Internal Medicine Commons^™

Does Gender Impact A Diagnosis Of Ankylosing Spondylitis?, Mark C Hwang, Martin Rozycki, David Kauffman, Theresa Arndt, Esther Yi, Michael H Weisman

Faculty, Staff and Student Publications

Objective: The study objective was to explore differences in ankylosing spondylitis (AS) diagnosis experiences between men and women by examining the coding of health events over the 2 years preceding AS diagnosis.

Methods: Claims data (January 2006-April 2019) from the MarketScan databases were examined. Patients who had received two or more AS diagnoses at least 30 days apart and had at least 2 years of insurance enrollment before their first AS diagnosis were analyzed. Men were matched 1:1 to women by age, diagnosis date, insurance type, and enrollment duration. Health events (diagnosis and provider codes) were examined over 2 years …

47xxy And 47xxx In Scleroderma And Myositis, R Hal Scofield, Valerie M Lewis, Joshua Cavitt, Biji T Kurien, Shervin Assassi, Javier Martin, Olga Gorlova, Peter Gregersen, Annette Lee, Lisa G Rider, Terrance O'Hanlon, Simon Rothwell, James Lilleker, Myositis Genetics Consortium, Yuta Kochi, Chikacshi Terao, Ann Igoe, Wendy Stevens, Joanne Sahhar, Janet Roddy, Maureen Rischmueller, Sue Lester, Susanna Proudman, Sixia Chen, Matthew A Brown, Maureen D Mayes, Janine A Lamb, Frederick W Miller

Faculty, Staff and Student Publications

Objective: We undertook this study to examine the X chromosome complement in participants with systemic sclerosis (SSc) as well as idiopathic inflammatory myopathies.

Methods: The participants met classification criteria for the diseases. All participants underwent single-nucleotide polymorphism typing. We examined X and Y single-nucleotide polymorphism heterogeneity to determine the number of X chromosomes. For statistical comparisons, we used χ2 analyses with calculation of 95% confidence intervals.

Results: Three of seventy men with SSc had 47,XXY (P = 0.0001 compared with control men). Among the 435 women with SSc, none had 47,XXX. Among 709 men with polymyositis or dermatomyositis (PM/DM), seven …

Pneumothorax And Pneumomediastinum In Covid-19: A Case Series, Stephan Reyes, Brad Roche, Farah Kazzaz, Daniel Ocazionez, Aditya P Lal, Rosa M Estrada-Y-Martin, Sujith V Cherian

Faculty, Staff and Student Publications

COVID- 19 has become a major pandemic affecting more than 11 million people worldwide. Common radiological manifestations of COVID-19 include peripheral based ground-glass or consolidative opacities; however, pneumothorax and pneumo-mediastinum are very rare manifestations; even more so within patients not on mechanical ventilation. We present a case series of 5 patients with COVID-19 who either presented with or developed spontaneous pneumothorax or pneumo-mediastinum within the course of hospitalization. With the exception of one patient, all other patients developed pneumothorax as a late manifestation in their illness; more than 10 days after initial symptom onset in COVID-19. From within this case …

Patient Perception Of Voxelotor Treatment Benefit In Sickle Cell Disease, Modupe Idowu, Anam Haque, Elisa M Williams, Arthi Sridhar

Faculty, Staff and Student Publications

Patients with sickle cell disease (SCD) experience a range of clinical symptoms, including acute and chronic pain, fatigue, and respiratory problems, as well as chronic organ complications that can lead to disability and accelerated mortality. Voxelotor is a first-in-class therapy that targets sickle hemoglobin polymerization, the root cause of SCD. It is approved by the US Food and Drug Administration for treatment of SCD in patients aged 4 years and older and in the European Union and United Arab Emirates for the treatment of SCD in patients aged 12 years and older. Here, we report the single-center experience of both …

Anal Cytology Screening In Men Who Have Sex With Men With Hiv At A University Hospital In Bogotá, Colombia, I Tatiana Ordoñez-Blanco, Samuel Martínez-Vernaza, Kevin J Blair, Camilo Quiroga, Ellen Lowenstein, Luis J Lombana Amaya, Jesse Clark, Jordan E Lake, Sandra Liliana Valderrama-Beltrán

Faculty, Staff and Student Publications

Background: Risk of anal squamous cell carcinoma (anal cancer) is greater among men who have sex with men (MSM) living with human immunodeficiency virus (HIV). We describe the frequency of and factors associated with abnormal anal cytology results in Colombian MSM living with HIV.

