Medicine and Health Sciences Commons^™

The Influence Of Body Mass Index On Survival And Length Of Stay In Patients With Septic Shock, Yasir Jawaid, Waseem Ahmed, Damir Kusmic, Aman Ajmeri, Kanaan Mansoor, Cristie Mannino, Thomas Judge, Larry E. Carter, Akash V. Ajmera

Marshall Journal of Medicine

Background: Obesity is one of the most widespread epidemics of our time. In fact, currently 65.7% of US adults age 20 and older are overweight, while 30.6% are obese. It has been well-established that obesity has numerous adverse effects on long-term health, however the specific effect on patients treated for sepsis and septic shock is unclear. Body Mass Index (BMI) is a measure of total body fat content and surrogate marker for obesity. In our study, we aimed to identify if BMI was an independent risk factor for poor survival or increased length of stay (LOS) in patients with sepsis. …

Perceptions Of Specialties And Primary Care Careers: Findings From West Virginia Medical Student And Resident Focus Groups, April L. Vestal, Laura Boone, Robert Walker, A. Brianna Sheppard, Dakota Morris, Ashley J. Noland

Marshall Journal of Medicine

The purpose of this study was to improve the understanding of how perceptions of practicing specific medical specialties contribute to career decisions. Participants included medical students and residents from training programs in West Virginia. Focus groups were conducted between September 2013 and February 2015. Thematic content analysis of focus group interviews was used to identify phrases indicating perceptions of person- versus technique-oriented personality medical specialties.

“Self-focused” and “other-focused” themes emerged within person-oriented comments. Factors affecting “self”, including work/life balance and salary and practice environment, made certain specialties more appealing. Technique-oriented comments included working in a hospital setting, performing technical procedures, …

Optimizing Quality Of Care By Patient Satisfaction For The Department Of Orthopaedics - A Survey Study, Milad Modarresi, Ammar Qureshi, Rodrigo Aguilar, Meghan Anderson, Felix Cheung

Marshall Journal of Medicine

Introduction: Hospital Consumer Assessment of Healthcare Providers and System (HCAHPS) has provided a standardized survey method in order to evaluate the patient’s satisfaction on the care they are provided. While overall patient satisfaction is clearly a multidimensional concept, the HCAHPS survey covers 8 domains of health care. This study tries to identify and establish the main determinants to patient’s level of satisfaction during their visit to Cabell Huntington Hospital Orthopaedics department.

Methods: Data was collected from surveys handed in 3 consecutive months; June, July and August of 2013. Sixteen questions were selected from HCAHPS that were appraised to be relevant …

Predicting Adverse Outcomes In End Stage Renal Disease: Machine Learning Applied To The United States Renal Data System, Zeid Khitan, Alexis D. Jacob, Courtney Balentine, Adam N. Jacob, Juan R. Sanabria, Joseph I. Shapiro

Marshall Journal of Medicine

We examined machine learning methods to predict death within six months using data derived from the United States Renal Data System (USRDS). We specifically evaluated a generalized linear model, a support vector machine, a decision tree and a random forest evaluated within the context of K-10 fold validation using the CARET package available within the open source architecture R program. We compared these models with the feed forward neural network strategy that we previously reported on with this data set.

Applying A Research Ethics Review Processes In Rural Practice-Based Research, Adam D. Baus, Tracy L. Hendershot, Martha Cook Carter, Laura K. Boone

Marshall Journal of Medicine

Introduction: Partnering with rural primary care in practice-based research allows researchers access to a vital segment of the health care sector and a window into some of the most vulnerable, high-risk, high-need patient populations. The readiness for rural primary care to fully embrace research partnerships, however, is often tempered by ethical questions in conducting research in close-knit settings. This research provides practices with a refined decision support tool for evaluating the fit of research opportunities for their unique practices.

