Luis Adolfo Gomez Espinoza
UNEXPO, Systems Engineering, Graduate Student
Adolescent alcohol use demonstrates distinct developmental trajectories with dissimilar times of onset and trajectories. Given the importance of brain-derived neurotrophic factor (mature BDNF) in this development stage, the current study... more
Adolescent alcohol use demonstrates distinct developmental trajectories with dissimilar times of onset and trajectories. Given the importance of brain-derived neurotrophic factor (mature BDNF) in this development stage, the current study investigated its relationship with alcohol use. It also extends the literature by assessing the role of its precursor (pro-BDNF). Therefore, over the span of 5 years, we enrolled and followed participants to define age-related changes in BDNF levels in healthy adolescents. Then, the onset and frequency of alcohol use from ages 11 to 18 were collected to determine how the relationship between alcohol, pro-BDNF, and m-BDNF unfolds over time. With respect to development, analyses demonstrated that BDNF concentration slowly increases throughout adolescence. However, despite having similar basal BDNF levels, compared to controls, adolescents that started drinking before 15 years of age always exhibited lower BDNF levels. They also had a significant decre...
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Of the many clinical manifestations seen in the antiphospholipid antibody syndrome (APAS), two deserve major therapeutic consideration: recurrent fetal loss and vascular thromboses. Treatment of these two major complications remain... more
Of the many clinical manifestations seen in the antiphospholipid antibody syndrome (APAS), two deserve major therapeutic consideration: recurrent fetal loss and vascular thromboses. Treatment of these two major complications remain empirical, although recent studies appear to indicate the beneficial use of multiple therapeutic options including low dose aspirin, alone or in combination with a moderate amount of prednisone, heparin and intravenous gammaglobulin for the prevention of fetal loss, and longterm anticoagulation with maintenance of an international normalized ratio (INR) of 3 to 4 as an effective measure in the prevention of vascular thrombosis. The use of interleukin-3 in animal models of the syndrome has been shown to be effective in the prevention of fetal loss, and this therapeutic modality appears promising, particularly because of its recognized low frequency of side effects in therapeutic trials in humans.
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A sólo ocho años de su primera descripción por el centro de control de enfermedades (CDC) en 1981, la infección por el virus de inmunodeficiencia humana (VIH) se ha convertido en una amenaza de creciente diseminación a través de todo el... more
A sólo ocho años de su primera descripción por el centro de control de enfermedades (CDC) en 1981, la infección por el virus de inmunodeficiencia humana (VIH) se ha convertido en una amenaza de creciente diseminación a través de todo el mundo. Para el 1ro. De octubre de 1988 se habían reportado 85,000 casos del síndrome de inmunodeficiencia adquirida (SIDA) solamente en el continente americano (cifra necesariamente menor de la real debido al escaso reporte de la enfermedad en varios países), 133 países habían reportado casos de SIDA a la Organización Mundial de la Salud (OMS), y las cifras continúan mostrando un incremento en el número total de casos.
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Research Interests: Dermatology, Medicine, Humans, Female, Tryptophan, and 5 moreClinical Sciences, Adult, Eosinophilia, Syndrome, and Myalgia
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To define the frequency and characteristics of human immunodeficiency virus (HIV)-associated rheumatic manifestations in patients receiving highly active antiretroviral therapy (HAART) referred to a rheumatology clinic. A total of 75... more
To define the frequency and characteristics of human immunodeficiency virus (HIV)-associated rheumatic manifestations in patients receiving highly active antiretroviral therapy (HAART) referred to a rheumatology clinic. A total of 75 patients with HIV infection receiving HAART were prospectively evaluated for the presence of rheumatic complaints. Diagnosis of HIV infection was performed by ELISA and confirmed by Western blot, and all HIV patients were classified according to the US Centers for Disease Control criteria. Seventy-five individuals with HIV infection and musculoskeletal manifestations were evaluated: 65 (86%) men and 10 (14%) women. Mean age was 32 +/- 4.5 years (range 21-58). The group included 40 (53%) heterosexuals, 30 (40%) intravenous drugs users, 9 (12%) homosexuals, 3 (4%) who had received blood transfusion, and 2 (2.6%) with unknown risk factors. Septic manifestations were the most common complications seen in 31 (41%) out of 75, and included septic arthritis, ce...
