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Hematometra in a Premenopausal Patient: A Case Report of Idiopathic Cervical Occlusion
No full textBackground: Hematometra is a structural condition characterized by the accumulation of menstrual blood within the cervix and/or uterus. Its counterpart, hematocolpos, refers to the accumulation of blood in the vaginal canal. Most cases occur secondary to congenital anomalies such as an imperforate hymen, transverse vaginal septum, distal vaginal agenesis, or OHVIRA (obstructed hemivagina and ipsilateral renal anomaly) syndrome. These congenital causes typically present in adolescence around the onset of menses with primary amenorrhea and cyclic pelvic pain. Hematometra and hematocolpos can also result from acquired vaginal obstruction, particularly in perimenopausal women. These cases may be attributed to a variety of etiologies, including trauma, infection, and iatrogenic causes of vaginal occlusion. Case Presentation: A 46-year-old G2P2002 with a history of two cesarean sections presented to the emergency department with progressively worsening pelvic pain and abnormal uterine bleeding. These symptoms had been present for five years, since her last cesarean delivery, and had acutely worsened over the past two weeks. CT imaging revealed a large hematometra. On physical exam, the uterus was boggy and enlarged to approximately 12 weeks gestational size. A sterile speculum exam demonstrated a purple, protruding vaginal mass obscuring the cervix. Subsequent bimanual examination identified a soft, non-dilated lower uterine segment and cervix. Digital pressure was then placed at the point of the external os and a large volume of hematometra was unintentionally released. Approximately 150mL of non-purulent dark blood was expelled. Repeat speculum examination showed a discolored, pale cervix and probable pinpoint external os, though this was difficult to discern. The patient reported some improvement in the pain after the incidental release of her hematometra. The patient was thus discharged home from the emergency department on a dose of doxycycline to prevent infection and encouraged to follow up outpatient for further workup. Conclusions: Hematometra in adult women is uncommon and often secondary to iatrogenic causes, such as surgical trauma or infection. This case is unusual in that the patient had no history of vaginal deliveries or cervical procedures, making the exact etiology unclear. To our knowledge, cesarean sections have not been associated with hematometra. However, it is plausible that surgical trauma from the patient's prior cesareans led to scarring and adhesions, potentially causing cervical stenosis over time. Ultimately, this case highlights the importance of thorough gynecologic evaluation in women with chronic pelvic pain and menstrual irregularities, especially when symptoms are mistaken for perimenopausal changes. Emergency physicians should include hematometra in the differential diagnosis and be prepared to manage drainage in a sterile environment while ensuring appropriate follow-up
The effect of STRN4 knockdown on triple-negative breast cancer cells in vitro
No full textBackground: Striatin 4 (STRN4) is a mammalian protein that plays a role in cytoskeletal scaffolding, signaling, and regulation of downstream phosphorylation. STRN4 is ubiquitously expressed in the body and is relevant to many signal transduction pathways, like the WNT/β-catenin and PI3K/Akt proliferative pathways. Interestingly, STRN4 overexpression has been correlated with multiple cancers, including hepatocellular carcinoma (HCC), bladder transitional cell carcinoma, as well as gastric cancers. Its overexpression has been associated with poorer prognoses in breast cancer patients as well. Breast cancer is one of the leading causes of death amongst women worldwide, making STRN4’s correlation in patients relevant to researchers. Despite this correlation, STRN4’s role in breast cancer progression is largely uncharacterized. The goal of this study was to better understand the role of STRN4 in breast cancer. In vitro siRNA-mediated knockdown of STRN4 was performed, followed by monitoring of proliferation, metabolism, migration, and morphology. Methods: For this study, a patient-derived xenograft (PDX)-derived triple-negative breast cancer (TNBC) cell line was used (TU-BcX-4IC), as well as a well-studied TNBC cell line (MDA-MB-231). Both cell lines were seeded overnight and treated with three separate, pre-validated siRNAs specific to the strn4 gene at a 5nM concentration (referred to as A, B, and C). One group of cells was collected, RNA was extracted, cDNA was synthesized, and qRT-PCR was performed to confirm the knockdown of the gene of interest. Another group of cells was seeded at a very low density, allowed to proliferate for fourteen days, then stained with a 3% crystal violet in methanol solution. These colonies were then counted and normalized to the control group. A third group of cells were seeded into a 96-well plate and allowed to grow for 72 hours. Then, an XTT metabolic assay was performed. Finally, to assess migration, the fourth group of cells was seeded into the top chamber of a Boyden chamber and then allowed to