Physician Assistant Scholarly Project Posters

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  Comparing the Effectiveness of a Low Carbohydrate Diet and Metformin on Glycosylated Hemoglobin Reduction in Type Two Diabetes Mellitus

  Ashley Schultz

  In this study, a low carbohydrate diet and metformin pharmacotherapy were compared to determine their effect on HbA1c in the type two diabetic patient. Several high quality studies were examined along with each treatment's effect on mainly HbA1c, but also other parameters such as body weight, cholesterol, and fasting and post prandial blood glucose levels. The study showed that both the low carbohydrate diet and metformin pharmacotherapy were effective at lowering HbA1c in the type two diabetic patient. The low carbohydrate diet showed a 0.2% increase in HbA1c all the way to a 2.2% decrease in baseline HbA1c in the studies that were examined. The metformin pharmacotherapy showed between a 0.45% decrease up to a greater than 1% decrease from baseline HbA1c in the studies examined within this project. After looking at the other parameters that were affected by each treatment, it was concluded that choosing treatment between the two options studied will be highly dependent on each individual patient and their readiness and willingness to implement lifestyle changes. Both methods of treatment are equally as effective and can be beneficial to different patients.

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  Treating Peri and Postnatal Depression & Anxiety

  Emily M. Stevenson

  - The objective of this research is to evaluate the commonly prescribed treatment methods for prenatal and postnatal depression, focusing on the efficacy of antidepressant medications and nonpharmacologic treatments while evaluating the effects these medications have on the fetus/breastfeeding infant.

  - The method of research included 15 studies completed within the past ten years on women who were pregnant or who had delivered a baby within the past 12 months. One study did evaluate long-term effects on offspring, which included a participant number of 3,342 children who were exposed to antidepressants during pregnancy. The total number of participants in the studies were 8,069 women.

  - Limitations within the data are due to small sample sizes in several of the studies and few available studies that directly evaluate this population of women and children.

  - Data results suggest that while cognitive group therapy does provide depression symptom improvement in prenatal and postnatal depression and anxiety, antidepressant medications tend to have a positive effect earlier in treatment. Unfortunately, many of these antidepressant medications have also been proven to have both short and long tern effects on the offspring exposed to pharmacologic treatment.

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  Associations Among Acne Vulgaris and Western Diet

  Kate Meredith Suda

  Acne vulgaris is one of the most common dermatologic conditions, especially among the adolescent population.

  The pathogenesis of acne is largely multifactorial, with heredity and hormones strongly contributing to one’s risk of developing the chronic inflammatory skin condition.

  High prevalence rates of acne in the adolescent population cannot be attributed to heredity alone, but by the influence of Western diet (WD) that overstimulates insulin-like growth factors (IGFs).

  The purpose of this scholarly project is to determine if there is an association between the presence of acne vulgaris and the consumption of WD, and if a physiological link between the high glycemic food and dairy products that compose the typical WD exists.

  Includes current research that focuses on the pathophysiology of acne vulgaris, the breakdown of high glycemic foods and dairy products and their propensity to cause inflammatory acne,as well as hyperinsulinism.

  Anticipated to be found that consuming a WD increases IGFs leading to hyperinsulinemia, and furthermore, acne presentation by increased sebum production.

  More research is needed before universal associations can be established.

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  New Ways of Predicting Efficacy of Antidepressants

  Kayla Ternes

  Major depressive disorder (MDD) is a neuropsychiatric condition that is becoming increasingly prevalent in our country. According to Cai, Huang, and Hao (2015), MDD is “common and devastating” (p. 61) and has a very complex pathophysiology. Until recently, a definitive etiology had not been found, however, new evidence has suggested that Brain-derived neurotrophic factor (BDNF) and cognitive-emotional biomarkers may be a key into the mechanism of this disorder.

