CNS derived Extracellular Vesicles as Biomarkers in Multiple Sclerosis (MS)

This project aims to develop biomarkers for the diagnosis and treatment of multiple sclerosis (MS), a clinically heterogenous disease resulting from demyelination of the central nervous system. Extracellular vesicles (EVs) have shown potential as such a biomarker. EVs were isolated from the plasma and cerebrospinal fluid (CSF) of patients with suspected MS and patients with headaches. Participants are recruited before starting treatment for their condition and controls were only included if the cause of headache was determined to be non-inflammatory. Proteomic analysis will be conducted on the plasma and CSF before isolating the EVs, as well as the isolated plasma and CSF derived EVs themselves. Currently, 7 MS patient’s samples and 7 control headache patients have enrolled. Proteomic bulk analysis will be conducted in January on the samples providing immediate and consistent comparison points. Preliminary analysis has shown a higher concentration of EVs in patients in MS compared to those with headaches consistent with the literature, and initial target molecules such as L-tryptophan have been found to be downregulated. This should be consistent with the bulk analysis. Recruitment was delayed as a result of the COVID-19 pandemic, however, as this study is the first to look at both plasma and CSF derived EVs at the diagnostic phase of MS, the results should reveal target molecules for further assessment with a larger sample size. Although the focus of the field of extracellular vesicles in MS has centered around treatment delivery mechanisms, this study should help show their potential as diagnostic biomarkers

Immigrant and Refugee COVID-19 Vaccination Attitudes in South Philadelphia

Immigrants and refugees have been disproportionately affected by the COVID-19 pandemic; therefore, it is important to determine the specific factors that are promoting vaccination in the immigrant and refugee populations to develop equitable health services. This study surveys the attitudes toward COVID-19 vaccination and vaccine mandates in the Southeast Asian and Hispanic immigrant and refugee populations in South Philadelphia. A questionnaire was administered to all patients receiving the COVID-19 vaccine during six clinic days from November 15th-31st 2021. Investigators asked participants about their intention behind vaccination, barriers to access, work requirements regarding COVID-19 vaccination, and attitudes toward vaccine mandates. For people receiving their booster vaccine, the most cited reasons for getting vaccinated were protecting their health (75.4%) and travel (11.0%), whereas most people receiving their first or second vaccine were most motivated by vaccine mandates at work (34.6%) and health (30.8%). Staying healthy or “health” was the most common reason for getting vaccinated among people receiving their booster vaccine (74.8%) which was significantly higher than the proportion of people getting their first or second vaccine (30.7%) (p<0.05). As people continue to get vaccinated, determining motivating factors can help promote appropriate messaging. The results of the study suggest that, in a clinical setting geared towards Southeast Asian and Hispanic immigrants and refugees, those getting their first and second dose were motivated by work mandates more than health at the time of the study, whereas those adults receiving their booster are most motivated by health and safely traveling. As we continue to aim for mass vaccination, vaccine mandates appear to be an effective method of motivating people to get their first and second dose

Steroid Responsive Idiopathic Calcitriol Induced Hypercalcemia: A Case Report and Review of the Literature

BACKGROUND: Idiopathic Calcitriol Induced Hypercalcemia is a rare cause of a common condition of hypercalcemia. Hypercalcemia is most commonly the result of hyperparathyroidism and together with hypercalcemia of malignancy accounts for over 95% of cases. Idiopathic Calcitriol Induced Hypercalcemia can mimic hypercalcemia secondary to granulomatous diseases like sarcoidosis, but with apparent absences of both imaging and physical exam findings consistent with the disease. We report here a 51-year-old man who presented with recurrent nephrolithiasis, hypercalcemia, and acute kidney injury. CASE PRESENTATION: A 51-year-old man presented with severe back pain and mild hematuria. He had a history of recurrent nephrolithiasis over the course of a 15-year period. On presentation his calcium was elevated at 13.4 mg/dL, creatinine was 3.1 mg/dL (from baseline of 1.2), and his PTH was reduced at 5 pg/mL. CT abdomen and pelvis showed acute nephrolithiasis which was managed medically. Work up for the hypercalcemia included an SPEP which was normal, Vit D,1,25 (OH)2 was elevated at 80.4 pg/mL, CT chest showed no evidence of sarcoidosis. Management with 10 mg prednisone showed marked improvement in the hypercalcemia and he no longer had any symptoms of hypercalcemia. CONCLUSION: Idiopathic Calcitriol Induced Hypercalcemia is a rare cause of hypercalcemia. All reported cases benefit from more intensive long-term immunosuppression. This report helps consolidate the diagnosis of Idiopathic Calcitriol Induced Hypercalcemia and encourages researchers to better investigate its underlying pathogenesis

Steroid responsive idiopathic calcitriol induced hypercalcemia: a case report and review of the literature

Abstract Background Idiopathic Calcitriol Induced Hypercalcemia is a rare cause of a common condition of hypercalcemia. Hypercalcemia is most commonly the result of hyperparathyroidism and together with hypercalcemia of malignancy accounts for over 95% of cases. Idiopathic Calcitriol Induced Hypercalcemia can mimic hypercalcemia secondary to granulomatous diseases like sarcoidosis, but with apparent absences of both imaging and physical exam findings consistent with the disease. We report here a 51-year-old man who presented with recurrent nephrolithiasis, hypercalcemia, and acute kidney injury. Case presentation A 51-year-old man presented with severe back pain and mild hematuria. He had a history of recurrent nephrolithiasis over the course of a 15-year period. On presentation his calcium was elevated at 13.4 mg/dL, creatinine was 3.1 mg/dL (from baseline of 1.2), and his PTH was reduced at 5 pg/mL. CT abdomen and pelvis showed acute nephrolithiasis which was managed medically. Work up for the hypercalcemia included an SPEP which was normal, Vit D,1,25 (OH)2 was elevated at 80.4 pg/mL, CT chest showed no evidence of sarcoidosis. Management with 10 mg prednisone showed marked improvement in the hypercalcemia and he no longer had any symptoms of hypercalcemia. Conclusion Idiopathic Calcitriol Induced Hypercalcemia is a rare cause of hypercalcemia. All reported cases benefit from more intensive long-term immunosuppression. This report helps consolidate the diagnosis of Idiopathic Calcitriol Induced Hypercalcemia and encourages researchers to better investigate its underlying pathogenesis