Internal Medicine Commons^™

Metabolomic Profiles In Jamaican Children With And Without Autism Spectrum Disorder, Akram Yazdani, Maureen Samms-Vaughan, Sepideh Saroukhani, Jan Bressler, Manouchehr Hessabi, Amirali Tahanan, Megan L Grove, Tanja Gangnus, Vasanta Putluri, Abu Hena Mostafa Kamal, Nagireddy Putluri, Katherine A Loveland, Mohammad H Rahbar

Faculty, Staff and Student Publications

BACKGROUND: Autism spectrum disorder (ASD) is a complex neurodevelopmental condition with a wide range of behavioral and cognitive impairments. While genetic and environmental factors are known to contribute to its etiology, the underlying metabolic perturbations associated with ASD which can potentially connect genetic and environmental factors, remain poorly understood. Therefore, we conducted a metabolomic case-control study and performed a comprehensive analysis to identify significant alterations in metabolite profiles between children with ASD and typically developing (TD) controls.

OBJECTIVE: To elucidate potential metabolomic signatures associated with ASD in children and identify specific metabolites that may serve as biomarkers for the disorder. …

Methodological Advances In Patient-Centered Rare Disease Research: The Uthealth Houston Turner Syndrome Society Of The United States Research Registry, Sara Mansoorshahi, Cindy Scurlock, Scientific Advisory Board Of The Turner Syndrome Society Of The United States Research Registry, Siddharth K Prakash

Faculty, Staff and Student Publications

BACKGROUND: Many different clinical specialists provide care to patients with Turner syndrome (TS), who have highly variable clinical manifestations. Therefore, a national TS registry is essential to inform a cohesive approach to healthcare and research. In 2015, the Turner Syndrome Society of the United States (TSSUS) created the Turner Syndrome Research Registry (TSRR) to engage directly with community participants who voluntarily provide longitudinal data about their experiences with TS. TSRR projects are collaborative partnerships between people with TS, TSSUS, and researchers.

RESULTS: To ensure that registry workflows conform to the data privacy choices of participants, TSSUS collaborated with UTHealth Houston …

Case Of Rosai Dorfman Disease In A Patient With Newly Diagnosed Hodgkin Lymphoma, Liza Salloum, Jennifer Rojas Huen, Ricardo Serna, Alisha Valdez

Research Symposium

Background: Rosai Dorfman Disease (RDD, also known as sinus histiocytosis with massive lymphadenopathy) is a rare non-Langerhans cell histiocytosis, classified into nodal (classic) and extranodal disease. Most patients present with non-tender cervical lymphadenopathy, although other sites including the inguinal and axillary regions have been reported. Extranodal disease (~43% of cases) can involve any organ system. RDD is more common in children, but cases have been reported in patients in their 70s. The prognosis of nodal RDD can correlate with the number of nodal groups involved. Many cases can be managed only with observation, although surgery, chemotherapy, corticosteroids, and immunomodulators have …

An Unusual Presentation Of The Severe Hypothyroidism Presenting As Shortness Of Breath, Shreel H. Patel, Kashif Ali, Eunbee Cho, Fatimah Bello, Andres Suarez Parraga, Alcibiades Fleires

Research Symposium

Background: Hypothyroidism is defined as failure of the thyroid gland to produce sufficient thyroid hormone to meet the metabolic demands of the body. Untreated hypothyroidism can contribute to hypertension, dyslipidemia, infertility, cognitive impairment, and neuromuscular dysfunction. It may occur as a result of primary gland failure or insufficient thyroid gland stimulation by the hypothalamus or pituitary gland. Primary gland failure can result from the congenital abnormalities, autoimmune destruction, iodine deficiency, and infiltrative diseases. Patients can clinically present with weight gain, cold intolerance, depression, muscle fatigue, poor concentration, and menstrual irregularities. The best laboratory test for the thyroid assessment is serum …

A True Bloody Emergency: An Unusual Case Of Thrombotic Thrombocytopenic Purpura, Joshua M. Ninan

Research Symposium

Background: Thrombotic thrombocytopenic purpura (TTP) is a primary thrombotic microangiopathy that is classically characterized by thrombocytopenia and microangiopathic hemolytic anemia (MAHA). Although rare with an annual incidence of 3.7 cases per one million adults, it is considered a true hematological emergency due to its fatality rate of almost 100% if appropriate treatment is not initiated immediately. This makes it vitally important to identify and treat patients with TTP, a task that becomes unusually challenging in the absence of the disorder’s other characteristically diagnostic clinical features such as mucosal bleeding, fever, or presence of schistocytes.

