Department of Obstetrics and Gynecology Medical Student Works

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    More Is Not Always Better: A Case Report of Excess Calcium Carbonate Ingestion Causing Milk-Alkali Syndrome
    (2021-03-25) Waller, Sydney; Luster, Taylor; Collins, Angela J.; Raymond-Guillen, Luke
    CASE DESCRIPTION: A 54-year-old female with a medical history significant for CKD stage 4 and alcohol use disorder presented to the Emergency Department with altered mental status. Labs were significant for hyponatremia, hypokalemia, hypochloremia, hypercalcemia, metabolic alkalosis, and Cr 9.3. Lorazepam was given due to concern for alcohol withdrawal. Ultimately, her symptoms were discovered to be due to excessive ingestion of calcium carbonate (aka: Tums), and she was diagnosed with milk-alkali syndrome (MAS). Pt was treated with IV KCl and normal saline, and her labs and mental status normalized over the subsequent 48 hours. | CLINICAL SIGNIFICANCE: MAS is constituted by metabolic alkalosis, acute kidney injury, and hypercalcemia. It is a result of a large intake of calcium and absorbable alkali. The syndrome was first recognized in the early twentieth century, and it essentially disappeared when histamine blockers began being used to treat peptic ulcers in the 1980s. Recently, the syndrome is becoming more common with the increased use of calcium-carbonate in antacids and osteoporosis prevention medications. MAS is the third most common cause of hypercalcemia, after malignancy and hyperparathyroidism. Management involves holding calcium and vitamin D supplements and administering aggressive intravenous hydration. Bisphosphonates and dialysis may be useful in severe cases. Prognosis of MAS is typically good as the condition is reversible. | CONCLUSION: The prevalence of MAS is increasing due to the wide availability of calcium-containing supplements and antacids. In order to counteract this, increased awareness amongst at risk patient populations, such as the elderly and those with renal disease, is vital. Furthermore, increased awareness amongst healthcare professionals may help prevent complications that can arise from untreated MAS.
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    Impact of Perinatal Mood & Anxiety Disorder Education for Mothers in IU Health Arnett Breastfeeding Support Group
    (2019-04-03) Collins, Angela J.; Rawat, Meghana; Straut, Ashley
    BACKGROUND & OBJECTIVE: During the perinatal period, beginning at conception at lasting until the baby is 1 year old, mothers are at increased risk of mood and anxiety disorders. Baby Blues are common feelings of sadness/loneliness, which typically go away within 2 weeks postpartum. However, 20-25% of women experience more significant mood changes and symptoms than typical baby blues. Perinatal Moods and Anxiety Disorder (PMAD) is defined as prolonged symptoms from pregnancy to 1 year post-childbirth. Postpartum Depression (PPD) is the most common PMAD; 1 in 7 women are diagnosed with PPD in the US, with 600,000 per year. Unfortunately, Indiana-specific data on PMAD/PPD is not readily available. The objective of our PMAD/PPD Education and Awareness Intervention was to increase postpartum mental health care provided to the mothers who deliver at IU Health Arnett by 1) informing and educating mothers about symptoms and prevalence of PMAD and PPD, and 2) empowering women to seek treatment and support at the new IU Health Postpartum Support Group. METHODS: First, additional questions were added to the Edinburgh postnatal depression scale survey administered at IU Health Arnett to more effectively screen for PMAD/PPD. Second, we wrote text and phone call follow-up scripts for staff to contact mothers 4-5 months post-delivery to follow-up for possible symptoms of PMAD/PPD. Finally, we developed a 20-minute PMAD/PPD Awareness and Education presentation based on the Health Belief Model and presented it to the breastfeeding support group. During the presentation, we utilized voluntary pre- and post-surveys which collected data on knowledge of symptoms of PMAD/PPD. The data was then analyzed to evaluate the effectiveness of presentation. RESULTS: Data collection regarding efficacy of the Edinburgh postnatal depression scale survey changes and text and phone call follow-up scripts are still ongoing. The PMAD/PPD awareness and education presentation resulted in a 75% increase in knowledge of PMAD/PPD symptoms. Over 70% felt support groups would help with PMAD/PPD, 86% reported awareness of resources available to address PMAD/PPD symptoms in comparison to 50% in pre-survey, and 57% of mothers indicated they are confident to seek help for friends and themselves for PMAD/PPD CONCLUSIONS & IMPLICATIONS: Our findings indicate that the presentation was effective due to a significant increase in participant's knowledge of PMAD/PPD symptoms and significant increase in participant's awareness of PMAD/PPD resources. We expect that our changes will continue to increase postpartum mental health care provided to the mothers who deliver at IU Health Arnett. It is essential to standardize maternal follow-up care for PMAD and/or PPD for up to a year post-delivery. We must aid mothers in the community to learn about PMAD/PPD symptoms, use education to empower women to better advocate for themselves, help more women attend support groups for PMAD/PPD, help women's healthcare providers understand the need for education on PMAD/PPD, and advocate for inclusive postnatal exams for PMAD/PPD to become the standard of care.
