Mariana Ramirez Posada

All Publications

• Disseminated coccidioidomycosis with cutaneous, pulmonary and suspected CNS involvement in an elderly patient with Parkinson's disease. BMJ case reports Villanueva Gaona, R., Linggonegoro, D., Ramirez Posada, M., Tang, J. Y. 2025; 18 (12)

  Abstract

  An elderly patient with recently diagnosed Parkinson's disease presented with disseminated coccidioidomycosis (DCM) manifesting as ulcerative nasal lesions, pulmonary involvement and acute-on-chronic cognitive decline. Culture-confirmed cutaneous disease, positive serology, and imaging demonstrated pulmonary and central nervous system (CNS) involvement, establishing the diagnosis. The patient achieved marked clinical improvement with high-dose oral fluconazole (800 mg, later tapered to 400 mg daily), with serial imaging documenting resolution of CNS and pulmonary lesions. Lymphocyte subset analysis revealed preserved immune function with subtle findings suggestive of age-related immunosenescence. This case demonstrates that DCM can occur in elderly patients without traditional immunocompromise and emphasises the importance of maintaining high clinical suspicion in endemic areas.

  View details for DOI 10.1136/bcr-2025-269449

  View details for PubMedID 41436220

• Progressive Symmetric Erythrokeratoderma in an Adolescent With a Novel GJB3 Variant. International journal of dermatology Ramírez-Posada, M., Vélez Arroyave, C., Jiang, X., Saldarriaga Giraldo, J. C., Chen, T. X., Choate, K. A., Rodríguez, L. 2025

  View details for DOI 10.1111/ijd.70200

  View details for PubMedID 41366560

• ARTIFICIAL INTELLIGENCE IN EVIDENCE SYNTHESIS: A SYSTEMATIC REVIEW AND META-ANALYSIS OF EMERGING BIOLOGICS FOR IMPROVING SKELETAL HEALTH IN OSTEOGENESIS IMPERFECTA Li, C., Dai, Z., Tang, W., Gao, Z., Chan, V. K. Y., Ramirez-Posada, M., Kim, J., Cheung, C. L., Wong, I., Dong, D., To, M., Craig, D., Li, X. ELSEVIER SCIENCE INC. 2025

  View details for Web of Science ID 001664024000221

• Artificial Intelligence and Medical Translation: An Editorial on the Ethical Considerations for Emerging Technologies in Dermatology. Cureus Scheinkman, R. J., Ramirez-Posada, M., Sharifi, S., Tordjman, L., Nouri, K. 2025; 17 (10): e95350

  Abstract

  The growing demand for medical translation services in the U.S. highlights the potential of artificial intelligence (AI), large language models (LLMs) like ChatGPT (OpenAI, San Francisco, CA), to bridge language gaps. However, their use in dermatology raises ethical concerns, including information accuracy, patient privacy, dialectical variations, legal accountability, and algorithm bias for a variety of skin colors. AI models may default to informal language, leading to misunderstandings, and their limited ability to handle less common dialects poses communication challenges. The risk of "hallucination," where incorrect information is generated, and inadequate data oversight further complicate their use. In dermatology, precise translation is crucial due to the field's visual nature and the sensitivity of cosmetic concerns. Linguistic diversity can lead to misinterpretations, affecting patient care. Dermatologists must consider these ethical implications to ensure AI tools address the nuances of dermatological terminology and regional language differences, ultimately improving patient outcomes.

  View details for DOI 10.7759/cureus.95350

  View details for PubMedID 41293332

• Fine-tuning LLMs in behavioral psychology for scalable health coaching. NPJ cardiovascular health Mantena, S., Johnson, A., Oppezzo, M., Schütz, N., Tolas, A., Doijad, R., Mattson, C. M., Lawrie, A., Ramirez-Posada, M., Schmiedmayer, P., Linos, E., King, A. C., Rodriguez, F., Kim, D. S., Ashley, E. A. 2025; 2 (1): 48

