Medicine and Health Sciences Commons^™

Orthopaedic Surgeon Density In West Virginia, Franklin D. Shuler, Grant S. Buchanan, Zachary Sanford, Milad Modarresi, James Timothy Reagan, Kelly Scott, Chad Fisher, Ali Oliashirazi

Marshall Journal of Medicine

Abstract

West Virginia (WV) has many healthcare disparities and access barriers. For bone and joint disorders, WV has some of the highest rates of musculoskeletal problems, including the highest reported rate of adult arthritis in the nation (36.2%). We hypothesized that WV has one of the lowest Orthopaedic surgeon densities in the country, which can negatively impact the delivery of musculoskeletal care. Using the WV Board of Medicine practitioner databank, the Veterans Administration practitioner data, and national Orthopaedic surgeon census data, we demonstrated a considerably low Orthopaedic surgeon density in WV (7.71/100,000 population versus the national average of 8.51/100,000 population) …

Self-Reported Tobacco Use And Correlation With Umbilical Cord Blood Cotinine Levels At Delivery Among Appalachian Gravidas, Jesse Cottrell, Brenda L. Mitchell, Pooja N. Sangani, D'Andrea S. Thomas, Monica A. Valentovic

Marshall Journal of Medicine

The detrimental effects of cigarette use during pregnancy are well documented. Studies have shown that cigarette smoking while pregnant is associated with multiple adverse outcomes including: pre-term birth, placental abruption, placenta previa, fetal growth restriction, stillbirth, increased rate of birth defects, and increased risk of sudden infant death syndrome. Cotinine is the primary metabolite of nicotine and allows for measurement of active as well as passive exposure. Cotinine freely cross the placental barrier and maternal concentrations are closely correlated with newborn plasma levels. The aim of this study was to compare maternally reported rates of tobacco use to fetal umbilical …

A Rare Case Of Paradoxical Left Sided Endocarditis Through Patent Foramen Ovale., George M. Yousef, Paul I. Okhumale, Haytham Aljoudi, Silvestre Cansino

Marshall Journal of Medicine

A 36 -year old woman IV drug abuser admitted with Right-Sided Infective Endocarditis (RSIE) as demonstrated by transthoracic echocardiogram. Patient was admitted 8 weeks later with recurrence of symptoms, moreover signs of systemic embolization were noted. Transthoracic and Transesophageal Echocardiograms revealed tricuspid valve vegetation, severe tricuspid regurgitation, left atrial mass, Patent Foramen Ovale (PFO), severely dilated right atrium and prominent Chiari's network. Systemic embolization included brain and Left iliacus abscesses. Patent Foramen ovale is the proposed mechanism leading to extensive systemic embolization in the present case.

Inferior Stemi Complicated By Retroperitoneal Hemorrhage Due To Ruptured Aaa, Farley B. Neasman Iii, Melissa D. Lester, Nepal C. Chowdhury

Marshall Journal of Medicine

When patients present with life threatening conditions, a rapid cost-benefit analysis prioritizes care and commits treatment to a certain course that, in the case of ST Elevation Myocardial Infarction (STEMI) treated with drug-eluting stents (DES), could be fatal if there is any deviation. Antiplatelet therapy is vital and secondary concerns (i.e. bleeding diatheses) may accept suboptimal outcomes – in rare cases, another life-threatening condition may be unmasked, the treatment for which runs directly counter to the first. We present a case of STEMI with high clot burden treated with multiple DES, complicated by retroperitoneal hemorrhage due to a ruptured abdominal …

Complete Esophageal Obstruction After Endoscopic Variceal Band Ligation In A Patient With A Sliding Hiatal Hernia, Munthir Mansour Md, Yousef Abdel-Aziz Md, Hesham Awadh, Nihar Shah Md, Akash Ajmera

Gastroenterology

Complete esophageal obstruction is a rare complication of endoscopic variceal banding, with only 6 cases in the English literature since the introduction of endoscopic variceal banding in 1986. We report a case of complete esophageal obstruction following esophageal banding due to entrapment of part of a sliding hiatal hernia. To our knowledge, our case is one of few with esophageal obstruction post-banding, and the first associated with a hiatal hernia. We recommend caution when performing esophageal banding on patients with a hiatal hernia.