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    Isolation and Analysis of a Mycobacteriophage Specific to Mycobacterium Smegmatis
    (2015-12-15) Collins, Angela J.; Ghazali, Danish M.; Li, Yi; Ha, Soo; Clase, Kari L.; Hatfull, Graham
    BACKGROUND: Bacteriophages are viruses that kill bacteria. It is estimated that there are roughly 1031 types of bacteriophages in the world, and that every bacterium has an average of 10 bacteriophages that can infect it. A mycobacteriophage is a type of bacteriophage which has a mycobacterial species as its host. There are 30 known clusters, or types, or mycobacteriophages which all contain very distinct genetic structures, but there are still countless mycobacteriophage populations that need to be isolated. Now that microorganisms are becoming resistant to many antibiotics, the study of bacteriophages is increasingly important because they have an incredibly untapped potential to treat resistant bacteria, eradicate bacterial contaminants in food products, promote ulcer healing, control bacterial growth during fermentation, and much more. The goal of this project was to discover new bacteriophages that might contribute to novel medical solutions. MATERIALS AND METHODS: We plated 29 agar plates for 8 different samples. One sample resulted in plaque growth, from which we performed 9 streak tests, underwent a dilution series and filtration to eliminate the contamination, and harvested a High Titer Lysate. After isolating and purifying the phage genomic DNA, we analyzed the sample and quantified the DNA using a Nanodrop spectrophotometer, and we used agarose gel electrophoresis to separate and analyze the DNA fragments. Finally, we used electron mycrocopy to visualize the physical structure and confirm the successful isolation of a single mycobacteriophage population. DISCUSSION: The cloudiness of the plaque produced by the bacteriophage suggests it is a temperate phage, meaning it switchs between two behavior types regarding replication and survival. Analysis of the physical structure of the mycobacteriophage reveals more information about its genomic DNA; its large capsid diameter suggests lengthy indwelling genomic DNAand its relatively long tail suggests a large tape-measure gene. We were unble to analyze the agarose gel electrophoresis results due to time constraints. However, the results of the genomic DNA sequence will hopefully prove that our bacteriophage is a distinct population. CONCLUSION: We successfully captured, isolated, and purified a single bacteriophage species from the local environment of West Lafayette, Indiana. Upon isolating a single bacteriophage species, we then isolated, purified, restricted, and analyzed the genomic DNA of the phage. Finally, we documented our findings on the Bacteriophage Database as FelixElFago ( and sent our DNA to the Sequencing Center.
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    Deworming Program In Low-Income Nicaraguan School
    (2020-04-24) Collins, Angela J.
    Infection of soil-transmitted helminths (STH), commonly referred to as intestinal worms, are estimated to plague over 1.5 billion of the world’s most impoverished communities. Developing countries bear the largest burden of STH infections due to lack of access to clean water, safe housing, sanitation infrastructure, education and healthcare. In 2017, the director of the World Health Organization’s Neglected Tropical Diseases department, stated, “There is now global consensus that periodic, large-scale deworming is the best way to reduce the suffering caused by intestinal worms,” [1]. In addition, numerous studies have shown significant efficacy particularly among school-based deworming interventions. Therefore, in order to best steward the health and wellbeing of their students, as well as to comply with the World Health Organization’s recommendations, the Granada Christian Education Center (GCEC) ― a primary school located in one of the poorest areas of Nicaragua ― is requesting $1000 in funding to establish a school-based deworming program among their growing student body.
