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Polycystic Ovarian Syndrome and Obstructive Sleep Apnea: A Dynamic Duo for Cardiorenal Risk?
No full textAbstract
Polycystic ovarian syndrome (PCOS) is an endocrine disorder that impacts women of reproductive age, with an estimated prevalence as high as 20%. PCOS is associated with obesity, hypertension, and in some studies chronic kidney disease (CKD). The pathophysiological nature of these relationships is complex and incompletely understood, but studies show a high prevalence of co-morbid Obstructive Sleep Apnea (OSA) in women with PCOS. Given that OSA is independently associated with the development of hypertension, glomerular dysfunction, and proteinuria we hypothesize that OSA in women with PCOS contributes to or exacerbates the development of renal damage, hypertension, and progression of CKD. A review of the literature was performed using the National Library of Medicine. Articles published between January 1998 and July 2023 were selected for review. Randomized controlled trials, reviews, and systematic reviews were all included. Search terms include ‘polycystic ovarian syndrome’, ‘obstructive sleep apnea’, ‘chronic kidney disease’, ‘cardiovascular risk’, and ‘hypertension. We found that women with PCOS and OSA have higher blood pressure and an increased risk of negative cardiovascular outcomes. In patients with PCOS high levels of urinary albumin excretion were noted as well as increased intraglomerular pressure, and microalbuminuria. OSA was also found to be associated with poor renal function, albuminuria, and decreased glomerular filtration rate. Potential pathophysiological links are discussed in greater detail in the poster presentation. More research is needed to determine if co-morbid PCOS and OSA results in greater risk for hypertension and CKD and should address underlying pathophysiological mechanisms
Functional outcomes after reverse shoulder arthroplasty. A systematic review comparing anterosuperior and deltopectoral surgical approaches.
No full textAbstract
Reverse shoulder arthroplasty (RSA) was approved by the FDA in 2003 as an alternative surgical intervention to anatomical shoulder arthroplasty (TSA). Expansion in indications for this surgical procedure and increasing surgical expertise has likely contributed to the dramatic increase in its utilization over the past two decades. The most common surgical approaches for RSA are deltopectoral (DP) and anterosuperior (AS). The active and passive anatomical structures affected by these two surgical approaches differ drastically, which prompted us to systematically review the literature comparing their functional outcomes.
Electronic databases were searched (PubMed and Cochrane Library) according to PRISMA guidelines for studies directly comparing functional outcomes of the AS and DP approaches for RSA. Multiple functional outcomes were included according to their validity and reliability (Constant Score, OSS, DASH, ASES or WOSI). After screening, published articles that met the inclusion criteria were reviewed.
A total of 165 studies were obtained during our initial search, and 33 were selected for full-text review. Ultimately, 5 studies were included, consisting of three retrospective reviews, one prospective cross-sectional cohort, and one prospective randomized trial. The methodological quality of the included studies was assessed using the Methodological Index for Nonrandomized Studies (MINORS). Synthesized data from these studies will be presented.
Besides surgeon training/preference, DP and AS approaches both have advantages and drawbacks. Illustrating the comparison of functional outcomes between these two surgical approaches for RSA with relevant clinical information may assist surgeons in choosing the most appropriate technique for improved patient specific outcomes
Ultrasound education at Des Moines University
No full textAbstract
Introduction: The ultrasound curriculum at Des Moines University started in 2015 and was fully functional in 2017. This study questioned 178 DMU students about the first-year ultrasound curriculum.
Methods: The survey questions consisted of mostly five-option Likert scale and one dichotomous question. In spring of 2023, we reviewed ultrasound training in specific areas of education such as anatomy, cardiovascular physiology, clinical medicine, and trauma evaluation.
Results: The students had a positive ultrasound experience at DMU with 44.5% responding that their experience exceeded expectations or far exceeded expectations, and 33.55% responding with equaled expectations. When asked if ultrasound improved their understanding of basic anatomy, 53.2% of students agreed or strongly agreed. 96.8% of students would like to have more ultrasound workshops after imaging-based anatomy lectures. 67.94% of students agreed or strongly agreed that ultrasound improved their understanding of cardiovascular physiology. 73.7% of students agreed or strongly agreed that ultrasound improved their learning of clinical medicine. 96.10% of responses indicated that including ultrasound in systems courses would help them better understand the principles of clinical ultrasound. 73.6% of students agreed or strongly agreed that learning the FAST exam enhanced their knowledge of trauma evaluation.
