Editors



Current Editors: Fareen Momin and Jane Onyemachi

(Please email editors if there is blog-worthy news that you would like to see shared)

Past Editors: Andrea Francis, Renat Ahatov, Michael Phan, Elise Weisert, Michael Ryan, Keith Wagner, Tim Allen, Kristyna Gleghorn, Dung Mac, Alex Acosta, William Tausend, Sheila Jalalat, Rebecca Philips, Chelsea Altinger, Lindsey Hunter, Alison Wiesenthal, Leslie Scroggins, Mara Dacso, Ashley Group, Fadi Constantine, Emily Fridlington, Joslyn Witherspoon, Tasneem Poonawalla.

Saturday, March 29, 2014

UTMB PGY3 Dermatology Resident Completes Barcelona Marathon

Congratulations are in order for Dr. Brandon Goodwin, who on March 16, 2014 completed his first marathon in Barcelona, Spain with a time of 4:32:00. Two other UTMB dermatology faculty also completed this race: Drs. Ashley Group and Ramon Sanchez. Thanks for representing UTMB so well!

UTMB DIG President Sheila Jalalat Schedules Dermatology Research Honors Presentation

Our UTMB DIG President, MS4 Sheila Jalalat, has scheduled her UTMB Dermatology Honors Program research presentation for Friday, April 25, 2014 at 8 am in the UTMB dermatology conference room (4.130 McCullough Bldg). Her research topic is, “Dermatology Interest Group Blog: The Impact of Medical School Interest Groups and Web 2.0 Tools As a Resource for Students and Residents.” Her UTMB Honors Committee members are the Committee Chair, Dr. M. Peek (Preventive Medicine & Community Health), and ad hoc dermatology committee members Drs. R. Wagner (dermatology faculty advisor), S. Raimer (Chair, Department of Dermatology) and B. Kelly. DIG members are welcome to attend, as well as the entire UTMB academic community and others with interest in this topic.

UTMB MS4 Lindy Ross Scheduled to Present Dermatology Honors Research on April 21, 2014


UTMB MS4 Lindy Ross will present her dermatology honors research, “Perception and Influence of Jersey Shore on Tanning Behaviors,” at noon on April 21, 2014 in the dermatology conference room (4.130 McCullough Bldg). Her UTMB Honors Committee members are the Committee Chair, Dr. M. Peek (Preventive Medicine & Community Health), and ad hoc dermatology committee members Drs. R. Wagner (dermatology faculty advisor), S. Raimer (Chair, Department of Dermatology) and B. Kelly. DIG members are welcome to attend, as well as the entire UTMB academic community and others with interest in this topic.

Friday, March 28, 2014

2014 Annual Spring Texas Dermatological Society Meeting

Fort Worth will host the 2014 Annual Spring Meeting of the Texas Dermatological Society (TDS) on  May 2nd and 3rd this year at the Worthington Renaissance Hotel. The TDS offers resident housing stipends for dermatology residents who apply for the stipend upon hotel check-in. This meeting will feature a dermatology resident podium and poster competition on Friday, May 2nd from 1-3 pm, with three awards for both categories ($500, $300, and $200 respectively for 1st, 2nd and 3rd place). Winners will be announced at the business lunch on Saturday, May 3rd. More information is available at the TDS business office (512-370-1502).

UTMB Dermatology Offers Free Melanoma Screening in May

The UTMB Department of Dermatology will be offering free melanoma screening to the public on May 10, 2014 at Stewart Road (6710 Stewart Rd., Suite 100, Galveston, TX 77555) from 10 am to 1 pm. DIG members are welcome to volunteer their services assisting UTMB Dermatology residents and faculty at this screening. The clinic map is available at: https://maps.google.com/maps?f=q&hl=en&geocode=&q=6710+Stewart+Road,+Galveston,+TX&sll=29.29381,-94.805317&sspn=0.020323,0.019741&ie=UTF8&ll=29.274027,-94.837182&spn=0.010164,0.009871&z=16&iwloc=addr

Thursday, March 27, 2014

Lee T. Nesbitt, MD (1941-2014)

The UTMB Department of Dermatology was saddened to hear of the death of Dr. Lee Nesbitt on March 22, 2014. Dr. Nesbitt was the Dermatology Chair at LSU-New Orleans and a friend and mentor to many of our UTMB medical students who rotated with him in New Orleans each year. Several of our UTMB medical students were selected by his department to take dermatology residencies with him, and they were well trained in Louisiana. Dr. Nesbitt will be greatly missed by all who were fortunate enough to know him. His obituary is available at http://obits.nola.com/obituaries/nola/obituary.aspx?pid=170363896  Donations may be made in his memory to the LSUHSC Foundation, LSUHSC Department of Dermatology, 1542 Tulane Ave., Room 639, New Orleans, LA 70112.

