Medicine and Health Sciences Commons^™

Why Medical Students Choose Rural Clinical Campuses For Training: A Report From Two Campuses At Opposite Ends Of The Commonwealth, William Crump, Anthony D. Weaver, R. Steve Fricker, Alllison M. Crump

Marshall Journal of Medicine

Introduction

Although US medical schools have increased their enrollment by about 30%, most of the increase has occurred in urban areas. The affinity model proposes that rural training of a rural student will more likely result in a rural physician, but the exact role of these rural campuses is unclear. Do they solidify and reinforce a pre-existing career plan, do they create social and marital ties that make the transition to rural medicine easier, or could they be replaced with a briefer and more efficient rural rotation? We administered a questionnaire to students attending two different two year rural clinical …

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

Marshall Journal of Medicine

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 …

Medicine Outside The Clinic: The Growing Need For Physicians In Sexual Education Policy, Zachary Sanford

Marshall Journal of Medicine

Sex and sexuality are both topics of immense social and personal importance, owing their openness or constraint in large part to the society in which they are discussed. In homogenous groups it may be possible to reach firm consensus on what is, or is not, appropriate to consider a sexual norm and use an overarching set of religious or spiritual morals to reaffirm this decision. However, in western society and specifically in the United States, a theme of integration and amalgamation of wildly different cultures has presented an interesting case study in searching for common ground on basic social issues. …

Acute Limb Ischemia Due To A Fractured Superficial Femoral Artery Stent, Alaa Gabi, Ahmed Amro, Haytham Aljoudi, Faisal Hayat, Rameez Sayyed

Marshall Journal of Medicine

Peripheral Vascular Disease (PVD) is a rapidly growing and recognized disease of the peripheral circulation. Its presentation can vary between asymptomatic state, exercise limiting limb pain, limb loss and even death. Advances have been achieved in the treatment of PVD specially in the field of interventional cardiovascular medicine. Different devices and techniques are used in the treatment of peripheral atherosclerotic disease, which has lowered the need for bypass surgery. Although invasive peripheral intervention has a low rate of complications, there are still well recognized acute and chronic complications that an operator should be aware of. We present an interesting case …

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

Marshall Journal of Medicine

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 …

An Unusual Case Of Escherichia Coli Meningitis And Bacteremia In An Elderly Woman Presenting With Intractable Low Back Pain, Andrea M. Lauffer, Mahmoud Shorman, Carl Mccomas

Marshall Journal of Medicine

Abstract

Introduction:

We report an unusual case of E. coli meningitis in an elderly woman who presented to the emergency room with a chief complaint of intractable low back pain.

Case Description:

A 67 year old woman presented to the emergency room for a chief complaint of intractable low back pain. After admission, the patient developed delirium. Blood cultures were drawn. Patient underwent a lumbar puncture which revealed purulent cerebrospinal fluid. Results of the cerebrospinal fluid and blood cultures revealed pan-sensitive E. coli.

Conclusion:

In the geriatric population, delayed presentation of meningitis can occur for various reasons. With the older …

When It Isn’T Always Lyme: Expanding The Differential Diagnosis For Acute-Onset Polyarthralgia In The West Virginia Eastern Panhandle, Natalie A. Moffett, Rosemarie Lorenzetti

Marshall Journal of Medicine

This case presentation discusses a 36 year-old female animal care worker presenting with an acute-onset polyarthropathy during the summer months in a Lyme endemic region. Though she appeared to be a good candidate for the diagnosis of Lyme borreliosis, her screening serology reported negative results and alternative diagnoses were considered. Her subsequent diagnosis with parvovirus B19 acts to remind the general practitioner to have confidence in the accuracy of a negative Lyme screen and, upon negative result, to expand the differential to include less common infections including parvovirus B19. It also highlights the need to remember parvovirus B19 in a …

Retrograde Pedal Access For Revascularization Of Infrapopliteal Arterial Occlusive Disease In Critical Limb Ischemia (Cli) Patients As A Primary Approach., Ahmed Amro, Alaa Gabi, Shahed Elhamdani, Haytham Aljoudi, Mehiar El-Hamdani

Marshall Journal of Medicine

Introduction:

We are presenting three cases (out of similar several cases) where tibio-pedal approach was performed as an initial primary approach for limb salvage in patients with CLI secondary to Infra-popliteal (IP) disease. We consider this approach to be a necessary evolution in endovascular intervention.

