Pediatrics & Women's Health
Permanent URI for this collectionhttps://hdl.handle.net/20.500.12503/30293
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Item A Systems Thinking Approach to the Prevention of Preterm Births(2020) Mupambo, TashingaBackground: Preterm birth is one of the leading causes of infant mortality in the United States every year. In 2017, 10.6% of Texas live births were preterm. The occurrence of preterm births is disproportionately higher in black women than other races. Looking at this issue from systems perspective will give us broader understanding how the behavioral, socio-economic and environmental risk factors interact and how organizations across different fields can work together to prevent or treat preterm births. Objective: The goal of this project was to identify organizations involved directly or indirectly in efforts to reduce preterm birth rates and to use the systems thinking approach to understand the role that each one plays and how they are connected using a concept map. Methods: The organizations were classified based on the stage of care they provide (preconception, prenatal or postpartum) and their level of reach (city-, county-, state-, or national-level). Information was collected from the organizations' websites and related web-based sources. Results: Selected organizations include Women with IMPACT, which provides preconception and inter-conception education and care; Live Tobacco Free, which offers smoking cessation programs and Great Expectation Doulas, which offers doula services. Conclusions: This perspective showed how women interact with these organizations and the potential for these organizations to form relationships which each other in order to make it easier for the women to be well-connected to necessary resources.Item Absolute Quantification of Mitochondrial DNA in Peripheral Blood from Women with Preeclampsia(2020) Silzer, Talisa; Phillips, Nicole; Goulopoulou, Styliani; Reid, Danielle; Sun, Jie; Scroggins, Sabrina; Santillan, Mark; Santillan, Donna; Cushen, SpencerIntroduction Mitochondrial DNA (mtDNA) in maternal blood has been proposed as a potential predictor of preeclampsia (PE). The objective of this study was to use an absolute PCR (abPCR) quantification protocol to determine concentrations of mtDNA in maternal plasma and peripheral blood mononuclear cells (PBMC) from normal and PE pregnancies. Methods Blood samples were collected from pregnant women with uncomplicated pregnancies and pregnancies with PE (University of Iowa IRB#200910784). abPCR quantification of mtDNA and nDNA was performed on DNA extracts from plasma (in the presence or absence of lysis buffer) and PBMCs using TaqMan(TM) probes and chemistry. Results When plasma DNA was extracted using lysis buffer, mtDNA concentrations were lower in women with PE than in controls (Control: 4.83 ± 1.09 vs. PE: 1.72 ± 0.38 pg/uL, n=19, P=0.017), while concentrations of nDNA did not differ (P=0.39). Without lysis buffer, plasma mtDNA remained lower in women with PE compared to controls (Control: 0.0106 ± 0.0019 vs PE: 0.0019 ± 0.0003 pg/uL, n=16-20, P< 0.0001). There were no group differences in PBMC mtDNA (P=0.66) and nDNA (P=0.13) concentrations. Conclusion mtDNA concentrations were lower in plasma of pregnant women with PE compared to controls. A significant amount of mtDNA was membrane bound as indicated by a 480-fold greater concentration in DNA isolated from plasma with lysis buffer vs. without. Use of this improved method of quantification of mtDNA in multiple blood fractions may allow for its development as a biomarker to detect PE prior to the onset of organ damage.Item Addressing Substance Abuse During the Pregnancy and Postpartum Period(2020) Raines-Milenkov, Amy; Fadeyi, Oluwatosin; Davis, Ambriale; Ghosh, Shanalyn; Le, ChristinePurpose: The purpose of this study is to identify the best practices to combat substance abuse in both the pregnancy and postpartum period. Methods: The research was conducted using a web-based search of peer-reviewed journal articles and state reports. Results: Our results demonstrate that there is a need for increased drug abuse screening during both the antepartum and postpartum period. Because opioids are a major contributor to maternal death, providers need to administer a tailored plan of care for pain relief to ensure the necessity of prescription painkillers. The Wisconsin Drug Monitoring Program saw a 7% decrease in opioid prescriptions from cesarean delivery and 6% decrease from vaginal delivery through effective monitoring prior to discharge. From 2012 to 2015, drug overdose accounted for 17% of all maternal deaths between the time of delivery and one-year postpartum in Texas. Conclusion: Although many states have taken initiatives to combat the growing rate of maternal mortality, research and interventions that addresses the role of substance abuse is still minute. California's maternal mortality rate tremendously decreased as a result of healthcare recommendations from their Pregnancy-Associated Mortality Review, but drug overdose