Materials and Methods: A two-phase effort was conducted to glean insight from currently available literature on ethical considerations in practice-based research …

Outcomes Of Transcutaneous Aortic Valve Replacement Among High Risk Wv Sample Population., George M. Yousef, Julia Poe, Cameron Killmer, Basel Edris, Jason Mader, Ellen A. Thompson, Daniel Snavely, Silvestre Cansino, Joseph I. Shapiro, Mark A. Studeny

Marshall Journal of Medicine

Introduction:Transcatheter aortic valve replacement (TAVR) is a relatively new strategy for replacing the aortic valve. We elected to review our early experience to see if we could identify clinical characteristics at baseline or immediately following the procedure that would predict death within one year.

Methods:Charts for all patients assigned to receive TAVR procedure at St Mary’s medical center, Huntington, West Virginia between April, 2013 till November, 2016 were identified and reviewed. A total of seventy-two (72) cases were included.

Results: All cause mortality rate at index hospitalization, 30 days, and 12 months was 5.6%(N=4), 6.9%(N=5), 19.4%(N=14) respectively. Stroke …

Nadolol In Pregnancy: A Medical Student’S Reflection On Her Pregnancy, Rebecca King-Mallory, Shawndra Barker, Kaitlin Mcgrogan, Adam M. Franks

Marshall Journal of Medicine

Hypertension is a common concern during pregnancy. Beta-blockers are one potential treatment, but third trimester exposure has correlated with an increased risk of perinatal events. Nadolol, a nonselective beta blocker, has properties that differ from those of its selective counterparts, including longer half-life, decreased protein binding, and renal excretion in the unchanged form. There is very limited data on the use of nadolol during pregnancy, and its safety has not been completely evaluated. This case study documents the perinatal outcomes of nadolol use throughout a medical student’s pregnancy and explores the experience in obtaining and undergoing medical care.

Diagnosis Of A Centronuclear Myopathy Case In Appalachia 20 Years From Symptom Onset., Christopher Burrell, Zachary Wilson, Dominika Lozowska

Marshall Journal of Medicine

Dynamin 2 (DMN2) mutations cause centronuclear myopathy (CNM) and Charcot Marie Tooth (CMT). Herein we discuss the details of a patient's case of adult onset CNM. We also highlight the unique features of this case with regards to the importance of electromyography (EMG), muscle biopsy and genetic testing in identifying CNM, as well as potential for improving outcomes by having a high index or suspicion and emphasizing better access to healthcare in underserved areas.

Ignorance Is Not An Option, Tamela J. White

Marshall Journal of Medicine

Health literacy is a vital component in the design of public health interventions. Public understanding of health literacy and its role in attaining down stream and outcomes is not only a necessity but a moral mandate.

Leaving A Legacy, Jay Lakhani

Marshall Journal of Medicine

No abstract provided.

The Future Of Personalized Care: Humanism Meets Artificial Intelligence, Darshana T. Shah

Marshall Journal of Medicine

Another exciting year for the Marshall Journal of Medicine has passed, giving us the opportunity to both reflect on the accomplishments of the past year and summarize recent developments. The readership distribution of the Marshall Journal of Medicine spans the globe, including over 169 countries and 32,000 plus downloads. We continue to expand our scope by incorporating new submission categories such as “At the ‘Heart’ of Healthcare” and “Machine Learning in Rural Health.” This issue particularly propels us forward with a focus on the humanism of health care.

Nonketotic Hyperglycemia Induced Occipital Lobe Seizures: A Case Report, Samantha Richardson, Sona K. Shah

Marshall Journal of Medicine

Typically, nonketotic hyperglycemia induces partial motor seizures. We present a rare case of nonketotic hyperglycemia induced occipital lobe seizures and discuss the impact of hemoglobin A1c on seizure activity, typical imaging results, and use of anti epileptic drugs in management.

