Browsing by Author "Neal, Chemen M."

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    Clinical challenges in diagnosis and treatment of recurrent vulvovaginal candidiasis
    (Sage, 2022-09-08) Neal, Chemen M.; Martens, Mark G.; Obstetrics and Gynecology, School of Medicine
    Vulvovaginal candidiasis is a common infection associated most often with the overgrowth of the fungal species Candida albicans. Although most women will have at least one episode of vulvovaginal candidiasis in their lifetime, some will experience recurrent infections. Recurrent vulvovaginal candidiasis can significantly impact quality of life, causing both physical and psychological symptoms, and poses a substantial financial burden for women and the health care system. Acute vulvovaginal candidiasis infections are often diagnosed symptomatically by clinicians or self-diagnosed by patients themselves; this can result in over- and underdiagnosis, as well as misdiagnosis, and has the potential to lead to ineffective treatment and incomplete infection resolution. Clinical diagnosis should include confirmatory laboratory tests, including microscopy and fungal culture, especially in women with a history of recurrent vulvovaginal candidiasis, who are more likely than women with vulvovaginal candidiasis to be infected with less-common Candida species or with azole-resistant strains. With proper diagnosis, most acute vulvovaginal candidiasis episodes can be successfully treated; however, women with recurrent vulvovaginal candidiasis may require long-term maintenance therapy. US-based guidelines recommend ⩽6 months of maintenance fluconazole treatment, but infection recurs in up to 50% of women treated. There are currently no US Food and Drug Administration–approved treatments for recurrent vulvovaginal candidiasis; however, several promising treatments for recurrent vulvovaginal candidiasis are in development.
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    Investigating the Effectiveness of Case-Based Learning Sessions for Integrating Anatomy Content
    (2022-04-28) Merritt, Emily R.; McNulty, Margaret A.; Neal, Chemen M.; Deane, Andrew S.; Haywood, Antwion A.; Byram, Jessica N.
    Introduction: Adjusting to medical school can be challenging as students learn to adapt to the curriculum’s fast pace and content volume. Gross anatomy, embryology, and histology are increasingly integrated into medical curricula, with the responsibility placed on students to find and understand the relationships between these content areas. Case-based learning (CBL) is an effective and commonly used means of teaching in medical education, and its application of problem-solving skills to clinical cases make it a useful method for integrating content. Study Objective: Therefore, the goal of this research was to assess the effectiveness and value of CBL sessions in integrating gross anatomy, embryology, and histology and promoting effective study techniques. Methods: In 2021, Indiana University School of Medicine implemented a pre-matriculation program (termed “Leadership and Academic Development”, or LEAD, Scholars) targeted toward under-represented students in medicine. The program included content from the first block of the medical anatomy course and four fully integrated CBL sessions that each included anatomy, embryology, and histology content from the upper extremity and thorax. LEAD Scholars (n = 25) were divided into groups of six or seven; for each session, they completed an individual pre- and post-quiz and worked as a group to answer case questions. Cases consisted of one or more clinical scenarios and questions that required students to interpret images, complete matching exercises, and make diagrams or flow charts. Students completed a post-session survey with Likert-style questions and free responses about preparation and session effectiveness. Pre- and post-quiz scores were compared using Wilcoxon signed rank tests. Free responses were analyzed using thematic analysis. Results: Analyses revealed a significant improvement on post-quiz scores for all CBLs (p≤0.002). In the post-session survey, students strongly agreed the sessions were effective at improving their understanding of course content and appropriately connecting anatomy, embryology, and histology content. Students commented that they enjoyed the real-life application of the material, found the sessions helpful for making connections between the topic areas, and encouraged them to keep up with the material. They noted that adding more cases and providing more pre-work to guide preparations would improve the sessions. Students also discussed needing to change their study habits as the sessions progressed and noted difficulty in keeping up with the embryology and histology content in light of the volume of gross anatomy material. Conclusion: These results suggest that CBL sessions are a viable means for delivering integrated medical anatomy content to medical students and providing opportunities to practice and adapt study techniques. Session modifications will focus on expanding the sessions to provide more opportunities to practice the content and study techniques and including specific pre-work activities to guide preparation.
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    Noncandidal vaginitis: a comprehensive approach to diagnosis and management
    (Elsevier, 2019) Neal, Chemen M.; Kus, Lauren H.; Eckert, Linda O.; Peipert, Jeffrey F.; Obstetrics and Gynecology, School of Medicine
    Vaginitis is one of the most common causes of patient visits to gynecologists, primary care providers, and urgent care centers. However, many women leave without a clear diagnosis or experience recurrent symptoms despite treatment. The 3 most common etiologies of vaginitis are trichomonas, bacterial vaginosis, and vulvovaginal candidiasis, which account for an estimated 70% of cases. The remaining 30% may be related to other causes of vaginitis, including atrophic vaginitis, desquamative inflammatory vaginitis, and vaginal erosive disease. The purpose of this review is to describe the noncandidal causes of acute and recurrent vaginitis, with the goal of improving the likelihood of accurate diagnosis as well as efficient and effective therapy. We excluded candidal vaginitis from our review because there was a recently published review on this topic in the Journal. The clinical presentation and evaluation of patients with symptoms of vaginitis can be triaged into 1 of 2 diagnostic pathways: noninflammatory and inflammatory vaginitis. The most common noninflammatory cause is bacterial vaginosis. Features such as irritation, purulent discharge, and the presence of polymorphonuclear neutrophils are more suggestive of an inflammatory process. Trichomoniasis is the most common cause of inflammatory vaginitis. Other well-described forms of inflammatory vaginitis include atrophic vaginitis, desquamative inflammatory vaginitis, and erosive disease. We present a review of the pathogenesis, symptoms, examination findings, diagnostic testing, and treatment for each of these causes of noncandidal vaginitis.