University of North Texas
UNTHSC Scholar (University. of North Texas Health Science Center)Not a member yet
6724 research outputs found
Sort by
Radiological Review of Discoid Meniscus
No full textBackground: Discoid meniscus is a congenital malformation commonly referred to as “snapping knee syndrome,” where the meniscus undergoes abnormal development during gestation, resulting in a disorganized collagen network and increase in size. Patients with a discoid lateral meniscus lose this C shape due to central hypertrophy and also suffer from a loss of stabilizing anterior and posterior ligaments of the lateral meniscus. This hypertrophy, abnormal fibrocartilaginous development, and increased mobility within the joint space predispose patients to meniscal degeneration and tearing. While the true incidence rate unknown. Surgical studies utilizing imaging and arthroscopy report that a discoid meniscus occurs in 3-5% of Western populations and up to 15% of Asian populations, typically affecting the lateral meniscus. A discoid medial meniscus is rare, affecting only 0.06-0.3%. While it is most commonly a unilateral process, up to a quarter of those affected have a discoid meniscus in each knee. Case Presentation: An adolescent male presented to the orthopedic clinic with three months of medial knee pain with flexion. On examination, the patient had full range of motion. However, there was medial joint tenderness, mild valgus alignment, and a snapping medial meniscus. Knee radiograph (Fig 1) showed mild widening of the medial joint space. Subsequent knee MRI (Fig 2) showed a discoid medial meniscus with a large horizontal cleavage tear. Conclusions: A discoid meniscus is a congenital malformation of the fibrocartilaginous discs of the knee. As a result of central hypertrophy, altered fibrocartilage development, and loss of stabilizing ligaments in the joint space, patients may present with a characteristic “snapping knee syndrome”, pain, and meniscal tears. Symptomatic patients typically have meniscal tears and at imaging, these tears appear as degenerative damage or horizontal tears. Diagnosis of discoid meniscus is best made with MRI and follows the Watanabe classification system where there are 3 classes: incomplete, complete, and hypermobile type. Surgical intervention is only recommended for symptomatic patients. Patient age and the degree of tissue removed are the largest drivers regarding patient outcome. While acceptable clinical results were achieved around 10 years following surgery, 40% of patients developed degenerative changes in their knees
31st Annual Research Appreciation Day Award Winners
No full textAward winners from the thirty-first annual Research Appreciation Day. RAD 2024 was the fourth all-virtual RAD. In total, 242 abstracts were submitted
Exploring the Link: The Impact of Plant-Based Diets on Plasma Cell Disorders
Get PDFThis systematic review investigates the potential relationship between plant-based diets and plasma cell disorder's, focusing on multiple myeloma (MM). A comprehensive literature search was conducted using databases American Society of Hematology (ASH) and google scholar. Data extraction and quality assessment were performed using the Cochrane Risk of Bias Tool and Newcastle-Ottawa Scale. Currently, there are few studies that have explored the correlation between plant-based diets and multiple myeloma. However, there is growing interest in how food intake can play a role in disease prevention. Studies reviewed in this literature highlight the role of butyrate, a product of plant-based dietary fermentation, in modulating the gut microbiome and enhancing immune function. This contributes to positive outcomes in patients with monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM). However, inconsistencies in study methodologies and short follow-up periods pose limitations to the generalizability of these findings. Overall, plant-based diets offer a viable nutritional strategy for slowing disease progression and improving MRD negativity in MGUS, SMM, and MM. Further research with extended follow-up is necessary to confirm the long-term benefits of plant-based nutrition for plasma cell disorders
Role of Patient-Provider Relationship in Overall Health and Well-being of Older LGBTQ Adults
No full textPurpose: LGBTQ aging encompasses the experiences and challenges encountered by lesbian, gay, bisexual, transgender, and queer individuals as they progress through life. LGBTQ individuals face unique obstacles related to their sexual orientation, gender identity, and the historical context in which they have lived. To effectively meet the specific needs of LGBTQ older adults, it's crucial to offer culturally sensitive healthcare and social support within nurturing healthcare communities. We aim to explore how the doctor-patient relationship impacts the overall well-being of LGBTQ seniors. Methods: A secondary analysis of the AARP survey titled "Maintaining Dignity: Understanding Challenges of Older LGBT Americans," was done. The online survey was conducted between October 27 and November 12, 2017, among adults aged 45 and older who identified as LGBTQ. Data analysis was conducted on SAS