Research Interests: Rheumatology, Immunology, Flow Cytometry, Medicine, HIV, and 15 moreHumans, Female, Male, Louisiana, The, Risk factors, Clinical Sciences, Middle Aged, Adult, Public health systems and services research, Highly Active Antiretroviral Therapy, Risk Factors, Rheumatic diseases, Enzyme Linked Immunosorbent Assay, and HIV infections
Various rheumatic manifestations associated with HIV infection have been recognized, ranging from infectious conditions, such as septic arthritis, to seronegative spondyloarthropathy. Other musculoskeletal manifestations include... more
Various rheumatic manifestations associated with HIV infection have been recognized, ranging from infectious conditions, such as septic arthritis, to seronegative spondyloarthropathy. Other musculoskeletal manifestations include lupus-like and Sjögren-like diseases and HIV-related malignancy. The introduction of HAART has changed the spectrum of the clinical manifestations of rheumatic disease seen today, with infections and articular involvement being the most frequently observed.
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Behçet's disease is a chronic relapsing form of vasculitis affecting multiple organs. Central nervous system involvement is a common presentation. Tumor necrosis factor-alpha (TNF-alpha) is considered to play a major role in the... more
Behçet's disease is a chronic relapsing form of vasculitis affecting multiple organs. Central nervous system involvement is a common presentation. Tumor necrosis factor-alpha (TNF-alpha) is considered to play a major role in the disease pathogenesis. We describe a patient with a long history of neuro-Behçet's disease who showed a remarkable response to infliximab therapy. Given the variable and limited success of other interventions, the use of anti-TNF-alpha therapy seems to be effective for patients with refractory disease.
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To review the course, predisposing risk factors, treatment employed, and complications of autoimmune hepatitis (AIH) during pregnancy. Maternal and fetal outcomes will be discussed. We reviewed the literature from February 1966 to January... more
To review the course, predisposing risk factors, treatment employed, and complications of autoimmune hepatitis (AIH) during pregnancy. Maternal and fetal outcomes will be discussed. We reviewed the literature from February 1966 to January 2004 using MEDLINE and the key words autoimmune hepatitis, chronic active hepatitis, lupoid hepatitis, and pregnancy. An additional case of ours was included as she had AIH since childhood with worsening of liver disease during pregnancy. Including the present case, 58 pregnant women with AIH were reported in 17 case reports and series. In the 101 pregnancies documented in these cases, there were 47 flare-ups, 5 clinical improvements, 45 stabilizations of the disease during pregnancy, and 4 cases in which the disease course was not reported. Two maternal deaths occurred. A perinatal mortality of 4% and 19 fetal deaths were described. Most women were treated with prednisone alone; however azathioprine was used in a number of patients. Pregnancy cour...
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Colorectal involvement with obstructed defecation is a common complication of progressive systemic sclerosis (pSSc), compromising quality of life and placing patients at risk for life-threatening complications. Treatment for colonic... more
Colorectal involvement with obstructed defecation is a common complication of progressive systemic sclerosis (pSSc), compromising quality of life and placing patients at risk for life-threatening complications. Treatment for colonic inertia in these patients includes laxatives, prokinetics, and ultimately colectomy, which is associated with high morbidity and mortality in pSSc. We describe a woman with scleroderma and colonic inertia recommended for total abdominal colectomy. As a result of respiratory decompensation, she was placed on oxygen by nasal cannula, after which bowel motility with regularity was restored, obviating the need for colectomy.
