Medicine and Health Sciences Commons^™

Accessible Design In Rural Health Care: Usability Profile Of Outpatient Health Care Facilities In Rural West Virginia, Jordan Elliott Miller, Chris Haddox

Marshall Journal of Medicine

The purpose of this research is to better understand the physical and environmental features of outpatient healthcare facilities that act as barriers to healthcare access in rural West Virginia and factors that contribute to non-compliance with the ADA. The research aims to explore the prevalence of barriers in rural West Virginia health facilities and the relationship between building characteristics (like year of construction and original purpose) and accessibility. The researcher evaluated ten rural outpatient member-sites of the West Virginia Practice-Based Research Network using the Outpatient Health Care Usability Profile to measure essential features for a facility to be considered ‘usable’. …

Statistical Methods Useful In Clinical Simulation And Medical Education Scholarship, Zuber D. Mulla, J. Hector Aranda, Donovan Rojas, Sanja Kupesic Plavsic

Marshall Journal of Medicine

The objective of this paper is to introduce selected statistical and epidemiologic topics that are of interest to interdisciplinary teams of healthcare quality professionals, educators, technical staff, and researchers who participate in clinical simulation scholarship. Four research vignettes in the setting of a hypothetical clinical simulation training workshop are presented. The first vignette illustrates the utility of exact logistic regression when analyzing a small dataset. The second underscores the importance of using an appropriate method to account for the repeated measurement of an outcome. The third illustrates the use of the intraclass correlation coefficient to measure inter-rater reliability. The final …

Cavernous Sinus Thrombosis Complicated By Carotid Artery Occlusion: A Case Report, Faisal Taleb, Seraj S. Ajaj, Abdussalam Abograra, Ali Eldeeb

Marshall Journal of Medicine

Cavernous sinus thrombosis (CST) is a fatal phenomenon that requires clinical suspicion and emergent imaging for correct diagnosis. . However, only a few authors reported severe involvement of the internal carotid artery (ICA). Here we report an 11 year old girl diagnosed with Cavernous sinus thrombosis complicated by left internal carotid artery occlusion.

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Diabetic Muscle Infarction: A Rare End-Organ Vascular Complication Of Diabetes, Callie Seaman, Michael Amos, Adam M. Franks, Asher Sexton, Kimberly Mcclelland, Erika M. Harris

Marshall Journal of Medicine

Diabetic muscle infarction (DMI) is a rare microvascular complication of spontaneous ischemic necrosis of skeletal muscle in patients with poorly controlled diabetes. We herein describe the case of a 26-year-old woman with a history of type I diabetes and accompanying diabetic microvascular complications of neuropathy, nephropathy and retinopathy, who presented with sudden onset of swelling and sharp pain in her bilateral thighs. T2-weighted MRI imaging revealed subcutaneous edema and sub-fascial, hyper-intense enhancement of proximal thigh musculature. DMI has a relatively non-specific clinical presentation; therefore, physician awareness is key for early diagnosis, as aggressive management has been associated with poor patient …

Artificial Intelligence And The Challenge For Rural Medicine, James Denvir

Marshall Journal of Medicine

Recent advances in artificial intelligence, machine learning, and deep learning are beginning to have an impact on everyday experiences, from natural language processing used in automated telephone call centers to semi-autonomous vehicles. These techniques have also been applied to medical care. In this editorial we discuss applications of AI to medicine and argue for a proactive approach to include rural medicine in this paradigm shift.

Pigmentary And Other Dermatologic Manifestations Of Minocycline: A Reminder Of Adverse Effects, Kayla Rodriguez, Courtney Wellman, Adam M. Franks, Kimberly Mcclelland, Tammy Bannister

Marshall Journal of Medicine

The applications of the tetracycline class of antibiotics extends beyond their antimicrobial activity to anti-inflammatory, immunosuppressive and neuroprotective applications making it a commonly used class of medication. Minocycline, a second generation tetracycline, has inherent characteristics that improve absorption and distribution. These benefits promote even more wide spread use. This familiarity of usage breeds prescriptive complacency toward the dermatologic complications including hyperpigmentation. The following case explores these adverse manifestations of Minocycline use.

Acute Diagnosis Of Wilson’S Disease In A Teenage Patient, Sarah Irvin, Ryan Mccarthy

Marshall Journal of Medicine

Wilson’s Disease, a rare autosomal recessive genetic disease, is caused by a mutation in the ATP7B enzyme gene. Without this enzyme, copper builds up in the brain, liver, and cornea causing a multitude of symptoms. It is important to consider Wilson’s disease because the prognosis is dependent on timely diagnosis. This is an interesting case of a 19-year-old male who presented with suicidal thoughts and rapid weight loss. After many months and an extensive work-up, Wilson’s Disease was diagnosed. Due to his rapid decline, he was transferred to a larger university healthcare center where he is currently enrolled in clinical …

Is Napping A Good Thing?, Sammar Atassi

Marshall Journal of Medicine

This article aims to explore new findings in research in the relationship between sleep disorders and dementia. The new research questions the glymphatic system's role in clearing the toxic proteins from the brain during sleep.