still ranks as the second leading cause of maternal deaths from pregnancy to one-year postpartum. This underscores the necessity for increased awareness of how substance abuse can affect mothers one-year past delivery in both outpatient and hospital-settings.Item An Assessment of Patient-Provider Communication Regarding Sexually Transmitted Infections Among Female Young Adults(2020) Griner, Stacey; Lee, JanetPurpose: To assess the importance of patient-provider communication regarding STI self-sampling methods among college-age women. Methods: Data were collected and analyzed from female college students aged 18-24 years (n=88). Measures of patient-provider communication included ranking the importance of not talking to a provider before STI screening. Response options were on a five-point Likert scale (not at all important to extremely important), which was treated as a continuous variable. Differences in importance ranking were explored by demographic factors, such as race, ethnicity, sexual orientation, and previous receipt of STI screening. T-tests were used to determine mean differences in importance by demographic factors. Results: The mean sample age was 19.9 (SD=1.4); 67% were white, 75% non-Hispanic, and 66% heterosexual. 25% of participants felt it was extremely important that they did not have to talk to a provider first when seeking STI self-sampling methods. No significant differences were noted in the importance of not having to talk to a provider before screening by race (p=.633), ethnicity (p=.725), sexual orientation (p=.997), or previous receipt of STI screening (.231). Conclusions: This study represents new inquiry into the importance of STI self-sampling methods among college-age women. Although no significant differences were noted based on demographic factors in this analysis, women often go unscreened due to fear of judgment from healthcare providers. Further research into the utility of STI self-sampling methods may still prove invaluable to address the persistent issue of undetected STIs in women.Item Assessing Women's Knowledge of HPV and Willingness to Undergo At-Home HPV Self-Testing(2020) Thompson, Erika; Nazim, AsadPurpose: At-home self-testing for human papillomavirus (HPV) may be a strategy for increasing access to cervical cancer screening. This project aimed to examine the correlation between women's knowledge of HPV and willingness to self-test for HPV. Methods: An online survey (n=725) of women aged 30-65 who had not had a hysterectomy was conducted in June 2018. Survey items assessed HPV knowledge using 16 items (α=0.82) and willingness to undergo HPV self-testing. The participants were categorized into a willing or unwilling to self-test group according to their willingness score. Correct responses to the true/false HPV knowledge questions were used to create knowledge scores. Results: Most women (59.59%) were either very willing or somewhat willing to have at-home self-testing. The mean HPV knowledge of the willing group was 9.38 (out of 16), and the mean HPV knowledge of the unwilling group was 8.62, meaning the willing group was more knowledgeable. There was a significant association between HPV knowledge and willingness to self-test (p< 0.05). The largest differences in HPV knowledge between the willing and unwilling groups pertained to HPV characteristics, such as symptoms, modes of transmission, and risk factors. Conclusions: The results indicate that HPV knowledge and willingness to self-test are statistically associated. Knowledge of HPV may be a needed first-step in promoting HPV self-testing for cervical cancer screening in rural areas. Increasing HPV education efforts could increase the willingness to self-test and reduce the number of cervical cancer cases.Item Catheter Directed Thrombolytic therapy for Pediatric Cerebral Sinus Vein Thrombosis(2020) Hamby, Tyler; Tilley, Jo; Torres, Marcela; Philip, SarahPurpose: Cerebral sinus vein thrombosis (CSVT) involves the thrombosis of the dural sinus and/or cerebral veins and is considered a form of stroke. No randomized clinical trials have been conducted on pediatric CSVT so current guidelines for treatment have been extrapolated primarily from adult studies. Method: This is a retrospective case review of patients treated with MT (Mechanical thrombectomy)/Catheter Directed Thrombolysis (CDT) for their CSVT at Cook Children's Medical Center. Results: Five children (aged 4 to 14 years) diagnosed with CSVT of multiple sinuses were treated with MT/CDT after failing anticoagulation treatment. Three patients had systemic bleeding prior to initiation of anticoagulation. All children were treated with UFH (unfractionated heparin) and due to neurologic deterioration and/or worsening of imaging findings needed MT/CDT. All cases had partial resolution of the sinus vein thrombosis, although 1 had quick re-occlusion. Post procedure bleeding happened in 1 patient and 2 patients developed petechial brain hemorrhages. Four patients had great neurologic recovery and minimal deficits, but 1 had significant neurologic