Browsing by Author "Vander Missen, Marissa"

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    At The Heart of the Matter: An Atypical Case of Spontaneous Coronary Artery Dissection
    (2022-03) Thamba, Aish; Patel, Bhumi; Vander Missen, Marissa; Frey, Julianne
    CASE: A 51-year-old female with a history of hypertension and ADHD presented to the emergency department with sharp substernal pain and nausea. Initial EKG showed anterior ST-segment elevation. Patient vitals were 53 bpm, 170/110 mmHg, and 90% O2 saturation on room air. The patient was on a prescribed amphetamine for ADHD and propanol. She was given nitroglycerin by EMS; and carvedilol, heparin, and ticagrelor at the hospital. Echocardiogram found diffusely hypokinetic to akinetic apex, distal anteroseptal wall, and mid to distal anterior/anterolateral walls, suggestive of ischemia or stress-induced cardiomyopathy. Subsequent coronary angiography demonstrated 95% stenosis in the left anterior descending artery with ulceration, type 4 dissection segment, and thrombosis. Two drug-eluting stents were placed successfully; lisinopril and carvedilol were increased, and atorvastatin and ticagrelor were initiated. CONCLUSION: This patient presented with multiple risks for SCAD: female, hypertension, use of dextroamphetamine-amphetamine, family cardiac history, and middle-age. However, the consult differential did not include SCAD. Instead, the leading diagnosis was stress-induced cardiomyopathy due to EKG presentation. SCAD was discovered after initial stent placement. SCAD is a rare vascular emergency where a tear spontaneously forms in a coronary artery and can precipitate myocardial infarction by occluding perfusion, potentially resulting in sudden death. Confounding factors in the presentation were newly increased dextroamphetamine-amphetamine and alcohol use, indicating that typical SCAD presentations, as taught, may not be inclusive of all cases. CLINICAL SIGNIFICANCE: Broadening differentials or diagnostic criteria for SCAD could improve SCAD screening and diagnosis. Additionally, providers have been shown in the literature to underdiagnose cardiac events and undertreat pain in females relative to male patients experiencing the same events. This case exemplifies the importance of a more inclusive differential to provide comprehensive care for female patients.
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    Slemenda Scholars: The Impact of Early Experiential Learning in Global Health Education​
    (2023-04-28) Gaviola, Micaela; Resner, Destiny; Vander Missen, Marissa; Baenziger, Jenny
    BACKGROUND: Global health electives, and other international experiences in medical education, typically expose medical students in their clinical years to the practice of medicine in a resource-limited setting. These experiences have been shown to improve medical knowledge and clinical skills, promote personal and professional development, and influence the trajectory of trainees’ careers. The Slemenda Scholars (SS) program at Indiana University School of Medicine offers preclinical students early exposure to the field of global health through a summer research program in collaboration with the Academic Model Providing Access to Healthcare (AMPATH), a 30-year partnership between Indiana University and Moi University that seeks to provide and expand sustainable access to high quality care through education and research. HYPOTHESIS: In this study, we analyze didactic and experiential learning opportunities described in publicly available articles written by students participating in the program, as well as responses to a survey. We hypothesize this analysis will demonstrate the influence of the SS program on students’ choosing a global health career, publishing scholarly work in the field of global health, and fostering personal and professional growth. We aim to identify unique aspects of the SS program relative to other global health programs. METHODS: This mixed methods study qualitatively assessed Internet articles written about the SS program and quantitatively analyzed a cross-sectional survey administered to past participants of the program via electronic mail in January 2023. Key phrases used to find Internet articles were “Slemenda Scholars,” “Slemenda Scholars Program,” “Slemenda,” and “IUSM Slemenda.” Themes were generated based on grounded theory and constant comparative model and finalized after three consensus meetings. The eight-question survey measured previous global health experience and personal and professional outcomes related to the program. Survey data collection is ongoing and will be analyzed via descriptive statistics. RESULTS: Thirty-one articles underwent full review and 25 were included in final analysis. Final themes were grouped into “Educational experience,” with 16 themes, and “Impact of Educational Experience,” with 14 themes. Salient examples included Cross-cultural Interactions and Motivation for a Service-Oriented Career, respectively. In themes of educational experience, 56% of all articles mentioned learning about AMPATH, research, personal and professional cross-cultural interactions, and 60% described network-building. In themes of “Impact,” 48% of articles reflected on ethical/sustainable global health, impactful patient experiences, and motivation for a career in global health. The survey was distributed to 70 former Slemenda Scholars. Results including demographics, rates of continuation in and publication of global health work, and measures of difference will be reported. CONCLUSIONS: The results of article analysis reveal the value of experiential global health learning early in the undergraduate medical career. Key program outcomes of expanding perspectives, developing relational skills with diverse colleagues, and building adaptability prepare medical students for success beyond undergraduate medical studies and fuel a future work force of global health leaders. Few schools offer engagement with long-term global health initiatives like AMPATH. This study highlights a need for the growth of long-term partnerships, with reciprocal benefits for care and education, as well as expanded access to such opportunities.
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    Steroids Precipitating Acute Thyrotoxic Paralysis
    (2022-03-25) Garcia, Jennifer; Pelton, Sarah; Vander Missen, Marissa; Vultorius, Daniela; Patel, Neha; Saeed, Zeb
    Case Description: A 34-year-old Black male was admitted with a new diagnosis of Graves’ disease and impending thyroid storm with a Burch-Wartofsky Score of 25. Initial labs showed undetectable TSH, total T3 of >800, free T4 of 7.21, and TrAb of 21.53. He was started on methimazole, propranolol, and hydrocortisone 100mg q8h. On day 2 of hospitalization, he presented with acute bilateral lower extremity paralysis shortly after eating lunch. His blood glucose was 231, and a stat BMP showed a potassium of 2.0. He was found to have thyrotoxic periodic paralysis (TPP). Steroids were stopped immediately, and he was given additional propranolol and potassium repletion. He received a total of 60mEq KCl and did not have recurrence after steroids were stopped. Conclusion: Steroids are very commonly used in treatment of thyroid storm but can potentially exacerbate endocrine emergencies, such as thyrotoxic periodic paralysis. Additionally, demographic factors may have also decreased the likelihood of considering the potential for TPP as the patient’s race did not correspond to the most common demographics, Asian populations. Thus, it is important to be aware of the potential effects of steroids. Clinical Significance: TPP is a rare complication of thyrotoxicosis. Excess thyroid hormones in the blood increase activity of the Na+/K+-ATPase pump, leading to intracellular shifts of potassium and consequential hypokalemia. Glucocorticoids have been shown to increase the relative amounts of Na+/K+-ATPase pumps and exacerbate hypokalemia. Steroids are one of four common treatments for thyroid storm, so their effects on transcellular ion balance must be monitored. Insulin was also found to increase Na+/K+-ATPase pump activity, explaining why episodes of TPP often correlate with carbohydrate-rich meals. Treatment of TPP, which can be done with repletion of KCl and beta blockers, must monitor for and avoid inducing a hyperkalemic state.