Implementing The Fib-4 Tool For Liver Fibrosis Screening In Diabetic Patients In Primary Care, Robert I. Montillano

Doctor of Nursing Practice Final Manuscripts

Abstract

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly non-non-alcoholic fatty liver disease (NAFLD), affects over 1 in 3 adults with type 2 diabetes mellitus (T2DM) and is a leading cause of advanced liver fibrosis. Despite guideline support from the American Diabetes Association (ADA) and American Association for the Study of Liver Diseases (AASLD), screening practices remain inconsistent in primary care. The Fibrosis-4 (FIB-4) index is a validated, low-cost, noninvasive tool for fibrosis risk stratification, yet it remains underutilized despite its availability in many electronic health record (EHR) systems.

Purpose: This Doctor of Nursing Practice (DNP) evidence-based practice (EBP) project …

Engineering A Novel Treg Population To Control Autoimmune Diabetes, Sofia Colon Guzman, Elly Puckett, Mary A. Markiewicz, Ryan T. Fischer

Research Days

We created a model to test the immunosuppressive capacity of Helios+FOXP3+ eTregs compared to nTregs against islet-specific autoreactive T cells. We also showed that nTregs decrease the response of these cytotoxic T cells when co-cultured with BetaLox5 cells.

The Impact Of Motivational Interviewing On African-American Men With Type 2 Diabetes Mellitus, Jamekia Kitchens

Doctor of Nursing Practice (DNP) Translational and Clinical Research Projects

African-American men with type 2 diabetes face an immense health disparity in the United States, with alarming mortality rates compared to their counterparts. This pilot study examined the impact of motivational interviewing on African-American Men with type 2 diabetes mellitus. The researcher conducted motivational interview sessions using the components of the Diabetes Management Self-Efficacy Scale to guide the meetings. Pre- and post-confidence levels and pre- and post-hemoglobin A1c levels were collected and analyzed. After the completion of three motivational interview sessions, participants displayed significantly higher self-efficacy scores with significantly decreased A1c levels. The results suggest that motivational interviewing has a …

Untreated Subclinical Hypothyroidism Is Associated With Higher Mortality And Hepatic Decompensation In Patients With Masld/Mash: A Multinational Analysis, Do Han Kim Md, Donghyun Ko Md, Jose A. Porres, Wilhelm S. Basegoda Md, Cristina H. Makarian, Luis M. Nieto Md, Pedro Palacios Argueta Md, Paul T. Kroner Md, Frank J. Lukens Md

Posters

This study aims to explore whether subclinical hypothyroidism contributes to the progression of MASLD/MASH, reflected as an increased risk of liver-related outcomes.

Functional Characterization Of The C-Terminal Cholinesterase-Like (Chel) Domain Of The Thyroid Hormone Precursor Protein, Berenice Morales-Rodriguez

Pharmaceutical Sciences (MS) Theses

Vertebrate life is unsustainable without thyroid hormones. The only known precursor for thyroid hormone synthesis is thyroglobulin (Tg), composed of upstream regions I-II-III and a C-terminal cholinesterase-like (ChEL) domain, which bears 47% similarity to acetylcholinesterase (AChE). Mutations in Tg cause congenital hypothyroidism, the most common congenital endocrinopathy affecting 1 in 2,000-4,000 newborns, with a varying degree of phenotypic manifestations. Tg protein, regulated by TSH, is secreted to the lumen of thyroid follicles, where thyroxine (T₄) is formed primarily at the N-terminus, and triiodothyronine (T₃) is formed primarily in the ChEL domain. Previous in vitro studies indicated …

Economy Smart Watch Fails To Accurately Monitor Blood Glucose Among Healthy Adults, Thinh Le Mr., Douglas Oberlin Dr., Adam Mohan Mr.

