bluuebunny/crossref_metadata_2025 huggingface dataset:
Investigating the Role of Sterol Regulatory-Element Binding Proteins (SREBPs) in Age-Related Macular Degeneration
Authors: Sivamohan Anjali , Wang Ting , Pattabiraman Padmanabhan
Published: January 2023

Background/Objective: SREBPs are transcription factors involved in lipid biogenesis and are known to play a role in angiogenesis. Vascular endothelial growth factor (VEGF) also promotes angiogenesis, with VEGF inhibitors as the predominant treatment for Age-related macular degeneration (AMD). AMD is the leading cause of permanent vision loss in the elderly population and is characterized by choroidal neovascularization (CNV). We hypothesize that VEGF can activate SREBPs in a SCAP-dependent manner.
Methods: Human retinal microvascular endothelial cells (HRECs) were grown in 5% media and treated at passage 7. Prior to treatment, cells were all starved for 1h in 0.5% media. To estimate the changes in SREBP activation - HRECs were treated with 50ng/ml VEGF for 1, 4, and 12h or with 20 μM fatostatin, an inhibitor of SREBP activation, translocation into the nucleus, and SREBP transcription for 6h and 12h. Post treatment cells were lysed and protein was collected in RIPA buffer and semi-quantitative changes in target proteins were analyzed using immunoblotting. Statistical analysis was done by t-test, with significance if p<0.05, and sample size of n=2-3.
Results: HRECs treated with VEGF exhibited an increasing trend for SREBP-1 and SREBP-2 in the cytoplasmic and nuclear forms at all time points. SCAP did not show a clear trend. HRECs treated with fatostatin exhibited a decreasing trend for SREBP-1 and SREBP-2 in the cytoplasmic form and nuclear SREBP-1 form at both time points. The nuclear form of SREBP-2 increased at both time points.
Conclusion and Potential Impact: VEGF has demonstrated a role in SREBP activation, with both playing a role in angiogenesis. Fatostatin inhibition of SREBP indicated a potential antiangiogenic property. The downregulation of SREBP could provide a novel target in controlling and preventing angiogenesis in AMD. Further studies using animal models should elucidate the role of SCAP in VEGF activation of SREBPs.
Does Direct Anterior Approach Training During Residency and Fellowship Influence Clinical and Surgical Outcomes in Primary Total Hip Arthroplasty?
Authors: Sloat Brittany , Ziemba-Davis Mary , Deckard Evan R. , Buller Leonard T.
Published: January 2023

Background and Hypothesis: Total hip arthroplasty (THA) can be performed using various surgical approaches. The direct anterior approach (DAA) has been popularized due to fewer immediate postoperative functional restrictions. However, when transitioning from a posterior based approach, the DAA has a steep learning curve associated with higher early complication rates. The influence of formal residency and fellowship training on the DAA learning curve remains unknown. We hypothesized that formal training would reduce the learning curve associated with DAA THA resulting in better outcomes than previously reported.
Project Methods: Prospectively documented data on 726 unilateral primary THAs were retrospectively reviewed. Intraoperative, perioperative, and 90-day postoperative outcomes were compared for the index surgeon with formal DAA training and four surgeons without formal DAA training. A Bonferroni-adjusted p-value of 0.004 denoted statistical significance. Fourteen additional covariates were examined in relationship to outcomes.
Results: Intraoperative fracture and nerve damage, calculated blood loss and blood transfusions, and 90-day emergency department visits, inpatient readmissions, reoperations, and wound complications did not differ between the two groups (p = .054 to .999). Mean procedure (140 versus 103) and anesthesia (192 versus 144) durations in minutes were significantly longer for index surgeon cases (p < .001). In multivariable analysis, statistically significant covariates of procedure and anesthesia durations were unreliable due to wide 95% confidence intervals.
Potential Impact: Excluding procedure and anesthesia durations, there were no significant differences in outcomes comparing a surgeon with formal DAA training to surgeons without formal training. Surgery durations may have been influenced by a difference in years of practice (first two years for the index surgeon and a mean of 16.5 years for comparison surgeons). Formal surgical training on the DAA may facilitate similar outcomes earlier in a surgeon’s practice, reducing the learning curve associated with the DAA.
Association Between Intestinal Changes and Systemic Cytokines in Mouse Dysbiosis Models
Authors: Jeffries Alison , Villarreal Cameron , Brubaker Douglas , Chan Deva
Published: January 2023

Background/Objective: Gut dysbiosis has been linked with the development of low-grade inflammation in part due to an increase in pro-inflammatory cytokines and a decrease in short chain fatty acid production. This project aims to study the effects of antibiotics-driven dysbiosis on host gene expression in murine ilea. Additionally, we will examine the ilea for morphological differences among treatment groups.
Methods: Wild-type C57Bl/6J mice were given either an antibiotic (ampicillin, neomycin, vancomycin, or metronidazole) in water or water alone from 5 to 16 weeks of age. Mice were euthanized at 16 weeks, and the ilea were collected. RNA isolation and quantification were performed using the QIAgen RNeasy Lipid Tissue Mini Kit and BioTek Cytation 5 with Take3 plate, respectively.Histology of the ilea will be performed using hematoxylin and eosin (H&E) staining.
Results: The average RNA yield was 3.91 ± 1.14 μg/mg of tissue, and the average RNA purity, reported as the 260/280 nm ratio, was 2.06 ± 0.02. A Kruskal-Wallis test revealed there was no statistically significant difference in the average RNA yield between experimental groups (p-value = 0.15). Transcriptomes of isolated samples will be sequenced, and results will be analyzed in association with 16S sequencing (Zymo) of bacterial communities of the gut. Based on prior murine studies, we expect upregulation of pro-inflammatory cytokines and downregulation of tight junction proteins, which contribute to inflammation and increased gut permeability.
Conclusion and Scientific Impact: At this time, conclusions on the effects of antibiotics- driven dysbiosis on murine ileal gene expression and H&E staining cannot be made as further results and analysis are pending. However, the RNA sequencing and H&E results will be important to examine the impact of changes to the gut microbiome resulting from the administration of various antibiotics and further understand the relationship between antibiotics- driven dysbiosis and the microbe-host relationship
Clinical Characteristics and Complications in Patients with Complex Vascular Anomalies
Authors: Johnson Megan , Haggstrom Anita M.
Published: January 2023