Rural Medical Student Opinions About Rural Practice: Does Choice Of College Make A Difference?, William J. Crump, Craig H. Ziegler, R. Steve Fricker

Marshall Journal of Medicine

Purpose

While many programs assume medical students who attended rural colleges are more likely to practice in smaller towns later, there are few studies to support this assumption. This study examines aspects of medical students’ opinions about rural living and rural practice based on where they attended college.

Method

Students with rural upbringing were identified and administered a previously published rural health opinion survey. The opinion survey was administered across three academic years, from 2015 to 2017, and included a total of three scales and nine subscales for analysis. Factor analysis was used to identify the nine subscales.

Results

Respondents …

Gastritis Induced St Segment Elevation On Electrocardiogram, Obadah Aqtash, Ahmed Amro, Ala Gabi, Amal Sobeih, Dr. Mehiar El-Hamdani, Ellen A. Thompson

Marshall Journal of Medicine

ST segment elevation on an electrocardiogram (EKG) is an alarming finding that warrants an urgent coronary angiogram. Early diagnosis and intervention is extremely important in the setting of Acute Coronary Syndrome (ACS) to prevent irreversible myocardium damage and reduce the mortality rate. However, it is very important to know that not all ST- Elevations (STE) on EKG are due to myocardial infraction. Etiologies can be divided into cardiac and non-cardiac causes. Cardiac causes can include coronary aneurysm and acute pericarditis while non-cardiac causes can include acute cholecystitis and pulmonary embolism. In this paper, we are presenting a unique case of …

Improving Postoperative Pain Control After Cesarean Delivery With Enhanced Recovery In Patients On Buprenorphine Therapy, Kevin D. White, Shirin Azadi, Nadim Bou Zgheib, Brenda L. Mitchell

Marshall Journal of Medicine

Abstract:

Introduction:

Prescription drug abuse presents a significant challenge to the management of post operative pain.Pain control amongst the opioid addicted patient can be especially challenging. We aimed to improve pain control after caesarian delivery with enhanced recovery in patients who are on buprenorphine medication-assisted therapy for the treatment of opioid addiction.

Materials and Methods:

We conducted a pilot study by implementing a protocol using liposomal bupivacaine injected at the time of cesarean delivery. Patients were then given 500mg acetaminophen every 4 hours, 800mg ibuprofen every 8 hours and 0.3mg IV buprenorphine every 6 hours as needed. The patients’ maintenance …

Knowledge And Risk Factors For Stroke Among Undergraduates In Southwestern Nigeria, Wasiu Olalekan Adebimpe

Marshall Journal of Medicine

The burden of non-communicable diseases due to stroke is increasing. Despite this, community based studies that could stimulate stroke primordial prevention among the population at risk are sparse. This study assessed community knowledge and risk factors to stroke among University undergraduates in Osogbo, southwestern Nigeria. A descriptive cross sectional study was conducted among 420 male undergraduates selected through multi-stage sampling method. Research instruments were self-administered semi structured questionnaire. Data was analyzed using the SPSS software version 17.0. Four hundred and seven (96.9%) have heard about stroke. Good mean knowledge score of causes, symptoms, warning signs and risk factors of stroke …

The State Of Neonatal Abstinence Syndrome In West Virginia, Sean Loudin

Marshall Journal of Medicine

No abstract provided.

Robotic-Assisted Laparoscopic Surgery In Pediatric Urology: Capacity Building And Reflecting On Five Years’ Experience In West Virginia, Chad B. Crigger, Osama Al-Omar

Marshall Journal of Medicine

Robotic surgery was born at the turn of the millennium as it was first approved by the US food and Drug Administration in 2000 with the introduction of the da Vinci (Intuitive Surgical, Inc., Mountain View, Ca) robotic surgical platform. However, its adoption by pediatric urologists did not occur until 2002, and even then it was used by only a select handful of surgeons. While the use of robotics in pediatric urology has grown steadily worldwide, its implementation in treating pediatric urology patients in West Virginia has been much slower. Reasons for this are twofold: historically, the lack of pediatric …

Siloed To Solutions: Creating A Culture Of Collaboration, Darshana T. Shah

Marshall Journal of Medicine

No abstract provided.