Undergraduate Research

Monitoring and maintenance of blood glucose (BG) concentrations is of critical importance to individuals with diabetes mellitus. However, this often requires multiple finger-sticks and a glucometer, or the use of a prescription continuous glucose monitor (CGM). Recently, some smart watches have become available which claim to non-invasively monitor BG. This should not be confused with watches that pair with CGMs. The purpose of this study was to assess whether the economy smart watches were capable of detecting BG changes among healthy individuals. Currently three participants have completed this study. Healthy young adults reported to the lab after a 4-6 hour …

Igg4-Related Autoimmune Pancreatitis In Patients With Prior Occupational Exposure: A Case Report And Review Of Risks Concerning Blue-Collared Workers, Zachary A. Coren, Justin Le, Jason Tran, Nicholas Moscardelli, Krish Patel, Joshua Coren

Rowan-Virtua Research Day

Autoimmune pancreatitis (AIP), a manifestation of IgG4-related disease (IgG4-RD), is a rare, often misdiagnosed condition that can closely mimic pancreatic cancer, particularly in its clinical and radiographic presentation. We report the case of a 76-year-old retired plumber who presented with painless jaundice and was initially suspected to have pancreatic cancer based on imaging findings. Subsequent endoscopic evaluation, biopsy, and markedly elevated serum IgG4 levels led to a diagnosis of type 1 AIP. Treatment with corticosteroids resulted in rapid clinical improvement and reduction in IgG4 levels, confirming the diagnosis.

This case highlights the diagnostic challenges of AIP, especially among blue-collar workers …

Case Report: Non-Ketotic Hyperglycemia Hemichorea-Hemiballismus In The Emergency Department, Veroneka Mikhail, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Non-ketotic hyperglycemia hemichorea-hemiballismus (NH-HC), also known as diabetic striatopathy, is a rare condition characterized by glucose levels greater than 200 mg/dL and continuous, involuntary, and irregular large amplitude jerky movements localized predominantly to one side of the body called hemichorea-hemiballismus. While the differential diagnosis of irregular movements is vast, including seizures disorder, stroke, tumors, Tourette’s syndrome and rheumatic fever, clinicians should also consider diabetic striatopathy as a differential as it has very good prognosis and is easily treatable if diagnosed early. Here we discuss the case of a 72 year-old male with history of non-insulin dependent type 2 diabetes (T2DM), …

Case Report And Brief Review: Hypoglycemic Hemiplegia As A Stroke Mimic, Joel Collins Ii, James A. Espinosa, James Lee, Alan Lucerna

Rowan-Virtua Research Day

Here we present the case of a 47-year-old male with a history of diabetes mellitus (DM), who was brought to the emergency department with right sided hemiparesis and slurred speech. His blood sugar was 37 mg/dL. An intravenous line was established quickly, and the patient was administered intravenous dextrose. Within five minutes, his symptoms had significantly improved and by 10 minutes had resolved completely. A CT head and CT angiogram of the head and neck were within normal limits. Basic laboratory tests were within normal limits. The initial neurology service consult noted that his diagnosis was hypoglycemic hemiplegia. The patient …

Effectiveness Of Exercise After Meals In Reducing Blood Sugar In People Who Are Overweight, Obese, Or Have Type 2 Diabetes: A Systematic Review And Meta-Analysis, Brian Fardman, Jie Kang, Nicholas Ratamess, Avery Faigenbaum, Jill Bush

Rowan-Virtua Research Day

Studies investigating the acute effect of postprandial exercise (PPE) on glucose responses exhibit significant heterogeneity in terms of participant demographic, exercise protocol, and exercise timing post-meal. As such, this study aimed to further analyze the existing literature on the impact of PPE on glycemic control in overweight individuals and individuals with obesity and type 2 diabetes (T2DM). A literature search was conducted through databases such as PubMed, CINAHL, and Google Scholar. Thirty-one original research studies that met the inclusion criteria were selected. A random-effect meta-analysis was performed to compare postprandial glucose area under the curve (AUC) and 24 h mean …

Effect Of Time-Restricted Feeding On Anthropometric, Metabolic, And Fitness Parameters: A Systematic Review, Brian Fardman, Jie Kang, Nicholas Ratamess, Avery Faigenbaum, Jill Bush, Noah Beller, Ariselle Vargas, Tyler Andriopoulos