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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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    Predictors of Disease Severity in Children at Riley Hospital with Multisystem Inflammatory Syndrome in Children (MIS-C)
    (2021-07-30) Collins, Angela J.; Rao, Megana; Khaitan, Alka K.; Bhumbra, Samina S.
    AUTHORS: Angela J. Collins, MPH, BS(1); Megana Rao, BS(1); Alka K. Khaitan, MD(2); Samina S. Bhumbra, MD(2) AFFILIATIONS: (1) Indiana University School of Medicine. (2) Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana. ABSTRACT: BACKGROUND & OBJECTIVE: Multisystem Inflammatory Syndrome in Children (MIS-C) is a novel condition temporally associated post-SARS-CoV-2-infection. The associated inflammation injures various organs (mainly cardiac and gastrointestinal) and can cause ventricular dysfunction and/or coronary aneurysms, potentially leading to death. This project assessed how lab trends may predict disease outcomes of MIS-C patients at Riley Hospital for Children (RHC). METHODS: Five lab values (intake procalcitonin, platelet count nadir, absolute lymphocyte count nadir, sodium nadir, troponin-I peak, CRP peak) were assessed as potential predictors of MIS-C severity. Patient demographics (age, sex, race, ethnicity), prior medical history (chronic conditions, obesity), and clinical presentation (days of fever prior to admission) were also assessed as potential predictors of MIS-C severity and lab peaks/nadirs. Indicators of MIS-C severity included PICU admission, length of hospital stay, left ventricular ejection fraction (EF), and abnormal coronary artery findings on echocardiogram. Chi-Square, ANOVA, linear regression, and logistic regression models were completed in SAS9.4 to assess for correlation (α=0.05). RESULTS: 66 MIS-C patients, aged 9 months to 18 years (mean=8.7 years), were admitted to RHC May 2020-April 2021. 61% were male (n=41). All patients presented with fever. Average length of stay at RHC was 5.9 days. 47% (n=31) were admitted directly to the PICU and 15% (n=10) were transferred to the PICU during their hospital course. Race predicted sodium nadir (p=0.0363), ethnicity predicted intake procalcitonin (p=0.0007), and obesity predicted CRP peak (p=0.0055). Age predicted abnormal EF (p=0.0206) and abnormal coronary outcome on echocardiogram (p=0.0365). Sex and obesity also predicted abnormal coronary outcome on echocardiogram (p=0.0182 and p=0.0478, respectively). Troponin-I peak predicted abnormal EF (p=0.0035) and CRP peak predicted days of hospital stay (p=0.0096). CONCLUSION & IMPACT: CRP peak is predictive of days of hospital stay and may inform hospital course. Analysis of additional lab values may reveal additional predictors of disease severity to inform clinical care.
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    Curriculum Intervention: Assessing Need for and Implementation of Sustainability Development in a Global Context within the First-Year Engineering Curriculum at Purdue University
    (2017-05-04) Collins, Angela J.
