Medicine and Health Sciences Commons^™

Traumatic Posterior Tibial Pseudoaneursym: A Rare Late Complication Repaired Conventionally, Farzad Amiri, Md, Zachary Sanford, Constantinous Constantinou, Md

Constantinous Constantinou, MD

Posterior tibial artery pseudoaneurysms are extremely rare. They commonly present as a late complication of trauma or iatrogenic injury. Diagnosis can be elusive. Treatment has been described in the context of open primary repair, endovascular stenting, and coil embolization. There has been increasing interest in the use of endovascular treatment options for this type of injury. If left untreated, pseudoaneurysms can rupture, partially thrombose, expand and cause adjacent local compression and compartment syndrome. The following case presented is of a young gentleman with a posterior tibial pseudoaneurysm incidentally discovered after stepping on glass and the management of his posterior tibial …

What Is Causing This Man's Rectal Pain And Urinary Retention?, Mikaela L. Mckenney-Drake, Kali E. Veness, Christopher T. Roman

Christopher Roman

Case: A 23-year-old man presented to an urgent care office with a 2-week history of rectal pain and scant rectal bleeding. In the few days leading up to his presentation, he also had a fever of 101° F (38.3° C), inguinal lymphadenopathy, and urinary retention.

An Unusual Migration Of A Stent: A Case Report, Fikadu G. Tekleyes Md, Melissa D. Lester Md, Mark A. Studeny Md, Ellen A. Thompson Md, Steven Craig Md

Ellen A. Thompson

Stent dislodgment and embolization is a rare complication of coronary stenting. There are reports of intra-coronary stent entrapment, stripping, and dislodgement during percutaneous coronary interventions causing potentially life threatening complications, including intra-coronary or systemic embolization. Reports of dislodgment and migration of previously placed drug eluting intra-coronary stent several months after deployment are very limited in the literature. We describe a drug eluting stent dislodgment and migration in an 88 year-old male 10 months after its deployment.

Involvement Of Reactive Oxygen Species In A Feed-Forward Mechanism Of Na/K-Atpase Mediated Signaling, Yanling Yan, Anna P. Shapiro, Steven Haller, Vinal Katragadda, Lijun Liu, Jiang Tian, Venkatesha Basrur, Deepak Malhotra, Zi-Jian Xie, Nader G. Abraham, Joseph I. Shapiro Md, Jiang Liu

Zijian Xie

Cardiotonic steroids (such as ouabain) signaling through Na/K-ATPase regulate sodium reabsorption in the renal proximal tubule. We report here that reactive oxygen species are required to initiate ouabain-stimulated Na/K-ATPase·c-Src signaling. Pretreatment with the antioxidant N-acetyl-L-cysteine prevented ouabain-stimulated Na/K-ATPase·c-Src signaling, protein carbonylation, redistribution of Na/K-ATPase and sodium/proton exchanger isoform 3, and inhibition of active transepithelial ²²Na⁺ transport. Disruption of the Na/K-ATPase·c-Src signaling complex attenuated ouabain-stimulated protein carbonylation. Ouabain-stimulated protein carbonylation is reversed after removal of ouabain, and this reversibility is largely independent of de novo protein synthesis and degradation by either the lysosome or the proteasome pathways. Furthermore, …

The Prescription Drug Epidemic In Appalachian Elderly, Suzanne Holroyd, Md

Suzanne Holroyd

No abstract provided.

Patient Satisfaction With The Annual Wellness Visit, Maria Espiridion, Raghavendra Mulinti, Md, Suzanne E. Kemper, Mph, Lynne J. Goebel, Md

Lynne J. Goebel

OBJECTIVES - To determine patient satisfaction with the Annual Wellness Visit (AWV) DESIGN – Survey SETTING- Charleston Area Medical Center and Marshall Health PARTICIPANTS – 66 volunteers, average age 74 years MEASUREMENTS – Patient satisfaction was assessed with a 13 item survey. RESULTS - Of 1,537 eligible patients, 211 (14%) of these agreed to schedule their AWV. From 66 patients surveyed, 87% of patients said the visit “met expectations,” “would recommend to friends,” and “would do it again.” Only 5 (8%) were disappointed that new problems were not addressed and 2 (3%) were dissatisfied that physical exams and blood tests …

Transformational Teamwork: The Virtues And Values Of Collaboration, Darshana Shah, Phd. Editor-In-Chief

Darshana Shah

No abstract provided.

