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Essien F, Westbrook M, Wolfley G, Patterson S, Carrol M. 'When Cryptococcus strikes and lupus is found': a unique covert unveiling of systemic lupus erythematosus presenting as subacute meningitis. Ther Adv Chronic Dis 2022; 13:20406223221102784. [PMID: 35847478 PMCID: PMC9280844 DOI: 10.1177/20406223221102784] [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] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/28/2022] [Indexed: 11/16/2022] Open
Abstract
Cryptococcal neoformans is a rare fungal pathogen that has been associated with immunocompromised individuals. Due to its rare occurrence, clinicians have a low index of suspicion for diagnosis, which can lead to increased morbidity and mortality. We present an 81-year-old fully functional woman with no known predisposing risk factors or previous immunocompromising conditions who was found to have cryptococcal meningitis on cerebrospinal fluid analysis in the setting of newly diagnosed uncontrolled type 2 diabetes and systemic lupus erythematosus (SLE).
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Affiliation(s)
- Francis Essien
- Department of Internal Medicine, David Grant USAF Medical Center, Travis AFB, Fairfield, CA, USA
| | - Marquise Westbrook
- Department of Internal Medicine, Keesler Medical Center, Keesler Air Force Base, Biloxi, MS, USA
| | - Graey Wolfley
- Department of Internal Medicine, Keesler Medical Center, Keesler Air Force Base, 301 Fisher Street, Biloxi, MS 39534, USA
| | - Shane Patterson
- Department of Infectious Disease, David Grant USAF Medical Center, Travis AFB, Fairfield, CA, USA
| | - Matthew Carrol
- Department of Rheumatology, Singing River Health System, Ocean Springs, MS, USA
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Adam S, Akroyd R, Bernabei S, Bollhalder S, Boocock S, Burlina A, Coote T, Corthouts K, Dalmau J, Dawson S, Defourny S, De Meyer A, Desloovere A, Devlin Y, Diels M, Dokoupil K, Donald S, Evans S, Fasan I, Ferguson C, Ford S, Forga M, Gallo G, Grünert SC, Heddrich-Ellerbrok M, Heidenborg C, Jonkers C, Lefebure K, Luyten K, MacDonald A, Meyer U, Micciche A, Müller E, Portnoi P, Ripley S, Robert M, Robertson LV, Rosenbaum-Fabian S, Sahm K, Schultz S, Singleton K, Sjöqvist E, Stoelen L, Terry A, Thompson S, Timmer C, Vande Kerckhove K, van der Ploeg L, Van Driessche M, van Rijn M, van Teeffelen-Heithoff A, Vitoria I, Voillot C, Wenz J, Westbrook M, Wildgoose J, Zweers H. How strict is galactose restriction in adults with galactosaemia? International practice. Mol Genet Metab 2015; 115:23-6. [PMID: 25873073 DOI: 10.1016/j.ymgme.2015.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 03/29/2015] [Accepted: 03/30/2015] [Indexed: 10/23/2022]
Abstract
Dietary management of 418 adult patients with galactosaemia (from 39 centres/12 countries) was compared. All centres advised lactose restriction, 6 restricted galactose from galactosides ± fruits and vegetables and 12 offal. 38% (n=15) relaxed diet by: 1) allowing traces of lactose in manufactured foods (n=13) or 2) giving fruits, vegetables and galactosides (n=2). Only 15% (n=6) calculated dietary galactose. 32% of patients were lost to dietetic follow-up. In adult galactosaemia, there is limited diet relaxation.