Case Reports: Add Value Beyond The Impact Factor, Darshana T. Shah

Marshall Journal of Medicine

No abstract provided.

How Acceptable Is The Hiv/Aids Self-Testing Among Women Attending Immunization Clinics In Effurun, Southern Nigeria, Wasiu Olalekan Adebimpe, Doraebikeme Ebikeme, Olubukunola Omobuwa, Edward Oladejo

Marshall Journal of Medicine

HIV testing remains the gateway to HIV/AIDS prevention, treatment, care and support interventions. In Nigeria, a significant proportion of the populations do not know their HIV status. HIV self-testing done without the help of a healthcare provider could remove identified barriers to HIV testing, and close gaps in HIV treatment and prevention cascades. This study set out to assess the knowledge and acceptability of hiv self-testing (HIVST) among women of child bearing age attending immunization clinics in Effurun, Nigeria. A descriptive, cross-sectional study was conducted among 357 women of child-bearing age selected using multistage sampling technique. Research instrument used was …

Prasugrel Inappropriate Use In Patients Post-Percutaneous Coronary Intervention (Pci). A Single Center Study, Ahmed Amro, Kanaan Mansoor, Mohammad Amro, Amal Sobeih, Obadah Aqtash, Hisham Hirzallah, Alaa Gabi, Madhulika Urella, Waseem Ahmed, Sandra Shenouda, Dr. Rameez Sayyed, Md

Marshall Journal of Medicine

Prasugrel is a thienopyridine that was approved by the US Food and Drug Administration (FDA) in combination with aspirin for the reduction of thrombotic events as well as stent thrombosis in patients with ACS who undergo PCI. This retrospective study aims to assess the frequency of inappropriate use of prasugrel and to emphasize that prasugrel still needs more attention as inappropriate use may result in significant morbidity.

Intralesional Corticosteroids For Long-Term Control Of Primary Cutaneous Marginal Zone Lymphoma Without Systemic Involvement, Pragya Tiwari, John Hall, Anand Rajpara, Carol Stanford, Daniel Aires

Marshall Journal of Medicine

Primary cutaneous marginal zone lymphoma (PCMZL) is a B cell lymphoma with a very low metastatic rate. Radiographic monitoring for internal involvement may be indicated initially. Favored treatments include radiation and excision. Radiation has high risk of local recurrence. Excision carries risk of infection and scarring. We report successful long-term treatment of recurrent PCMZL via intralesional steroid injections into new lesions as they arose. This was preferred by the patient over her prior radiation and surgical treatments. Intralesional steroids have the advantages of being simple and well tolerated, without exposure to ionizing radiation, or to the infection and scarring associated …

Availability Of Long Acting Reversible Contraceptives For Adolescents In Urban Vs Rural West Virginia Counties, Brooke Andrews, Cameron Ross, Jennie L. Yoost

Marshall Journal of Medicine

The study objective was to evaluate long acting reversible contraceptive (LARC) method availability and access for adolescents in rural and urban counties in West Virginia (WV). A cross-sectional survey of Title X family planning providers throughout WV was conducted from January 2016-July 2017. This survey was sent to 226 family planning providers in WV to assess patterns of LARC availability. The survey assessed provider training level, LARC services provided and frequency, clinical practice, referral patterns, and comfort level providing adolescent LARC services. Survey results were analyzed by providers’ rural vs urban status, based on US census county codes. Survey responses …

Incidental Retroperitoneal Castleman’S Disease Found In Patient With Renal Cell Carcinoma: A Case Report, Samantha Richardson, James Jensen, Niru Nahar, Nadim Bou Zgheib

Marshall Journal of Medicine

This report briefly discusses a case of retroperitoneal Castleman’s disease in a 52 year old post-menopausal woman with renal cell carcinoma.

Group A Streptococcus Brain Abscess In A Patient On Adalimumab Therapy, Ryan Carroll, Ahmad Abu-Hashyeh, James Gainer, Kara Willenburg, Charles Meadows

Marshall Journal of Medicine

Brain abscesses represent a group of dangerous infections typically caused by a number of classic organisms. Group A Streptococcus is a rare cause of brain abscesses and those patients that do have this particular condition will typically have a distal source of infection. We present a case of patient with a biopsy confirmed Group A Streptococcal without a distal source of infection. His only identifiable risk factor was his adalimumab therapy for ankylosing spondylitis. While adalimumab has not been linked to Streptococcal infection in the past, it has been associated with multiple atypical infections and some of the consequences of …

The Challenge Of Electronic Cigarettes, Sutoidem Akpanudo

Marshall Journal of Medicine

No abstract provided.