Case Presentation: A 30-year-old gentleman with …

A Rare Encounter: Extracranial Meningioma Mimicking Musculoskeletal Neoplasms, Liza Salloum, Jennifer Rojas Huen, Ricardo Serna, Andrew Kolodziej

Research Symposium

Background: Meningiomas are the most common primary brain tumor in adults. While commonly encountered intracranially, 2% manifest extracranially. Although usually benign, 10% of meningiomas can become malignant. Despite their relatively high incidence, they are often difficult to diagnose due to long asymptomatic periods, often diagnosed after mass effect symptoms occur. This case explores the intricacies of diagnosing and managing an extracranial meningioma that mimicked musculoskeletal neoplasms.

Case Presentation: A 70-year-old female, with a history of hypertension and dyslipidemia, presented with diplopia, blurry vision, and intermittent right orbital pain. A recent CT had identified a slow-growing right temporal mass, yet she …

Development Of A Follow-Up Measure To Ensure Complete Screening For Colorectal Cancer, Elizabeth L Ciemins, Jeff T Mohl, Carlos A Moreno, Francis Colangelo, Robert A Smith, Mary Barton

Faculty, Staff and Student Publications

IMPORTANCE: The current quality performance measure for colorectal cancer (CRC) screening is limited to initial screening. Despite low rates, there is no measure for appropriate follow-up with colonoscopy after receipt of an abnormal result of a stool-based screening test (SBT) for CRC. A quality performance measure is needed.

OBJECTIVE: To develop and test a quality performance measure for follow-up colonoscopy within 6 months of an abnormal result of an SBT for CRC.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective quality improvement study examined data from January 1, 2016, to December 31, 2020, with 2018 plus 6 months of follow-up as the …

Outcomes Of Upper Gastrointestinal Bleeding In Hospitalized Covid-19 Patients In The United States: A Propensity-Score Matched Analysis Of A Large National Database, Moon Ryu, Mohammed Quazi, Niloy Ghosh, Karthik Gangu, Amir H Sohail, Asif Farooq, Babu Sriram , Maringanti, Aman Goyal, Anupa Patel, Muhammad Salman Khan, Abu Baker Sheikh

Journal of Community Hospital Internal Medicine Perspectives

Patients with cirrhosis that are hospitalized with COVID-19 infection have been found to have worse outcomes. No comparative study has been conducted between gastrointestinal (GI) bleeding in patients with cirrhosis who are diagnosed with COVID-19. We utilized the National Inpatient Sample (NIS) database to perform a retrospective analysis of 24, 050 patients diagnosed with cirrhosis and COVID-19. The identified patients were separated into variceal bleeding, nonvariceal bleeding, and no (or neither) GI bleeding groups. After performing propensity sample matching and multivariate analysis of mortality, we found no significant differences in mortality among the three groups. However, the variceal bleed group …

The Utility Of Interventional Anesthesia, Kylie Daguio, Kiley Jackson, Samantha Boever, Andrew Chang, James Keane, Leonard B. Goldstein

SOMA Faculty Publications

no abstract

The Art Of Medicine: “Meeting Patients Where They’Re At”, Elyse Stevens

School of Medicine Faculty Publications

No abstract provided.

The Internist's Post V.1 N.1, The University Of Texas Rio Grande Valley. School Of Medicine, Diana Othon Martinez, Roque Mifuji Lira, Jian Garcia Cruz, Edgar Dorsey Trevino, Eunbee Cho

School of Medicine Publications

No abstract provided.

Surgical Site Infections Post Cesarean Section And Associated Risk Factors: A Retrospective Case-Control Study At A Tertiary Hospital In Kenya., David Odada, Jasmit Shah, Annastacia Mbithi, Reena Shah

School of Nursing & Midwifery, East Africa

Background: Surgical site infection is a common healthcare-associated infection that affects maternal health, yet it can be prevented or controlled. Caesarian sections are most likely to develop surgical site infections. The rates of delivery by caesarian section in reported to be higher that the acceptable rates in some healthcare facilities. Risk factors for surgical site infections can be identified and modified to reduce the occurrence of surgical site infections. This study aims to determine the risk factors that contribute to surgical site infections post caesarian section in a tertiary teaching hospital in Kenya.