  A literature review of articles found in PubMed, CINAHL, Cochrane Library, and PsychINFO within the last ten years focused on the hypotheses of the pathophysiology of MDD, cognitive-emotional biomarkers, and BDNF. The review found that MDD has a multitude of interconnecting systems that highlight its mechanism, and this is why it is so difficult to find a treatment option that works. However, cognitive-emotional biomarkers were able to predict the efficacy of certain antidepressants in the treatment of MDD. BDNF was also found to be decreased in patients with MDD and increased after treatment with certain medications. These systems may help predict better treatment response and an overall improvement of the burden of this disease.

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  Antibiotic Therapy in Preventing Exacerbations of Severe Chronic Obstructive Pulmonary Disease

  Jamie Trautner

  • Chronic obstructive pulmonary disease (COPD) is a progressive disease that has no cure but is treatable. The treatment goal is to have adequate symptom control, decreased exacerbations, prevent hospitalizations and maintain an independent quality of life.

  • The review of literature is to determine if the benefits of long-term antimicrobial therapy outweigh the risks in the treatment of severe COPD.

  • The gold standard for pharmacotherapy consists of inhaled corticosteroids and bronchodilators (long-acting beta2agonist (LABA).

  • Adding azithromycin to standard therapy for patients with frequent exacerbations showed a 27% reduction in exacerbation frequency.

  • With prolonged use of antimicrobials there is an increased risk of bacterial resistance. However, in doing this research, it was found that bacterial resistance was not noticed between azithromycin (52%) versus placebo (57%), p = 0.64.

  • Although long-term antimicrobial therapy is becoming a hot topic, it is imperative that we continue to study the detrimental development of bacterial resistance.

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  Decreased Mortality of Pulmonary Arterial Hypertension in Duchenne Muscular Dystrophy and Down Syndrome

  Mitchell Volin

  The genetic cause of significant disorders like Down syndrome (DS) and Duchenne muscular dystrophy (DMD) is well documented. Pulmonary arterial hypertension (PAH), a co-morbid condition, is tied to mortality among these groups. Individuals with the ability to communicate their symptoms and actively participate in treatment are at an advantage with subsequent benefit. DS and DMD significantly decrease physical ability and communication capacity. Genetic research has allowed for earlier identification of, or predisposition for, the development of PAH. Work has also progressed toward manipulation at the genetic level to decrease the severity and even eradicate the cardiopulmonary disorder. This information is beginning to be applied in treatment for individuals with PAH. A literature review was conducted to identify the research, prediction methods and treatment of PAH in individuals with Duchenne muscular dystrophy (DMD) and Down syndrome (DS) as it relates to decreased mortality or increased life expectancy among those groups. The results showed significant gains in the understanding of PAH, DS and DMD individually. There was little evidence of research focusing on PAH as it pertains particularly to DS or DMD.

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  The Effect of Statins in Primary Prevention on All-Cause Mortality

  Brian Adams

  During routine yearly physicals, primary care providers often evaluate serum laboratory lipid levels. Many of these patients have no past medical history of cardiovascular events related to atherosclerotic disease. Some patients do not have secondary risk factors, such as diabetes mellitus or smoking history.

  Previous cardiovascular events provide stronger indications for the use of HMG-CoA reductase inhibitors (statins). In the absence of these, the provider may turn to current guidelines, in this case the 2013 the American College of Cardiology and the American Heart Association published the 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults.

  There is however, controversy, even within the evidence to this guideline, about the effect of statins in primary prevention with respect to the reduction that they have on all-cause mortality. There are many factors that could influence the use of statin therapy for primary prevention. These could include non-fatal myocardial infarction, non-fatal cerebral vascular accident, among others. One of the biggest factors is all-cause mortality.

  A review of the evidence cited for these guidelines demonstrates that the majority of the clinical trials did not show a reduction in all-cause mortality, in primary prevention. It is important to understand that this evidence comes directly from the same evidence that the ACC/AHA used to create the primary prevention guidelines.