Conclusion: Ultrasound has shown to be beneficial in better understanding clinical medicine, trauma, anatomy, and physiology. Not only has it improved students’ knowledge of these concepts, but students also identified that they would benefit from more incorporation of ultrasound into their education. This survey revealed that the ultrasound curriculum is well received by osteopathic medical students at DMU
An exploratory literature review of DNA methylation related to a rapid eating rate
No full textAbstract
Background: Obesity rates are rising worldwide and with it an increased risk for other conditions like cardiovascular disease and diabetes. One factor linked to obesity is the eating rate, defined as how fast an individual finishes a meal. However, little information is available about whether a rapid eating rate may epigenetically modify DNA or if there is an epigenetic predisposition in individuals with a rapid eating rate. We conducted an exploratory review to understand whether prior research identified a connection between eating rate and methylated DNA regions.
Methods: A keywords list was generated for both eating rate and methylation. An exploratory review of the literature in English was conducted through the PubMed database.
Results: The keyword list generated 97 possible publications tied to eating rate and methylation. Through the exploratory review, only 14 were identified as relevant. Of the 14 publications, 5 were human studies, 6 were animal experiments and the remaining 3 were reviews. A variety of DNA regions were epigenetically modified in subjects with a rapid eating rate, including hypomethylated genes related to binge eating disorder in adolescents. However, there was little overlap of DNA regions among the publications.
Conclusion: The relation of eating rate to methylation was investigated in previous studies, justifying a more thorough scoping review of the literature to identify DNA regions for future work
Learning goals, outcomes, and impactful course elements in diversity, equity, and inclusion education: A mixed methods analysis
No full textAbstract
Diversity, equity, and inclusion education are important elements in the medical school curriculum for future providers. The Physician as a Professional Course for first year DO students at Des Moines University provides an opportunity for students to learn about their own biases, attitudes, and cultural humility as it relates to the patient populations they will serve in the future. Within the course, students are asked to complete a pre-course survey in which a subset of questions asked about identification of individualized learning goals and patient populations they would like to know more about, in support of the self-directed learning components of the course. Additionally, the students participate in a post-course survey that includes identification of what they learned the most about, their satisfaction with the course content regarding their learning goals, and their qualitative suggestions for improvement in course content, logistics, etc. The surveys are a course assignment, with optional research participation (N=201/220 students consented for research inclusion). Overall, 93.7 percent of students reported at least some sort of satisfaction with the course regarding their individualized learning goals. The students found many elements of the course to be helpful, but some students identified their own actions outside of the self-directed modules to be most helpful. Thematic and frequency analysis of the qualitative data revealed a wide range of feedback. The insight provided by students allows for continued growth and modification of the course content, objectives, and format for future students
Group 2 - Biomedical Posters, 11-14, 16-20
No full textThe second group of the presentation breakout consists of Biomedical posters 11-14 and 16-20
Blood pressure cuff size accessibility for larger-bodied patients in physical therapy settings
No full textAbstract
Arm sizes vary among Americans with 43% requiring large size blood pressure cuffs. Negative patient perception occurs when equipment does not accommodate their body size. Additionally, improperly sized blood pressure cuffs result in invalid measures. The aim of this study was to investigate the availability of blood pressure cuffs to accommodate larger-bodied patients in physical therapy settings. A secondary aim was to compare availability between outpatient and inpatient settings.
This was part of a larger descriptive study. An electronic survey was distributed to 406 Clinical Affiliates of Des Moines University’s Physical Therapy Program to assess blood pressure cuff availability in various sizes (standard, large, thigh). Frequencies were calculated and reported in valid percent for each setting. Chi square analyses were performed comparing frequencies between outpatient and inpatient settings.
Ninety-five responses were received, 75 outpatient, 20 inpatient. Reported frequencies of available standard-size blood pressure cuff were 98.6% and 100% for outpatient and inpatient settings respectively. Frequencies of available large-size blood pressure cuffs were 83.8% and 100% for outpatient and inpatient physical therapy settings respectively. Reported available thigh-size blood pressure cuff were 14.1% and 31.6% for outpatient and inpatient physical therapy settings respectively. No significant difference was found between settings.
Outpatient settings did not consistently report availability of standard or large cuffs. Neither setting consistently reported availability of thigh cuffs. Appropriately sized blood pressure cuffs are required for valid measurement. Inappropriately sized equipment may compromise patient outcomes and elicit negative patient perceptions. Clinicians should advocate for all cuff sizes to be available
Using machine learning to quantify the cellular and vascular subcomponents of the neuropil space in five regions of the crocodilian brain.