    BACKGROUND & OBJECTIVE: Globalization is a world-wide phenomenon that is reshaping international relations in tremendous ways and at impossible rates. Due to rapid advancements in communication, transportation, and information technologies, there has been an increasing connectedness of humanity around the globe. With this trans-global integration comes many benefits, but also countless challenges. It is critical that engineering education facilities constantly update and restructure their curriculum to produce engineers who are capable of tackling the world’s greatest global challenges of this globalization era. Therefore, our team proposes a curriculum intervention of the First-Year Engineering Program. We wish to analyze the depth of global competency concepts taught in the course, with a specific focus on sustainability because it is crucial that young engineers develop an understanding of sustainability and perform their specialized tasks with a sustainable vision in mind. METHODS: To ensure high quality development of Purdue engineers is this area, our research team proposes a curriculum intervention involving two parts: (1) An analysis of the global competency and understanding of sustainability of current engineering sophomores who recently completed the First-Year Engineering (FYE) program at Purdue University; (2) An implementation of concepts from a current Purdue course, CE/EEE 355 Engineering Environmental Sustainability, into the FYE curriculum, as well as an implementation of globalization concepts as needed. Furthermore, our team seeks to answer the following research questions: (1) How consistent is the material that is taught across different sections within the FYE program? (2) How much control and influence does each engineering professor have in covering the topics of globalization and sustainability? (3) What hands-on, practical experience and exposure to globalization concepts are the students getting? EXPECTED OUTCOMES: At the conclusion of this research project, our team expects two tangible outcomes: (1) A plan of implementation of sustainability and globalization concepts into the Purdue engineering curriculum; (2) A set of data measurements and specific goals to determine whether the implemented concepts make a difference. Countless research papers stress the importance of evaluating the impact of new initiatives. Thus, our research team seeks statistical evidence that the concepts learned in CE/EEE 355 make a significant impact on the capability of the student, and the implementation of new concepts based off of CE/EEE 355 make a significant difference when implemented into the FYE engineering curriculum. CONCLUSION: In conclusion, the forces of globalization are leading to rapid changes among global dynamics and international relations, and several effects of globalization, such as poor resource utilization, are beginning to pose a threat to humanity. Therefore, engineers must be able to evolve alongside society and must have the skills to tackle the world’s leading problems. Engineers must also understand the importance of sustainable development to ensure a bright future for younger generations to come. As a result, our team suggests a curriculum intervention of the FYE program to better educated Purdue’s young engineers on issues of globalization and sustainability. Purdue is among the top engineering institutions, but to maintain its relevance and influence, there must be a shift in the curriculum to better prepare its graduates to work in this highly-globalized era.
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    Intrauterine Fetal Demise and Bereavement Care
    (2022-03-24) Hand, Breanne L.; Gripe, Amanda M.
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    IU School of Medicine Correctional Medicine Student Outreach Project
    (2022-10-22) Nunge, Rebecca A; Gates, Kayla L; Fazle, Trilliah; Garcia, Jennifer; Messmore, Nicole M; Agarwal, Neeta
    Background: This project was founded on the basis that correctional medicine is an important component frequently missing from medical education. Opportunities to participate in medical care within correctional facilities, while concurrently engaging in discussions about disproportionate incarceration of certain populations and mass incarceration as a whole, will cultivate empathetic, socially-engaged, and passionate young physicians. This student organization was formed to facilitate clinical opportunities within correctional facilities and host events that focus on the broader socioeconomic and political context and forms of structural and cultural violence that have contributed to mass incarceration in the United States. Methods: In order to facilitate organizational goals, a relationship was fostered between IUSM and Dr. Kristen Dauss, the Chief Medical Officer of the IDOC. Following affiliation agreements, students may now gain clinical exposure at any facility in the state. Since its creation, IUCM has hosted virtual educational lectures, panels, and journal clubs, in collaboration with other student organizations and scholars in the field. The organization encourages engagement with original research in coordination with faculty advisors. We have also worked with administration to incorporate correctional health topics officially into the curriculum. Conclusions: As physicians who will practice medicine in the country with the highest incarceration rate in the world, having a fundamental understanding of topics related to correctional health, adverse health experiences while incarcerated, and longstanding traumatic effects of incarceration is imperative. IUCM’s goal is to create introductory materials and share resources relating to the socioeconomic and political context which has led to mass incarceration and the deficits in care for currently and formerly incarcerated people. Developing a better understanding of the justice system as well as the emotional, mental, and physical impact incarceration has on patients, and will stimulate interest in engaging with these concepts through research, volunteer work, educational events, and in patient care.
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    Treatment of Opioid Use Disorder During Pregnancy: Buprenorphine or Methadone?
    (2020-03) Davis, Elizabeth; Owusu, Raiven; Vinze, Sanjna; Arnaduo, Camilla
    BACKGROUND: 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.