Nutritional and Metabolic Diseases Commons^™

Shocking Side Effect: Hypophosphatemia Induced By Hydrochlorothiazide, Kenneth Salu

Gulf Coast Division GME Research Day 2023

No abstract provided.

A Case Of Acquired Acrodermatitis Enteropathica Associated With Inflammatory Bowel Disease And Amyloidosis, Laura Landis, Mitalie Gupta, Ricardo Estrada, Kathryn Hall, Adam Gomez

Central & West Texas GME Research Day 2023

No abstract provided.

A Case Presentation Of Gout Tophus In The Ascending Colon, Alexandria Dennison, Corbin Stephens, Ahmed Saeed, Jay Helsel

Continental, MidAmerica, & Mountain Divisions GME Research Day 2023

No abstract provided.

A Case Of Hyperkalemia Secondary To Table Salt Alternative In A Patient With Normal Renal Function, Souhil M. Jaafil, Laura Tortora, Erin Marra, Steven Shapiro

East Florida Division GME Research Day 2023

Introduction: Hyperkalemia is a commonly presenting electrolyte derangement, usually secondary to chronic kidney disease or medication use. In one retrospective study by Singer et al of 100,260 Emergency Department (ED) patient visits it was found that 1 in 11 ED patients presented with a potassium derangement (1). Patients can present in various ways, from asymptomatic to life threatening arrhythmias. A less commonly recognized cause of hyperkalemia is dietary substitutions for everyday table salt. Ayach et al reported a patient with potassium of 9.8 mmol/L secondar to dietary substitutions but with acute kidney injury and ACE inhibitor use (2). Through a …

Perioperative Anesthesia Optimization Can Be Life Saving In Mitochondrial Disease: A Case Report, Christian Schroeder, Ethan Mosley, Austin Mccrea, Saptarshi Biswas

South Atlantic Division GME Research Day 2023

No abstract provided.

Longitudinal Study On The Effects Of Implementing Continuous Glucose Monitoring For The Management Of Patients With Type-I And Type-Ii Diabetes Mellitus On Multiple Insulin Injections In An Internal Medicine Residency Clinic, Andrey Manov, Sukhjinder Chauhan, Gundip Dhillon, Athena Dhaliwal, Sabrina Antonio, Yema Jalal, Ashrita Donepudi, Jonathan Nazha, Melissa Banal, Joseph House

Far West Division GME Research Day 2023

No abstract provided.

The Impact Of Physical Activity Education During Pregnancy, Lizeth Banuchi

DNP Research Projects

Abstract

Background: Physical Activity (PA) during pregnancy is important to maintain optimal maternal and neonatal health. Gestational Diabetes Mellitus (GDM) requires close monitoring during pregnancy due to the health risk it can cause to mother and fetus. It is evident that PA can help improve maternal health outcomes to positively offer overall wellness throughout the pregnancy.

Objective: The purpose of this Quality Improvement Project (QIP) is to evaluate the impact of PA education on PA implementation during pregnancy and improve clinical practice for healthcare providers to introduce PA education during prenatal care per ACOG and CESP guidelines.

Method: This quality …

Effects Of A Residential Lifestyle Intervention Program On Selected Lipid Measures And Nutritional Choices, Delores M. Rugless

DNP Research Projects

Abstract

Objective: Cardiovascular disease has been the leading cause of death since the early 1920s. As with other chronic diseases, cardiovascular disease is primarily influenced by behaviors and the environment, with poor nutrition being a major contributing factor. Despite knowing the importance of lifestyle modification to manage cardiovascular disease effectively, many individuals have difficulty adhering to lifestyle modification principles. Residential lifestyle modification centers provide the education and support necessary to assist individuals with implementing behavioral changes. This DNP project aimed to demonstrate the value of diet modification implemented at a residential lifestyle center to decrease specific cardiovascular risk factors. Method: …

Lifestyle Tools For Men’S Health And Disease Prevention: Well-Being Through Nutrition, Physical Activity, Stress Management, And Connection, Leigh A. Frame

Clinical Research and Leadership Faculty Publications

Mental health is an often-overlooked aspect of overall health and wellness (well-being). Mental illness is increasingly common with 1 in 5 American adults experiencing it annually, and 1 in 20 suffering from a serious mental illness each year [1]. Treatment rates for mental illness are lower in men (37.4%) compared to women (51.2%) [1]. Globally, treatment rates are similar with an estimated cost to the global economy of $1 trillion annually, yet less than 2% of government health expenditure is for mental health worldwide [2]. Despite this, only nine studies have been published specifically targeting men’s mental health through lifestyle …