Methods: This retrospective observational cohort study included MSM ≥18 years old living with HIV screened with anal cytology at Hospital Universitario San Ignacio in Bogotá, Colombia between January 2019 and February 2020. A multivariable log-binomial regression model estimated associations with abnormal anal cytology.

Results: A total of 211 patients were included. Mean age was 35.6 years. …

Klif-Associated Cytoskeletal Proteins In Trypanosoma Brucei Regulate Cytokinesis By Promoting Cleavage Furrow Positioning And Ingression, Qing Zhou, Huiqing Hu, Ziyin Li

Faculty, Staff and Student Publications

Cytokinesis in the early divergent protozoan Trypanosoma brucei occurs from the anterior cell tip of the new-flagellum daughter toward the nascent posterior end of the old-flagellum daughter of a dividing biflagellated cell. The cleavage furrow ingresses unidirectionally along the preformed cell division fold and is regulated by an orphan kinesin named kinesin localized to the ingressing furrow (KLIF) that localizes to the leading edge of the ingressing furrow. Little is known about how furrow ingression is controlled by KLIF and whether KLIF interacts with and cooperates with other cytokinesis regulatory proteins to promote furrow ingression. Here, we investigated the roles …

Role Of The Chemokine System In Liver Fibrosis: A Narrative Review, Kyle L Poulsen, Christina K Cajigas-Du Ross, Jarod K Chaney, Laura E Nagy

Faculty, Staff and Student Publications

BACKGROUND AND OBJECTIVE: Liver fibrosis is a disease with characteristics of an aberrant wound healing response. Fibrosis is commonly the end-stage for chronic liver diseases like alcohol-associated liver disease (ALD), metabolic-associated liver disease, viral hepatitis, and hepatic autoimmune disease. Innate immunity contributes to the progression of many diseases through multiple mechanisms including production of pro-inflammatory mediators, leukocyte infiltration and tissue injury. Chemokines and their receptors orchestrate accumulation and activation of immune cells in tissues and are associated with multiple liver diseases; however, much less is known about their potential roles in liver fibrosis. This is a narrative review of current …

Noninvasive Testing And Surrogate Markers In Invasive Fungal Diseases, George R Thompson, David R Boulware, Nathan C Bahr, Cornelius J Clancy, Thomas S Harrison, Carol A Kauffman, Thuy Le, Marisa H Miceli, Eleftherios Mylonakis, M Hong Nguyen, Luis Ostrosky-Zeichner, Thomas F Patterson, John R Perfect, Andrej Spec, Dimitrios P Kontoyiannis, Peter G Pappas

Faculty, Staff and Student Publications

Invasive fungal infections continue to increase as at-risk populations expand. The high associated morbidity and mortality with fungal diseases mandate the continued investigation of novel antifungal agents and diagnostic strategies that include surrogate biomarkers. Biologic markers of disease are useful prognostic indicators during clinical care, and their use in place of traditional survival end points may allow for more rapid conduct of clinical trials requiring fewer participants, decreased trial expense, and limited need for long-term follow-up. A number of fungal biomarkers have been developed and extensively evaluated in prospective clinical trials and small series. We examine the evidence for these …

Impact Of Serum Igg Levels Against Sars-Cov-2 On Clinical Outcomes For Hopitalized Covid Patient, Bipin Ghimire, Bijaya Thapa, Nishant Aggarwal, Luai Madanat, Melinda Sager, Daniel O'Connor, Alexandra Halalau

Conference Presentation Abstracts

BACKGROUND: The SAR-CoV-2 pandemic continues to negatively impact the healthcare system globally with over 800,000 deaths in the United States and millions more worldwide. The cases are rising despite availability of vaccines. For most immunocompetent patients these vaccines will generate a humoral response and also a memory T-cell response. Few if any studies have reported data that measure anti-spike IgG titers and also correlate those titers with clinical outcomes in the instance of breakthrough infection.

