Medicine and Health Sciences Commons^™

Beyond The Skin: A Case Report Of Vaginal Melanoma, Brittany Gilbert, Wm Tanner Gilbert, Ardeshir Hakam, Lynne J. Goebel

Marshall Journal of Medicine

Mucosal melanomas are rare, accounting for only 1.4% of all melanomas. Only 18% of mucosal melanomas are vulvovaginal in origin, making it exceedingly rare. Mucosal melanomas typically carry a worse prognosis than those arising from cutaneous sites with a higher risk of recurrence and disseminated disease. We report a rare case of vaginal melanoma presenting as postmenopausal bleeding and discuss management of this disease.

Assessment Of Commercially Available Computerized Neurocognitive Testing In The Adolescent Concussed Athlete: A Retrospective Analysis., Brock Hardin, Andrew Gilliland, Thomas Belmaggio, Charles Giangarra, John R. Castillo, Mark K. Timmons

Marshall Journal of Medicine

Introduction

Clinicians frequently use computer-based neurocognitive assessments to aid in the diagnosis and management of Sport-Related Concussion (SRC). With practitioners using varied Neuro-Cognitive Assessment Tools (NCAT), questions arise concerning differences among NCAT and how these differences may affect patient care. The purpose of the current study is to offer a comparative analysis of two widely accepted, commercially available computer-based neurocognitive testing modalities in the adolescent concussed athlete.

Methods

In order to identify patients that were diagnosed with SRC, the records of patients reporting to a sports medicine practice were reviewed for a period of eighteen months. All patients were assessed …

Increasing Number Of Unusual Brain Abnormalities Seen In Rural West Virginia, Taylor R. Maddox, Jessica Haas, Lacey Andrews, Hannah Redman, Balaji Govindaswami, Todd H. Davies

Marshall Journal of Medicine

The incidence rate of schizencephaly is 1.5 in 100,000 live births and the rate of holoprosencephaly is 1 in 16,000 live births. Both malformations are rare, but our institution has seen a dramatic increase in both malformations in recent years with no known cause. Schizencephaly is the most severe cortical malformation and holoprosencephaly is the most common defect in the prosencephalon during development however, it is still not very common to see a fetus with this defect live to delivery. Our institution seen four cases of schizencephaly and three cases of holoprosencephaly within two years. No two neonates seem to …

Bilateral Pulmonary Embolism Associated With Varicella Zoster Meningoencephalitis In An Immunocompetent Adult: A Case Report And Literature Review, Alexandra Gillispie, Sofanit Dessie, Rodrigo Aguilar, Kemnasom Nwanwene, Ghassan Bandak, Elie Khalil, Imran Khawaja

Marshall Journal of Medicine

Association of Varicella Zoster Virus (VZV) with a considerable variety of complications has been well documented throughout literature. Primary infection, most often seen in children, is generally characterized by mild symptoms, as opposed to the more severe presentations in adult and immunocompromised populations. Manifestations of disseminated VZV include dermatologic, pulmonary, neurologic, and ocular involvement. Vascular and hematologic complications are also reported and sometimes pose serious health threat. We present an interesting case of disseminated VZV infection, complicated by meningitis, encephalitis, and bilateral pulmonary embolism in an otherwise immunocompetent 52-year-old man with no prior chicken pox exposure.

Acute Marjolin Ulcer From A Dog Bite, Brandon S. Henderson, Katalin Z. Kovacs, Lynne J. Goebel

Marshall Journal of Medicine

Marjolin ulcers are cancers, usually of squamous cell carcinoma pathology, that occur in scars or wounds. They are classically described in burn victims but can occur with other types of trauma and are rarely seen in association with bite wounds. Marjolin ulcers typically have a latent period of many years post-injury until the development of malignancy, but there are a few case reports of an exceedingly rare acute form. We present a case of a 78-year-old female who developed a Marjolin ulcer one month after sustaining a dog bite to the left index finger.

