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SteadFAST: Case Reports in PA Studies 2 (1)
No full textDr. Eugene A. Stead was a physician and innovator in many areas of health care and healthcare delivery. Dr. Stead is credited as the founder of the PA profession after graduating the first class of PAs in 1967. As more physicians began to specialize than remain in general practice after WW2, Dr. Stead saw the importance of increasing the number of providers for an increasing patient population. Building on the experience and training of Naval Corpsmen (advanced trained medics) who had recently left the service, he designed a program in the early 1960s to advance their medical knowledge toward physician level. Initially dubbed “assistants to physicians”, the nascent program graduated the first three physician assistants in 1967. Since that time, PAs have been on the forefront of medical care provision across nearly every specialty and in many areas of leadership.UNT Health Fort Worth Physician Assistant Studies ProgramDedication to Dr. Eugene Stead -- Editorial Board (page i) -- Contents (page iii) -- Case Reports (page 1) -- Unique Cocaine Complication in a Young Adult / Pablo Perez, PA-C; Joshua Trussell, PA-C; Vic Holmes, PA-C, EdD (page 2) -- Impact of Chronic Cocaine Use on Urinary Tract Infection Recurrence and Complications / Hallie Brown, PA-S; Moneeza Matin, PA-C; Amanda Brosnan, PA-C, MPH; Vic Holmes, PA-C, EdD (page 6) -- HIV-Associated B-Cell Lymphoma / Bar Forte Reznik, PA-S; Ashley Twining, PA-C; Amanda Brosnan, PA-C, MPH; Vic Holmes, PA-C, EdD (page 11) -- Emergency Department Screening of Syphilis During Pregnancy / Kaleia Walden, PA-S; Andrew Badillo, PA-C; Amanda Brosnan, PA-C, MPH; Vic Holmes, PA-C, EdD (page 15) -- Chest Pain in Near-Term Pregnancy: A Case of Spontaneous Coronary Artery Dissection / Juan Salazar Ruiz, PA-S; Emory Roper, MD; Jamie Park, PA-C; Vic Holmes, PA-C, EdD (page 19) -- Magnetic Sphincter Augmentation for Hiatal Hernia with Gastroesophageal Reflux Disease / Madeline Lassman, PA-S; John Birbari, MD; Paula Olson, PA-C; Vic Holmes, PA-C, EdD (page 23) -- Early Prolactin Screening in Evaluation of Erectile Dysfunction / Allison Bollinger, PA-S; Andrea Wilson, FNP; Jennifer Crumm, PA-C, MPH; Vic Holmes PA-C, EdD (page 27) -- Cerebellar Cyst Causes Dizziness / Claudia Cox, PA-S; Charles Heflin, MD; Vic Holmes; PA-C (page 31) -- Evaluation of Memory Changes in Patient with Down Syndrome / Marisa Suzuki, PA-S; Yamini Chennu, MD; Paula Olson, PA-C; Vic Holmes, PA-C, EdD (page 34) -- Psychosocial Challenges in Managing and Diagnosing a Patient with Catatonia: Case Study / Yassamin Azadani, PA-S; Emily Elkins, PA-C; Vic Holmes, PA-C, EdD (page 38) -- Cognitive Behavioral Therapy for Insomnia / Mary Clayshulte, PA-S; Vikas Jain, MD; Amanda Brosnan, PA-C, MPH; Vic Holmes, PA-C, EdD (page 42) -- Management of Insomnia in a Veteran with Post-Traumatic Stress Disorder / Grace Rushwin, PA-S; Jane Joy, PA-C; Jamie Park, PA-C; Vic Holmes, PA-C, EdD (page 46) -- An Uncommon Complication of Bilateral Total Knee Arthroplasty / Ellen Sommerdorf, PA-S; Benjamin Deheshi, MD; Audrey Lively, PA-C; Vic Holmes, PA-C, EdD (page 50) -- Surgical Considerations in the Management of Benign Endometrial Polyps / Lindy Thompson, PA-S; James Herd, MD; Vic Holmes, PA-C, EdD (page 54) -- Abaloparatide for Insufficiency Fracture in a Collegiate Athlete: A Case of the Female Athlete Triad / Christine Tahan, PA-S; Adam Bruntz, Preceptor, PA-C; Audrey Lively, PA-C; Vic Holmes, PA-C, EdD; Uterine Fibroid Embolization: Complications in the Setting of a Large Fibroid Burden / Sue Odom, PA-S; Carolyn W. Quist, DO; Paula Olson, PA-C; Vic Holmes, PA-C, EdD (page 62) -- About the PA Program (page 67
Decreased parkin expression in retinal ganglion cells may mediate mitophagy declines in response to elevated endothelin-1
No full textPurpose: Several studies have found endothelin-1 and its receptors to be upregulated during glaucoma, and has been shown to cause retinal ganglion cell (RGC) neurodegeneration. This study was to determine the effect endothelin-1 has on mitophagy in RGCs, and how that contributes to RGC loss in glaucoma. Methods: MitoQC mice, containing a genetic dual fluorophore mitophagic flux indicator, were used to assess mitophagy in retinal ganglion cells in live ex-vivo retinas after intravitreal ET-1 injection. In another experiment, C57BL6/J mice, the background strain of the MitoQC mouse, received IVT ET-1 injection, and eyes were fixed and sectioned for immunohistochemistry to evaluate parkin expression