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  Fructose and its Contribution to Cardiovascular Disease and Metabolic Syndrome

  Jessica Anderson

  The incidence of obesity, cardiovascular disease, and combination of symptoms classified as “metabolic syndrome” that eventually leads to type 2 diabetes have risen dramatically over the past few decades. The current dietary guidelines that advised patients to avoid dietary fats were originally developed in the 1960’s. This led the way for food manufacturers to remove fats in processed foods and replace them with sugars, particularly fructose. At the time there was no clinical trial data that definitively supported these guidelines.

  The increased use of fructose as a food additive has dramatically increased the per-capita consumption of this sugar. More recent research has found that the unique structural and metabolic differences of fructose as compared to glucose lead to specific pathophysiologic changes in the body that promote obesity, hypertension, atherosclerosis, dyslipidemia and glucose intolerance. Other studies have also found that consumption of certain fats may be beneficial and protective, actually preventing some of the previously mentioned conditions.

  It is evident that fructose consumption, as compared to glucose or fat consumption, leads to a higher incidence of cardiovascular disease and metabolic syndrome in the population. New dietary guidelines, strategies, and changes to food production are necessary to combat this problem, however the reversal of rules that have been in place for decades will be difficult and take many years. Therefore, to have the most impact, patient education needs to start at the primary care level.

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  Curcumin and Fish Oil: Potential Alternative or Adjunctive Treatments to NSAIDs and Immune Modulating Medications for the Treatment of Chronic Inflammation

  Vicki Andvik

  The aim of the present review is to evaluate the efficacy and safety of curcumin and fish oil as alternative or adjuvant treatments to NSAIDs and immune modulating medications for the treatment of chronic inflammation.

  An online search of CINAHL, PubMed, Cochrane and Alt Healthwatchdatabases was conducted. It was limited to peer-reviewed articles and clinical trials in academic journals within the last ten years.

  Current research suggests that curcumin may be efficacious in the treatment of chronic inflammation. It is generally regarded as safe up to 12 gm/day with mild gastrointestinal effects but poor bioavailability has limited its clinical application.

  Current research provides evidence that fish oil is efficacious for the treatment of chronic inflammation in a variety of chronic diseases. It is generally regarded as safe at doses of 3 gm/day with mild gastrointestinal effects and no increased risk of bleeding.

  In vitro studies have demonstrated a synergistic anti-inflammatory effect when curcumin and fish oil are used concomitantly.

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  Proton Pump Inhibitors (PPIs): A Review of the Efficacy, Usage, and Current Literature Recommendations

  Travis M. Booke

  • As Klepser, Collier, and Cochran (2013) noted, PPIs are a class of agents that reduce acid secretion by parietal cells in the stomach by irreversibly blocking H+/K+ adenosine triphosphate. They are commonly prescribed for many gastrointestinal (GI) conditions including gastric and duodenal ulcers, gastroesophageal reflux disease (GERD), upper gastrointestinal bleeding, and Helicobacter pylori infections. They are frequently utilized in the primary care setting. The purpose of this study was to examine the efficacy, usage, and current literature on PPIs.

  • There were several complications noted with PPI usage. Gomm et al. (2016) found that that use of PPI is associated with an increased risk of dementia and that avoiding PPIs may contribute to the prevention of dementia. Klepser et al. (2013) concluded that PPIs were associated with renal disease after controlling for confounding conditions. They noted patients who had renal disease were twice as likely to have used PPIs in the past. In yet another study, Lazarus et al. (2016) concluded that PPI use is an independent risk factor for CKD and AKI, while H2 antagonist use is not. Shih et al. (2014) concluded PPI use was associated with an increased risk of myocardial infarction for both a 7- and 14- day window period. Finally, van der Hoorn et al. (2015) also determined that PPI use was associated with a substantially increased risk of requiring osteoporosis medication and fractures.

  • Histamine-2-receptor antagonists (H2RAs) are often prescribed in place of PPIs. Sigterman et al. (2013) concluded that were superior to H2RAs in treating heartburn in patients both treated empirically and in patents with endoscopy-negative reflux disease (ENRD). PPIs were also noted to be more effective in patients requiring long-term treatment. H2RAs, however, were found to be superior to PPIs in speed of relief of symptoms and may be a better option for patients with only occasional symptoms.

