University Of Texas Medical Branch Research Articles

113 Acute Kidney Injury Secondary to Kidney Crystallization Attributable to Nelfinavir

ACUTE KIDNEY INJURY SECONDARY TO KIDNEY CRYSTALLIZATION ATTRIBUTABLE TO NELFINAVIR. Zaher Hamadeh, Tejinder S. Ahuja, Jeffrey Kopp. Jacobi Medical Center, New York, NY; University of Texas Medical Branch, Galveston, TX; National Institutes of Health, Bethesda, MD. Indinavir a Protease Inhibitor (PI) that can cause nephrolithiasis, crystalluria and acute kidney Injury (AKI). We are reporting a case of AKI and kidney crystallization induced by Nelfinavir another PI. A 72 years old African American male with history of HIV infection admitted with a creatinine of 3.2mg/dl (0.9mg/dl 4 months ago). His CD4 lymphocyte count is 753cells per cubic millimeter, viral load < 75 copies/ml and has been on the same highly active antiretroviral therapy (HAART) regimen including Nelfinavir for the last 2 years. He denied hematuria, back or flank pain. There was no history of urinary retention, nephrolithiasis or Nephrotoxins use. Labs showed no eosinophilia. Urinalysis showed bland urine sediment with no proteinuria. Renal ultrasound was unremarkable. Percutaneous kidney biopsy was performed and light microscopy showed tubules with intraluminal deposits and chronic tubulo-interstitial nephritis (see Fig); Electron Microscopy confirmed the amorphous crystals within the tubular lumina. Nelfinavir serum trough level was 3ug/ml at the upper normal (normal range of 1-3ug/ml). HPLC was done on a urine sample which detected Nelfinavir. A kidney tissue sample was sent for Mass Spectrometry which showed MW of the kidney crystals consistent with Nelfinavir free-base. HAART regimen was discontinued and creatinine level returned to 1.4mg/dl eight months later.

13th International Congress on Antiphospholipid Antibodies (APLA 2010)

The 13th International Congress on Antiphospholipid Antibodies (APLA 2010) was hosted and conducted in Galveston, TX, from 13 to 16 April 2010. Our goal was to make this event a truly international and multispecialty one and to provide the attendees with the latest evidence-based science on antiphospholipid syndrome (APS). We were were able to bring to Galveston more than 40 invited speakers from all APS-related specialties and more than 280 attendees from 28 different countries. The congress was accredited and supported by the University of Texas Medical Branch (UTMB) as a CME event. The three-and-half day event included stateof-the-art lectures, selected abstract oral presentations, poster sessions, and pre-conference ‘consensus’ workshops that gathered to report and discuss conclusions of specially assembled Task Forces. The Task Forces were charged with re-evaluating and validating the Sapporo revised classification criteria and discussing unsolved issues such as treatment and diagnostics in APS. Seven Task Forces, which included the topics ‘criteria’ and ‘non-criteria’ anti-phospholipid (aPL) antibody tests, obstetric APS, management of thrombosis, clinical studies in APS, the brain in APS, catastrophic APS, and non-traditional APS-related clinical manifestations, were assembled to address in an evidence-based manner the various topics that were further discussed at the pre-conference workshops along with congress attendees. This special issue of Lupus includes reports with recommendations and conclusions from those Task Forces and pre-conference workshops. We thank all of the contributors and members of the Task Forces and the editors of Lupus for allowing us to publish these important reports. It is expected that the Task Forces will continue to work to address these issues and will be able to report additional conclusions and recommendations at the next International Congress on Antiphospholipid Antibodies in Rio de Janeiro, Brazil, in 2013. Finally, we do hope that these reports will be useful to clinicians that are involved in diagnosing and treating patients with APS and will be of interest to scientists that are working on this debilitating disease.

