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Stubby Versus Stabby: A Preliminary Analysis of Canine Microwear in Primates: Implication for Inferring Ingestive Behaviors
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Analysis of ADRs, ADEs, Drug Interactions, Toxicity and Side Effects of Drugs in the Shadow of Vaccines, Drug-Antibody Conjugates and Pharmacogenomics
No full textMedicare Part D Low-Income Subsidies Expanded in January 2024, but More Needs to Be Done to Ensure That Eligible Beneficiaries Enroll
No full textAdaptive Optics
No full textAdaptive optics (AO) is used for in vivo visualization of individual cells in the retina; historically, this was only possible using in vitro histological methods. Today, AO imaging systems use active optical elements to correct wavefront aberrations in retinal technologies such as the flood-illumination fundus camera, scanning laser ophthalmoscopy (SLO), and optical coherence tomography (OCT). This tool also provides advanced lateral resolution, which facilitates the visualization of photoreceptors, retinal vasculature, and the optic nerve head. This chapter will highlight the history, technology, techniques, and application of AO, as well as the advantages and limitations of implementing AO imaging in a clinical setting
Pancreatic Panniculitis: A Case Associated With Acute Pancreatic Allograft Rejection
No full textWe present a unique case of pancreatic panniculitis (PP) in a 42-year-old male with a history of pancreas-after-kidney (PAK) transplant. The patient developed PP due to acute pancreas allograft rejection. Clinical manifestations included fevers, myalgias, arthralgias, and tender erythematous subcutaneous nodules on the lower extremities. A recent hospital admission was noted for acute pancreas allograft rejection related to low tacrolimus levels. Rheumatological and infectious disease workups were negative. Skin nodule punch biopsy confirmed PP with lobular panniculitis, necrotic adipocytes, basophilic debris, and calcification. Pancreatic biopsy showed evidence of parenchymal acute cellular rejection. Lipase and amylase levels were elevated (1781 U/L and 881 U/L, respectively). Treatment involved pulse solumedrol and thymoglobulin for pancreatic rejection, alongside adjustments to immunosuppressive medications. This case highlights the rarity of PP in a PAK recipient and its association with acute pancreas allograft rejection. Importantly, it is the first reported case of PP occurring solely in the context of pancreas transplant rejection, without concurrent kidney damage or rejection. Prompt diagnosis and management led to the resolution of skin and systemic symptoms. In conclusion, this report presents a clinically relevant and unique case of PP resulting from acute pancreas allograft rejection in a PAK transplant recipient. The findings underscore the importance of early diagnosis and management for positive patient outcomes, serving as a reminder to consider underlying pancreatic pathology when encountering PP in transplant recipients
Clinicopathologic Features, Demographics, Disease Burden, and Therapeutics in Alopecic Sarcoidosis: a Case Series and Systematic Review
No full textBACKGROUND: Alopecic sarcoidosis is an uncommon cutaneous manifestation of sarcoidosis. Scarring and nonscarring alopecic sarcoidosis have been reported; however, information on the epidemiology, systemic disease associations, and treatment efficacy is limited.
OBJECTIVE: To address these gaps, we conducted a retrospective chart review and systematic literature review of alopecic sarcoidosis cases.
METHODS: Full-text English publications from PubMed, Scopus, and Google Scholar from inception to August 2023 were analyzed. Treatment evidence quality was assessed using the modified Oxford Centre for Evidence-Based Medicine rating scale. Three patients with biopsy-proven alopecic sarcoidosis were included as a case series, all demonstrating systemic sarcoidosis and 2 requiring multiple therapies. Among 1778 search results, 60 articles representing 77 cases of alopecic and scalp sarcoidosis were included. Patients were categorized into 4 distinct alopecic subgroups. Black patients constituted the majority of all subgroups.
RESULTS: Extracutaneous sarcoidosis burden was high across all alopecic subgroups, with ocular disease appearing overrepresented. Topical and oral corticosteroids were the main treatments. Though scarring alopecia patients had poor outcomes despite receiving immunomodulators/cx, limited data suggest potential efficacy of tumor necrosis factor-alpha inhibitors.
LIMITATIONS: This study has a small sample size.
CONCLUSION: Our findings underscore the importance of evidence-based strategies for improving alopecic sarcoidosis management. Prompt diagnosis and systemic evaluation, especially for scarring alopecia, are essential for timely intervention to optimize patient outcomes
Evaluation of Concordance Between Remotely Supervised Resident and Attending Ophthalmologist Evaluations with Smartphone-Based Portable Digital Fundus Camera in a Hospital Setting
No full textPurpose : This study evaluates a portable, web-linked smartphone fundus camera integrated with a HIPAA-compliant image sharing platform. The technology aims to provide immediate bedside feedback to residents-in-training in hospital or acute care settings, thereby expediting diagnosis and aiding in prompt treatment decisions. The study assesses the agreement between device-assisted remotely supervised inpatient resident examinations (DARE) and subsequent examinations by attending ophthalmologists (AOE).