deficits. One patient died from lupus complications. Conclusion: Endovascular therapy including MT and CDT with tPA (tissue plasminogen activator) in conjunction with systemic UFH, may have a role in pediatric patients with CSVT who have deterioration despite initial anticoagulation. In our series, after procedures, all patients had partial resolution of their CSVT (but 1 had quick re-occlusion) and 4 out of 5 patients had good neurologic outcomes despite coma or extensive CSVT.Item Chronic Disease Presentations found in Elementary School Children(2020) Khan, Urooj; Robinson, Christina; Madina, RevanthPurpose: For the past few decades, chronic illnesses in children have been increasing. Chronic conditions generally lasts more than three months, affects everyday activities, and can require extensive medical care. In the United States, approximately 18% of children live with a chronic health condition. Common chronic childhood diseases include asthma, obesity, food allergies, and ADHD. Catch-1 is a health program which offers free health screenings to elementary students. It features a team of health providers including physicians, nurses, dental hygienists, audiologists, and speech pathologists, as well as their respective students. Through this program, health screenings are provided to the children of Morningside Elementary school in Fort Worth, Texas, while fostering an interprofessional learning environment. In this study, the investigators discovered the prevalence of common chronic diseases in the school's pediatric population. Methods: The investigators conducted a retrospective chart analysis to illustrate a statistical overview of the chronic diseases of Catch-1 participants during the years 2015 - Spring of 2019. The participants were aged three to twelve, from Pre-K to 5th grade. Results: The primary diagnoses were obesity (32%), dental carries (21%), and BMI > 85%ile (18%). Most of the participants had one diagnosis (68%), while 22% had two, 2% had three, and 32% had none. Conclusion: The results of the Catch-1 program highlight the need for regular medical screenings for children. Ideally, these results will encourage policy makers to expand school nursing and medical partnerships so that chronic conditions may be screened, and interventions may occur earlier.Item Clinical drug drug interactions between antiepileptic drugs and hormonal contraceptives: pharmacist considerations(2020) White, Annesha; Tran, ElizabethObjective: More than 50 years ago hormonal contraceptive agents (HCAs) were introduced and are used by 100 million women. However, investigation of the effects of antiepileptic drugs (AEDs) is lacking. The objective of this study was to provide a comprehensive review of the evidence on the relationship between antiepileptic use and hormonal contraceptive failure. Methods: A systematic review concerning HCAs and AEDs was performed, 2000-2019, using PubMed. PRISMA guidelines were used to document key search terms. Outcomes were categorized into: effectiveness of therapy, toxicity, and pharmacokinetics. The selected articles were summarized by year, author, title, design, methods, findings, and source. Articles were graded using the Oxford for Evidence-based Medicine scale. Preliminary Results: Thirteen articles met the inclusion criteria. An interaction between AEDs and the combined oral contraceptive pill was first proposed when estradiol was reduced from 100 to 50 microg. Studies report a higher incidence of breakthrough bleeding and contraceptive failure among women with epilepsy. Phenobarbital, phenytoin, carbamazepine, oxcarbazepine, felbamate and topiramate have been shown to increase the metabolism of ethinylestradiol and progestogens. There were no studies showing an interaction between the combined oral contraceptive pill, progesterone-only pill, medroxyprogesterone injections or levonorgestrel implants and the AEDs valproic acid, vigabatrin, lamotrigine, gabapentin, tiagabine, levetiracetam, zonisamide, ethosuximide and benzodiazepines. Conclusions: Considerations for pharmacists when counseling women taking AEDs: preparation containing at least 50 microg of ethinylestradiol is needed. This is an important study as access for HCAs expands. Eight states and D.C. allow pharmacist HCA prescribing.Item De-tethering of MRI demonstrated tethered cord(2020) Hamby, Tyler; Donahue, David; Howells, MadeleineRecognition of tethered cord syndrome (TCS) in children is important because as the child grows, the spinal cord is stretched; and for patients with TCS, this leads to ischemia and subsequent neurological deficits, including bowel or bladder dysfunction, back pain, or lower extremity weakness. Radiologically, the presence of a fatty filum, thickened filum, or conus medullaris located caudal to L2 is considered a marker for tethering. The objective of this study is to ascertain how symptomatic tethering is defined in our institution and assess the rationale for surgical detethering in asymptomatic patients. Charts for patients who underwent detethering surgery between 4/1/2015 and 