Lamina Spreader Technique Improves Debridement Of Loose Bone And Cement In Total Knee Arthroplasty, Sinan E. Ozgur, Ali Oliashirazi, Grant S. Buchanan, Franklin D. Shuler

Franklin D. Shuler

Abstract Loose bone and cement can promote polyethylene wear that may lead to failure in total knee arthroplasty. The authors propose a technique to enhance the debridement of loose bodies by distracting the cemented components with a lamina spreader following standard debridement with pulsatile lavage. Cement and bone/soft tissue debris was recovered from 51 consecutive primary total knee arthroplasty patients. This technique facilitated the removal of hidden debris in 80% of patients (41/51). On average, 2.6 fragments measuring 158 mm3 were removed per patient. The authors advocate that distraction with a lamina spreader be used to reduce potential sources of …

A Comparison Of Imaging Modalities For The Diagnosis Of Osteomyelitis, Brandon J. Smith, Md, Grant S. Buchanan, Md, Franklin D. Shuler, Md, Phd

Franklin D. Shuler

Osteomyelitis is an increasingly common pathology that often poses a diagnostic challenge to clinicians. Accurate and timely diagnosis is critical to preventing complications that can result in the loss of life or limb. In addition to history, physical exam, and laboratory studies, diagnostic imaging plays an essential role in the diagnostic process. This narrative review article discusses various imaging modalities employed to diagnose osteomyelitis: plain films, computed tomography (CT), magnetic resonance imaging (MRI), ultrasound, bone scintigraphy, and positron emission tomography (PET). Articles were obtained from Pubmed and screened for relevance to the topic of diagnostic imaging for osteomyelitis. The authors …

Lamina Spreader Technique Improves Debridement Of Loose Bone And Cement In Total Knee Arthroplasty, Sinan E. Ozgur, Ali Oliashirazi, Grant S. Buchanan, Franklin D. Shuler

Franklin D. Shuler

A lamina spreader was introduced to the non-articulating, posterior aspect of the tibial and femoral components, and gentle distraction was applied to improve the inspection of the posterior compartment

Vitamin K2 (Menaquinone) Supplementation And Its Benefits In Cardiovascular Disease, Osteoporosis, And Cancer, Grant S. Buchanan, Md, Thomas Melvin, Brandon Merritt, Charles Bishop, Md, Franklin D. Shuler, Md, Phd

Franklin D. Shuler

Vitamin K is known to play an essential role in the coagulation cascade; however, a growing body of research has found that a subtype of this vitamin, vitamin K2 (menaquinone) may have a beneficial effect in osteoporosis, cardiovascular disease, and cancer. This purpose of this article is to provide a comprehensive review of recent literature regarding menaquinone and its role in human health. This review discusses the physiology of menaquinone, its clinical benefits in cardiovascular disease, osteoporosis, and cancer, and how it may interact with certain medications. The authors conclude that menaquinone supplementation has been shown to improve carboxylation of …

Lamina Spreader Technique Improves Debridement Of Loose Bone And Cement In Total Knee Arthroplasty, Sinan E. Ozgur, Ali Oliashirazi, Grant S. Buchanan, Franklin D. Shuler

Ali Oliashirazi

A lamina spreader was introduced to the non-articulating, posterior aspect of the tibial and femoral components, and gentle distraction was applied to improve the inspection of the posterior compartment

Lamina Spreader Technique Improves Debridement Of Loose Bone And Cement In Total Knee Arthroplasty, Sinan E. Ozgur, Ali Oliashirazi, Grant S. Buchanan, Franklin D. Shuler

Ali Oliashirazi

Abstract Loose bone and cement can promote polyethylene wear that may lead to failure in total knee arthroplasty. The authors propose a technique to enhance the debridement of loose bodies by distracting the cemented components with a lamina spreader following standard debridement with pulsatile lavage. Cement and bone/soft tissue debris was recovered from 51 consecutive primary total knee arthroplasty patients. This technique facilitated the removal of hidden debris in 80% of patients (41/51). On average, 2.6 fragments measuring 158 mm3 were removed per patient. The authors advocate that distraction with a lamina spreader be used to reduce potential sources of …