Does a reduction in anabolic signaling contribute to muscle wasting in chronic heart failure?

chronic heart failure (CHF) is a complex and prevalent disease affecting 2% of adults in developed countries. This number increases to 6–10% in adults over the age of 65 ([3][1], [8][2]), and on diagnosis, half of all CHF patients die within 4 years ([11][3]). In addition to the significant

A Symbol of Our Profession: White Coat Ceremony Address to the Class of 2014

President Callender, Dean Anderson, Dean Thomas, Class of 2014, family members and distinguished guests, welcome to the 15th White Coat Ceremony at the University of Texas Medical Branch. I’d like to thank the School of Medicine Honor Education Council for inviting me to speak today.

The Long Polar Fimbriae of STEC O157:H7 are inducers of intestinal inflammation and reliable markers for identification of pathogenic E. coli.

Event Abstract Back to Event The Long Polar Fimbriae of STEC O157:H7 are inducers of intestinal inflammation and reliable markers for identification of pathogenic E. coli. Alfredo Torres1* 1 University of Texas, Department of Microbiology and Immunology, United States Alfredo Torres1*, Douglas Botkin1, Vinoth Sankarapani1, Roberto Vidal2, Lidia Cantero2, and Mauricio J. Farfan2 1 Dept Microbiol & Immunol, University of Texas Medical Branch, USA 2 School of Medicine, University of Chile, Chile Background. Shiga toxin-producing Escherichia coli (STEC) O157:H7 contains two non-identical loci encoding the long polar fimbriae (Lpf). Mutations in one or both of the lpf loci confer diminished colonization abilities in different animal models of infection and alter human intestinal tissue tropism. Further, it was demonstrated that different lpfA (putative major subunit) gene alleles are highly prevalent among STEC and enteropathogenic E. coli (EPEC) strains associated with severe and/or epidemic disease. Therefore, we sought to investigate the involvement of Lpf in the STEC-induced intestinal inflammation and to determine whether lpf alleles can be used for a rapid and specific identification of virulent E. coli strains. Aims: To assess the role of Lpf as an inducer of intestinal inflammation and as a biomarker for diagnosis. Methods. Secretion of pro-inflammatory cytokines in response to STEC wild type and lpf isogenic mutants was evaluated on non-polarized intestinal epithelial cells. The intracellular pathways activated by Lpf were determined using an array containing representative genes of 18 different signal transduction pathways. Finally, a multiplex PCR (mPCR) method was established containing genes unique to STEC and EPEC. Results. Of 27 cytokines assayed, IL-8 and GM-CSF were significantly reduced in the lpfA double mutant as compared to wild-type strain. The array analysis also demonstrated that the NF-κB pathway is activated in response to Lpf-producing STEC. A screen of gDNA from a collection of STEC and EPEC strains revealed that the mPCR was successful in predicting the correct pathotype in the majority of the strains tested. Conclusions. In this study, we demonstrated a role for Lpf in colonization and STEC-induced intestinal inflammation. Further, approximately ¾ of the isolates from a diarrheagenic E. coli collection were correctly identified via mPCR, strongly suggesting that the assay could be used as rapid diagnostic tool to detect STEC and EPEC strains. Keywords: Lpf, inducer of inflammation and biomarker, STEC O157:57 Conference: ECMIS - E. coli and the Mucosal Immune System : Interaction, Modulation and Vaccination, Ghent, Belgium, 2 Jul - 5 Jul, 2011. Presentation Type: Oral Presentation Topic: Immune responses in humans, ruminants, pigs and poultry Citation: Torres A (2011). The Long Polar Fimbriae of STEC O157:H7 are inducers of intestinal inflammation and reliable markers for identification of pathogenic E. coli.. Front. Immunol. Conference Abstract: ECMIS - E. coli and the Mucosal Immune System : Interaction, Modulation and Vaccination. doi: 10.3389/conf.fimmu.2011.01.00013 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 26 Sep 2011; Published Online: 03 Oct 2011. * Correspondence: Prof. Alfredo Torres, University of Texas, Department of Microbiology and Immunology, Galveston, Texas, 77555, United States, altorres@utmb.eu Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Alfredo Torres Google Alfredo Torres Google Scholar Alfredo Torres PubMed Alfredo Torres Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Update and optimal use of a brinzolamide-timolol fixed combination in open-angle glaucoma and ocular hypertension