Progressive Acceleration Of Insulin Exposure Over 7 Days Of Infusion Set Wear, Jasmin R. Kastner, Timothy S. Bailey, Poul Strange, Leon Shi, Keith A. Oberg, Paul J. Strasma, Jeffrey I. Joseph, Douglas B. Muchmore

Department of Anesthesiology Faculty Papers

Insulin exposure varies over 3 days of insulin infusion set (IIS) wear making day-to-day insulin dosing challenging for people with diabetes (PWD). Here we report insulin pharmacodynamic (PD) and pharmacokinetic (PK) data extending these observations to 7 days of IIS wear. PWD (A1C ≤8.5%, C-peptide tmax (P < 0.001), Cmax (P < 0.05), and mean residence time (P < 0.0001). Area under the insulin concentration curve (AUC0–300) declined by ∼24% from days 0 to 7 (P < 0.05). These results confirm/extend previous observations showing progressive acceleration of insulin exposure over IIS wear time. This may have implications for PWD and designers of closed-loop algorithms, although larger studies are necessary to confirm this. The study was registered in clinicaltrials.gov (NCT04398030).

Eating Disorders In Men: A Comprehensive Summary, Connor James Spratt, Liam Alexander Mackenzie Myles, Emanuele Maria Merlo

Journal of Mind and Medical Sciences

Eating disorders (EDs) have detrimental effects on an individual’s physical and mental health, along with significant interpersonal, social and economic effects. Furthermore, men who are suffering with an ED face unique challenges with this. Men suffering with EDs have historically received little attention within ED research, diagnosis and intervention. However, the number of men suffering with these issues is significant and growing. Understanding of EDs tend to ignore male experiences, meaning many are left to suffer in silence until the ED has developed to a critical point. However, many now recognize the need to understand the issues facing men suffering …

Vitamin C Deficiency In A Food Insecure Patient: A Rare Case Report, Gersham J. Rainone, Tatiana J. Han, Muhammed Rahim, Gregory J. Pirolli, Alina Popa, Jayaram Thimmapuram

Transformative Medicine

Introduction: Scurvy is rarely seen in developed countries and is characterized by deficiency of vitamin C, which can lead to symptoms including wound impairment, bleeding manifestations, and loss of teeth. Case Description: We present a case of a 53-year-old male with a right knee hemarthrosis after a fall. The patient also noted progressively enlarging spontaneous hematomas, denying any recent trauma except for the fall to the knee. He denied family history of bleeding and clotting disorders and endorsed aspirin use in the setting of a prior stroke. He actively resided at a local shelter with limited means of transportation for …

Efficacy Of Various Interventions For Achieving Target Hba1c Levels For Patients With Type Ii Diabetes Mellitus And On Exogenous Insulin, Caitlin S. Welch, Archie Troxel

Longitudinal Scholar's Project

Objective: To learn the rates at which patients at UT Family Medicine–St. Francis (UTFM–SF) with type II diabetes mellitus are being prescribed recommended medications—namely metformin, sodium-glucose cotransporter 2 (SGLT2) inhibitors, and glucagon-like peptide 1 receptor agonists (GLP1RAs)—whether these rates correspond to the severity of hyperglycemia (as indicated by HbA1C level). A secondary goal of the study was to investigate if HbA1C levels are being checked at recommended intervals.

Methods: A retrospective chart review was conducted using records of patients seen at the clinic in the previous four years between the ages of 18 and 65 who had visits with ICD …

The Effects Of Vitamin D Supplementation On Athletic Performance And Injury Prevention, Amani Adeeb Abushamma

Journal of Sports Medicine and Allied Health Sciences: Official Journal of the Ohio Athletic Trainers Association

Vitamin D supplementation has numerous effects on athletic performance and plays a significant role in preventing an athlete’s risk of getting injuries. Vitamin D has an impact on numerous physiological functions such as: bone health, muscle function, inflammatory response, and immune function. An athlete’s bone and muscle health are essential for maximum performance and career success. A bone fracture due to vitamin D deficiency can delay an athlete’s training and ultimately inhibit obtaining a collegiate scholarship and/or contract. A cross sectional study found that more than half of athletic trainers did not view 25-hydroxyvitamin D(25[OH]) testing and vitamin D supplementation …

A Sailor’S Disease Presenting In Urban America With Red Spots On The Legs, John A. Buchan, Bruce H. Gray