statistical analysis software. Descriptive statistics were completed to determine survey participant characteristics. Logistic regression was conducted to assess the association between the patient-provider relationship and overall health after adjusting for demographics and chronic health conditions. Results: Participants were predominantly white (67.08%), between ages 45-54 years (34.6%) and 55-64 years (34.1%). The majority of the participants self-identified as gay (43%) or lesbian (43%). Most participants described their overall health as "good" or better (85.5%), 71.93% informed their physician about their sexual identity (71.93%) and described their physician-patient relationship as open and honest (71.43%). The patient-provider relationship influenced the overall self-reported health status in our study population. Compared to those who had open and honest discussions with their healthcare providers, individuals with difficult relationships with their providers were less likely to have good overall health (OR 0.098, 95% CI 0.032, 0.298). Conclusion: In conclusion, the well-being of older LGBTQ adults is significantly influenced by the quality of their relationship with their healthcare providers, emphasizing the crucial role of fostering supportive patient-provider connections and highlighting the imperative for healthcare professionals to be knowledgeable and compassionate in their care of LGBTQ patients
Perceived Vulnerability When Drinking: Daily-Level Associations with Alcohol Use and Consequences by Sexual Minority Status Among Adolescent Girls and Young Adult Women
No full textPurpose: Although cross-sectional research on perceived vulnerability (i.e., the likelihood of experiencing consequences if the individual were to engage in a behavior) when drinking suggests that greater perceived vulnerability is associated with less alcohol use and fewer alcohol-related consequences between-persons, there has been minimal research and mixed findings on within-person perceived vulnerability to alcohol-related consequences at the daily-level. Women have been found to experience more alcohol-related consequences compared to men, which may relate to their levels of perceived vulnerability. Additionally, sexual minority girls and women appear to be at increased risk for engaging in greater alcohol use and experiencing more alcohol-related consequences compared to heterosexual women, which may exacerbate their perceived vulnerability. The present study aims to (1) examine daily-level associations between perceived vulnerability and alcohol use and consequences among adolescent girls and young adult women and (2) assess whether sexual minority status moderates the association between perceived vulnerability and alcohol use and consequences at the daily-level. Methods: Participants were recruited as part of a longitudinal ecological momentary assessment (EMA) study conducted in Texas. Participants completed up to two surveys each day (eight surveys per week) in 3-week EMA bursts, which were repeated quarterly across the 12-month study. The sample for the current study included 410 cisgender (i.e., gender identity aligns with sex assigned at birth) adolescent girls and young adult women ages 15 to 25 (M= 20.8) who reported drinking days (44.9% White, Non-Hispanic; 39.8% sexual minority). The analytic sample included 3526 drinking days. Planned Analyses: In each multilevel model, daily-level predictors will be centered-within-person and person-level predictors will be grand-mean-centered. Age, race/ethnicity, weekend/weekday, week in burst, and burst number will be used as covariates in all models. Perceived vulnerability will be used as the predictor for (H1a) alcohol use (i.e., number of drinks) estimated with a mixed effects zero-truncated negative binomial model (count outcome starting at 1) and (H1b) the number of alcohol-related consequences estimated with a mixed-effects zero-inflated negative binomial model (count outcome with excessive zeros). Sexual minority status will be used as a moderator within these models (H2). Hypothesized Results: On drinking days when individuals report greater perceived vulnerability than their average, it is predicted that they will engage in less alcohol use (H1a) and experience fewer negative consequences (H1b). The daily-level associations between perceived vulnerability and alcohol use (H2a) and consequences (H2b) are predicted to be stronger among sexual minority individuals compared to heterosexual individuals. Potential Conclusion: The findings of this study have the potential to increase our understanding of how perceived vulnerability at the daily-level influences drinking among adolescent girls and young adult women, as well as differences based on sexual minority status. These findings could potentially improve the precision and efficacy of in-the-moment preventative interventions by identifying when girls and women are at increased risk of experiencing alcohol-related harm. Furthermore, these findings may inform the need to tailor in-the-moment interventions to target sexual minority girls and women.NIH/NIAAA R01AA02561
An Unusual Case of Metabolic Acidosis- Mind the Gap!