No full textAbstract
Historically, the study of the reptilian nervous system has received very little attention. Central to this issue, has been ongoing public and scientific misconceptions that reptiles are emotionless and unintelligent. In the following study we provide much needed empirical data on regional and individual variation in the morphology of the neuropil space in the Nile crocodile (Crocodylus niloticus). The neuropil space is an important intercellular component supporting the complexity of the cortical column and has been used as a robust proxy for connectional and functional differences. Using a combination of design based stereological sampling and machine learning, we sampled the neuropil space in the stained histological sections of the dorsal thalamus (DT), dorsal ventricular ridge (DVR), optic tectum (OT), torus semi-circularis (TS) and cerebrum (C) of 5 crocodiles ranging in size from 1.2Kg to 10.06 Kg. Mean neuropil space was greatest in DT\u3e C\u3eOT\u3eDVR\u3eTS. Neuropil, cellular and vascular fractions ranged from a high of 73%; 29%; 7% respectively to a low of 60%; 23%; 3%. Aside for the DVR, all other areas seemed to undergo a modest increase in neuropil space with increasing body mass, while the DVR remained constant in terms of its neuropil complement. These preliminary results provide an important step towards validating our approach for automating the extraction of neuropil data from large histological datasets and comparing these within and between species
A loss of branched-chain aminotransferase (BCAT) enzyme function enhances T regulatory cell lineage commitment
No full textAbstract
Amino acid availability strengthens T cell-driven immunity. The branched-chain amino acids (BCAAs) are essential for T cell activation. The cytosolic and mitochondrial branched-chain aminotransferases (BCATc and BCATm), which catabolize BCAAs, are implicated as T cell immunosuppressive enzymes. While BCAT enzymes are well characterized in tumor growth, their impact on CD4+ T cell lineage commitment remains unknown. The objective of this study was to decipher the role of BCATc and BCATm in the differentiation of CD4+ T cells into regulatory T cells (Tregs), which are known to maintain peripheral immunotolerance. CD4+ T cells were isolated from the spleens of wild type (WT) mice or mice with T cells deficient in BCATc (T-BCATcKO) or BCATm (T-BCATmKO) followed by activation with anti-CD3/CD28 in the absence (undifferenced control) or the presence of transforming growth factor (TGF ), cytokine-IL2, anti-IFNy and anti-IL4 for 4 days to induce Treg lineage commitment. RT-PCR was performed to analyze expression levels of the Treg lineage specific transcription factors: forkhead box protein 3 (FOXp3) and TGF . WT CD4+ T cells, induced to Tregs, significantly downregulated BCATc and BCATm. Further, a loss of expression of BCATc or BCATm significantly increased Foxp3 and TGF expression in Tregs compared to undifferenced controls. Pharmacological treatment with n-acetyl leucine amide (NALA), an antagonist of the BCAA, leucine, reversed the effect of a loss of function of BCAT. Taken together, these results indicate a loss of BCAT enzymes enhances Treg differentiation and point toward a role of BCAA metabolism in the regulation of immunotolerance
The influence of psychiatry clerkship’s setting and nature on students’ attitudes and empathy towards patients with mental illness
No full textAbstract
Purpose: The National Alliance on Mental Illness Provider Education Program is a required curricular program at Des Moines University aimed at increasing health care professionals’ delivery of patient-centered and collaborative care for patients with mental illness (MI). This study assesses how the nature of setting and location of psychiatry clerkship influences OMS-III students’ attitudes and empathy towards patients with MI diagnoses from baseline to 6-month follow-up.
Methods: Participants completed surveys assessing their affect, beliefs and behavioral intentions regarding individuals with MI. The predictors were inpatient psychiatric unit training and training at more than 1 clinical setting during psychiatry clinical rotation. Outcomes included the medical condition regard scale (MCRS) and the 7-item Day’s Anxiety Scale (DMISS). The MCRS measured “regard” for patients with auditory hallucinations and paranoid delusions and patients with comorbid hallucinations, delusions, and substance use disorder. The DMISS assessed anxiety about interacting with individuals with MI. We calculated change scores for outcomes of interest. Baseline vs 6-month change score association were performed using independent samples t-tests with a significance cutoff of p\u3c 0.05. Cohen’s d effect sizes were calculated (d\u3e0.20=small, \u3e0.50=medium, and \u3e0.80=large).
Results: Overall, students who completed their psychiatry clerkship in more than one clinical site had lower levels of anxiety about interacting with someone with MI (t(91)=0.418, p\u3c 0.042, d=0.44). Students who completed their psychiatry clerkship in an inpatient psychiatric unit compared to all other settings of psychiatry clinical rotation displayed better regard towards patients with MI (t(86)=2.519, p\u3c 0.005, d=0.64) and towards patients with MI with comorbid substance use (t(85)=2.185, p\u3c 0.02, d=0.44)