Browsing by Author "Noel, Josey"

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    Decision Making in Fertility Preservation Prior to Pursuing Curative Treatments for Sickle Cell Disease
    (2023-03-24) Collins, Angela J.; Noel, Josey; Abraham, Olivia; Hornberger, Sydney; Rahim, Mahvish Q.; Jacob, Seethal A.; Saraf, Amanda J.
    AUTHORS: Angela Collins, MPH(1), Josey Noel(1), Olivia Abraham(1), Sydney Hornberger(1), Mahvish Rahim MD, MBA, MSCR(1,2), Seethal Jacob MD, MS, FAAP(1,2), Amanda Saraf DO(1,2). AFFILIATIONS: (1) Indiana University School of Medicine, Indianapolis, IN. (2) Department of Pediatrics, Riley Hospital for Children, Indianapolis, IN. ABSTRACT: RELEVANT BACKGROUND: Sickle cell disease (SCD) is one of the most commonly inherited hemoglobinopathies, often well controlled on Hydroxyurea (HU). Curative therapy options exist with stem cell transplant (SCT) and gene therapy. While both the underlying condition and routine therapy such as HU is thought to impact fertility, the chemotherapy used for both SCT and gene therapy can result in permanent sterility. Infertility can have a negative impact on long-term measures of quality of life. As a result, fertility preservation ought to be offered to all patients with SCD planning for curative treatment. Ovarian tissue cryopreservation and mature oocyte or embryo cryopreservation are fertility preservation options available for pre and postpubescent females respectively. Testicular tissue cryopreservation (TTC) is an experimental option for prepubescent males and sperm cryopreservation is utilized for postpubescent males. CASE DESCRIPTION: We present three cases of patients with SCD who pursued fertility preservation prior to receiving curative therapy with a myeloablative preparative regimen. Patient 1 is a prepubescent 8-year-old male with SCD controlled with HU who opted for TTC as fertility preservation prior to receiving a matched sibling SCT. Patient 2 is a 13-year-old male with SCD controlled with HU who opted for TTC following a failed sperm banking attempt prior to haploidentical SCT. Patient 3 is an 18-year-old female with SCD controlled with HU and Voxelator who opted to have eggs harvested prior to gene therapy. CLINICAL SIGNIFICANCE: As highlighted by these cases, continued research on safe and effective fertility preservation as well as counseling about both the impact of the underlying disease on fertility and treatment-related fertility risks is imperative to improve long-term quality of life measures. CONCLUSION: These patients demonstrate a need for further emphasis on fertility risk counseling in this patient population and ensuring that discussions regarding preservation options is standard of practice at every institution.
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    Decision Making in Fertility Preservation Prior to Pursuing Curative Treatments for Sickle Cell Disease
    (2023-03-24) Collins, Angela; Noel, Josey; Abraham, Olivia; Hornberger, Sydney; Rahim, Mahvish; Jacob, Seethal; Saraf, Amanda
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    Effects of maternal depression on fetal health
    (2022-03) Burger, Taylor; Crowley, Evelyn; Koester, Jami; Noel, Josey; Raza, Mubashra
    Case Description Patient is a 27 years old pregnant (18 weeks) female with a past medical history of depression, post-traumatic stress disorder (PTSD), and military sexual trauma admitted for suicidal ideation with intent and plan. During admission, the patient refused all antidepressants after emesis on sertraline and prenatal vitamins. Patient was discharged after clinical stabilization and scheduled for follow-up outpatient. Conclusions Depression during pregnancy can have numerous adverse effects on mother as well as fetal and child development and thus treatment is of the utmost importance. Depression leads to alterations in the serotonin system and the HPA axis, as well as causes epigenetic changes to the infant glucocorticoid receptor gene. Changes in these pathways are most apparent during the second trimester and have downstream consequences leading to altered fetal heart rate variability, preterm birth, and low birth weight. Maternal depression can also lead to altered cortisol reactivity, and delayed motor and cognitive development in childhood. Furthermore, prevalence of depression varies throughout the pregnancy with depression more prevalent in the second and third trimesters. Clinical Significance Pregnant women are less likely to receive any mental health treatment for depression than their non-pregnant counterparts; 49% and 57% respectively, and screening for depression focuses on postpartum screening with few guidelines to screening during pregnancy. Due to the adverse effects on the fetus, maternal surveillance and treatment of depression during pregnancy is essential.