Rowan-Virtua Research Day

Time restricted feeding (TRF) as a form of intermittent fasting (IF) has gained popularity because its ability to reduce body mass (BM) without an emphasis on caloric restriction. However, how this dietary protocol may affect health, fitness, and performance in a relatively healthy cohort remains less clear. The purpose of this article was to systematically review the current literature concerning the effect of TRF on anthropometric, metabolic, and fitness parameters in normal-weight adults and overweight and obese individuals. A systematic search of English literature was conducted through databases including PubMed, CINAHL, and Google Scholar. The search was facilitated by using …

A Systematic Review On Cinacalcet’S Effect In Reducing Pth Serum Levels In Peritoneal Dialysis Patients, Akhil Gumidyala, Youssef Daoud, Mark Hanna, Han Jie Liu, Rikita Doshi

Rowan-Virtua Research Day

Background: Patients with Chronic Kidney Disease (CKD) have low calcium levels. Low blood calcium triggers the parathyroid gland to constantly secrete parathyroid hormone (PTH) in an attempt to raise blood calcium levels back to normal. One way PTH tries to do this is by removing calcium from bone. Chronically high PTH levels leads to increased bone resorption and increases the risk for bone fractures and mortality risk. This phenomenon is called secondary hyperparathyroidism (SHPT). Calcimimetics, like cinacalcet (sensipar), act similarly to calcium by binding allosterically to Calcium-Sensing Receptors (CaSR) on the parathyroid gland, thereby reducing PTH levels. The effect of …

Analysis Of Blood Pressure, Blood Glucose, And Cholesterol Screening Results Collected During Street Outreach Events In Atlantic County, New Jersey, As Part Of A Mobile Community Health Worker Program To Identify Residents At High Risk For Severe Covid-19, Kenneth W. Stagliano, Richard T. Jermyn, Alexander E. Abbott, Donato F. Tassoni, Amy Palen, Frank Carozza, Nicole M. Miller

Rowan-Virtua Research Day

Background: This study seeks to evaluate the status of random blood pressure, cholesterol, and blood glucose screening results in Atlantic County, NJ. This study also aims to identify the rates of hyperlipidemia, hyperglycemia, and hypertension within the target population, and potential differences between surveyed age demographics.

Methods: Medical students participating in the COVID-19 CHW Service Corps collected blood pressure, cholesterol, and blood glucose screenings at multiple screening events in Atlantic County, NJ during a two-year period. This data was analyzed retrospectively using ANOVA, non-parametric Kruskal Walis Test, and Tukey's pairwise comparisons.

Results: Senior adults had significantly higher SBP than …

A Case Report Of Primary Central Nervous System Lymphoma Presenting With Diabetes Insipidus, Lan Ngo, Adam Kandil

Rowan-Virtua Research Day

Diabetes insipidus (DI) is characterized by decreased secretion or action of antidiuretic hormone (ADH), resulting in polyuria, polydipsia, and potential electrolyte disturbances. Severe hypernatremia secondary to uncontrolled DI can manifest with neurologic symptoms including seizure-like activity. This case report discusses a case of central DI arising from damage to the pituitary gland as the first presentation of a brain tumor, in the context of a 56-year-old patient who presented with seizure-like activity and sensory changes.

Navigating Insulin Access For Pediatric Type 1 Diabetes: Caregivers' Experiences And Challenges, Ella Anderson

Doctoral Dissertations

Between 2012 and 2018, the annual 14% increase in insulin prices made Type 1 Diabetes (T1D) the most expensive chronic health condition, significantly raising out-of-pocket costs for uninsured or underinsured individuals in the United States (Hayes & Farmer, 2020; Willner et al., 2020). This study utilized a qualitative content analysis methodology to explore the challenges and experiences of parents with children diagnosed with T1D with accessing insulin for their child. Five participants from various areas of the United States responded to open-ended questions both in person and via Zoom. The analysis revealed three main themes: pragmatics of managing diabetic care, …