  • Rickenbacher et al. (2014) studied medical vs. surgical management of GERD. Their data showed a statistically significant pooled effect estimate in favor of fundoplication over medical management of GERD, although several patients complained of dysphagia after surgery. Nissen fundoplication has long been the surgical intervention of choice for GERD treatment. It has some drawbacks in that many patients complain of dysphagia and bloating post-surgery. Lal et al. (2017) compared laparoscopic Nissen fundoplication (LNF) to laparoscopic anterior partial fundoplication (LAPF) and found it to be just as effective as LNF for GERD treatment with less dysphagia.

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  Analysis of Metabolic Syndrome as a Modifiable Risk Factor for Prostate Cancer

  Michael Butler

  • Prostate cancer and metabolic syndrome are both prevalent among men in developed countries with peak incidence after age 50.

  • Prostate cancer has no known modifiable risk factors.

  • Most risk factors for metabolic syndrome are modifiable.

  • If metabolic syndrome is identified as contributing to the risk of prostate cancer it would give an element of self determination to men at risk for prostate cancer.

  • Past studies provide conflicting results in the correlation between these two conditions.

  • A literature review was performed to evaluate consistencies in current literature.

  • Metabolic syndrome or its components do not increase the risk of developing overall prostate cancer.

  • Metabolic syndrome does increase mortality from prostate cancer.

  • Men with metabolic syndrome are found to have higher grades of disease upon diagnosis of prostate cancer

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  Evaluating Internet Based Cognitive Behavioral Therapy in Adults with Depression

  Togan Cottrell

  • Depression is one of the most prevalent and costly mental health issues worldwide.

  • Cognitive Behavioral Therapy (CBT) has been a long-standing treatment for patients with depression. CBT has been proven to reduce or eliminate depression symptoms while increasing quality of life.

  • Due to lack of access to care and a deficiency of mental health providers throughout the United States, the frequent and lengthy visits that are required for traditional CBT may not be an option.

  • The use of internet based CBT has been studied as an alternative to traditional therapy and may serve to fill a gap in current care.

  • This review of literature examined the use of internet based forms of CBT in patients ages 18 and older.

  • Internet based forms reviewed included videoconferencing, computer based therapy and smartphone applications.

  • Current research was examined to determine the safety of internet based CBT and compare the cost and outcomes to in- person therapy.

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  Prophylactic Use of Metformin to Decrease the Incidence of Breast Cancer in High Risk, Predisposed Women

  Aly Dahl

  • Breast cancer is one of the most common types of cancer in American women and is the second leading cause of mortality.

  • In 2015, 234,190 new diagnoses were made and 40,730 deaths from breast cancer.

  • Along with a thorough history from the patient, there are also several risk assessment models that should be utilized, such as the common Gail-2 model.

  • Any women with a significant family history should also be educated on genetic counseling and/or testing to detect a BRCA1 or 2 mutation.

  • Numerous individuals who are positive for this gene elect to undergo prophylactic treatment, such as an oophorectomy, mastectomy or the use of Tamoxifen, or an aromatase inhibitor, also called selective estrogen receptor modulators or SERMS.

  • These medications reduce the amount of estrogen in the body, have been shown to reduce cases of breast cancer, but also come with side effects, such as an increased risk of endometrial cancer, cataracts or venous thrombolytic events.

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  Prolotherapy: Applications, Mechanism of Action, Controversy and Evidence

  Boris M. Davydov

  Merriam-Webster defines prolotherapy (PROLO) as “an alternative therapy for treating musculoskeletal pain that involves injection of irritant substance (as dextrose) into a ligament or tendon to promote the growth of new tissue”. Experimental research and multiple clinical trials have generated evidence suggesting that PROLO is effective at treating a variety of musculoskeletal conditions, including tendinopathies, joint instability and ligament laxity. PROLO may also hold a potential to delay or avoid joint replacement and rotator cuff surgeries. Further research is needed to demonstrate the therapeutic effect of PROLO unequivocally.