and activation, and optic nerves prepared for transmission electron microscopy (TEM) to evaluate mitochondrial morphology. Results: Mitophagy, as assessed by the ratio of red flourescence to green flourescence in MitoQC mouse RGCs, was slightly increased 48 hours following ET-1 injection (p=.03, Mann-Whitney Test), but was decreased at 72 hours following ET-1 injection (p=.04, Mann-Whitney Test), compared to vehicle injected animals. This decline occurs in the time period where significant cell death is first seen in the central (p=.01, Two way ANOVA with Tukey’s post hoc analysis), and midperipheral retina (p=.02, Two way ANOVA with Tukey’s post hoc analysis). Through immunofluorescence, a significant decrease in parkin expression was found 72 hours following ET-1 injection (p=.0006, Student’s T test), although the trend towards decreased parkin activation was not significant (p=.2, Student’s T test). TEM revealed that while both groups had lower mitochondrial health 24 hours following IVT injection, animals injected with vehicle saw quick and significant recovery of mitochondrial health, but that recovery is delayed in ET-1 treated animals. Conclusions: Analysis of mitochondrial morphology revealed that ET-1 injection delayed the recovery of damaged mitochondria. Reduced mitochondrial turnover was also seen in MitoQC live imaging, and was associated with RGC loss. Immunohistochemistry revealed that parkin expression was decreased at the same time mitophagy was decreased, and presents a possible mechanism
Refractory Anaphylactic Shock leading to Cardiac Arrest
No full textBackground: Anaphylaxis is a severe, rapid-onset allergic reaction, clinically identified by the acute onset of symptoms involving the skin or by acute hypotension, bronchospasm, or laryngeal involvement after exposure to an allergen. In most cases, prompt administration of intramuscular epinephrine can stabilize the patient. However, in rare instances, patients may develop refractory anaphylaxis, characterized by persistent symptoms despite three or more doses of epinephrine or initiation of intravenous epinephrine infusion alongside fluid resuscitation. Intravenous epinephrine is indicated for patients who exhibit profound hypotension or signs of impending shock who do not respond to initial intramuscular epinephrine and fluid resuscitation. Cardiac arrest remains a rare complication of anaphylaxis, reported in approximately 2.5% of cases. Case Information: A 43 year old female with a past medical history of multiple episodes of anaphylaxis, hypertension, and type II diabetes mellitus presented to the emergency department for a rash. The erythematous and papular rash began on her wrist with an acute onset with no identified trigger. Initially, vitals were stable and the patient received 125mg methylprednisolone, 20mg famotidine, 8mg ondansetron, and 50mg diphenhydramine. However, on reassessment the patient was stuporous and her rash progressed to diffuse urticaria with associated nausea, vomiting, fecal incontinence, and hypotension. She was given 0.3mg epinephrine IM via EpiPen followed by 0.5mg epinephrine IM via vial without appropriate response by the patient. She subsequently lost a pulse resulting in initiation of CPR and 0.7mg IV epinephrine for a grand total of 1.5mg epinephrine. The patient achieved ROSC during the first round of CPR, was started on 4mg norepinephrine and 250mL of fluids for hypotension and admitted. Conclusions: This case illustrates the challenges and critical nature of managing refractory anaphylactic shock, especially when it progresses to cardiac arrest. Despite prompt initial treatment with intramuscular epinephrine, severe anaphylaxis may persist, requiring escalated care, including intravenous epinephrine and vasopressor support. Early and aggressive intervention is essential in these high-risk cases, underscoring the need for clinicians to recognize refractory anaphylaxis quickly and initiate advanced protocols. This case highlights the importance of timely management and preparedness for potential complications in patients prone to severe allergic reactions. Further research into predictive factors and optimal management strategies for refractory cases is needed to improve patient outcomes
Understanding the Structure and Function of Protein Kinase C-epsilon using Site Directed Mutagenesis