Discussion:

Retrograde pedal access is safe, feasible with high technical success rate and a relatively low procedural complication rate, with low 30 days mortality and low rate of major adverse cardiac events. Freedom from major adverse limb events and limb salvage are both high at 1 year follow up. It allows quick therapy and short …

An Atypical Cause Of Atypical Hemolytic Uremic Syndrome, Abhinav Sharma, Carolina De Elia, Eric Arguelles, Christine L. Gilkerson

Marshall Journal of Medicine

Atypical hemolytic syndrome is an extremely rare, life threatening, progressive disease. Approximately one to two cases per million are seen annually in the US (3,4). It is known to be associated with variety of conditions including infections, drugs, autoimmune conditions, vaccination, malignancy, organ transplantation, pregnancy, and metabolic conditions (11,13).We hereby describe a case of atypical hemolytic uremic syndrome associated with CABG surgery. A 58 year old female presented to the emergency department (ED) with three days of worsening shortness of breath and cold like symptoms including nausea, vomiting and rhinorrhea. Twenty six days prior to presentation she had undergone Coronary …

Spinal Cord Injury And Autonomic Dysreflexia- A Case Report, Apurva Bhatt, Brit Moore, Talal Asif, Kristy E. Steigerwalt, Rebecca R. Pauly

Marshall Journal of Medicine

Autonomic dysreflexia (AD) is a life threatening condition affecting patients with spinal cord lesions T6 level and above. A 51 year old male with a history of paraplegia due to a C6 spinal cord injury (30 years prior) presented with recurrent debilitating episodic diaphoresis, hypertension, low body temperature, and bradycardia. Previous hospitalizations presumed sepsis from UTI to be the etiology, however on further evaluation his symptoms were consistent with undiagnosed AD. This article describes a unique case presentation and reviews AD in depth, including the etiology, pathophysiology and management.

Splenic Infarction: An Uncommon Presentation Of Acute Infectious Mononucleosis, Madhulika Urella, Roma Srivastava, Waseem Ahmed, Yehuda Lebowicz

Marshall Journal of Medicine

Splenic infarction is a relatively uncommon diagnosis. It occurs when the splenic artery or one of its sub-branches is occluded with an infected or bland embolus or clot. Splenic infarction may be caused by atrial fibrillation, bacterial endocarditis, sickle cell disease, antiphospholipid syndrome, and trauma whereas an infectious etiology is uncommon. It is considered a rare presentation of acute infectious mononucleosis. Currently, its pathogenesis is still unclear. We describe a 24-year-old African American female who was admitted for evaluation of left-sided chest pain. Chest imaging, abdominal ultrasound, and initial laboratory data were normal, followed by a negative hypercoagulability panel. Signs …

Contribution Of Medical Education To Rural Health, Roger Y. Wong

Marshall Journal of Medicine

Rural health is an important priority in many jurisdictions as an example of social accountability. The choice to practice in a rural community can be influenced by personal factors, educational factors, and systemic factors. Medical education makes significant contribution to rural health by proactively and positively modifying the educational factors. The experience of the Faculty of Medicine at the University of British Columbia, Canada is used to illustrate how this can be accomplished. A multi-component approach that is tailored to address the personal and systemic determinants of rural practice must also be developed to maximize the positive impact of medical …

Academic Medicine Responds To The Opioid Crisis, John Prescott

Marshall Journal of Medicine

Opioid dependence has devastated communities across the nation particularly in rural states and academic medicine has responded in a variety of ways. Through its tripartite mission of education, research, and clinical care, creative solutions are being implanted. Medical schools and teaching hospitals are partnering with public health and law enforcement agencies, as well as local healthcare providers to address the clinical, social, and rehabilitative challenges. Academic medicine continues to adapt to the needs of the nation and teach, train, and prepare the next generation of physicians to be at their best when things are at their worst.

The Time For Multidisciplinary Research Is Now, Jerome A. Gilbert

Marshall Journal of Medicine

No abstract provided.