Background/Objective: Vascular anomalies are rare complications of development, with some forms affecting less than 1% of the population. In addition to visible manifestations, they may cause pain, swelling, bleeding, thrombosis, and infection. These conditions often require more than one field of medical expertise, so incorporating multidisciplinary care is essential for optimizing management strategies. In an effort to better describe a cohort of these patients requiring complex interventions and understand the spectrum of care they need, we captureddemographic, clinical, and quality-of-life data to serve as a launching point for future studies.
Methods: We designed a RedCap database and conducted a retrospective chart review of 100 patients who presented at the Vascular Lesions Clinic (VLC) at Riley Children’s Hospital from May 2020 to May 2022. Demographic, clinical, and quality-of-life data using the OVAMA scale was obtained from Cerner and captured on RedCap. Excel and RedCap software were used to characterize this patient population.
Results: The majority of patients had diagnoses of venous malformations and lymphatic malformations. These anomalies showed no male or female predominance and most lesions were segmental. Sclerotherapy was the most common intervention, with venous malformations receiving a higher median number of treatments than lymphatic malformations. Lymphatic malformations were associated with lower appearance satisfaction and a younger median age at the time of the VLC visit than venous malformations. Older age, larger lesion size, female sex, and lesion location on the lower extremities also correlated with worse quality-of-life outcomes.
Conclusion and Potential Impact: The characterization of this cohort will guide broader studies of treatments and quality-of-life trends among patients with complex vascular anomalies. Future directions could explore patient outcomes, complication rates, and influences on quality-of-life in a prospective study design.
The Role of Physical Activity in Inflammation and Neurogenesis in 5xFAD Mice
Authors: Kaur Manpreet , Eisinger Brian E. , Lamb Bruce T. , Bissel Stephanie J.
Published: January 2023

Objective/Hypothesis: The apoliprotein E epsilon 4 (APOE4) variant is the strongest genetic risk factor for late-onset Alzheimer’s disease (AD) and is associated with accelerated clinical disease. Increasing evidence suggests that the immune system plays a direct role in AD pathogenesis, and several studies show that APOE genotype alter inflammatory pathways. However, the mechanism by which APOE4 influences the immune system is unknown. Physical activity (PA) is thought to play a neuroprotective role in late-onset AD and represents a possible strategy to attenuate cognitive decline and amyloid beta deposition in APOE4 carriers. We hypothesize that PA counteracts the negative inflammatory effects mediated by APOE4 by promoting a protective microglial response.
Methods: Mice with humanized APOE3 and APOE4 were crossed to 5xFAD transgenic mice, which carry mutant human APP and presenilin genes to drive amyloid pathology and neurodegeneration. The resultant transgenic mice (5xFAD;APOE4/4 and 5xFAD;APOE3/3) were subjected to a voluntary wheel running paradigm or stationary wheels for 4 months. We used immunohistochemical and ELISA-based techniques to evaluate microglia and neurons. The microglia disease-associated phenotype was assessed by Clec7a staining while homeostatic microglia markers were evaluated by P2ry12 staining. Neuronal numbers in cortical lamina V were evaluated by NeuN staining. Neurogenesis was evaluated by doublecortin staining.
Results: We expect to see an increase in Clec7a and a decrease in P2ry12 staining on microglia surrounding beta amyloid plaques in 5xFAD;APOE4/4 mice subjected to running compared to mice housed with stationary wheels. In addition, we anticipate PA will ameliorate neuronal loss and promote neurogenesis in the subgranular zone of the dentate gyrus in the hippocampus.
Conclusion/Potential Impact: The study will support the benefit of PA in attenuating the progression of late-onset AD in individuals with the APOE4 risk allele. The study will also elucidate the relationship between microglial responses, APOE genotype, and PA in AD.
Emergency Medicine Physician Attitudes in the Treatment of Heart Failure (EMPATH)
Authors: Koester Jami , Harrison Nicholas , Farmer Annabelle , Hannon Aidan , Jakupco Nicholas , Nanagas Jill
Published: January 2023