3/31/2019 at our institution were examined. Univariate logistic regression analyses were used to determine whether demographic and diagnostic factors predicted symptoms at presentation with TCS. There were 289 patients included. The modal patient was < 5 years of age, male, had a fatty filum and thickened filum, and did not have a low-lying conus. Patients < 5 years of age were less likely to have urological, gastrointestinal, and neurological or orthopedic symptoms; males were less likely to have urological symptoms; those with fatty fila were more likely to have gastrointestinal and neurological or orthopedic symptoms; patients with thickened fila were less likely to have urological symptoms; patients with low lying coni were less likely to have urological and gastrointestinal symptoms. Timely diagnosis and treatment of patients experiencing signs and symptoms related to tethering offers the possibility of resolution of deficits related to tethering, or at least prevents their progression.Item Do autopsies and perimortem testing still have a place in today's world of medicine?(2020) Wilson, Don; Hamilton, Luke; Eng, RyanBackground: Autopsies and perimortem testing have previously been a staple for improving patient care and expanding the field of medicine. In recent decades, autopsy rates have dropped dramatically, with current estimates of autopsy rates at 5%, yet data shows that clinical diagnoses are significantly less accurate than autopsy findings. In this case report, we aim to demonstrate the continued importance of autopsies using the case of a boy who passed away due to undiagnosed adrenoleukodystrophy (ALD). Case Information: An 8-year old male with a long history of severe headaches, emesis, and dehydration presented to Cook Children's Medical Center ICU after undergoing cardiac arrest. Workup of the patient did not find an etiology of these symptoms and the patient expired. Prior to expiration, a discussion was had with the parents about collecting samples for peri-mortem testing to determine cause of death. Whole exome sequencing (WES) of a peri-mortem blood sample revealed an ABCD1 variant, allowing the diagnosis of ALD. The patient's family members were recommended for genetic testing. Conclusions: Autopsy and perimortem testing were necessary to determine the patient's cause of death, which was not detected by routine pediatric screening or workup upon admission to the ICU. The patient's diagnosis proved especially important as it allowed family members to be referred to genetic counseling. Despite advances in diagnostic techniques, perimortem testing remains beneficial in cases of unknown or uncertain diagnoses, as seen in this case report.Item Do physical activity levels differ by number of children at home in women aged 25 and 44 in the general population?(2020) Hartos, Jessica; Tanase, Kelly; Gilmore, Madison; Winnicki, Anna; Holmes, Victor L.; Abell, Laura P.Purpose: While physical activity is important for health, many women do not meet recommended levels, particularly mothers. The purpose of this study was to assess whether physical activity levels differ by number of children at home in women aged 25and44 in the general US population. Methods: This cross-sectional analysis used 2017 BRFSS data for females aged 25and44 (N = 6266) from California, Colorado, New York, Texas, and Utah. Ordered logistic regression analysis assessed the relationship between physical activity levels and number of children at home while controlling for state and demographic, socioeconomic, and health-related factors. Results: About half of participants reported insufficient physical activity and about two-thirds reported children at home. Results of adjusted analysis indicated that physical activity level was significantly related to having one child (AOR = 0.75, 95% CI = 0.63, 0.89), two children (AOR = 0.79; 95% CI = 0.67, 0.93), and three or more children (AOR = 0.80, 95% CI = 0.67, 0.94) at home. Overall, physical activity levels were significantly related to presence of children at home, but increasing number of children at home did not impact effect size. Conclusions: For women aged 25and44 in a primary care setting, a moderate prevalence of insufficient physical activity may be expected. Providers should address physical activity with all patients in this target population during well-visits, especially those with children; educate patients about the benefits of regular physical activity; and provide resources to help them integrate physical activity into their daily lifestyles.Item Does mental health status relate to smoking status in pregnant women ages 18-34?