Methods : Utilizing the VistaView™ Portable Mydriatic Fundus Camera (Volk Optical, Mentor, OH, USA), this prospective study captured fundus images during initial in-patient consults. Images of both anterior and posterior segments were obtained as clinically indicated. Exclusion criteria included patients unable or unwilling to cooperate. Images were anonymized, transmitted to off-site attending ophthalmologists for review, and followed by in-person examinations either later the same day or the next. Data was categorized by patient demographics, resident training level, and disease severity. Concordance between DARE and AOE was analyzed using the Kappa statistic.
Results : The study encompassed 114 eyes from 57 patients (32 male, 25 female) with an average age of 57 years. There was a notable agreement between DARE and AOE, with a Cohen\u27s Kappa inter-rater reliability score of 0.886 (p\u3c 0.002). Discrepancies in diagnoses were noted in 5 cases (8.8%) involving varied conditions. The study also found that the concordance rate increased and discrepancy rate decreased with the rising experience level of residents (from PGY-2 to PGY-3).
Conclusions : The study concludes that in a hospital setting, there is significant concordance between resident examinations assisted by the device and those conducted by attending ophthalmologists. The portable, HIPAA-compliant, web-connected camera proved to be a reliable tool for remote supervision of ophthalmology residents, potentially enhancing their learning and aiding in the supervisory and patient care responsibilities of attending ophthalmologists
Comprehensive Murine Model of Ige Mediated Multiple Food-Group Cross-Reactive Anaphylaxis
No full textRationale Approximately 32 million people in the US suffer from food allergies. Clinically, peanut/tree nuts, fish and shellfish food groups have substantial risk of cross reactivity. A murine model of multiple food group-cross reactivity is needed for developing novel therapies. Methods Mice were sensitized intraperitoneally (i.p.) weekly for three weeks with 500 μg protein of each cashew, walnut, shrimp, and cod, with 2 mg Alum. Naive mice were controls. IgE levels against the sensitized allergens and their cross-reactive allergens were measured at weeks 0 and 3. During weeks 4 and 5, mice received intragastrical challenges with 200 mg/mouse of each food as follows: peanut on day one, cashew, almond, and pistachio on day two, pecan on day three, shrimp and lobster on day seven, then cod and salmon on day 10 ( 2 hours apart for each group of foods). Following each challenge, anaphylactic symptom scores, plasma histamine levels, and rectal temperatures were measured. Results The levels of IgE against sensitized allergens (peanut, cashew, walnut, shrimp, and cod) and cross-reactive allergens from each group of foods (almond/pistachio, pecan, lobster, salmon) were significantly elevated at week 3 (P\u3c 0.01). Consistently, significantly increased anaphylactic symptom scores (P\u3c 0.05), decreased rectal temperatures (P\u3c 0.001) and increased plasma histamine levels (P\u3c 0.05), compared to the naïve mice, occurred following individual challenge with sensitized and unsensitized, but cross-reactive food. Conclusions We generated a comprehensive murine model of IgE mediated multiple food-group cross-reactive anaphylaxis, which will provide a valuable tool for developing novel therapies for cross-reactive multiple food allergies
AKI and Hyponatremia in a Patient with Crohn Disease: A Case Report
No full textIntroduction: Crohn\u27s disease (CD) and ulcerative colitis are examples of inflammatory bowel disease (IBD), which frequently has systemic symptoms that extend outside of the digestive tract. Although they are less frequent, renal and urologic problems can present serious treatment difficulties. Glomerulonephritis is an uncommon but serious extraintestinal manifestation. This case report demonstrates an uncommon correlation between immunoglobulin A nephropathy (IgAN), the most common glomerulonephritis worldwide and Crohn\u27s disease. Case Description: A week-long history of malaise, flu-like symptoms, and myalgias brought this 47-year-old White female patient to the emergency room. She had a history of Crohn\u27s disease following ileostomy. Severe electrolyte abnormalities and acute kidney damage (AKI) with a creatinine level of 10.7 mg/dL were discovered during laboratory examinations. Renal ultrasonography revealed modest bilateral renal enlargement without hydronephrosis or calculi, despite stable vitals and an unremarkable physical examination. Urine culture came back negative, but urinalysis revealed severe hematuria, pigmented granular casts, and proteinuria. The patient\u27s sodium and creatinine levels gradually improved subsequent to fluid restriction, desmopressin and hypertonic saline. Subsequently, a kidney biopsy demonstrated IgAN. Notably, at the time of the development of renal failure, the patient was not receiving immunosuppressive medicine and was not going through an aggressive flare-up of Crohn\u27s disease. Discussion: This case emphasizes the need of keeping an eye out for renal involvement in individuals with IBD. The patient\u27s abrupt renal failure and biopsy-proven IgAN demonstrate the intricate interactions between systemic immune responses and renal pathology in inflammatory bowel disease. Although uncommon, IgAN requires regular renal function monitoring in individuals with inflammatory bowel disease (IBD) in order to facilitate the early identification and treatment of any renal consequences. This report supports the use of an integrated strategy to patient management that takes into account both extraintestinal and gastrointestinal IBD symptoms. It is critical to research the pathogenic processes that connect IgAN and IBD and to ascertain if the two conditions are coincidental or suggest that they share common etiopathogenic pathways