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Zuberi H, Staples CJ, Housewright CD. Respecting the Art of Medicine: Wide Local Excision of Melanoma Within a Tattoo Sleeve. Dermatol Surg 2024; 50:290-291. [PMID: 38048269 DOI: 10.1097/dss.0000000000004043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Affiliation(s)
- Hafsa Zuberi
- Texas Tech University Health Sciences Center School of Medicine, Lubbock, Texas
| | - Cecil Jordan Staples
- Dermatologic Surgery, Department of Dermatology, Baylor Scott & White Healthcare, Temple, Texas
- Texas A&M College of Medicine, Temple, Texas
| | - Chad D Housewright
- Dermatologic Surgery, Department of Dermatology, Baylor Scott & White Healthcare, Temple, Texas
- Texas A&M College of Medicine, Temple, Texas
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Avila M, Tan Y, Hernandez R, Zuberi H, Rivera VM. Multiple Sclerosis and Neuromyelitis Optica Spectrum Disorder: Onset Following Acute COVID-19 Infection, a Case Series. Neurol Ther 2023; 12:319-327. [PMID: 36399224 PMCID: PMC9672646 DOI: 10.1007/s40120-022-00418-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/28/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Acute COVID-19 infection has been associated with neurological involvement. We report a case series of newly diagnosed patients with multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) developed in a short period of time after acute COVID-19 infection. METHODS New MS patients developing initial symptoms shortly after an acute COVID-19 infection were diagnosed based on the 2017 McDonald Criteria [Garcia-Ramos et al. in Cells, 2021]. The patients diagnosed with NMOSD met the 2015 International Panel criteria for the diagnosis of NMOSD (IPDN) [Thompson et al. in Lancet Neurol 17:162-173, 2018]. RESULTS FROM THE MS PATIENT GROUP Ten patients were included who had developed initial MS symptoms after COVID-19 infection. Gender distribution was equal (50% male). The mean age was 28 (range 17-39) years. Average time to neurological presentation was between 2 and 6 weeks following acute COVID-19 infection. Partial transverse myelitis was the initial presentation in 40% of the cases, and 60% of patients had spinal cord lesions present at the moment of diagnosis. All patients showed enhancing lesions on brain magnetic resonance imaging (MRI). The presence of cerebrospinal fluid (CSF) oligoclonal bands was found in all six tested cases. The majority of patients (80%) were unvaccinated for COVID-19. The two vaccinated patients had received two doses of the monovalent COVID-19 messenger ribonucleic acid (mRNA) (Pfizer Biotech) vaccine and no booster, a year prior to contracting COVID-19. RESULTS FROM THE NMOSD GROUP Two patients with NMOSD were included. Positive aquoporin-4 protein antibody (AQP-4 Ab) was detected in serum in both cases [one Enzyme Linked immunosorbent assay (ELISA) and one cell based]. Both patients had mild COVID-19 infection prior to presentation, initial neurologic symptoms presented between 3 and 6 weeks after COVID-19 infection. Neither patients were vaccinated. Both responded partially to steroids, one developed a relapse 40 days after diagnosis. CONCLUSION COVID-19 infection has been linked to several neurological and immune-driven conditions. This study suggests that in susceptible individuals, acute COVID-19 infection may act as a trigger for developing MS and NMOSD.
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Affiliation(s)
- Mirla Avila
- Texas Tech University Health Sciences Center, Lubbock, TX, USA.
