Research Spotlight

Miranda, L., Kugasia, I., Han, L., Chandy, D. and Epelbaum, O. (2021). “Tuberculous placenta: a rare bird but not extinct.” Postgrad Med J Mar 15;postgradmedj-2021-139902. [Epub ahead of print].

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A 26-year-old woman from Pakistan presented to our institution in New York with episodic right-sided weakness and expressive aphasia. She was at 36 weeks’ gestation of an uncomplicated third pregnancy. On presentation, the patient appeared well, had normal vital signs and was afebrile. Her neurological examination was normal between recurrences. The patient reported usual fetal movement, and fetal monitoring displayed a reassuring tracing. MRI of the brain without gadolinium revealed numerous ring-like hyperintense lesions most consistent with an inflammatory or infectious aetiology (figure 1A). CT of the chest demonstrated multiple bilateral lung nodules with areas of coalescence (figure 1B). The patient denied respiratory symptoms. HIV and vasculitis testing was negative. Interferon gamma release assay had been positive earlier in the pregnancy. Lumbar puncture was performed: there was an elevated opening pressure, lymphocytic pleocytosis, low glucose and high protein. [No abstract; excerpt from article].

Meyer, E.C., Zimering, R.T., Knight, J., Morissette, S.B., Kamholz, B.W., Coe, E., Carpenter, T.P., Keane, T.M., Kimbrel, N.A. and Gulliver, S.B. (2021). “Negative Emotionality Interacts with Trauma Exposure to Prospectively Predict Posttraumatic Stress Disorder Symptoms During Firefighters’ First 3 Years of Service.” J Trauma Stress 34(2): 333-344.

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Firefighters (FFs) protect the public despite significant risks to their health and well-being stemming from frequent trauma exposure and other occupational stressors. A minority of FFs develop posttraumatic stress disorder (PTSD) or related mental health problems, whereas most remain remarkably resilient despite enormous stress. This points toward substantial variability in responses to traumatic stress among FFs. Personality, particularly negative emotionality (NEM), has been shown to predict the development of PTSD in other trauma-exposed populations, yet has not been prospectively studied in relation to PTSD in FFs. The aim of this secondary analysis from a broader study of mental health in FFs was to test whether preemployment NEM predicted PTSD symptom severity over time by influencing how FFs respond to traumatic experiences. In this first prospective study of the development of PTSD symptoms in professional FFs, 322 FFs were recruited from seven urban fire academies across the United States and followed over their first 3 years of fire service. We assessed NEM during the fire academy as well as trauma exposure and both self-reported and clinician-rated PTSD symptoms at 1-, 2-, and 3-year follow-ups. Level of trauma exposure and NEM predicted PTSD symptoms over time, and NEM moderated the effect of trauma exposure on clinician-rated PTSD symptoms across both trauma exposure measures at 1- and 3-year follow-ups, f(2) = .03-.10, but not at 2-year follow-up nor for self-reported PTSD symptoms. These findings indicate that NEM, assessed upon entry into a high-risk occupation, is useful in predicting PTSD symptom development.

Menter, A., Krueger, G.G., Paek, S.Y., Kivelevitch, D., Adamopoulos, I.E. and Langley, R.G. (2021). “Interleukin-17 and Interleukin-23: A Narrative Review of Mechanisms of Action in Psoriasis and Associated Comorbidities.” Dermatol Ther (Heidelb) 11(2): 385-400.

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Psoriasis is an immune-mediated inflammatory skin disease associated with numerous inflammatory comorbidities, including increased cardiovascular risk. The interleukin (IL)-23/IL-17 axis plays a central role in the immunopathogenesis of psoriasis and related comorbidities by acting to stimulate keratinocyte hyperproliferation and feed-forwarding circuits of perpetual T cell-mediated inflammation. IL-17 plays an important role in the downstream portion of the psoriatic inflammatory cascade. This review discusses the distinct mechanisms of action of IL-17 and IL-23 in the immunopathogenesis of psoriasis and related comorbidities plus the significant therapeutic benefits of selectively inhibiting these cytokines in patients with moderate to severe plaque psoriasis.

Mendel, J.T., Schroeder, S., Plitt, A., Patel, A., Joo, M., Stojadinovic, S., Dan, T., Timmerman, R., Patel, T.R. and Wardak, Z. (2021). “Expanded Radiosurgery Capabilities Utilizing Gamma Knife Icon™.” Cureus 13(3): e13998.

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The indications and techniques for the treatment of intracranial lesions continue to evolve with the advent of novel technologies. The Gamma Knife Icon™ (GK Icon™) is the most recent model available from Elekta, providing a frameless solution for stereotactic radiosurgery. At our institution, 382 patients with 3,213 separate intracranial lesions have been treated with frameless stereotactic radiotherapy using the GK Icon. The wide range of diagnoses include brain metastases, meningiomas, arteriovenous malformations, acoustic neuromas, pituitary adenomas, and several other histologies. The ability to perform both frame and frameless treatments on the GK Icon has significantly increased our daily volume by almost 50% on a single machine. Although the frameless approach allows one to take advantage of the precision in radiosurgery, the intricacies regarding treatment with this frameless system are not well established. Our initial experience will help to serve as a guide to those wishing to implement this novel technology in their practice.

McCullough, P.A. and Vijay, K. (2021). “SARS-CoV-2 infection and the COVID-19 pandemic: a call to action for therapy and interventions to resolve the crisis of hospitalization, death, and handle the aftermath.” Rev Cardiovasc Med 22(1): 9-10.

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In this bold issue of Reviews in Cardiovascular Medicine, we present the most comprehensive and scalable early ambulatory treatment program for high-risk patients who have contracted SARS-CoV-2. No such published regimen has received so much acclaim and the concepts embodied in this paper have been responsible for saving hundreds of thousands of lives and sparing millions of hospitalization. Since it took months for the large body of information to congeal on the pathophysiology and rationale for treatment, we cannot go back in time and estimate avoidable losses [6]. Going forward, available sources of data from Zelenko and Procter, suggest available drugs used in combination can reduce hospitalizations and death by 85% and that no high-risk patient with COVID-19 should go untreated at home. Lack of home treatment can only lead to long durations of illness, more intense symptoms, and increases the risk of hospitalization, death, and potentially post-COVID-19 syndromes. At this point in time, there is no justification in any part of the world for denial of available, appropriately prescribed off label intracellular anti-infectives, corticosteroids/colchicine, and antithrombotics. [No abstract; excerpt from article].