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Browsing Abstracts by Author "Ahmed, Affan"
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Item Acute sex difference in response to repeated mild traumatic brain injury in mice(2023) Kuo, Aaron; Schreihofer, Derek; Sumien, Nathalie; Vann, Philip; Ahmed, AffanAcute sex difference in response to repeated mild traumatic brain injury in mice Aaron Kuo, Philip Vann, Nathalie Sumien, Ahmed Affan, Derek Schreihofer Background: Repetitive mild traumatic brain injury (rmTBI), such as that occurring in contact sports, is associated with the development of neurodegenerative diseases of aging. Severe TBI and repetitive concussions are associated with chronic traumatic encephalopathy (CTE), Alzheimer’s disease (AD), and Parkinson’s disease (PD), among others. However, less severe injuries may also lead to delayed neurological disfunction if repeated often and without sufficient rest time between injuries. Previously, we found that the progression of behavioral deficits in males and female mice differed from 5 to 15 weeks after 25 rmTBI. Both sexes showed motor deficits at 5 weeks, but only males showed affective and cognitive deficits at 15 weeks. Purpose: This study tested the hypothesis that rmTBI neurological deficits in male mice will appear earlier after rmTBI than in female mice. Methods: C57BL/6 male and female mice (8 wk old) were assigned to sham and rmTBI groups (n=20/group). Lightly anesthetized mice received 7 mild head injuries, once a day (M-F) using a weight drop model (75 g from 1 meter) that included a free fall with rotational injury. Five minutes after the final injury, mice were tested on a balance beam. Additional behavioral assessments began the following day. Results: No sex differences in balance beam performance were observed 5 minutes after the final injury. There were no significant effects of rmTBI on vestibular motor function assessed with a rotarod; cognition assessed with the Morris water maze; or affective behavior assessed with the elevated plus maze. However, in the open field test there was a significant increase in total distance traveled in rmTBI mice (F1,35 = 6.47, P=0.016). Post-hoc analysis revealed that this effect was only significant in male mice (Fisher LSD, P<0.05), supporting the hypothesis that males exhibit earlier deficits than females. Conclusion: At extended time points following rmTBI, both male and female mice develop motor deficits. However, up to 15 weeks after injury, only male mice experience cognitive and affective deficits. The current study reveals that male mice also display hyperactivity in the week after rmTBI that is not observed in female mice. Thus, sex differences in response to rmTBI are apparent both in the acute and chronic phase of injury and suggest that interventions to reduce brain injury may require different timing for males and females. Ongoing studies are examining potential differences in biochemical and histological responses in the brains of male and female mice. AUP: 2021-0035Item Case Report: Infective Endocarditis With Pulmonary Emboli, Effusion, and Pneumonia (Last Methamphetamine Abuse 15 Years Ago)(2023) Patel, Salman; Charolia, Samita; Ahmed, Affan; Kasim, ChaitanyaBackground: Infective endocarditis of the right-sided native valve involves the tricuspid or pulmonic valve; isolated right-sided IE accounts for approximately 10 percent of all IE cases. Methamphetamine use is known to cause cardiac complications including vasospasms and damage to the myocardial surface. Case Presentation: Patient is a 51-year-old Caucasian male presented to the ED with cough, fever, shortness of breath and wheezing for the last 2 weeks. Past medical history significant of COPD, hypertension (not on home medications), history of skin cancer of unknown type 10 years ago status postresection, methamphetamine use 15 years ago, current tobacco use disorder, and marijuana use disorder. Patient reported that his symptoms started with fever and a cough that is productive with yellow-colored sputum. He also lost about 15 to 20 pounds in the last 2 to 3 weeks. Patient also noticed hemoptysis and had a couple episodes of bloody sputum. He also reported worsening shortness of breath associated with wheezing and has been using albuterol nebulizer up to 4 times a day without much relief in symptoms. He denies sick contacts. He has been experiencing left upper quadrant abdominal pain worse with breathing/deep inspiration. Patient denies family history of blood clots. Work-up in the ED showed elevated leukocytosis with hyponatremia and mild hyperkalemia. Initial troponin was 0.06 and elevated BNP at 460. Urine analysis was only positive for