METHODS: We conducted a pilot prospective observational clinical study enrolling 30 immunocompetent patients who were admitted with a positive SARS-CoV-2 PCR. Leftover blood from admission …

Why Not Dipyridamole: A Review Of Current Guidelines And Re-Evaluation Of Utility In The Modern Era, Mahmoud Allahham, A Lerman, D Atar, Y Birnbaum

Faculty, Staff and Students Publications

Dipyridamole is an old anti-platelet and coronary vasodilator agent that inhibits platelet phosphodiesterase and increases interstitial adenosine levels. Its use in coronary artery disease (CAD) has fallen out of practice in the modern era with the advent of new anti-platelet agents, and most modern guidelines on the management of CAD either neglect to comment on its utility or outright recommend against it. The majority of the studies used in these guidelines are outdated and took place in an era when high doses of aspirin were used and statins were not widely utilized. There is growing evidence in rat models of …

Prune1 C933g>A Synonymous Variant Induces Exon 7 Skipping, Disrupts The Dhha2 Domain, And Leads To An Atypical Nmihba Syndrome Presentation: Case Report And Review Of The Literature, Christina L Magyar, David R Murdock, Lindsay C Burrage, Hongzheng Dai, Seema R Lalani, Richard A Lewis, Yuezhen Lin, Marcela F Astudillo, Jill A Rosenfeld, Alyssa A Tran, James B Gibson, Undiagnosed Diseases Network, Carlos A Bacino, Brendan H Lee, Hsiao-Tuan Chao

Faculty, Staff and Students Publications

Prune exopolyphosphatase-1 (PRUNE1) encodes a member of the aspartic acid-histidine-histidine (DHH) phosphodiesterase superfamily that regulates cell migration and proliferation during brain development. In 2015, biallelic PRUNE1 loss-of-function variants were identified to cause the neurodevelopmental disorder with microcephaly, hypotonia, and variable brain abnormalities (NMIHBA, OMIM#617481). NMIHBA is characterized by the namesake features and structural brain anomalies including thinning of the corpus callosum, cerebral and cerebellar atrophy, and delayed myelination. To date, 47 individuals have been reported in the literature, but the phenotypic spectrum of PRUNE1-related disorders and their causative variants remains to be characterized fully. Here, we report a novel homozygous …

Spontaneous Coronary Artery Dissection In A Young Male: A Case Report, Irene Tchuente M.D.

Advances in Clinical Medical Research and Healthcare Delivery

Abstract

Cardiovascular disease remains the number one cause of death worldwide. In recent years, there has been an increased focus on Coronary Artery Dissection due to the increasing number of young individuals without any cardiovascular risk factors presenting with chest pain. Many of these patients would also have elevated troponins and sometimes electrocardiogram changes suggestive of myocardial infarction. Many reported cases have been in women and only a handful of cases have been reported in men. Although some potential risk factors have been identified, more data is needed to support these hypotheses. Coronary Artery Dissection (CAD) mimics Acute Coronary Syndrome …

Management Of Right Sided Carcinoid Heart Failure, Ganesh Arun, Ismat Cheema, Lorrie Pennfield, Mohammed Raza, Erik Raborn, Ami Patel, Farhan Ali

Advances in Clinical Medical Research and Healthcare Delivery

Carcinoid heart disease is a rare complication of an already rare disease. This issue is theorized to be secondary to released proinflammatory molecules that deposit on the surfaces of heart valves. These molecules are released from the carcinoid tumor itself and manifest symptoms based on liver, lung and brain function. The detection of 5-HIAA, a breakdown source of serotonin, is useful for diagnosis. These deposits occur most commonly on the endocardium of valvular cusps and cardiac chambers. This case presents a 48 year old woman with echo findings of right heart failure in the setting of a carcinoid tumor. It …

Cardiovascular Outcomes In Aortopathy: Gentac Registry Of Genetically Triggered Aortic Aneurysms And Related Conditions, Kathryn W Holmes, Sheila Markwardt, Kim A Eagle, Richard B Devereux, Jonathan W Weinsaft, Federico M Asch, Scott A Lemaire, Cheryl L Maslen, Howard K Song, Dianna M Milewicz, Siddharth K Prakash, Dongchuan Guo, Shaine A Morris, Reed E Pyeritz, Rita C Milewski, William J Ravekes, H C Dietz, Ralph V Shohet, Michael Silberbach, Mary J Roman

Faculty, Staff and Student Publications

BACKGROUND: The GenTAC (Genetically Triggered Thoracic Aortic Aneurysm and Cardiovascular Conditions) Registry enrolled patients with genetic aortopathies between 2007 and 2016.

OBJECTIVES: The purpose of this study was to compare age distribution and probability of elective surgery for proximal aortic aneurysm, any dissection surgery, and cardiovascular mortality among aortopathy etiologies.