migrate through the chamber towards a chemoattractant medium for 24 hours. They were then stained with crystal violet and imaged. Results: STRN4 expression in TU-BcX-4IC and MDA-MB-231 breast cancer cell lines was significantly diminished in all three siRNA-treated groups (A, B, C), confirming successful gene knockdown. In the TU-BcX-4IC cell line, proliferation was significantly lower in the C-treated group but not in the A and B groups. In contrast, in the MDA-MB-231 cell line, the opposite was true. TU-BcX-4IC cells treated with siRNA C had significantly lower metabolic activity, but other siRNA-treated groups did not reflect these results. There were no significant changes to migratory capacity post-knockdown. Conclusion: Decreasing expression of STRN4 in vitro has minimal effects on TNBC cell lines. Based on the results shown, siRNA C may be most effective at silencing the STRN4 gene, but the effects were still conflicting and inconsistent between cell lines. However, characterizing STRN4 knockdown breast cancer lines through molecular interactions, metabolism, proliferation, and migration patterns will be crucial in providing future therapeutic options for breast cancer patients. It will give researchers a better understanding of cancer heterogeneity amongst subtypes
Association of reported sleep disturbances with objectively assessed mild cognitive impairment among adults in the United States
Full text linkBACKGROUND: Sleep is a multifaceted phenomenon influenced by both duration and quality. Various sleep disturbances have been associated with mild cognitive impairment, but the role of specific disturbances in mild cognitive impairment pathophysiology remains unclear. This study investigated the associations between distinct sleep disturbances and mild cognitive impairment in adults aged 50 and older using nationally representative data. METHODS: Longitudinal data from the Health and Retirement Study were analyzed to explore the association between mild cognitive impairment and three types of sleep disturbances: trouble falling asleep, trouble waking up, and waking up too early. Logistic regression models estimated unadjusted (Model 1) and adjusted associations accounting for sex, race/ethnicity, age, social determinants of health (Model 2), general health (Model 3), depression (Model 4), and pain and physical activity (Model 5). RESULTS: The study cohort included 8877 participants aged >50 years in 2018 (baseline) who were followed up in 2020. Overall, 15.4% reported trouble falling asleep, 23.2% reported trouble waking up, and 12.8% reported waking up too early and being unable to fall back asleep most of the time. Among older adults, approximately 13.1% reported experiencing mild cognitive impairment; The prevalence of mild cognitive impairment was even higher in those who experienced sleep disturbances. The unadjusted odds ratio (uOR) for experiencing trouble falling asleep most of the time was 1.69 (95% CI: 1.42-2.03), for trouble waking up most of the time was 1.31 (95% CI: 1.10-1.57), and for waking up early most of the time was 1.88 (95% CI: 1.51-2.35). However, these positive associations attenuated depending on the covariate adjustment. CONCLUSIONS: Nearly one in seven adults had mild cognitive impairment. The relationship between sleep disturbances and mild cognitive impairment has been challenging to delineate. Our findings demonstrate a positive association between sleep disturbances and mild cognitive impairment, although these associations were sensitive to covariate adjustments. These findings suggest multifaceted pathways for reducing the risk of mild cognitive impairment.The authors received no financial support for the research, authorship, and/or publication of this article
Epidemiology of Hepatitis B Virus Infection in Nigeria: A Narrative Review of Prevalence, Transmission, Genotypes, Coinfections, and Mortality
No full textBackground: Nigeria has the highest burden of hepatitis B virus (HBV) infection in sub-Saharan Africa. However, the lack of a robust surveillance system and program data has limited the understanding of the burden and the distribution of HBV across different populations. This narrative review aimed to summarize available data on the epidemiology of HBV in Nigeria and identify research gaps in the existing literature. Methods: We searched PubMed, Scopus, and Google Scholar for relevant articles published between January 2000 and June 2025. Primary studies, reviews, and reports that contained data of interest, including prevalence, incidence, mode of transmission, mortality, and genotypes, were included in this review. Where available, we restricted our results to findings from representative surveys (conducted across the six geopolitical zones) or systematic reviews. Prevalence rates < 2%, 2%-7%, and >/= 8% were described as low, intermediate, and high, respectively. Results: Studies on the prevalence of hepatitis B surface antigen (HBsAg) have reported intermediate to high rates in the general population (5.4%-13.6%), with evidence suggesting declining trend. The most recent estimates showed a prevalence of 5.4% in 2022, corresponding to approximately 14.4 million people living with HBV. Available data indicate