No full textPurpose: Gain a better understanding of PKC-epsilon, a calcium-dependent protein kinase involved in a wide range of cellular functions including cell proliferation, survival, and apoptosis. This interest in PKC-epsilon derives from the discovery of a de novo mutation in the PKC-epsilon gene in patients suffering from SHORT syndrome. This syndrome is a debilitating disorder characterized by short stature, hyperextensibility, ocular depression, Rieger anomaly, and teething decay. Methods: This project involved recapitulating the naturally occurring de novo mutations in vitro as well as determining if other mutations in PKC-epsilon could cause similar disease-state phenotypes. Using a technique known as Site Directed Mutagenesis (SDM) mutations were introduced into the PKC-epsilon gene and the effects of these mutations on protein expression were assessed. Results: Of the eleven mutants that were found in patients eight of them were successfully recapitulated in vitro. The mutants were shown to have similar levels of expression and similar size to wild type (WT). With the exception of E599K, which ran faster and was found to be truncated due to an inadvertent frameshift mutation that was introduced during SDM which required a rework of this mutant. Conclusion: Mutational analysis will help identify the regions of PKC-epsilon that are vital for its function. This will help elucidate the effect of the same mutations in patients and could help correlate with the severity of disease. Obtaining a clearer picture of the different regions of the PKC-epsilon protein allows for future studies to focus on successfully fixing these regions when they become damaged and could therefore be used to help patients with SHORT syndrome achieve a better quality of life
The Association of Glucagon-Like Peptide-1 Receptor Agonists (GLP-1) and Cardiovascular Health in Adults with Diabetes in the United States (US): Insights from Real-World Data
No full textPURPOSE: To determine the association of GLP-1 use with cardiovascular (CV) benefits among adults with diabetes in the United States using real-world data from a nationally representative survey. METHODS: We conducted a retrospective cohort analysis of adults aged 18 years or older with diabetes (N = 3,514, representing approximately 28.3 million adults) using pooled panel data from the Medical Expenditure Panel Survey. Multiple panels covering 2016-2017, 2018-2019, and 2020-2021 were used. GLP-1 use was determined from prescription medication files based on Multum therapeutic sub-class groups. CV health was determined using the presence of CV conditions during follow up periods. Multivariable logistic regressions accounting for the complex survey design were used to examine the association of GLP-1 with CV health, controlling for sex, age, race and ethnicity, Social Determinants of Health (SDOH), comorbidities, obesity, physical activity, and MEPS year. RESULTS: 7.6% of adults with diabetes used GLP-1, with use increasing from 3.8% in 2016-2017 to 11.8% in 2020-2021; 26.5% reported CV events during follow up period. There were no statistically significant differences in the rates of CV events among GLP1 users (28.7%) and non-users (26.3%), p=0.519. Multivariable logistic regressions did not indicate a statistically significant difference in CV conditions during follow up (AOR =1.23, 95% CI=[0.82,1.84], p=0.317) among GLP-1 users and non-users, after controlling for sex, age, race, ethnicity, SDOH, co-morbidities, obesity, physical activity, and MEPS year. CONCLUSIONS: Approximately one in ten adults with diabetes used GLP-1. GLP-1 use was not associated with improved CV health. Further research with robust study designs is needed to confirm this study’s finding
Neck Pain and Its Effect on Postural Sway and Fall Risk
No full textNeck Pain and Its Effect on Postural Sway and Fall Risk Alexander Lovrien, OMS-II, Ethan Bond, OMS-II, Zach Dashner, OMS-II, Rita Patterson, PhD, Kathleen Camp, DPT, Shawn Kennedy, MS Introduction: Falls are the leading cause of injury and injury-related deaths in adults over 65 years old. Balance control is maintained by the integration of three primary systems: the vestibular complex, somatosensory tracts, and the visual system. Traditional fall prevention strategies focus on individuals who have already fallen, rather than preventing the first fall. Postural sway, a quantitative measure of balance, can be used to assess fall risk in patients who might otherwise go unscreened. Neck pain, the fourth leading cause of disability worldwide, affects approximately 30% of individuals annually and is known to impact balance-related physiological systems. The aims of this study are to determine whether individuals with neck pain exhibit increased postural sway, potentially elevating their fall