Cooper Rowan Medical Journal

Sailors were often affected by nutritional deficiencies due to the absence of fresh foods on long voyages. One example is the development of scurvy from a lack of vitamin C ingestion. In modern society in which fresh food are available this disease is infrequently recognized. The following case describes a 62-year-old male who presented with “red spots” on his legs and a large area of ecchymosis on his thigh. After initial testing failed to elicit a cause, a dietary history revealed that the patient had a peculiar diet of only ice cream with a total avoidance of fruits and vegetables. …

Health Equity & Obesity Management: An Improvement Project In A Federally Qualified Healthcare Center In Central Harlem, Brianna Bouchez

Doctor of Nursing Practice Scholarly Projects

Description of the problem: Obesity is a growing healthcare problem worldwide with extraordinary costs to the individual's health and the healthcare system. Individuals most affected by obesity include socioeconomically disadvantaged individuals, often with limited resources to seek specialized care.

Available knowledge: Various weight-loss interventions exist but access and success rates vary. Weight loss is often modest and additional factors such as social determinants of health, health literacy, and patient motivation are all factors important to the success of an intervention.

Specific Aims: The purpose of this quality improvement project was to improve self-regulatory weight loss behaviors and increase weight loss …

Feasibility And Efficacy Of Bisphosphonate Use For The Prevention Of Bone And Muscle Loss, Laura E. Flores

Theses & Dissertations

Loss of bone and muscle mass often occurs in tandem, increasing the risk of fragility fractures. Whereas many drugs are approved for the treatment of bone loss, there are few treatments available for the concomitant loss of bone and muscle. Identification of a treatment to mitigate pathologic bone and muscle atrophy has the potential to impact countless populations and influence approaches for healthy aging. Bisphosphonates have emerged as a potential treatment for both bone and muscle loss in cellular, murine, and observational human studies. Our findings of modest weight maintenance in postmenopausal women treated with 12-months of risedronate, relative to …

Evaluation Of Awareness, Knowledge, And Preventive Intervention Of Nonalcoholic Fatty Liver Disease Among Chinese Young Adults, Yi Du

Theses & Dissertations

The prevalence of nonalcoholic fatty liver disease (NAFLD) among Chinese young adults (CYA) aged 18-25 years ranges from 4.7% to 15.1% and has kept increasing in recent years. Previous studies reported limited awareness and knowledge of NALFD among middle-aged and older Chinese populations, however, they have not investigated awareness in CYA, for which there is no well-validated questionnaire. There is currently no efficacious educational intervention on NAFLD for CYA.

The objectives were 1) to develop and validate a questionnaire which can be used to assess the awareness and knowledge of NAFLD among CYA; 2) to assess the awareness and knowledge …

A Case Of Diabulimia In A 23-Year-Old Woman With Extensive Comorbidities, Stephen Poos, Kaitlin Mcgowan, Ashaki Martin

Rowan-Virtua Research Day

Diabulimia is defined as intentionally withholding insulin injections for the purpose of weight loss in the setting of type 1 diabetes mellitus (T1D).

It is characterized as an eating disorder (ED), although it does not yet have DSM diagnosis status.

Recognition of the condition among medical professionals is limited but growing.

Wernicke’S Encephalopathy Secondary To Hyperemesis Gravidarum, Mohammad Rattu, Alexander Norinsky, James Espinosa, Alan Lucerna, Henry Schuitema

Rowan-Virtua Research Day

Wernicke’s encephalopathy (WE) is a neurological disorder secondary to thiamine deficiency that is precipitated by administration of glucose-containing fluids prior to thiamine supplementation. Though WE is typically diagnosed among alcoholics (12.5%), the prevalence among nonalcoholics can vary from 0.04-0.13%. Around 30-40% of patients with underlying thiamine deficiency will only experience one of the symptoms from the typical triad, with the complete triad (encephalopathy, oculomotor dysfunction/nystagmus, and ataxia) only evident among 5-16% of the population. Among the non-alcoholic patient population presenting with WE, a history of vomiting is more frequent. While nausea affects around 80% of pregnant women, an extreme form …

Painless Scrotal Ulcers Become Something Unexpected: A Rare Case Of Scrotal Calciphylaxis, Riddhima Issar, Jinisha Patwa, Yvette Wang

Rowan-Virtua Research Day

Calciphylaxis is a rare vascular disorder that presents with painful skin necrosis due to calcium accumulation in skin and adipose tissue. Most commonly, cutaneous manifestations of calciphylaxis are seen on the buttocks, thighs and extremities. Very few cases have presented unconventional locations of these calcified eschars and ulcers such as the penis and scrotum. Risk factors for this disease include chronic kidney disease, hyperparathyroidism, long-term hemodialysis and diabetes. This case presents an atypical presentation of painless scrotal ulcers.