(2020) Hartos, Jessica; Willmoth, Tamara; Younger, Emily; Baker, Stacy; Touch, Stephanie; Liu, DianeIntroduction: Mental health issues and smoking can negatively impact a pregnant mother and her baby. The purpose of this study was to assess whether mental health status is related to smoking status in pregnant women ages 18-34. Methods: This cross-sectional analysis used 2017 Behavioral Risk Factor Surveillance Survey (BRFSS) data for pregnant women ages 18-34 from Florida (N=118), Minnesota (N=87), Nebraska (N=80), New York (N=65), and Utah (N=82). Combined state data in ordered logistic regression analysis assessed the relationship between mental health status and tobacco use, while controlling for health-related conditions, demographic factors, socioeconomic factors, and state. Results: Very few of the participants reported current smoking (2-9%) and one-fourth to one half reported mental health issues in the past 30 days (26-50%). Adjusted results show moderate mental health was significantly related to smoking status and depression was significantly related to smoking status with large effect sizes. Conclusions: Mental health status and depression are highly related to smoking status in pregnant women ages 18-34. Clinicians in obstetrics and gynecology may expect to see a very low proportion of pregnant women who smoke and one quarter to one half of pregnant women who report low to moderate mental health in the past 30 days. Pregnant women should be screened for both mental health status and tobacco use at each visit, educated on the risk of smoking and importance of good mental health during pregnancy, and provided mental health and smoking cessation resources as needed.Item Efficacy of Medial Branch Blocks for Pain Control and Functionality in Pediatric Patients with Spinal Pain(2020) Reichert, Ryan; Holbrook, HayleyPurpose: While medial branch blocks (MBB) are relatively common for pain relief in adults with spinal pain, they are rarely performed on children. To our knowledge, this is the largest study examining the effectiveness and safety of using MBB as an intervention for spinal pain in pediatrics. Methods: A retrospective chart review was conducted on a population of pediatric patients who underwent MBB at Cook Children's Medical Center between June 1, 2012 and May 31, 2019. Demographics, diagnoses, overall functional improvement, complications, and pre-/post-intervention pain scores on 0-10-point scales were reviewed. Only the first MBB was analyzed. Patients missing a pain score or lost to follow-up were excluded from analyses. Change in pain scores was assessed with Wilcoxon's signed-rank test. Results: There were 52 patients (39 females; 42 white; median age 15.84 years, range 9.36-18.86) with a total of 66 MBB; 17 patients had repeat interventions. Common diagnoses included back pain (48%), spondylolysis (31%), lumbago (29%), and facet pain (23%). Pain scores improved for 87% of patients, 12% were unchanged, and 2% worsened. The pain score change was statistically significant (median= -4.5, range= -9 to 5, p< 0.0001). Post-intervention, 81% of patients had overall improvement in functionality. Procedural complications (e.g., weakness, numbness) occurred in 12% of patients; side effects (e.g., muscle spasms, bruising) occurred in 12% of patients. Conclusions: These results suggest that MBB may improve pain and function in pediatric patients with spinal pain.Item Expecting the Unexpected: An Unusual Presentation of Pelvic Inflammatory Disease(2020) Cameron, Benjamin; Dowell, Katherine; Elete, KunalBackground: Pelvic Inflammatory Disease (PID) is an acute infection of the female upper reproductive organs that can also involve neighboring abdominal and pelvic organs. Case Information: A 36-year-old female with a PMH of bipolar disorder and polysubstance use disorder, but no known history of STIs, presented to the ER with abdominal pain of 1 day. The pain was constant, diffuse, not worse with eating, and without relieving factors. She denied fever, chills, nausea, vomiting, diarrhea, urinary frequency or urgency, and vaginal discharge. However, she did complain of dysuria. Patient also used methamphetamines and marijuana 3 days prior to pain onset. On physical exam, she was tachycardic and diffusely tender to palpation in all quadrants but worse across the epigastrium; Murphy's and McBurney's signs were negative, but rebound tenderness was positive. General surgery performed an exploratory laparotomy during which a right tubo-ovarian abscess (TOA) was discovered along with diffuse adhesions, leading to a diagnosis of PID. OB-GYN was consulted because of salpingitis, but excision was not recommended, and the TOA was managed with IV antibiotics. Post-operatively, the patient opened up about, a recent sexual assault, and consuming a drugged alcoholic drink the previous night. Her symptoms improved and she was discharged on post-op day 4. Conclusion: This case demonstrates that PID, at advanced stages, can be difficult to distinguish from similarly presenting conditions. Current substance abuse, poor nutrition, and psychiatric conditions can prove challenging to obtaining a focused history and developing the differential diagnosis.Item Focal Nodular Hyperplasia in a Pediatric Cancer Survivor(2020) Chor, Holy; Bowman, WilliamBackground: Focal nodular hyperplasia (FNH) are benign hepatic nodules that rarely occur in the pediatric population. Although pathogenesis of FNH is not elucidated, alteration in hepatic blood flow