UTMB Dermatology Resident Co-Authors April 2014 Photo Quiz in Consultant

Congratulations to UTMB dermatology PGY3 resident Dr. Lindsey Hunter-Ellul for her most recent upcoming publication, “What is Causing this Man’s Pain?” April 2014 Photo Quiz feature in the Consultant. Her co-authors on this paper were UTMB medical students Jessica Delaisse, Tyler Bliss, and Drs. Emilio Gonzales, Shraddha Jatwani and Ahmed Morsy.

UTMB Dermatology Resident Named Co-Editor of Dermatology Publication

Congratulations to Dr. Lindsey Hunter-Ellul, a former UTMB DIG Editor-in-Chief, for her new appointment as co-editor to the American Academy of Dermatology publication for dermatology residents,  Directions. Dr. Hunter is currently a PGY3 dermatology resident at UTMB. Her Directions physician co-editor will be Dr. Lacey L. Cruse . This publication is sent to dermatology residents nationwide and is probably most well known for its American Board of Dermatology Certification Examination review feature, “Boards Fodder.”

Wednesday, March 26, 2014

"Likability" a Factor for Dermatology Resident Selection?

Reporter Sue Shellenbarger in the Wednesday, March 26, 2014 Wall Street Journal (Why Likability matters more Than Ever at Work, page D3) wrote that "Likable people are more apt to be hired..." and reviews personal characteristics such as authenticity, curiosity, expressiveness, listening, mimicry and similarity and their impact at the work environment.

Dermatology Residents Invited to Submit Cosmetic Abstracts for Rio de Janeiro Meeting Scholarship

The 10th World Congress of the International Academy of Cosmetic Dermatology is sponsoring an academic competition for dermatology residents and fellows. They are requesting case reports on cosmetic dermatology topics by noon central time on April 15, 2014 for the Edward L. Keyes Resident Contest for Outstanding Case Reports.  Abstracts (no longer than 2500 characters including spacing) should be submitted to vrosic@medicine.bsd.uchicago.edu The winner will be invited to present their research at the 10th World Congress of the International Academy of Cosmetic Dermatology meeting in Rio de Janeiro, Brazil from July 18-20, 2014. Travel expenses, lodging for 3 nights, registration fee and stipend will be part of the award. Previously published, presented or submitted materials are of no interest. The winning submission will have high educational value and will feature new, significant work to the subspecialty. The awarded paper will be published in SKINmed: Dermatology for the Clinician, the official journal of the International Academy of Cosmetic Dermatology. The winner will be notified by May 15, 2014.

Monday, March 24, 2014

UTMB Faculty Authors Celebratory Editorial

Dr. Richard Wagner (UTMB Dermatology Faculty) was invited to write an editorial for the 10th anniversary issue of the Journal of Medicine and Movies, and his work was published in the March 2014 issue (Wagner RF Jr. 10 Years with the Journal of Medicine and Movies. J Med Mov 2014;10:1-2). Since 2012 he has published 5 articles in this journal related to his experience teaching medical students about skin diseases through film, as well as co-authoring original articles with medical students and residents about films with skin disease content. His editorial is available at the link below:
 http://revistamedicinacine.usal.es/index.php/volumenes/volumen10/num1/777 

UTMB Authors Publish Academic Critique of Contemporary Films Featuring Orolabial Herpes Depictions

PGY2 Internal Medicine Dr. Alex Holliday was the first author on a recently published manuscript, “Cold Sore, Cold Soul? An Examination of Orolabial Herpes in Film,” that was published in the March 2014 issue of the Journal of Medicine and Movies (J Med Mov 2014; 10:19-25). His coauthors were UTMB MS4 Amanda Salih and UTMB dermatology faculty, Dr. Richard Wagner. This is the third manuscript published by the Journal of Medicine and Movies with UTMB resident and medical student authors since 2013. This article is available at:

Lessons From the 2014 Dermatology Residency Match

Yes, the 2014 dermatology residency match appears to have been the most competitive one yet. Many qualified applicants failed to match this year. Applicants are often interested about their chance to match in the next cycle. What have we learned from the dermatology residency match this year?
 
