General Medicine

Permanent URI for this collectionhttps://hdl.handle.net/20.500.12503/21685

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Complications in the Management of Pulmonary Arterial Hypertension: A Case Report
(2017-03-14) Nguyen, Stephanie; Wong, Long; Ramani, Azaan
Background: Pulmonary arterial hypertension (PAH) is a rare but highly lethal condition characterized by progressive elevation of pulmonary pressures and vascular remodeling. Etiologies of PAH are multifactorial including idiopathic, secondary to chronic conditions, and most importantly genetics. Recent research has identified multiple genes that lead to the manifestation of this condition. It is a difficult condition to manage as patients present with a multitude of co-morbid conditions. Much of the issues involve the cardiovascular and pulmonary systems, which progressively worsen if left untreated. Perioperative complications rates also increase after surgery, including increase in morbidity and mortality. Significant advances have been made in the management of PAH, including treatments that target the vascular remodeling. Purpose: We present the case of a 33-year-old female who presents with pulmonary arterial hypertension and aim to highlight the challenges in management and treatment of this patient. Methods: N/A Results: N/A Conclusions: Physicians and medical students will encounter patients on various treatments for PAH. Providers should remain aware of the latest treatment and management to improve morbidity and mortality in patients with PAH.
Cutaneous Endometrioma in a 26-year-old Female with Abdominal Pain
(2017-03-14) Nash, Lisa; Kinsley, Stephanie
Objective: To describe a case of cesarean scar endometriosis presenting as abdominal pain, and review literature for signs and symptoms that may allow prompt diagnosis and treatment. Materials and Methods: N/A Summary: Endometriosis is defined as the growth of functional endometrial tissue outside of the uterine cavity. The primary difficulty in diagnosing endometriosis is due to its variable presentation, causing a delay in treatment and management. The present study describes a case of cesarean scar endometriosis presenting as abdominal pain, and reviews literature for signs and symptoms that may allow prompt diagnosis and treatment. A 26-year-old female presented to her primary care physician with complaints of abdominal pain for two months, and was ultimately referred to the general surgeon for evaluation. Physical exam revealed a a tender, palpable, soft tissue mass deep to her lower midline scar, and CT scan revealed a 1.8cm x1.8cm fluid-filled area in the anterior midline of the abdomen inferior to the umbilicus. The mass was surgically excised, and pathology findings were consistent with cutaneous endometriosis. Cutaneous endometriosis should be suspected in a female of childbearing age presenting with a tender, painful mass, associated with a previous gynecological scar. Definitive diagnosis is made histologically, and treatment is surgical excision with follow-up. Conclusions: Cutaneous endometriosis should be suspected in a female of childbearing age presenting with a tender, painful mass, associated with a previous gynecological scar. Definitive diagnosis is made histologically, and treatment is surgical excision with follow-up.
Epigenetics Evidence to Advance Utility of Multifaceted Lifestyle Interventions in Primary Care Practice: The Lessons from a Targeted Review
(2017-03-14) Negedu, Grace; Lee, Jenny; Okunowo, Oluwatimilehin
Background: Epigenetics is a science that deals with the impact of environmental factors and lifestyle on healthful or pathological alterations in epigenetic processes. Primary care providers (PCPs) may need to redefine their roles in health care that requires lifestyle counseling or coaching on healthy lifestyle choices, and prescribing behavioral interventions to tackle lifestyle related chronic diseases. The knowledge of epigenetics can motivate PCPs to incorporate multifaceted lifestyle intervention practices in their clinical encounters with patients to improve their health outcomes. Objectives: The objectives of this study are: 1) to explore the relationship between epigenetics and multiple dimensions of lifestyle and environmental factors; and 2) discuss the implication of epigenetics knowledge driven multifaceted lifestyle interventions in primary care practice. Methods: A targeted search was carried out on articles published in English from MEDLINE over an 11 year period, from January 1st, 2005-December 31st, 2016, with a focus on seven selected categories of lifestyle dimensions (spiritual, intellectual, emotional, physical, social, occupational, and environmental), and the corresponding lifestyle interventions commonly used in patient care. Results: The study identified a large base of literature (11,500 articles) connecting epigenetics to the various components of lifestyle factors. The percentage of articles found on the various lifestyle categories varied significantly - spiritual (1%), intellectual (4%), emotional (40%), physical (24%), social (8%), occupational (5%) and environmental (19%). 927 articles were also investigated for epigenetic effects driven by lifestyle interventions. A causal and effect relationship between lifestyle and epigenetics was highly observed in emotional and physical lifestyle dimensions. Conclusions: Generally, Epigenetics modification occurred in response to the multidimensional lifestyle factors reviewed in this study. This evidence would improve knowledge, attitudes, and approaches PCPs use in their clinical encounters with patients suffering from lifestyle-associated chronic diseases. Integrating epigenetics knowledge may advance the use of a multifaceted lifestyle intervention approach in primary care practice to address chronic diseases.
