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Browsing by Author "Owusu, Raiven"
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Item Black vs African American: Why are communication and clinical researchers not paying attention to what descendants of the African Diaspora want to be called, and why is that a problem?(Indiana Medical Student Program for Research and Scholarship (IMPRS), 2020) Owusu, Raiven; Ridley-Merriweather, Katherine; Hoffmann-Longtin, KristaProblem: Descendants of African Diaspora (DADs) in the U.S. experience greater health disparities than other racial or ethnic minority groups. Many factors play a role, including their lack of participation in clinical trials. By refusing to participate, DADs cannot benefit from medical research. The barriers to recruiting DADs is well discussed in literature, but we found no research suggesting that mislabeling participants could be creating another barrier. This essay delves into the history of labeling DADs to illuminate the existing tensions between the use of “Black” and “African American” and the impact they may have on recruitment. Processes: Communication Theory of Identity and Critical Race Theory shaped our analysis of this mislabeling issue and its possible implications. Both theories offer insight into how an individual shapes and is simultaneously shaped by communication. We reviewed, summarized, and coded literature in the academic and popular press to answer the research question: How can mislabeling DADs possibly deter them from participating in clinical trials? Findings: Within DADs, there are several subgroups with different cultural heritages that contribute to how people identify. Therefore, no “catch-all” label can be used to accurately describe DADs. Academic and popular press literature indicate that preferences exist amongst this group for how they wish to be identified. Researchers should realize that “Black” and “African American” are not perceived the same by many DADs and should refrain from using them interchangeably. Conclusion: Given the current Black Lives Matter movement, it is imperative that health communication scholars and health researchers consider how language shapes participation and research outcomes for DADs. More research is needed to determine if the use of “Black” and “African American” interchangeably creates another barrier to the recruitment of DADs. However, if possible, researchers should take time to note the preferences of their target populations prior to recruitment.Item Cerebral Vein Thrombosis in Concomitant Combination Oral Contraceptive Pill Use and COVID-19(2023-03) Owusu, Raiven; Bode, Leah; Jansen, Nicole; Libke, Megan; Mehta, RakeshCase Description: Patient is a 27-year-old female who presented with confusion, fever, and chills and was found to have a cerebral vein thrombosis (CVT) on MRI. She had a seven-year history of combination oral contraceptive pill (OCP) use and prior to onset of symptoms tested positive for COVID-19. After CVT diagnosis, she started apixaban, which was discontinued 6 months later. She decided to discontinue her OCP and had a copper intrauterine device (IUD) placed. Clinical Significance: CVT is a rare form of stroke that most commonly affects young women. Pregnancy, puerperium, and OCP all use induce a hypercoagulable state which increases risk for CVT. Estrogen causes increased circulating procoagulant factors in the plasma, and combined OCP users are often found to have an acquired resistance to activated protein C6, which both contribute to a hypercoagulable state. COVID-19-associated coagulopathy also induces concurrent hyper-inflammatory response, hypercoagulability, and vascular endothelial cell dysfunction. These pathologic mechanisms are believed to be linked to elevated plasma levels of coagulation factors and reduced fibrinolysis, resulting in prothrombotic events. COVID-19 infection is thought to exacerbate existing prothrombotic states like OCP use. Conclusion: Concomitant hypercoagulable states, such as combination OCP use and COVID-19 coagulopathy, increase overall risk for thrombotic events. Patients with risk factors for hypercoagulability presenting with headache, visual changes, and confusion should be evaluated for CVT. Following a thrombotic event in a patient on combined OCPs, finding an alternative contraceptive that meets the patient’s reproductive goals and lowers their risk of repeat thromboembolic events is important. Progesterone-only and non-hormonal contraceptive options, such as IUDs, have a decreased risk of thrombosis compared to combined OCPs and can provide alternative contraceptive methods.Item Hyperprolactinemia Secondary to Paliperidone: Considerations for Women of Childbearing Age(2022-03) Gensel, Annie; Owusu, Raiven; Owens, Jourdan; Wendel, Kaitlin; Davis, HillaryCASE DESCRIPTION: A 27 year old female with past medical history significant for schizoaffective disorder, borderline personality disorder, major depressive disorder, and catatonia was admitted following a suicide attempt. During her admission, she revealed that she has had a persistent delusion of believing she was pregnant despite not being sexually active in several months and having multiple negative pregnancy tests. After the patient was started on paliperidone, she stopped menstruating, further perpetuating this delusion. The patient also expressed concerns for infertility in the future. CONCLUSION: Paliperidone has a high incidence of hyperprolactinemia which can lead to reproductive concerns including menstrual irregularity and infertility. These side-effects highlight the critical need