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  Metformin and Vitamin B12 Deficiency: Consequences and Patient Monitoring

  Kathryn Dietz

  • The incidence of type 2 diabetes has been increasing at a rapid rate in the United States.

  • Metformin is recommended as the first line treatment to be started at the time of diagnosis in all patients without contraindications and has been associated with vitamin B12 deficiency.

  • There are currently no clinical guidelines for the routine monitoring of B12 levels in this population.

  • The purpose of this scholarly project is to determine if there are consequences of this deficiency and to make recommendations for screening patients.

  • It includes current research that focuses on the pathophysiology of a B12 deficiency, the prevalence and consequences of such a deficiency, and practices in monitoring patients for it.

  • While many type 2 diabetics treated with metformin will develop a vitamin B12 deficiency, there may not be any consequences of this deficiency.

  • More research is needed before universal guidelines can be established. At this point in time, monitoring B12 levels should be a decision based on individual patient’s risk factors and symptoms.

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  Prescription Opioids: A Band-Aid for Chronic Low Back Pain

  Rebekah Dunn

  Pain is one of the most common reasons patients seek medical care in the outpatient clinic and emergency department setting.

   • In the last decade, per the Centers for Disease Control (CDC), prescription drug abuse and overdose, specifically opioids, has become the leading cause of injury and deaths in the United States.

  • “Opioids—primarily prescription pain relievers and heroin—are the main driver of overdose deaths and were involved in 28,647 deaths in 2014…opioid overdoses have quadrupled (an increase of 200%) since 2000” (Rudd et al. 2016).

  • In 2016 the CDC established guidelines of clinical practice regarding management of chronic low back pain (CLBP).

  • Clinical evidence shows treatments such as physical therapy, chiropractic care and cognitive behavioral therapy provide positive outcomes.

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  Language Concordance: Overcoming Language Barriers

  Pamela Flavin-Lee

  • Language discordance is a growing problem facing health care today. Communication barriers can be cultural or language based and are commonly cited as a major contributor to poor patient compliance and health outcomes.

  • This research project seeks to identify promising developments aimed at overcoming language discordance through analysis of different translation implementation methods and correlating these with health outcomes.

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  Introduction of Peanuts to the Pediatric Patient

  Leslee Graff

  Peanut allergies have been diagnosed exponentially over the last ten-years and are more severe now than ever before. (DuToit et al. 2106) Some of the latest statistics are citing more than double the amount of peanut allergies diagnosed in the last few years. Guidelines set forth in 2010, by the American Academy of Allergy, Asthma, and Immunology stated that peanut, milk, soy, wheat, egg, and other tree nuts were to be avoided until three years of age, unless these patients have other chronic illnesses such as asthma or other atopic conditions. If so, the patient is to abstain from these items until the age of five years. Once the patient reaches this stage of life, foods are to be introduced slowly, in small quantities, one food at a time. (American Academy of Allergy, Asthma & Immunology, 2010) The guidelines have changed in the last two-years after a study known as Learning Early About Peanut Study, LEAP, became published in 2015. It was previously advised to withhold peanut-laden foods until at least three years of age. Recent guidelines suggest children who are exposed to these food sources can allow for desensitization from these allergens at an early age, before their immune systems are completely competent, minimizing potential anaphylactic reactions. (Learning Early About Peanut Study, 2011) The results of this project aim to justify the newest guidelines and research and show that introduction to the peanut protein at age four to six months, allows for immune competency in the pediatric body and quite possibly in-utero. The pathophysiology of the immune response is exponentially different as the body continues to be introduced to cross-reactive allergens as you age.

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  Anticoagulation Therapy for the Elderly with Atrial Fibrillation

  Rebecca Hoistad

  • Atrial fibrillation increases in occurrence as we age with about 9% of patients developing it by age 90. When a patient is diagnosed with atrial fibrillation, one of the drugs that they are prescribed is an anticoagulant. The purpose of this drug is to prevent thrombus formation in addition to preventing an ischemic stroke. Today, there are many options available for anticoagulation therapy. The options include aspirin, vitamin K antagonists like warfarin, factor Xa inhibitors like rivaroxaban and apixaban, direct thrombin inhibitors like dabigatran, and antiplatelet agents such as clopidogrel.

