Catastrophic Merkel Cell Carcinoma in a Liver Transplant Recipient.

Merkel cell carcinoma (MCC) is a rare skin cancer, is difficult to diagnose, and carries a high mortality rate. Solid organ transplant recipients (SOTR) are at a disproportionately increased risk of MCC and other malignancies due to chronic immunosuppression. We discuss the case of a 47-year-old woman with a remote history of liver transplant on chronic immunosuppression with tacrolimus for over a decade who presented for a third recurrence of MCC on her left forearm.

Refractory right ventricular myocarditis induced by immune checkpoint inhibitor despite therapy cessation and immune suppression.

Background: Immune checkpoint inhibitors (ICIs) are currently widely used for treatment of various types of cancers. ICI-induced myocarditis, though uncommon, accounts for high risk of major adverse cardiac events and mortality, which makes appropriate diagnosis important. We here present a unique, challenging case of ICI-induced, refractory and isolated right ventricular (RV) myocarditis.

A machine learning model in predicting hemodynamically significant coronary artery disease: A prospective cohort study.

Background: Coronary artery disease (CAD) costs healthcare billions of dollars annually and is the leading cause of death despite available noninvasive diagnostic tools.

Objective: This study aims to examine the usefulness of machine learning in predicting hemodynamically significant CAD using routine demographics, clinical factors, and laboratory data.

Methods: Consecutive patients undergoing cardiac catheterization between March 17, 2015, and July 15, 2016, at UNC Chapel Hill were screened for comorbidities and CAD risk factors.

B careful: Humoral responses and COVID-19 severity.

Neutralizing antibody responses to SARS-CoV-2, though often of limited longevity, have generally been assumed to be protective against COVID-19 disease.

Pediatric sleep questionnaire predicts more severe sleep apnea in children with uncontrolled asthma.

Objective: While up to 35% of children with asthma have evidence of sleep disordered breathing (SDB), it is unclear if nocturnal symptoms stem from asthma itself or SDB. The Pediatric Sleep Questionnaire (PSQ) is a validated tool for identifying SDB in childhood asthma. We hypothesize children with asthma and abnormal PSQ demonstrate decreased asthma control and are at higher risk of obstructive sleep apnea (OSA).

Viral strategies predisposing to respiratory bacterial superinfections.

Acute respiratory infections are amongst the leading causes of childhood morbidity and mortality globally. Viruses are the predominant cause of such infections, but mixed etiologies with bacteria has for decades raised the question of the interplay between them in causality and determination of the outcome of such infections. In this review, we examine recent microbiological, biochemical, and immunological advances that contribute to elucidating the mechanisms by which infections by specific viruses enable bacterial infections in the airway, and exacerbate them.

Use of Ga DOTATATE, a new molecular imaging agent, for neuroendocrine tumors.

Neuroendocrine tumors (NET), such as insulinomas and carcinoid tumors, can be challenging to diagnose since patients often present with vague symptoms. Adding to the challenge, these tumors are often occult on typical cross-sectional imaging modalities. Because of these challenges, there has been an increase in the utilization of radiopharmaceuticals that take advantage of specific receptors expressed by NET.

Changes in microbiome diversity following beta-lactam antibiotic treatment are associated with therapeutic versus subtherapeutic antibiotic exposure in cystic fibrosis.

In persons with cystic fibrosis (CF), decreased airway microbial diversity is associated with lower lung function. Conflicting data exist on the impact of short-term antibiotics for treatment of acute pulmonary exacerbations. However, whether differences in antibiotic exposure impacts airway microbiome changes has not been studied.

Relationship of Pulmonary Outcomes, Microbiology, and Serum Antibiotic Concentrations in Cystic Fibrosis Patients.

Objectives: To determine the frequency of subtherapeutic exposure to intravenously administered β-lactam antibiotics in a cohort of cystic fibrosis (CF) patients who were treated for a pulmonary exacerbation, and its impact on pulmonary function.

