Community Medicine

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    Screening for Methylenetetrahydrofolate Reductase (MTHFR) Mutation
    (2023) Charolia, Samita
    Purpose: The C677T and A1298C allele codes for methylenetetrahydrofolate reductase enzyme in the liver that coverts folate to L-methylfolate (LMF). L-methlyfolate is the version of folate the brain can absorb. Once in the brain L-methyl folate is thought to help stimulate production of essential neurotransmitters. Mutations in this enzyme are strongly linked to depression, however it could also lead to other psychiatric conditions.1 Studies show that when L-methylfolate supplementation was used alongside antidepressants in 502 participants with depression, they reported improvement in depressive symptoms.2 With more people tested for this mutation we can identify people that need on proper L-methylfolate supplement and get them on it. Thus, improving their overall health. Methods: We implemented a screening tool that comprised of multiple questions including a PHQ-9 and GAD-7. We gave it to all adult patients at the Hendrik Family Medicine Clinic in Abaline, Texas between August 2022 and October 2022. Positive screening results were based on the criteria of history of depression or a five or greater on the screening. Results: We screened a total of 188 patients with 106 qualifying for the test. Fifty-three patients preformed the test, and the other half did not due to cost, loss to follow up, or other reasons. Forty-one, or 77%, of the patients screened tested positive for a mutation in one or both alleles. On average PHQ-9 scores were higher in patient who had a mutation in both alleles. 14 of the 41 positive mutation patients were on additional pain medication (Tylenol-3, Tramadol, or Both). Conclusion: This study suggests that MTHFR gene mutations is prevalent in people who met criteria through the screening. Even though it was prevalent more research need to be done to know the impact of obtaining screenings and outcomes once starting supplementation. A future goal is to follow up with patients who have the mutation and test if there is any improvement in their symptoms after supplementation. 1. Wan L, Li Y, Zhang Z, Sun Z, He Y, Li R. Methylenetetrahydrofolate reductase and psychiatric diseases. Translational psychiatry. Published November 5, 2018. Accessed October 5, 2022. 2. Shelton RC, Sloan Manning J, Barrentine LW, Tipa EV. Assessing Effects of l-Methylfolate in Depression Management: Results of a Real-World Patient Experience Trial. Prim Care Companion CNS Disord. 2013;15(4):PCC.13m01520. doi:10.4088/PCC.13m01520
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    Depression in opioid-dependent chronic pain patients in rural Texas: a complex relationship
    (2023) Hinkley, Dawson; Tandon, Saloni; Montalvo, Emily; Helton, Baley; Lin, Emily
    Purpose: Chronic pain and depression are frequently cited as two of the most common causes for seeing a primary care provider. The link between pain, depression, and opioid use has an interdependent relationship that has measurable effects on patient care. Rural patients are often more susceptible to the challenges of managing chronic pain and depression. The goal of this study is to evaluate multiple factors of depression and treatment in chronic pain patients using long term opioids amongst three different rural Texas populations. Methods: Participants were recruited at local clinics in Graham, Athens, and Andrews, Texas. Patients included in the study were adults aged 18+ who have used opioid pain medication for greater than three months. A survey and Patient Health Questionnaire-9 scoring (PHQ9) questionnaire were self-completed by each participant. The survey gathered information on participant demographics, description of pain and medication use, limited medical history, and alternative pain therapy. Results: In total, 107 people enrolled in the study. After reviewing data, 27 (25.2%) incomplete surveys were excluded, leaving a total of 80 surveys for analysis. Of the remaining participants, 28 (35%) were from Graham, 48 (60%) from Athens, and 4 (5%) from Andrews. Forty-seven respondents (58.8%) were female and 33 (41.3%) were male. Average age of respondents was 64.74 years (SD=13.05). Depression, as diagnosed by PHQ9, was identified in 45 (56.3%) of participants. Significant risk factors for clinical depression among study participants included family history of substance abuse (OR=23.67, p=0.008), personal history of depression (OR=6.86, p<0.001) and previous session with a counselor or therapist (OR=2.76, p=0.035). The severity of depression in study participants was significantly associated with a prescription for Naloxone (p=0.015), family history of substance abuse (p<0.001), personal history of depression (p<0.001), current use of an SSRI (p<0.001), and the use of physical therapy (p=0.036). Additionally, there was a statistically significant difference in mean pain scale scores (p=0.022), length of opioid use (p=0.011), and PHQ9 scores (p=0.02) between participants from Graham and Athens. Conclusions: The results of this study suggests a high burden of depression among study participants and enhances our understanding of the risk factors for depression among chronic pain patients in these communities. The data further emphasizes the need for proper depression screening and treatment for individuals with chronic pain and opioid use. Further research should explore effects of rural physician beliefs about prescribing opioids with antidepressants, rural vs urban opioid prescribing practices, and the relationship between opioid use and other common mental health conditions.
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    Hyperemesis Cannabinoid Syndrome Chart Review
    (2023) Patterson, Tyler; Porter, Cardon; Birky, Jaxton; Judd, Dallin; Zhang, Fan; Espinoza, Anna; Galke, Curtis; Petersen, James
    Purpose: The purpose of this research study is to determine if the combination of Compazine and Benadryl is a superior method of treatment for patients who present with nausea and vomiting symptoms due to a diagnosis of Hyperemesis Cannabinoid Syndrome. Based on patient charts from a regional hospital emergency department in Oklahoma, an analysis was performed to determine if this combination of medications is more effective in quickly reducing the nausea, vomiting, and other symptoms associated with cannabis use.Methods: An agreement was created between a regional hospital in Duncan Oklahoma and The University of North Texas Health Science Center which allowed students at the Texas College of Osteopathic Medicine to review and analyze a total of 75 patients’ charts from the regional hospital. IRB approval was obtained for this project. The chart review process consisted of evaluating the patient's age, chief complaint, abnormal lab values, history of present illness (HPI), and medications administered in the emergency department. The important variables that assisted in this study were drug screening values, and the medications administered. The main outcome for which statistical efficacy of drug treatment was measured by duration of stay in the emergency department and whether or not an additional dose of medication was given. Results: This chart review showed that the 12 patients that used the Benadryl and Compazine combination had a decreased time spent in the emergency department by an average of 56 minutes when compared to 38 patients who received alternative medications. The average time spent in the emergency department for those who received Benadryl and Compazine was 127 minutes vs the average time spent for those using an alternative medication was 183 minutes. The typical dose was 50 mg of Benadryl and 10 mg of Compazine. While using an ANOVA statistical analysis these doses showed a significantly statistical relationship by decreasing provider-to-discharge time with a p value of 0.012. It was also found while using a logistic regression analysis that those patients who received this combination as their initial dose were less likely to receive a second dose. This relationship also was statistically significant with a p value of 0.005. It was also noted in the logistic analysis that females were more likely to receive a second dose when compared to men. This relationship also showed a relationship with significance and a p value of 0.037. Conclusions:The findings from this study recommend and encourage providers who are in a setting where Hyperemesis Cannabinoid Syndrome is prevalent to consider the medication combination of 50 mg of Benadryl and 10 mg of Compazine when providing treatment. There may be multiple ways to alleviate the discomfort and symptoms that patients may present with, however the combination stated above appears most effective to reduce provider-to-discharge time 56 minutes and eliminate second doses of medication based off of the data reviewed from the charts provided.