marijuana. Patient's chest x-ray showed left sided pleural effusion. CTA chest with PE protocol was done and showed numerous cavitary consolidate to masses suspicious for septic emboli and left lower lobe pulmonary embolus with left lower lobe pneumonia and moderate pleural effusion. Day 1 he had a left thoracentesis showing exudative effusion. Day 3-5 PPD skin test, quant gold and AFB sputum cultures x3 are negative. BCX show initially MSSA and then repeat BCX show corynebacterium and staph capitis likely skin contaminant. Patience was placed on oxacillin for MRSA coverage. Day 5 TEE shows 1 cm vegetation in tricuspid valve confirming infective endocarditis. CT surgery is following outpatient for improvement of vegetation in 4 weeks with OP cardiology f/u. Heparin drip switched to Argatroban for heparin resistance and possible HIT. Argatroban bridged to warfarin. PT is now therapeutic. ANA is elevated 1:640, but further work up is negative. Patient will need continued IV antibiotic with oxacillin for at least 6 weeks. Will follow up echo with Cardiology in 4 weeks then revaluate with ID and CT surgery. Order heparin resistance antithrombin III evaluate OP after acute treatment. Conclusion: This case illustrates a unique presentation of infective endocarditis with pulmonary effusion, embolus, and pneumonia. Not certain what caused this patient case if it was his current use of marijuana or is methamphetamine use 15 years ago that just started presenting now.Item SARS-CoV-2 induced exacerbation of HbA1c in Type 2 Diabetics(2023) Ahmed, AffanBackground: The Covid-19 pandemic started when severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) was discovered in Wuhan, China. Although the majority of those infected suffer mild symptoms and recover, it is estimated that about 20% of infected patients can develop pneumonia, and some of these patients can develop acute respiratory distress syndrome (ARDS). Diabetes mellitus is a complex disease that affects millions of people worldwide. When it comes to type 2 diabetes mellitus the CDC reports that about 11.3% of the United States population is affected by diabetes. Case Presentation: A 56-year-old Hispanic male presented to the clinic for his routine 6-month diabetes follow-up. He had a medical history of type 2 diabetes mellitus, morbid obesity, benign hypertension, BPH without urinary obstruction, and unspecified hyperlipidemia. For his diabetes, the patient took 500 mg metformin, 4 mg glimepiride, and 2 mg/dose semaglutide. The patient had been compliant with his medication. His only relevant family history included his mother with a diagnosis of diabetes mellitus. The patient denied constitutional, cardiovascular, respiratory, and neurological ROS questions. There was no change in the patient’s medical history except that he had contracted SARS-CoV-2 three months before the visit. The patient described his symptoms, and his infection was classified as a mild version of the disease. The patient’s vitals were within normal limits, and he had a BMI of 37.3. His general, cardio, respiratory, and skin PE findings were all normal as well. HbA1c was recorded at 10.2% and his estimated average blood glucose was 242 mg/dl. Both values had increased from 7.1% and 157 mg/dl respectively since his previous visit on July 22, 2022. At this current visit, his (nonfasting) glucose was 324 mg/dl. The patient’s semaglutide was stopped and replaced with tirzepatide in hopes of reducing his HbA1c along with helping him lose weight. Unfortunately, the patient could not tolerate a higher dose of metformin. Discussion: The question remains whether this patient’s sudden increase in HbA1c of 3.1% from 7.1% to 10.2% could be attributed to the patient’s mild infection of COVID-19. A study published by Joshi & Pozzilli in 2022 in the Diabetes Research and Clinical Practice journal found that SARS-CoV-2 can dysregulate glucose homeostasis even in patients with no previous risk factors for diabetes mellitus. One report that studied the relationship between these two variables found that there was an association between severe COVID-19 and increased blood glucose. They also found that HbA1c was slightly elevated in those with severe COVID-19 compared to mild COVID-19 however, this finding did not reach significance. Physicians taking care of type 2 diabetic patients can caution their patients on the possibility of being infected with COVID-19 and worsening their A1c levels. For those patients battling a severe form of COVID-19, their A1c levels could also be measured after the infection to rule out COVID-19-induced diabetes mellitus. This case report also expands the list of long-term complications from COVID-19.