Browsing by Author "Iloani, Nwamaka Amy"
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Item Association of Specificity Proteins with Hepatocellular Carcinoma Patients Survival(2022) Iloani, Nwamaka Amy; Dulemba, Victoria; Hafeez, Areeba; Bao, Serena; Basha, RiyazPresenter: Nwamaka Amy C. Iloani Authors: Nwamaka Iloani, Victoria Dulemba, Areeba Hafeez, Serena Bao and Riyaz Basha Title: Association of Specificity Proteins with Hepatocellular Carcinoma Patients Survival Background: Liver cancer is one of the most diagnosed cancers worldwide and ranks third in cancer mortality, leading to over 700,000 deaths per year. Of these liver cancers, the most common is hepatocellular carcinoma (HCC), accounting for nearly 80% of all liver cancer diagnoses. Since the current treatment options have limited improvement in prognosis over the years, identifying novel targets to induce therapeutic efficacy and reduce resistance to current therapeutic option is urgently needed. Specificity protein (Sp) transcription factors Sp1 and Sp3 are associated with incidences and poor prognosis of several cancers. Sp1 is implicated in the development and metastasis of HCC by binding to GC-rich sequences of the promoter region. Sp1 influences genetic transcription of the oncogenes encoding for the HCC by binding to gene regions such as RING1 and YY1 Binding Protein (RYBP), Ras guanine nucleotide-releasing protein 1 (RasGRP1) and many others to regulate their genetic expression. Sp3 works in a similar fashion and binds to GC and GT rich sequences in regulatory genes to affect HCC cell expression. The objective of this study is to ascertain the association of Sp1 and Sp3 expression with the survival of HCC patients using publicly available data bases. Method: Information regarding the expression levels of Sp1, Sp3, RYBP, RasGRP1 and Kaplain-Meier curves were obtained from accessing the data in the public data basses, R2 genomics visualization platform and The Cancer Genome Atlas (TCG). These data used to assess the probabilities of HCC patients with high vs low expression of Sp1 or Sp3. Results: The analysis of these data indicated significant findings. When comparing normal liver cell lines and HCC cell lines, HCC cell lines showed increased expression of both Sp1 and Sp3. The high expression of Sp1 or Sp3 is associated with decreased probability and chance of survival in comparison to individuals with decreased expression (Sp1: p< 0.027; Sp3: p< 0.0087). The survival curves of RYBP and RasGRP1 also following similar patten, however the relevance to Sp1 and Sp3 has higher impact and poor prognosis. Conclusion: Higher expressions of Sp1 and Sp3 are typically associated with poorer patient survival rates. These results suggest that the therapeutic interventions that focus on targeting Sp1, Sp3 and their downstream mechanisms have the chance for impeding HCC tumorigenesis. We are investigating the association of Sp1 and Sp3 regulated oncogenes with HCC. Investigational agents with inhibitory effect against Sp1 and Sp3 are also currently being tested against HCC proliferation. Research reported in this publication was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under Award Number (R25HL125447). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.Item Iatrogenic Ureter Injury and Repair: Comparing Suture Versus Suture and Glue in Ureter End-to-End Anastomosis(2023) Iloani, Nwamaka Amy; Wade, Michael; Joseph, Matthew; Martinez, Maria; Ntekim, Nedeke; Mallet, Robert T.; Yurvati, AlbertFunding: Dallas Southwest Osteopathic Physicians The ureter is a delicate structure due to its size and anatomical location. It is found deep within the retroperitoneal space and the lower third of the ureter lies adjacent to numerous pelvic structures such as the uterine artery, cervix, vagina, colon, and iliac vessels, and due to its proximity, the ureter is subject to unintentional accidental injury during diagnostic or medical procedures, termed iatrogenic. This paper and associated aim to explore the odds of iatrogenic ureteral injuries (IUI) when comparing different surgical methods, discuss the best preventative options and review the current repair measures, as well as any associated complications. The aim of this study focused on ureter transection that require surgical repair using a ureterouretal anastomosis, a procedure that ligates the free ends of the transected ureter together. Ureters were obtained from anesthetized Yorkshire pigs via standard laparotomy [protocol: IACUC-20-0011]. Ureters were transected laterally midway along the length of the harvested ureter. In Group A ureters, 2 standard stay sutures were placed 180˚ degrees opposite one another to anchor the ureter and ligated using a simple continuous running suture technique. In Group B, ureters were anchored in a similar fashion with stay sutures and ligated using glue to perform the anastomosis. 