Evaluating the Diagnostic Criteria for NAFLD
(2017-03-14) Keng, Jane; Ogunmola, Nicholas; O'Reilly, Crystal; Gonzalez, Jose; Hamilton, Luke; Wilson, Don; Zangla, Emily
Purpose: Nonalcoholic Fatty Liver Disease (NAFLD) is the most prevalent chronic liver disease in American children and adolescents, thought to involve hepatic fat deposition and inflammatory changes secondary to insulin resistance. Methods: Diagnosis is currently based on elevated ALT levels and subsequent liver ultrasound. Ultrasound, however, has proven to be less accurate in pediatrics than adults. Due to these limitations of utilizing ultrasound, liver biopsy remains the gold-standard of NAFLD diagnosis on children. Although biopsy is the most definitive diagnostic method, non-invasive biomarkers need to be further investigated for their diagnostic value to children. A retrospective chart review was completed to describe the clinical parameters of patients with NAFLD. Results: 45 patients (56% male) had a primary diagnosis relating to NAFLD; mean age 9.8 years (range 0‒18 years). Mean BMI percentile was 84% (90% males; 79% females). Median ALT 79; 82.5 males; 79 females; range 25‒1823 (ref 7‒55 U/L males; 7‒45 U/L females). Median AST 59; 60 males; 55 females; range 18‒2353 (ref 8‒60 U/L males 1‒13 years; 8‒50 females 1‒13 years). These results allow us to study the profile of patients evaluated for NAFLD at Cook Children’s. Conclusions: A better understanding of the criteria used by physicians can potentially help with early identification, prevention of disease progression, and improve care of children with NAFLD.
For general health, do COPD rates differ by ethnicity/race in women 50-85 years old?
(2017-03-14) Syed, Midhat; Abdallahi, Dallah; Reynolds, Julia; Hartos, Jessica; Escamilla, Amairany
Purpose: Chronic obstructive pulmonary disease (COPD) is a diagnosis with increasingly significant public health and economic implications, but there is limited research exploring racial and ethnic differences in COPD rates among genders. Therefore, the purpose of this study was to assess whether COPD rates differ by ethnicity/race in women 50-85 years old. Methods: This cross sectional analysis used 2014 BRFSS data for females 50 years and older from Alabama, Arkansas, Kentucky, and West Virginia. Multiple logistic regression analysis was used to assess the relationship between COPD and ethnicity/race while controlling for asthma, tobacco use, education level, employment status, income level, and healthcare access. Results: Few women 50 to 85 years old reported COPD (15-18%), most were white (73-95%), less were black (2-24%), and only a few were of "other" ethnicity/race (3-4%). After controlling for psychosocial and demographic factors, African Americans were about 2 to 3 times less likely to report COPD than other races in Alabama, Arkansas, and Kentucky. Additionally, COPD was significantly related to asthma, employment status, and tobacco use across all states. Conclusions: COPD was significantly related to ethnicity/race across three states (Alabama, Arkansas, and Kentucky), and it was related to asthma, employment status, and tobacco use across all states in samples representative of females 50 to 85 years old. Due to the cross sectional nature of the study, comorbidities and the progression of COPD were not accounted for. Nevertheless, screening African Americans for COPD in primary practice is recommended if the patient presents with indicating symptoms. Moreover, primary care clinicians should always educate and screen all patients with a history of tobacco use or asthma for COPD.
How Primary Care Manages the Patient with Acute Chest Pain
(2017-03-14) Large, Stephanie; Wong, Long; Matthew, Susan
Objective: Chest pain is a common complaint among primary care patients. Primary care clinics are limited in their ability to differentiate acute cardiac chest pain from chest pain due to other causes. This is a case analysis exploring the management of a primary care patient with chest pain from clinic to emergency room treatment to return office visit. Methods: Case analysis of a primary care patient. The electronic health record was used to obtain information from the clinic visits and the emergency room records. Results: The primary care patient went to the emergency room for acute chest pain and was diagnosed with anxiety. Conclusions: Primary care providers should use a combination of chest pain algorithms, clinical assessment tools, electrocardiograms and clinical judgment. Even with these tools it remains difficult to predict the outcomes of primary care patients who present to clinics with acute chest pain.
Is Diabetes a Risk Factor for Stroke in Women Ages 45-54?
(2017-03-14) Grabow, Ivonne; Faulk, Katelynn; Morgan, William; Meyer, Kim; Hartos, Jessica; Turner, Hannah
Introduction: Diabetes has been identified as a risk factor for stroke. However, there is little known about the relationship between stroke and diabetes by gender and specific age groups. The purpose of this study was to assess whether diabetes is a risk factor for stroke in women ages 45-54. Methods: This cross-sectional analysis used 2014 BRFSS data for females ages 45-54 in Arkansas, Kentucky, Maryland, South Carolina, and West Virginia. Multiple logistic regression was used to assess the relationship between stroke and diabetes, while controlling for alcohol use, education level, ethnicity/race, exercise, tobacco use, and weight status. Results: Few women ages 45-54 reported ever being diagnosed with stroke (3-6%) or diabetes (10-17%). After controlling for alcohol use, education level, ethnicity/race, exercise, tobacco use, and weight status, diabetes was significantly related to stroke in Kentucky (AOR=2.92, 95% CI=1.40, 6.09) and Maryland (AOR=3.32, 95% CI=1.07, 10.3) but not in Arkansas, South Carolina, and West Virginia. Conclusions: Diabetes was found to be significantly related to stroke in two out of five states. This cross-sectional study does not reflect previous history of stroke and diabetes or their comorbidities. Since this data was from a population-based study, the results may reflect patients in the primary care setting. Therefore, practitioners in primary care can expect to see a very low percentages of stroke and diabetic patients and may consider screening for diabetes or stroke in patients with signs and symptoms of either disease.
