Browsing by Author "Patel, Kavita"
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Item Control Case Study: E-Health Text Messaging Based Intervention on Developing Lifestyle Changes Related to the Improvement of Childhood Obesity(2023) Patel, Kavita; Robinson, ChristinaBackground: The prevalence of chronic diseases in the United States including heart disease and cancer is majorly attributable to adverse lifestyle factors such as smoking, physical inactivity, poor diet, stress, negative emotion, etc. (CDC, 2012). Recent studies have shown that mothers with unhealthy lifestyles serve as an impetus for childhood obesity (Dhana et al, 2018). Community health promotion efforts and lifestyle interventions are successful in introducing healthy behaviors and promoting its adherence (Dickinson et al., 2006; Kent et al., 2015; Pekmezi, Marquez, & Marcus-Blank, 2010; Tucker et al., 2014; Tucker et al., 2016). Our study evaluates the utilization of an E-health text message system as an effective intervention for caregivers of obese pediatric patients to improve lifestyle behaviors that influence childhood obesity. Case Presentation: A 30 year old African American female presented to the Pediatric Mobile Clinic with her 3 year old child who had a BMI in the 82nd percentile. The caregiver and child met the inclusion and exclusion criteria including adequate biometric markers before they were randomized to one of 2 intervention arms: control health group or e-health group. This subject was randomized into the control intervention arm. Participants of the control arm received weekly text messages for 6 months inquiring subjects on any SMART goal and duration of their choosing as well as assessing their motivation and confidence related to that goal (scored on a scale of 10). They also received follow-up messages asking introspective questions regarding habit formation and messages with self-scripted inspirational statements. The intervention arm differed in that the SMART goal chosen by subjects had to focus on one of six lifestyle medicine factors emphasized for that week's duration. The SMART goals input by this subject centered on improving the outlook, organization, and control of her finances and career. The subject's motivation scores were similar to her confidence scores for each specific goal even though they varied overall. More importantly, both scores trended upwards within self chosen goal periods lasting ≥ 3 weeks. Additionally, a common theme emphasized in the subject’s responses to introspective questions regarding her goals focused on maintaining "positivity”. The patient indicated a 7/10 on her 6-month exit survey, highlighting that the program "somewhat” supported the patient on a road to wellness by helping her "break things down into achievable goals each week”. Conclusions: This case illustrates the role an E-health intervention program had in helping the patient construct and keep track of achievable goals. The program was still beneficial to the control-intervention arm subject as indicated by her exit survey. Observed increases in confidence and motivation scores within prolonged goal periods highlights the impact this program had in establishing the self-accountability necessary for conceiving new goals and maintaining consistency. In effect, this case emphasizes how the intervention aids in promoting a subject’s intrinsic motivation in relation to the development of their goals and eventual habits. Overall, this case suggests that having any intervention in place, even to the degree involved within case controls, is significant compared to no intervention.Item Hyposplenia(2022) Patterson, Tyler; Ramirez, Cynthia; Park, Chanyang; Sabbaghi, Tiffany; Patel, Kavita; Fisher, Cara L.Background: The spleen is the largest secondary lymphoid organ in the human body. It is an intraperitoneal organ, located in the left upper quadrant, posterior to the stomach and inferior to the diaphragm from the T8-T11 vertebral levels. The typical size of the spleen is 6 cm in width and 10 cm in length, with a depth length of 3 cm. Embryonically, it is derived from mesenchyme in the dorsal mesogastrium, and during fetal development in utero, the spleen transiently functions in the production of blood cells during fetal development. During adulthood, the spleen acts as a major repository for phagocytic cells, lymphocytes, and platelets, with a primary function of blood filtration. Hyposplenia is reduced size and function of the spleen. It is a condition that can complicate many diseases, such as sickle cell anemia, alcoholic liver disease, and many autoimmune disorders. Functional hyposplenia is characterized mostly by defective immune responses against pathogens. This cadaver case report presents the clinical condition of hyposplenia. Case Information: First-year medical students engage in anatomy courses in which routine cadaver dissections are performed. An abnormally small spleen was found in the upper abdominal cavity of a 66-year-old female. The donor presenting with the hyposplenia outlined in this case report passed from acute liver failure of uncertain etiology, chronic kidney disease, and peripheral artery disease. A typical spleen as compared to the cadaver's spleen indicated the cadaver's spleen was drastically reduced in size. The donor's spleen measured 2.72 cm in width and 4.38 cm in length, with a depth of 1.39 cm. Conclusions: In contrast to splenomegaly, the clinical determinant of a small spleen, hyposplenia, is unclear. However, there are potential causes for the spleen's size to decrease. Exposure to radiation, sickle cell disease, diabetes and chronic alcoholism are all hypotheses for this change in size. Patients with a defect in Kupffer cell function in relation to alcoholism have a predisposition to hyposplenism. In this case, the donor had the pathologies of diabetes and liver disease. The cause of death of acute liver failure of uncertain etiology could have been linked to the consumption of alcoholic beverages and their effects on the liver, as well as the effect on the Kupffer cells in the spleen.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 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.