Extrapulmonary Histoplasma capsulatum infections in the immunocompetent population are rare and pose a diagnostic challenge. Upper extremity histoplasmosis without a primary lung infection is uncommon. It is possible to acquire it by inadvertent trauma with direct inoculation. Our case describes an immunocompetent patient with progressive swelling with minimal pain in the wrist associated with a small puncture wound on the left dorsal forearm. The initial workup failed to identify a specific etiology. For the following six weeks, the patient experienced progressive worsening of symptoms, warranting a referral to an orthopedic hand surgeon. Left lower extremity magnetic resonance imaging (MRI) findings were non-specific. The surgeon performed a surgical exploration and debridement with the excision of hypertrophic tissue. Initial stains showed a granulomatous tissue but did not reveal an organism; however, a month later, mold was identified on the growth medium. The patient was initiated in isavuconazole empiric therapy. Four weeks later, a matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) confirmed the diagnosis as Histoplasma capsulatum . The patient had clinical remission with isavuconazole used as the United States Food and Drug Administration (FDA) off label use.
Post-traumatic stress disorder (PTSD) can occur when someone experiences a scary event or serious injury. This disorder can affect multiple parts of a person’s life, from relationships with loved ones to performance at work. Unfortunately, PTSD is not understood well. It is considered an invisible disability, which means it can be difficult to determine if someone has PTSD just by looking at them, since they have no visible symptoms. Because of the difficulty of diagnosing PTSD, healthcare professionals are working toward checklists that can be used by all doctors for PTSD diagnosis and treatment, which will hopefully improve the care of PTSD patients. Similarly, disability activists continue to raise awareness and educate the public on PTSD. In this article, we will discuss the causes of PTSD, its effects on daily life, diagnosis, treatment, and the importance of showing kindness toward people with this invisible disability.
Our previous work has shown that epithelial sodium channel (ENaC) proteins are present in distal convoluted tubule (DCT) cells of the distal nephron. The purpose of these experiments was to show whether these proteins were functional. We also wish to show whether the channels were stimulated by aldosterone, inhibited by amiloride, and regulated by the ENaC chaperone protein, MLP‐1, as ENaC is regulated in collecting duct principal cells. We used DCT‐15 cells in monolayer culture on permeable polyester supports to measure transepithelial voltage, resistance, and current. The properties of DCT‐15 cells are quite similar to those of in situ cells of the DCT2 segment of the nephron. Our results showed that DCT‐15 cells had relatively low resistances (206 ± 5.71 Ω‐cm2, n=36) and small, but measurable amiloride‐sensitive currents (2.87 ± 0.237 μA, n=36), showing that these cells contain functional ENaC. 100 nM aldosterone significantly increased mean DCT‐15 cell current (from 2.87 ± 0.237, n=36, to 5.33 ± 0.395μA, n=8). Amiloride significantly lowered the current across DCT cells to very low levels (from 2.74 ± 0.219, n=42, to 0.825 ± 0.186μA, n=15). MLP‐1 is a myristoylated protein that when associated with the membrane promotes ENaC activity. When three critical serines are phosphorylated by PKC, MLP‐1 dissociates from the membrane and ENaC activity decreases. We transfected the cells with four MLP FLAG‐tagged mutants: wild type (WT), constitutively active (S3A), constitutively inactive (S3D), and myristoylation negative (GA) and measured DCT‐15 current. For comparison, we examined a principal cell line, mpkCCD cells. Transfection with MLP‐1 modified current in both DCT and CCD cells: median current was highest in S3A mutant and lowest in S3D mutant; the current after transfection with either construct was significantly different from WT. ENaC and MLP construct expression was also studied in lysates of both cell types by Western blotting with FLAG and anti‐ENaC subunit antibodies. In DCT‐15 cells with the highest current, expression of ENaC was greatest. Lastly, we calculated based on an average current of 2 μA/cm2 and ENaC single channel current of 0.4 pA that DCT‐15 cells must have approximately 5 million functional channels per square centimeter.Support or Funding InformationSupported by R01 DK‐110409 to DCE and K01 DK‐115660 and ASN Gottschalk AWARD to BMWThis abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.
Traumatic brain injury, or TBI, is an injury to the brain caused by a bump or hit to the head. It is a common injury in children and can cause lasting symptoms and disabilities. There are di erent causes of TBI, such as car accidents, falls, or football tackles. Fortunately, there are ways we can reduce TBI by making safe choices, such as buckling our seatbelts and wearing helmets while playing sports.
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