A high degree of clinical suspicion in patients with ESRD on HD and T2DM is needed to effectively reach a diagnosis of …

The Impact Of The Covid-19 Pandemic On Pediatric Obesity In School-Aged Children, Amaani Faizal, Maryanna Schweininger, Suzanna Hosein

Rowan-Virtua Research Day

The prevalence of childhood obesity in those aged 2-19 in the United States was 19.3% in 2017-2018. Childhood obesity is a major health concern with growing rates of incidence. Being overweight or obese put children at risk for developing several chronic conditions such as coronary artery disease, type 2 diabetes mellitus, hypertension and asthma at a younger age. Studies have shown that higher BMI numbers in childhood added an increased risk of being obese as an adult.

The pathophysiology of developing obesity includes several complex factors ranging from nutrition, physical activity, genetic background and lifestyle preferences. Among children, nutrition and …

Case Report: Thyrotoxic Hypokalemic Periodic Paralysis, Kelly Schuitema, Wayne Tamaska, Robin Lahr

Rowan-Virtua Research Day

Thyrotoxic crisis, or thyroid storm, is an acute, life threatening event caused by hyperthyroidism with mortality up to 8-25% that can present with multi-system organ involvement. It is a rare, but well studied complication in the emergency department but can lead to further, less common complications. In this study we will discuss a case of thyrotoxic hypokalemic periodic paralysis. Thyrotoxic hypokalemic periodic paralysis (TPP) most commonly affects Asian men. The key features of the syndrome include acute onset of hypokalemia and paralysis. The hypokalemic aspect of the disorder is secondary to the shift intracellularly by thyroid hormones’ sensitization of Na+/K+-ATPase …

Case Study Of Metformin-Induced Lactic Acidosis, Kajel Patel, Kishan B. Patel

Rowan-Virtua Research Day

Metformin induced lactic acidosis is when high levels of metformin cause dangerously high levels of lactic acid. Here is a case report of a 72-year-old female who came in for nausea, vomiting, and diarrhea found to have a high suspicion for metformin induced lactic acidosis. She stabilized in the emergency department, nephrology and ICU was contacted, and she went for emergent dialysis. For many patients the prognosis of metformin induced lactic acidosis is poor. This patient was made comfort care by her family.

Childhood Mortality During And After Acute Illness In Africa And South Asia: A Prospective Cohort Study, Childhood Acute Illness And Nutrition (Chain) Network, Abdoulaye Hama Diallo, Abu Sadat Mohammad Sayeem Bin Shahid, Ali Fazal Khan, Ali Faisal Saleem, Benson O. Singa, Blaise Siezanga Gnoumou, Caroline Tigoi, Syed Asad Ali, Zaubina Kazi

Department of Paediatrics and Child Health

Background: Mortality among children with acute illness in low-income and middle-income settings remains unacceptably high and the importance of post-discharge mortality is increasingly recognised. We aimed to explore the epidemiology of deaths among young children with acute illness across sub-Saharan Africa and south Asia to inform the development of interventions and improved guidelines.
Methods: In this prospective cohort study, we enrolled children aged 2-23 months with acute illness, stratified by nutritional status defined by anthropometry (ie, no wasting, moderate wasting, or severe wasting or kwashiorkor), who were admitted to one of nine hospitals in six countries across sub-Saharan Africa and …

Prevention Of Diabetes-Related Hospital Readmission Following Initial Diagnosis Of Diabetes In Patients Over The Age Of Fifty: A Scoping Review, Nathan Miller Dnp, Agacnp, Fnp, Jasmine Harris Dnp, Fnp, Michael Clardy Dnp, Agacnp, Diana Dedmon Dnp, Acnp, Fnp-Bc

Doctor of Nursing Practice Projects

Purpose/Background: By reviewing multiple studies related to the treatment of patients with new diagnoses of diabetes, this scoping review will endeavor to determine which interventions, when implemented for patients over 50 years old which are newly diagnosed with type 2 diabetes, can decrease the likelihood of hospital readmission related to diabetes within 90 days when compared with those patients who did not receive or participate in follow-up.