Glaucoma encompasses a wide clinical spectrum of disease, with the common pathophysiology of progressive optic neuropathy leading to visual field loss. Elevated intraocular pressure (IOP) is a key risk factor in disease progression. Treatment is aimed at reduction of IOP to minimize continued optic nerve head damage. Pharmacologic treatment with various classes of IOP-lowering medications is generally employed before more aggressive surgical interventions. Monotherapy is generally accepted as initial therapy for glaucoma, but at least half of patients may require more than one IOP-lowering medication. One option is the fixed combination of brinzolamide 1% and timolol maleate 0.5%, which is commercially available in some countries as Azarga® for treatment of glaucoma not adequately responsive to monotherapy. These agents may also be used in an unfixed fashion, but fixed combination therapy is generally more convenient for patients, which may result in improved compliance, a reduction of the “washout effect” from instilling multiple drops, and a potential reduction in the side effects related to multiple doses of preservatives.

Not Connected in 2010

From the Clinics Administration, University of Texas Medical Branch, Galveston, TX. Reprints: Peggy Mann, MS, MT(ASCP), Clinics Administration, University of Texas Medical Branch, Galveston, TX. E-mail: [email protected].

Prehospital wireless transmission of electrocardiograms showing presumed ST-elevation myocardial infarction to an on-call cardiologist's handheld device: can the reduction in time to reperfusion be maintained in a single community and achieved in larger and medically complex communities?

Prehospital wireless transmission of electrocardiograms showing presumed ST-elevation myocardial infarction to an on-call cardiologist's handheld device: can the reduction in time to reperfusion be maintained in a single community and achieved in larger and medically complex communities? George L. Adams , Ghassan H. Abusaid , Benjamin A. Lee , Charles Maynard , Galen S. Wagner , Alejandro Barbagelata ,1 The Duke University Medical Center, Durham, NC University of Texas Medical Branch, Galveston, TX Department of Health Services, University of Washington, Seattle, WA

First arrhythmia collection of transvenous and simultaneous subcutaneous implantable defibrillator data (FACTS ICD) multicenter study

Prehospital wireless transmission of electrocardiograms showing presumed ST-elevation myocardial infarction to an on-call cardiologist's handheld device: can the reduction in time to reperfusion be maintained in a single community and achieved in larger and medically complex communities? George L. Adams , Ghassan H. Abusaid , Benjamin A. Lee , Charles Maynard , Galen S. Wagner , Alejandro Barbagelata ,1 The Duke University Medical Center, Durham, NC University of Texas Medical Branch, Galveston, TX Department of Health Services, University of Washington, Seattle, WA

Are cutaneously derived electrocardiography signals reliable surrogates for subcutaneous sensing algorithm testing?

Prehospital wireless transmission of electrocardiograms showing presumed ST-elevation myocardial infarction to an on-call cardiologist's handheld device: can the reduction in time to reperfusion be maintained in a single community and achieved in larger and medically complex communities? George L. Adams , Ghassan H. Abusaid , Benjamin A. Lee , Charles Maynard , Galen S. Wagner , Alejandro Barbagelata ,1 The Duke University Medical Center, Durham, NC University of Texas Medical Branch, Galveston, TX Department of Health Services, University of Washington, Seattle, WA