Does Perioperative Angiotensin-Converting Enzyme Inhibitor Therapy Correlate With Increased Use Of Vasopressors During Posterior Lumbar Interbody Fusion Versus Those Not Receiving Angiotensin-Converting Enzyme Inhibitor Therapy: A Retrospective Study, Joshua Ross

Theses, Dissertations and Capstones

Abstract: The purpose of this study was to evaluate if patients who took Angiotensin Converting Enzyme (ACE) inhibitors the morning of surgery for Posterior Lumbar Interbody Fusion (PLIF) required more treatment for intraoperative hypotension.

Introduction: PLIF is a surgical procedure used to correct spinal disorders that include compression, instability, pathological lesions, deformities, and pain. PLIF is completed utilizing the prone position for optimal access to the lumbar spine. Complications associated with prone position have included Post-Operative Vision Loss (POVL), compression of abdominal vessels, and head and neck venous compression resulting in neurologic injury. Currently, there are no set recommendations …

Intraoperative Administration Of Intravenous Acetaminophen At Induction Or End Of Surgery And Its Relationship With Opioid Consumption And Pain Scores, Spencer Davis Greenwood

Theses, Dissertations and Capstones

Obesity has become increasingly prevalent in the United States. Bariatric surgeries have increased as the prevalence of obesity has risen, providing an effective alternative to weight loss. Intravenous acetaminophen (IVA) is a safe and effective non-opioid medication that can be given without the risk of respiratory or cardiac complications. Research has shown that the use of IVA during surgery can improve postoperative pain scores, reduce opioid requirements, and improve patient satisfaction.

A retrospective cohort study of 200 patients (100 per group) undergoing laparoscopic bariatric surgery (LBS) was performed. Statistical analysis was used to determine the relationship between those who received …

The Association Between Intraoperative Single-Dose Dexamethasone And Postoperative Pain In Patients Undergoing Laparoscopic Cholecystectomy, Sara Hatfield

Theses, Dissertations and Capstones

Abstract: The purpose of this study was to examine the association between a single dose of intraoperative dexamethasone in patients undergoing outpatient laparoscopic cholecystectomy surgery and postoperative pain scores and the amount of postoperative opioid administration.

Introduction: Pain is one of the most common complaints in the postoperative period and the days following a patient’s procedure. While opioids are commonly used for treating intraoperative and postoperative pain, anesthesia providers can lessen their use by adopting multimodal analgesia techniques. This study attempts to fill the research gap related to the association of a single dose of intravenous dexamethasone intraoperatively …

The Influence On Morbidity And Mortality When Blood Products Are Transfused Using Conventional Coagulation Tests Versus Teg Or Rotem In Trauma Patients Perioperatively, Teresa Diana Kelley

Theses, Dissertations and Capstones

Abstract: Coagulopathy in trauma patients occurs due to tissue injury, hemodilution (dilution of hematocrit and clotting factors), infusion of hypo-coagulable blood products (e.g., packed red blood cells), acidosis, hypothermia, continued blood loss, and depletion of clotting factors. The onset of coagulopathy begins with the initial tissue injury and evolves rapidly. Many factors need consideration when determining resuscitative treatment for the trauma victim. These factors include the amount of time for extraction from the field, transport time to a trauma center, associated weather, and treatment provided in route. This study compared two clinical laboratory pathways (Conventional Coagulation test and Rotational Thromboelastometry …

What Is The Relationship Of Increased Intraocular Pressure And Body Mass Index In Patients Undergoing Robotic Prostatectomy In Sleep Trendelenburg Position?, Seth Parsons

Theses, Dissertations and Capstones

Introduction: Robotic Prostatectomy is a common procedure performed in surgery centers all over the world, but these procedures can be long and difficult to manage for Anesthesia providers. This study examined the relationship between increased intraocular pressure (IOP) and Body Mass Index (BMI) during Robotic Prostatectomies in Steep Trendelenburg (ST) position. Other variables studied were length of procedure, age, and ASA physical classification.