Half of emergency department (ED) to hospital admission for acute heart failure may be unnecessary. Methods for ED risk stratification has improved in recent years, but their implementation has been questioned under the presumption that most acute heart failure (AHF) patients have higher risks of short-term adverse events than physicians will tolerate. There is a lack of modern data on emergency physician risk attitudes in heart failure despite this presumption, so our objective was to assess modern emergency physician risk attitudes and how they compare historical assumptions and modern risk stratification tools.
Emergency physicians representing 9 emergency departments across Indiana were surveyed. Participants were board certified in emergency medicine and participation was voluntary. Each physician was asked to identify risk thresholds of outpatient treatment as opposed to admission for both 30-day mortality and 30-day adverse events in patients with AHF. For these risk thresholds, a range of choices was offered from 0-<15%. Bayesian analysis was performed, and results were compared to risk thresholds of both literature suggest values and lowest risk score values.
The response rate to the survey was 97.3% (73/75) physicians. The mean emergency physician risk tolerance for 30 day death and 30-day major adverse events were 3.8% (95% CI: 3.3%-4.4%) and 4.3% (3.8%-5.0%) respectively. Risk tolerance distribution is multimodal, with physician subpopulations who tolerate as high as 5-15% risk rates for outpatient disposition. Subgroups of risk tolerance differed only by race demographics.
Current emergency medicine physicians are more risk tolerant than previously thought with risk tolerances not even reaching the average of prior values. Compared to historical literature, current risk tolerance more closely aligns with modern risk stratification tool values that were not available when past studies were performed. For reasons not fully understood there appears to be three distinct groups of risk tolerances among emergency physicians.
Trends in Metastases among Patients with Masaoka-Koga Stage IV Thymic Epithelial Tumors
Authors: Laniak Louis J. , Davis Hannah O. , Heldman Emily M. , Wuthrich Brice S. , Kesler Kenneth A. , Loehrer Patrick J.
Published: January 2023

Background: Thymic epithelial tumors (TET’s), including thymomas (5 histological subtypes) and thymic carcinomas, are rare tumors with an estimated incidence of 0.15 per 100,000 person-years in the United States. While their etiologies remain largely unknown, some are associated with uniquely high rates of paraneoplastic syndromes and an elevated risk of secondary malignancies. And, though thymomas were once thought to be benign tumors, it is now well-documented that all TET's can metastasize. The gold-standard in TET staging, the Masaoka-Koga system, defines metastatic disease as Stage IV, further specifying pleural/pericardial metastases as Stage IVa and lymphogenous/hematogenous metastases as IVb. Unfortunately, little is known about patient prognosis as it relates to metastasis location. Here, we assemble and analyze one of the largest single-institution databases of TET patients in the world and seek to examine trends in metastases and their correlation with patient prognosis.
Methods: Files of 1023 TET patients seen at Indiana University Hospital were accessed via Cerner, after which a standardized information list including demographics, diagnostics, tumor histology, treatments used, disease course, and patient outcome at last follow-up was extracted and input into a RedCap database.
Results: Stage IV disease cases were filtered, yielding a total of 428 patients. Of these patients, 122 (29%) had carcinoma, making carcinoma the single largest histology represented in Stage IV. Locations of metastases also varied, with 284 patients (66%) having pleural metastases, 171 (40%) having lung, 71 (17%) liver, 58 (14%) bone, 56 (13%) pericardium, 37 (9%) neck lymph nodes, 12 (3%) brain, and 5 (1%) kidney. Moreover, 98 (23%) patients presented in stage IVb without any pleural/pericardial metastases. At last follow-up, 10% (19) of Stage IVa patients had no recurrence compared to only 3% (7) of IVb patients.
Potential Impact: These data altogether suggest that disease spread outside the thorax occurs much more commonly than previously reported, and that rates of metastasis vary with tumor histology. Future analysis will elucidate the exact differences in the patterns of spread among histological types, how these patterns correlate with prognosis, and the implications of this on screening and treatment options.
Social Determinants of Health and Adverse Health Outcomes in an Urban Community Hospital in Northwest Indiana
Authors: Love Emma , Nosbusch Sydnye , Ryan Elizabeth , Guerrero Jonathan , Muvuka Baraka
Published: January 2023

Background: Social determinants of health (SDOH) are underlying contributing factors ofhealth inequities. Facility-based SDOH screenings inform targeted care, community resource referrals, and actions. St. Mary Medical Center (SMMC), an urban hospital in Northwest Indiana, was first acute care hospital in the state to pilot comprehensive SDOH screenings and referrals using the Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences(PRAPARE), a nationally recognized and validated tool. This study is part of a three-phased Community Based Participatory Research (CBPR) partnership between SMMC and IUSM-NWto examine and address SDOH from January 2021-January 2025. This study’s research questions are: What is the distribution of adverse health outcomes by demographics and by SDOH in SMMC’s inpatients?
Methods: This descriptive study analyzed a limited dataset generated from EPIC™ by SMMC. It included demographics, behavioral, health outcomes, and SDOH measures for adult inpatient visits from January 2021 to June 2022. Data analysis was conducted in SPSS 28.0 usingdescriptive statistics and tests of association (p<0.05) including One-way ANOVA, Kruskal Wallis H, Chi-square, and Fisher’s Exact. This study was exempted by Indiana UniversityHuman Research Protection Program (IRB #14040).
Results: The sample comprised 4370 patients, majority non-Hispanic (90.4%), White (75.7%), older adults (median age 65, IQR = 24), and publicly insured (76.3%). 30-day readmissions accounted for 9.1%. The top three discharge diagnoses were diseases of the circulatory system (20%), digestive system (12.4%), and injury (7.5%). Discharge diagnoses differed significantly (p<.001) by family income, insurance type, stress presence, race, ethnicity, and sex. 30-day readmission was significantly associated with housing risk (p=.036) and insurance type (p<.001).
Conclusions: This study underscores the role of SDOH in influencing health outcomes and the importance of continuous SDOH screenings. This study will inform subsequent advanced analysis, the program evaluation, and the translation-to-action phase of the CBPR project.
Fatty Acid Excess Increases Lipid Droplet Size and Modifies Gene Expression in Osteocytes
Authors: Mansoori Afsheen , Kitase Yukiko , Prideaux Matt , Bonewald Lynda
Published: January 2023