A Review Of Mesenchymal Stem Cell Injections For Osteoarthritis, Ammar Qureshi, Jill Goodwin, Franklin D. Shuler, Timothy Wilson-Byrne, John J. Jasko, Charles Giangarra

Marshall Journal of Medicine

Mesenchymal stem cell (MSC) injections for osteoarthritis is reviewed.

Methods- PubMed search identifying articles in English from 2003-2018 that used intra- articular injection (IA), cartilage repair, cartilage regeneration, chondral injury, adipose stem cells, bone marrow stem cells, mesenchymal stem cells, or autologous stem cells.

Results – 388 patients receiving IA MSC injections are discussed with data obtained from 10 case reports or case series, 4 randomized clinical trials (RCT), 1 cohort study, and 3 case controlled therapeutic studies.

Conclusions – MSC injections may be an effective adjunct in the management of osteoarthritis and a variety of cartilage related pathologies.

Effect Of Removing Outliers On Statistical Inference: Implications To Interpretation Of Experimental Data In Medical Research, Todd W. Gress, James Denvir, Joseph I. Shapiro

Marshall Journal of Medicine

Background Data editing with elimination of “outliers” is commonly performed in the biomedical sciences. The effects of this type of data editing could influence study results, and with the vast and expanding amount of research in medicine, this effect would be magnified.

Methods and Results We first performed an anonymous survey of medical school faculty at institutions across the United States and found that indeed some form of outlier exclusion was performed by a large percentage of the respondents to the survey. We next performed Monte Carlo simulations of excluding high and low values from samplings from the same normal …

The Effect Of Hepatitis C On Maternal Bile Acid Level And The Fetal Left Ventricular Tei Index, Kelly Cummings, Jesse Cottrell, Songthip Ounpraseuth, Ryan Stone, David G. Chaffin, Everett Magann

Marshall Journal of Medicine

Hepatitis C (HCV) is a common form of liver disease encountered in pregnancy. The purpose of this study is to evaluate if hepatitis C is associated with elevated maternal serum bile acids and abnormal fetal cardiac function measured by the left ventricular Tei index in the absence of intrahepatic cholestasis of pregnancy. This is a prospective cohort study on pregnant women with hepatitis C seen through Marshall University’s high-risk obstetrics clinic from 2013 to 2014. Women with hepatitis C had a laboratory evaluation and an ultrasound on the fetus to calculate the left ventricular Tei index. Demographic information and delivery …

Ecg Measurement Parameters Of Athletes Are Reliable When Made With A Smartphone Based Ecg Device, Andrew Gilliland, Mark Timmons, Jeffrey K. Harris, Stephen M. Petrany, Terry A. Shepherd, Grant S. Buchanan, Nicole Decker, Charles Giangarra

Marshall Journal of Medicine

Pre-participation cardiac screening including electrocardiogram (ECG) is a subject of controversy among sports medicine practitioners. Opponents of pre-participation ECG screen site concerns regarding the cost and accuracy of the testing. Recently, a single lead ECG accessory has become available for use with smartphones. The purpose of this study was to evaluate the between and within rater validity and reliability of the Kardia device in recording the ECG parameters rate, rhythm, and PR, QRS, and QT intervals. The ECG parameter made with the smartphone were also compared to same measures made using a 12 lead electrocardiograph.