by vascular injury associated with chemotherapy and radiation therapy is thought to play a role. Differential diagnosis of hepatic nodules in the general population is wide and encompasses benign and malignant conditions. Discovery of hepatic nodules at follow-up in patients treated for pediatric malignancy raises a diagnostic dilemma. Case Information: In this case report, we discuss a 21-year-old Caucasian male who presented in 2006 at the age of 8-years with neuropathic leg pain and was diagnosed with embryonal rhabdomyosarcoma of the pelvis. Patient underwent protocol-directed chemotherapy with vincristine, actinomycin D, and cyclophosphamide, and radiation therapy. He completed therapy one year later in 2007 and has remained in continuous complete remission. Follow-up radiological imaging performed from year 2007 through 2020 include 3 computed tomography (CT) scans, 5 abdominal ultrasounds (US), and 2 abdominal magnetic resonance imaging (MRI). The initial diagnosis of FNH was suspected in 2015 by abdominal US and confirmed by MRI. Subsequent MRI and US imaging remained stable and consistent with FNH. No biopsy has been done. Conclusions: The discovery of FNH in follow-up post treatment may pose a diagnostic dilemma in pediatric cancer survivors. A systematic approach to radiological imaging will reduce the exposure of pediatric cancer survivors to unnecessary radiation, adverse effects, and invasive diagnostics.Item Gestational Diabetes Systems(2020) Moore, JessicaPurpose: Gestational diabetes is one of the most common metabolic disorders and medical complications of pregnancy, and trends show rates increasing over time. Mismanagement of gestational diabetes can lead to adverse effects for both mother and infant, indicating the importance of prevention and proper prenatal care. Both prevention and management of gestational diabetes may require a complex interaction between many organizations. The aim of this study is to use systems-thinking to identify organizations that provide services related to either prevention or management of gestational diabetes. Methods: A web-based search was conducted to identify organizations related to gestational diabetes. Organizations were categorized and organized by the population served, including national level, state level, and local level. Connections between organizations were made based on services provided by each organization. Results: Ten organizations were identified that serve women with gestational diabetes. Organizations identified include The American Diabetes Association (ADA), the Texas Department of Health and Human Services, and John Peter Smith (JPS) Hospital. Organizations provide services such as health education, access and connection to health care resources, and delivery of health care itself. Conclusion: Access to health care resources can greatly improve the outcomes of a pregnancy affected by gestational diabetes. Applying systems-thinking to the prevention and treatment of gestational diabetes may help achieve improved outcomes. The identification of and connections between organizations that aide in the prevention and treatment of gestational diabetes may greatly increase access to information and resources and reduce the adverse effects of such a disease.Item Heterotopic Pregnancy with Intrauterine Quadruplets(2020) Hoang, Christine; Douglas, ElizabethBackground: Abdominal pain is a common complaint during pregnancy but it does require thorough evaluation. One in 500-700 pregnancies is complicated by non-obstetric abdominal emergencies, and one in 50 pregnancies is ectopic. In cases of in vitro fertilization (IVF), ectopic implantation may be as high as one in 12 pregnancies. A heterotopic pregnancy is the coexistence of intrauterine and extrauterine gestations at two or more implantation sites, the incidence of which can be as high as one in 50,000 natural pregnancies in certain populations. In cases of IVF, heterotopic pregnancies are as common as 1 in 100. Case information: A G2P1001 34-year-old female presents to the emergency room with 8-10/10 abdominal pain. The pain began in the right lower quadrant and flank but progressed to the entire abdomen. The patient reports of pain with inspiration, right shoulder pain, and nausea. The patient's medical history includes current pregnancy with quadruplets after IVF 6 weeks prior. Physical exam shows a well-nourished female in no apparent distress with diffuse abdominal tenderness, positive rebound, and guarding. Vital signs are within normal limits. Laparoscopic evaluation shows hemoperitoneum, enlarged uterus, and enlarged right fallopian tube. Treatment included laparoscopic salpingectomy without complications. Conclusion: While the possibility of ectopic or heterotopic pregnancies can be easily overlooked, early diagnosis, evaluation, and treatment are imperative. Suspicion should be high for ectopic implantation, particularly in assisted pregnancies, and even with intrauterine gestations.Item HPV Vaccine Acceptability in Postpartum Women Up to 45 years