sociodemographic disparities in HBV prevalence, with higher rates among men, adults (> 18 years), and rural dwellers. Reported prevalence rates among specific subpopulations include blood donors (13.2%-14.0%), pregnant women (5.5%-14.1%), prison inmates (4%-42.2%), people who inject drugs (7%-7.8%), healthcare workers (1.1%-25.7%), female sex workers (0%-17.1%), men who have sex with men (8.4%-11.7%), and transgender women (15.6%). The prevalence of hepatitis B e-antigen (HBeAg) in the general population ranged from 6.0% to 23.6%. The prevalence of occult HBV infection (OBI) ranged from 0.9% to 17.0%. Genotype E was consistently reported as the predominant HBV genotype. Most studies reported low, intermediate, and high prevalence rates for HBV-hepatitis C virus (HCV), HBV-hepatitis D virus (HDV), and HBV-HIV coinfections, respectively. In 2022, approximately 46,000 deaths were attributed to HBV, translating to a mortality rate of 21 per 100,000 population. Conclusions: A wide range of HBV prevalence rates has been observed across various population groups in Nigeria. Key research gaps in HBV epidemiology that must be addressed include modes of transmission, incidence rate, prevalence among key populations, prevalence of OBI in the general population, and spatial distribution of the burden.No funding was received for this study
Cerebral Inflammation and Sex Differences in Young Rodents Exposed to a Low Resourced Environment May Predict the Onset of Hypertension in Adulthood
No full textPoster Highlight: Texas College of Osteopathic Medicine - Research, RAD 2025 Award Winning Posters & Oral PresentationsIntroduction: Adverse Childhood Experiences (ACEs) are associated with negative health outcomes as children progress to adults. Poverty, a type of ACE, impacts 16 million children annually in the USA. Childhood poverty is associated with hypertension (HTN) and increased inflammation in adulthood. To mimic poverty, we utilized the Limited Bedding and Nesting (LBN) rodent model during weaning. Previous studies from our lab show that adult male (M) rats exposed to a low resourced environment have elevated blood pressure and cerebral inflammation, while females (F) display no changes. This suggests that inflammation may contribute to HTN in LBN M. The onset of these inflammatory changes is unknown. We hypothesize that M, and not F, rats exposed to LBN treatment, will exhibit an increase in pro-inflammatory cytokines and decrease in anti-inflammatory cytokines in childhood. Methods: Pregnant Sprague Dawley dams and their pups were either exposed to a normal environment of bedding and nesting or LBN on postnatal days 2-9. After weaning, rats were grouped by sex and experimental status: LBN M, LBN F, CON M, and CON F (n=6-7/group). At 4 weeks (childhood), brains were collected and used to assay pro-inflammatory cytokines [interleukin 17 (IL-17), tumor necrosis factor alpha (TNFα), and IL-6] and anti-inflammatory cytokines (IL-4 and IL-10). Results: IL-17 was increased in LBN M vs CON M (814 ±141 vs 421 ±39, p=0.04) and trending downward in LBN F vs CON F (352 ±41 vs 692 ±149, ns). TNFα was elevated in F vs M in both LBN and CON rats (F(1,19)=44; p<0.0001). Moreover, there was no difference in TNFα in LBN vs CON in M or F. No changes were observed in IL-6 between M and F, however, there was a 5-fold decrease in IL-6 in LBN F vs CON F (567 ±153 vs 3066 ±593, p=0.002). Both anti-inflammatory cytokines, IL-10 (F(1,14)=5.2; p=0.038) and IL-4 (F(1,20)=8.8; p=0.007) were increased in F vs M in both LBN and CON rats. Discussion: In summary, LBN M may have an increase in cerebral inflammation, due to an increase in IL-17 compared to CON M. LBN F may have a decrease in inflammation due to a decrease in IL-17 and IL-6, and an increase in IL-4 and IL-10 compared to CON F. Surprisingly, F had elevated TNFα concentrations compared to M. Despite increases in TNFα, F appeared to be protected against an increase in cerebral inflammation, due to an overall anti-inflammatory state. These sex differences in cerebral inflammation, linked to rodent models of early life stress, may provide insights into novel biomarkers and predictive factors that contribute to HTN development. Childhood poverty has long lasting effects on one’s health that could persist throughout one’s lifetime. Thus, early interventions are crucial to ensuring that every child has a chance for a healthier future
Leading Presentation of Syndrome of Inappropriate Antidiuretic Hormone (SIADH) Secretion in an Adolescent Female as an Indication of Olfactory Neuroblastoma