  • A review of the literature was done of peer reviewed journal articles using the databases PubMed, Dynamed, CINAHL and Clinical Key. A total of 14 articles were used in this paper with the inclusion criteria of being published within the past five years, the patients all have atrial fibrillation, over 65 years old, and are on some form of anticoagulation therapy.

  • Previously, warfarin has been one of the few anticoagulation drugs on the market until the newer novel anticoagulants were released. Bell et al. (2016) found that warfarin is still used in 53.6% of the patients, even though the prevalence has decreased by 3.9% between the years of 2011 and 2013. (p

  • It was found that patients who were diagnosed with atrial fibrillation needed some form of anticoagulation as compared to no anticoagulation to reduce stroke. Most of the studies compared warfarin versus no anticoagulation treatment. There were not many studies that looked at the newer novel anticoagulants. It was mentioned that there has been a decrease in warfarin use since the newer novel anticoagulants have been released. There are considerations that a prescriber needs to be conscious of before prescribing a specific anticoagulant. Some of these considerations are renal function, other medication usage to avoid drug-drug interactions and age.

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  The Effectiveness, Benefits, and Challenges of FertilityAwareness-based Methods of Family Planning

  Annette M. Larson

  The aim of this scholarly project was to evaluate data regarding the efficacy, challenges, and benefits of fertility awareness-based methods (FABMs) of family planning, in order to determine whether there are methods that may be considered effective and beneficial options. After reviewing the available literature regarding current FABMs, it became evident that there are, in fact, current methods available which are viable choices. The most effective methods according to this data are the ovulation and Sympto-Thermal methods, which have actual-use efficacy ratings that, when compared to the commonly prescribed oral contraceptive pill, would recommend them for use. The FABMs, as with all user-dependent family planning options, come with their own set of challenges which affect their actual-use efficacy rates. The FABMs also tout a set of unique benefits which recommend them for use. Though the FABMs may not be the family planning option of choice for all women, the evidence compiled in this review highly recommends them for further study and application. Motivated women who desire a natural option are excellent candidates for these methods.

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  Autism: Benefits and Outcomes of Early Diagnosis and Intervention

  Mitchel Leers

  •The purpose of this review was to determine the importance of early diagnosis and intervention during infancy, leading to significant outcomes which include improvements in communication skills, receptive language and social interaction in children with ASD.

  •Nass et al.,(2016) described ASD as a “heterogeneous group of biologically based, neurodevelopmental disorders characterized by impairments in two areas: deficits in social communication and social interactions and restricted plus repetitive patterns of behavior, interests, and activities”

  •The findings showed that early diagnosis and referral to intervention makes a significant impact on children with ASD showing improvements in many areas of delay including receptive communication, adaptive behavior, social interactions, social approach, joint attention, and IQ.

  •The finding found when applying early intervention children maintained the gains in all areas with no to minimal regression loss of skills after a two year follow-up.

  •The findings indicated that most providers that incorporate screening tools into their practice are referring to early intervention centers and the children are starting intervention prior to official diagnosis.

  •The findings showed that most children are being diagnosed at appropriate ages ranging from 30-120 months.

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  Opioid Maintenance Treatment: Methadone, Buprenorphine, and Naltrexone

  Nicole Lemieux

  Opioid dependence plagues the United States with millions of people suffering from the effects. Throughout recent years, there has been a surge in research in treatment options for patients suffering from opioid dependence. Three medications have stood out: methadone, buprenorphine, and naltrexone. The purpose of this study was to investigate the three and decipher which provides the best outcomes for patients. Research was conducted by reviewing literature via PubMed, PsychInfo and Cochrane. A review of the literature found that methadone has been used the longest and has been shown to be efficacious, but can be severely limiting for patients due to lack of clinics and the need for daily dosings. As a result, buprenorphine was developed as an alternative medication with similar efficacy and retention rates to combat the daily dosages and provide a more readily available medication. Unfortunately buprenorphine also has geographical limitations. Naltrexone is the newest medication added to the mix. Orally, it has poor retention, but an extended release form has been developed that is showing promise. There are no geographical limitations associated with naltrexone and the extended release form allows for only monthly injections. Going forward with opioid treatment, medications like naltrexone and those that are more readily available will become more widely used for treatment as patient preference is pointing towards medications that are not limited by geography or frequent dosing.

