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A Retrospective Study Characterizing Myocardial Strain Patterns in Patients with Mitral Annular Disjunction with and without Mitral Valve Prolapse
Get PDFBackground: Mitral annular disjunction (MAD) is an atrial displacement of the mitral valve hinge point. MAD may occur with or without mitral valve prolapse (MVP) and has been linked to ventricular arrhythmias (VA) and sudden cardiac death (SCD). Although cardiac magnetic resonance imaging (cMRI) is the gold standard for MAD detection, it is not practical for screening. We used 2D transthoracic echocardiography (TTE) with speckle tracking echocardiography (STE) to characterize segmental and global longitudinal myocardial strain (SLMS, GLMS) patterns in patients with MAD, +/-MVP.
Methods: 43 subjects were identified by searching “MAD” in our institution’s database. GLMS and SLMS patterns were analyzed by STE, and hospital charts were reviewed to record comorbidities.
Results: 43 MAD patients (36 +MVP and 7 -MVP) were studied using 2D TTE (average MAD distance 9.6 mm, range 3-22mm). 17 (40%) patients had prior VA (average MAD distance 11.6mm, range 6.6-22mm). Average GLMS was -18.2%; attenuated MS was noted in basal inferior, inferoseptal, and anteroseptal segments (-15.2%, -12.5%, and –13.8%, respectively).
Conclusion: It is postulated that MAD causes myocardial fibrosis, leading to arrhythmia. Though MAD can be identified on cMRI, TTE is a better screening test, and STE with MS mapping may offer a novel way of additional characterization.
Clinical Implications: We used TTE with STE for MS mapping to profile GLMS and SLMS in patients with MAD, +/-MVP. Our results show that deranged basal LMS may reflect MAD severity. Future research should optimize screening practices with STE to improve outcomes for patients with MAD
Home Visits: A Way to Build Genuine Connection and Learn from a Vulnerable Refugee Population
Get PDFAmong non-immigrant populations, maternal psychosocial stress was associated with impaired maternal bonding. Parents’ stress and depressive symptoms were associated with lower levels of supportive coparenting and impaired child development. To date, no studies have evaluated whether coparenting is related to maternal bonding in immigrant families. The goal of this study was to examine the relationship between maternal psychosocial stress (acculturative stress, posttraumatic stress, maternal depression), coparenting, and maternal bonding with the child among a sample of Arab-American immigrant and refugee mothers. As a first-generation Egyptian-American medical student, I was part of the team who went to the homes of immigrant mothers. My colleague and I followed the study protocol for data collection. Mothers would complete the consent forms, then the survey questions, and I would use the Bayley-IV Standardized Scales of Infant & Toddler Development to assess the child\u27s development. Arab American immigrants and refugees are vulnerable and have undergone unique trauma, which can make traditional methods of conducting research more challenging. Quantifying trauma, bonding, and building trust are not as simple as collecting demographic data. Through home visits, we were able to uniquely connect and learn from our community. We found a significant relationship between acculturative stress (ρ=.39; p\u3c.001), posttraumatic stress (ρ=.39; p\u3c.001), maternal depression (ρ=.53; p=,.001), non-supportive coparenting (ρ=.35; p= .002), supportive coparenting (ρ=-.38; p= .002), and maternal- bonding impairment. Maternal depression was significantly correlated with non-supportive coparenting (ρ=.32; p=.004) and with supportive coparenting (ρ=-.27; p=.016). Finally, acculturative stress, posttraumatic stress, and maternal depression were significantly positively correlated
Activating Neuroprotective Effects of Glial Cells in Vps13D-associated Ataxia
Get PDFAtaxia is a common symptom among many neurological conditions. Due to its high prevalence and quality of life impact, there is significant interest in understanding the underlying cause, as well as potential therapeutic approaches to mitigate its severity. Our lab uses a model of Vps13D-associated ataxia in the fruit fly, Drosophila Melanogaster, which recapitulates aspects of the human disease including age-dependent motor deficits.
The anti-oxidant compounds gastrodin and 4-HBA were found to have neuroprotective effects in Drosophila and mouse models of Parkinson’s disease. Previous work has demonstrated that these compounds can activate the Nrf2-pathway, a master regulator of anti-oxidant defenses. These compounds are believed to act through supportive glial cells, upregulating their anti-oxidant associated assistance of degenerating neurons.
We supplemented Drosophila diet with low-dose (0.1mM) and high-dose (1mM) concentrations of gastrodin and 4-HBA to determine the impact of these compounds on ataxia in our animal model. Flies’ motor ability was tested through negative geotaxis assays at one and two weeks of age. Supplemented animals were compared to untreated controls.
We found that low-dose gastrodin may improve motor function in later life. In addition, low-dose 4-HBA supplementation may improve motor function early in the disease course. Gastrodin is a glycoside precursor of 4-HBA, so these data are interesting in their differing temporal effects. The lack of similarity may indicate a complex metabolic pathway or extensive interactions within glial cells. These data lay the foundation for further investigation into the possibility of glial cell antioxidant activation in the treatment of neurodegenerative ataxia
Alcohol And Cannabis Use Among Women With Infertility: Associations With Psychological Distress, Attempts To Conceive, And Engagement In Fertility Treatment
Get PDFObjective: An infertility diagnosis can lead to distress. Although substance use is common and can also lead to distress, little is known about use among those with an infertility diagnosis. This is important since substance use can have implications for fertility. The purpose of this study was to estimate the rate of alcohol and cannabis use among women with infertility and examine whether substance use had associations with psychiatric symptoms, attempts to conceive, and engagement in fertility treatments.