Technique To Improve Cement Penetration In Total Knee Arthroplasty, Richard Boe Jr, Ali Oliashirazi

Ali Oliashirazi

In total knee arthroplasty, infection has always been cited as being the number one cause of failure. However, more recent studies have shown aseptic loosening as the top reason for failure now. Proper cement technique is an important factor in reducing the occurrence of aseptic loosening. Clean and dried bone are important in achieving rigid cement fixation. Subchondral cysts may be hidden below the cut bone surface and may interfere with cement interdigitation. During a recent total knee arthroplasty case, a simple technique was developed for identifying and clearing out these cysts. By only using the suction tip, the gentle …

Technique To Improve Cement Penetration In Total Knee Arthroplasty, Richard Boe, Ali Oliashirazi

Ali Oliashirazi

Pre-operative and post-operative AP radiographs of initial patient using described technique with the evacuated cyst filled with cement highlighted

Bad Hair Days And The Good Of Pamela Bone's Literary Journalism, Carolyn Rickett

Carolyn Rickett

“I can’t die! I haven’t finished saving the world yet!” (Bone, 2007c, p. 206).

As a recipient of the United Nations media peace prize, Pamela Bone was noted for her fearless reporting on humanitarian, gender and social justice issues. While some of her thought-provoking columns invited controversy, Michael Gawenda notes, “even when people disagreed with her, they respected and understood what she wrote came from her heart and mind and her great moral clarity” (quoted in Chandler, 2008, n.p.).

Retiring from The Age at the end of 2005, Bone accepted an invitation from Melbourne University Press to write a memoir …

Clostridium Difficile Infection: Nursing Considerations, Brett G. Mitchell, Philip L. Russo, Paul T. Race

Paul Race

Clostridium difficile is a bacterium which commonly causes diarrhoea in inpatients. C. difficile affects hospitalised patients worldwide and can pose a significant risk to patients. This article explores the transmission and risk factors for C. difficile infection (CDI). There are many aspects to the prevention and control of CDI: appropriate antibiotic use, early instigation and maintenance of prevention and control strategies, and high standards of environmental cleanliness, education, and surveillance. This article discusses the role of the nurse in each of these prevention and control activities.

The Relative Value Of Measures Of Omega-3 Index, Perceived Stress, Cortisol And Sleep Time In Identifying Depression Among A Cohort Of Australian Adolescents, Ross Grant, Ayse Bilgin, Jade Guest, Margaret J. Morris, Manohar Garg, Robyn Pearce

Robyn Pearce

Objective: To assess the relative prognostic value of 11 variables including, omega-3, perceived stress, cortisol and sleep duration, in predicting adolescent depression. Design, Setting and Participants: A cross-sectional study of 444 healthy adolescents aged 16-18 years, from 10 schools within the Northern Sydney and Central Coast regions of New South Wales, Australia. Participants provided blood and saliva samples and completed questionnaires. Statistical classification methods were used to model the relationships between the predictors and depression. Main Outcome Measures: relative predictive value of each variable in correctly classifying depression. Results: 6% of boys and 9% of girls were categorised as experiencing …

The Relative Impact Of A Vegetable-Rich Diet On Key Markers Of Health In A Cohort Of Australian Adolescents, Ross Grant, Ayse Bilgin, Carol Zeuschner, Trish Guy, Robyn Pearce, Bevan Hokin, John Ashton

Robyn Pearce

Childhood obesity is a widespread health problem in Australia. Overweight in childhood can lead to adult overweight and the development of risk factors for cardiovascular disease (CVD). Effective strategies for reducing childhood obesity are urgently required. A vegetarian diet has been shown to be an effective prophylactic to many lifestyle diseases in the adult population and may therefore be beneficial in children. However the metabolic demands of adolescents are different to adults and the impact of a vegetarian diet on CVD markers in this demographic is not certain. We compared key physiological and biochemical markers of health against responses to …

Evidence For Under-Nutrition In Adolescent Females Using Routine Dieting Practices, Jade Guest, Ayse Bilgin, Robyn Pearce, Surinder Baines, Carol Zeuschner, Corilda Le Rossignol-Grant, Margaret J. Morris, Ross Grant