The relationship between obesity and bone remains controversial, although recent studies suggest that obesity can confer an increased risk of osteoporosis resulting in bone fractures in skeletal sites such as the wrist. Osteocytes are the most numerous bone cells functioning as key regulators of bone formation, resorption, and renal phosphate homeostasis; therefore, they likely play an important role in obesity-induced skeletal pathology. Cells exposed to excess free fatty acids (FA) in obesity strive to detoxify the cytotoxic free FA by taking up and storing free FA into lipid droplets (LD). It is unknown how osteocytes respond to FA and how this would affect their functions.
In this study, we assessed the effects of FA overload on osteocytes using two cell lines, MLO-Y4 and IDG-SW3. We hypothesized that normal osteocyte energy metabolism is disrupted by excess FA, resulting in increased lipid storage and abnormal osteocyte function. To study this, MLO-Y4 cells were treated with palmitate to induce LD accumulation, and then stained to quantify LD. To determine palmitate’s effects on osteocyte function, we performed qPCR analysis for lipid accumulation genes and osteocyte markers. To examine LD formation in IDG-SW3 mature osteocytes, LipidSpot fluorescent staining was performed; preliminary observations show LD accumulation.
Using this in vitro system, MLO-Y4 cells under fatty acid overload demonstrated a greater percent area and size of LDs. RT-qPCR analysis showed an increase in lipid storage genes, Dgat2 (1.5- fold, p<0.001) and Cidec (4-fold, p<0.05). Opg, an inhibitor of osteoclast differentiation, was decreased (0.75-fold, p<0.01), whereas there was no change in Rankl, an inducer of osteoclast differentiation. Dmp1, an early osteocyte marker which plays a role in matrix mineralization, was increased (2-fold, p<0.05). This indicates that FA most likely disrupts osteocyte metabolism through increased lipid storage, which may alter osteocyte function to promote osteoclast activity leading to bone loss.
Does Intraesophageal Bougie Use Prevent Post-operative Dysphagia in Laparoscopic Nissen Fundoplication?
Authors: Martine Victoria , Kalantar Mohammad , Giannopoulos Spyridon , Stefanidis Dimitrios
Published: January 2023

Background: It is yet unknown what contributes to the variable degrees of post-operative dysphagia following a laparoscopic Nissen fundoplication (LNF). Previous studies have not found a contributing factor to post-operative dysphagia. This study reviews the effect of procedure practices, especially Bougie device use, that could be possible contributors to post-operative dysphagia.
Methods: A retrospective study was conducted of patients who had undergone LNF procedures from 2012 – 2014. All demographic and procedure characteristics were recorded and compared between groups with Bougie (WB) and without Bougie (WOB). Association of all available factors with any post-operative dysphagia were evaluated using univariate and multivariate logistic regression analysis.
Results: A total of 127 patients (89 female) were operated on by 4 surgeons. A Bougie device was used in 99 (78%) cases, and 38 (30%) patients experienced some degree of post-operativedysphagia. There was no significant difference between WB and WOB groups demographically. WOB cases tended to have a longer operative time (134.3 min ± 43.6 vs 95.8 min ± 46.3; P<0.001) and estimated blood loss (47.5 mL, (95%CI:28 – 68) vs 24 mL (95%CI: 19 – 29, P=0.001). Post-operative dysphagia was not associated with use of Bougie device (OR=0.99 (0.38-3.44), P=0.81). The success rate of the dilation procedure was not associated with prior utilization of Bougie in the primary surgery (OR= 0.9, 95% CI: 0.12-6.5).
Conclusions: Use of Bougie was correlated with shorter operative time and less bleeding; however, post-operative dysphagia does not appear to be associated with its use in laparoscopic Nissen fundoplication. Data analysis did not suggest any other contributors to post-operative dysphagia. Further studies with larger number of surgeons are suggested in order to evaluate the effect of surgeon experience on outcomes.
The Impact of a Lack of Diversity in Leadership Positions on Self-Perceptions and Views of Success in Latino/a/x Youth
Authors: Thomas Jordan , Zeh Janie , Messmore Niki
Published: January 2023

