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Chimerism in Males and Recurrent Miscarriages: A Case Study
No full textChimerism is a rare biological phenomenon in which an individual harbors two or more genetically distinct cell lines, typically resulting from the fusion of two embryos or from twin-to-twin cell transfer in utero. Though often asymptomatic, chimerism can have significant implications for fertility, development, and immunological compatibility. Its true prevalence remains unknown due to frequent underdiagnosis, especially in the absence of phenotypic clues. Recurrent pregnancy loss, defined as the occurrence of two or more consecutive miscarriages, is often attributed to chromosomal abnormalities, uterine malformations, thrombophilia, or immune dysfunction. Paternal contributions, particularly involving rare genetic anomalies, are far less investigated. Here, we report a unique case of a male with 46,XX/46,XY chimerism, discovered during the evaluation of a couple with three consecutive pregnancy losses. We hypothesize that the presence of 46,XX germ cells in the testes might give rise to epigenetically abnormal spermatozoa, which could disrupt embryonic development through faulty genomic imprinting. Although causality cannot be confirmed in the absence of functional assays, we propose that chimerism might represent an underrecognized and understudied cause of recurrent miscarriage. This case highlights the need to further explore rare paternal genetic configurations in the context of unexplained recurrent pregnancy loss
Build Your Capacity for Aging Research: A Research Readiness Curriculum
Get PDFThis curriculum was developed with and for older adults in order to provide a basic understanding of the academic research process and to familiarize them with research terms and concepts to increase thier overall level of confidence engaging with researchers
How the Conflicts in the Middle East Affect the Mental Health of Arab American Medical Students
Get PDFBackground and Relevance
Medical school students represent a vulnerable population frequently experiencing mental health disorders such as chronic stress and anxiety (Dederichs et al., 2021). The unstable political climate in the Middle East may contribute to worsening mental health among the population of Arab American medical students. Helplessness regarding unfolding political events and perceptions from peers often deter students from accessing already limited mental health resources (Mental Health America, 2021).
Design and Methods
An anonymous survey distributed to Arab American medical students in Michigan evaluated the impact of recent events in the Middle East on their well-being. The Future Anxiety Scale was adapted to collect data on experiences related to the environment of war and conflict (Zaleski, 1996). In addition, data was collected on demographics, presence of family abroad, and year in medical school.
Results of Data Collection and Analysis
Findings are anticipated to align with prior studies linking future anxiety to indirect war exposure, such as news or family reports (Alotaibi, 2021).
Limitations
Self-reporting bias and fluctuating mental health due to crisis instability are potential limitations. Lack of incentive may reduce participation.
Conclusions and Significance
Those indirectly impacted by conflict have been found to experience PTSD, trauma, and anxiety, especially when family/friends are involved (Alghazo and Premuda-Conti, 2024). Thus, it is essential to address the mental health of those affected by war in their home countries. Incorporating culturally competent counseling, crisis-intervention training, and trauma-informed care in the curriculum will support students psychologically and create a better learning environment
Pulling the Trigger on Patient Care: A Comparison of ASC and HOPD Settings for Trigger Finger Release
Get PDFIntroduction
There is an increased focus on balancing cost-effectiveness with positive patient outcomes. Trigger finger release (TFR) offers an opportunity to compare its value in a hospital outpatient department (HOPD) versus an ambulatory surgical center (ASC). We hypothesized that TFR performed in an ASC provides greater value.
Methods
Time-Driven Activity-Based Costing (TDABC) was used to collect cost data for each procedure. Steps in the patient care pathway were timed, and costs were categorized as:
Direct Variable: Staff salaries, supplies
Direct Fixed: Facility, utilities
Indirect: Administration, marketing
Changes in PROMIS Pain Interference (PI) and Upper Extremity (UE) from pre-operative to three months post-operative were multiplied by the average patient life-years to calculate productivity-adjusted life-years (PALYs) for each metric. Costs were divided by PALYs to determine average cost-effectiveness ratios (ACERUE and ACERPI) for both settings.
Results
Data from 33 patients (n=22 HOPD, n=11 ASC) showed the average cost for TFR was 3,842.79 in HOPD (p=0.319). ASC PALYUE (0.77) exceeded HOPD PALYUE (0.23, p=0.302). HOPD ACERUE was greater than ASC (6,888.59/PALY), as was ACERPI (5257.270/PALY).
Discussion/Clinical Significance
Our study found that procedures performed in an ASC generally outperformed those in a HOPD in costs, utility, and pain improvement. However, none of the differences were statistically significant (p\u3e0.05). However, lower ACERs for PROMISUE and PROMISPI suggest that ASC may provide better value for eligible patients
Perspective of Adolescents with Migraine: A Survey Based Study
Get PDFIntroduction
Pediatric migraine, the leading cause of years lived with disability among adolescents, affects 62% of this population, making it a widespread and debilitating disorder. Numerous studies highlight the link between increased patient engagement and improved health outcomes. However, pediatric engagement presents unique challenges, including ethical considerations, the patient\u27s capacity for clinical decision-making, and parental preferences. This study seeks to guide physicians in prioritizing the assessment and enhancement of patient involvement and health literacy in the management of pediatric migraine.