Robyn Pearce

In Western countries the increasing prevalence of obesity in young people is a major public health concern. While the focus has been on reducing obesity, paradoxically the success of these campaigns may result in unhealthy nutritional practices. The aim of this study was to investigate the use and impact of weight control techniques on the health of adolescent females. Using Analysis of Variance we compared physiological and biochemical markers of health against responses to a modified, Schools Physical Activity and Nutrition Survey (SPANS) in 482 adolescent females (14-17 yrs) from secondary schools in the northern Sydney and Central Coast regions …

Addressing Disability In The Health System At Caritas Takeo Eye Hospital, Manfred Morchen, Gail Ormsby, Te Serey Bonn, David Lewis

Gail Ormsby

The article describes how the CARITAS Takeo Eye Hospital (CTEH) in Cambodia has worked hard to be more inclusive of people with disabilities. It mentions that the process to address the disability at the CTEH began in 2008 with the construction of new premises with universal design which reduced the physical barriers for everybody. The CTEH staff was trained on inclusion by CBM Australia and the Nossal Institute for Global Health; disability-inclusive practices reported a positive outcome.

Knowledge, Attitudes And Practice Of Diabetes In Rural Bangladesh: The Bangladesh Population Based Diabetes And Eye Study, Fakir M. Amirul Islam, Rahul Chakrabarti, Mohamed Dirani, Mohamed T. Islam, Gail Ormsby, Mohamed Wahab, Christine Critchley, Robert P. Finger

Gail Ormsby

Background: To assess the Knowledge, Attitudes and Practice (KAP) amongst the general community regarding type 2diabetes mellitus (DM) in rural Bangladesh. Methods: Data was collected using cluster random sampling from 3104 adults residing in a rural district in Bangladesh. Participants underwent a KAP questionnaire survey regarding assessing diabetes, socio-demographic and medical history. Descriptive, Chi-square and regression analyses were performed. Results: Participants were aged between 30 and 89 years (M = 51, SD = 11.8) and 65.5% were female. The prevalence of diabetes was found to be 8.3%. The majority (93%) reported to have heard of diabetes, yet only 4% knew …

The Effectiveness Of The Complete Health Improvement Program (Chip) In Australasia For Reducing Selected Chronic Disease Risk Factors: A Feasibility Study, Darren Morton, Paul Rankin, Peter Morey, Lillian Kent, Trevor Hurlow, Esther Chang, Hans A. Diehl

Darren Morton

Abstract Aim To examine the effectiveness within the Australasian context of the Complete Health Improvement Program (CHIP) lifestyle intervention, which has been shown to produce meaningful reductions in selected chronic disease risk factors in the United States. Methods Changes in body weight, blood pressure, blood lipid profile and fasting plasma glucose were assessed in 836 self-selected participants (age=55.9±12.7 yrs, 35% male/65% female) from 18 sites throughout New Zealand (N=731) and Australia (N=105). Results In the 30 days of the program, significant overall reductions (pConclusions Significant reductions in selected chronic disease risk factors were observed in 30 days using the CHIP …

The Effect Of A Low-Fat, Plant-Based Lifestyle Intervention (Chip) On Serum Hdl Levels And The Implications For Metabolic Syndrome Status - A Cohort Study, Lillian Kent, Darren Morton, Paul Rankin, Ewan Ward, Ross Grant, John Gobble, Hans A. Diehl

Darren Morton

Background

Low levels of high-density lipoproteins (HDL) are considered an important risk factor for cardiovascular disease and constitute one of the criteria for the Metabolic Syndrome (MetS). Lifestyle interventions promoting a low-fat, plant-based eating pattern appear to paradoxically reduce cardiovascular risk but also HDL levels. This study examined the changes in MetS risk factors, in particular HDL, in a large cohort participating in a 30-day lifestyle intervention that promoted a low-fat, plant-based eating pattern.

Methods

Individuals (n = 5,046; mean age = 57.3 ± 12.9 years; 33.5% men, 66.5% women) participating in a in a Complete Health Improvement Program (CHIP) …

The Complete Health Improvement Program (Chip), Darren Morton

Darren Morton

Over 2,000 years ago Hippocrates asserted: "Food and exercise... work together to produce health". Evidence for the wisdom of this Hippocratic council emerged throughout the 20th Century as large epidemiological studies, including the Framingham Heart Study, Nurses Health Study, EPIC (European Prospective Investigation into Cancer and Nutrition) and the Adventist Health Study, highlighted the relationship between lifestyle and disease.

