Medicine and Health Sciences Commons^™

Building Collaborative Research To Drive Improvement Of West Virginia Health Outcomes, Sally L. Hodder Md, Gary O. Rankin Phd

Pharmaceutical Science and Research

Mortality rates in Appalachia have not declined in recent years as they have for the remainder of the US. Appalachian mortality rates have actually increased. Most counties of southern West Virginia have mortality rates well in excess of the US average. West Virginia ranks at or near the bottom in most U.S. chronic disease categories, with the highest rate of drug overdose deaths and near the highest rates of cancer and cardiovascular mortality. And yet, West Virginia has many dedicated heath care providers, committed to the care of their patients. The West Virginia Clinical and Translational Science Institute (WVCTSI) seeks …

Musical Hallucinations Treated With Atypical Antipsychotics In A Geriatric Population – A Case Series, Adam Schindzielorz Md, D. Scott Murphy Md, Suzanne Holroyd Md

Psychiatry

Musical hallucinations have been likened to the auditory equivalent of Charles Bonnet Syndrome, which involves complex visual hallucinations, most often in the context of visual impairment. Musical hallucination frequently take the form of hymns, carols, and show-tunes and are strongly associated with hearing loss, with some studies suggesting a prevalence of 2.5–3.6% in the hearing impaired. Musical hallucinations are typically treated with anticonvulsant and anticholinesterase medications, with some studies having evaluated the efficacy of sedative hypnotics, antipsychotics and antidepressants in various psychiatric and medical subpopulations suggesting a heterogeneous spectrum of causes for this disorder.

We present two cases of musical …

Restoration Of Completely Transected Common Bile Duct Continuity Using Single Operator Cholangioscopy, Saad Emhmed Ali, Houssam Mardini, Mohsin Salih, Steven J. Krohmer, Wesam M. Frandah

Internal Medicine

Common bile duct (CBD) injury, ranging from a partial tear to a complete transection, is a major surgical complication of cholecystectomy with significant morbidity and mortality. Proper management of these complex injuries depends on the type and extent of injury and time of recognition. Identifying and repairing injuries during cholecystectomy can prevent development of complications, but this only occurs in about one-third of cases. We report a novel technique to reconnect a transected CBD with assistance of single-operator cholangioscopy.

Research Days At West Virginia’S Allopathic Medical Schools: Ten Year Publication Rates And Impact, Mohammad Halaibeh Md, Alexander H. Slocum Jr., Phd, Md, Yousif Mohammed Md, Zain N. Qazi Md, Franklin D. Shuler Md, Phd

Orthopaedics

Participation in research and scholarly activity is critical to successful medical student and resident matriculation and to faculty development. Both Marshall University and West Virginia University sponsor yearly peer-reviewed School of Medicine Research Days’ to support these missions. This article evaluates the successful publication of Research Day presentations for West Virginia’s Allopathic Medical Schools. Both Marshall University (MU) and West Virginia University’s (WVU) School of Medicine use a competitive review process for abstract selection ensuring high quality research is presented. Over a 10-year period, MU published 12% (74/616) of its abstracts while WVU published 22% (265/1185) of its abstracts. We …

Pneumonia Due To A Rare Pathogen: Achromobacter Xylosoxidans, Subspecies Denitrificans, Hesham Awadh, Munthir Mansour, Obadah Aqtash, Yousef Shweihat

Internal Medicine

Achromobacter xylosoxidans, subspecies denitrificans, is a gram-negative rod recently implicated as an emerging cause of infection in both immunosuppressed and immunocompetent populations. Few cases are reported in literature involvingmultiple body systems. Diagnosis depends on cultures of appropriate specimens, and management usually is by administration of appropriate antibiotics(usually agents with antipseudomonal activity).We report a rare case of pneumonia due to infection with this organism, in a patient with preexisting bronchiectasis secondary to chronic aspiration.

Bronchopleural Fistula Resolution With Endobronchial Valve Placement And Liberation From Mechanical Ventilation In Acute Respiratory Distress Syndrome: A Case Series, Haris Kalatoudis, Nikhil Meena, Fuad Zeid, Yousef Shweihat

Internal Medicine

Patients who have acute respiratory distress syndrome (ARDS) with persistent air leaks have worse outcomes. Endobronchial valves (EBV) are frequently deployed after pulmonary resection in noncritically ill patients to reduce and eliminate bronchopleural fistulas (BPFs) with persistent air leak (PAL). Information regarding EBV placement in mechanically ventilated patients with ARDS and high volume persistent air leaks is rare and limited to case reports. We describe three cases where EBV placement facilitated endotracheal extubation in patients with severe respiratory failure on prolonged mechanical ventilation with BPFs. In each case, EBV placement led to immediate resolution of PAL. We believe endobronchial valve …

Pembrolizumab Reactivates Pulmonary Granulomatosis, Majdi Al-Dliw, Mohammed Megri, Ibrahim M. Shahoub, Gaurav Sahay, Teresa I. Limjoco, Yousef Shweihat

