Faculty Bibliography

Rationale Cases of granulomatous reaction to pneumocystis have been reported in immuno-compromised patients, most commonly in HIV infected patients but also rarely in patients with hematologic disease. Because of the low incidence of G-PCP, there are only case reports and case series describing different presentations. It has been suggested that because of low organism burden and distribution of disease, bronchoscopy with lavage and biopsy has a low yield in non-HIV patients in diagnosing granulomatous pneumocystis pneumonia (G-PCP). We reviewed our cumulative experience in G-PCP, to characterize the disease and diagnostic approach among patients with different underlying diseases. Method We reviewed the medical records of patients whose pathology results were G-PCP in our tertiary urban hospitals between 1993 and 2012 including demographics, underlying disease, radiographic findings and diagnostic approach. Result We identified 38 G-PCP patients; 27 medical records were available for review. Sixteen patients were HIV-infected. The 11 non-HIV patients had lymphoma or rheumatoid arthritis. Nine of the 11 non-HIV patients had non-diagnostic bronchoscopies and required either CT guided core or open lung biopsy. By contrast, 13 of the 16 HIV patients had diagnostic bronchoscopies(p value=0.002). Among the 11 non-HIV patients, 4 had diffuse large B cell lymphoma that had been treated with multiple cycles of chemotherapy and were subsequently found to have solitary or multiple lung masses. Disease recurrence was suspected based on CT-PET scan findings. However, all pathology specimens showed non-necrotizing granulomatous inflammation with pneumocystis. None showed malignancy or acid fast bacilli. Of note, none of these patients had respiratory symptoms and pneumocystis pneumonia was not considered in the differential diagnosis prior to biopsy. All responded well to anti-pneumocystis therapy. Conclusion The presentation of granulomatous pneumocystis pneumonia in patients without HIV is often atypical. Specifically, the diagnosis should be considered in patients with treated large B cell lymphoma who present with a lung mass on chest imaging. Non-bronchoscopic biopsy is usually required for diagnosis

When analyzing thousands of event histories, analysts often want to see the events as an aggregate to detect insights and generate new hypotheses about the data. An analysis tool must emphasize both the prevalence and the temporal ordering of these events. Additionally, the analysis tool must also support flexible comparisons to allow analysts to gather visual evidence. In a previous work, we introduced align, rank, and filter (ARF) to accentuate temporal ordering. In this paper, we present temporal summaries, an interactive visualization technique that highlights the prevalence of event occurrences. Temporal summaries dynamically aggregate events in multiple granularities (year, month, week, day, hour, etc.) for the purpose of spotting trends over time and comparing several groups of records. They provide affordances for analysts to perform temporal range filters. We demonstrate the applicability of this approach in two extensive case studies with analysts who applied temporal summaries to search, filter, and look for patterns in electronic health records and academic records.

Epilepsy partialis continua is an uncommon, localisation-related, seizure characterised by simple partial motor seizures with repetitive clonic jerks. A case of type I diabetes mellitus in a child who had presented with epilepsy partialis continua is presented. Antiglutamic acid decarboxylase 65 antibodies were found in his serum. Seizures were eventually controlled by anti-epileptic drugs, insulin and IV gamma.