Associations Between The Timing Of 24 H Physical Activity And Diabetes Mellitus: Results From A Nationally Representative Sample Of The Us Population, Qian Xiao, Qiuyu Feng, Martin K Rutter, Gali Albalak, Heming Wang, Raymond Noordam

Faculty, Staff and Student Publications

Aims/hypothesis: Growing evidence suggests that timing may be an important aspect of physical activity that influences cardiometabolic health. However, the current literature is inconclusive regarding the time of day that physical activity offers the greatest metabolic advantages. We investigated associations between hourly physical activity levels and diabetes mellitus and glycaemic biomarkers in a cross-sectional and nationally representative sample of US adults.

Methods: We studied 7074 adults (mean age 48 years; 52% women) from the National Health and Nutrition Examination Survey (2011-2014). Physical activity was measured by actigraphy. A monitor-independent movement summary (MIMS) unit was used to derive the total activity …

Diabetic Retinopathy: A Pathophysiological Discussion, Nathanael C. Nicholls

Senior Honors Theses

Diabetic retinopathy is a severe complication of diabetes that is capable of causing vision loss or blindness. As a result of hyperglycemia, the disease increases oxidative stress and activates biochemical processes such as the Hippo pathway and the complement system to cause significant damage to the retina. Overexpression of BTG1 and microRNA-183 enables activation of biochemical pathways that lead to negative effects on the retinal vascular endothelium including angiogenesis and inflammation. Conventional methods of diagnosis for diabetic retinopathy include fundus examination, nucleoside detection, and optical coherence tomography angiography. Photocoagulation and hormonal intravitreal injection are the most popular current treatments, while …

The Combined Effect Of High-Intensity Interval Training And Time-Restricted Feeding On The Akt-Igf-1-Mtor Signaling Pathway In The Muscle Tissue Of Type 2 Diabetic Rats, Motahareh Mohebinejad, Fatemeh Kazeminasab, Mahtab Ghanbari Rad, Reza Bagheri, Mazdak Razi, Darryn Willoughby, Fred Dutheil

Faculty, Staff and Students Publications

Background/Objectives: High-intensity interval training (HIIT) and time-restricted feeding (TRF) have shown potential in enhancing glucose metabolism, increasing insulin sensitivity, and promoting muscle health. This study investigates the combined effects of HIIT and TRF on the AKT-IGF-1-mTOR signaling pathway in the muscle tissue of type 2 diabetic (T2D) rats.

Methods: 42 male Wistar rats (4-5 weeks of age) were included in the study. The animals were randomly divided into two groups: 1. Standard diet (SD) non-diabetic (n = 7) and 2. High-fat diet (HFD n = 35) for 4 weeks. T2D was induced by intraperitoneal injection (IP) of streptozotocin (STZ) …

Impact Of Cde Referral On A1c Control In Adult Type 2 Dm Patients., Alivia Watts Bsn, Rn, Yesica Sanchez Bsn, Rn, Morgan Hilliard Bsn, Rn, Laura Reed Dnp, Fnp-Bc

Doctor of Nursing Practice Projects

Type II Diabetes Mellitus is a chronic health condition impacting many adults in Tennessee. Certified Diabetic Educators (CDEs) are specifically trained in educating and addressing the health care needs of patients with diagnoses of Type I or Type II Diabetes. Research has shown that education conducted by CDEs leads to improved outcomes and self- care in those with diabetes (Bowen, et al., 2016, King et al., 2019). Not only are CDEs cost effective services leading to a decrease in healthcare costs, but they also aid in the improvement of hemoglobin A1C (Hgb A1C) levels and decrease complications associated with Type …

Thyrotoxic Periodic Paralysis: Acute Paralysis As The Initial Presentation Of Graves' Disease Triggering A Stroke Alert, Osadebamwen Osaghae, Hafiza Qadeer, Sapna Sharma, Vinita Singh

Tower Health Research Day

No abstract provided.