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Assessing Platelet Counts as Predictors of Vasospasm and Discharge Outcomes in Aneurysmal Subarachnoid Hemorrhage
Get PDFIntroduction: Aneurysmal subarachnoid hemorrhage (aSAH) carries a 21.9% 30-day case fatality rate, largely due to complications from cerebral vasospasm (CVS), which can lead to delayed cerebral ischemia (DCI). Despite extensive research, the best predictive biomarkers for vasospasm remain unclear. This study evaluates whether variations in platelet count predict vasospasm and patient outcomes in aSAH.
Methods: A retrospective cohort study included 297 aSAH patients from the Henry Ford Health System electronic medical records. Inclusion criteria required an aSAH diagnosis, hospital admission within 24–48 hours of symptom onset, transcranial Doppler (TCD) data, daily platelet count, and modified Rankin scale (mRS) scores. Platelet counts were categorized as thrombocytosis (\u3e450,000), normal (150,000–450,000), or thrombocytopenia (
Results: Vasospasm occurred in 62% of thrombocytotic patients (p = 0.4), 57% of thrombocytopenic patients (p = 0.8), and 57% of those with normal platelet counts. Middle cerebral artery (MCA) flow velocities exceeded 120 cm/sec across all groups. No significant association was observed between platelet count and vasospasm incidence. The average mRS was 3 (SD = 2) across all groups, indicating no difference in discharge outcomes.
Conclusion: Platelet count does not predict vasospasm or patient outcomes in aSAH. Future research should focus on alternative biomarkers to improve the management and prognosis of aSAH
Cardiovascular Interoceptive Accuracy Correlates with Piezo 1 Mediated Baroreceptor Sensitivity and State Anxiety: Implications for Hypoglycemic Awareness
Get PDFCARDIOVASCULAR INTEROCEPTIVE ACCURACY CORRELATES WITH PIEZO 1 MEDIATED BARORE- CEPTOR SENSITIVITY AND STATE ANXIETY: IMPLICATIONS FOR HYPOGLYCEMIC AWARENESS. Jack Summers, B.S., Zachary Miklja, M.D., Warren Lockette, M.D., Wayne State University School of Medicine, Detroit, Ml, USA.
Background: There is a brisk, reflex autonomic response to low blood glucose in which surges of catecholamines are released to enhance glycogenolysis, gluconeogenesis, and lipolysis. In addition to providing metabolic substrates, the cardiovascular responses to this surge in norepinephrine and epinephrine include an increase in heart rate and cardiac contractility. How these changes in heart rate and contractility are subjectively sensed and perceived as hypoglycemia is unknown. Exteroceptive sensors (e.g. visual and auditory receptors) allow us to respond to external threats from the environment. Interoceptive sensory receptors allow us to identify threats within the internal milieu, but their nature is unknown. Teleologically, interoceptive cues can serve as a warning as humans perceive changes in their heart rate or rhythm (“my heart skipped a beat”) brought about by stressors such as hypoglycemia or pain. Hypothesis: We propose that Piezo 1 channels in the heart of men and women are responsible for cardiac interoception. Because Piezo 1 channels mediate baroreceptor sensitivity, we postulated awareness of stress-induced increases in heart rate (i.e. cardiac interoceptive accuracy, “IA”) would correlate with changes in an individual’s heart rate and pulse pressure. Furthermore, those individuals with greater IA would have greater behavioral state anxiety. Finally, we expected that ex vivo measurements of Piezo 1 sensitivity could be used to predict an individual’s IA and state anxiety levels. Methods: We recruited 21 healthy men and women in whom IA was measured with a heartbeat detection task. We used the cold pressor test as our surrogate stressor to obviate the need to induce untoward hypoglycemia. Hemodynamics were measured non- invasively before and during a cold (1o C) pressor test over three minutes. State anxiety was assessed with a validated questionnaire. Piezo 1 channel activity was measured using a hypotonicity lysis assay on erythrocytes from our volunteers. Results: An increase in IA was inversely correlated with baroreceptor sensitivity as determined by the change in heart rate induced by cold pressor test-induced increases in pulse pressure, Spearman’s r = -0.58, p = 0.0056. IA also correlated positively with state anxiety, Spearman’s r = 0.52, p = 0. 042. Finally, our ex vivo assay demonstrated that erythrocyte Piezo1 channel sensitivity also correlated with state anxiety, Spearman’s r = 0.72, p = 0.016. Conclusions: Individual variations in Piezo 1 channel activity could explain individual differences in the subjective sensing of cardiovascular and subjective behavioral responses to physiological stressors such as hypoglycemia. Our ex vivo assay of Piezo1 sensitivity could identify those individuals predisposed to impaired awareness of hypoglycemia
The Intersectionality of Cultural and Religious Barriers to Mammography in the Arab American Population
Get PDFBreast cancer is the most common cancer and the second leading cause of cancer-related deaths among women in the U.S. (American Cancer Society, 2023). Mammograms are crucial for early detection and have reduced breast cancer mortality rates by 40% from 1987 to 2017. However, Arab American women have lower mammography utilization rates despite being at higher risk for breast cancer (Alkhafi et al., 2023). This trend increases their likelihood of late-stage diagnoses, with higher rates of non-localized breast cancer among Middle Eastern immigrants compared to non-Hispanic whites (Ziadeh et al., 2018). As breast cancer staging at diagnosis is a key predictor of survival, these findings point to an elevated mortality risk and highlight significant healthcare disparities within the Arab American community.