risk. Methods: A total of 308 patients presenting with neck pain were recruited from the UNTHSC health clinics. Patients stood on a force plate for three 10-second trials with eyes open (EO) and three trials with eyes closed (EC). Twenty-one postural sway variables were recorded, including total excursion (Totex), velocity, average radial distance (AVG rd), and rotational frequency (Rot. Freq.). Pain levels were self-reported using a 0-10 scale and grouped into four categories: No pain (0, n=5), Mild pain (1-3, n=149), Moderate pain (4-6, n=129), and Severe pain (7-10, n=29). Single-tailed t-tests were used to compare postural sway variables between pain groups, with statistical significance set at p < 0.05. Results: Patients with higher self-reported neck pain demonstrated significant increases in certain postural sway variables, indicating greater postural instability. However, Totex, Rotational Frequency, and Velocity did not show significant differences across pain levels. Additionally, no significant differences were observed between mild and moderate pain groups, suggesting a nonlinear relationship between neck pain and postural sway. Conclusion: The study’s findings suggest a potential correlation between neck pain and postural instability, though the results are inconclusive. The lack of a control group, reliance on self-reported pain levels, and limited sample size in the no-pain category pose significant limitations. Future research should include a larger control group, objective pain assessment methods, and measurements on different surfaces to better account for vestibular and somatosensory contributions to balance. References: 1. Kumar, N., et al. (2022). Chronic neck pain and postural rehabilitation: A literature review. *Journal of Bodywork and Movement Therapies. 2. Burton, W., et al. (2023). The impact of neck pain on gait health: A systematic review and meta-analysis. *BMC Musculoskeletal Disorders. 3. G., P. E. J. (n.d.). The influence of neck pain on balance and gait parameters in community-dwelling elders. *Manual Therapy. 4. Knapstad, M. K., et al. (2019). Associations between pressure pain threshold in the neck and postural control in patients with dizziness or neck pain – a cross-sectional study. 5. Madsalae, T., et al. (2024). Changes in gait performances during walking with head movements in older adults with chronic neck pain. Frontiers in Medicine
Evaluating Hyperbaric Oxygen Therapy for Chemotherapy-Related Cognitive Impairment
No full textPurpose: Chemotherapy-related cognitive impairment (CRCI), also known as “chemobrain”, affects multiple cognitive domains including attention, executive function, learning, and memory in many cancer survivors. CRCI can persist for 20 years after chemotherapy exposure, significantly diminishing survivors’ quality of life. Despite the growing recognition of CRCI, effective intervention options remain limited. Hyperbaric oxygen therapy (HBO), an FDA-approved treatment for several conditions including chronic wounds and infections, is gaining attention for its neuroprotective abilities against neurological disorders such as Alzheimer’s disease and traumatic brain injury. Coupled with its demonstrated safety and potential as an adjunct cancer therapy, HBO holds promise as a novel intervention to reduce CRCI. This study investigated whether HBO alleviates CRCI across chemotherapy doses and sexes. Methods: Adult (4-month-old) male and female C57BL/6 mice received three weekly injections of methotrexate (MTX) and 5-fluorouracil (5-FU) at two different doses (low-dose: MTX 37.5 mg/kg & 5-FU 50 mg/kg; high-dose: MTX 70 mg/kg & 5-FU 100 mg/kg) to induce CRCI. Concurrently, subsets of mice underwent daily HBO sessions (2.4 ATM for 90 minutes) five days a week for three weeks. Learning and memory were assessed using Morris water maze, active avoidance (T-maze), and fear conditioning to evaluate CRCI severity and HBO efficacy to reverse deficits. Results: Low-dose had minimal effect on cognition, whereas high-dose chemotherapy consistently impaired spatial learning and memory in both sexes, reduced discriminated learning in females, and reduced context discrimination in males. HBO improved discriminated learning across doses in males, and alleviated high-dose-induced discriminated learning in females. Conclusion: This study provides the first preclinical evidence that HBO mitigates CRCI in a dose- and cognitive domain-dependent manner. Additionally, chemotherapy and HBO exhibited sex-specific effects on cognition, highlighting the need for future investigation into sex differences. As cancer survival rates and life expectancy increase, identifying therapies like HBO is essential for preserving brain health and improving quality of life for survivors
