University Transportation Center for Railway Safety
Scholarworks@UTRGV Univ. of Texas RioGrande ValleyNot a member yet
35333 research outputs found
Sort by
A Diagnostic and Therapeutic Challenge in Thrombotic Thrombocytopenic Purpura Masked as Pancreatitis: A Case Report from a Facility Lacking Immediate Plasmapheresis Access
No full textThrombotic thrombocytopenic purpura (TTP) is a rare, life-threatening thrombotic microangiopathy requiring urgent plasma exchange for survival. Diagnostic delays and lack of immediate access to plasmapheresis significantly increase morbidity and mortality. This report describes an unusual presentation of TTP initially presented as acute pancreatitis and the management challenges in a facility without plasmapheresis capability.
A 73-year-old woman with hypertension and hyperlipidemia presented with severe abdominal pain, nausea, and vomiting. Laboratory evaluation revealed profound thrombocytopenia (platelets 4,000/µL), anemia, elevated creatinine, and lipase of 2663 U/L. Abdominal imaging demonstrated pancreatic edema, leading to an initial diagnosis of pancreatitis. Despite supportive care, the patient developed neurological deterioration and respiratory failure requiring intubation. Further workup revealed schistocytes, elevated lactate dehydrogenase, and indirect hyperbilirubinemia, consistent with TTP. In the absence of plasmapheresis at the initial facility, high-dose corticosteroids were administered as bridging therapy, resulting in transient improvement. She was transferred to a tertiary center for urgent plasma exchange and immunosuppressive therapy (rituximab), leading to hematologic recovery. ADAMTS13 activity was confirmed to be severely reduced (\u3c 5%).
This case illustrates how TTP can mimic pancreatitis, leading to diagnostic delays and worsening clinical outcomes, particularly in facilities lacking definitive therapy. Early recognition, prompt initiation of bridging therapy, and rapid transfer for plasma exchange remain essential for survival. Improving access to diagnostic testing and therapeutic interventions in community hospitals is critical to reduce disparities in TTP care. Focus on bridging therapies should be a goal to promote better outcomes
The Link Between Pre-existing Medical Conditions and Knee Meniscus Tear and Repair in Medically Underserved Community
Full text linkIntroduction: Menisci function primarily in shock absorption and load transmission and can be torn, in isolation or concomitantly, via various activities. Our primary objective in this study was to analyze patients in the unique RGV community with various pre-existing medical conditions and determine if there was an association with the odds of having knee meniscus tear and repair surgery.
Methods: We conducted a retrospective chart review using the University of Texas Rio Grande Valley (UTRGV) UTHealth electronic database utilizing medical charts during the period January 1, 2018, to January 1, 2025. We collected and analyzed medical charts of individuals who were diagnosed with various pre-existing medical conditions using ICD-10 codes, and individuals who underwent meniscus tear and repair surgery using current procedural terminology codes. Bivariate and multivariate analyses were conducted. Results were reported as odds ratios with 95% confidence intervals. All analyses were performed with R statistical software.
Results: For bivariate analysis, T2DM, hypertension, obesity, and anemia showed statistically significant effects. T2DM, hypertension, and anemia showed decreased odds while obesity showed an increased odds of meniscus surgery. For multivariate analysis, T2DM and anemia show statistically significant decreased odds of meniscus surgery.
Conclusion: This study shows that some potentially overlooked pre-existing medical conditions may decrease the odds for meniscus tears requiring meniscus repair surgery. If supported in future studies, physicians and other healthcare providers may use this knowledge to help evaluate the odds of having surgery when caring for individuals with a meniscus tear, especially in this underserved community
Stroke Risk in the Rio Grande Valley: A Demographic and Comorbidity-Based Perspective
No full textBackground: Stroke remains a leading cause of morbidity and mortality in the United States. The Rio Grande Valley (RGV), a medically underserved region with a predominantly Hispanic population, carries a significant burden of stroke-related comorbidities. This study aims to describe the demographic and clinical characteristics of stroke patients in the RGV and identify high-risk subgroups for delayed prehospital presentation.
Methods: A retrospective chart review was conducted using de-identified data from 3,121 adult patients at UT Health Rio Grande Valley with ICD-10 codes for ischemic stroke, hemorrhagic stroke, or transient ischemic attack. Variables analyzed included age, sex, BMI, race, ethnicity, and key comorbidities such as hypertension, type 2 diabetes, and hyperlipidemia. Descriptive statistics were used to identify trends and stratify risk by subgroup.