Current literature often overlooks the Arab community by grouping them with “White” in census data, limiting targeted research on their specific health needs (U.S. Census Bureau, 2022). This miscategorization fails to address the unique geographical, socioeconomic, and cultural factors affecting their healthcare access. Cultural barriers, such as shame, knowledge gaps, and traditional beliefs, hinder mammography utilization (Alatrash, 2020; Mellon et al., 2013; Racine and Andsoy, 2022).
Recent studies aim to enhance the visibility of Arab Americans in breast cancer research, exploring cultural, religious, and economic barriers to mammography. This narrative review will assess these barriers and evaluate past interventions, aiming to inform future culturally competent strategies for improving mammography utilization in the Arab American community
Patient Perception of Chronic Disease Management and Preference for Resources at a Student-Run Free Clinic in Metro Detroit
Get PDFIntroduction
Malta Medical Clinic is a student-run free clinic that provides health care to uninsured and underinsured patients in Metro Detroit. Many Malta patients have chronic diseases, including hypertension, diabetes, dyslipidemia, chronic obstructive pulmonary disease, asthma, arthritis, and chronic kidney disease. Most patients rely on the clinic for medical management, free prescriptions, and other resources to better control their chronic disease. The objective of this investigation was to identify patient understanding of chronic diseases to inform provider decisions on offering patient resources and education at Malta Medical Clinic.
Methods
Over two months, patients with a chronic disease who came to Malta Medical Clinic were administered a standardized eleven-question survey. The survey assessed patient perception of their chronic disease management and interest in various resources to assist in chronic disease management. Resources were compiled by the study team and distributed by medical student volunteers at the clinic as requested by patients.
Results
Surveys were completed by 10 patients. The average rating for patient perception of how well their chronic disease was managed was 7.8 out of 10. The most commonly distributed resource was a medication log, which was requested by 6 patients. Four patients requested educational materials regarding their chronic disease.
Conclusions Patients may overestimate how well their chronic disease is controlled. Patients showed more interest in resources to log elements of their disease management compared to resources focused on education. Further investigation could compare patient versus provider perception of how well the patient’s chronic disease is controlled
The Role of Biological Sex in the Treatment of Acute Cholecystitis
Get PDFBackground
Some patients with symptomatic gallstones present with more severe disease, have more difficult anatomy and require more complex operations. While cholecystitis has a female preponderance, some observe a trend towards more challenging disease in male patients. The confluence of gender and patient acuity has not been thoroughly investigated. We hypothesize that males present with worse disease compared to females.
Methods
The analysis cohort of adults who underwent cholecystectomies was filtered from a five-hospital health system administration registry containing inpatients admitted from Fall 2015 to Fall 2021. The dataset contained demographics, health characteristics, and variables reflecting disease severity and acuity. Univariate analysis and multivariate logistic regression were performed to highlight the relationship between patient variables, including gender, and disease acuity. The data were de-identified prior to analysis and deemed exempt from IRB review. Data were analyzed using R within R-Studio.
Results
Of 2789 cholecystectomy patients, 1616 (58%) were female and 1173 (42%) were male. Univariate analysis highlighted that males had higher rates of harm (p-value: 0.002), longer inpatient length of stay (p-value: \u3c 0.001), higher hospital cost (p-value: \u3c 0.001), increased laboratory usage (p-value: \u3c 0.001), higher MS-DRG weight (p-value: \u3c 0.001) and greater mortality risk (p-value: \u3c 0.001). Further, multivariate analysis found male cholecystectomy patients were correlated with higher instances of open surgical approach (OR: 1.93; p-value: \u3c 0.001) compared to their female counterparts.
Conclusion
Males present with worse risk-adjusted gallstone disease and require more hospital resources
A Comparison of Social Determinants of Health and Maternal Mortality Rates in Detroit, Michigan, and the United States
Get PDFTitle: A comparison of social determinants of health and maternal mortality rates in Detroit, Michigan, and the United States
Authors: Audrey Steiert, Constance Cleveland
Background: Maternal mortality in the United States represents a rising healthcare crisis as the United States is the only developed country to experience an increase in the maternal mortality rate from 2000-2017. However, maternal mortality is not uniformly represented across the US–it differs regionally by state as well as by race. The maternal mortality rate in Detroit, Michigan, is three times that of the national average. Among these women, African American women were disproportionately affected. Due to the social determinants of health having a significant impact on health outcomes, we analyzed various measures across the country to provide better insight into what could be causing Detroit’s divergence from the national average. Social determinants such as median household income, education level, healthcare access, and food insecurity were the variables chosen for analysis, given their considerable effects on health outcomes. These factors help to identify the additional barriers to health that Detroit citizens face.
