Browsing by Author "Patel, Pooja"

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    Effects of Sex Hormones on Ocular Blood Flow and Intraocular Pressure in Primary Open Angle Glaucoma: A Review
    (Wolters Kluwer, 2018-10) Patel, Pooja; Harris, Alon; Toris, Carol; Lang, Matthew; Tobe, Leslie; Belamkar, Aditya; Ng, Adrienne; Verticchio Vercellin, Alice C.; Matthew, Sunu; Siesky, Brent; Ophthalmology, School of Medicine
    Primary open-angle glaucoma (POAG) is a multifactorial optic neuropathy characterized by progressive retinal ganglion cell death and visual field loss. Some speculate that gender plays a role in the risk of developing POAG and that the physiologic differences between men and women may be attributed to the variable effects of sex hormones on intraocular pressure (IOP), ocular blood flow, and/or neuroprotection. Estrogen, in the form of premenopausal status, pregnancy, and post-menopausal hormone therapy is associated with increase in ocular blood flow, decrease in IOP and neuroprotective properties. The vasodilation caused by estrogen and its effects on aqueous humor outflow may contribute. On the other hand, although testosterone may have known effects in the cardiovascular and cerebrovascular systems, there is no consensus as to its effects in ocular health or POAG. With better understanding of sex hormones in POAG, sex hormone-derived preventative and therapeutic considerations in disease management may provide for improved gender-specific patient care.
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    Management of Coarctation of the Aorta during Pregnancy: A Case Report.
    (2019-07) Patel, Pooja; Ciresi, Colette; Asdell, Stephanie M.; Hopkins, Kali; Kay, W. Aaron
    BACKGROUND: Patients with coarctation of the aorta are increasingly reaching child-bearing age. Unrepaired coarctations and/or repaired coarctations with recurrent or residual stenosis require close monitoring for hypertension and heart failure, which can increase maternal risk for aortic rupture or dissection and neonatal risks for intrauterine growth retardation, abruptio placentae, and premature delivery. The potential for adverse outcomes may necessitate repair during pregnancy. CASE: An 18-year-old primigravida at 11 weeks gestation with history significant for unrepaired coarctation of the aorta presented with chest pain for 2-3 days and nonpalpable lower extremity pulses. She was previously diagnosed with coarctation at age 3 years, which did not require surgical repair and she was subsequently lost to follow up. Echocardiogram (ECHO) showed a dilated ascending and transverse aorta with decreased pulsatility in the descending aorta, consistent with critical coarctation. Emergent cardiac catheterization was performed and a balloon expanded stent was used to dilate the area of coarctation. Post-procedurally she had zero gradient and went on to have an uneventful pregnancy and delivery. She is now a 23-year-old G5P3. She has two living children with Shone’s complex and had two pregnancies end in miscarriages. Fetal ECHO was performed for each pregnancy and the patient received genetic counseling but declined further genetic testing. CLINICAL SIGNIFICANCE: This case illustrates a successful percutaneous repair of coarctation during pregnancy via balloon expanded stent placement. Fetal ECHO should occur from 18-22 weeks gestation in pregnant women with history of coarctation as prevalence of left-sided obstructive lesions may occur in 10–20% of first-degree relatives. As shared cardiac genetic markers exist between coarctation and Shone’s complex, this case also demonstrates the impact prenatal genetic testing can potentially have on subsequent pregnancies and neonatal outcomes.