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Various infections have been causative in the pathogenesis of systemic vasculitides, and HIV infection is not spared. In an immunocompromised host, cytomegalovirus, Epstein-Barr virus, varicella zoster virus, herpes simplex virus,... more
Various infections have been causative in the pathogenesis of systemic vasculitides, and HIV infection is not spared. In an immunocompromised host, cytomegalovirus, Epstein-Barr virus, varicella zoster virus, herpes simplex virus, hepatitis B and hepatitis C virus, and mycobacteria, along with HIV infection can cause vasculitis. Herein we emphasize the spectrum of vasculitides, their pathogenesis, presentation, course, and therapy in the HIV-infected population. Every spectrum and size of the blood vessel involvement have been seen in HIV-associated vasculitides. We review each spectrum in detail and describe our experience with polyarteritis nodosa, the most common presentation occurring in HIV-infected patients. We also discuss the differences in HIV, hepatitis B, and hepatitis C- related polyarteritis nodosa in detail.
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Psoriatic arthritis (PsA) is a systemic inflammatory condition associated with psoriasis. Despite considerable heterogeneity in clinical presentation, genetic studies and animal models support the notion that PsA is a distinct disease. We... more
Psoriatic arthritis (PsA) is a systemic inflammatory condition associated with psoriasis. Despite considerable heterogeneity in clinical presentation, genetic studies and animal models support the notion that PsA is a distinct disease. We aimed to characterize the PsA genotype by gene expression profile and to research the effect in gene modulation of methotrexate (MTX) and TNF-inhibitors (TNF-I) in PsA-treated patients. Nine PsA patients, according to CASPAR criteria, and three healthy controls were recruited from an outpatient rheumatology clinic. Three out of nine PsA patients were naïve to treatment, three received TNF-I, and the remaining three were on MTX-monotherapy. Blood samples were collected and analyzed by human genome U95 Array-Affymetrix (GeneChip® instrument system). Identification of statistically significant differences between differentially expressed genes was determined by Mann-Whitney and t test (p < 0.05). The microarray profile identified a predominance of ...
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Reactive arthritis (ReA) is an inflammatory process triggered by certain Gram-negative bacteria, with Chlamydia trachomatis being the most common cause. The pathophysiology of ReA represents the classic interplay between environment... more
Reactive arthritis (ReA) is an inflammatory process triggered by certain Gram-negative bacteria, with Chlamydia trachomatis being the most common cause. The pathophysiology of ReA represents the classic interplay between environment (infectious agents) and host responses. The host responses are, at least in part, governed by genetics. These bacteria or bacterial products are trafficked to the target organs, such as the synovial tissue. The bacterial persistence and ensuing inflammatory response lead to the pathogenic sequelae of ReA. This entire process represents a delicate balance of the major histocompatability complex, cellular uptake of the pathogens, chemokine regulation, Toll-like receptors and T-helper (Th)1 versus Th2/Th3 responses. Therapy has had limited success. As our knowledge of the pathophysiology of ReA continues to grow, our therapies can become more focused and efficacious. This review will devote special attention to Chlamydia, since it is the most common cause of ReA.
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The role of prolactin (PRL) in the pathogenesis of systemic lupus erythematosus (SLE) is controversial. The effect of conventional treatment (steroids, antimalarials, immunosuppressor drugs) on PRL concentrations is unclear. We... more
The role of prolactin (PRL) in the pathogenesis of systemic lupus erythematosus (SLE) is controversial. The effect of conventional treatment (steroids, antimalarials, immunosuppressor drugs) on PRL concentrations is unclear. We investigated correlation of PRL levels with lupus activity in patients at entry and after 6 months of conventional treatment. We studied 43 female patients with active SLE, who were divided in 2 groups; Group 1: 16 patients with minor organ involvement (cutaneous and articular involvement), and Group 2: 27 patients with major organ involvement (glomerulonephritis). Controls were 36 healthy individuals. PRL levels were determined by an immunoradiometric assay at entry and after 6 months of treatment. PRL levels were correlated with SLE Disease Activity Index (SLEDAI) score. Mild hyperprolactinemia (HPRL, 20-40 ng/ml) was found in 30/43 (69.7%) SLE patients. After 6 months of treatment a reduction in PRL levels was found in both groups: Group 1: 24.3 +/- 10.8 t...