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

Marshall Journal of Medicine

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 …

Incidence Of Hypomagnesemia On Proton Pump Inhibitors At The Huntington Veterans Affairs Medical Center – Ihop, Ebrahim Sabbagh, Do, Chelsey R. Houchins, James Allman, Ii, Pharmd, Samson Teka, Md

Marshall Journal of Medicine

Abstract

Title: Incidence of hypomagnesemia on proton pump inhibitors at the Huntington Veterans Affairs Medical Center – IHOP

Purpose:

Proton pump inhibitors (PPIs), both prescription and over-the-counter, are widely used for the treatment of acid-related disease states such as dyspepsia, gastroesophageal reflex disease, esophagitis, and peptic ulcers. These medications are generally considered safe in most patient populations; however, there are several adverse effects that may occur with long-term use. Hypomagnesemia is a newer complication arising in the literature following multiple case reports over the past several years, although the true incidence of hypomagnesemia associated with PPI use remains unclear at …

The Impact Of Tobacco Smoking On One Year Patient Outcomes At A Family Medicine Residency Clinic, Scott A. Fields, Phd, Satyakant Chitturi, Md, Anoop Kumar, Md, Jennifer Rose, Do, Andy Tanner, Do

Marshall Journal of Medicine

Abstract

Objectives: In Appalachia, tobacco smoking rates are significantly higher than the United States average, and many of the comorbidities that exist with tobacco are prominent. The researchers investigated the impact of tobacco smoking on patients for one year of health outcomes at our resident primary care clinic.

Methods: The present study examined outpatient clinic charts and hospital records for a calendar year to determine patient self-reported tobacco rates. Patient medical comorbidities were tracked as well as rates of hospital utilization during the calendar year, and those figures were compared for a group of 90 patients who currently smoke and …

Left Ventricular Noncompaction Syndrome: A Rare Congenital Cardiomyopathy, Ashwini V. Mallad, Mbbs, Waseem Ahmed, Md, Madhulika Urella, Md, Dr. Mehiar El-Hamdani, Md, Facc, Fscai

Marshall Journal of Medicine

Isolated left ventricular noncompaction cardiomyopathy (LVNC) is a rare congenital condition occurring due to arrest of myocardial compaction in the first trimester, resulting in a thin layer of compacted epicardium and thick hypertrabeculated myocardium containing deep recesses. This article presents a 44-year-old female with progressive dyspnea, orthopnea, paroxysmal nocturnal dyspnea, and pleuritic chest pain. Examination revealed elevated jugular venous distention, lower extremity edema, and bibasilar crackles on lung auscultation, while the electrocardiogram (EKG) exhibited left bundle branch block. Two-dimensional echocardiography (2D-Echo) showed a dilated left ventricle (LV) with ejection fraction (EF) of 25% and severe diffuse hypokinesia. Cardiac magnetic resonance …

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

Marshall Journal of Medicine

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 …

Potential Adverse Effects Of Long Term Use Of Proton Pump Inhibitors., Shreyans M. Doshi, Md, Kazumi A. Khamar, Ms, Inder Sehgal, Dvm, Phd, Nihar Shah, Md Facp

Marshall Journal of Medicine

Proton-Pump Inhibitors (PPIs) have changed the therapy of numerous upper gastrointestinal tract disorders; but their use is not without risk of adverse effects. Recent studies suggest more serious adverse events with chronic use of PPIs. Because of these risks, clinicians should reassess individual patient’s needs for chronic PPI therapy.

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

Marshall Journal of Medicine

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 …

Endovascular Therapy Of Tasc-D Lesion In Critical Limb Ischemia, Ahmed Amro, Md, Alaa Gabi, Md, Dr. Mehiar El-Hamdani, Md, Facc, Fscai

Marshall Journal of Medicine

CLI (Rutherford class IV-VI) is a terminal stage of peripheral artery disease (PAD); it is defined by the presence of resting pain and/or tissue loss for at least two weeks that may require urgent revascularization to promote healing and prevent limb loss.For patients with infrarenal aortoiliac occlusive disease, the revascularization options are surgery like aortofemoral bypass and axillofemoral bypass or percutaneous intervention. Aortoiliac and aortofemoral bypass procedures are associated with 74% to 95% 5-year patency rates, respectively, which are comparable but not superior to percutaneous therapies.These operations may imply a significant morbidity and mortality on CLI patients who usually have …