Results: The median patient age was approximately 60 years, with most patients aged 50–70. Comorbidities were highly prevalent, particularly among Hispanic/Latino individuals identifying as White or Other Race. Female patients were overrepresented in several high-risk subgroups. The most common comorbidities were type 2 diabetes (16.1%), hypertension (15.1%), and hyperlipidemia (13.9%). Risk factor prevalence increased with age and BMI.
Conclusion: This study highlights key demographic and clinical patterns in stroke-prone populations of the RGV. Identifying these high-risk groups is essential for developing targeted, culturally sensitive interventions aimed at improving stroke recognition and reducing prehospital delays. These findings support further research into healthcare disparities and community-based strategies for stroke prevention in underserved regions
Comprehensive Review of In Vitro Gut-Brain Axis Models in Parkinson’s Disease Research
Full text linkBackground: The pathophysiology of Parkinson\u27s Disease (PD) can be attributed to a gradually progressive dopaminergic neuron (DN) degeneration and aggregation of abnormal α-synuclein in the basal ganglia. While the classic paradigm of PD focuses on the role of neurotransmitter imbalance and motor impairments, there has been increasing scientific interest in the link between the intricate connection between gut dysbiosis with synucleinopathies and PD. This review explores the relevance of the Braak hypothesis, short-chain fatty acids (SCFAs) in neuronal viability, and gastrointestinal barrier dysfunction through the lens of in vitro modeling.
Methods: A collection of prospective literature was conducted on the search engine PubMed to systematically look for in vitro models relating PD to gut-brain axis models. The search was limited to English-language articles from 1 January 2016–10 November 2024. Only in vitro experiments with relevance to the gut-brain axis or gastrointestinal organoids relating to PD were chosen for inclusion. All assessments for eligibility were done in person. Initial discussion prioritized the identification of in vitro models that either (1) focused primarily on PD or (2) involved the gut-brain axis with neurodegenerative disease within the title and abstract.
Results: A total of 1090 records were identified from the database search, and no duplicates are found; based on the exclusion and inclusion criteria by full texts screening, a total of 7 studies is selected. Discussion of differences in cell type, interconnections between organoid chips, method of measurement and detection, and overall structures and design of the in vitro models was made and tabulated. Multiculture models (n=4) utilized [e.g., HepG2, Caco-2, AHPC] cells to evaluate MPP+ neurotoxin, 5-HT epithelial secretion, and overall disease study typically via toxin or neurotransmitter attenuation as a control. Monoculture models (n=3) introduce rat progenitor cell lines or astrocyte cells to make direct measurements of gut epithelium and brain cells in PD. Organ-on-chip models (n=11) demonstrated 2D and 3D platform modeling to stimulate DN function, neuroinflammation, blood-brain integrity, and α-synuclein pathology. These models incorporate advanced features such as vascularization, microfluidics, multisensor integration, and real-time neuronal activity monitoring, supporting applications in disease modeling and drug screening.
Conclusions: In vitro models allow simulation of human biological processes in a controlled environment, and therefore offer a promising, scalable avenue of PD research where specific pathophysiological mechanisms, systemic interactions, and feedback mechanisms may be explored. However, these models are not without limitation. Multisection chip models, while working in series as sequential passages of cell cultures, still cannot mimic systemic factors and key body elements. We hope that as more challenges in developing complex in vitro systems become solved, the integration of additional organ systems will enable multi-organ frameworks to more accurately replicate the interactions underlying Parkinson’s disease pathophysiology
Misleading Elevated PSA Following Recent Prostate Manipulation: A Case Report and Review of Appropriate PSA Screening
Full text linkWe present a case highlighting the pitfalls of prostate-specific antigen (PSA) testing shortly after prostate manipulation. A patient with obstructive uropathy and acute kidney injury underwent Foley catheter placement and was subsequently found to have a PSA of 261 ng/mL. A prostate biopsy revealed no evidence of malignancy. This case underscores the importance of timing and indications for PSA testing in outpatient settings and reinforces current screening guidelines
A Narrative Review of the Use of Ayurvedic Treatments for Urinary Tract Infections
No full textIntroduction: Urinary Tract Infections are among the most common infections worldwide, and the rise of antibiotic resistance has created an urgent need for effective alternative therapies. Ayurvedic medicine, a traditional system of India, offers herbal and non-pharmacological interventions that may serve as potential treatments for UTIs. This narrative review evaluates existing literature on Ayurvedic treatments for UTIs, with a focus on assessing the clinical effectiveness of commonly used herbs and formulations.