Giving Hope: Best Healing Power In Medicine, Nadim Bou Zgheib

Marshall Journal of Medicine

No abstract provided.

Extending Our Reach: Looking To The Future For The Marshall Journal Of Medicine, Darshana T. Shah

Marshall Journal of Medicine

No abstract provided.

Symptomology Associated With In Utero Exposures To Polysubstance In An Appalachian Population., Will Lester, Lacey Andrews, Emma M. Nellhaus, Sara Murray, Sean Loudin, Todd H. Davies

Marshall Journal of Medicine

Neonatal abstinence syndrome (NAS) is seen as a very high rate at our institution in Huntington, West Virginia, and the majority of exposures are polysubstance in nature. Polysubstance can have different meaning for each region. At our institution, polysubstance is any combination of opioids, gabapentin, methamphetamine, cocaine, marijuana, benzodiazepines, nicotine or other neuroactive substances with 3-4 substances being the norm. Rapidly changing combinations of drug use and the lack of literature create a difficult situation for clinicians who are often reliant on treatment recommendations that lack references or conclusive data supporting the clinical approaches. Elucidating withdrawal symptoms consistent with in …

Trans-Radial Coronary Intervention (Tci) Using 5-Fr Versus 6-Fr Guiding Catheters In The Setting Of Acute Coronary Syndrome (Acs)., Ahmed Amro, Mohammad Amro, Amal Sobeih, Obadah Aqtash, Hisham Hirzallah, Majd Kanbour, Adee El-Hamdani, Alaa Gabi, Yazan Numan, Mark Studeny, Mehiar El-Hamdani

Marshall Journal of Medicine

Background:

As in any vascular access the size of guiding catheter is an operator preference. Although multiple studies showed the use of 5-Fr versus 6-Fr guiding catheters for Transradial coronary intervention (TCI) have similar vascular safety profile and can be performed safely and successfully with both of them, the data comparing the 5-Fr vs 6-Fr guiding catheters for TCI in terms of fluoroscopy time, procedure time and contrast amount in the setting of ACS is limited. We conducted this study to compare the use of 5-Fr versus 6-Fr guiding catheters for TCI in the settings of ACS.

Method:

Our study …

Surgery For Esophageal Adenocarcinoma: Three Field Open Mckeown Procedure Has A Role In Assessment And Treatment Of Extensive Locally Advanced Esophageal Adenocarcinoma With A Favorable Clinical And Pathological Outcome., Mark H. Cooper, Paul Bown, Toni O. Pacioles

Marshall Journal of Medicine

Esophageal adenocarcinoma has seen an increased incidence due to gastroesophageal reflux disease , smoking and obesity. There are no established guidelines for screening of esophageal cancer and many patients present late in their disease process. Most early stage adenocarcinoma of the esophagus is treated with neoadjuvant chemotherapy and radiation follow by surgical resection in suitable operative candidates. We describe a case of locally advanced esophageal cancer, where the patient had a relatively insignificant response to neoadjuvant chemotherapy and radiation, who was then treated by open direct resection of the esophagus and proximal stomach (three field McKeown approach) with lymphadenectomy. The …

Bilateral Foot Drop Linked To Rapid Intentional Weight Loss And Long Distance Walking., Morgan S. Aguirre, Josh Gibson, Dominika Lozowska

Marshall Journal of Medicine

There are many causes of acute onset foot drop ranging from deep fibular nerve or sciatic nerve injury caused by trauma or a compressive mass such as a neuroma, to spinal cord disorders like disc herniation causing L4-5 radiculopathy, and various muscular dystrophies affecting the tibialis anterior muscle responsible for foot dorsiflexion and eversion. Even brain disorders like MS, stroke or ALS can result in foot drop. We present a case of bilateral foot drop as a complication of rapid 70 lb weight loss which was described in literature previously as “slimmer’s palsy”.

Kounis Syndrome: A Simple Mri With Contrast Turned Into A Life Threatening Condition, Ahmed Amro, Kanaan Mansoor, Mohammad Amro, Amal Sobeih, Mehiar El-Hamdani

Marshall Journal of Medicine

Kounis syndrome [KS] is a hypersensitivity coronary disorder induced by various allergens. It is a rare condition which has been reported in every age group (2-90 years), every race and geographic location, its incidence has been reported to range from 7.9 to 19.4 per 100,000. The presentation of the detrimental effects of KS on coronary arteries ranges from vasospastic angina to allergic myocardial infarction.