Background:The Boys and Girls Club (BGC) is a national organization that cares for diverse youths ages 6-18. At a national level, BGC states that a commitment to inclusion is a core value. This research explores the demographic makeup of BGC of Tippecanoe County’s staff/volunteer members and analyzes its impact on the Latino/a/x youth that attend the club.
Methods:A 2-part anonymous survey was developed and distributed to all active staff/volunteers that work at BGC of Tippecanoe County. Part 1 consisted of basic demographic questions. Part 2 of the survey had participants answer questions about their Adverse Childhood Experiences (ACEs) and an ACEs score was calculated from their responses.
Results:Data analysis found that 89% of employees identified as “White/European”. In addition, 100% of responses labeled “English” as their primary language. Data revealed that 94% of respondents listed their sexual orientation as “heterosexual”. 100% of the participants selected either “male” or “female” as their gender identity, showing no divergence from the “male/female” binary at the club. In the final two demographics questions from the survey, 56% of the respondents indicated that their childhood household had an income greater than $50,000 and another 56% stated that they had an education level at or below a high school diploma.
Potential Impact/Conclusions:The demographic makeup of BGC of Tippecanoe County puts Latino/a/x youth at risk of struggling when developing their social-emotional and ethnic identities. The current staff/volunteer list does not put Latino/a/x youth in the best possible developmental environment for cultural appreciation and self-confidence. Several strategic diversity recommendations have been created and passed on to the organization. These aim to increase the engagement level and cultural appreciation of Latino/a/x culture to empower youth that identify with this group.
Association between Serum Biomarkers of Inflammation One Week after ICU Admission and Post-Discharge Mortality in Critically Ill Patients
Authors: Nasser Baker , Macha Alexis , Khan Sikandar H. , Perkins Anthony , Wang Sophia , Conrad Peter , Seyffert Sarah , Borman Courtney , Athar Ammar , Mulkey Malissa , Gao Sujuan , Boustani Malaz A. Boustani , Khan Babar A.
Published: January 2023

Background: Delirium occurs among up to 80% of critically ill patients and is associated with poor patient outcomes. Levels of serum biomarkers of inflammation and astrocytic and glial activation measured at ICU admission are associated with increased delirium duration, delirium severity, and in-hospital mortality. The utility of measuring biomarkers at later points during ICU stay has not been elucidated.
Objective: To determine how serum biomarker levels collected at one week of ICU stay are associated with mortality.
Design: Observational study.
Setting: Three Indianapolis hospitals.
Patients: One hundred seventy-eight critically ill patients.
Main Results: The median cohort age was 61 years (IQR 53.5-70.1), 56.2% were female, and 48.3% were African American. The median APACHE II score was 21.0 (IQR 16.0-27.0), and the median Charlson Comorbidity Index score was 3.0 (IQR 1.0-5.0). Approximately 76% were mechanically ventilated; 54% had acute respiratory failure and/or sepsis. Median ICU stay was 13 days (IQR 10.0-22.0).We analyzed the relationship between serum biomarkers of inflammation (interleukin-1, 6, 8, 10, and tumor necrosis factor α), neuroprotection (insulin-like growth factor 1), and astrocytic and glial activation (S-100β) and mortality 30 days post-discharge. Higher levels only of IL-6 and IL-10 at day 8 of ICU stay were associated with higher odds of death 30 days post-discharge (IL-6 OR: 2.45, 95% CI: 1.49, 4.03, p<0.001; IL-10 OR: 2.07, 95% CI: 1.23, 3.49, p=0.006), while day 1 levels of the same biomarkers were not (IL-6 OR: 1.10, 95% CI: 0.72,1.70, p=0.662; IL-10 OR: 1.40, 95% CI: 0.88, 2.25, p=0.157).
Conclusion: Measuring serum biomarkers of systemic inflammation one week after ICU admission may be more useful than measuring at ICU admission for predicting longer-term outcomes in critically ill patients.
Investigating the Role of Meal Quality and Food Look, Smell, and Taste on Perceived Health Improvement for Clients of Meals on Wheels of Central Indiana
Authors: Boyer Jacob , Messmore Niki
Published: January 2023

Meals on Wheels organizations across the country have the common goal of ending hunger among the elderly, malnourished, and disabled population. Meals on Wheels of Central Indiana (MOWCI) primarily serves Marion County and the rest of the state through one of its programs. The organization offers daily hot and cold meals Monday through Friday, frozen meal deliveries, and pantry boxes. Minus the pantry boxes, meals are assembled at one of nine participating health corporations: Community Health Network, Eskenazi Health, IU Health- Methodist, Marquette, Franciscan Health, Ascension St. Vincent, and Westminster Village. MOWCI offers traditional or Medicaid subsidized hot and cold meals (for Marion County clients), Ryan’s Meals for Life (HIV/AIDS clients), and Embrace Cancer programs (low-income cancer treatment clients from Eskenazi). In this study, phone surveys were conducted investigating food quality and delivery satisfaction for daily hot and cold clients (n=149). Results were analyzed in Excel using a Chi-Square analysis of independence (alpha 0.05, 3 degrees of freedom). It was found that overall food quality and food smell, taste, and appearance were associated with perceived health improvements in a significantly significant manner with a p-value of 0.0000113 and 0.0198 respectively. There are 248 clients who as of July 7th have not been evaluated and thus, is still an active area of focus for MOWCI. A model has been created and shared with the organization that continues to allow them to collect data on future clients and input the data in order to determine what effect meals have on all of their client population as opposed to the 37.5% of clients that have been evaluated in this project. These efforts will be used in the future to aid in writing grants to allow for the expansion of current and future programs.
Evaluation of Temporal Bone Infections - Comparing Sensitivity of Multiplex Assay to Standard Bacterial Culture
Authors: Higgins Jasmine , Mulinaro Lindsay , Calcagno Joey , Kimble Milani , Burgin Sarah J. Burgin,
Published: January 2023