Enhancing Diabetes Education and Management for Immigrant and Low Literate Patients Through AI Driven Web-Based Application
No full textPoster Highlight: College of Nursing, RAD 2025 Award Winning Posters & Oral PresentationsPurpose: This evidence-based practice project aims to explore how an AI-driven web application can improve diabetes education and management for immigrant and low-literate patients by addressing disparities. Traditional educational methods often lack cultural relevance, limiting their effectiveness. This proposed web-based application will utilize artificial intelligence to incorporate audio, visual, and language capabilities, thereby improving access to diabetes education and management, to enhance patient outcomes. The goal is to analyze existing literature on the use of AI and digital tools in health education and promotion, to improve initiatives for immigrant and low-literacy populations. It is hypothesized that delivering a culturally tailored, personalized, and accessible tool will effectively address existing gaps and significantly improve health outcomes for these communities. Methods: A literature review was conducted using PubMed, CINAHL Complete, and Google Scholar, with search terms including “AI-driven applications for diabetes education,” “immigrant population and diabetes care,” and “culturally adapted AI applications in healthcare.” The review focused on studies examining AI or digital technology in diabetes management and education, specifically addressing cultural, language, and literacy barriers in underserved populations. Inclusion criteria consisted of studies on immigrant or minority populations with type 2 diabetes, AI-driven interventions, and publications from the past decade. Five studies were selected including surveys, interviews, and pre- and post-intervention comparisons. The studies utilized quantitative, mixed-methods, and quasi-experimental designs, with a structured quality assessment approach. Results: The review examined five studies on how digital health tools can enhance diabetes education for vulnerable populations. Das and Janszen (2022) demonstrated that higher literacy and culturally tailored content significantly increased app usage and engagement. Yu et al. (2023) found that language-specific content and culturally relevant visuals improved app acceptability and user engagement among Chinese and Hispanic immigrants. Rotberg et al. (2016) showed that a literacy-sensitive diabetes education program, using visual aids and simplified language, significantly improved diabetes knowledge and self-management in a Latino population. Yoon and An (2024) highlighted that family-based support enhanced engagement with educational materials among Korean American women. Ho et al. (2015) concluded that culturally tailored materials improved understanding and retention of diabetes information among Chinese American patients. Collectively, these studies highlight that culturally and digitally sensitive education programs nurture improved engagement and knowledge within target populations. Conclusion: The literature supports the potential of an AI-driven, web-based applications that incorporates culturally sensitive audio, visual, and language capabilities. However, gaps remain, including the lack of studies assessing the long-term impact of digital health interventions, limited diversity in study populations, and underutilization of AI for personalization. This project aims to build on the current literature, suggesting that an innovative approach could increase utilization. Nurses are well-positioned to lead in this area due to their expertise in patient care and advocacy for health equity. Future research should adopt a mixed-methods approach, incorporating surveys and focus groups to assess the effectiveness of such applications, while considering factors like literacy, culture, and health literacy. Such research is essential for improving long-term diabetes outcomes, advancing public health, and establishing new standards for chronic disease management
A Rapid and Sensitive LC-MS Method with Single Quadrupole Mass Spectrometry for Quantitation of Olmesartan in Mouse Plasma