Factors Predicting Advanced Stage Hepato-Cellular Carcinoma at Diagnosis

Purpose: Hepatocellular Carcinoma (HCC) is increasing worldwide. Outcome depends on stage of the HCC with a poor outcome in patients with advanced stage at the time of diagnosis. Data on factors predicting advanced stage of HCC at the time of diagnosis are scanty. We performed this study with the aim of identifying factors predictive of advanced stage of HCC at diagnosis. Methods: Medical charts of patients with HCC seen and managed at the University of Texas Medical Branch, Galveston, TX, between 01/2007-05/2010 were reviewed. Diagnosis of HCC was determined based on standard AASLD guidelines. Cases were categorized into early stage (group I) or advanced stage (group II) based on number and size of lesions, portal vein (PV) invasion, nodal, and distant spread. Patients with > 3 lesions, size > 3cm, bilobar disease, PV invasion, and metastases were defined as advanced stage HCC. Two groups were compared for patient demographics, location of the patient (prison population or free world), indication for work-up (screening or triggered by symptoms), clinical presentation, presence of and etiology of cirrhosis, laboratory parameters including alfa-feto protein (AFP) levels, and imaging data. Fisher's exact and t-tests were used for comparing proportions and means ± SD respectively. Multivariate logistic regression by backward elimination was used to identify predictors [reported as odds ratio (OR) with 95% confidence interval (CI)]. Results were considered significant at p<0.05. Results: Total of 122 patients with HCC (55 in group I and 67 in group II) were analyzed. In comparison to early stage HCC at diagnosis (group I), patients with advanced disease (group II) at presentation were younger (mean age 58.5±9 years vs. 55.4±6 years; p=0.032) and more likely to be males (78 vs. 94%; p=0.0099). As expected, lesions among group II patients in comparison to group I patients were bigger (mean size 61 mm vs. 37 mm; p=<0.0001), more likely to be multiple (51% vs. 22%; p=0.0046), and more likely to be bi-lobar(43% vs. 22%; p=0.0265). There were no differences between the two groups with regards to patient' race, previous known diagnosis of cirrhosis, location of patient, indication for workup, and laboratory parameters including AFP values. On logistic regression analysis, age of the patient independently predicted advanced stage HCC at the time of diagnosis with an OR of 0.930 (95% CI 0.88- 098); P=0.0075. Conclusion: Advanced stage of HCC at the time of diagnosis occurs more frequently in younger males. If confirmed in studies with larger sample size, these data may have implication for understanding the pathogenesis of HCC, in respect of host-virus interaction and help to evolve better strategies for detection and management of HCC.

Oxidative stress in critical care medicine

International Journal of Clinical PracticeVolume 64, Issue 11 p. 1480-1488 Oxidative stress in critical care medicine M. E. Bernal, M. E. Bernal Universidad de Monterrey, Escuela de Medicina, Monterrey, Nuevo León, MéxicoSearch for more papers by this authorJ. Varon, J. Varon The University of Texas Health Science Center of Houston, The University of Texas Medical Branch at Galveston, St. Luke’s Episcopal Hospital/Texas Heart Institute, Houston, TX, USASearch for more papers by this authorP. Acosta, P. Acosta The University of Texas Medical Branch,Galveston, TX, USASearch for more papers by this authorL. Montagnier, L. Montagnier World Foundation for AIDS Research and Prevention, Paris, France Dr Luc Montagnier was the recipient of the 2008 Nobel Prize in Medicine and PhysiologySearch for more papers by this author M. E. Bernal, M. E. Bernal Universidad de Monterrey, Escuela de Medicina, Monterrey, Nuevo León, MéxicoSearch for more papers by this authorJ. Varon, J. Varon The University of Texas Health Science Center of Houston, The University of Texas Medical Branch at Galveston, St. Luke’s Episcopal Hospital/Texas Heart Institute, Houston, TX, USASearch for more papers by this authorP. Acosta, P. Acosta The University of Texas Medical Branch,Galveston, TX, USASearch for more papers by this authorL. Montagnier, L. Montagnier World Foundation for AIDS Research and Prevention, Paris, France Dr Luc Montagnier was the recipient of the 2008 Nobel Prize in Medicine and PhysiologySearch for more papers by this author First published: 15 September 2010 https://doi.org/10.1111/j.1742-1241.2010.02506.xCitations: 16 Joseph Varon, MD, FACP, FCCP, FCCM.,2219 Dorrington St Houston, TX 77030-3209, USATel.: +1 713 669 1670Fax: +1 713 669 1671Email: [email protected] Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Citing Literature Volume64, Issue11October 2010Pages 1480-1488 RelatedInformation