500 mL saline was then flushed through the ureter to assess the structural integrity of the ureterouretal anastomosis. Group A ureters showed less stricture formation and fluid leakage at the site of anastomoses, indicating that the standard suture technique used in ureter repair is a safe and reasonable gold standard. In contrast, Group B ureters showed stricture formation and some fluid leakage at suture/glue line, indicating the method of ureter anastomoses was inferior. When IV saline was pushed in Group B ureters, the fluid often exited the ureter at both the suture site and the end portion of the ureter, more so than the Group A ureters. Future study needs to be conducted in suture/glue method as it is promising. However, it is not at the level where it can replace current ureter repair end to end anastomoses gold standard. *These authors are solely listed in alphabetical order Research reported in this publication was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under Award Number R25HL125447. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.Item Review of an Advanced Case of Psoriatic Arthritis and Barriers to Management of Chronic Disease in the West Texas Region(2023) Martin, Delaney; Joseph, Matthew; Iloani, Nwamaka Amy; Tadesse, Meron; Hadley, Lesca; Allsopp, Leslie C.Background: Psoriatic arthritis is a debilitating, inflammatory musculoskeletal spondyloarthritis associated with the skin condition psoriasis that affects the hands, feet, spine, and other parts of the body. Nearly 80% of patients develop the associated arthritis after skin lesions of psoriasis develop. Management of psoriatic arthritis can be difficult, with severe variants recommended to receive specialized care from a rheumatologist for optimal treatment. The clinical case that will be discussed refers to a patient presenting with psoriatic exacerbation, which progressed from skin lesions to psoriatic arthritis with unmanaged pain. Despite the severity of this progression, he received minimal education on psoriatic arthritis management. Case Presentation: A 34-year-old male presented to clinic with a primary complaint of pain for uncontrolled psoriatic arthritis that had been diagnosed one year prior, two years after an original diagnosis of psoriasis. He reports the diagnosis of psoriatic arthritis was made after diffuse rashes spread over his body and extensor surfaces with increasing joint pain. At the clinic, the patient complained of weakness in his extremities; severe pain at elbow, ankle, knee, and toe joints bilaterally; a diffuse erythematous rash particularly at the ankles; and difficulty with daily activity due to pain. Notable physical exam findings included a personal history of psoriasis, joint pain, nodules growing past the distal interphalangeal joint of his hands and feet along with dactylitis and nail dystrophy consistent with psoriatic arthritis. Based on Classification for Psoriatic Arthritis criteria (CASPAR), he would be due to a score above 5 classified as having psoriatic arthritis. He has a known history of epilepsy, spinal stenosis, generalized anxiety disorder, chronic PTSD, and type 1 bipolar disorder. Patient reported recurrent methamphetamine use along with frequent use of marijuana for pain control. His social history was significant for lack of employment and symptoms worsening while uninsured. He stated an inability to attend scheduled appointments due to lack of transportation, the distance from Terlingua to the clinic in Alpine, TX, and inability to obtain telemedicine visits with his current provider. Conclusion: This case study on management of advanced psoriatic arthritis examines the health disparities faced by patients in rural west Texas regions, including lack of patient education, access to qualified rheumatologists, and adequate resources to manage disease exacerbation. A literature search on PubMed was conducted to clarify the current standard of care for treatment of advanced psoriatic arthritis, as well as current restrictions in management within the West Texas area. For social determinant factors, the social vulnerability index for west Texas regions was reviewed using public Center for Disease Control and Prevention data to note qualified health centers for this level of need and found appropriate services are lacking within the town of Terlingua and its neighboring areas. In addition to the healthcare team, an appropriate and safe environment for those suffering with psoriatic arthritis also includes stable infrastructure, social support, and public transportation. Without public health measures and capable providers, there are increased barriers to care of chronic disease for those living in rural areas like Terlingua.