Browsing by Author "Willhite, Sydney"
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Item An Abscessed Tooth that Wasn't: An Unusual Case of Mumps in an Elderly Patient(2020-03) Lin, Jenny; Willhite, Sydney; Moore, Hannah; Smith, Maddie; Duncan, FrancescaCase: A 62-year-old African American female with history of self-resolving parotitis initially presented with progressive neck and bilateral facial swelling. She attributed this to an abscessed tooth. CT revealed parotitis with inflammatory changes and mass effect on the hypopharynx and larynx, although the patient denied breathing difficulty. Antibiotics were administered for two days, discontinuing due to lack of abscess. Six days later, the patient presented with worsening facial swelling, sore throat, and dysphagia. She remained afebrile but with a WBC count of 12.8. Antibiotics and steroids were given. MRI displayed retropharyngeal space involvement of 2.6 cm in thickness. ENT performed surgical debridement and culture collection. Upon return from the OR, respiratory distress and inability to manage secretions resulted in intubation via an upright awake fiberoptic approach given concern for impending airway compromise. Finally, a positive IgM antibody to mumps virus was detected from the debridement culture. Discussion: The differential for nonsuppurative parotitis includes viruses, autoimmune disorders, and granulomatous inflammation. Paramyxovirus, specifically mumps, is the most common viral cause, with EBV, HSV, CMV, and HIV as other concerns. Autoimmune causes are Sjogren syndrome and SLE. Mycobacterium species are the likely granulomatous culprit. Though mumps is the most common viral cause of parotitis, it typically occurs in children and young adults, not fitting of the patient described. However, mumps cases have increased recently. MMR vaccination began in 1967 and cases decreased more than 99%; yet, since 2006 there have been outbreaks. Vaccine-induced protection may wane over time. Mumps is highly contagious and complications include meningitis, encephalitis, pancreatitis, and deafness, occurring more commonly in elderly patients. Patients with nonsuppurative parotitis should thus be surveyed for vaccination history and examined for MMR titers.Item Activation of the oncogene ERG by the Ras/ERK and PI3K/AKT pathways(2019-08) Willhite, Sydney; Strittmatter, Brady; Hollenhorst, PeterBackground and Hypothesis: The TMPRSS2-ERG re-arrangement occurs in ~50% of prostate cancers and results in aberrant expression of the transcription factor ERG in the prostate. ERG is known to be activated by the Ras/ERK and PI3K/AKT pathways, however, the exact mechanism of this activation is not fully understood. The aim of this project is to identify how activation of these signaling pathways differentially effect transcription of ERG target genes. Experimental Design or Project Methods: In order to test how the Ras/ERK and PI3K/AKT pathways effect ERG target gene transcription, normal prostate epithelial cells (RWPE1) were transfected with constitutively active AKT in combination with phospho-mutants of ERG. These cell lines were then used to conduct Quantitative Reverse Transcription PCR and Western blotting of known downstream ERG target genes to identify how the activation status of these signaling pathways affected transcription and protein production. Results: Overall, our results demonstrate that ERG mediated transcription of the VIM gene, a marker of EMT, was activated by the Ras/ERK pathway and was repressed by the PI3K/AKT pathway. In addition, we found that ERG expression decreased FOXO1 protein expression in our cell lines regardless of Ras/ERK and PI3K/AKT status. Transcription and protein quantification was also measured for ERG target gene VEGFA, a critical regulator of angiogenesis. Conclusion and Potential Impact: This project helps identify the molecular mechanisms by which a common oncogene in prostate cancer is activated. Our results demonstrate how upstream signaling pathways differentially regulate oncogenic transcription and cell transformation. Overall, this project will provide insight to the molecular mechanisms of possible therapeutic targets in prostate cancer, the most common cancer amongst men.Item Chemical‐induced aseptic meningitis as a result of intrathecal hydromorphone therapy: Case report(Wiley, 2021-08-16) Willhite, Sydney; Juloori, Sangeeta; Medicine, School of MedicineChemical meningitis, though rare, is a diagnosis of exclusion that must be considered in patients presenting with neurologic symptoms of undetermined cause. It is likely that any substance in contact with CSF can be the culprit.Item Don't Always Depend on Your D-Dimer: An Atypical Case of Pulmonary Embolism(2021-03) Willhite, Sydney; Betts, Aislinn; Lee, Maya; Juloori, SangeetaCase: A 35-year-old female patient, with current IV drug use and a history of endocarditis warranting tricuspid valve replacement, presented with dyspnea and chest pain. On physical exam, she was found to have scattered wheezes on expiration with no shortness of breath or LE edema. As the Wells’ score for PE revealed a moderate risk, CTA and D-dimer were obtained. CTA revealed low contrast uptake in the right pulmonary artery, most concerning for a PE. D-dimer and coagulation studies were normal, making DVT unlikely and PE questionable. Therefore, there was high suspicion for endocarditis with septic emboli. On day two, TEE showed no valvular vegetations or thrombus. With no evidence of endocarditis, DVT was reconsidered. Bilateral LE doppler ultrasounds were negative for DVT. However, a repeat D-dimer was found to be elevated (596 ng/mL). Clinical impression on day three was a PE secondary to a small superior venous thrombosis from IV drug use. Conclusions: IV drug use is recognized as a risk factor for SVT and DVT due to endothelial damage of injected veins and/or increased coagulation factors. As a LE DVT was ruled out through ultrasound, this patient likely had an UE thrombus with a secondary PE. However, her low D-dimer in the setting of a PE is puzzling considering the test’s high sensitivity (95%). Given that her subsequent D-dimer was elevated, this suggests that the initial test may have been inaccurate. Clinical Significance: D-dimer is considered to be a useful test to rule out DVT and PE in cases of low or moderate probability. However, a few reasons for false-normal D-dimer have been elicited: small emboli, anticoagulant pretreatment, and symptoms ongoing for ≥ 10 days. In this case with moderate probability, the initial falsely low D-dimer decreased suspicion for thrombosis and was most likely due to small emboli. Therefore, the causes of false-normal D-dimer must be well known and considered in order to avoid misdiagnosis.Item Protocol for RNA Primer Building: Hawkins Lab 2021(2021-07) Ivaturi, Samantha; Sowers, Adrianne; Willhite, SydneyStep-by-step protocol for building customized and optimized primers for select RNA sequences using NCBI and Primer3Web available software.