This investigation used a repeated …

Post-Traumatic Stress Disorder: Review Of Dsm Criteria And Functional Neuroanatomy, Cornelius W. Thomas

Marshall Journal of Medicine

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for post-traumatic stress disorder (PTSD) consist of over twenty possible symptoms that can be divided into six broad categories. These categories correlate with specific brain networks that regulate emotions, behaviors, and autonomic function. Normal functioning of these networks depends on two key regions; the prefrontal cortex and the amygdala. The prefrontal cortex provides top-down executive control over amygdala, whereas the amygdala is critical for threat detection and activation of the ‘fight or flight’ response. Events that trigger extreme and/or prolonged fear can cause persisting dysregulation within the prefrontal-amygdala circuit; resulting …

Pyomyositis Mistaken For Septic Hip Arthritis In Children: The Role Of Mri In Diagnosis And Management, Franklin D. Shuler, Grant S. Buchanan, Cody Stover, Brock Johnson, Milad Modarresi, John J. Jasko

Marshall Journal of Medicine

Septic arthritis is an orthopaedic emergency which requires timely management to prevent joint destruction and poor outcome. Differentiating septic arthritis from transient synovitis in pediatric patients is aided by the use of Kocher criteria which have excellent sensitivity but lack specificity. In addition to these two disorders, primary pyomyositis is bacterial infection of skeletal muscle that most commonly affects children. Patients present with pain, swelling, fever, and elevated inflammatory markers which mimics septic arthritis. If left untreated, pyomyositis can lead to abscess formation and sepsis.

Due to potential for nearly identical presentations of septic arthritis and pyomyositis, differentiation of these …

Urgent Coronary Artery Bypass Grafting Due To Multi- Vessel Coronary Aneurysm, Obadah Aqtash, Ahmed Amro, Bilal Alam, Amal Sobeih, Melissa Lester, Rameez Sayyed

Marshall Journal of Medicine

Coronary Artery Aneurysm (CAA) is defined as a dilation of more than 1.5 times normal in a segment of the coronary artery. While the incidence of CAA is highest in the Right Coronary Artery (RCA), it is agreed that left main coronary artery or three-vessel involvement is extremely rare. Wide ranges of factors have been implicated in the cause of CAA with atherosclerosis being the most common at 50%. Congenital CAA occurs in 20-30% of cases followed by connective tissue disease at 10%. Blood stagnation and exposure of the underlying collagen make aneurysms prone to thrombosis, dissection, and vasospasm. Depending …

Going Beyond The Final Impression With Radiologic Data In The Era Of Clerical Medicine: A Case Report Of Coronary Artery Disease Found Incidentally On Computed Tomography, Andrea M. Lauffer

Marshall Journal of Medicine

Introduction:

Given the challenges in modern healthcare, physicians find themselves devoting a great deal of mental and emotional energy into executing the appropriate care for patients as well as performing their daily clerical duties. Many clinicians have resorted to innovative ways to minimize their tasks which often leads to narrowing the focus of a patient’s overall care and the birth of medical errors described in the Swiss cheese effect model.

Case Description:

A 66 year old male established care with a new primary care physician. Previous radiologic data revealed a pulmonary nodule that did not have appropriate follow up imaging. …

Why Introduce Machine Learning To Rural Health Care?, Alfred A. Cecchetti

Marshall Journal of Medicine

Machine learning, the process of teaching a machine to recognize patterns without explicitly being programmed, can provide to medical personnel a powerful tool that can dramatically improve rural patient health.

Advancing The Mountain State, Appalachia, And Beyond, Darshana T. Shah

Marshall Journal of Medicine

No abstract provided.

A Case Review Of A Morel Lavellee Lesion With Delayed Presentation, Ammar Qureshi, Pradeep Monoot

Marshall Journal of Medicine

A Morel Lavellee lesion is a relatively rare post traumatic condition which is missed at the time of early presentation. It involves a closed internal degloving injury where the subcutaneous tissue is torn away from the underlying fascia and thus creating a cavity containing hematoma and necrotic fat. It occurs most commonly over the greater trochanter. The lesion can be treated conservatively and surgically. Here we report an unusually delayed presentation of a Morel Lavellee lesion that was treated by incisions, drainage and primary closure.