignant Disorders: Early Functional Immunity And High Survival, Caridad Martinez, Paibel Aguayo-Hiraldo, Natalia Chaimowitz, Lisa Forbes, Nicholas Rider, Sarah Nicholas, Filiz Seeborg, Javier Chinen, Ivan Chinn, Carla Davis, Howard Roseblatt, Lenora Noroski, Bilal Omer, Tami John, Khaled Yassine, Swati Naik, John Craddock, Saleh Bhar, Carl Allen, Nabil Ahmed, Ghadir Sasa, David Steffin, Erin Doherty, Anil George, Baheyeldin Salem, Brian Friend, Meenakshi Hegde, Malcolm K Brenner, Helen E Heslop, Ann Leen, Amanda Peña, Mengfen Wu, I Celine Hanson, Robert A Krance

Faculty, Staff and Students Publications

There is no consensus on the best donor for children with nonmalignant disorders and immune deficiencies in the absence of a matched related donor (MRD). We evaluated the 2-year overall survival (OS) after umbilical cord blood transplantation (UCBT) in patients with nonmalignant disorders from 2009 to 2020 enrolled in a prospective clinical trial using either 5/6 or 6/6 UCB as the cell source. Patients receive a fully ablative busulfan, cyclophosphamide, and fludarabine without serotherapy. Fifty-five children were enrolled, median age 5 months (range, 1-111 months); primary immune deficiency (45), metabolic (5), hemophagocytic lymphohistiocytosis (1), and hematologic disorders (4). Twenty-six patients …

Knowledge And Misconceptions Among Lebanese Community On Immunizations, Hala Ahmadieh, Tala Safa, Ihab Nahle, Yahya Obeid, Dalal Hariri, Etaf Rawass, Tala Kanaan, Ahmad Sabalbal

BAU Journal - Health and Wellbeing

Two centuries ago, immunization practices have become the greatest land mark in medical history as they significantly contributed to a decline in several major infectious diseases worldwide thus decreasing both the mortality and morbidity. Moreover, they have been able to eradicate small pox and eliminate poliomyelitis in most regions of the world. However, in recent years the general opinion towards vaccination began shifting due to the emergence of certain opposing views to it, questioning the vaccine's safety and efficacy. This study aims to shed light on the vaccination status in Lebanon by assessing the knowledge, attitude, awareness, and misconceptions among …

Perspectives On Non-Prescription Antibiotic Use Among Hispanic Patients In The Houston Metroplex, Lindsey Laytner, Patricia Chen, Susan Nash, Michael K Paasche-Orlow, Richard Street, Roger Zoorob, Barbara Trautner, Larissa Grigoryan

Faculty, Staff and Students Publications

BACKGROUND: Non-prescription antibiotic use includes taking an antibiotic without medical guidance (e.g., leftovers, from friends/relatives, or purchased without a prescription). Non-prescription use contributes to antimicrobial resistance, adverse drug reactions, interactions, superinfection, and microbiome imbalance. Qualitative studies exploring perspectives regarding non-prescription use among Hispanic patients are lacking. We used the Kilbourne Framework for Advancing Health Disparities Research to identify factors influencing patients' non-prescription use and organize our findings.

METHODS: Our study includes Hispanic primary care clinic patients with different types of health insurance coverage in the Houston metroplex who endorsed non-prescription use in a previous survey. Semistructured interviews explored the factors …