Runner's Stitch And The Thoracic Spine, Darren Morton, T Aune

Darren Morton

The cause of the abdominal pain commonly referred to as "stitch", but more accurately known as exercise related transient abdominal pain (ETAP), had until recently attracted more speculation than research. Explanations for the pain have included diaphragmatic ischaemia, (1) stress on peritoneal ligaments, (2) and irritation of the parietal peritoneum. (3) Although the exact cause of the pain remains to be elucidated, a neurogenic explanation has not appeared in the literature. We present the case of an elite runner who, after a thoracic spine trauma, developed severe and recurrent episodes of ETAP which were relieved by localised treatment. As a …

Short-Term Effectiveness Of A Lifestyle Intervention Program For Reducing Selected Chronic Disease Risk Factors In Individuals Living In Rural Appalachia: A Pilot Cohort Study, David Drozek, Hans A. Diehl, Masato Nakazawa, Tom Kostohryz, Darren Morton, Jay Shubrook

Darren Morton

Most Western chronic diseases are closely tied to lifestyle behaviors, and many are preventable. Despite the well-distributed knowledge of these detrimental behaviors, effective efforts in disease prevention have been lacking. Many of these chronic diseases are related to obesity and type " diabetes, which have doubled in incidence during the last 35 years. The Complete Health Improvement Program (CHIP) is a community-based, comprehensive lifestyle modification approach to health that has shown success in addressing this problem. This pilot study demonstrates the effectiveness of CHIP in an underserved, rural, and vulnerable Appalachian population. Two hundred fourteen participants in CHIP collectively demonstrated …

Long-Term Effectiveness Of The Community-Based Complete Health Improvement Program (Chip) Lifestyle Intervention: A Cohort Study, Lillian Kent, Darren Morton, Trevor Hurlow, Paul Rankin, Althea Hanna, Hans A. Diehl

Darren Morton

Objective: To examine the long-term (three or more years) effectiveness of the volunteer-delivered CHIP intervention.

Design: Cohort study

Setting: Hawera, New Zealand

Participants: Of the total cohort of 284 individuals who self-selected to complete the CHIP lifestyle intervention between 2007 and 2009, 106 (37% of the original cohort, mean age = 64.9±7.4 years, range 42-87 years; 35% males, 65% female) returned in 2012 for a complimentary follow-up health assessment (mean follow-up duration = 49.2+10.4 months).

Intervention: 30-day lifestyle modification program (diet, physical activity, substance use and stress management) delivered by volunteers in a community setting.

Main outcome measures: Changes in …

Gender Differences In Effectiveness Of The Complete Health Improvement Program, Lillian Kent, Darren Morton, Paul Rankin, John Gobble, Hans A. Diehl

Darren Morton

Objective: To determine the differential effect of gender on outcomes of the Complete Health Improvement Program, a chronic disease lifestyle intervention program.

Design: Thirty-day cohort study.

Setting: One hundred thirty-six venues around North America, 2006 to 2009.

Participants: A total of 5,046 participants (33.5% men, aged 57.9 ± 13.0 years; 66.5% women, aged 57.0 ± 12.9 years).

Intervention: Diet, exercise, and stress management.

Main Outcome Measures: Body mass index, diastolic blood pressure, systolic blood pressure, lipids, and fasting plasma glucose (FPG).

Analysis: The researchers used t test and McNemar chi-square test of proportions, at P < .05.

Results: Reductions were significantly greater …

Heart Rate Responses And Fluid Balance Of Competitive Cross-Country Hang Gliding Pilots, Darren Morton

Darren Morton

Purpose: To evaluate the physiological challenges of competitive cross-country hang gliding.

Methods: Seventeen experienced male pilots (age = 41 ± 9 y; mean ± SD) were fitted with a monitor that recorded heart rate and altitude at 0.5 Hz throughout a competitive flight. Fluid losses were evaluated by comparing pilot pre- and postflight mass.

Results: The pilots’ displacement was 88.4 ± 43.7 km in 145.5 ± 49.4 min. Mean flight altitude was 1902 ± 427 m (range = 1363–2601 m) with a maximum altitude of 2925 ± 682 m (1870–3831 m). The mean in-flight heart rate of the pilots was …