Background: The multiplex assay is a nucleus acid/base assay that can detect a wide array of distinct nucleic acid sequences from different pathogens. This study hopes to show the necessity and utility of this technology in detecting pathogens that cause middle ear infections. Methods: This observational study was conducted from May 2021-July 2022 to assess the sensitivity of a multiplex assay in a microfluidics pouch in the detection of bacterial and viral pathogens in middle ear fluids. Standard bacterial culture was used as a control. Middle ear fluid was obtained from 98 pediatric patients undergoing tympanostomy to treat otitis media. The BioFire PNA panel was used, which detects bacterial, viral, drug resistance, and atypical bacterial nucleic acid targets. Patient demographics, past medical history, and otitis media risk factors were also recorded.
Results: A total of 107 ear samples were assessed from 98 patients. The average age of study subjects was 3.53 ± 2.99 years. The population of this study was 61.22% male, 75.51% Caucasian, 22.44% African American, and 2.04% Other, 88.78% Non-Hispanic, 10.2% Hispanic, and 1.02% Unknown. We found that Haemophilus influenzae was she most common pathogen detected (multiplex; culture) - (34.58%; 14.02%), followed by Moraxella catarrhalis (10.28%; 4.67%), Streptococcus pneumoniae (6.54%; 2.80%), Staphylococcus aureus (1.5%; 5.61%), and Proteus spp. (.94%; 0%). All bacteria, except Staphylococcus aureus were identified in more ear specimens by multiplex testing than bacterial culture.
Conclusion: Our study demonstrates that multiplex testing is more sensitive than culture in identification of pathogens in middle ear fluid from patients undergoing tympanostomy for treatment of otitis media. The increased sensitivity for bacterial identification and simultaneous detection of viral targets in a very limited patient specimen make the multiplex assay a novel diagnostic tool which may be useful in the management of patients with otitis media in the future.
Socialization of Graduate and Medical Students into Academic Careers
Authors: Stamper Gavin , Sotto-Santiago Sylk
Published: January 2023

Purpose: Socialization is the process through which individuals acquire and incorporate understanding of the organizational culture with shared attitudes, beliefs, values, and skills. This process differs from student to student but is impacted by culture. Our study examines the socialization of medical and graduate students into academic careers and considers their cultural background.
Methods: This research uses the CECE model for cultural engagement along with the graduate student socialization scale by Weidman & Steins (2003). Study population included graduate, medical, and professional students. Participants were recruited via social media advertising as well as targeted communication through various national organizations and school diversity offices. The survey was available from June 15, 2020 and preliminary data was taken on July 8, 2020 which yielded 110 survey responses.
Demographics: Race/Ethnicity: Asian/Asian American (18.39%); Black/African American (10.34%); Latina/o/x/e (6.90%; Middle Eastern or Northern African (2.30%); White (59.77%); Multiracial (1.15%); Caribbean (1.15%). Gender: Woman (69.41%); Man (21.28%); Genderqueer/fluid, Questioning/Unsure, Trans Man, Trans Woman, Non-binary (1-3% each). Sexual orientation Heterosexual/straight (68.24%); Bisexual (7.06%); Gay (8.24%); Queer (5.88%); Lesbian, Asexual, Pansexual, Questioning/Unsure, prefer not to respond (1-4% each).
Results: Between 58-62% of respondents report never being given an opportunity to: engage in research that helps advance their knowledge of inequities, engage in research relevant to their identity, engage in research contributing to the improvement of the communities with whom they identify. Most students (56-71%) have never discussed becoming a faculty member, what it entails, or other careers in academia.
Conclusions: Students report lacking cultural engagement in research; this includes both learning about the cultural communities they belong to but also working on research aimed to improve those communities. Institutions have an opportunity to fill a gap in education by working towards a more culturally engaging campus environment while also recruiting students to academia.
Effects of autologous stem cell therapy for fertility enhancement among women with premature ovarian insufficiency
Authors: Banu Jesmine , Jahan Nishat , Anwary Shaheen A. , Tarique Mostafa , Aziz Itrat , Laskar Nastaran , Hasan M. Rifat , Alamgir Chowdhury F. , Darmini Maliha
Published: January 2023

Background: Premature ovarian insufficiency (POI) is a condition where the ovary loses its normal reproductive potential earlier than 40 years, compromising fertility. There is no treatment for POI, only ovum or embryo donation. Autologous stem cell ovarian transplant (ASCOT) may be a procedure that creates new eggs in the ovaries of women with POI. The aim of the study was to find out the efficacy of ASCOT in patients suffering from POI.
Methods: A total of 50 patients were included according to inclusion and exclusion criteria in this prospective observational study. POI was confirmed with low levels of anti-mullerian hormone (AMH) (<0.5 ng/dl), high level of follicle stimulating hormone (FSH) >25 ng/ml, and or a low number of antral follicle count (AFC) (<3 in each ovary).
Results: Results showed that after stem cell therapy, mean AMH values increased by 0.48±0.306 and mean FSH values increased by 2.73±3.98 but the difference was not statistically significant. AFC values significantly decreased by 1.33±0.625 at 1st post-stem-cell cycle. During the second cycle, AMH and AFC increased by 0.110±0.051 and 4.63±1.49, respectively, and FSH decreased by 7.4±2.78. The increase in AMH and AFC was statistically significant, and the decrease in FSH was also statistically significant compared to baseline values.
Conclusions: The study showed that autologous stem cell therapy can have a significant effect on women’s ovarian function and fertility. It showed that ASCOT can increase AMH and AFC, and decrease FSH in patients with POI, with a total pregnancy rate of 4% after the third cycle follow-up.
Effect of bilateral uterine artery ligation in cases of postpartum hemorrhage on ovarian reserve
Authors: Abo Zaid Mohamed A. , Hagras Ahmed M. , Hefeda Mohamed M. , Hwidy Medhat S.
Published: January 2023