Methods: A comprehensive literature search was conducted in June 2025 across six databases: Medline (Ovid), Embase (Elsevier), Allied and Complementary Medicine (Ovid), Index Medicus for the South-East Asia Region (IMSEAR), the WHO’s International Clinical Trials Registry Platform (ICTRP), and the Ayush Research Portal. No restrictions were placed on publication date or language. Eligible studies focused on Ayurvedic interventions for the treatment or prevention of UTIs. Studies were included if they involved men, women, or individuals of other genders presenting with recurrent or acute UTIs and exhibiting UTI-related symptoms. Eligible studies focused on Ayurvedic interventions administered either before or after symptom onset. Exclusion criteria included studies focused on non-UTI genitourinary pathologies, those using non-Ayurvedic treatments, and all in-vitro or animal studies. Clinical trial contacts were reached for unpublished results, and additional studies were included based on citations within relevant literature reviews.
Results: Screening and selection were performed using Covidence. A total of 1646 studies were imported, and after removing 95 duplicates, 1551 studies were screened. Of these, 63 full-text studies were assessed for eligibility, and 20 studies met the inclusion criteria. Among these, 15 were clinical trials and 3 were case reports, with the remaining studies falling under observational or review-type formats.
The included studies collectively evaluated various Ayurvedic formulations. Findings showed statistically significant improvements in UTI symptoms, including reductions in urinary frequency, urgency, dysuria, and associated systemic symptoms. Many of the studies also show antibacterial effects through negative urine cultures. While the methodologies and outcomes varied across studies, the data consistently suggested that specific Ayurvedic herbs possess antimicrobial and anti-inflammatory properties which are beneficial in UTI treatment.
Improvements in dysuria were reported in nearly every study. The rates of improvement ranged from 31.25% to 100%. Several studies also reported post-treatment urine culture conversion rates ranging from 100%-40% (Anjana 2021, Udmale 2022, Swati 2023, Lohan 2021, Sahu 2022 & Rajana 2022). Six studies used a control group that included comparisons with antibiotics (Maurya 2014, Guptai 2010, Pathak 1994) or standard treatments like Norflox (Sharma 2010 & Swati 2023). In these trials, the Ayurvedic interventions showed comparable symptom relief. There were three case reports (Anju 2021, Malagi 2021, Rana 2023) which reported complete or significant improvement in UTI symptoms as well as bacterial clearance.
Discussion: To our knowledge, this is the first narrative review to assess the efficacy of Ayurvedic formulations in the treatment and prevention of urinary tract infections. Ayurvedic interventions may serve as promising alternative options for managing UTIs, especially in the context of rising antibiotic resistance. While preliminary findings are encouraging, there remains a need for further clinical trials to validate efficacy, establish standardized dosing, and assess safety.
Some limitations of this review include the fact that some of the studies are older and may not reflect current research standards. Ayurvedic formulations varied and were not standardized across trials, limiting comparability. Additionally, not all studies performed urine cultures, making it unclear whether symptoms were due to confirmed UTIs or other genitourinary conditions. Access to Ayurvedic practitioners and specific formulations is limited in the U.S., which may affect the use of these interventions in Western clinical settings. Additionally, most of the studies neglected to consider any side effects, or did not have any side effects at all. Even with these limitations, we hope to highlight this alternative treatment option for recurrent UTIs, which can have a big impact on quality of life
No Safety Trade-Off: Triple Therapy Matches DAPT in Acute Stenting with Thrombectomy
Full text linkBackground: Patients who acutely undergo intra- or extracranial stenting are typically placed on a dual antiplatelet therapy (DAPT) regimen to decrease the risk of in-stent thrombosis. However, initiating these medicines in patients who are already on direct oral anticoagulants (DOACs) is controversial due to the increased risk of hemorrhagic transformation. Studies have been done on patients with atrial fibrillation on DOACs who undergo coronary stenting and subsequently begun on DAPT, but there are no corollaries for patients undergoing acute carotid or intra-cranial stenting and associated safety outcomes. This retrospective cohort study aims to bridge that understanding and checked whether patients with acute ischemic stroke requiring mechanical thrombectomy and acute stenting experienced different rates of adverse outcomes depending on whether they were on triple therapy with DAPT and DOACs or DAPT only.
Methods: A prospectively maintained endovascular database was searched for patients who acutely underwent mechanical thrombectomy and carotid or intra-cranial stenting from 2013 to 2025 at a comprehensive stroke center and were categorized whether they received prior anticoagulation or not. Patient demographics extracted include age, gender, BMI (body mass index), manual ASPECTS (Alberta Stroke Program Early CT score), stroke risk factors, and admissions NIHSS (National Institute of Health Stroke Scale) scores. Safety and functional outcomes assessed include hemorrhagic transformation, mass effect, mortality, symptomatic and asymptomatic intracranial hemorrhage, and NIHSS and mRS (modified Rankin Scale) scores at discharge and three months. Patients with missing variables were excluded from analysis of that variable.