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  Folate as an Adjunctive Therapy for Treatment Resistant Depression

  Katherine McFarland

  Numerous medications are available to treat depression, yet many patients do not achieve remission or recovery of their symptoms with traditional therapies alone. Folate supplementation has been shown to be beneficial in the treatment of depression when used in addition to traditional prescription therapy. A literature review was conducted to determine the effect of low folate levels on depression and if supplementation with either folic acid or L-methylfolate benefits this patient population. Key search terms including folate, folate deficiency, methylfolate, nutrition, and depression were used to perform searches of multiple databases and journals including PubMed, CINAHL, PsycInfo, and the American Journal of Psychiatry. Studies such as the one conducted by Loria-Kohen et al. (2013), demonstrated benefit in the use of folic acid supplementation in lowering depression scores. Researchers including Zajecka et al. (2016) have shown that due to its ability to cross the blood brain barrier, L-methylfolate is the better option in the treatment of depression. Medical providers must determine the best treatment plan based on an individuals personalized needs while also considering the risks, benefits, testing options, and cost of treatment.

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  Effectiveness and Safety of the Bronchial Thermoplasty Procedure

  Kathy Mohammadi

  • Asthma: a heterogeneous disease characterized by chronic airway inflammation resulting in respiratory difficulty.

  • Bronchial Thermoplasty (BT): a bronchoscopy procedure that delivers radiofrequency energy to the tissues of airway walls thus heating the tissue, causing ablation to reduce the mass of the airway smooth muscle (ASM), hence attenuating bronchoconstriction.

  • BT was designed to decrease, de-bulk or partially eliminate excess smooth muscle tissue in the distal airways, with a subsequent decrease in the number of severe asthma attacks.

  • BT is an alternative treatment for patients with severe, uncontrolled asthma in which the airway smooth muscle is eliminated using radio ablation.

  • In this project, several studies are presented to demonstrate the effectiveness and potential adverse impacts of BT.

  • Special attention to a study performed to evaluate the safety and the effectiveness of BT in 580 asthma patients across 6 nations with symptoms despite being treated with high doses of Inhaled corticosteroid (ICS) and long acting beta agonist (LABA), the current standard of care for severe asthma.

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  Treatment Options for Patients With Irritable Bowel Syndrome & Comorbid Depression

  Elizabeth Morton

  • Irritable bowel syndrome & depression are common comorbidities, however there is a wide variability regarding the appropriate treatment regimens for these patients.

  • IBS is classified as a functional bowel disease in which patients suffer from recurrent abdominal pain or discomfort associated with alterations in bowel habits.

  • While the cause of IBS is multifactorial, studies have revealed that the dysfunction of the brain-gut pathways are a culprit to disease appearance and progression, as seen in the biopsychosocial model of IBS. This model proposes that abdominal symptoms secondarily impact anxiety & depression symptoms and that psychological factors influence physiologic aspects such as motor functions, sensory threshold & stress reactivity of the gut through the vagal & sympathetic afferents.

  • Due to the complexity of the causal mechanisms that produce symptoms of IBS with depression, there is some uncertainty regarding the best treatment regimen for these patients.

  • Commonly, patients are advised to increase physical activity, reduce stress & implement dietary modifications. Pharmacotherapy may be advised for some, depending on their symptoms, & may include antidepressants, antispasmodics or laxatives.

  • There is not a standardized method of treating IBS with comorbid depression, therefore symptom management must be performed on a patient-by-patient basis.