Background: Bilateral uterine artery ligation (BUAL) is a fertility-preserving procedure used in women experiencing postpartum hemorrhage (PPH). However, the long-term effects of this procedure on ovarian reserve remain unclear. Aim to investigate the effect of BUAL in cases of PPH on ovarian reserve,
Methods: This study was carried out at department of obstetrics and gynecology Tanta university on 40 patients divided into 2 groups: (The study group); included 20 patients underwent cesarean section with successful BUAL for intractable atonic PPH, (The control group); included 20 patients underwent cesarean section without BUAL; during a period between April 2020 and December 2021,
Results: There is no-significant difference between study and control group according to AMH (ng/ml), resistivity index (RI) and pulsatility index (PI) of right and left uterine artery and ovarian artery after 6 months of bilateral UAL,
Conclusions: Bilateral UAL had no negative effects on ovarian reserve or ovarian blood supply, so this treatment should be used as a fertility preservation technique to avoid hysterectomy in patients experiencing PPH.
Correlation of HbA1c levels in third trimester with maternal and perinatal outcome in patients with gestational diabetes mellitus
Authors: R. Pavithra , S. Sreelatha , P. Pooja
Published: January 2023

Background: Gestational diabetes mellitus (GDM) is one of the most common metabolic disorders complicating pregnancy. GDM occurs in 2-22% of pregnancies depending on the diagnostic criteria and the epidemiologic characteristics of the population. Elevation of HBA1c have strong correlation with risks of adverse maternal and neonatal outcomes. Aims and objective were to determine the HbA1c levels and to evaluate the maternal and neonatal outcomes in women with HbA1c <5.8% and >5.8%
Methods: A retrospective study at ESIC-PGIMSR from June 2021 to December 2021.All mothers diagnosed with GDM using IADPSG criteria were included. HbA1c measured during the 2nd or 3rd trimester. Cut offs of HbA1c in 3rd trimester was taken as 5.8 according to Versantvoort et al. Maternal and neonatal outcome were assessed among two groups i.e., HbA1c <5.8% the control group and HbA1c >5.8% the case group. Demographic, maternal, and infant data were entered and statistical analysis done using SPSS software.
Results: Total GDM mothers diagnosed were 152 out of 1454 pregnancies. Incidence is 10.4%. the 38.8% were of 25-30 years age group and 46% were multiparous.48.6% neonates were male and 50.6% were females. Among women with HbA1c >5.8%- Preeclampsia seen in 11 cases (21%), polyhydromnios in 5 cases (11.6%), hypothyroidism in 6 cases (12%) UTI in 1 case (2.3%) and candidiasis in 2 cases (4.6%) while among women with HBA1c <5.8% preeclampsia seen in 20 cases (18.3%), polyhydromnios in 2 cases (1.8%), hypothyroidism in 14 cases (13%) UTI in 2 cases (1.8%) and candidiasis in 4 cases (3.6%). Among women with HbA1c >5.8%-respiratory distress syndrome in 6 babies (13%), hyperbilirubinemia in 9 babies (18.6%), hypoglycemia 2 (4.6%) and hypocalemia in 2 babies (4.6%), 14 babies had normal course (32.5%) while among women with HbA1c 5.8% Among women with HbA1c >5.8%-respiratory distress syndrome in 13 babies (12%), hyperbilirubinemia in 20 babies (18.3%) and hypoglycemia 3 (2.7%).
Conclusions: Optimal control of HbA1c along with lifestyle modification and glycemic control helps to reduce maternal and neonatal complications
Micronutrient supplementation in pregnancy: a KAP survey with healthcare consultants in India
Authors: Chandra Sunita , Mane Sheela V. , Biniwale Parag , Sundari M. Tripura , Mulye Anuradha , Adhav Charles
Published: January 2023

Background: Maternal nutrition during pregnancy is a serious public health issue as it negatively impacts women and their children. The most commonly used nutritional interventions during pregnancy are folic acid and omega-3 fatty acid (n-3 FA). This survey aimed to evaluate the knowledge, attitude and perception towards folic acid, n-3 FA and other supplementation amongst healthcare practitioners (HCPs).
Methods: A close-ended questionnaire-based survey was distributed among obstetricians-gynaecologists and HCPs overlooking pregnant and lactating women between July and September 2022 in India. An excel based survey analysis was performed once the survey completed.
Results: A total of 500 valid questionnaires were collected. Only 55% of them recommended n-3 FA, whereas 45% did not recommend as they believed that the typical Indian diet provides enough n-3 FA and supplements are not necessary. The majority (58.91%) of prescribers prescribed n-3 FA to all pregnant women, followed by older women with a history of abortion and high-risk pregnancy. Both eicosapentaenoic acid and docosahexaenoic acid were favoured in clinical practice. In addition, 56.8% of HCPs recommended folic acid at a dose of 5 mg/day for patients with a bad obstetric history, while 43.2% of HCPs recommended folic acid at a dose of 1 mg/day.
Conclusions: Supplements and adequate nutrition can reduce the likelihood of poor maternal and foetal outcomes in high-risk pregnancies. Nutritional supplementation is a cost-effective and safe risk-reduction method, given the high prevalence of pregnancy complications. However, more knowledge dissemination on n-3 FA supplements, folic acid and micronutrients is essential.
A prospective comparative study of urinary calcium creatinine ratio versus doppler study in predicting preeclampsia
Authors: Mounika Murukuti , Haneesha Pottipati , Kameswaramma
Published: January 2023