Methods: Nineteen CF patients between the ages of 5 and 21 years treated at Children's National Health System for a pulmonary exacerbation were followed between March 2015 and August 2016 in a prospective, longitudinal study. Pharmacokinetic modeling and minimum inhibitory concentrations (MICs) of the involved pathogens were used to determine therapeutic or subtherapeutic β-lactam antibiotic exposure based on the time the antibiotic concentration was above the MIC.

Antibiotic multidrug resistance in the cystic fibrosis airway microbiome is associated with decreased diversity.

Background: Cystic fibrosis (CF) is associated with significant morbidity and early mortality due to recurrent acute and chronic lung infections. The chronic use of multiple antibiotics increases the possibility of multidrug resistance (MDR). Antibiotic susceptibility determined by culture-based techniques may not fully represent the resistance profile.

Electrochemical properties and C-H bond oxidation activity of [Ru(tpy)(pyalk)Cl] and [Ru(tpy)(pyalk)(OH)].

[Ru(tpy)(pyalk)Cl]Cl (pyalk = 2-(2'-pyridyl)-2-propanol) was synthesized and characterized crystallographically and electrochemically. Upon dissolution in water and acetonitrile, [Ru(tpy)(pyalk)Cl]Cl was found to form [Ru(tpy)(pyalk)Cl]+ and [Ru(tpy)(pyalk)(OH)]+, respectively. The Ru(ii/iii) couple of [Ru(tpy)(pyalk)Cl]+ was found to be relatively low compared to that of other Ru complexes in acetonitrile, but the Ru(iii/iv) couple was not significantly different than other Ru complexes bearing anionic ligands.

Phenotypic Characterization of the c.1679+1643G>T (1811+1643G>T) Mutation in Hispanic Cystic Fibrosis Patients.

Cystic fibrosis (CF) is the most common fatal genetic diseases in the United States in Caucasians. More than 2000 genetic mutations have been described and CF is now known to affect other races. The incidence of CF in individuals of Hispanic descent is estimated to be 1:9200.

The Impact of Total Gastrectomy on Pharmacokinetics in Kidney Transplant Immunosuppressive Drug Regimes: A Case Study.

Background: Ensuring reliable gastrointestinal drug absorption of orally administered immunosuppressive medications posttransplant is critical to ensuring graft survival.

Methods: A 66-year-old man of East Asian origin with a previous total gastrectomy was evaluated for living donor kidney transplantation. Pretransplant pharmacokinetic testing was performed to determine the most appropriate posttransplant medication strategy.

A comparison of the extended-release and standard-release formulations of tacrolimus in de novo kidney transplant recipients: a 12-month outcome study.

BACKGROUND: Limited comparative data are available on the outcomes between extended-release and standard-release tacrolimus when used de novo in kidney transplant recipients (KTRs). METHODS: We identified KTRs transplanted at our institution during 2009-10 routinely prescribed extended-release tacrolimus and compared them with those transplanted during 2008-09 prescribed standard-release tacrolimus. Graft function (eGFR by MDRD-7 equation) at 12 months post-transplant (primary outcome); new-onset diabetes and other cardiovascular risk factors, BK viremia incidence, acute rejection, and graft survival to 12 months (secondary outcomes) were compared by intent-to-treat analysis.

Renal cell carcinoma extending into vena cava and right atrium.

We report on a patient who underwent complete removal of a renal cell carcinoma extending into the vena cava and the right atrium. A review of the literature confirms the rarity of vena caval obstructive symptoms. Emphasis is on preoperative diagnosis, thoracoabdominal exposure, and team approach.

Radioisotope penogram in diagnosis of vasculogenic impotence.

A radioisotope technique to estimate penile blood flow is described. The radioisotope penogram is noninvasive and gives a dynamic evaluation of the arterial supply, venous drainage, and blood flow in the corporeal bodies. The penogram is a valuable adjunct in evaluation of patients with vasculogenic impotence.