  Abstract

  Personalized, smartphone-based coaching improves physical activity but relies on static, human-crafted messages. We introduce My Heart Counts (MHC)-Coach, a large language model fine-tuned on the Transtheoretical Model of Change. MHC-Coach generates messages tailored to an individual's psychology (their "stage of change"), providing personalized support to foster long-term physical activity behavior change. To evaluate MHC-Coach's efficacy, 632 participants compared human-expert and MHC-Coach interventions encouraging physical activity. Among messages matched to an individual's stage of change, 68.0% (N = 430) preferred MHC-Coach-generated messages (P < 0.001). Blinded behavioral science experts (N = 2) rated MHC-Coach messages higher than human-expert messages for perceived effectiveness (4.4 vs. 2.8) and Transtheoretical Model alignment (4.1 vs. 3.5) on a 5-point Likert scale. This work demonstrates how language models can operationalize behavioral science frameworks for personalized health coaching, showing the potential for promoting long-term physical activity and reducing cardiovascular disease risk at scale.

  View details for DOI 10.1038/s44325-025-00083-5

  View details for PubMedID 40994879

  View details for PubMedCentralID PMC12454129

• Post translational Modifications and Protein-Protein Interactome of Endemic Pemphigus in El Bagre, Colombia: A New Variant Analysis. Dermatology practical & conceptual Abreu Velez, A. M., Ramírez-Posada, M., Howard, M. S. 2025; 15 (3)

  Abstract

  A new variant of endemic pemphigus foliaceus, El Bagre-EPF, is an orphan autoimmune disease occurring in El Bagre and neighboring municipalities in Colombia, South America.We aimed to evaluate current state-of-the-art databases and protein-protein interactomes, focusing on post-translational modifications as potential tools to study interactions among El Bagre-EPF antigen proteins.We consulted multiple databases for the known target antigens and their protein-protein interactions. We searched for their network nodes (they represent proteins; each node corresponded to all the proteins produced by a single, protein-coding gene locus). We also searched for any post-translational modifications.We identified similarities in proteins bound by several autoantigens but also found differences in protein linkages. We found that desmoglein, periplakin, desmoplakins, and proteins from subfamilies of the Armadillo repeat proteins and some spectrin domains linked to other cell junctions; these played important roles in membrane-plaque and intermediate filament junctions. A typical drawback in current databases is the lack of information on lipid-protein interactions.Our results show that state-of-the-art protein databases as tools for studies of interactomes fall short in areas including tertiary and quaternary protein interactions and in vivo protein functioning. Enhanced three-dimensional or multi-dimensional functions are required for more accurate interactome analyses.

  View details for DOI 10.5826/dpc.1503a5097

  View details for PubMedID 40790431

  View details for PubMedCentralID PMC12339050

• Patient-Centered Research Through Artificial Intelligence to Identify Priorities in Cancer Care. JAMA oncology Kim, J., Chen, M. L., Rezaei, S. J., Ramirez-Posada, M., Caswell-Jin, J. L., Kurian, A. W., Riaz, F., Sarin, K. Y., Tang, J. Y., Asch, S. M., Linos, E. 2025