Results: Of the 186 patients who met inclusion criteria of acutely undergoing MT and stenting, 63 were already on DOACs, 68.25% of whom are male. There was a significant difference in rates of coronary artery disease (33.33% triple therapy cohort vs. 16.67% DAPT-only cohort, p=0.01) and hyperlipidemia (68.25% triple therapy cohort vs. 54.17% DAPT-only cohort , p=0.01); age of patients with mean age±SD of 70.98±11.37 triple therapy cohort vs 65.91±14.163 DAPT-only cohort (p=0.01); and NIHSS scores on admission with median [IQR] scores of 12 [7-17] in the triple therapy cohort group vs. 15 [10-21] in the DAPT-only cohort (p=0.02). None of the measurable safety outcomes displayed any significant differences in the two groups.
Conclusion: Patients who underwent acute mechanical thrombectomy with stenting may be safely started on a triple-therapy regimen if they were already on an anticoagulation therapy regimen prior to their stroke. Our study shows no significant differences in safety and functional outcomes, and supports the elective use of triple therapy in patients requiring acute MT and stenting
Triple or Double? Safety Holds Steady in Acute Stenting
Full text linkBackground: Acute stenting is typically performed for patients presenting with focal neurological deficits due to intracranial or extracranial atherosclerotic stenosis. Following the procedure, dual antiplatelet therapy (DAPT) regimen is commonly prescribed to reduce the risk of in-stent thrombosis. However, very few studies have examined safety outcomes in patients already on direct oral anticoagulants (DOACs) who undergo acute carotid or intracranial stenting with subsequent dual anti-platelet regimen (DAPT). The combination of DOAC and DAPT, referred here as triple therapy, is controversial given the increased risk of hemorrhagic transformation. This retrospective cohort study aims to analyze the safety of triple therapy in patients who undergo acute carotid or intracranial stenting by assessing the rates of adverse outcomes of patients whether they were on triple therapy with DOACs and DAPT, or DAPT only.
Methods: A prospectively maintained endovascular database was reviewed to identify patients ongoing only acute carotid or intracranial stenting between 2013 and 2025 at a comprehensive stroke center. Patients were categorized based on whether they were managed with oral anticoagulation prior to acute stenting. Collected demographic data included age, gender, BMI (body mass index), manual ASPECTS (Alberta Stroke Program Early CT score), stroke risk factors, and admissions NIHSS (National Institute of Health Stroke Scale) scores. Safety and functional outcomes assessed include hemorrhagic transformation, mass effect, mortality, symptomatic and asymptomatic intracranial hemorrhage, and mRS (modified Rankin Scale) scores at discharge and three months. Patients with missing variables were excluded from analysis of that variable. No triple therapy patients had a recorded NIHSS score at three months leading to exclusion of the variable in analysis.
Results: Of the 58 patients who met inclusion criteria of acute stenting, 18 were already on DOACs, 72.2% of whom are male. Based on patient demographics, there was a significant difference in rates of coronary artery disease (CAD, 44.4% triple therapy cohort vs. 12.5% DAPT-only cohort, p=0.014) and hyperlipidemia (HLD, 77.8% triple therapy cohort vs. 45.0% DAPT-only cohort, p=0.025). After adjusting for NIHSS score on admission, age, CAD, and HLD, discharge mRS was found to be significantly lower in the triple therapy group median [IQR] of 3.5 [1.75-4] in the triple therapy group vs. 4 [3-5] in the DAPT only group. All other safety and functional outcomes displayed no statistically significant difference between the two groups.
Conclusion: Patients undergoing acute carotid or intracranial stenting who are already on anticoagulation therapy may be safely managed with a triple-therapy regimen. Our findings demonstrate improved functional outcomes at discharge and show no significant difference in safety or other functional outcomes, supporting the safe and effective use of triple therapy in patients undergoing acute stenting
Vitamin D3 Improves Non-Surgical Periodontal Treatment Outcomes, with Reduced Benefit in Type 2 Diabetes: Evidence from Two Randomized Controlled Trials (RCT)
Full text linkBackground: Non‐surgical periodontal therapy reduces bacterial biofilm and inflammation in chronic periodontitis but often leaves residual pockets. Vitamin D₃ has immunomodulatory and anti‐inflammatory effects that may improve healing when added. Randomized evidence in patients with type 2 diabetes mellitus (T2DM) is scarce.