1.      Dermatology residency programs are still looking for the best qualified academic students to fill their positions. This currently seems to be defined as having a Step 1 of at least 240 and being a member of AOA. Applicants with these high academic credentials get the most interview offers, increasing their chance to match. They almost always match if they do well at the interviews.
a)      Applicants with advanced degrees and published research, especially those with Ph.D.s are favored at some top dermatology research programs, and with excellent past research productivity and future potential, will still be able to match despite lower Step 1 scores and without AOA membership. Extremely high research productivity may also help other applicants without a Ph.D. get a residency position, especially if the specific dermatology program needs to boost their research productivity as a result of insider or outsider criticism that their recent dermatology research (publications) is lacking.
b)      Even though applicants with 240/AOA almost always match, they still may not match high on their rank list. That is because dermatology is still a highly competitive match, and there are relatively few positions available. These applicants need to remember that if they list a program on their rank list, they may match there! Think it through before you certify your match list. Would I be willing to live anywhere for three years in order to become a dermatologist? If the answer is “no” for any reason, don’t rank those programs, but realize that you are increasing the risk of not matching into a dermatology program. Every year dermatology applicants match at their last choice program and are not happy about it.

2.      Applicants not elected to AOA may need much higher Step 1 scores to get enough interviews needed to match (about 7 last year). Think 260 and higher. Some dermatology residency programs understand that there is occasional subjectivity in AOA elections, and that sometimes excellent academic students are not included because of other selection criteria such as research, leadership roles, and community service.

3.      Applicants with Step 1 less than 240 and not AOA: Yes, there is still a chance that you could match. Maybe you have demonstrated to your home program or an away program where you rotated what a superb dermatology resident you would be. However, still be prepared not to match. Other applicants to these programs may have 240/AOA and interview well. If you plan on reapplying, plan to spend an additional 1-2 years in a clinical dermatology fellowship gaining additional national exposure through multiple research presentations, posters and publications. This path is only for the most stalwart because even after doing this, there is no guarantee for a dermatology residency position, and your chances to resume another residency may be limited. Consider if there is an alternative career to dermatology that you would enjoy. There are other ROAD specialties, and other lifestyle shortage area specialties where you will have great geographic flexibility. There is also primary care and primary care specialties that have some overlap with dermatology, such as infectious diseases, rheumatology, and allergy.

Saturday: Galveston Melanoma Walk

The Galveston AIM at Melanoma walk is this Saturday, March 29 at the UTMB Field House. Registration Sign is at 8:00am and the walk starts at 8:30am. Participants are encouraged to seek sponsorship and T-shirts will be available to the first 15 or so walkers to arrive.
 

For more information:
http://www.aimatmelanoma.org/en/aim-for-action/1158/1159/galveston-2014.html

Sunday, March 23, 2014

Houston Chronicle Highlights Dermatology Residency Match for Twins

The Saturday, March 22, 2014 issue of the Houston Chronicle (Kyrie O'Connor, "Match Day pumps up med students,", pages B1, B2) focused on two twins who attended the same college (UT Austin), medical school (UT Houston) and now, the same dermatology residency program (UT Houston). One of them was quoted in the article, "It's a good lifestyle and good money." The reporter also added that dermatology "...lends itself to having a balanced family life, which is crucial to both of them."

Friday, March 21, 2014

UTMB Dermatology Increases Enrollment for Dermatology Acting Internship DERU-4006

UTMB Dermatology has offered a 4 week Acting Internship in Dermatology for the past several years, and it has been extremely popular with medical students with a professional goal of a dermatology career. Due to increased demand for this rotation and with improved clinical facilities and supervision to accommodate interested students, the number of students permitted to take this course has been increased to 2 students each Period. This course is currently being offered during Periods 1-7. For additional information, please see http://ar.utmb.edu/04-05review/bdisplay.asp?rec=499

2014 UTMB Dermatology Residency Match Results

The four new  UTMB dermatology residents for July 1, 2015 are:

Chinelo Ikpeama (Texas Tech)

Lindy Ross (UTMB)

Adrian Subrt (UTMB)

Will Tausend (UTMB)

Congratulations and welcome to Galveston! Our DIG looks forward to working with you!