A Unique BSL-3 Cryo-Electron Microscopy Laboratory at UTMB

This article describes a unique cryo-electron microscopy (CryoEM) facility to study the three-dimensional organization of viruses at biological safety level 3 (BSL-3). This facility, the W. M. Keck Center for Virus Imaging, has successfully operated for more than a year without incident and was cleared for select agent studies by the Centers for Disease Control and Prevention (CDC). Standard operating procedures for the laboratory were developed and implemented to ensure its safe and efficient operation. This facility at the University of Texas Medical Branch (Galveston, TX) is the only such BSL-3 CryoEM facility approved for select agent research.

Healthcare Reform and Nursing

Authors' Affiliations: Senior Director, Federal Relations and Policy (Ms Webb), American Organization of Nurse Executives, Washington, DC; Chief Nursing and Patient Care Services Officer (Dr Marshall), University of Texas Medical Branch, Galveston. Corresponding author: Ms Webb, American Organization of Nurse Executives, 325 Seventh Street NW, Suite 700, Washington, DC 20004 ([email protected]).

Emergency Preparedness for Residency/Fellowship Programs: Lessons Learned During Hurricane Katrina and Applied During Hurricane Ike

When it struck the US Gulf Coast in 2005, Hurricane Katrina severely disrupted many graduate medical education residency/fellowship programs in the region and the training of hundreds of residents/fellows. Despite the work of the Accreditation Council for Graduate Medical Education in responding to this natural disaster and facilitating communication and transfer of residents/fellows to other unaffected training programs, the storm exposed the gaps in the existing system. Subsequently, the Accreditation Council for Graduate Medical Education, with the aid of its member organizations, including the American Medical Association, developed a new disaster recovery plan to allow for a more rapid, effective response to future catastrophic events. These policies were instrumental in the rapid relocation of 597 residents/fellows from the University of Texas Medical Branch at Galveston after the landfall of Hurricane Ike in September 2008. As a further accommodation to affected trainees, medical certification boards should be as flexible as possible in waiving continuity requirements in the event of a disaster that affects residency/fellowship programs.

Sensitization with atypical mycobacteria is a potent risk factor for cross-reaction with the delayed type hypersensitivity assay in mice

Sensitization with atypical mycobacteria is a potent risk factor for cross-reaction with the delayed type hypersensitivity assay in mice Eduardo Martins de Sousa1, Fernando Bonfim de Bortoli1, Bruna Daniella de Souza Silva1, Ediane Batista da Silva1, Scott M Irwin2, Ana Paula Junqueira Kipnis11Department of Microbiology, Immunology, Parasitology and Pathology, Institute of Tropical Pathology and Public Health, Federal University of Goias, Goi&acirc;nia-Go, Brazil; 2Department of Pediatrics, University of Texas Medical Branch, Galveston, TX, USAAbstract: Tuberculosis is a disease that infects approximately two billion people worldwide. The current diagnostic test utilizes purified protein derivative (PPD) obtained from Mycobacterium tuberculosis cultures to elicit a host delayed type hypersensitivity reaction to identify infected individuals. This reaction is manifested as an induration at 48 hours following intradermal i&shy;njection. These experiments demonstrate that in a mouse model, repeated administrations of PPD do not elicit a positive tuberculin skin test (TST). However, prior sensitization to &shy;environmental mycobacteria does induce a positive TST when administered via the intraperitoneal or oral route. This work has important implications regarding the specificity of the PPD reagent, disease diagnosis, and environmental mycobacteria.Keywords: tuberculin skin test, environmental mycobacteria, immune response

Shelf life of embryo culture media: Buffering potential of media apparently not the determining factor

