Browsing by Author "Jafferji, Fatema"
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Item Assessment of Patient Engangement in Pediatric Mental Health Calls in Mothers of Young Children Since COVID-19 with Improvement Solutions(2023) Jafferji, Fatema; Fathima, AfraPurpose: COVID-19 restrictions led to a rise in telehealth visits. To combat the issue of limited in-person visits, Pediatric Mental Health Calls (PMHC) were created to bridge the gap and provide continued mental health support to UNTHSC Pediatric patients and their caregivers during the pandemic and beyond. Patient engagement was analyzed to gain a better understanding of the impact of PMHC during COVID-19 in 2020 and 2021-22 and to provide improvement for future calls. Methods: PMHC was completed by HSC student volunteers. Quantitative analysis of patient involvement was made in mothers whose children were infants in 2020 and toddlers in 2021-2022. Patients no longer with UNTHSC clinic or phone numbers no longer in service were omitted from the count. Participation of these mothers (n=292) was assessed using the percentage of the total number of responses in open or close-ended questions (<5, ≧5, or no response at all) and the number of word sentences in open-ended questions (<5 in any category, ≧5 in 1 category, ≧5 in 3 categories). Analysis used chi-square test of independence. Statistical significance was set at p < 0.05. Additionally, Edinburg Postnatal Depression Scale (EPDS) phone screenings and referrals in mothers of infants were compared with early COVID-19 in 2020 to follow-ups in 2021-2022. In 2020, 199 out of 543 infant mothers who agreed to complete the EPDS screenings over the phone were compared to 229 out of 473 mothers of infants in 2021-2022. A comparison was also evaluated for 2020 (n=165) and 2021-2022 (n=190) postnatal mothers with an EPDS score of ≧10 indicating an increased risk for depression, thereby given referrals based on volunteer judgment. Results: There was a positive response in patient engagement in early 2020 compared to 2021-2022. Chi square test showed a statistically significant decline in both the number of responses in open or closed-ended questions (<5, ≧5, with an increase in no response at all category) and in the number of word sentences in open-ended questions (<5 in any category, ≧5 in 1 category, ≧5 in 3 categories) in 2021-2022. In 2020, from the 199 infant mothers willing to complete the EPDS screening over the phone, 127 answered yes and 72 answered no. In 2021-2022, from the 229 infant mothers, 147 answered yes and 82 answered no. There was a drop in percentage in the number of referrals made for mothers of infants with an EPDS score of ≧10 in 2021-2022 when compared to 2020. Discussion: Modifications of the PMHC are recommended to increase patient participation beyond the pandemic. Volunteers are encouraged to connect with patients using motivation and interpersonal interaction. Demographic data must be considered to assess patterns of patient engagement. Mothers should be educated on the data and the importance of completing EPDS screenings. Specific questions relevant to current concerns in the country affecting maternal and pediatric health should be focused upon. Alternatives should be suggested to patients who are less likely to respond.Item Os Intermetatarseum: An important consideration in chronic foot pain(2024-03-21) Patel, Kavita; Jafferji, FatemaBackground: The os intermetatarseum is the rarest accessory bone of the foot. It was first described by Gruber in 1856 but well documented cases have been infrequently reported throughout literature. This accessory bone is located on the dorsal aspect of the foot in between the base of the first and second metatarsals. It varies in shape and size and usually presents bilaterally. Chronic dorsal mid foot pain following impingement of the deep peroneal nerve by the os intermetatarseum is common in symptomatic patients and an important consideration in this case. Case Presentation: A 70 year old Caucasian female with a past medical history of depression, thyroid disease, and neuropathy presents with chronic left foot pain rated 10/10, starting 4 years ago. She describes it as a burning and aching pain that comes and goes. The pain, described as burning and aching, occurs on the left anterior ankle, lateral ankle, and forefoot, aggravated by walking, prolonged standing, and toe extension. Alleviated by leg elevation, rest, and sitting. She has been seen by 2 podiatrists and was given a steroid injection by both. The first injection did not help and the 2nd injection lasted for one year. Physical examination revealed pain upon palpation of the peroneal tendon as it courses posterior to the lateral malleolus and at the tip of the fibula. Both peroneus longus and brevis were intact with manual testing. No pain upon palpation of the 1st metatarsal joint, but pain upon palpation of the left 3rd and 4th metatarsal shaft. The dorsalis pedis pulse was 2/4 bilaterally and the posterior tibial pulse was 2/4 bilaterally. Neurological assessment of positive sensation and light touch were intact bilaterally. There were no significant dermatologic lesions present. Bilateral foot assessment showed adequate skin tone, texture, and turgor with a normal temperature gradient. After the initial visit, the patient was instructed to modify her activity and shoe wear to incorporate more fitted supportive tennis-type shoe. On the one-week follow-up visit to discuss MRI findings, the patient reported her pain level decreased to a 4/10. MRI reveals a marked longitudinal arch, moderate hallux valgus, longitudinal split tear of peroneus brevis retromalleolar to inframalleolar distribution, and short segmental split tear of peroneus longus proximal to cuboid tunnel. There was no convincing evidence of an occult fracture or stress injury. A small intermetatarseum was noted between the bases of the first and second metatarsals dorsally that likely articulates with the 1st metatarsal base. Due to the presence of segmental tears involving the peroneus brevis and longus, the podiatrist catered his treatment plan to address tenosynovitis. After discussing the diagnosis and