Volume 119, Issue 1

Background Polycystic ovary syndrome (PCOS) is a common hormone disorder that affects the reproductive, metabolic, and psychological health of reproductive-aged females, with a number of long-term health risks, including type 2 diabetes mellitus and cardiovascular sequelae. Sympathetic hyperactivity in affected persons may be involved in the pathogenesis of the disorder. Objective To determine whether physiologic and osteopathic measures of increased sympathetic tone correlate in a population of women with PCOS. Methods For this descriptive observational study, women with PCOS between the ages of 20 and 44 years were recruited. Physiologic measures of sympathetic tone (resting heart rate and blood pressure, resting heart rate variability, and postexercise heart rate recovery and blood pressure) were compared with osteopathic measures of sympathetic tone (Chapman points and viscerosomatic reflexes) for the heart, adrenal glands, and ovaries. Results Twenty-four women participated in the study. Overall, the participants exhibited both physiologic and osteopathic signs of increased sympathetic tone compared with reference values. In some participants, the number of osteopathic findings were greater than the number of physiologic findings of increased sympathetic tone. Conclusions Women with PCOS exhibit increased sympathetic tone by physiologic and osteopathic measures, indicating the utility of assessing sympathetic hyperactivity in these patients by osteopathic methods. Osteopathic structural examination is a valuable diagnostic tool that may allow detection of sympathetic hyperactivity in women with PCOS even before physiologic symptoms manifest. The osteopathic indicators of increased sympathetic tone may represent potential therapeutic targets to improve health in this population. (ClinicalTrials.gov NCT03383484)

Context Rib raising is an osteopathic manipulative treatment modality that can help patients with various respiratory conditions to improve their work of breathing. However, the tolerance of this technique in hospitalized patients has not been assessed in a systematic manner. We hypothesized that rib raising would be a well-tolerated treatment modality for hospitalized patients admitted for asthma, pneumonia, chronic obstructive pulmonary disease, and/or congestive heart failure. Objective To determine hospitalized patients’ tolerance of rib raising through a prospective pilot study. Methods The study included patients at University Hospitals–Richmond Medical Center and University Hospitals–Bedford Medical Center who were admitted for asthma, pneumonia, chronic obstructive pulmonary disease, and/or congestive heart failure between November 1, 2016, and October 31, 2017. Each patient was treated with rib raising, which was performed in a standardized fashion. Immediately after treatment, patients were asked to rate their tolerance of the procedure on a scale of 0 to 10, where 0 represented no discomfort and 10 represented maximum discomfort. Results The study population consisted of 87 hospitalized, non–intensive care unit patients. The mean tolerance score for rib raising was 1.18, and the median score was 0. The score was between 0 and 3 in 80 patients (92.0%), between 4 and 6 in 6 patients (6.9%), and between 7 and 10 in 1 patient (1.1%). Conclusion Rib raising was shown to be well tolerated by the majority of the patients in the study population.

Polycystic ovary syndrome is the most common hormone disorder in females of reproductive age, affecting reproductive, metabolic, and cardiovascular health. With an unknown cause and a spectrum of common signs and symptoms, diagnosis is based on consensus criteria, and treatment options often target individual symptoms, with variable effectiveness. Safe, effective complementary and alternative therapies can be used to manage symptoms. The first-line intervention is lifestyle modification, including weight loss when appropriate, with caloric restriction and exercise to maintain a healthy weight. Low-carbohydrate and/or low-glycemic index diets can provide additional benefits, and nutritional supplements may be useful adjuncts. The recommended physical activity regimen should include both aerobic and resistance exercise.

Autism spectrum disorder (ASD) is a neurodevelopmental condition associated with difficulties in the social, communicative, and behavioral domains. Most cases of ASD arise from an unknown etiologic process, but there are numerous risk factors, including comorbidities and maternal exposures. Although it is not part of the diagnostic criteria, hearing difficulties ranging from deafness to hyperacusis are present in the majority of persons with ASD. High-functioning children with ASD have been found to have significantly slower and asymmetric auditory brainstem reflexes. Additionally, histopathological studies of postmortem brainstems in decedents who had ASD have consistently revealed significantly fewer neurons in auditory nuclei compared with those in people who did not have ASD. The authors review the literature implicating auditory dysfunction in ASD along with results from human study participants and postmortem human brain tissue. Together, these results implicate significant structural and functional abnormalities in the auditory brainstem in ASD and support the utility of auditory testing to screen for ASD.

Context The Lake Erie College of Osteopathic Medicine (LECOM) is a large, diverse medical school spread across 3 campuses, which makes it challenging to deliver comparable learning experiences to all students. Osmosis is a Web and mobile application that can integrate with a variety of existing curricula and, through its content creation and sharing features, can foster student cohesion in an online environment. Objective To analyze the first year of use for the Osmosis platform among LECOM students at each campus and to identify barriers to this use. Methods Medical education at LECOM is delivered across 3 campus locations using 3 main pathways: the lecture-discussion, problem-based learning, and directed-study pathways. Beginning in the 2016-2017 academic year, all LECOM first-year medical students could use the Osmosis platform free of charge; second-year students were informed about the platform but were required to pay for a subscription. For all students, engagement metrics were tracked within the platform, and periodic student surveys and informal student feedback supplemented these metrics. Results Of 1135 LECOM students, 567 (50%) signed up for an account, including 416 (73%) of 573 first-year and 151 (27%) of 562 second-year students. In aggregate, students created 17,901 items and answered 123,050 practice questions and flashcards. Student use of the platform varied considerably, with the highest use at the Erie campus, where the platform was championed by faculty, and among a portion of second-year students preparing for board examinations. Some students were “superusers”; 2 students completed more than 20,000 items, and 5 created more than 1000 items each. The greatest barriers to use of the platform were preferences for previous study methods and lack of time to learn new study habits. Conclusion Although the use of the platform across LECOM campuses was uneven, it was greatest when there was overt support by faculty and when students were already motivated to use the platform. The lessons learned during the first year of the program will be used to improve use of the platform. The authors offer their insights into this new technology.

Dry needling is a widely used alternative therapy for musculoskeletal disorders, such as myofascial pain. The procedure involves placing a solid monofilament needle into myofascial trigger points or connective tissue to relieve pain. Some of the complications secondary to this procedure include cardiac tamponade, hematoma, infection, nerve injury, and pneumothorax. Although the incidence is low, the complications can be potentially life threatening. We present the case of a 44-year-old man who had dry needling of the infraspinatus, supraspinatus, rhomboid, and paraspinal muscles with subsequent development of a left apical pneumothorax. Given that the pneumothorax was small, the patient had good recovery with supplemental oxygen. Although the incidence of pneumothorax is very low, it is an important diagnosis to consider for a patient presenting with dry cough, malaise, chest pain, or shortness of breath after a dry needling procedure. Patients should be made aware of these potential complications as part of an informed consent.