To investigate if the buffering power of embryo culture media is compromised by expiration. Buffering potential of expired culture media was evaluated by measuring pH values. Fertility Laboratory, the University of Texas Medical Branch, USA. The pH of expired culture media were measured and compared with those of unexpired ones in three experimental conditions: (1) pre-incubation, (2) CO 2 incubation and (3) post-incubation. Sequential media, comprising Quinn's advantage fertilization, cleavage and blastocyst media (Sage assisted reproduction products Inc.), were used. The media were divided into expired and unexpired groups, based on the manufacturer's indicated expiration dates. The unexpired group was evaluated in their original condition (first time opened). The expired media bottles underwent more than one opening. The pH of the media was measured sequentially in conditions 1, 2 and 3. The expired media (30–390days) displayed significantly ( p <0.05) different pH values compared to unexpired media in pre-incubation condition. However, expired media were capable of yielding similar pH values ( p ⩾0.23) to those of the corresponding unexpired controls in CO 2 incubation as well as post-incubation suggesting that the buffering capacity of the media is apparently not affected by expiration. Time-dependent nutrient depletion, not the weakening of the buffering system, is probably the determining factor in setting the shelf life of the culture media.

University of Texas Medical Branch Telemedicine Disaster Response and Recovery: Lessons Learned from Hurricane Ike

Despite previous efforts and expenditure of tremendous resources on creating and simulating disaster response scenarios, true disaster response, specifically for healthcare, has been inadequate. In addition, none of the >200 local and statewide telemedicine programs in the United States has ever responded to a large-scale disaster, let alone, experienced one directly. Based on its experience with hurricanes Rita and, most recently, Ike, the University of Texas Medical Branch (UTMB) experienced its most challenging trials. Although there were significant disruptions to a majority of UTMB's physical and operational infrastructures, its telemedicine services were able to resume near normal activities within the first week of the post-Ike recovery period, an unimaginable feat in the face of such remarkable devastation. This was primarily due in part to the flexibility of its data network, the rapid response, and plasticity of its telemedicine program. UTMB's experiences in providing rapid and effective medical services in the face of such a disaster offer valuable lessons for local, state, and national disaster preparations, policy, and remote medical delivery models and programs.

The Struggling Resident

The Struggling Resident

A Randomized, Placebo-Controlled, Multicenter Study of Divalproex Sodium Extended-Release in the Acute Treatment of Mania

Divalproex sodium extended-release (ER) was examined for the treatment of acute mania in adults in 2 randomized, placebo-controlled clinical trials. One study demonstrated statistically significant improvements in mania symptoms compared to placebo, while an earlier study did not. Results of the earlier study are presented here. A total of 225 DSM-IV-diagnosed bipolar I disorder patients were randomly assigned in a 2:1 ratio to 21 days of double-blind treatment with divalproex ER (n = 147) or placebo (n = 78). The daily divalproex ER dosage was initiated at 20 mg/kg. The primary efficacy variable was the change from baseline to final evaluation in Mania Rating Scale (MRS) score. Subjects were discontinued from the study if they were discharged from the hospital or if they met prespecified improvement criteria. The study was conducted from May 1998 to July 1999 at centers in the United States. There was no statistically significant difference in MRS score change from baseline to final for patients treated with divalproex ER compared with those treated with placebo. With the exception of back pain and constipation, adverse event rates between placebo and divalproex ER were very similar. A large proportion of patients prematurely discontinued study treatment (divalproex ER: 83%, placebo: 82%). The mean daily dose of divalproex ER was 2,211 mg with a mean maximum serum valproic acid concentration of 77.9 microg/mL. The results of the current study did not demonstrate statistically significant improvement in mania symptoms associated with divalproex ER treatment compared to placebo. A number of methodological considerations may have contributed to the negative findings, including allowance for early study discontinuation and lower than optimal dosing. clinicaltrials.gov Identifier: NCT00060905.