Methods: This was a retrospective case-control (1:2 …

Incidental Ring-Hyperenhancing Liver Micronodules At Ct Hepatic Arteriography-Guided Percutaneous Thermal Ablation Of Colorectal Liver Metastases, Jessica Albuquerque, Yuan-Mao Lin, Iwan Paolucci, Caleb S O'Connor, Ching-Wei Tzeng, Jean-Nicolas Vauthey, Kristy K Brock, Bruno C Odisio

Faculty, Staff and Student Publications

CT during hepatic arteriography (CTHA) is a highly sensitive imaging method for detecting colorectal liver metastases (CLMs), which supports its use during percutaneous thermal liver ablation. In contrast to its high sensitivity, its specificity for incidental small CLMs not detected at preablation cross-sectional imaging is believed to be low given the absence of specific imaging signatures and the common presence of pseudolesions. In this retrospective study of 22 patients (mean age, 55 years ± 10.6 [SD]; 63.6% male, 36.4% female) with CLMs undergoing CTHA-guided microwave percutaneous thermal ablation between November 2017 and October 2022, the authors provided a definition of …

Chronic Glp1 Therapy Reduces Postprandial Il6 In Obese Humans With Prediabetes, Vala Hamidi, Hongyu Wang, Vi Pham, Karla Bermudez Saint Andre, Heinrich Taegtmeyer, Absalon D Gutierrez

Faculty, Staff and Student Publications

Single-dose glucagon-like peptide 1 (GLP1) therapy increases postprandial plasma IL6 levels in prediabetic, obese humans. GLP1-IL6 interactions underly multiple antidiabetic effects, but these may differ after acute versus chronic therapy. This study examines postprandial effects of GLP1 after chronic therapy. Seven humans (six Black) with prediabetes and obesity completed 6 weeks of exenatide extended release therapy. Then subjects returned for pre- and post-meal measurements of plasma IL6, GLP1, glucagon, and related inflammatory markers. Weight, which was measured before and after therapy, did not change. Plasma IL6 decreased from baseline to postmeal state ( = 0.016), with decreases in free fatty …

Association Of Timely Comprehensive Genomic Profiling With Precision Oncology Treatment Use And Patient Outcomes In Advanced Non-Small-Cell Lung Cancer, Jeff Yorio, Katherine T Lofgren, Jessica K Lee, Khaled Tolba, Geoffrey R Oxnard, Alexa B Schrock, Richard S P Huang, Lorraine Brisbin

Faculty, Staff and Student Publications

PURPOSE: Timely biomarker testing remains out of reach for many patients with advanced non-small-cell lung cancer (aNSCLC). Here, we studied the quality-of-care implications of closing the gap in timely receipt of comprehensive genomic profiling (CGP) to inform first-line (1L) decisions.

METHODS: Using a real-world clinicogenomic database, we studied testing and 1L treatment patterns in aNSCLC after the approval of pembrolizumab in combination with pemetrexed and carboplatin (May 10, 2017). To estimate the association of timely CGP results with therapy selection and patient outcomes, we identified patients with no previous genomic testing beyond PD-L1 immunohistochemistry and dichotomized patients by whether CGP …

A Case Of Diffuse Thyroid Lipomatosis With Amyloid Deposits Presenting With Thyrotoxicosis, Adrian M Gonzalez-Gil, Marco A Ruiz-Santillan, Bahar K Force, Ruchi Gaba

Faculty, Staff and Students Publications

Diffuse thyroid lipomatosis (DTL) is a rare entity of unknown etiology that can be associated with amyloidosis and rarely, thyrotoxicosis. Here, we present a case of DTL with amyloid deposits and concurrent thyrotoxicosis. A 64-year-old South-Asian woman with a several-year history of an enlarging goiter, unintentional weight loss, and work-up 10 months prior suggestive of thyroiditis presented with a viral syndrome in setting of several weeks of progressive fatigue. Her examination was notable for resting sinus tachycardia and massive painless goiter. Initial work-up revealed nephrotic range proteinuria with hypoalbuminemia, which progressed to end-stage-renal disease, elevated inflammatory markers, and elevated free …