Is Obesity a Risk Factor for COPD in Females Ages 55 and Older?
(2017-03-14) Mehta, Tarjani; Schmidt, Katherine; Feeney, Patrick; Hartos, Jessica PhD; Martinez, Wendy
Purpose: Research has shown a relationship between COPD and weight status; however, the information was not specific to a gender or age groups. Thus, the purpose of our study is to determine whether obesity is a risk factor for COPD in females who are 55 years and older. Methods: This cross sectional analysis used data from the BRFSS 2014 survey for females aged 55 and older from Alabama, Kentucky, Oklahoma, and Ohio. Multiple logistic regression analyses was used to assess the relationship between obesity and COPD, while controlling for age, race/ethnicity, asthma, diabetes, exercise, heart disease, and tobacco use. Results: Few of the target population reported having lifetime diagnosis of COPD (15-18%) and the majority reported being obese (67-70%). After controlling for demographic factors, COPD was significantly related to obesity in Oklahoma (small effect size), and significantly related to exercise (small effect sizes), heart disease (moderate effect sizes), tobacco use (moderate effect sizes) and asthma (large effect sizes) in all four states. Conclusions: The majority of the states found that obesity was not related to COPD in females aged 55 and older. However, asthma, exercise, heart disease, and current smoking were significant in all states. A limitation to this study was that it lacked information on COPD severity and history. Primary care providers should screen and educate patients with COPD symptoms for tobacco use, heart disease, and lack of exercise. Providers should also screen, educate, and refer for obesity as necessary.
Is Weight Status a Risk Factor for Depression in Young Adult Females?
(2017-03-14) Landon, Margaret; Rice, Kelsey; Whitney, Steven; Hartos, Jessica; Bernbaum, Shannon
Introduction: Depression and obesity are prevalent and growing in the general population, and this poses a serious concern for the healthcare system (1,2). An association between depression and obesity has been demonstrated in the general population (3,4,5,6), but there has been little research on the association in young females. The purpose of this study was to determine if weight status is a risk factor for depression in females aged 18-24. Methods: This cross-sectional study used 2014 BRFSS data on females aged 18-24 from Maine, Missouri, Montana, and Vermont. Multiple logistic regression analysis was used to determine the relationship between weight status and depression while controlling for ethnicity/race, marital status, education level, employment status, and income level. Results: Most of the participants reported they had never received a diagnosis of depression or dysthymia in their lifetime (74-76%), and the majority reported they were not overweight or obese (58-66%). After controlling for psychosocial and demographic factors, depression was significantly related to weight status (large effect sizes) in Maine and Missouri. Conclusions: Weight status was related to depression in two of four states in young adult females. These findings may be generalizable to primary care, but the association may be different in specialty practice. A temporal relationship between weight status and depression could not be determined from the cross- sectional data. It is recommended that practitioners screen for depression criteria in overweight and obese female young adults only if the patients present with signs and symptoms of depression.
Is Weight Status Related to Depression in Young Adult Females?
(2017-03-14) Sanford, Jill; Curry, Alexa; Hung, Alexandra; Hartos, Jessica; Hooda, Norin
Introduction: Clinical depression is prevalent in young adult females in the U.S. and leads to physical and psychosocial illness and mortality. While many risk factors for depression have been previously studied, little information is available on the relationship between depression and weight status in young adult females. Thus, the purpose of this study was to assess the relationship between depression and weight status in young adult women. Methods: This cross-sectional analysis used 2014 BRFSS data for females of ages 18 to 35 from Arkansas, Oregon, Alabama, and Oklahoma. Multiple logistic regression analysis was used to assess the relationship between depression and being overweight while controlling for ethnicity/race, education level, employment status, income level, exercise, and tobacco use. Results: Few participants reported ever being diagnosed with any form of depression or dysthymia (22-32%) and the majority of participants reported being overweight (47-64%). After controlling for psychosocial and demographic factors, depression was not significantly related to weight status in Arkansas, Oregon, Alabama, or Oklahoma. Depression was significantly related to high income (large effect sizes) in Alabama and Oklahoma. Conclusions: In general population samples of young adult females, few reported depression, and the majority reported being overweight, but depression was not related to weight status. However, depression was related to income level. Limitations to this study include inability to assess the relationship over time and self-reported data with the possibility of inaccuracy. It is recommended that primary care practitioners become informed, screen, and educate their young adult female patients on depression and weight status independently due to an abundance of adverse effects. However, due to the absence of a relationship between the two conditions, it is not indicated that practitioners evaluate one due to the presence of another.

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