Pyloric Stenosis Leading To Sinus Venous Thrombosis; A Case Report, Amber Wright, Andrew J. Weaver, Daniel Beals

Marshall Journal of Medicine

Pyloric stenosis is typically diagnosed early and repaired after resuscitation and electrolyte correction in a timely manner. Delay in diagnosis or presentation of patient can lead to significant morbidity and even mortality. Here we present a case of pyloric stenosis leading to dehydration severe enough to lead to venous sinus thrombosis. This case highlights the importance of early detection of pyloric stenosis with timely correction of fluid status and electrolytes. Venous sinus thrombosis is a serious complication associated with our patient’s pyloric stenosis that has not yet been reported in literature.

Cataplexy Versus Pseudoseizure : A Case Study, Sammar Atassi, Katherine Atassi

Marshall Journal of Medicine

Cataplexy is frequently misdiagnosed as pseudo seizures. This case study about a young patient shows the necessary steps needed to accurately diagnose and treat cataplexy as well as understand the differences between narcolepsy Type I and Type II.

Chronic Inflammatory Demyelinating Polyneuropathy (Cidp) In A Patient With Diabetes: A Primary Care Perspective, Jordan Dever, Adam M. Franks, Laura M. Given, William Rollyson, Adrienne Mays-Kingston

Marshall Journal of Medicine

Chronic inflammatory demyelinating polyneuropathy (CIDP) is a recurrent and progressive disease that causes proximal, symmetrical extremity weakness. The disease is diagnosed using clinical features, electrophysiologic testing, albumino-cytological disassociation in the cerebrospinal fluid, and sural nerve plexus biopsy. However, because of the low sensitivity of diagnostic criteria and other similar neuropathies, including diabetic polyneuropathy (DPN), accurate diagnosis is difficult. Differentiating between these diseases is especially important as CIDP’s changes are reversible and DPN’s are not. Making this differentiation allows for symptomatic improvement in a patient’s quality of life that would not be achieved otherwise. Early recognition and treatment, with modalities including …

Nipple Sign, A Stigmata Of Recent Arteriovenous Malformation Bleed In The Bronchial Tree, Rami Batarseh, Yousef Shweihat

Marshall Journal of Medicine

Hemoptysis is defined as expectoration of blood originating from the lower respiratory tract (i.e., below the vocal cords). Among the potential sources of bleeding from the bronchial tree are arteriovenous malformations (AVMs). Although pulmonary AVM and its diagnostic imaging features have been well described, less is known about bronchial AVM. This report describes an elderly man with multiple AVMs in his gastrointestinal tract who was admitted with hemoptysis and found to have AVM in his bronchial tree.

Covid19 Perspective From Operation Gotham, Juan R. Sanabria

Marshall Journal of Medicine

No abstract provided.

Reflecting Backward, Moving Forward, Darshana T. Shah

Marshall Journal of Medicine

No abstract provided.

Postpartum Opioid Use Following Vaginal Deliveries With No Or Minor Obstetric Perineal Lacerations, Samantha Richardson, Todd W. Gress, Amanda Pauley, David C. Jude

Marshall Journal of Medicine

Introduction

Recommendations for management of pain following vaginal delivery are not specific and do not differentiate patients based on the degree of perineal trauma. Our objective is to describe patterns of postpartum opioid use in women with no or minor perineal trauma.

Methods

This is a retrospective cohort study describing the characteristics of opioid analgesia usage among women with no or minor perineal lacerations at the time of vaginal delivery in a university affiliated regional hospital.

Results

For the 6-month study period, 433 patients were eligible for inclusion. Of these, 423 (97.69%) were ordered as needed narcotics during their post-partum …

Reducing Overtreatment Of Urinalysis In Obstetric Triage Patients, Emelia Winston, Rachel Marteney, Erin Casey, Kevin Conway

Marshall Journal of Medicine

Introduction

Overtreatment of asymptomatic bacteriuria (ASB) is a major issue that has been coming to the forefront in recent decades. Studies have shown that it can lead to adverse side effects, extra costs, and antimicrobial resistance. The purpose of this study was to determine the number of patients presenting to obstetric triage who were overtreated for a urinalysis (UA) and to see if an educational intervention could reduce the incidence of overtreatment for suspected ASB.