Background: Hypertensive disorders represent the most common medical complication of pregnancy complicating 5 to 10% of all pregnancies. Several changes have already occurred before the development of clinical syndrome of preeclampsia. One such change occurs in renal function leading to hypo-calciuria. Thus, in present study, urinary calcium creatinine ratio (UCCR) and doppler study are tested as parameters to predict development of preeclampsia in asymptomatic pregnant woman and assessing better predictor among them.
Methods: Hospital based prospective study. Randomly selected pregnant women meeting inclusion and exclusion criteria, will be subjected to detailed history including age, parity, duration of pregnancy, examination including general examination, abdominal examination, routine laboratory investigations, calculate UCCR and ultrasound with doppler study at less than 20 weeks.
Results: Out of 100 women, 25 had UCCR<0.04 and out of which 14 developed pre-eclampsia. Among them 33 had abnormal pulsatility index (PI) at 11-14 weeks and out of which 24 developed pre-eclampsia. In those 100 women, 58 had abnormal PI at 16-20 weeks and out of which 23 developed pre-eclampsia.
Conclusions: Our study shows that we can predict preeclampsia by screening in early weeks of gestation i.e., by uterine artery doppler during NT scan around 11 to 14 weeks and during TIFFA appointment around 16 to 20 weeks and by UCCR. This study shows doppler study prediction is more sensitive and specific compared to UCCR.
A prospective study to investigate the epidemiology of various gynaecological problems among women at a tertiary care centre
Authors: Thiyagarajan Kamalpriya , Chaudhari Vaishali , Patil Yogini , Shah Kshama , Gawali Vijaykumar
Published: January 2023

Background: Women have unique health concerns and are affected by health issues that are either more prevalent in women than in men or a disease that is common in men too but require a different treatment approach in women and this is where women’s health comes into play. Women are afflicted by some or the other reproductive morbidity at least once in their lifetime. These reproductive morbidities are broadly categorised into obstetric, gynaecological or contraceptive morbidity. Among these three categories of reproductive morbidities, gynaecological morbidities are relatively more frequent and account for a major proportion (43%-92%) of the disease burden in women.
Methods: This study was a prospective, single-centre, controlled, observational study conducted from January 2021 to December 2021 in the department of obstetrics and gynaecology of Bhaktivedanta hospital and research institute, Thane, India. The objective of this study was to study the magnitude and impact of a particular type of gynaecological problem in this region and to know the need of developing better preventive and therapeutic protocols including the start of specialised gynaecological clinics.
Results: Among various reproductive health issues, there were three most frequently occurring issues reported which were menstrual disorder, abnormal vaginal discharge and lower abdominal pain with a frequency of 29%, 24% and 19% respectively. Among the menstrual disorders commonly observed in women, the most common disorders were irregularity of menstrual cycles (39%) and menorrhagia (31%). Out of all the characteristics of vaginal discharge, changes in its colour constituted the highest percentage (51%) with white and yellow colour discharge being the most common (23% and 24% respectively).
Conclusions: Menstrual irregularities and reproductive tract infections were the major gynaecological morbidities observed. This study identifies major gynaecological problems and highlights the need for dovetailing health care resources towards it.
Diagnostic difficulties of leptospirosis during pregnancy: a maternal near miss
Authors: Rajandran Priyanka , Papa Dasari
Published: January 2023

A 24-year-old G2A1 at 34 weeks of gestation was admitted with complaints of nausea, vomiting, pedal edema and high blood pressure recordings. She developed imminent symptoms after admission for which she received prophylactic magnesium sulphate therapy and a provisional diagnosis of severe preeclampsia with imminent symptoms was made. With worsening hematological, liver and renal parameters as she did not fulfill the Swansea’s criteria for acute fatty liver of pregnancy (AFLP), partial hemolysis elevated liver enzymes and low platelet count (HELLP) was suspected. She was delivered by cesarean section. Infectious disease work up was sent in view of rising counts and elevated liver enzymes which was positive for leptospirosis. There was also history of walking in the rice fields bare foot and rat infestations in the fields supporting the diagnosis. Both the mother and baby were discharged in a healthy condition. The diagnosis becomes challenging in pregnancy as it mimics pregnancy induced hypertension, acute fatty liver of pregnancy, partial HELLP, obstetric cholestasis and viral hepatitis.
Missed tubal ectopic pregnancy in hysterectomised patient: a rare case report
Authors: Satodiya Mohit , Takkar Navneet , Pandher Dilpreet Kaur
Published: January 2023

Tubal ectopic pregnancy (EP) in hysterectomised patient is uncommon. It has propensity to be overlooked. We report a rare case of missed tubal ectopic in 46 years old hysterectomised patient. She presented with abdominal pain and adnexal mass on imaging. Diagnosis was only possible intraoperatively owing to overlapping symptoms and imaging features with that of ovarian tumor.
Diprosopus tetraophthalmos: a rare congenital anomaly
Authors: Thumar Nidhi , Thakker Yesha , Rathi Neha , Joshi Saumya
Published: January 2023

Diprosopus is an extremely rare form of conjoined twins which is found in newborns where there is partial or complete duplication of face. The etiology and pathophysiology remain unknown and no genetic mutations have definitively associated with the condition so far. This article described a case of an infant born at 33.4 weeks gestation with multiple congenital anomalies including diprosopus tetraophthalmos and discussed the possible hypothesis and implications of prenatal diagnosis.