METHODS: The GenTAC study had a retrospective/prospective design. Participants with bicuspid aortic valve (BAV) with aneurysm (n = 879), Marfan syndrome (MFS) (n = 861), nonsyndromic heritable thoracic aortic disease (nsHTAD) (n = 378), Turner syndrome (TS) (n = 298), vascular Ehlers-Danlos syndrome (vEDS) (n = 149), and Loeys-Dietz syndrome …

Optimizing Oxygen Therapy, Gizam Gokalp, Ramez Massoud, Jopher Bernal, Guru Chinnaraj, Michael Delzoppo, Nicole Brenner

North Florida Division GME Research Day 2022

No abstract available.

Antimicrobial Stewardship Meets Transitions Of Care: Defining Length Of Therapy For Community-Acquired Pneumonia (Cap), Christopher Whitman, Sarah E. Moore, Matthew Song, Brian C. Bohn, Ashley M. Wilde

The University of Louisville Journal of Respiratory Infections

Introduction: Hospital-based antimicrobial stewardship efforts have traditionally focused on inpatient settings. Antibiotic prescribing at discharge is often an overlooked area of focus for antimicrobial stewardship programs. Discharge prescribing optimization is necessary to combat antibiotic overuse.

Methods: This was an observational, retrospective cohort study at a four–adult community hospital system. Four hundred adult patients admitted with community-acquired pneumonia and discharged with antibiotics were included. The primary outcome was overall (inpatient and discharge) antibiotic length of therapy. The secondary outcome was percentage of patients discharged on a fluoroquinolone who had not received one in the hospital. Descriptive statistics were utilized.

Results: The …

2022 Beijing Winter Olympics: Spotlight On Cardiac Metabolism, Heinrich Taegtmeyer, Vlad G Zaha, Darren K Mcguire

Faculty, Staff and Student Publications

No abstract provided.

Covid-19 Case Complicated With Organizing Pneumonia And Pneumothorax: Correspondence, Hammad A. Bhatti, Minh Q. Ho

The University of Louisville Journal of Respiratory Infections

No abstract provided.

A Systematic Review And Meta-Analysis Of Diagnostic Accuracy Of Whole-Body 18f-Fdg Pet And 18f-Fdg Pet/Ct In Detecting Occult Malignancy In Patients With Idiopathic Inflammatory Myopathy, A Ali, R Alkilany, J Asif, B Basida, Z Al-Sagri, N Mahabadi, H Sarakbi

Conference Presentation Abstracts

Background Idiopathic inflammatory myopathies (IIMs) are chronic, systemic autoimmune diseases that can cause muscle inflammation, weakness, and skin manifestations. Several studies have confirmed the association between IIMs and malignancy in adult population with varied frequency (4-42%), highest in patients with dermatomyositis. Detecting occult malignancy is a diagnostic challenge involving cost- and time-consuming methods. The (18)F] fluorodeoxyglucose positron emission tomography ([(18)F] FDG-PET) role in this context has been studied in multiple studies.

Objectives The purpose of this study is to assess the diagnostic performance of whole-body 18F-FDG PET or 18F-FDG PET/CT for detection of occult malignancy in patients with IIMs.

Methods …

Definition Of Germ Layer Cell Lineage Alternative Splicing Programs Reveals A Critical Role For Quaking In Specifying Cardiac Cell Fate, W Samuel Fagg, Naiyou Liu, Ulrich Braunschweig, Karen Larissa Pereira De Castro, Xiaoting Chen, Frederick S Ditmars, Steven G Widen, John Paul Donohue, Katalin Modis, William K Russell, Jeffrey H Fair, Matthew T Weirauch, Benjamin J Blencowe, Mariano A Garcia-Blanco

Faculty, Staff and Student Publications

Alternative splicing is critical for development; however, its role in the specification of the three embryonic germ layers is poorly understood. By performing RNA-Seq on human embryonic stem cells (hESCs) and derived definitive endoderm, cardiac mesoderm, and ectoderm cell lineages, we detect distinct alternative splicing programs associated with each lineage. The most prominent splicing program differences are observed between definitive endoderm and cardiac mesoderm. Integrative multi-omics analyses link each program with lineage-enriched RNA binding protein regulators, and further suggest a widespread role for Quaking (QKI) in the specification of cardiac mesoderm. Remarkably, knockout of QKI disrupts the cardiac mesoderm-associated alternative …