No full textBackground: Euglycemic diabetic ketoacidosis (EDKA) is a rare, life-threatening condition characterized by acidosis, elevated ketone levels, and a high anion gap (AG) in the presence of normal blood glucose. We present a unique case of EDKA in a non-diabetic patient linked to sodium-glucose cotransporter-2 (SGLT2) inhibitor use. Case Presentation: A 64-year-old female with a history of chronic hypercapnic respiratory failure, Charcot-Marie-Tooth disease, hypertension, depression, and chronic diastolic congestive heart failure was admitted for progressively worsening confusion, left-sided weakness, facial numbness, dyspnea, generalized weakness and feeling ill for 24 hours duration. Physical exam revealed afebrile, confused patient with bilateral lower extremity weakness. At home she was on Dapagliflozin, Metoprolol, Sacubitril-Valsartan, and Spironolactone. Laboratory results showed a glucose level of99 mg/dl, a bicarbonate level of 13 mmol/l, an AG of 18mEq/l, delta gap of 6mEq/l, arterial pH of 7.08, and PCO2 of 36. Urinalysis revealed leukocytes, positive nitrate, high glucose (>1000 mmol/l), ketones (>80 mmol/l), and beta-hydroxybutyrate (6.7 mmol/l). Computed tomography (CT) brain scan showed no intracranial hemorrhage. EDKA was diagnosed, and her treatment included intravenous dextrose, insulin, and broad-spectrum antibiotics for a urinary tract infection. She responded well to treatment, with resolution of her metabolic acidosis. Conclusion: The incidence of EDKA due to SGLT2 inhibitors is approximately 0.1%. Timely diagnosis can be challenging due to normal glucose levels. We know that SGLT2 inhibitors enhance glycosuria, promoting ketone body production through lipolysis. Elevated glucagon and reduced glucose levels contribute to hepatic ketone production. Increasing glucagon levels and low glucose levels promote the production of ketones, and this glucagon-insulin imbalance leads to the development of EDKA. Differential diagnoses for high anion gap metabolic acidosis (HAGMA) include methanol, uremia, diabetic ketoacidosis, propylene glycol, isoniazid, iron overdose, lactic acidosis, ethylene glycol, and salicylate toxicity. Initial laboratory assessments should include basic electrolytes, glucose, calcium, magnesium, creatinine, blood urea nitrogen, serum and urine ketones, beta-hydroxybutyric acid, arterial or venous blood gas analysis, lactic acid, and complete blood count, among others. Blood cultures, urine analysis, and chest radiographs are needed to rule out any infection. High-calorie glucose infusion and tight glycemic control are key elements in ameliorating intractable metabolic acidosis brought about by SGLT2 inhibitor-induced EDKA. Remember to always mind the gap in patients with HAGMA! Healthcare providers should remain diligent, considering EDKA, especially with normal glucose levels. Patients need to be educated about the risks associated with SGLT2 inhibitors, fostering open communication and shared decision-making for safer medication management
Preclinical Characterization of Novel Drug Candidates for Ocular Drug Delivery
No full textResearch Appreciation Day Award Winner - School of Biomedical Sciences, 2024 Department of Pharmaceutical & Pharmacotherapy Award - 2nd PlacePurpose:
Retinitis pigmentosa (RP) is the leading cause of vision loss and blindness for people under 60 years old. RP is an inherited disease causing progressive and irreversible deterioration of the retina. To date, over 150 mutations in 90 genes have been identified to contribute to the disease through various pathways. Except for a single mutation responsible for less than 5% of cases, RP is incurable. Currently available treatments largely focus on slowing progression by relieving oxidative stress and are met with limited success. The sigma 2 receptor, also established as transmembrane protein 97 of the endoplasmic reticulum (s2r/TMEM97), has been shown to have neuroprotective effects on retinal cells and is a potential drug target for RP. Recently, a series of novel drug compounds have been identified to modulate the s2r/TMEM97 protein and are under investigation as possible candidates for treatment of RP.
Here, as part of preclinical evaluation, we performed thermal analysis of the novel compounds, including thermogravimetric analysis (TGA) and differential scanning calorimetry (DSC). These techniques give insight to drug behavior at different temperatures and provide information on stability and structure. We also conducted a series of drug release studies which monitored movement of the compounds from vitreous humor through a dialysis membrane. This will allow for correlation with previously collected data.