for shared decision making in discussions about fertility in patients with psychotic disorders. Further complicating this issue is the significant increase in psychosis risk during the perinatal period. There are other alternatives that exist and may be better options for some patients but changing medications to oral options should be balanced with medication adherence needs. CLINICAL SIGNIFICANCE: Through shared decision-making, the selection of antipsychotic maintenance therapy should consider a variety of patient and physician goals. A younger age of initial psychotic break has strong indications for reproductive counseling, which should remain consistent with patients’ goals and be reassessed as goals evolve throughout their lifetime. Patients who struggle with medication adherence may benefit from long acting injectable antipsychotic medications. However, some of these injections, like paliperidone, can cause hyperprolactinemia and contribute to infertility. Prolactin levels can be monitored and lowering medication doses can be effective for mitigating hyperprolactinemia. There are oral medications available that have a lower chance of causing hyperprolactinemia. However, oral only medication options must be balanced with patient medication adherence concerns.Item PAS the Salt: A Case of Autoimmune Polyglandular Syndrome Type II(2021-03) d'Arnaud, Lindsey; Owusu, Raiven; Vinze, Sanjna; Vucescu, Raluca I.CASE DESCRIPTION: Here we present the case of a 71 year old female with a decades-long history of Hashimoto thyroiditis and vitiligo who developed Addison Disease (AD). Routine labs showed serum sodium of 124, and the patient reported fatigue and lightheadedness on follow-up with her primary care physician. Despite discontinuation of hydrochlorothiazide, subsequent labs showed Na of 112 and she was sent to the emergency department and found to have hypoosmolar hyponatremia consistent with syndrome of inappropriate antidiuretic hormone secretion. Fluid restriction, saline infusion, and later sodium-chloride tablets failed to improve sodium levels two days after admission. Further investigation revealed low morning cortisol that did not respond to adrenocorticotropic hormone (ACTH) stimulation, demonstrating adrenal insufficiency. Later workup revealed elevated serum ACTH and positive 21-hydroxylase antibodies consistent with autoimmune adrenalitis. CONCLUSION: AD, albeit rare, is important to consider in severely hyponatremic patients with established monoglandular endocrinopathy. CLINICAL SIGNIFICANCE: The patient has autoimmune polyglandular syndrome type II (PAS-II), defined by the presence of AD and either autoimmune thyroid diseases (AITDs) and/or type one diabetes mellitus; patients may also exhibit other autoimmune conditions such as pernicious anemia, premature ovarian failure, alopecia, vitiligo, celiac disease, or multiple sclerosis. PAS-II is a rare diagnosis with a prevalence of 1-2 per 100,000 and a male-to-female ratio of 1:3. It is usually not recommended to routinely screen for other autoimmune diseases in patients with existing AITDs. Autoimmune endocrinopathies pose potential harms to patients, such as life-threatening adrenal crisis, metabolic derangements, infertility, and worsened quality of life; these harms ought to be considered in deciding if and how often to screen for concomitant autoimmune disorders in patients with monoglandular autoimmune endocrinopathies.Item Treatment of Opioid Use Disorder During Pregnancy: Buprenorphine or Methadone?(2020-03) Davis, Elizabeth; Owusu, Raiven; Vinze, Sanjna; Arnaduo, CamillaBACKGROUND: In 2011, 5% of pregnant women 15 to 44 yo reported opioid/illicit drug use during pregnancy, and this percentage is rising. Opioid use disorder (OUD) is a chronic disease associated with adverse effects on maternal and fetal health, such as physiologic withdrawal at birth, low birth weight, congenital abnormalities, and higher relapse rates. Pregnant women treated for OUD with medication-assisted-treatment (MAT) have significantly reduced adverse effects. MAT is the standard treatment of OUD in along with counseling/therapy. Opioid agonists, namely buprenorphine and methadone, are common treatments, as they prevent opioid withdrawal symptoms, improve adherence to prenatal care, and reduce the risk of relapse. CASE: Patient is a 26 year old G2P1 female presenting with buprenorphine, heroin, and methamphetamine use during pregnancy. She had a vaginal delivery of a healthy baby girl at 40+2 weeks (APGARs 8 and 9). She used heroin during the first trimester of pregnancy and started buprenorphine treatment at 5 months’ gestation. Pregnancy complicated by a 3 weeks in a rehab center at 8 months following relapse on methamphetamine. CLINICAL SIGNIFICANCE: Research is being conducted on the risks and benefits of buprenorphine vs methadone as MAT. Buprenorphine overall has better maternal and neonatal outcomes when compared to methadone. Mothers taking buprenorphine during their pregnancy were more likely to start MAT prior to or earlier in pregnancy and had longer gestations compared to methadone. In regards to neonatal outcomes, methadone has been associated with higher rates of neonatal mortality and congenital anomalies when compared to buprenorphine. NAS generally is less severe with buprenorphine, and newborns require treatment significantly less often and for a shorter duration. Newborns exposed to buprenorphine are associated with greater birth weight but more gastrointestinal abnormalities. With the increase in OUD during pregnancy, research regarding the most effective MAT is timely and critical.