Materials and Methods: Patients from one healthcare system were eligible if they received a female infertility diagnosis within the past 2 years. Participants (N=188) completed an online questionnaire on their alcohol use, cannabis use, and psychiatric symptoms.
Results: The rates of hazardous alcohol use, any cannabis use, and hazardous cannabis use were 30.3%, 30.9%, and 8.5%, respectively. Hazardous alcohol use was not associated with depression or anxiety (p’s\u3e .05). Those with any cannabis use were more likely to have higher depression scores than those without (p= .02). Those with hazardous cannabis use were also more likely to have higher depression scores (p= .001) and higher anxiety scores (p= .03). Substance use was not associated with actively trying to conceive. However, participants pursuing fertility treatments were less likely to engage in hazardous alcohol use (p= .02).
Conclusion: Cannabis use was associated with depression and anxiety scores, suggesting that cannabis may be used for coping. Though many women engage in hazardous alcohol or cannabis use, pursuing fertility treatments may serve as a protective factor
RAPID (Reducing the Anxiety of Patients in Interventional and Diagnostic) Radiologic Procedures: A Review of the Literature
Get PDFAbstract Title: RAPID (Reducing the Anxiety of Patients in Interventional and Diagnostic) Radiologic Procedures: A Review of the Literature
Background: Pre-procedural anxiety is a prevalent concern that can be associated with negative effects for patients including perceived pain. Most interventional radiologic procedures are performed under local anesthesia with minimal sedation if any, which may not be sufficient in relaxing the patient. Effective patient education with appropriate pain management and anxiety control can improve comfort and can yield optimal post-procedural outcomes.
Methods: A search was done with the PubMed database for studies concerning patient anxiety in radiologic procedures. Search terms included, “pre-procedural anxiety”, “radiologic procedure” and other variations. Studies were screened based on inclusion-and-exclusion criteria developed prior. Studies were reviewed by two reviewers using Covidence software, followed by a third reviewer who resolved any disputes. The quality of each study will be analyzed using the NIH quality assessment tools.
Results: Preliminary data reveals various methods in which patient anxiety can be addressed and relieved apart from pharmacological methods. Strategies include, but are not limited to, implementation of a preoperative preparation video, music therapy, meditation, aromatherapy, and communication strategies. One example of improved outcomes includes reduced preoperative anxiety and postoperative pain in children after guided imagery relaxation before minor surgery.
Conclusion: The implementation of non-pharmacological strategies to reduce preoperative anxiety in surgical and radiological specialties has resulted in improved postoperative outcomes. Procedural indications and processes are discussed in medical education, but there is a lack of patient perspective during the peri-procedural window. Patient anxiety is a concern that influences patient outcomes; therefore, it is in the interest of trainees to incorporate it into the curriculum
Retracted: Efficacy of observational care versus antibiotic therapy for treatment of acute uncomplicated diverticulitis
Get PDF2024.07.15: This paper was inadvertently published without proper license/consent from the author(s), and has been retracted.
A clinical decision report using:
van Dijk ST, Daniels L, Ünlü Ç, et al. Long-Term Effects of Omitting Antibiotics in Uncomplicated Acute Diverticulitis. Am J Gastroenterol. 2018;113(7):1045-1052. https://doi.org/10.1038/s41395-018-0030-y
for a patient with acute uncomplicated diverticulitis
Stopped Inside Time: Re-ordering Everyday Pandemic Temporalities
No full textDuring the first Danish lockdown of the COVID-19 pandemic in spring 2020, the usual order of everyday time became destabilized. Everyday rhythms and the quotidian “here-and-now” were transformed, and the near past surfaced as a utopian future many wished to return to, while people tried to re-order everyday time in narratives and sequences by means of new routines and materialities, and within ambiguous and affective moods. Using empirical material of over sixty-five student diaries and essays written during the Danish pandemic situation, the objective is to analytically open the complexity of temporal practices as they are performed in everyday life
Juramentos and Firmas: Narrating Assemblages in Afro-Cuban Religions
No full textThis essay examines narratives produced with entities in Cuban Palo traditions for the purpose of invoking copresences through the assemblage of images, words, and bodies. The dead, nkisi, tell multilayered, coded stories of strife and affliction in ways that weaponize practitioners and objects. We bring together primary sources from the Lydia Cabrera Papers, alongside ethnographic encounters in Cuba with Congo-inspired material, culture, and spiritual elders to trace the afterlives of narrating assemblages. Following Édouard Glissant, we further argue for an understanding of Palo narratives as sites of revelation and opacity whose fugitivity pushes against colonial practices of knowability and appropriation
Surveys: Who\u27s asking? Who\u27s answering? Is anybody listening?
Get PDFThe author examines the historical impact of surveys and opinion polls on the U.S. Congress