Auburn Research Day 2021

Cl i n i ca l Case Repor t | Med i ca l St udent Transesophageal Echocardiography is a Vital Tool in the Assessment and Management of Valvular Atrial Fibrillation Prior to a Planned Cardioversion Regardless of the CHA2DS2-VASc Score

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Ghassan Dalati; James Healy; Charles Bergdolt; Kimberly Hernandez; Wisam Dalati Medical Center Enterprise, Enterprise, AL

Rheumatic heart disease is the most common cause of mitral stenosis (MS) worldwide. Patients with rheumatic heart disease have a high risk of developing MS and, subsequently, valvular AF. Once the mitral valve begins to stenose, cardiac remodeling begins to take place with elevated left atrial and pulmonary venous pressures and left atrial enlargement being common findings. These anatomical and hemodynamic changes significantly predispose patients to development of AF and subsequent thrombus formation. The prevalence of AF in patients with rheumatic mitral stenosis is 70% which is why close monitoring of these patients with regular scheduled clinic visits is recommended. CHA2DS2-VASc score is an important and a valid tool to determine the risk of embolization in AF patients; however, it should not be the main factor when determining the safety of restoring the normal sinus rhythm via an electrical or

chemical cardioversion. Left atrial thrombi can be best visualized with a transesophageal echocardiography (TEE) especially when a more urgent pre-cardioversion assessment (as opposed to 3-4 weeks of anticoagulation) is warranted. Extremely large intracardiac thrombi pose a risk for fragmentation and systemic embolization with thrombolytic usage and, therefore, require clinical judgement for the appropriate management. Surgery is a viable option for thrombus removal when the risk of fragmentation with thrombolytic administration is considered too high. In this paper, we will be discussing a case report of a 49-year-old Korean gentleman with a history of rheumatic mitral stenosis and new-onset atrial fibrillation who developed several large thrombi in his left atrium which were surgically removed via a median sternotomy approach.

Nikki Lauderback, OMS-II; Ahmad Abukhader, OMS-III; Bari Elfenbein, OMS-III; Zachary Holley, OMS-III; Kaelin Young, PhD; Siraj Abdullah, DO; Danielle Wadsworth, PhD; Joshua Hollingsworth, PharmD, PhD Edward Via College of Osteopathic Medicine - Auburn, AL; Auburn University School of Kinesiology - Auburn, AL Cl i n i ca l Resea rch | Med i ca l St udent Minute Calisthenics: A Randomized Trial with a Delayed-Start Control of a Daily, Habit-Based, Bodyweight Resistance Training Program 017

Background: Resistance-training (RT) provides significant health benefits. However, roughly 3/4 of U.S. adults do not meet current RT guideline recommendations. Studies are needed that assess the effectiveness of RT programs that are time-efficient and simple to perform. Methods: Untrained osteopathic medical students and college/ university “office workers” were recruited and randomized (1:1) to a delayed-start control group or an intervention group. The control group was instructed to refrain from any RT during Phase I (baseline to midpoint), while the intervention group was instructed to perform push-ups, angled-rows, and air squats every weekday. In Phase II (midpoint to final), the control group was instructed to start performing the daily workouts, and the intervention group was instructed to continue performing the workouts. Before the intervention, both groups received equipment and training needed to safely perform the exercises and were taught the Tiny Habits ® Method and received digital coaching via email to promote consistency and habit formation regarding the exercises. The outcome of interest was the change in composite repetitions (push- ups + angled-rows + squats) under a standardized protocol (i.e., the strength assessment) over time (baseline vs. midpoint vs. final) in the intervention group as compared to the control group. Phases I and II were set at 12 weeks (84 days) and other in-person measures (blood pressure, hemoglobin A1c, blood lipids, body composition, muscle thickness) were included, under the original protocol.

Results: A total of 47 participants were recruited. Baseline characteristics did not differ significantly between the control group (n=22; 14 females; 29.5±9.8 years of age) and intervention group (n=25; 17 females; 34.8±12.4 years of age). Due to the COVID-19 pandemic, in-person follow-up could not be completed as planned. In order to collect composite repetitions from as many participants as possible, the decision was made to forgo all in- person measures and to conduct the midpoint and final strength assessments remotely via Zoom. Midpoint strength assessments were performed 243±4.9 days (~35 weeks) after baseline, and final strength assessments were performed 86.3±3.5 days (~12 weeks) after midpoint assessment for 30/47 (64%) participants. Intervention group composite repetitions increased significantly from baseline to final (56±26 vs. 69±28, p=0.03) and from midpoint to final (64±26 vs. 69±28, p=0.03), with no significant difference between baseline and midpoint (56±26 vs. 64±26, p=0.12). Composite repetitions in the control group showed no significant change from baseline to midpoint (56±27 vs. 53±25), before starting the intervention, and increased significantly from midpoint to final (53±25 vs. 65±25, p=0.006) after 12 weeks of the intervention. Discussion: This study suggests that a simple, habit-based RT intervention consisting of brief, but daily, bodyweight exercises can significantly increase physical strength in untrained individuals. Future studies should assess the impact of such an RT program on other clinical health markers (e.g., hemoglobin A1c, blood lipids, blood pressure, body composition, muscle thickness) as was originally planned in this study.

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