No full textBackground: Olfactory neuroblastoma (ONB) is an uncommon nasal tumor that may occur at any age, but most commonly presents in the second and sixth decades of life with symptomatic epistaxis and headaches. Syndrome of inappropriate antidiuretic hormone (SIADH) has been estimated to present in 2% of the ONB population and has become a pathognomonic finding due to the occurrence of a leading presentation of several months to a few years before clinical diagnosis. Presentation: A16-year-old Hispanic female with past medical history of acute pansinusitis and ventricular septal defect (VSD) presents to the emergency department with nausea, fatigue, and muscle cramping. Laboratory studies reviewed hypoosmolar hyponatremia with normal thyroid function tests and MRI of pituitary. Patient was sent home with regimen of fluid restriction, salt supplementation, and clinician follow-up. Months later, similar symptoms led to readmission for hyponatremia management and revealed opacifications on CT scan of L maxillary sinus, anterior ethmoid cells, and frontal sinus. Management remained the same. A few months later, a third admission with a reported headache prompted an ophthalmologic exam showing L optic disc edema. Follow up CT and MRI imaging showed a sinonasal tumor in L nasal cavity with extension into surrounding sinuses. Additional laboratory work up continued to indicate normal thyroid, pituitary, and adrenal serum hormone levels. Histologic samples of the mass were studied and found to be consistent with ONB Hyams Grade II due to characteristic findings of pleomorphic, small round blue cells with scant cytoplasm, speckled/salt and pepper appearing chromatin, and rare Homer-Wright rosettes without necrosis. Conclusion: This case illustrates a unique presentation of ONB in an atypical age group without contributory medical history or identifiable risk factors, highlighting ONB as a differential diagnosis of SIADH without a known underlying origin. Keywords: olfactory neuroblastoma, esthesioneuroblastoma, syndrome of inappropriate antidiuretic hormon
Investigating changes in students' perceptions of cultural competency and bias following exposure to peer narratives
No full textPurpose: As the United States becomes more diverse every day, it is more important than ever that healthcare providers effectively connect with patients of various backgrounds to prevent miscommunication, cultural insult, and adverse patient outcomes. This phenomenon is not limited to medical students; effective cultural humility training is necessary for all healthcare professionals. This study explores the efficacy of a novel form of cultural humility education through the use of peer narrative among healthcare students and faculty. Methods: A registered student organization at the University of North Texas Health Science Center (UNTHSC), the Cross-Cultural Alliance (CCA), has created three educational seminars based on the cultural education tenets set forth by the AAMC. These seminars combine a guest speaker, who is an expert on the specific topic, with student narratives to supplement cultural competency curricula and induce empathy through personal connection. The first seminar focused on Implicit Bias, the second on Epidemiology and Healthcare Disparities, and the third on Medical Interpretation with Foreign Languages and Customs. Before and after each seminar, participants were asked to fill out a virtual survey on Qualtrics. CCA officers created these surveys to assess the change in participants' understanding of cultural humility and bias to evaluate the efficacy of peer narrative medicine. All results will be analyzed in IBM SPSS. Results: The final seminar will take place in mid-March 2025. Data analysis will be performed afterward. At this time, we have received positive verbal feedback from seminar attendees, and we expect our data to pan out accordingly. Conclusion: This study has revealed a desire and need for change in how health profession curricula present cultural education. It is important to provide opportunities for interaction with individuals from differing backgrounds to try and understand diverse circumstances. Peer narrative medicine not only provides that necessary exposure, but also creates a space of emotional vulnerability that strengthens humanitarian connections between different demographics. The ability to be open to those who are different is an essential skill for quality patient care
Impact of Mild Cognitive Impairment on Learning and Short-term Memory in Visuospatial and Verbal Memory Modalities
No full textPurpose: This study examined differences in short-term memory (STM) and learning ability between verbal and visuospatial memory modalities in older adults with or without amnestic mild cognitive impairment (aMCI). Methods: Thirty-nine aMCI subjects (71.5±6.0 yrs) and 33 non-MCI (control) subjects (71.1±5.7 yrs) of similar age and educational attainment consented to participate in the study that was approved by the North Texas Regional IRB (Protocol #2022-031). Short-term memory was assessed using Digit-Span-Test (DST), California-Verbal-Learning-Test-2nd edition – short-form (CVLT-II), and Brief-Visuospatial-Memory-Test-Revised (BVMT-R), along with verbal-learning vs visuospatial-learning assessments. Results: DST-Backward (P=0.016) and DST-Sequencing (P<0.001) scores were significantly lower in the aMCI vs. control subjects, but DST-Forward scores did not differ (P=0.237). Immediate and delayed free-recall scores in both CVLT-II (P<0.001) and BVMT-R (P<0.001) were lower in the aMCI subjects. The immediate free-recall scores in both tests improved with repeated trials (P<0.001 for trial factor) to similar extents in the aMCI and control groups with no significant interaction of the trial and group factors (P=0.266 in CVLT-II and P=0.239 in BVMT-R). Conclusions: Amnestic MCI subjects have diminished STM in verbal and visuospatial memory modalities, however, their learning ability seems to be preserved. Verbal memory evaluation with DST-Forward may not be sufficiently sensitive to detect aMCI-related differences in STM. Targeted intervention with memory training at this early stage of cognitive decline may help delay or prevent STM deterioration or slow its progression