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Psoriatic arthritis is a common systemic inflammatory disorder, which in addition to skin and nail involvement may be associated with peripheral and axial joint involvement, enthesitis, dactylitis, and important comorbidities – especially... more
Psoriatic arthritis is a common systemic inflammatory disorder, which in addition to skin and nail involvement may be associated with peripheral and axial joint involvement, enthesitis, dactylitis, and important comorbidities – especially cardiovascular morbidity. Better insights into the involved pathogenic mechanisms have resulted in an improved therapeutic armamentarium, which targets key pathways in its pathogenesis. This has resulted in significant clinical responses to newer therapeutic agents, especially those directed at inhibition of tumor necrosis factor α. Biological therapy leads to significant levels of remission, improved quality of life, and retards or improves structural radiological damage.
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Evaluation of: Bostrom J, Shang-Fan Y, Kan D et al.: Variants of the antibody Herceptin® that interact with HER2 and VEGF at the antigen binding site. Science 323, 1610–1614 (2009). The longstanding held notion that one antibody equals... more
Evaluation of: Bostrom J, Shang-Fan Y, Kan D et al.: Variants of the antibody Herceptin® that interact with HER2 and VEGF at the antigen binding site. Science 323, 1610–1614 (2009). The longstanding held notion that one antibody equals one antigen and, hence, one function has been challenged in recent years. Improved technology in antibody production, especially the accumulation of sequence data of immunoglobulin genes and the advent of PCR have made it possible to clone antibody gene repertoires. The current paper provides further challenge to the notion of one antibody = one antigen by developing ‘two-in-one’ antibodies with an antigen-binding site that binds two distinct proteins with high affinity. A therapeutic variant antibody of Herceptin® (Genentech, CA, USA) was isolated that binds the human EGF receptor (HER)2 and also to VEGF. This development may represent a breakthrough discovery and may have significant implications in the therapy of malignant, infectious, allergic and...
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The seronegative spondyloarthropathies appear to be the genetically predisposed host&amp;#x27;s clinical expression to acute, subacute or chronic reaction to the invasion by environmental microorganisms. In the ensuing days or weeks,... more
The seronegative spondyloarthropathies appear to be the genetically predisposed host&amp;#x27;s clinical expression to acute, subacute or chronic reaction to the invasion by environmental microorganisms. In the ensuing days or weeks, depending on the infectious load, clinical ...
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Publisher Summary This chapter discusses the pregnancy, hormones, and autoimmune rheumatic diseases. It analyzes the influence of the immune–neuroendo-crine system on autoimmune disease during pregnancy. Pregnancy is a physiological... more
Publisher Summary This chapter discusses the pregnancy, hormones, and autoimmune rheumatic diseases. It analyzes the influence of the immune–neuroendo-crine system on autoimmune disease during pregnancy. Pregnancy is a physiological condition characterized by complex molecular interactions between the mother and the embryo. Inadequate progesterone secretion, luteal phase deficiency, hyperprolactinemia, thyroid disease, hypopara-thyroidism, uncontrolled diabetes, decreased ovarian reserve, and polycystic ovarian syndrome are some examples of conditions that affect the outcome of pregnancy. Cytokines make important contributions to successful pregnancy. Th1 and Th2 cytokines play roles at different stages of pregnancy. During pregnancy, experimental animals and patients with autoimmune diseases develop abnormal immune–neuroendocrine responses. The placenta plays a key role in the maintenance of local tolerance and allows the mother to accept the embryo until completion of pregnancy. During normal pregnancy, cellular immunity and Th1 cytokines, which are potentially harmful to the fetus, are inhibited, whereas humoral immunity, autoantibody production, and Th2 cytokines are enhanced.
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Elevated IgG4 is characteristic of cases of IgG4-RD, a newly recognized systemic disease. However, several chronic inflammatory conditions, including rheumatic diseases, can also be associated with increased levels of IgG4. There have... more
Elevated IgG4 is characteristic of cases of IgG4-RD, a newly recognized systemic disease. However, several chronic inflammatory conditions, including rheumatic diseases, can also be associated with increased levels of IgG4. There have also recently been several reports describing an increased IgG4 immune response to some vasculitis syndromes, in particular Churg-Strauss syndrome and granulomatosis with polyangiitis. To avoid misdiagnosis, clinicians must be aware that the clinical manifestations of IgG4-RD and ANCA-associated vasculitis may overlap. The meaning of these observations is not yet understood, and more studies are needed to determine the true significance of the increased IgG4 response to vasculitis syndromes, especially anti-neutrophil cytoplasmatic antibodies (ANCA)-associated vasculitis.