  Abstract

  Patient-centered research is essential for bridging the gap between research and patient care, yet patient perspectives are often inadequately represented in health research.To leverage artificial intelligence (AI) and natural language processing (NLP) to analyze a large dataset of patient messages, defining patient concerns and generating relevant research topics, and to quantify the quality of these AI-generated topics.This case series was conducted using an automated framework involving a 2-staged unsupervised NLP topic model and AI-generated research topic suggestions. The study was based on deidentified patient portal message data from individuals with breast or skin cancer at Stanford Health Care and 22 affiliated centers over July 2013 to April 2024.A widely used large language model (ChatGPT-4o [OpenAI]; April 2024) was used and guided through multiple prompt-engineering strategies to perform multilevel tasks, including knowledge interpretation and summarization (eg, interpreting and summarizing the NLP-defined topics), knowledge generation (eg, generating research ideas corresponding to patients' issues), self-reflection and correction (eg, ensuring and revising the research ideas after searching for scientific articles), and self-reassurance (eg, confirming and finalizing the research ideas).Three breast oncologists (J.L.C., A.W.K., F.R) and 3 dermatologists (K.Y.S, J.Y.T., E.L.) evaluated the meaningfulness and novelty of the AI-generated research topics using a 5-point Likert scale (1 representing exceptional to 5 representing poor). Mean (SD) scores for meaningfulness and novelty were computed for each topic.A total of 614 464 patient messages were analyzed from 25 549 individuals, 10 665 with breast cancer (98.6% female) and 14 884 had skin cancer (49.0% female). The overall mean (SD) scores for meaningfulness and novelty were 3.00 (0.50) and 3.29 (0.74), respectively, for breast cancer topics and 2.67 (0.45) and 3.09 (0.68), respectively, for skin cancer topics. One-third of the AI-suggested research topics were highly meaningful and novel when both scores were lower than the average (5 of 15 for breast cancer and 6 of 15 for skin cancer). Notably, two-thirds of the AI-suggested topics were novel (10 of 15 for breast cancer and 11 of 15 for skin cancer).This case series demonstrates that AI/NLP-driven analysis of large volumes of patient messages can generate quality research topics in cancer care that reflect patient perspectives, providing valuable guidance for future patient-centered health research endeavors.

  View details for DOI 10.1001/jamaoncol.2025.0694

  View details for PubMedID 40272833

• Major Depressive Disorder in Long COVID and Exposure to Pro‐Inflammatory Cytokines During Infection by SARS‐CoV‐2 Psychiatric Research and Clinical Practice Guillen‐Burgo, H. F., Gálvez‐Flórez, . F., Moreno‐López, S., Wong, S., Kwan, A. T., Ramirez‐Posada, M., Anaya, ., McIntyre, R. S. 2025
• Determining the medical Spanish translation capabilities of three artificial intelligence translation models for Mohs micrographic surgical instructions. Journal of the American Academy of Dermatology Scheinkman, R., Montoya, S., Náder, M., Ramírez, M., Barbato, K., Jean-Pierre, P., Vignau, A., Nouri, K. 2024

  View details for DOI 10.1016/j.jaad.2024.09.070

  View details for PubMedID 39447753

• Immunofluorescence findings in a reactivating lichenoid photoallergic chronic dermatitis (actinic reticuloid). Photodermatology, photoimmunology & photomedicine Abreu Velez, A. M., Ramírez-Posada, M., Howard, M. S. 2024; 40 (5): e12995

  Abstract

  Chronic photosensitivity dermatitis (CPD) (also named actinic reticuloid) is an unusual disease classically referred often in elderly men. Affected patients have severely itchy, thickened dry skin in areas exposed to the sun throughout the years.A Caucasian female patient who worked most of her life outside who had "chronic dermatitis" in her neck started planting chrysanthemum in her garden on a sunny day. Later, she presented edema, erythema, papules, and a few vesicles in her neck with severe pruritus.A skin biopsy revealed the diagnosis of CPD, along with positive testing for ultraviolet B (UVB), minimal erythema doses (MED) for UVB (MEDB) UVA (MEDA) and PhotoPath.Direct immunofluorescence (DIF) stains using anti-human antibodies against fibrinogen, albumin, IgG, IgM, lambda, kappa, and C3c and C1q were positive at the base membrane area of the dermal epidermal junction, in the papillary dermis, as well as the neurovascular bundles in all the dermis and the extracellular matrix, especially those under the blisters.With this case, we suggest not forgetting the importance of using DIF in reactivated CPD cases in addition to the photo patch testing.

  View details for DOI 10.1111/phpp.12995

  View details for PubMedID 39145412

• Overall and disease-free survival in women being overweight/obesity at the diagnosis of breast cancer. A singlecenter observational study Oncología (Ecuador) Arturo-Restrepo, N., Arango-Jaramillo, C., Arevalo-Gutierrez, A. M., Rada-Gonzalez, P., Ramirez-Posada, M., Montoya, M. E., Montoya Lezcano, K., Rivas Bedoya, Y., Vasquez Trespalacios, E. M. 2023