The Role Of Arterial Blood Gas In Distinction Of Intravascular Hemolysis In A Patient With Lupus Nephritis., Ahlim Al Sanani, Md

Marshall Journal of Medicine

Dapsone is a Leprostatic agent routinely used for Malaria, Leprosy and as a prophylaxis for Pneumocystis jiroveci pneumonia (PCP), as well as Toxoplasma gondii in immunocompromised patients. Methemoglobinemia is an adverse effect of dapsone which can be life-threatening. Detailed is a case of dapsone-induced methemoglobinemia in a young woman with lupus nephritis treated with chronic immunosuppressant medications.

The Use Of Hyperbaric Oxygen Therapy In Idiopathic Sensorineural Hearing Loss: A Case Study, Chad B. Crigger, Md, Stephen L. Wilson, Md

Marshall Journal of Medicine

Idiopathic sudden sensorineural hearing loss (ISSHL) is an otologic emergency that can provoke anxiety in the patient and can be clinically challenging for the practitioner. The natural history of the condition can be as varied as its possible etiologies. Adding to the clinical challenge is the current debate of treatment modalities available. In what follows, we provide a case detailing our treatment course, including the novel use of hyperbaric oxygen therapy (HBOT) as an emerging therapy for sensorineural hearing loss. Additionally, we provide a brief review of the current state of treatment options available in the armament for ISSHL. As …

Linezolid Induced Delirium In The Absence Of Serotonin Syndrome: A Psychiatric Consultation/Liaison Case Report, Hani Nazha, Md, Nathan T. Harrington, Md

Marshall Journal of Medicine

Delirium is one of the most common mental illnesses that can affect elderly patients and patients with advanced medical problems. Because these patients are frequently on multiple medications and/or are more sensitive to medications secondary to their age, interactions with current medications, or existing medical problems; medication toxicity is frequently the etiology behind their delirium. This is a case report of a patient admitted for cellulitis that developed delirium from Linezolid however did not develop any other signs or symptoms of Serotonin Syndrome; a known side effect of Linezolid. This distinctive case highlights the importance of a careful analysis of …

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

Marshall Journal of Medicine

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 …

Public Health West Virginia 3.0, Danny Scalise, Mba Ii, David Didden, Md

Marshall Journal of Medicine

Public health across West Virginia and the nation faces a time of tremendous change. Health is influenced by individual lifestyle, social networks, living and working conditions, and general environmental conditions. As a result, the West Virginia Bureau for Public Health created the West Virginia Public Health Impact Task Force (PHITF) to develop an innovative, custom fit public health system in West Virginia. With goals of improving health, improving quality, and reducing costs, the PHITF recommended a health in all policies approach which combines innovative patient-centered public health services in every community, and asks that local public health partner with stakeholders …

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

Marshall Journal of Medicine

No abstract provided.

Use Of Surface-Enhanced Laser Desorption/Ionization With Time Of Flight (Seldi-Tof) Of The Urine In The Assessment Of Acute Kidney Injury (Aki), David J. Kennedy, Phd, Joseph M. Chan, Dinkar Kaw, Md, Anand M. Ravindaran, Md, Shobha Ratnam, Md, Phd, Deepak Malhotra, Md, Phd, Joseph I. Shapiro Md

Marshall Journal of Medicine

Background: Urinalysis is an important component in the assessment of acute kidney injury (AKI). Proteonomics is a rapidly developing approach in the analysis of physiological states. Several techniques have been developed to screen for protein populations. In this regard SELDI-TOF is a technique based on mass spectroscopy that is being utilized in proteonomics research.

Methods:For this study, clean catch or catheterized urine was collected from normals (n=18) and patients referred to the renal service with AKI. Based upon urine and serum chemistries, clinical parameters, and microscopic urinalysis, the urines were separated into those consistent with prerenal azotemia (n=17) and acute …

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

Marshall Journal of Medicine

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.