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The distribution of the anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitides (AAV) is not uniform across geographical regions and ethnic and racial groups, suggesting that genetic and environmental factors affect the... more
The distribution of the anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitides (AAV) is not uniform across geographical regions and ethnic and racial groups, suggesting that genetic and environmental factors affect the pathogenesis of these diseases. In addition, genetic factors affect not only the clinical syndrome phenotypes and their prognosis, but also ANCA specificity; these data suggest that AAV may need reclassification. Several genes have been evaluated, including ANCA targets and those of the immune system, for example co-stimulatory molecules, signaling regulators, cytokines, Fc and other receptors, and other proteins. This article provides a review of genetic factors affecting the pathogenesis and prognosis of AAV. Further studies to determine the effect of genetic factors on the clinical syndrome phenotypes and ANCA specificity need to be performed across different ethnic groups.
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This study was performed to raise awareness among rheumatologists about two autoimmune disorders associated with long-term minocycline therapy that can coexist in the same patient. We provide an update on the occurrence of these... more
This study was performed to raise awareness among rheumatologists about two autoimmune disorders associated with long-term minocycline therapy that can coexist in the same patient. We provide an update on the occurrence of these disorders, their main characteristics, and the current knowledge of potential pathogenic mechanisms. We searched the medical literature in English indexed in MEDLINE from 1966 through April 1998 for the term minocycline combined with each of the following: autoimmune hepatitis (AIH), chronic hepatitis, lupus, systemic lupus erythematosus (SLE), anti-myeloperoxidase (anti-MPO), arthritis, vasculitis, and toxicity. We also reviewed relevant references cited in the articles our search uncovered. We identified over 60 minocycline-induced cases of SLE and 24 cases of minocycline-induced AIH. Both autoimmune disorders coexisted in the same patient in 12 cases reported in the literature and in one case seen at our clinic. These 13 patients were characterized by symmetrical polyarthralgias/polyarthritis, elevated liver enzymes, and positive antinuclear antibodies (ANA); they also were generally anti-histone-negative, and only two patients had perinuclear anti-neutrophil cytoplasmic antibodies (p-ANCA). After withdrawal of minocycline, their symptoms resolved, and abnormal laboratory results normalized or markedly improved. Although data on the actual prevalence of autoimmune disorders induced by minocycline are not available, numerous case reports or small series deal with such disorders. Probable pathogenic mechanisms for each of these conditions are discussed.
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To evaluate the efficacy of the cyclooxygenase-2 selective inhibitor celecoxib in treating patients with psoriatic arthritis (PsA) in flare. This 12-week, multicenter, randomized, double-blind, double-dummy, placebo-controlled,... more
To evaluate the efficacy of the cyclooxygenase-2 selective inhibitor celecoxib in treating patients with psoriatic arthritis (PsA) in flare. This 12-week, multicenter, randomized, double-blind, double-dummy, placebo-controlled, parallel-group study compared the efficacy and safety of celecoxib 400 mg (n=201) or celecoxib 200 mg (n=213) once daily (qd) with placebo (n=194) in treating the signs and symptoms of PsA in flare. The primary efficacy measure was the number of patients responding to treatment according to the American College of Rheumatology Responders Index 20% (ACR-20) at week 12. Efficacy and safety were assessed for all randomized patients who received at least 1 dose of study medication. At the week-12 primary endpoint, approximately 50% of patients in each treatment group were responders according to the ACR-20 criteria, and no statistically significant treatment differences between treatment groups were observed. However, at week 2, the ACR-20 response rates for the celecoxib 400 mg (49%) and 200 mg (39%) groups were significantly higher than for the placebo group (28%) (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001 and P=0.016, respectively). Within the celecoxib 400 mg group, ACR-20 response rates were similar at weeks 2, 6 (46%), and 12 (49%). In contrast, in the celecoxib 200 mg and placebo treatment groups, ACR-20 response rates increased 7 and 16%, respectively, from week 2 to week 6, and remained relatively unchanged from week 6 to week 12. There were no statistically significant differences in ACR-20 response rates between the celecoxib 400 mg and 200 mg groups at any time point. Treatment with celecoxib 200 and 400 mg qd was statistically superior to placebo treatment at weeks 2 and 6 for Patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Assessment of Arthritis Pain. Both doses of celecoxib were well tolerated. Celecoxib 400 mg and 200 mg qd were efficacious and well tolerated in treating the signs and symptoms of PsA in flare after 2 weeks of treatment. However, although the clinical effects of celecoxib 400 mg and 200 mg qd were observed for 12 weeks, there was a high placebo response at these time points, and there were no differences relative to placebo treatment at week 12.