Methods: For resources to be eligible to review they had to be from 2015 or after. Studies selected included patients over the age of 50 newly diagnosed with type 2 diabetes subject to …

Vitamin D Level Testing In An Urban Midwest Clinic: To Test Or Not To Test?, Daniel Mundt, Marianne Klumph, Kayla Heslin, Wajih Askar

Journal of Patient-Centered Research and Reviews

Vitamin D deficiency (VDD) is significantly higher among urban populations in the U.S. Midwest, with African Americans being disproportionately affected. There is ongoing debate surrounding who and how often individuals should be screened for VDD. This study aimed to understand the prevalence of VDD, associated risk factors, and discrepancies in testing at an urban-based internal medicine residency clinic. Data were retrospectively collected on all adult patients seen by the clinic during 2018 and descriptive statistical analysis performed. Among 3976 total patients (mean age: 53 years), 18% (n = 698) had vitamin D levels analyzed, with deficiency found in 71% of …

Association Between Self-Reported Body Mass Index And Active Life Expectancy In A Large Community-Dwelling Sample Of Older U.S. Adults, Haomiao Jia, Erica I. Lubetkin

Publications and Research

Background: Obesity may have a protective effect (greater survival) in older adults, a finding known as the "obesity paradox." This study examined the association between self-reported body mass index (BMI) and active life expectancy (ALE) among older U.S. adults.

Methods: Using the Medicare Health Outcomes Survey Cohort 15 (2012 baseline, 2014 follow-up), we estimated life expectancy and ALE by participants' baseline BMI and age using multi-state models. A participant was classified as in an active state if this person reported having no difficulty for any of these six activities of daily living (ADLs).

Results: Small differences in life expectancy were …

Increased Inflammatory Low-Density Neutrophils In Severe Obesity And Effect Of Bariatric Surgery: Results From Case-Control And Prospective Cohort Studies, Maria Dulfary Sanchez-Pino, William S. Richardson, Jovanny Zabaleta, Ramesh Thylur Puttalingaiah, Andrew G. Chapple, Jiao Liu, Yonghyan Kim, Michelle Ponder, Randi Dearmitt, Lyndsey Buckner Baiamonte, Dorota Wyczechowska, Liqin Zheng, Amir A. Al-Khami, Jone Garai, Rachel Martini, Melissa Davis, Jessica Koller Gorham, James B. Wooldridge, Paulo C. Rodriguez, Lucio Miele, Augusto C. Ochoa

School of Medicine Faculty Publications

Background: Low-density neutrophils (LDN) are increased in several inflammatory diseases and may also play a role in the low-grade chronic inflammation associated with obesity. Here we explored their role in obesity, determined their gene signatures, and assessed the effect of bariatric surgery. Methods: We compared the number, function, and gene expression profiles of circulating LDN in morbidly obese patients (MOP, n=27; body mass index (BMI) > 40 Kg/m2) and normal-weight controls (NWC, n=20; BMI < 25 Kg/m2) in a case-control study. Additionally, in a prospective longitudinal study, we measured changes in the frequency of LDN after bariatric surgery (n=36) and tested for associations with metabolic and inflammatory parameters. Findings: LDN and inflammatory markers were significantly increased in MOP compared to NWC. Transcriptome analysis showed increased neutrophil-related gene expression signatures associated with inflammation, neutrophil activation, and immunosuppressive function. However, LDN did not suppress T cells proliferation and produced low levels of reactive oxygen species (ROS). Circulating LDN in MOP significantly decreased after bariatric surgery in parallel with BMI, metabolic syndrome, and inflammatory markers. Interpretation: Obesity increases LDN displaying an inflammatory gene signature. Our results suggest that LDN may represent a neutrophil subset associated with chronic inflammation, a feature of obesity that has been previously associated with the appearance and progression of co-morbidities. Furthermore, bariatric surgery, as an efficient therapy for severe obesity, reduces LDN in circulation and improves several components of the metabolic syndrome supporting its recognized anti-inflammatory and beneficial metabolic effects. Funding: This work was supported in part by grants from the National Institutes of Health (NIH; 5P30GM114732-02, P20CA233374 – A. Ochoa and L. Miele), Pennington Biomedical NORC (P30DK072476 – E. Ravussin & LSU-NO Stanley S. Scott Cancer Center and Louisiana Clinical and Translational Science Center (LACaTS; U54-GM104940 – J. Kirwan).

Does Tight Glycemic Control Slow The Progression Of Chronic Kidney Disease?, Elani Dodd

Graduate Research Projects

No abstract provided.