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Affiliation(s)
- S Adam
- Royal Hospital for Sick Children, Glasgow, UK
| | - R Akroyd
- National Metabolic Service, Starship Children's Health and Auckland City Hospital, Auckland, New Zealand
| | - S Bernabei
- Ospedale pediatrico Bambino Gesù, Rome, Italy
| | | | - S Boocock
- University Hospitals Birmingham NHS Foundation Trust, UK
| | - A Burlina
- Division of Inherited Metabolic Diseases, Reference Centre Expanded Newborn Screening, Department of Pediatrics, University Hospital, Padova, Italy
| | - T Coote
- National Metabolic Service, Starship Children's Health and Auckland City Hospital, Auckland, New Zealand
| | - K Corthouts
- University Hospitals Leuven, Center of Metabolic Diseases, Belgium
| | | | - S Dawson
- Royal Hospital for Sick Children Edinburgh, UK
| | - S Defourny
- Hôpital Universitaire des Enfants, Reine fabiola, Bruxelles, Belgium
| | - A De Meyer
- Center of Metabolic Diseases, University Hospital, Antwerp, Belgium
| | | | - Y Devlin
- Royal Victoria Hospital, Newcastle, UK
| | - M Diels
- University Hospitals Leuven, Center of Metabolic Diseases, Belgium
| | - K Dokoupil
- Dr. von Hauner Children's Hospital, Munich, Germany
| | | | - S Evans
- Birmingham Children's Hospital, Birmingham, UK
| | - I Fasan
- Division of Inherited Metabolic Diseases, Reference Centre Expanded Newborn Screening, Department of Pediatrics, University Hospital, Padova, Italy
| | | | - S Ford
- North Bristol NHS Trust Southmead and Frenchay, UK
| | - M Forga
- Hospital Clinic Barcelona, Spain
| | - G Gallo
- Ospedale pediatrico Bambino Gesù, Rome, Italy
| | - S C Grünert
- University Children's Hospital Freiburg, Germany
| | | | - C Heidenborg
- Karolinska University Hospital Stockholm, Sweden
| | - C Jonkers
- Academic Medical Hospital, Amsterdam, Netherlands
| | - K Lefebure
- Royal Melbourne Hospital, Melbourne, Australia
| | - K Luyten
- Center of Metabolic Diseases, University Hospital, Antwerp, Belgium
| | - A MacDonald
- Birmingham Children's Hospital, Birmingham, UK.
| | - U Meyer
- Clinic of Paediatric Kidney, Liver- and Metabolic Diseases Medical School Hannover, Germany
| | | | - E Müller
- Children's Hospital Heidelberg, Germany
| | | | | | - M Robert
- Hôpital Universitaire des Enfants, Reine fabiola, Bruxelles, Belgium
| | - L V Robertson
- University Hospitals Birmingham NHS Foundation Trust, UK
| | | | - K Sahm
- Children's Hospital Heidelberg, Germany
| | - S Schultz
- Universitätsklinikum Hamburg-Eppendorf, Germany
| | | | - E Sjöqvist
- Children's Hospital, University Hospital Skåne, Sweden
| | - L Stoelen
- Oslo University Hospital Rikshospitalet, Norway
| | - A Terry
- Alderhey Children's Hospital, Liverpool, UK
| | - S Thompson
- Children's Hospital, Westmead, Sydney, Australia
| | | | | | | | | | - M van Rijn
- University of Groningen, University Medical Center Groningen, Netherlands
| | | | | | | | - J Wenz
- CHU Bicëtre Hospital, Paris, France
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Braithwaite J, Greenfield D, Westbrook J, Pawsey M, Westbrook M, Gibberd R, Naylor J, Nathan S, Robinson M, Runciman B, Jackson M, Travaglia J, Johnston B, Yen D, McDonald H, Low L, Redman S, Johnson B, Corbett A, Hennessy D, Clark J, Lancaster J. Health service accreditation as a predictor of clinical and organisational performance: a blinded, random, stratified study. Qual Saf Health Care 2010; 19:14-21. [DOI: 10.1136/qshc.2009.033928] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Vicanová J, Ponec M, Weerheim A, Swope V, Westbrook M, Harriger D, Boyce S. Epidermal lipid metabolism of cultured skin substitutes during healing of full-thickness wounds in athymic mice. Wound Repair Regen 2007; 5:329-38. [PMID: 16984443 DOI: 10.1046/j.1524-475x.1997.50407.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Cultured epidermal keratinocytes provide an abundant supply of biologic material for wound treatment. Because restoration of barrier function is a definitive criterion for efficacy of wound closure and depends on the lipids present in the epidermis, we analyzed lipid composition of the epidermis in cultured skin substitutes in vitro and after grafting to athymic mice. The cultured skin substitutes were prepared from human keratinocytes and fibroblasts attached to collagen-glycosaminoglycan substrates. After 14 days of incubation, cultured skin substitutes were grafted orthotopically onto full-thickness wounds in athymic mice. Samples for lipid analysis were collected after 14 and 34 days of in vitro incubation, and 3 weeks and 4 months after grafting. Both in vitro samples show disproportions in epidermal lipid profile as compared with the native human epidermis, i.e., a low amount of phospholipids (indicating imbalance in proliferation and differentiation); a large excess of triglycerides (storage lipids); and low levels of free fatty acids, gluco-sphingolipids, cholesterol sulfate, and ceramides-suggesting abnormal composition of stratum corneum barrier lipids. Fatty acid analysis of cultured skin substitutes in vitro revealed insufficient uptake of linoleic acid, which resulted in increased synthesis of and substitution with monounsaturated fatty acids, mainly oleic acid. These abnormalities were partially corrected by 3 weeks after grafting; and 4 months after grafting, all epidermal lipids, with some minor exceptions, were synthesized in proportions very similar to human epidermis. Results of this study show that grafting of cultured skin substitutes to a physiologic host permits the recovery of lipid in proportion to that required for barrier formation in normal human epidermis.