Drugs are the major iatrogenic cause of KS, but virtually everything in the environment around us can cause KS. In recent years contrast mediums used in the radiologic investigation have come forth as a leading cause …

Angiogram Negative Subarachnoid Hemorrhage In The Setting Of Sexual Intercourse And Chronic Cannabis Use, Dakota T. May, Dominika Lozowska

Marshall Journal of Medicine

Etiology of unprovoked subarachnoid hemorrhage (SAH) is predominantly from cerebral aneurysm rupture and manifests classically as a thunderclap headache. Orgasmic cephalgia may herald SAH given that 4-12% of SAH sufferers were found to have engaged in prior sexual activity.(1) Precipitating causes of SAH leading to aneurysmal rupture may be the rise in blood pressure caused by physical activity. A conventional angiogram (CTA) is used to reveal a source of the bleed and but occasionally this is normal, and is labelled angiogram-negative SAH or non-aneurysmal SAH. In those cases digital subtraction imaging (DSA) is needed for verification. Herein we discuss an …

Rare Sarcomatoid Carcinoma Of The Liver In A Patient With No History Of Hepatocellular Carcinoma: A Case Report, Kevat B. Patel, Rita H. Hawarny, Elizabeth Saunders, Marc Hettlinger, Niru Nahar

Marshall Journal of Medicine

Sarcomatoid carcinoma is a rare malignant tumor of unknown pathogenesis characterized by poorly differentiated carcinoma tissue containing sarcoma-like differentiation of either spindle or giant cell and rarely occurs in the gastrointestinal tract and hepatobiliary-pancreatic system.¹ Primary hepatic sarcomatoid carcinoma accounts for only 0.2 % of primary malignant liver tumors, and 1.8% of all surgically resected hepatocellular carcinomas.² The majority of hepatic sarcomatoid carcinoma cases appear to occur simultaneously with hepatocellular or cholangiocellular carcinoma.³ The preferred treatment for hepatic sarcomatoid carcinoma is surgical resection and the overall prognosis is poor.⁴ This case depicts a 62-year-old female whom …

On Watson, Racism, And Standardized Tests, Joseph I. Shapiro

Marshall Journal of Medicine

No abstract provided.

Advancing Science Through Diversity Begins With Cultural Immersion In Science Education, Darshana T. Shah

Marshall Journal of Medicine

No abstract provided.

The Use Of Dermoscopy Following A One-Day Workshop Among Family Medicine Residents, Dylan Maldonado, Kathleen M. O'Hanlon

Marshall Journal of Medicine

Skin cancer is the most common form of cancer in the United States. The purpose of this study is to determine if a single grand rounds workshop impacts the use of dermoscopy in a single Family Medicine Residency training program. Dermoscopy is a non-invasive tool to allow for higher magnification of skin lesions thereby increasing the ability to assess qualities which are unable to be seen by the naked eye. This study utilized a pre- and post-workshop survey questionnaire to assess participant practices in evaluation, diagnosis, and management of skin lesions. Eighteen (18) residents completed the survey prior to the …

Reducing Postoperative Opioids After Minimally Invasive Hysterectomy With Enhanced Recovery, Kevin D. White, Shirin Azadi, Amanda Pauley, Dr. Brenda L Mitchell,, Nadim Bou Zgheib

Marshall Journal of Medicine

I

Introduction:

We evaluated the efficacy of various strategies utilized for the control of postoperative pain after minimally invasive hysterectomy. The primary enhanced recovery after surgery (ERAS) protocol of interest utilized premedication (acetaminophen, celecoxib and pregabalin), then intraoperative subcutaneous liposomal bupivacaine followed by scheduled oral acetaminophen and ibuprofen postoperatively. Patients also had tramadol and oxycodone as needed for moderate or severe breakthrough pain, respectively.

Materials and Methods:

We conducted a retrospective cohort study that included all patients who underwent minimally invasive hysterectomy (total laparoscopic hysterectomy and laparoscopic-assisted vaginal hysterectomy) for both benign and oncologic indications over a 2-year period. We …

Failure Of Effective Contraception In Opioid Addicted Mothers: A Disparity In Planned And Actual Usage, Robert C. Bowers, Makenzie Hatfield Kresch, Amy Roy, Danielle Lancaster, Jennie L. Yoost

Marshall Journal of Medicine

The ongoing opioid epidemic in West Virginia has given rise to a unique population of opioid-addicted obstetric patients. Appropriate education, counseling, and implementation of contraception is of extreme importance among this high risk patient population. This study was a retrospective chart review aimed at evaluating contraception choice and initiation rates among patients enrolled in a maternal buprenorphine maintenance program compared to non-opioid addicted patients. Rates of planned contraception initiation were compared between the two groups. Rates of actual contraception initiation were also compared. Contraceptive choices were then placed into one of three tiers based on efficacy, and rates of initiation …