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Browsing by Author "Khan, Maria"
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Item Atypical HUS: A Rare Life-Threatening Pregnancy Complication Not to Miss(2021-03) Khan, Maria; Burger, Taylor; Mulcahey, Caitlyn; Taber-Hight, ElizabethCase Description: 32yo G2P2002 woman developed hypertension and AKI on the day after her c-section. She also had vision and mental status changes, headaches, paresthesia, dyspnea, and abdominal pain. Her labs were significant for increased LFTs, thrombocytopenia, and worsening kidney function. After receiving urgent hemodialysis and not responding to plasmapheresis, she was diagnosed with atypical hemolytic-uremic syndrome (aHUS) and started on eculizumab which resulted in significant improvement. She continued to receive dialysis for 2.5 weeks. Conclusions: Atypical hemolytic uremic syndrome is a rare but life-threatening postpartum complication that can resemble other conditions like preeclampsia, HELLP, and TTP. Post-partum patients experiencing hypertension or other kidney injury symptoms should be evaluated further and started on eculizumab early to prevent permanent kidney damage. Clinical Significance: Pregnancy represents a complement amplifying condition which may reveal underlying genetic abnormalities. When working up women who experience acute kidney injury (AKI) during pregnancy, it is important to consider risk preceding obstetric conditions such as hypertensive disorders (preeclampsia, HELLP), fetal death, and hemorrhagic events which may trigger disorders like aHUS/TTP. Plasma exchange response can help differentiate TTP from aHUS. If unresponsive to plasmapheresis, eculizumab effectively treats aHUS by inhibiting the terminal complement cascade. Renal recovery after aHUS is variable. Women can undergo complete recovery or long term dialysis with eventual kidney transplantation. Early initiation of Eculizumab is linked to greater improvement in GFR after one month and fewer incidences of end-stage renal disease. Recurrent episodes of aHUS are possible and prophylactic Eculizumab has been shown to decrease the likelihood of recurrence. Future pregnancies are advised against due to the risk of pregnancy to cause further thrombotic events.Item Fostering Leadership in a Student-Run Free Clinic Medical Executive Board and Across Interdisciplinary Partners.(2022-03-30) Haddad, Aida; Khan, Maria; Gensel, Annie; Barber, Mckenzie; Aksu, Eric; Klipsch, Eric; Class, Jon; Brown, Lucy; Kabir, Jason; Etling, Mary AnnBackground: Being a member of a healthcare executive board requires a unique sense of resolve and passion for service. Not only are these leaders operating a student-run free clinic, but they are also full-time professional students while balancing extracurricular activities to discern their healthcare vocation. Board members feel pulled in many directions, resulting in imposter syndrome and possibly untapped leadership potential. Leadership succumbing to this pressure in 2021 might have resulted in the permanent closure or dysfunction of a clinic after COVID-19 required closure for one year. This study will discuss the interventions employed by the clinic’s Chair, Vice-Chair, Women’s Health co-chairs, and Operations chair to overcome the burden felt when faced with reopening a large, interdisciplinary, free clinic serving approximately 34 patients per weekly clinic day. Though fostering interpersonal relationships best encompasses the theme with which the above leaders encouraged hope during a time of global suffering, relationships were encouraged through multiple discrete interventions forming camaraderie and trust within and between interdisciplinary executive boards. Interventions: Medical Executive Board: In anticipation of the added pressures of reopening the clinic amid COVID-19, the Chair took special care to create a culture of collegiality and mutual vulnerability by facilitating various ways to ‘check-in’ with her board. She hosted preterm and midterm check-ins with each leader to discuss their vision for their role on the board. The Chair and Chair-elect also hosted the clinic’s first annual leadership retreat to support each member in finding their leadership style, and in turn, becoming familiar with their colleagues’ leadership styles. The Chair and Chair-elect will also perform exit interviews with all graduating board members. Partners: Reopening during the pandemic meant reorganizing the entire clinic flow and limiting the number of volunteers present. As a result, many interdisciplinary partners could not participate in the initial reopening and had to be brought in slowly throughout the year. Partner participation was encouraged by monthly meetings with all partners (regardless of clinical presence), and an active group chat with leaders. The Vice-Chair also emphasized alternate means of participation. Some partners organized winter clothes and food drives, while others fundraised for the clinic. All partners were encouraged to develop telehealth plans. The fall partners’ retreat fostered community, during which all partners brainstormed 2022 goals. Results/Conclusion: Medical Executive Board: As a result of the above interventions, clinic leadership not only reopened the free clinic but fulfilled many years-long goals, which include rolling out a weekday telehealth protocol, serving record numbers of patients during a time of immense need, publishing the inaugural clinic-wide monthly newsletter, and formulating the clinic’s first-ever mistreatment policy. The leadership retreat inspired our Women’s Health Coalition to host a retreat; a check-in with the Women’s Health chair led to a midterm co-chair election to sustain the coalition long-term. Finally, the Operations chair spearheaded changes to clinic flow to avoid COVID-19 outbreaks–in doing so, she inspired a record turnout for this position at the 2022 elections. Partners: By the end of 2021, all interdisciplinary partners had resumed in-person care. However, the regular monthly meetings, alternate projects, and retreats fostered community and interest in the clinics even when all could not physically participate.Item Pediatric emergency department use by Afghan refugees at a temporary housing facility(Wiley, 2023-04-17) Ulintz, Alexander; Anderson, Katherine; Shah, Ishani; Khan, Maria; Weinstein, Elizabeth; Peterson, Rachel; Emergency Medicine, School of MedicineObjectives: In August 2021, "Operation Allies Welcome" evacuated 76,000 Afghan refugees to 8 US temporary housing facilities. The impact of refugee influx on local emergency department (ED) use and the resources needed during resettlement are poorly described. We report the frequency of pediatric ED visits and characterize the ED resources needed by pediatric Afghan refugees from 1 temporary housing facility. Methods: This single-center, retrospective cohort study identified participants via a refugee identifier in the medical record. The primary outcome was the frequency and timing of pediatric ED visits; secondary outcomes included resources used during ED evaluation and management. Trained reviewers collected data using a predefined instrument and descriptive statistics are reported. Results: This study included 175 pediatric ED visits by Afghan refugees. The highest volumes (n = 73, 42%) occurred 3-5 weeks after evacuation. Common presenting complaints included fever (36%), gastrointestinal (15%), and respiratory (13%). Resources used included radiography (64%), lab testing (63%), and medication (78%). Specialist consultation occurred in 43% of visits; infectious diseases (17%) and neurology (15%) were the most common. Discharge (61%) was more common than admission (39%), though 31% of discharged patients had a repeat ED visit. Only 51% attended a recommended follow-up appointment. Conclusion: In this study, most pediatric ED visits by refugees occurred within 5 weeks of arrival. Most patients were discharged after diagnostic testing, medication, and specialist consultation, but repeat ED visits were common. These patterns have important implications in preparing for future mass displacement events.