No full textPurpose: Quantifying drug concentrations in biological samples is critical for pharmacokinetic studies. While triple quadrupole mass spectrometry (MS) is the standard for such analyses, it is costly and complex. Olmesartan medoxomil is a prodrug of olmesartan (OL), widely prescribed as a first-line antihypertensive drug. Olmesartan medoxomil is converted to OL in the body to have therapeutic efficacy. This study aimed to develop and validate a simple, rapid, and cost-effective LC-MS method using a single quadrupole MS for olmesartan (OL) quantitation in mouse plasma. Methods: Plasma samples were prepared using a protein precipitation method without solvent evaporation. A Waters ARC HPLC system coupled with a Waters SQD2 single quadrupole MS was used. Chromatographic separation was achieved with a Waters XBridge C18 column in a 5-minute run time. Selective ion monitoring mode was optimized for OL at m/z 447.4 and internal standard (sorafenib) at m/z 465.3. Method validation followed the FDA guidelines for specificity, linearity, accuracy, precision, and stability. Results: The method showed excellent linearity (R² = 0.9988) over 3.9–1000 ng/mL. The lower limit of quantitation was 3.9 ng/mL, comparable to triple quadrupole MS-based methods. Intra- and inter-day precision ranged from 4.0% to 8.4%, and accuracy was within 93.9% to 106.5%. Extraction recovery exceeded 93%, and samples were stable for 18 hours in the autosampler. Conclusions: This validated single quadrupole LC-MS method offers a reliable, rapid, and economical alternative for OL quantitation in preclinical plasma studies. It provides comparable performance to triple quadrupole systems, simplifies sample preparation, and reduces run time, making it ideal for routine analysi
Investigating the impact of fluorination on the locomotor and discriminative stimulus effects of amphetamine and methamphetamine analogs in mice and rats
No full textPurpose: The chemical modulation of scheduled drug compounds can result in the creation of novel psychoactive substances (NPS). Through minor alterations to the chemical structure, these designer drugs differ enough from the original compound to bypass legal regulation and scheduling while still providing pharmacological effects. The continually growing number of NPS represents an increasing public health concern. The addition of fluorine to the Schedule II drugs amphetamine and methamphetamine results in the analogs, fluoroamphetamine and fluoromethamphetamine. Each analog contains three regioisomers depending on the structural position of the fluorine atom; 2-fluoroamphetamine (2-FA), 3-fluoroamphetamine (3-FA), and 4-fluoroamphetamine (4-FA) and 2-fluoromethamphetamine (2-FMA), 3-fluoromethamphetamine (3-FMA), and 4-fluoromethamphetamine (4-FMA). Current pharmacological analyses of these compounds range from extensive to limited, however their usage has been associated with severe cardiovascular and cerebrovascular adverse effects and fatality. We aimed to investigate the effects of phenyl ring fluorination on the abuse liability potential of amphetamine and methamphetamine analogs, using 2-FA, 3-FA and 2-FMA, 3-FMA and 4-FMA. Methods: The open-field assay was used to observe the locomotor effects of the compounds and to evaluate effective dose ranges and time courses for psychoactive effects in groups of male Swiss-Webster mice. Male Sprague-Dawley rats were trained to discriminate methamphetamine (1 mg/kg) from saline following IP injection using a FR 10 food-maintained schedule of reinforcement. Results: All compounds tested resulted in time- and dose-dependent stimulation of locomotor activity. 2-FMA was the most potent and similar to methamphetamine followed by 3-FA, 3-FMA, 2-FMA and lastly, 4-FMA. Peak locomotor effects produced also differed across compounds. While 2-FA, 3-FA and 3-FMA produced peak effects similar to methamphetamine, 2-FMA and 4-FMA were weak stimulants producing much lower peak effects. 3-FA was the most efficacious and similar to methamphetamine, followed by 3-FMA, 2-FA, 4-FMA and 2-FMA. Administration of the fluorinated compounds elicited a dose-dependent and full substitution for methamphetamine with similar potencies. Conclusion: The present study provides behavioral data to suggest these fluorinated amphetamine and methamphetamine analogs have a potential for abuse comparable to that of methamphetamine. The locomotor activity data highlights possible mechanistic differences between the positional analogs through contrasting potencies and efficacies, which may be due to other pharmacodynamic/pharmacokinetic parameters resulting from the structural edits. Further research is needed to elucidate the differences in mechanism between these regioisomers and how it translates into variation in locomotor activity