old(2020) Allen, Ashley; Hoang, Christine; Nash, Madeline; Teigen, Kari; Dhume, MahimaBACKGROUND: Cervical cancer and dysplasia is a preventable cause of morbidity and mortality in women's health by virtue of the HPV vaccine. Initiating the HPV vaccine in the immediate postpartum period has proven to be an effective strategy to improve the low vaccine rate amongst women ages 16-26 years. In 2018, the FDA approved women to be vaccinated up to age 45. To impact newly eligible patients similar vaccination programs could be used. PURPOSE: To evaluate eligibility and acceptance of the HPV vaccination among postpartum women up to age 45 in an urban county hospital setting. METHODS: A questionnaire was used to survey postpartum women aged 16-45 on prior vaccination status, desire, and barriers to vaccination. 200 surveys were collected at John Peter Smith Hospital in Fort Worth, Texas. RESULTS: Overall, 18% of respondents reported being previously vaccinated. Among the 82% of patients eligible for vaccination, 69% (95% confidence interval 62% - 76%) desired vaccination. The most common barrier was lack of awareness of the HPV vaccine. CONCLUSION: Results of this survey shows a high proportion of postpartum women are eligible and willing to receive the vaccine if it were available to them. This is an opportunity for healthcare providers to initiate the HPV vaccine series. Methods to eliminate barriers to vaccination such as education of availability in the postpartum period can also improve vaccine acceptability. The results of the survey will be used to implement HPV vaccination accessibility to postpartum women at JPS Hospital.Item Human Papillomavirus (HPV) and Oropharyngeal Cancer in the LGBT Population(2020) Raines-Milenkov, Amy; Bui, Priya; Fulda, Kimberly; Thompson, Erika; Fernando, Shane; Felini, Martha; Aziz, HadiaPurpose: In 2015, HPV-positive oropharyngeal squamous cell carcinoma (oropharyngeal SCC) became the most prevalent HPV-associated cancer in the United States. Oral HPV infection disproportionately affects gay and bisexual males, with men who have sex with men almost twice as likely to have a high-risk oral HPV infection than men with predominantly female sex partners. Despite the rise of HPV-positive oropharyngeal SCC, the rate of HPV vaccination among male adolescents in Texas lags behind the national rate of vaccine uptake. This review examines the barriers to vaccination uptake in gay and bisexual males. Methods: The databases used for this review were PubMed Central, UpToDate, and the Center for Disease Control. Key words searched included HPV rates in LGBT, HPV Oropharyngeal cancer, HPV vaccine barriers, and HPV vaccination rates in LGBT. Results: Three main barriers to vaccination were identified in the LGBT population. These barriers included lack of recommendation from a healthcare provider, lack of funding for new age of majority individuals, and outdated marketing strategies. Conclusion: The most important factor that determines whether a LGBT adolescent receives the HPV vaccine is a recommendation from a healthcare provider. Additionally, when the HPV vaccine is marketed as preventing anal, penile, and oral cancer in males versus just preventing genital warts, the intent of an LGBT patient to initiate the vaccination series is greater. Further research should be done to determine which educational methods and marketing materials used by a healthcare provider impact a patient's decision to vaccinate most significantly.Item Identifying Congenital Disorders of Glycosylation(2020) Gorrepati, KrishnaCongenital disorders of glycosylation (CDG) constitute a diverse group of errors involved with protein glycosylation, a post-transcriptional modification that is essential for life. Due to the diversity of clinical presentations of CDG, they lead to multiple organ systems that are affected and delayed diagnosis. CDGs are usually diagnosed through whole exome sequencing, but carbohydrate deficient transferring (CDT) testing is a quick and cost-effective alternative that can be used as a screening tool for CDG. Although CDGs are rare and have varying presentations, there are two main subtypes, CDG I and CDG II, both of which we explored. We reviewed findings of seven confirmed cases of CDG (5 boys and 2 girls; mean age of 6.42 years at diagnosis) followed at Cook Children's Medical Center. We looked at the most common symptoms and age of diagnosis to determine which symptoms led to a diagnosis of CDG. The most frequent symptoms include ataxia (n=6), developmental delay (n=7), and hypotonia (n=7). Typically, within a year of documentation of these symptoms, a diagnosis of CDG was established either through CDT testing or WES. In cases that both CDT testing and WES were done, the CDT test proved to show results that correlated with WES. We believe that this is an important finding because when children present with ataxia, with or without developmental delay, and hypotonia, a CDT test can be ordered by a primary care physician as a rapid and economical screening tool that could lead to a quicker diagnosis of CDG.