All UTMB MS4 Dermatology Applicants Match Into Dermatology Residencies

UTMB SOM has officially published their match list for the Class of 2014 (please see http://www.utmb.edu/iutmb/article8048.aspx ). It was an exceptional year for UTMB MS4 dermatology applicants. All six of them have successfully matched into dermatology residencies that begin in July 2015. Congratulations to:

Sheila Jalalat (University of South Florida College of Medicine, Tampa, FL)

Sterling Mckissack (San Antonio Military Medical Center, Fort Sam Houston, TX)

Trisha Patel (Howard University Hospital, Washington, DC)

Lindy Ross (UTMB, Galveston, TX)

Adrian Subrt (UTMB, Galveston, TX)

Will Tausend (UTMB, Galveston, TX)

The UTMB DIG congratulates everyone for your outstanding academic accomplishments!

Dermatology Lifestyle

According to the March 2014 issue of Dermatology Times (“Derms score well in physician lifestyle report,” page 18), 37% of dermatologists take supplemental vitamin D. Could they be avoiding natural sunlight and using sunscreens? Over half of dermatologists (53%) are very or extremely happy at work, the highest percentage of physicians surveyed.

Wednesday, March 19, 2014

Does Job-Seeking Advice Apply to Dermatology Applicants?

It’s is hard to know why dermatology applicants with excellent paper credentials fail to match. Certainly there is strong competition and not enough spots for everyone. The Monday, March 17, 2014 issue of Wall Street Journal (Pierce DL, To My Fellow Job-Hunting College Seniors, page A15) offered interesting advice that may be applicable to dermatology applicants. In this article, Pierce advised job-seekers to:

1)      Never wear a black suit to interviews (plan to spend $500 on navy blue or gray)
2)      Practice meeting new people in social situations. This will happen at interviews and socials skills are important in making first impressions.
3)      Don’t talk about thing that others can’t relate to unless strongly encouraged (Icelandic art studies during winter semester abroad).
4)      Obtain a Gmail address for correspondence with your real name.
5)      Keep track of business cards you receive during rotations/interviews and keep in contact every few months with a personal email update.
6)      Prospective employers may check your social media. Privacy is the word. Make sure profile pictures are professional.
7)      Google yourself to see what your employer might see. Take down inappropriate links if you can.
8)      Set up a professional voice mail for messages on your cell phone.
9)      Join LinkedIn
10)   Write thank-you notes (both email and traditional) and mail them immediately following the interview

Monday, March 17, 2014

All UTMB Residency Positions Fill

UTMB has filled all of its available residency positions in all specialties offered through the 2014 NRMP and the San Francisco Match.

UTMB Dermatology Fills All Dermatology Positions in NRMP

UTMB dermatology has learned that all 4 of the PGY2 positions offered through the 2014 NRMP have filled. Filled programs will be notified on Thursday (3/20/14) with the names of their matched applicants, and applicants will learn where they matched on Friday, 3/21/14.

Wednesday, March 12, 2014

Dallas Buyers Club Added to Film Class

The UTMB Film Class (DERU-4007 and DERU-4051) has updated its required film list to include Dallas Buyers Club (2013). It will replace Philadelphia (1993) in the required film list starting in Period 10. Actors Matthew McConaughey was awarded “Best Actor” and co-star Jared Leto was awarded “Best Supporting Actor” at the 2014 Academy Awards.  Dallas Buyers Club was also nominated for Best Picture. This film realistically depicts Kaposi’s sarcoma and seborrheic dermatitis during the early years of the AIDS epidemic. Interestingly, Tom Hanks also was awarded “Best Actor” for his role in Philadelphia.

Tuesday, March 11, 2014

2nd Annual Healthy Living Fair: A Success

On Saturday March 1st, 2014 UTMB DIG members volunteered at the 2nd Annual Healthy Living Fair hosted by Students Together for Service (STS) and the American and Texas and Medical Student Associations (AMA/TMA) in the Galveston area. The event had a great turn out! DIG members provided educational handouts on sun protection and skin cancer awareness. There were also hands-on activities including making UV bead bracelets. Thank you to everyone who volunteered!