potential treatment plans the patient opted to undergo surgery. Conclusion: Refractory foot pain aggravated by physical activity and symptoms of deep peroneal nerve compression should prompt consideration of a painful os intermetatarseum. Initially, conservative measures like NSAIDs, shoe adjustments, and rest should be employed to address this potential diagnosis, reserving surgical interventions as a final option.Item Ruptured Giant Abdominal Aortic Aneurysm(2022) Mahasamudram, Prathyusha; Jafferji, Fatema; Heckart, Logan; George, Kevin; Luka, Stacy; Fisher, Cara L.Abstract Background: An aneurysm is commonly defined as permanent and irreversible localized dilation of a vessel. Any aneurysm located in the infradiaphragmatic aorta could be clinically known as an abdominal aortic aneurysm (AAA), but this classification is typically limited to aneurysms of the infrarenal aorta rather than suprarenal aorta. Literature varies on the exact definition of AAA, but common definitions include vessel dilation of at least 150% compared to relative normal diameter of the artery, as well when the infrarenal aortic diameter is expanded greater than 3.0 cm. The infrarenal aortic aneurysm is the most common type of AAA with a frequency of 65%, but aneurysms do occur at other locations along the aorta. AAA's are also classified by their shape as either fusiform, which are expanded circumferentially, or as saccular, which are expanded in a spherical, but more localized manner. The greater the diameter of the AAA is versus the normal diameter at the level of the renal arteries, which is approximately 2.0 cm, the greater the risk of rupture. An AAA that is greater than 8.0 cm is estimated to have a 30%-50% chance of rupture according to the Joint Council of the American Association for Vascular Surgery. Case Information: During a routine cadaveric dissection, a AAA was identified in an 86-year-old Caucasian male, whose cause of death was documented as senile degeneration of the brain. The donor was 6'0" and 186 lbs (BMI = 25.2). He had a history of heart disease and chest pains. The aneurysm was discovered after noting evidence of significant bleeding in the retroperitoneum in the form of a blood clot. The blood clot itself measured 37.55 cm in transverse diameter and 22.35 cm in height. Removal of the blood clot revealed the aneurysm, which measured 10.82 cm in transverse diameter and 11.28 cm height. Conclusion: Documentation of this case adds to the current literature and understanding of AAA's of this size. With a transverse diameter greater than 10-13 cm, the identified AAA would be classified as a giant AAA. Bleeding from the rupture of this large aneurysm involved foregut, midgut, and hindgut structures. The inferior mesenteric artery, a branch of the abdominal aorta, which supplies the distal ⅓ of the transverse colon, descending colon, sigmoid colon, and the superior rectum was the most impacted. Other nearby arteries were also affected and damaged. Furthermore, we are able to note associations between the patient's medical history and the likelihood of development and rupture of an abnormal AAA. Increased risk for AAA is associated with ethnicity, age, sex, renal cysts, smoking history, CHD, and more. Our findings indicate that close follow-up with patients with increased risk-factors for AAA would be beneficial.Item Understanding the Pressure Recovery Phenomenon: A Case Study on the Discrepancies Between Echocardiography and Cardiac Catheterization in Aortic Stenosis Assessment(2024-03-21) Jafferji, Fatema; Patel, Kavita; Kline, GeoffreyThis detailed case study addresses the significant clinical implications of the pressure recovery phenomenon in the assessment of aortic stenosis (AS), emphasizing the discrepancies that can arise between echocardiography (ECHO) and cardiac catheterization measurements. The focal point of this study is an 80-year-old male patient with a complex medical history of coronary artery disease, hypertension, diabetes, and dyslipidemia, who underwent evaluation for AS. Our patient presented with a grade 3/6 systolic murmur loudest at the right upper sternal border consistent with AS but was asymptomatic for common cardiac-related symptoms such as angina, dyspnea, extremity edema, and syncope. The echocardiographic assessment indicated severe AS, with the aortic valve area measured at0.79 cm² and pressure gradients at 50 mmHg (mean) and86 mmHg (peak). However, a significant divergence was observed during cardiac catheterization, which showed a considerably lower gradient of30 mmHg, indicative of moderate AS. This discrepancy is analyzed through understanding the pressure recovery phenomenon. This phenomenon occurs when blood, having flowed through a narrowed valve at high velocity (and hence low pressure), enters a larger vessel like the ascending aorta, leading to a reconversion of kinetic energy into potential energy, and thus, a recovery of pressure. This results in an overestimation of pressure gradients when using ECHO, as opposed to the direct measurements obtained via cardiac catheterization. The study delves into the broader clinical implications of this phenomenon, particularly its influence on the categorization of AS severity and the subsequent impact on clinical management decisions. The case demonstrates how a diagnosis of severe AS based on ECHO findings might lead to considerations for surgical or percutaneous interventions, which could be unnecessary or even risky for the patient, as highlighted by the more moderate classification derived from catheterization results. In conclusion, this study emphasizes the necessity for clinicians to be aware of the pressure recovery phenomenon and its potential to skew AS assessments. It advocates for a comprehensive, multimodal diagnostic approach, integrating both echocardiography and catheterization findings along with a thorough clinical evaluation. This approach would ensure a more accurate assessment of AS severity, leading to safer and more effective patient management strategies. The study also suggests the need for enhanced educational efforts to increase awareness and understanding of this phenomenon among healthcare providers.