Methods

This was a retrospective chart review analyzing UA results and outcomes of OB triage patients that came through labor and delivery before and after …

Chronic Abdominal Pain In A Geriatric Patient: A Rare Case Of A Spigelian Hernia, Thomas D. Wright, Olumayowa Dayo, Lynne J. Goebel

Marshall Journal of Medicine

We present a case of Spigelian hernia in a 77-year-old patient to highlight the difficulty in making this diagnosis and to raise awareness of this rare condition among physicians who care for geriatric patients with chronic bouts of abdominal pain. The patient presented to the emergency department with a two-day complaint of abdominal pain after three years of similar recurrent attacks. Results of the physical examination and computed tomography (CT) of the abdomen were consistent with a left-sided Spigelian hernia. Operative repair was performed using robotic-assisted reduction and the patient recovered without any complications.

Hyperkalemia Secondary To Prophylactic Heparin Use In A Trauma Patient: Case Report, Marco Custodio, Errington C. Thompson

Marshall Journal of Medicine

This case report describes a complex trauma patient who develops hyperkalemia secondary to heparin. Heparin is a commonly used drug in trauma patients. Physicians need to be aware of this potentially harmful adverse reaction in these high-risk patients.

Reccurent Reversible Encephalopathy With Ataxia And D-Lactic Acidosis In Short Bowel Syndrome, Abdul Rana, Salman Assad, Sucharita Katikala, Shuja Asad Malik, Mahmoud Abouzid, Mehar Zahid, Swaroopa Pulivarthi

Marshall Journal of Medicine

The short gut syndrome can lead to multiple metabolic disorders along with chronic malnutrition. Such patients can develop changes in mental status due to metabolic alterations. We present a case of eleven years old male who presented to the hospital with an altered mental state. There were repeated admissions to the hospital with a similar complain with non-conclusive cerebrospinal fluid analysis and normal neuroimaging findings. The patient suffered from chronic malnutrition and multiple hospitalizations with altered mental status, encephalopathy. However, he responded well to bicarbonate therapy and prophylactic metronidazole treatment.

An Unusual Metastatic Site Of Head And Neck Cancer; Case Report And Literature Review, Abdulrauf A. Salamah, Moftah M. Sharad, Mohamed Sultan

Marshall Journal of Medicine

The annual occurrence of Head and Neck caner (HNC) is documented to be more than 650,000 cases with 330,000 deaths. In the United States, it represents 3% of all malignancies and affects 53,000 Americans. Metastasis to the lung, liver and bones are considered the most common locations. Herein, We are reporting a case of HNC and an unusual synchronous gastric metastasis found on an upper gastrointestinal endoscopy (EGD) after CECT scanning of Abdomen shows only the mass that related to stomach fundus and MRI pelvic no mass could be seen. Both cancers were poorly differentiation on histopathology, which raises the …

Blocking Serine Protease (Tmprss2) By Bromhexine; Looking At Potential Treatment To Prevent Covid-19 Infection, Ramin Tolouian, Audrey C. Tolouian, Mohammadreza Ardalan

Marshall Journal of Medicine

Not applicable. Manuscript is being submitted under Viewpoints category.

Successful Treatment Of A Cervical Ectopic Pregnancy With Single-Dose Methotrexate Therapy, Hannah Dearworth, Jesse Cottrell

Marshall Journal of Medicine

Ectopic pregnancies implanted in the cervix account for less than 1 percent of all extra-uterine pregnancies. Due to the limited incidence of cervical ectopic pregnancies, there are no established guidelines for medical versus surgical management. We report a case of a cervical ectopic pregnancy with a fetal heartbeat successfully treated with single dose methotrexate therapy.