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Research Interests: Medicine, Humans, Female, Male, Psoriasis, and 6 moreArthritis, Phenotype, Ankylosing Spondylitis, Clinical Sciences, Middle Aged, and Adult
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Gouty panniculitis is an unusual clinical manifestation of gout, characterized by the deposition of monosodium urate crystals in the lobular hypodermis. Its pathogenesis is poorly understood but is associated with hyperuricemia, and the... more
Gouty panniculitis is an unusual clinical manifestation of gout, characterized by the deposition of monosodium urate crystals in the lobular hypodermis. Its pathogenesis is poorly understood but is associated with hyperuricemia, and the clinical presence of indurate subcutaneous plaques, which may precede or appear subsequently to the articular clinical expression of tophaceous gout. The aim of this report is to describe the clinical characteristics and potential risk factors for the development of lobular panniculitis secondary to chronic tophaceous gout. This is a retrospective clinical review of 6 patients with gouty panniculitis seen at the rheumatology service at the National University of Colombia. All cases fulfill diagnostic criteria for gout. The presenting clinical characteristics of each case were analyzed. All 6 patients were men, with an average age of 26 years. Two patients initially presented with cutaneous manifestations, and in the remainder 4 joint involvements preceded the cutaneous manifestations. Articular involvement first developed in lower extremities, of intermittent nature, and subsequent occurrence of polyarthritis of upper and lower extremities. A positive family history of gout was observed in half of the patients. Smoking and high alcohol intake were relevant risk factors. On physical examination, all exhibited the presence of erythematous, irregular surface, deep indurate subcutaneous plaques. Biopsy of skin and deep dermis including panniculus revealed the presence of granulomatous inflammatory changes with deposition of amorphous eosinophilic material surrounded by palisading histocytes and lymphocytes. Characteristic negative birefringent monosodium urate crystals were observed in the synovial fluid of patients with arthritis. All patients exhibited high levels of serum uric acid and were non-complaint to treatment with allopurinol, NSAIDs, and colchicine. Gouty panniculitis should be considered in the differential diagnosis of panniculitis, especially in the presence of high levels of uric acid. It is usually observed in the third decade of life and may appear prior to the inflammatory articular manifestations of tophaceous gout.
Research Interests: Rheumatology, Crystallization, Medicine, Family history, Humans, and 15 moreMale, Differential Diagnosis, Risk factors, Hyperuricemia, Clinical Sciences, Middle Aged, Colchicine, Adult, Retrospective Studies, Physical examination, Gout, Risk Factors, Lower Extremity, Allopurinol, and Diagnostic Criteria
... Patients infected with Acinetobacter, Klebsiella, or Pseudomonas had lower probabilities of 14-day survival (71.4%, 55.6%, and 42.9 ... levels of HPV infections (European HPV-16 variants at a high viral load), abnormal cervical... more
... Patients infected with Acinetobacter, Klebsiella, or Pseudomonas had lower probabilities of 14-day survival (71.4%, 55.6%, and 42.9 ... levels of HPV infections (European HPV-16 variants at a high viral load), abnormal cervical cytology, and squamous intraepithelial lesions (SIL). ...