Methods:
TGA was performed on a TGA550 thermogravimetric analyzer from TA Instruments. The instrument measured the mass of the pan as the temperature was increased from 20°C to 700°C at a rate of 10°C/min. DSC was completed using a DSC250 from TA Instruments. The instrument was programed to increase the temperature of the sample chamber from 10°C to 200°C at a rate of 5°C/min while measuring the heat flux of each pan. A series of drug release studies were performed using a specialized dialysis plate. Drug movement from vitreous humor across a membrane was evaluated over a 12-hour period.
Results:
The data collected here for the novel compounds did not show any red flags which would indicate a poor drug candidate. TGA data showed all compounds were thermally stabile until approximately 175°C, at which point they began to lose mass. DSC differential thermograms did not exhibit crystalline behavior. Drug release studies did not show a strong interaction between the compounds and vitreous humor.
Conclusion:
Our goal is to aid in narrowing the series of novel drug compounds by providing robust preclinical characterization. TGA thermograms obtained demonstrated the compounds were thermally stabile up to approximately 175°C, which is standard for small molecules. DSC results reveal the compounds are not crystalline and indicate the need for a special formulation. The drug release studies show there were no strong interactions with the compounds and vitreous humor. The data here was included with stability, solubility, and in vitro and in vivo pharmacokinetic analysis and used to select the two leading candidates to advance to in vivo efficacy studies in a transgenic rat model for retinitis pigmentosa.This work was supported by the Foundation for Fighting Blindness and the Gund Harrington Initiative
Pseudopheochromocytoma: A Case of Benign Endothelial Cyst of the Adrenal Gland
No full textBackground: Benign endothelial cyst of the adrenal gland (ECAG) with pheochromocytoma-like symptoms, or pseudopheochromocytoma (pseudoPHEO), is an extremely rare condition. Adrenal cysts seldomly occur with an incidence of 0.06% in the general population. Most cases are asymptomatic and discovered incidentally on imaging. ECAG predominately affect females and represent approximately 45% of all cystic tumors involving adrenal glands with two subtypes: angiomatous and lymphangiomatous. The association of adrenal cysts with pseudopheochromocytoma is a rare but well-documented relationship. Occasionally, these cysts can increase pressure in the adrenal medulla leading to elevated metanephrine levels. PseudoPHEO is a diagnosis of exclusion with pheochromocytoma being an important differential diagnosis. Patients may present with pheochromocytoma-like features such as symptomatic paroxysmal hypertension. If adrenal cortical tumors are involved, elevated catecholamines can be found on evaluation, although catecholamine-secreting tumors are diagnosed in less than 0.5% of patients with hypertension. Case Information: A 63-year-old female with a past medical history of an adrenal nodule discovered in 2017 during colon resection and poorly-controlled hypertension presented for adrenalectomy for suspected pheochromocytoma. Her normetanephrine level was 342 (normal: <148pg/mL) and metanephrine was 50 (normal: <57pg/mL). CT of the abdomen demonstrated an adrenal lesion with some features of benign etiology. She underwent robotic-assisted laparoscopic right adrenalectomy during which a 3 cm cyst in the adrenal medulla was found abutting the adrenal cortex. Microscopically, a multilocular cyst associated with hemorrhage involving the adrenal medulla was present. Conclusion: To diagnose pseudoPHEO, pheochromocytoma must be excluded especially when symptomatic paroxysmal hypertension is present with or without elevated catecholamines. The cells were positive for CD31 and negative for calretinin on immunohistochemistry staining which support an endothelial cell origin consistent with benign ECAG, not pheochromocytoma. These cysts may occupy space in the adrenal gland, increasing pressure in the adrenal medulla to cause elevated metanephrines, as seen in this patient. While the prognosis for ECAG is good, ECAG with associated pseudopheochromocytoma can cause life threatening complications. Treatment of pseudoPHEO is dependent on severity and etiology of disease process. Medical management can be complicated by unpredictable episodes of hypotension as patients can be normotensive between symptomatic episodes. In cases of pseudopheochromocytoma caused by ECAG, adrenalectomy is often indicated