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Raymond CM, Gaul SP, Han S, Huang G, Dong J. Variability of Clinical Presentation in Patients Heterozygous for the F508del Cystic Fibrosis Variant: A Series of Three Cases and a Review of the Literature. Cureus 2023; 15:e40185. [PMID: 37431359 PMCID: PMC10329848 DOI: 10.7759/cureus.40185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2023] [Indexed: 07/12/2023] Open
Abstract
Cystic fibrosis (CF) is a genetic disease that affects the lung, pancreas, and other organs caused by the presence of biallelic CF-causing variants in the cystic fibrosis conductance regular gene (CFTR). CFTR variants can also be found in CFTR-related disorders (CFTR-RD), which present milder symptoms. Increasing access to next-generation sequencing has demonstrated that both CF and CFTR-RD have a broader array of genotypes than formerly thought. Here we present three patients who carry the most common CFTR pathogenic variant - F508del - but express a wide array of phenotypes. These cases open discussion on the role of concurrent variants in CFTR, the importance of early diagnosis and treatment, and the contribution of lifestyle factors in CF and CFTR-RD presentation.
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Affiliation(s)
| | - Simon P Gaul
- Medicine, University of Texas Medical Branch, John Sealy School of Medicine, Galveston, USA
| | - Song Han
- Pathology, University of Texas Medical Branch, Galveston, USA
| | - Gengming Huang
- Pathology, University of Texas Medical Branch, Galveston, USA
| | - Jianli Dong
- Pathology, University of Texas Medical Branch, Galveston, USA
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Raymond CM, Nielsen MC, Silva C, Tanabe M, Clement C, Williams-Bouyer N, He J. Vacuoles in the Breast: A Histologic Clue for an Unusual Presentation of an Atypical Organism. Cureus 2023; 15:e36586. [PMID: 37095826 PMCID: PMC10122441 DOI: 10.7759/cureus.36586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2023] [Indexed: 04/26/2023] Open
Abstract
Infections with nontuberculous mycobacteria (NTM) are increasing in prevalence worldwide, and this group of organisms is emerging as significant clinical pathogens. We present a case of a 58-year-old female with persistent furuncles of the breast who was found to have an NTM infection. This case is unique for the lack of risk factors for NTM in the patient's history, the location of the infection in the breast, and the close cooperation needed across disciplines to arrive at the diagnosis. This multi-disciplinary discussion considers the classic clinical presentation of NTM, it is a characteristic morphological appearance on histopathology, the differential diagnosis, treatment, and the ultimate outcome of the case. This case report and discussion will assist both clinicians and pathologists in the diagnosis of this important infectious disease.
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Affiliation(s)
- Caitlin M Raymond
- Pathology, University of Texas Medical Branch at Galveston, Galveston, USA
| | - Marisa C Nielsen
- Pathology and Laboratory Medicine, Boston Medical Center, Boston, USA
| | - Colleen Silva
- Surgery, University of Texas Medical Branch at Galveston, Galveston, USA
| | - Melinda Tanabe
- Infectious Disease, University of Texas Medical Branch at Galveston, Galveston, USA
| | - Cecilia Clement
- Pathology, University of Texas Medical Branch at Galveston, Galveston, USA
| | | | - Jing He
- Pathology, University of Texas Medical Branch at Galveston, Galveston, USA
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Raymond CM, Bui DH, Dong J. Homozygous Carriers of F2 c.20210G>A Variant: A Report of Two Cases and Literature Review. Cureus 2023; 15:e36668. [PMID: 37102003 PMCID: PMC10124579 DOI: 10.7759/cureus.36668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2023] [Indexed: 04/28/2023] Open
Abstract
Thromboembolism is known to be a multifactorial event that is impacted by various genetic and environmental factors. The genetics society's recommended name for this variant is c.*97G>A (this is the nomenclature we need to use in the patient report). However, people have been using legacy names c.20210G>A or G20210A (so these are common names). One of the most common genetic variants associated with inherited thrombophilias, F2 c.20210G>A is acknowledged to be a weak but significant risk factor for thromboembolism. However, its clinical presentation has been described as phenotypically heterogeneous. We present two rare cases with homozygous F2 c.20210G>A variant, one of which also carries a heterozygous variant in coagulation factor V gene F5, c.1601G>A (p.Arg534Gln; commonly known as factor V Leiden). We described the clinical courses of these two cases and discussed F2 c.20210G>A and factor V Leiden as genetic risk factors in thromboembolism, the role of provoking factors, such as surgery and malignancy, and the management of such patients.