Combination Therapy with Mithramycin and Etoposide Against Ewing Sarcoma Cells
No full textIntroduction/Study Question: Combination therapy with mithramycin and etoposide initiates apoptosis in Ewing sarcoma cells through the upregulation of reactive oxygen species and associated pathways. Methods: Ewing Sarcoma cells (CHLA 10 and TC205) and cardiomyocytes (H9C2) were cultured and treated with Mithramycin, Etoposide, and their combination using optimized concentrations determined for each drug. Cell viability, Caspase 3/7 activity and ROS production were measured using respective luminescence-based assays. Flow cytometry with Annexin V/7AAD staining evaluated apoptosis levels, and protein expression of apoptosis-related markers, such as C-Parp, was analyzed using a capillary-based Simple Western system. Statistical analyses were performed using GraphPad Prism to evaluate significance. Results: The combination of Mithramycin and Etoposide significantly inhibited ES cell viability compared to the treatment with each agent individually. Significantly elevated apoptotic markers were observed in combination-treated cells with associated amplification in Caspase 3/7 activity and ROS production. Flow cytometry analysis confirmed an elevated apoptotic response, with a higher percentage of Annexin V-positive cells in the combination group. Western blot analysis demonstrated elevated C-Parp expression, indicative of enhanced apoptotic activity. In H9C2 cardiomyocytes, no treatment exhibited significant toxicity at equivalent concentrations. Discussion: The combination of Mithramycin and Etoposide significantly inhibited ES cell viability compared to either agent alone. Apoptotic markers were markedly elevated in the combination-treated cells and associated with an upregulation of Caspase 3/7 activity and ROS production. Flow cytometry analysis confirmed an elevated apoptotic response, with a higher percentage of Annexin V-positive cells in the combination group. Additionally, Western blot analysis revealed increased C-Parp expression, consistent with enhanced apoptosis. The lack of statistically significant elevation of apoptotic markers in H9C2 cardiomyocytes suggest a low potential for cardiac side effects. These findings highlight the synergistic effects of Mithramycin and Etoposide in selectively targeting cancer cells while sparing healthy tissue
Adaptive Sampling for the Simultaneous Analysis of STRs, SNPs, and mtDNA in Human Remains Identification
No full textPurpose: Short tandem repeat (STR) markers evaluated via capillary electrophoresis (CE) continue to be the gold standard for human remains identification (HRID) in forensic investigations due to their high variability and robust database of comparative samples. However, CE excludes valuable sequence-level information both within and around STRs, and is not suitable for mitochondrial DNA (mtDNA) or single nucleotide polymorphism (SNP) analysis. The analysis of both mtDNA and SNPs is critical in cases where STR analysis fails, such as cases of damaged and degraded remains. Human remains are frequently encountered in forensic laboratories, coming from crime scenes, mass graves, historical samples, mass disasters, and military conflicts. The problem faced by forensic laboratories when analyzing such samples is choosing between depleting sample volumes to repeat individualizing STR analysis or perform costly, time-consuming, and less discriminatory mtDNA analysis. New DNA sequencing methodologies combined with novel enrichment techniques may provide a more effective platform for HRID that overcomes the most common challenges associated with the processing of damaged and degraded remains, bone fragments, aged tissue, and hair samples. Methods: Here, we harness the Adaptive Sampling (formerly Read Until) capabilities of Oxford Nanopore Technologies (ONT) sequencing to simultaneously analyze STRs, SNPs, and mtDNA for the purpose of HRID. Adaptive sampling utilizes on-instrument enrichment of target regions of interest (ROI), bypassing costly, and often error-inducing, amplification methods. DNA samples were barcoded with ONT-compatible barcode adapters, pooled, and then sequenced using adaptive sampling enrichment on the PromethION using a P2 flow cell. This targeted enrichment approach offers the most efficient DNA-based HRID by allowing simultaneous interrogation of various forensic markers, including STRs, SNPs, and mtDNA, from a single sample while also reducing sample processing costs and turnaround times. Results: We found that adaptive sampling was successful in the selective sequencing of our target regions, but struggles to provide sufficient enrichment of low quantity DNA samples. Conclusions: The results of our project to date indicate that adaptive sampling may be a viable enrichment technique for DNA samples with sufficient modifications