Browsing by Author "Nadeem, Manahil"

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    In the Weeds: Identifying the Underlying Etiology in a Patient with Suspected Hypertrophic Obstructive Cardiomyopathy
    (2024-03-22) Wojciechowska, Klaudia; Denning, Ellen; Bice, Caroline; Nadeem, Manahil; Robles, Maria
    BACKGROUND Many cases of Hypertrophic Obstructive Cardiomyopathy (HOCM) go undetected or are underdiagnosed. Patients are typically young athletes who experience decreased cardiac output, syncope with exercise, or sudden death. The disease is diagnosed with echo but cannot be certain unless a gene mutation is identified. This creates challenges for those who do not fit the classic profile nor have an identified gene mutation. METHODS A 57 y.o. black female presented with a heart murmur. A referral was made to cardiology where imaging results pointed to HOCM, but due to a history of hypertension (HTN) and missing medical records, an underlying etiology of hypertrophy secondary to HTN could not be ruled out. Genetic testing for HOCM was negative despite the patient’s extensive family history of cardiac disease. Due to these conflicting findings, a cardiac MRI was performed. While HTN could not be ruled out as a contributing factor, HOCM was placed as the leading differential. RESULTS The fragmentation of the patient’s medical records meant that the duration of the murmur and HTN is unknown. In addition, each cardiology provider had different interpretations of the radiologic imaging. The led to difficulties obtaining a diagnosis of HOCM vs HCM due to HTN. Given that the patient did not fit the classic demographic presentation of HOCM, it is possible that the diagnosis was not initially considered. By the time a full work-up had been conducted, her HTN had been poorly controlled for years and therefore delineating the root cause of HOCM was difficult. Lastly, the patient tested negative for the 24 gene mutations linked to HOCM, despite an extensive family history of cardiac disease. This highlights that there are likely more unknown mutations and there is a need for improved diagnostic criteria independent of genetic tests. CONCLUSION This case demonstrates the importance of keeping an expanded differential diagnosis, maintaining coherent and comprehensive medical records, and pursuing prompt diagnoses.
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    Perceptions and Barriers to Care for Burmese Refugees, a multi-method qualitative study
    (2024-04-25) Nadeem, Manahil; Messmore, Niki
    BACKGROUND Since 2015, Indiana has been home to over 40,000 Burmese refugees (1). Although the Model Minority Myth would lead U.S. policymakers to believe that all Asian Americans are wealthy, overwhelmingly have college degrees, and have access to health insurance, this is a fallacy (2). According to the Pew Research Center, only 38% of Burmese residents in the U.S. speak English and 25% of Burmese residents experience poverty. Although there is little research on Burmese health outcomes in the U.S., research points to poor health outcomes (3). STUDY OBJECTIVE/HYPOTHESIS This research project aims to identify the barriers and perceptions to healthcare for Burmese refugees and provide plausible solutions. This project includes a narrative review of the existing literature combined with interviews with physicians who specialize in immigrant care. METHODS A narrative review was conducted via PubMed and Google Scholar to analyze the research published on the healthcare of Burmese refugees in the United States. Search terms and MESH terms like refugees, Myanmar, Burma, southeast Asian people, Rohingya, health services accessibility, health status disparities, social determinants of health, and socioeconomic factors were used. Ultimately, 40 articles were included. Interviews with physicians specializing in immigrant care in Indianapolis were also conducted and included in this study. The project includes interviews from Dr. Ashley Overley, CEO of Sandra Eskenazi Mental Health Center, and Dr. Maurice Henein, a family medicine physician at Community Health Network's Center for International Health. RESULTS 40 articles, published in 2005-2023, were included and analyzed for themes. The barriers to care for Burmese refugees are related to languages & communication, healthcare structure, pediatric care, reproductive care, and mental health. Many articles expressed a dire need for reliable interpreters and trauma-informed care (4,5). Moreover, cost and the concept of preventative care are the largest barriers relating to healthcare structure. For pediatric care, research indicates that Burmese parents feel that physicians do not obtain proper consent before treating their children. (6,7,8). Mental health is often equated to craziness when translated and is difficult to navigate with patients (11). Lastly, research found that Burmese women wanted to talk about sex during their health visits, but did not want to initiate the conversation themselves (14,15). Interviews with expert physicians were included in this study. The interviewers expressed that physicians should mobilize community partners and take part in cultural trainings. CONCLUSION AND RECOMMENDATIONS This project aimed to evaluate healthcare for Burmese refugees and provide solutions accordingly. After analyzing the research, it is critical we advocate for reliable interpreters for our patients. Without proper communication, it is impossible to build rapport and trust. Moreover, physicians should educate their patients about the importance of preventative care, mental health, and reproductive health screenings. To improve the quality of care they provide, physicians should initiate workshops and empower community organizations that are providing help to their patients. Indianapolis is home to one of the largest populations of Burmese refugees; it is time we provide the best healthcare for them.
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    Perinatal events and development of juvenile idiopathic arthritis-associated uveitis
    (Springer Nature, 2023-10-16) Chaudhary, Aysha; Nadeem, Manahil; Townsend, Jack; Miller, Victoria J.; Hajrasouliha, Amir R.; Ophthalmology, School of Medicine
    Uveitis is one of the most common manifestations of juvenile idiopathic arthritis (JIA). Currently, JIA is associated with decreased gut microbiota diversity. Studies confirm that perinatal events can cause aberrant microbial colonization. The objective of this study is to determine if JIA is associated with perinatal events with a secondary focus on these variables to the development of JIA-uveitis. 369 patients with strabismus (n = 200) or JIA (n = 196) were included in the study. Completed surveys (JIA 37; strabismus 18) collected data about birth route, pregnancy and labor complications, JIA medications, and the presence of eye disorders. Analysis indicates that there is no relationship between JIA development and the perinatal events investigated. Similarly, no significance was found between JIA-uveitis and birth route or labor complications. Pregnancy complications, namely gestational diabetes (GD), were statistically higher in the JIA group with uveitis compared to JIA without uveitis. The data from this survey study showed that JIA-uveitis was highly associated with pregnancy complications, particularly with GD. However, no statistically significant association was found between JIA and route of delivery, labor complications, or pregnancy complications. Further studies are needed to understand the ways that GD interrelates with the development of uveitis in JIA patients.