Methods: We meta‐analyzed two RCTs from 2023–2024. Lei et al. randomized 60 non‐diabetic adults to high‐dose (100 000 IU/month), low‐dose (25 000 IU/month), or no vitamin D₃ with standard therapy. Ramaprabha et al. enrolled 92 males (46 with T2DM, 46 without) randomized to 60 000 IU/week vitamin D₃ or therapy alone. Outcomes were changes in probing pocket depth (PPD), clinical attachment level (CAL), gingival bleeding index (GBI), and serum 25-hydroxyvitamin D 25(OH)D. Random‐effects models estimated Hedges’ g and subgroup analyses compared results by diabetes status.
Results: Adjunctive vitamin D₃ significantly reduced PPD (g = –3.39) and CAL (g = –2.94), and decreased GBI (g = –1.80) (all p \u3c 0.05). Serum 25(OH)D rose markedly (g = 7.67) with high heterogeneity (I² \u3e 90%). Non-diabetics experienced greater PPD and CAL gains than participants with T2DM (p \u3c 0.05); GBI response was similar across groups. Attenuated effects in T2DM may reflect altered vitamin D metabolism and chronic inflammation.
Conclusions: Adjunctive oral vitamin D₃ enhances periodontal outcomes, especially in non-diabetic patients. Future large RCTs should refine dosing protocols and assess efficacy in metabolically disregulated populations
Long Non-Coding RNA UCA1 Regulates MPC1 Expression to Promote the Warburg Effect and Colorectal Cancer Progression
Full text linkBackground: Colorectal cancer (CRC) is the third most commonly diagnosed malignancy worldwide and the second leading cause of cancer-related deaths in the United States. In 2025, an estimated 154,270 new cases of colon cancer are expected to be diagnosed. CRC is projected to cause approximately 52,900 deaths in the U.S. in 2025, slightly increased from the 52,550 deaths estimated the previous year. Metastatic colorectal cancer (mCRC) continues to have a poor prognosis, with a survival rate of less than 15%. Urothelial cancer-associated 1 (UCA1), a long noncoding RNA (lncRNA), is known to be dysregulated in CRC and contributes to tumor progression. Compared to the isogenic oncogenic SW480 cell line, we found that UCA1 is significantly overexpressed in the metastatic colon cancer cell line SW620. This overexpression correlates with the downregulation of mitochondrial pyruvate carrier 1 (MPC1), a protein responsible for transporting pyruvate into the mitochondria. Reduced MPC1 expression impairs oxidative phosphorylation and may contribute to the metabolic reprogramming observed in metastatic CRC.
Methods: Migration, invasion, and proliferation assays were performed on colorectal cancer (CRC) cell lines, including parental (SW480, SW620) and genetically modified variants (SW480+Vec, SW480+UCA1, SW620+shCtrl, SW620+shUCA1). Quantitative RT-PCR was used to measure the expression levels of UCA1, YAP1, Glut1, Fdft1, and MPC1. Immunofluorescence staining was conducted to analyze the localization of YAP1, Glut1, and MPC1 proteins. Glucose and lactate concentrations were measured to evaluate metabolic changes in CRC cells.
Results: The long noncoding RNA UCA1 showed significantly higher expression in the metastatic colorectal cancer (CRC) cell line SW620 compared to the oncogenic (non-metastatic) SW480 cell line. Along with elevated UCA1 levels, the expression of genes involved in glucose metabolism, such as Glut1, YAP1, and Fdft1, was also markedly higher in SW620 cells than in SW480 cells. At the same time, mitochondrial pyruvate carrier 1 (MPC1) was notably downregulated. To further explore this relationship, UCA1 was overexpressed in SW480 cells. This led to significantly increased expression of Glut1, YAP1, and Fdft1, suggesting that UCA1 regulates glucose metabolism. In line with the Warburg effect, where cancer cells limit mitochondrial pyruvate uptake even in the presence of oxygen, MPC1 expression was significantly reduced in metastatic SW620 cells compared to non-metastatic SW480 cells. Similarly, UCA1-overexpressing SW480 cells also showed a marked downregulation of MPC1, suggesting that UCA1 may directly or indirectly suppress MPC1 expression. Since MPC1 is essential for transporting pyruvate into mitochondria and supporting oxidative phosphorylation, its downregulation disrupts mitochondrial metabolism. This implies that MPC1 plays a key role in the Warburg effect and contributes to the metabolic reprogramming and progression of colorectal cancer