DIG Members pictured above: Dung Mac (MSII, Left) and Alfreda Batts (MSII, Right) 

Monday, March 10, 2014

UTMB Adopts New Requirement for House Staff

Beginning July 1, 2014, the UTMB Graduate Medical Education Committee (GMEC) approved a requirement for all UTMB House Staff related to patient safety and quality improvement. All house staff will have two years to complete 7 PS modules from the Institute for Healthcare Improvement (IHI) Curriculum. Medical students who are planning to take residency at UTMB are encouraged to complete this assignment before starting their residency. Those failing to complete this requirement by the deadline will be removed from clinical services. To register with the IHI, please to https://www.ihi.org/_layouts/ihi/userregistration/userregistration.aspx  Since this activity is becoming so important, medical students may want to complete all IHI PS modules to demonstrate their commitment to and proficiency in patient safety to prospective residency programs.

Reminder: DIG meeting TODAY 5:30pm


This is a reminder that there will be a DIG meeting TODAY at 5:30pm held in 4.112 McCullough Bldg, Dermatology Conference Room.

Things to discuss on the agenda:
-Q&A session led by current fourth year dermatology residency applicants for students
-Galveston AIM for a Cure Melanoma Walk (March 29)
-Upcoming “Stay Shady!” Presentations
-Bake Sale fundraiser (April)
-2012 Houston Walk to Cure Psoriasis, 1K or 5K (May 10th)
-Discuss future DIG election for officer positions

We also have DIG shirts available to purchase for $10

We’d love to see you there!

Sunday, March 09, 2014

UTMB MS3 Published Article in The Texas Dermatologist

Congratulations to UTMB MS3 Jonathan Stubblefield and his co-author, UTMB PGY3 dermatology resident Dr. Lindsey Hunter-Ellul, for the publication of their article, “Medical Student Research: an Obstacle or Catalyst?” This article was published in the “Resident’s Corner” feature of the Spring 2014 issue of The Texas Dermatologist (pages 6 and 7). This article nicely outlines some of the strategies used by the UTMB Department of Dermatology to make research projects available to interested home and visiting medical students, such as our DIG blog and an active departmental bulletin board that lists research opportunities with dermatology residents and faculty.

Friday, March 07, 2014

Many Dermatologists in 43.4% Tax Bracket (Before State Income Taxes)

According to Victoria J. Powell, JD, LLM (2014 Planning Solutions for the Highly Taxed Dermatologist, The Dermatologist: Practical and Clinical Insights into Today’s Dermatology Issues, February 2014, pages 38-39), many dermatologists are in the maximum marginal tax bracket (39.6%). However, additional taxes have increased the marginal tax rate to 43.4% in high income earners. The author suggests several strategies to minimize taxes.

Thursday, March 06, 2014

DIG meeting time/day change to 3/10 at 5:30pm


Note: The upcoming DIG meeting day is this Monday 3/10 at 5:30pm at 4.112 McCullough Bldg, Dermatology Conference Room.

Refer to previous post for meeting details.

We also plan to have a Q&A session led by current fourth year dermatology residency applicants for students.

Wednesday, March 05, 2014

March 2014 Association of Professors of Dermatology Newsletter

The March 2014 Association of Professors of Dermatology Newsletter contains information of interest to dermatology applicants and residents. In this letter, Dr. Suzanne Olbricht wrote about the procedural dermatology match. It discussed the week long “audition rotation” or “mini-rotation” that some applicants take at other institutions. This type of rotation may raise state licensing issues and malpractice insurance. Currently very few applicants who apply widely fail to match into a procedural dermatology fellowship because there are so many programs available.

Dr. Alexandra Kimball wrote an article, “Advice for Medical Students.” She indicated that the “magic number” for a dermatology match is 7 (most applicants who have 7 or more interviews have a very high chance of matching). She also indicated that failing to match after two attempts makes it harder to match on the third or fourth try. This suggests that the second application should be significantly improved from the first attempt (different letters of recommendation from academic dermatologists, additional published articles, additional presentations, advanced dermatology fellowship work). It is also harder to match with Step 1 scores lower than 230 because of interview cutoff scores employed by some residency programs.