Internal Medicine

Sarcoid like reaction is a well-known entity that occurs as a consequence to several malignancies or their therapies. Immunotherapy has gained a lot of interest in the past few years and has recently gained approval as first line therapy in multiple advanced stage malignancies. Pneumonitis has been described as complication of such therapy. Granulomatous inflammation has been only rarely reported subsequent to immunotherapy. We describe a case of granulomatous inflammation reactivation affecting the lungs in a patient previously exposed to Pembrolizumab and have evidence of a distant granulomatous infection. We discuss potential mechanisms of the inflammation and assert the importance …

Buspirone For The Treatment Of Dementia With Behavioral Disturbance, Maria R. Santa Cruz, Priscilla Hidalgo, Meredith Lee, Cornelius Thomas, Suzanne Holroyd

Psychiatry

Behavioral disturbances are common but serious symptoms in patients with dementia. Currently there are no FDA approved drugs for this purpose. There have been case reports and small case series of the use of buspirone. In this retrospective study, we review 179 patients prescribed buspirone for treatment of behavioral disturbance in dementia to better characterize the efficacy and potential side effects. All patients prescribed buspirone for behavioral disturbance due to dementia from a geropsychiatric outreach program were reviewed. Data was collected and analyzed using SPSS. One hundred-seventy-nine patients met criteria for the study with a mean age of 83.8 + …

Cigarette Smoking And Cardio-Renal Events In Patients With Atherosclerotic Renal Artery Stenosis, Christopher A. Drummond, Pamela S. Brewster, Wencan He, Kaili Ren, Yanmei Xie, Katherine R. Tuttle, Steven T. Haller, Kenneth Jamerson, Lance D. Dworkin, Donald E. Cutlip, Timothy P. Murphy, Ralph B. D'Agostino Sr., William L. Henrich, Jiang Tian, Joseph I. Shapiro Md, Christopher J. Cooper

Biochemistry and Microbiology

Cigarette smoking causes cardiovascular disease and is associated with poor kidney function in individuals with diabetes mellitus and primary kidney diseases. However, the association of smoking on patients with atherosclerotic renal artery stenosis has not been studied. The current study utilized data from the Cardiovascular Outcomes in Renal Atherosclerotic Lesions (CORAL, NCT00081731) clinical trial to evaluate the effects of smoking on the risk of cardio-renal events and kidney function in this population. Baseline data showed that smokers (n = 277 out of 931) were significantly younger at enrollment than non-smokers (63.3±9.1 years vs 72.4±7.8 years; p<0.001). In addition, patients who smoke were also more likely to have bilateral renal artery stenoses and peripheral vascular disease (PVD). Longitudinal analysis showed that smokers experienced composite endpoint events (defined as first occurrence of: stroke; cardiovascular or renal death; myocardial infarction; hospitalization for congestive heart failure; permanent renal replacement; and progressive renal insufficiency defined as 30% reduction of GFR from baseline sustained for ≥ 60 days) at a substantially younger age compared to non-smokers (67.1±9.0 versus 76.1±7.9, p<0.001). Using linear regression and generalized linear modeling analysis controlled by age, sex, and ethnicity, smokers had significantly higher cystatin C levels (1.3±0.7 vs 1.2±0.9, p<0.01) whereas creatinine and estimated glomerular filtration rate (eGFR) were not different from non-smokers. From these data we conclude that smoking has a significant association with deleterious cardio-renal outcomes in patients with renovascular hypertension.

Charles A. Hoffman, M.D.: Physician, Leader, Humanist, Lawrence M. Wyner M.D.

Surgery

Physician role models are as important for the seasoned practitioner as they are for the recent medical school graduate. To this end, the life and career of Charles "Carl" A. Hoffman, M.D. (Fig. 1), American Urological Association (AUA) President 1967-1968, are legion. Dr. Hoffman had humble origins in the southern Ohio industrial town of Ironton. Born in 1904, he lost both parents before the age of 10 years, and was taken in by relatives. To help support his extended family, he got an after-school job at a local pharmacy (Fig. 2a), running errands and delivering prescriptions. The sight of people …

Prospect Of The Use Of Checkpoint Inhibitors In Hepatocellular Cancer Treatments, Ali Raufi

Internal Medicine

Hepatocellular cancer (HCC) is a very fatal disease due to limited therapeutic options as well as due to its association with underlying chronic liver disease in the majority of cases. The immune evasion in HCC signifies a major barrier to the delivery of effective immunotherapy. Sorafenib is the only Food and Drug Administration-approved drug available with an overall response rate of 2%–3% and overall survival of 2.8 months. Chemotherapy has not been used routinely because of the relative refractoriness of advanced HCC. The introduction of immune checkpoint inhibitors (cytotoxic T-lymphocyte antigen 4, programmed death 1, and programmed death-ligand 1) has …

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.

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.