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Affiliation(s)
- J Vicanová
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
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Jemmerson R, Buron S, Sanishvili R, Margoliash E, Westbrook E, Westbrook M. Crystallization of two monoclonal Fab fragments of similar amino-acid sequence bound to the same area of horse cytochromecand interacting by potentially distinct mechanisms. Acta Crystallogr D Biol Crystallogr 1994; 50:64-70. [PMID: 15299477 DOI: 10.1107/s0907444993009084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The mouse monoclonal antibodies (mAb), 2E5.G10 and 1F5.D1, are specific for horse cytochrome c and appear to bind the same epitope, since their heavy (H) and light (L) chains are functionally interchangeable. Comparison of the amino-acid sequences suggests that slightly different interactions may be involved in antigen recognition. In addition, the H chains differ at only a few amino-acid residues from the H chain of a rat cytochrome c-specific mAb suggesting that specificity for one protein over another may be determined by these amino-acid differences. To address these possibilities, the three-dimensional structures of the Fab portions of the mAb bound to cytochrome c are being determined by X-ray diffraction analysis. Here we describe the preparation and crystallization of the two complexes with horse cytochrome c. The complex of the Fab fragment of 2E5.G10 with horse cytochrome c yielded crystals of X-ray diffraction quality under two sets of conditions; in both the space group was P2(1). The corresponding complex of 1F5.D1 under one of these conditions crystallized in the P2(1)2(1)2(1) space group. Three-dimensional X-ray data for these two complexes have been collected with nominal resolutions of 2.86 and 2.48 A, respectively.
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Affiliation(s)
- R Jemmerson
- Department of Microbiology, University of Minnesota, Minneapolis 55455, USA
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Skrzypczak-Jankun E, Carperos VE, Ravichandran KG, Tulinsky A, Westbrook M, Maraganore JM. Structure of the hirugen and hirulog 1 complexes of alpha-thrombin. J Mol Biol 1991; 221:1379-93. [PMID: 1942057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The isomorphous structures of the hirugen (N-acetylhirudin 53'-64' with sulfato-Tyr63') and hirulog 1 (D-Phe-Pro-Arg-Pro-(Gly)4 desulfato-Tyr63'-hirugen) complexes of human alpha-thrombin have been determined and refined at 2.2 A resolution to crystallographic R-factors of 0.167 and 0.163, respectively. The binding of hirugen to thrombin is similar to that of the binding of the C-terminal dodecapeptide of hirudin, including that of the terminal 3(10) helical turn. The sulfato Tyr63', which, as a result of sulfation, increases the binding affinity by an order of magnitude, is involved in an extended hydrogen bonding network utilizing all three sulfato oxygen atoms. The hirugen-thrombin complex is the first thrombin structure determined to have an unobstructed active site; this site is practically identical in positioning of catalytic residues and in its hydrogen bonding pattern with that of other serine proteinases. Hirulog 1, which is a poor thrombin substrate, is cleaved at the Arg3'-Pro4' bond in the crystal structure. The Arg3' of hirulog 1 occupies the specificity site, the D-Phe-Pro-Arg tripeptide is positioned like that of D-Phe-Pro-Arg chloromethylketone in the active site and the Pro4'(Gly)4 spacer to hirugen is disordered in the structure, as is the 3(10) turn of hirugen. The latter must be related to the simultaneous absence both of sulfation and of the last residue of hirudin (Gln65'). In addition, the autolysis loop of thrombin (Lys145-Gly150) is disordered in both structures. Changes in circular dichroism upon hirugen binding are therefore most likely the result of the flexibility associated with this loop.
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