Methods
Children aged 12–19 years with a confirmed diagnosis of migraine were recruited from the headache clinic at Children’s Hospital of Michigan (CHM) and the CHM neurology clinic in Troy, MI. Participants independently completed a survey evaluating their knowledge of their diagnosis, the names, doses, and side effects of both daily and acute medications, common comorbidities, and whether they had conducted independent research on migraines. A PedMIDAS evaluation was also administered to assess degree of disability.
Results
Data collection is ongoing, and results will be finalized and presented at the symposium.
Conclusions
Encouraging pediatric engagement is a critical component of quality clinical care. By assessing current levels of pediatric involvement, identifying factors influencing engagement, and addressing gaps in health knowledge, targeted strategies can be developed to enhance participation among pediatric patients. This, in turn, can improve patient outcomes and reduce the daily burden of migraines and other chronic conditions
Stopping the Cirrhosis: An international review of Hep C Screening in Prisons and Jails from 2004-2023
Get PDFBackground: As of 2023, HCV prevalence in state prisons in the United States was 9 times higher than the general population1. Without treatment, 20% of people with HCV will develop cirrhosis, and some estimate that 70% of hepatocellular carcinoma (HCC) cases arise from cirrhosis or advanced fibrosis2. Despite the high prevalence in prisons, the US does not have nationally standardized Hep C screening in correctional facilities. The goal of this study is to investigate different models of existing programs in prisons internationally. Understanding these models will inform Hep C screening in US prisons on a state and national level. Methods: PubMed and EMBASE databases were used. Covidence removed duplicates. 2727 abstracts were screened for eligibility according to predetermined inclusion and exclusion criteria and data extraction proforma for full text screening. Results: 62 publications were included. Of these, 4 implemented more than one model. 27% (17) were published in the United States, and 73% (45) published abroad. In terms of screening models, 52% (30/58), 29% (17/58), 5% (3/58), 7% (4/58), 5% (3/58), and 2% (1/58) were screened with opt-out, opt-in, cohort, point-of-care, opt-out cohort, and peer-supported models, respectively. 71% (41/58) of all reviewed studies linked participants to treatment. Conclusion: There is a need to develop and evaluate Hep C screening models in prisons and jails. More investigation within the US is necessary as studies primarily originate on the East Coast and in Texas, and regulations for correctional care vary per state. The opt-out screening model was the most common
Analysis of chromatin accessibility changes in endothelial cells exposed to plastic contaminants
Get PDFDegradation products from everyday plastic products are known to bioaccumulate and have also been shown to contaminate drinking water and food sources. BPA and phthalates are endocrine disrupting chemicals and plastic components that have previously been associated with endothelial cell dysfunction, atherosclerotic and other adverse cardiovascular events. However, there is a limited understanding of the mechanisms underlying these associations, such as genome-wide chromatin accessibility changes in endothelial cells exposed to these compounds. The purpose of this study is to explore genome-wide changes in chromatin accessibility associated with plastic exposure, as well as the discovery of transcription factor binding motifs dysregulated by plastic exposure. Human umbilical vein endothelial cells (HUVECs) were exposed for 6 or 24 hours to monobutyl phthalate (MBP), bisphenol A (BPA), or a vehicle control and were then processed by Assay for Transposase-Accessible Chromatin using sequencing (ATAC-seq). After peak calling, three different read counting strategies, which include percent in peaks (PIC), chromVar, and Rsubread, were evaluated for quantifying chromatin accessibility of peaks. PIC was determined to be superior in terms of robustness to outliers caused by transposition artifacts, and had better pairwise correlations between untreated controls. This research will serve as the basis to subsequently identify differentially accessible regions (DARs) of chromatin associated to MBP and BPA exposure. This study will also provide deeper insight into endothelial gene regulatory pathways that are altered as a result of this exposure, and will be integrated with genes associated with cardiovascular disease that are modulated by plastic exposure in endothelial cells
ERGODIC SWITCHING CONTROL FOR MARKOV-FELLER PROCESSES II
Get PDFThis is the continuation of Part I [14], where we considered control problems with long term average (or ergodic) cost for Markov switching processes (zt , nt ), nt being a discrete component with values in a finite set N . The control acts only on this discrete component and consists of immediate switching actions. We solve the ergodic problem in several situations extending previous works, mainly when zt is a reflected diffusion with or without jumps and when the set of control values is strictly smaller than N . In this Part II, we conclude our theoretical analysis with a list of ergodic-type conditions on general Markov-Feller processes to allow a resolution of this switching model
Lebanese Subversive Folktales: Najla Jraissaty’s Pearls on a Branch
No full textNajla Jraissaty compiled stories that were orally narrated by Lebanese women to children and other women. This article focuses on telling tales as an oral performance and how these storytellers narrated tales featuring resilient, intelligent, powerful women. Drawing on Jack Zipes’s notion of fairy tales as an art of subversion with a civilizing mission, Joan Riviere’s notion of “womanliness as a masquerade,” and Terry Castle’s argument that female disguises in literature are liberating, this article contends that the tales in Najla Jraissaty’s Pearls on a Branch display subversiveness through multiple strategies such as feminist revisions, satire, sexual innuendo, and female disguise