| | - Yuanyuan Tan
- Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | | | - Hafsa Zuberi
- Texas Tech University Health Sciences Center, Lubbock, TX, USA
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Kooner KS, Angirekula A, Treacher AH, Al-Humimat G, Marzban MF, Chen A, Pradhan R, Tunga N, Wang C, Ahuja P, Zuberi H, Montillo AA. Glaucoma Diagnosis Through the Integration of Optical Coherence Tomography/Angiography and Machine Learning Diagnostic Models. Clin Ophthalmol 2022; 16:2685-2697. [PMID: 36003072 PMCID: PMC9394657 DOI: 10.2147/opth.s367722] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 06/29/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To establish optical coherence tomography (OCT)/angiography (OCTA) parameter ranges for healthy eyes (HE) and glaucomatous eyes (GE) for a North Texas based population; to develop a machine learning (ML) tool and to identify the most accurate diagnostic parameters for clinical glaucoma diagnosis. Patients and Methods In this retrospective cross-sectional study, we included 1371 eligible eyes, 462 HE and 909 GE (377 ocular hypertension, 160 mild, 156 moderate, 216 severe), from 735 subjects. Demographic data and full OCTA parameters were collected. A Kruskal-Wallis test was used to produce the normative database. Models were trained to solve a two-class problem (HE vs GE) and four-class problem (HE vs mild vs moderate vs severe GE). A rigorous nested, stratified, group, 5×10 fold cross-validation strategy was applied to partition the data. Six ML algorithms were compared using classical and deep learning approaches. Over 2500 ML models were optimized using random search, with performance compared using mean validation accuracy. Final performance was reported on held-out test data using accuracy and F1 score. Decision trees and feature importance were produced for the final model. Results We found differences across glaucoma severities for age, gender, hypertension, Black and Asian race, and all OCTA parameters, except foveal avascular zone area and perimeter (p<0.05). The XGBoost algorithm achieved the highest test performance for both the two-class (F1 score 83.8%; accuracy 83.9%; standard deviation 0.03%) and four-class (F1 score 62.4%; accuracy 71.3%; standard deviation 0.013%) problem. A set of interpretable decision trees provided the most important predictors of the final model; inferior temporal and inferior hemisphere vessel density and peripapillary retinal nerve fiber layer thickness were identified as key diagnostic parameters. Conclusion This study established a normative database for our North Texas based population and created ML tools utilizing OCT/A that may aid clinicians in glaucoma management.
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Affiliation(s)
- Karanjit S Kooner
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA,Department of Ophthalmology, Veteran Affairs North Texas Health Care System Medical Center, Dallas, TX, USA,Correspondence: Karanjit S Kooner, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9057, USA, Tel +1 (214) 648-4733, Fax +1 (214) 648-2270, Email
| | - Ashika Angirekula
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Alex H Treacher
- Lyda Hill Department of Bioinformatics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ghadeer Al-Humimat
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA,Department of Ophthalmology, King Hussein Medical Center, Amman, Jordan
| | - Mohamed F Marzban
- Department of Electrical Engineering, University of Texas at Dallas, Dallas, TX, USA
| | - Alyssa Chen
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Roma Pradhan
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nita Tunga
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Chuhan Wang
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Pranati Ahuja
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Hafsa Zuberi
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Albert A Montillo
- Lyda Hill Department of Bioinformatics, University of Texas Southwestern Medical Center, Dallas, TX, USA,Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA,Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, TX, USA,Albert A Montillo, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9057, USA, Email
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Wooliscroft J, Akram R, Zuberi H, Tong B, Gu J, Hurd A, Kooner K. Predictors of Early Onset Glaucoma. Clin Ophthalmol 2022; 16:1925-1932. [PMID: 35711969 PMCID: PMC9196659 DOI: 10.2147/opth.s360719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 06/03/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose/Relevance To determine the influence of hypertension (HTN), type 2 diabetes (DM2), migraine, and obstructive sleep apnea (OSA) on the onset of primary open-angle glaucoma (POAG) to enhance predictive accuracy. Methods In this cross-sectional study, data for 389 eligible patients with POAG were collected through medical records review and phone surveys. All data were assessed collectively using stepwise multiple regression analysis to determine the relative contribution to age at POAG diagnosis. We used the following groups, based on age at diagnosis, HTN for patients with or without DM2 (model 1), HTN for patients with DM2 (model 2), DM2 for patients with or without HTN (model 3), and DM2 for patients with HTN (model 4). Results In model 1, age at HTN diagnosis was associated with age at POAG diagnosis (β = 0.14; 95% CI, 0.01–0.26, p = 0.04). In model 2, age at HTN diagnosis was not associated with age at POAG diagnosis (p > 0.05). In model 3, age at DM2 diagnosis was associated with age at POAG diagnosis (β = 0.37; 95% CI 0.16–0.58, p = 0.001). In model 4, age at DM2 diagnosis was associated with age at POAG diagnosis (β = 0.40; 95% CI 0.00–0.15, p = 0.003). Asian race/ethnicity was associated with early onset of POAG in model 3 (β = −6.44; 95% CI −12.34–0.54, p = 0.033). OSA and migraine did not influence the onset of POAG. Conclusion Our study found that the diagnosis of DM2 and HTN at an earlier age is associated with the early onset of POAG.
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Affiliation(s)
- Jeffrey Wooliscroft
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rubeel Akram
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Hafsa Zuberi
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Betty Tong
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jane Gu
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Aaron Hurd
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Karanjit Kooner
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Ophthalmology, Veteran Affairs North Texas Health Care System Medical Center, Dallas, TX, USA
- Correspondence: Karanjit Kooner, Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA, Tel +1 (214) 648-4733, Fax +1 (214) 648-2270, Email
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