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Affiliation(s)
| | - Duc-Hieu Bui
- Medicine, John Sealy School of Medicine, University of Texas Medical Branch, Galveston, USA
| | - Jianli Dong
- Pathology, University of Texas Medical Branch, Galveston, USA
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Raymond CM, Lechner AM, Lockwood M, Carter O, Harris RMB, Gilfedder L. Private land manager capacity to conserve threatened communities under climate change. J Environ Manage 2015; 159:235-244. [PMID: 26067646 DOI: 10.1016/j.jenvman.2015.04.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 04/26/2015] [Accepted: 04/29/2015] [Indexed: 06/04/2023]
Abstract
Major global changes in vegetation community distributions and ecosystem processes are expected as a result of climate change. In agricultural regions with a predominance of private land, biodiversity outcomes will depend on the adaptive capacity of individual land managers, as well as their willingness to engage with conservation programs and actions. Understanding adaptive capacity of landholders is critical for assessing future prospects for biodiversity conservation in privately owned agricultural landscapes globally, given projected climate change. This paper is the first to develop and apply a set of statistical methods (correlation and bionomial regression analyses) for combining social data on land manager adaptive capacity and factors associated with conservation program participation with biophysical data describing the current and projected-future distribution of climate suitable for vegetation communities. We apply these methods to the Tasmanian Midlands region of Tasmania, Australia and discuss the implications of the modelled results on conservation program strategy design in other contexts. We find that the integrated results can be used by environmental management organisations to design community engagement programs, and to tailor their messages to land managers with different capacity types and information behaviours. We encourage environmental agencies to target high capacity land managers by diffusing climate change and grassland management information through well respected conservation NGOs and farm system groups, and engage low capacity land managers via formalized mentoring programs.
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Affiliation(s)
- C M Raymond
- Geosciences and Natural Resource Management, University of Copenhagen, Rolighedsvej 23, Frederiksberg, Denmark; Enviroconnect, PO Box 190, Stirling, South Australia 5152, Australia.
| | - A M Lechner
- Centre for Environment, University of Tasmania, Private Bag 141, Hobart, Tasmania 7001, Australia; Centre for Social Responsibility in Mining, Sustainable Minerals Institute, Sir James Foots Building (47A), Staff House Road, The University of Queensland, Brisbane, Queensland 4072, Australia
| | - M Lockwood
- Geography and Spatial Sciences, School of Land and Food, University of Tasmania, Private Bag 78, Hobart, Tasmania 7001, Australia
| | - O Carter
- Natural and Cultural Heritage Division, Department of Primary Industries, Parks, Water and Environment, PO Box 44, Hobart, Tasmania 7001, Australia
| | - R M B Harris
- Antarctic Climate and Ecosystems Cooperative Research Centre (ACE CRC), University of Tasmania, Private Bag 80, Hobart, Tasmania 7000, Australia
| | - L Gilfedder
- Natural and Cultural Heritage Division, Department of Primary Industries, Parks, Water and Environment, PO Box 44, Hobart, Tasmania 7001, Australia
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Lechner AM, Raymond CM, Adams VM, Polyakov M, Gordon A, Rhodes JR, Mills M, Stein A, Ives CD, Lefroy EC. Characterizing spatial uncertainty when integrating social data in conservation planning. Conserv Biol 2014; 28:1497-1511. [PMID: 25382071 DOI: 10.1111/cobi.12409] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Accepted: 07/30/2014] [Indexed: 06/04/2023]
Abstract
Recent conservation planning studies have presented approaches for integrating spatially referenced social (SRS) data with a view to improving the feasibility of conservation action. We reviewed the growing conservation literature on SRS data, focusing on elicited or stated preferences derived through social survey methods such as choice experiments and public participation geographic information systems. Elicited SRS data includes the spatial distribution of willingness to sell, willingness to pay, willingness to act, and assessments of social and cultural values. We developed a typology for assessing elicited SRS data uncertainty which describes how social survey uncertainty propagates when projected spatially and the importance of accounting for spatial uncertainty such as scale effects and data quality. These uncertainties will propagate when elicited SRS data is integrated with biophysical data for conservation planning and may have important consequences for assessing the feasibility of conservation actions. To explore this issue further, we conducted a systematic review of the elicited SRS data literature. We found that social survey uncertainty was commonly tested for, but that these uncertainties were ignored when projected spatially. Based on these results we developed a framework which will help researchers and practitioners estimate social survey uncertainty and use these quantitative estimates to systematically address uncertainty within an analysis. This is important when using SRS data in conservation applications because decisions need to be made irrespective of data quality and well characterized uncertainty can be incorporated into decision theoretic approaches.
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Affiliation(s)
- A M Lechner
- The Centre for Environment, University of Tasmania, Private Bag 141, Hobart, TAS, 7001, Australia
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