Decreasing Polypharmacy In Older Adults With Cancer: A Pilot Cluster-Randomized Trial Protocol, Erika Ramsdale, Mostafa Mohamed, Holly M Holmes, Lisa Zubkoff, Jessica Bauer, Sally A Norton, Supriya Mohile

Faculty, Staff and Student Publications

Introduction: Polypharmacy is prevalent in older adults with cancer and associated with multiple adverse outcomes. A single-site, cluster-randomized clinical trial will enroll older adults with cancer and polypharmacy starting chemotherapy and will assess the effectiveness and feasibility of deprescribing interventions by comparing two arms: a pharmacist-led deprescribing intervention and a patient educational brochure.

Materials and methods: The study will be conducted in two phases. In phase I, focus groups and semi-structured individual interviews will guide adaptation of deprescribing interventions for the oncology clinic (phase Ia), and eight patients will undergo the pharmacist-led deprescribing intervention with iterative adaptations (phase Ib). In …

The Efficacy-Associated Biomarkers For Immune Checkpoint Inhibitors In Gastrointestinal Cancer: A Literature Review, Jessie Lee, Yifei Shan, Angelique Wong, Elizabeth A Brown, Mitchell Callahan, Robert A Hernandez, Michael J Mienaltowski

Faculty, Staff and Student Publications

White striping (WS) is a common myopathy seen in fast-growing broilers. Studies have demonstrated that chitosan is effective as an antioxidant and has antiobesity and fat-absorption reduction properties. We hypothesized that the dietary supplementation of chitosan would have similar effects when fed to fast-growing broilers and would thus lower WS incidence and improve meat quality. One hundred twenty-six broilers were fed corn-soy diets. The grower and finisher diets contained either 0, 0.2, or 0.4% chitosan. After a 6 wk growth period, birds were euthanized, and then WS and gross pathology scores were assessed. Pectoralis major tissues were collected to evaluate …

Overcoming Fear Of Developing Country: A Case Report Of Retroperitoneal Laparoscopic Partial Nephrectomy For T3a Renal Cell Carcinoma, Vo Anh Vinh Trang, Thien Tan Tri Tai Truyen, Nam Hoang Nguyen, Giang Trieu Quach, Phu Phat Pham, Phuc Cam Hoang Nguyen

Faculty, Staff and Student Publications

INTRODUCTION: Renal cell carcinoma poses significant challenges in kidney diseases, particularly in the context of the T3 stage, where treatment strategies remain controversial. The utilization of laparoscopic partial nephrectomy, particularly in developing countries, has been restricted for such patients, primarily due to limited infrastructure and concerns about recurrence risk and long-term pathologic outcomes.

PRESENTATION OF CASE: In this report, we present a case of a 64-year-old male diagnosed with T3aN0M0 renal cell carcinoma (RCC). Abdominal computed tomography revealed a 5.2 × 5.2 × 5.1 cm mass on the right upper part of the kidney with a possible thrombus in the …

Acute Kidney Injury After Percutaneous Coronary Intervention Guided By Intravascular Ultrasound, Minh Tran Duc, Thai Nguyen Quoc, Bach Yen T Nguyen, Ngoc Vu Quang, Nhuong Nguyen Duc, Hung Nguyen Duc, Lam Truong Hoai, Vu Nguyen Hoai, Hung Phan Kieu, Hieu Nguyen Trung

Faculty, Staff and Student Publications

Purpose We investigated the impact of intravascular ultrasound guidance on reducing the incidence of contrast-induced acute kidney injury (CI-AKI) in patients undergoing percutaneous coronary intervention (PCI). Methods Ninety-nine patients were enrolled in this prospective cohort who were not randomly assigned to angiography-guided percutaneous coronary intervention or intravascular ultrasound-guided percutaneous coronary intervention. The patients were hospitalized at the Vietnam National Heart Institute - Bach Mai Hospital between 2019 and 2020. Acute kidney injury incidence during hospitalization was the primary endpoint. Results A total of 99 patients were divided into two groups: the intravascular ultrasound-guided group (33 participants) and the angiography-guided group …