Successful Treatment of Rapidly Evolving Cutaneous Leishmaniasis With Amphotericin B and Miltefosine in an Immigrant From Venezuela.

Leishmaniasis is a vector-borne disease uncommonly encountered in the United States. This case report describes a 54-year-old man presenting with rapidly progressing, pruritic, painful ulcerative lesions after recently immigrating from Venezuela. A punch biopsy confirmed infection with Leishmaniasis braziliensis. He was successfully treated with amphotericin B and miltefosine.

Associations of Incomplete SARS-CoV-2 Vaccination among Patients with Unstable Housing in Houston.

Vaccination is a safe and effective way to protect against SARS-CoV-2. Two of the three authorized SARS-CoV-2 vaccines require two doses, presenting logistical challenges. Those with unstable housing face barriers that amplify these challenges. In this study, we utilized a database maintained by Healthcare for the Homeless-Houston to determine the rates of partial vaccination among those with unstable housing in Houston (n=294). We then performed post-hoc analyses to identify predictors of partial vaccination. Our key finding was that 30% of those with unstable housing missed their second dose, a proportion far higher than the national average. Those with permanent supportive housing and those who had a Harris County Gold Card (financial assistance for health care costs) were more likely to return for dose two, while those who were younger, living on the streets, or staying in a temporary homeless shelter were more likely to miss the second dose.

Emergency Department Utilization Patterns in Patients with Opioid-Related Emergency Department Visits.

Opioid-related Emergency Department (ED) visits have surged over the past decade. There is limited data on ED utilization patterns of patients with opioid use disorder (OUD). An improved understanding of utilization may underscore missed opportunities for screening, intervention and referral.This was a retrospective 2:1 matched case-control study conducted at a single urban ED. Cases were patients with an opioid-related index ED visit from June 1, 2017 to May 31, 2018. Controls were patients with a non-opioid related index ED visit from June 1, 2018 to May 31, 2019. The primary outcome was the association between the number of ED visits in the 24-month period surrounding the index visit (12 months prior and 12 months following) and having an opioid-related index ED visit.There were a total of 224 cases. One or more visits preceding (OR: 1.63, 95% CI: 1.17, 2.26) and following the index visit (OR: 2.69, 95% CI: 1.91, 3.78) was significantly associated with case status. Following adjustment, a higher number of visits preceding (aOR: 1.24, 95% CI: 1.08, 1.43) and following the index visit (aOR: 1.39, 95% CI: 1.23, 1.57) remained significantly associated with case status.Patients with an opioid-related index ED visit had significantly higher rates of ED utilization 12 months before and after the index visit when compared to a matched control population. These findings suggest that there are significant opportunities for ED intervention and referral to treatment both prior to and following an opioid-related ED visit in this patient population.

The effect of multistage nanovector targeting of VEGFR2 positive tumor endothelia on cell adhesion and local payload accumulation.

Nanovectors are a viable solution to the formulation of poorly soluble anticancer drugs. Their bioaccumulation in the tumor parenchyma is mainly achieved exploiting the enhanced permeability and retention (EPR) effect of the leaky neovasculature. In this paper we demonstrate that multistage nanovectors (MSV) exhibit rapid tumoritropic homing independent of EPR, relying on particle geometry and surface adhesion. By studying endothelial cells overexpressing vascular endothelial growth factor receptor-2 (VEGFR2), we developed MSV able to preferentially target VEGFR2 expressing tumor-associated vessels. Static and dynamic targeting revealed that MSV conjugated with anti-VEGFR2 antibodies displayed greater than a 4-fold increase in targeting efficiency towards VEGFR2 expressing cells while exhibiting minimal adherence to control cells. Additionally, VEGFR2 conjugation bestowed MSV with a significant increase in breast tumor targeting and in the delivery of a model payload while decreasing their accumulation in the liver. Surface functionalization with an anti-VEGFR2 antibody provided enhanced affinity towards the tumor vascular endothelium, which promoted enhanced adhesion and tumoritropic accumulation of a reporter molecule released by the MSV.