Methodology: The study was a retrospective cross-sectional design of 100 patients with a BMI over 30 and 100 patients with a BMI under 30 who have undergone Robotic Prostatectomies at Charleston Area Medical Center (CAMC) between …

Does Rotem-Guided Therapy Influence Postoperative Chest Tube Output In On-Pump Cabg?, Preston Franklin Woodburn-Camp

Theses, Dissertations and Capstones

Abstract: The purpose of this study was to identify the association between ROTEM-guided therapy and chest tube output in patients who have undergone elective on-pump CABG.

Introduction: In open heart surgery, there are a variety of ways that coagulation disturbances occur, such as hemodilution of coagulation factors and platelets, a reduction in coagulation factors due to the use of cardiopulmonary bypass the administration of the anticoagulant heparin, and altered temperature. Severe bleeding is frequently associated with open-heart surgery, especially on-pump coronary artery bypass grafting (CABG). Thromboelastometry using rotational thromboelastometry (ROTEM) is a point-of-care testing that can show specific defects in …

The Assessment Of Medial Stability Of The Elbow Using Sonography And Three Clinical Tests, Andrew Michael Demoss

Theses, Dissertations and Capstones

Introduction: Injuries to the Ulnar Collateral Ligament of the elbow are a common occurrence in overhead throwing athletes. Clinical assessment of the medial elbow can be assisted using Sonography. Ultrasound imaging can be used to determine the width of the medial joint space. This study will determine whether altering the joint angle in the elbow during various clinical tests has an effect on the width of the medial joint space.

Methods: Ultrasound images of the non-dominant elbow were collected during three clinical tests of medial elbow stability; valgus stress test, weighted valgus test and the milking maneuver. The …

Employing The Enzyme Cofactor Function Of Ascorbic Acid To Affect Oncogenic Pathways In Human Melanoma: Modulating Hypoxia Inducible Factor-1Α And Dna Demethylation To Reduce Malignant Potential, Adam Patrick Fischer

Theses, Dissertations and Capstones

Dioxygenase enzymes such as the HIF hydroxylases (PHD1-3, FIH) and the Ten-eleven translocation (TET1-3) enzymes regulate the activity of the hypoxia inducible factor-1_a (HIF1_a) transcription factor and the DNA methylation status of cells, respectively. Aberrant accumulation and activation of HIF-1_a can allow malignant cells to acquire attributes that promote progression, chemotherapy resistance, and survival, while aberrant hypermethylation of gene promoters can silence the expression of tumor suppressor genes essential to preventing tumorigenesis. Inadequate levels of intracellular ascorbic acid (AA), a necessary cofactor for optimal dioxygenase enzyme function, could potentiate these tumorigenic conditions. In fact, plasma levels …

Doxorubicin Cytotoxicity In A Human Proximal Tubular Epithelial Cell Line Was Attenuated By The Natural Product Resveratrol, Morghan Schuyler Getty

Theses, Dissertations and Capstones

The cancer chemotherapeutic agent doxorubicin (DOX), Adriamycin, is part of the treatment regimen for breast, ovarian, small cell lung cancer and acute/chronic lymphoid leukemia. Adverse effects associated with DOX are cardiotoxicity and nephrotoxicity. Interventions are needed to reduce DOX nephrotoxicity. Resveratrol (RES) is a phytochemical contained in grapes, berries and nuts, which possesses antioxidant and anticancer properties. This study tested the hypothesis that RES will attenuate DOX renal cytotoxicity in human noncancerous renal proximal tubular epithelial (HK-2) cells and that RES will reduce DOX mediated changes in mitochondrial function. HK-2 cells were plated and grown for 48 hours (h). Cells …

Mrsa Induced Pulmonary-Renal Syndrome, Mohammed Megri, Majdi Al-Dliw, Yousef Shweihat, Zeid Khitan

Internal Medicine

We present a rare case of pulmonary-renal syndrome secondary to recurrent MRSA spondylodiscitis. The mechanism of involvement of each organ system is unique. The organs, lung and kidneys, have been affected by different pathologic processes that were induced, we think, by the chronic MRSA infection.