Methods: Data regarding median household income, education level, healthcare access, and food insecurity was collected from national census records and compared using independent t-tests to analyze for a significant difference in these variables between Detroit and the country as a whole. Maternal mortality was analyzed in a similar fashion to compare for a significant difference between Detroit and the country to help identify what is causing Detroit’s divergence from national statistics.
Results: Analysis demonstrated a significant difference between median household income, education level, healthcare access, and food insecurity when compared between Detroit and the United States census levels.
Conclusion: These social determinants of health could predispose women in Detroit to a higher maternal mortality rate. The identification and mitigation of these social components is crucial in order to combat the rising maternal mortality rate in Detroit and in the United States overall
Indeterminate benefit of long-term beta-blocker use after acute myocardial infarction for some patients
Get PDFA clinical decision report using:
Yndigegn T, Lindahl B, Mars K, et. al., Beta-blockers after myocardial infarction and preserved ejection fraction. N Engl J Med. April 7 2024;390:1372-1381. https://doi.org/10.1056/NEJMoa2401479
for a patient showing 55% left ventricular ejection fraction after myocardial infarction
Development And Implementation Of A Novel Method To Quantify Fos-Related Neuronal Activity In Vivo Using High-Resolution Photoacoustic Imaging
No full textMental health disorders, such as post-traumatic stress disorder (PTSD), are complex, leaving challenges for the development of effective interventions. Increasing our detailed understanding of these disorders, by studying the micro-neurocircuitry behind them, can help provide tailored solutions corresponding to the complexity of the individual’s symptoms. This micro-neurocircuitry can be investigated by studying small groups of highly-active neurons, collectively known as neuronal ensembles, that are accountable for unique behavioral responses, e.g. fear learning, in PTSD. Behavioral studies examining neuronal ensembles have thus far been largely ex vivo, using immediate early genes associated with neuronal activity (e.g. Fos). In vivo imaging methods are currently limited (very invasive or low resolution), and generally measure indirect neuronal activity, such as the blood oxygen dependent response. To address this knowledge gap, we developed a new high-resolution imaging approach to detect and quantify fear-related neuronal activity in vivo, with the goal of discovering more detailed roles of the neuronal ensembles that mediate fear learning.Specifically, we used photoacoustic (PA) imaging to map activated neurons in vivo in a Fos-LacZ transgenic rat model. Fusion of Fos, which is induced by neuronal activity, with the lacZ gene product β-galactosidase gives active (Fos+) cells the ability to cleave pro-chromogenic substrates, such as X-Gal, enzymatically, into PA-active dyes. My phantom and ex vivo pilot studies in rat brains demonstrate high-contrast PA images using these dyes and image reconstructions with a very high signal-to-noise ratio. We hypothesized that during fear acquisition, unique neuronal ensembles will be activated and detectable in the medial prefrontal cortex (a region tightly associated with fear behavior) using a novel Fos-LacZ PA imaging system, providing a means to track longitudinal changes in these ensembles in vivo. To test this hypothesis, we used male and female Fos-LacZ transgenic rats administered X-Gal upon exposure to footshock (fear). This technique was first developed (Chapter 2) and then tested in vivo and validated with traditional methods for immunohistochemical detection of c-Fos and β-Gal in brain slices ex vivo (Chapter 3). This project provided deeper insight into the role of fear-related neuronal ensembles and a new wide field-of-view, low cost, high-resolution methodological approach to measure c-Fos expression (representative of neuronal ensembles) in vivo. This will be broadly useful for behavioral research, not only in PTSD, but also in a variety of psychiatric models by allowing us to better define mechanisms behind complex mental health disorders
Are Parental Nonstandard Work Schedules a Barrier to Their School Involvement?
Get PDFParental school involvement is consistently associated with better child development outcomes. Although parental work schedules are expected to shape school involvement, little empirical research examines this relationship. Using nationally representative data from the Early Childhood Longitudinal Study, Kindergarten Cohort 2010-11, (N=6,047), we estimated associations between parents’ work schedules and multiple indicators of school involvement. Compared to daytime schedules, flexible variable schedules were associated with more parental school involvement. Working a regular nonstandard schedule or employer-set variable schedule was not associated with school involvement, except that working nights was associated with attending fewer school events. We found limited evidence of heterogeneity by family structure or parent gender. These findings suggest parental work schedule flexibility may benefit child outcomes through increased parental involvement
Subjugation and Survival: Animal and Nature Narratives in the Himalayas
No full textThis article examines both vernacular and establishment narratives about animals and nature in Tibet and the Himalayas. Close readings of documents from the Tibetan Imperial Period and major works of Tibetan literature will be juxtaposed with community narratives collected during fieldwork in the Spiti region of India’s Northwest Himalayas. This article suggests that the historical tendency to emphasize the subjugation of nature has been challenged by recent vernacular and establishment accounts. We shall see that narratives in Spiti have stressed that the relationship between humans and the natural world is a reciprocal one, rather than one of subjugation