Dr. Matt Zirwas wrote an article about the future potential for standardized letters of recommendation. Other competitive specialties like orthopedic surgery have found them helpful. These letters may be more like a checklist or Likert Scale. Eventually some dermatology programs may require letters of recommendation in this format. He did recommend that applicants develop longitudinal relationships with academic dermatologists as well as rotations.

Former UTMB Dermatology Resident to Lecture on Campus

Dr. Dan McCoy (UTMB Dermatology 1997) is scheduled to speak to UTMB dermatology residents and faculty about future reimbursement trends for dermatology on April 30th. He was invited to campus to delivered an invited health policy lecture on earlier that day. He is currently the Chief Medical Officer of Blue Cross and Blue Shield of Texas, a position that he has held since 2013.

UTMB Dermatology Offers New Elective for Aspiring Dermatologists

The newest clinical elective for UTMB and visiting medical students is “Dermatology Boot Camp,” (DERU-4052). It is only offered during Periods 10 and 11 of each academic year, with a limit of 4 students per Period. It will provide comprehensive exposure to dermatology residency, and teach the procedural skills needed to be successful on the first day of dermatology residency. The UTMB dermatology course directors are Drs. Brent Kelly and Cris Berlingeri. For more information about this elective, please see http://ar.utmb.edu/04-05review/bdisplay.asp?rec=561

DIG Meeting Tuesday 3/11 at 5:45pm


We will be having a DIG meeting this Tuesday March 11 at 5:45 pm at 4.112 McCullough Bldg, Dermatology Conference Room.
 
Things on the agenda to discuss:
Galveston AIM for a Cure Melanoma Walk (March 29)
Upcoming “Stay Shady!” Presentations
Bake Sale fundraiser (April)
2012 Houston Walk to Cure Psoriasis, 1K or 5K (May 10th)
Discuss future DIG election for officer positions
 
We also have DIG shirts available for purchase for $10
 
Email szjalala@utmb.edu if you plan to attend, thank you!

Saturday, March 01, 2014

Predicting Dermatology Residency Interviews


A survey of dermatology program directors from 2012 (http://b83c73bcf0e7ca356c80-e8560f466940e4ec38ed51af32994bc6.r6.cf1.rackcdn.com/wp-content/uploads/2013/08/programresultsbyspecialty2012.pdf ) indicated that the three most important factors for getting dermatology interviews were the Dean’s Letter/Medical Student Performance Evaluation (85%), letters of recommendation in the specialty (77%), and the personal statement (74%). Graduating from a US allopathic medical school was 4th (72%), with Step 1 and Class Rank/Quartile tied for 5th place (70%). Only 57% cited AOA membership as an important factor for interview selection. However, 78% of dermatology residency programs reported using “target scores” on Step 1 for offering interviews. Applicants scoring below 220 on Step 1 were unlikely to receive interviews. When a Step 1 score of 240 or higher was made, interviews were much more frequent.
 
The most important factor in ranking applicants was “interactions with faculty during interview and visit,” followed by “interpersonal skills.” The third most important factors were a tie between “interactions with residents during interview and visit” and “evidence of professionalism and ethics.” 90% of dermatology programs did not schedule any dermatology interviews prior to November 1, the date when the Medical Student Performance Evaluation/Dean’s Letter was released.
 
According to the pooled data from dermatology programs, approximately 10% of applicants are invited to interview, and 8% are ranked.

2014 Knox Lecture Scheduled for November 15th

UTMB Dermatology has scheduled the 2014 Knox lecture for November 15, 2014 in Galveston. UTMB medical students are permitted to contribute to the academic meeting case presentations, so check with your UTMB favorite dermatology resident faculty and see if you can help.

Chikungunya In Galveston?


No US acquired cases of Chikungunya have been reported, but this mosquito born infection is already present in the Caribbean and experts warn it could spread to Texas because our warm climate supports the mosquitoes known to transmit this virus (http://www.chron.com/life/healthzone/article/Texas-arrival-of-new-mosquito-borne-virus-called-5270667.php ). A few tourists to endemic areas have reportedly been infected.  There are skin manifestations of this infection, so dermatologists may play a role in detecting this disease
( http://www.ncbi.nlm.nih.gov/pubmed/18211486 ). Since there is no vaccine at present, the key to avoiding infection is avoiding mosquitoes (primary prevention). This is generally a good plan anyway, because mosquito borne diseases such as West Nile are already know to be present in Texas.