Black Lung: Old Disease, New Lessons, Mohammed I. Ranavaya Ii, Mohammed Ranavaya, Natavoot Chongswatdi

Marshall Journal of Medicine

Previous to 2016, cases of progressive massive fibrosis secondary to mining exposure had dwindled and were considered nearly eradicated. However, over 40 new cases were recently discovered in Kentucky, indicating a resurgence of a previously rare disease. We herein report a case of a 44-year-old male underground coal miner from Appalachia with fifteen years coal mining dust exposure who presented with four years of productive cough, dyspnea upon exertion and wheezing for an occupational pneumoconiosis evaluation. Since 2016, he suffered a precipitous decline in lung function consistent with restrictive lung disease and concomitant progression from simple coal workers’ pneumoconiosis to …

Case Report On Leiomyosarcoma Of The Vulva: A Rare Pathology, Samantha A. Smith, Nadim Bou Zgheib, Andrea M. Vallejos, Jonathan D. Cuda

Marshall Journal of Medicine

Leiomyosarcoma (LMS) of the vulva is rare. However it is the most common histologic subtype of vulvar sarcoma, accounting for approximately 1% of all vulvar malignancies. ^[1-8] Whether genetics and epigenetics play a role in pathogenesis is unclear. ^[1] The tumor is slow-growing with non-specific symptoms, has high metastatic potential, and follows a bimodal age distribution. ^[1-8] Diagnosis and prognosis are based upon immunohistochemical expression and criteria from early literature. ^[1,3,5-7] The most common therapeutic approach involves radical vulvectomy with lymph node resection. The value of adjuvant chemotherapy and radiation remains unknown. ^[1,3,5-8] Our case describes a 46-year-old Caucasian G2P2 …

Eradication Of Stage Iv Gastric Cancer: Case Report, Ibrahim Mohammed, Cherishma Nagisetty, Arslan Iqbal, Michael Abdelmasseh, Doreen Griswold, Muhammad Omer Jamil, Juan R. Sanabria

Marshall Journal of Medicine

Background. Gastric cancer has a low overall survival rate worldwide, and surgery still remains the intent to cure option on early stages of disease. HER-2 positive cancers may have a survival advantage. We present a patient with stage IV gastric cancer HER-2 positive responsive to Herceptin, free of detectable disease two years after surgery.

Patient Presentation. 70 years old Caucasian male complained of left-sided chest pain. Upon evaluation, he was diagnosed with HER-2 positive adenocarcinoma of the stomach at the pylorus with two liver metastases. Near complete response was observed with Herceptin and Cis-platinum based chemotherapy followed by 80% distal …

All The Easy Jobs Are Filled": The Enduring Promise Of A Life In Medicine, Maurice A. Mufson

Marshall Journal of Medicine

N/A

How Covid Has Illuminated The Pitfalls Of A Single-Payer System In The Us, Tamela J. White, Nicholas Wright

Marshall Journal of Medicine

Health care quality measures are impacted by resources invested into outcomes. COVID-19 has had a direct impact upon quality outcomes, the same illuminating just some of the problems with the concept of a single-payer health care system. The US government's inefficiencies in attempting to run the single-payer system known as IHS in context with its repeated failures in managing the COVID-19 crises along with the economic impact of the same, is but one call for strong leadership to dispel the myth that a single-payer system is a panacea for America.

When The Hospitalist Gets Hospitalized, Jay R. Lakhani

Marshall Journal of Medicine

Hospitalists have a unique opportunity to provide a compassionate environment for patients and families, who themselves are facing fear and uncertainty. Recently, I was able to experience hospitalization from the other side of the hospital bed. In this short article, I share a few lessons I am learning from my recent experiences with my father, my daughter, and my own experience.

Changing For The Better: Academic Scholars Find New Audience Through Video Abstracts, Darshana T. Shah

Marshall Journal of Medicine

No abstract provided.

A Career Eulogy Reflective Exercise: A View Into Early Professional Identity Formation, William Crump, R. Steve Fricker, Allison Crump-Rogers

Marshall Journal of Medicine

Introduction

Beginning medical students have a very early idea of what their physician identity will be. Providing a brief structured opportunity to reflect on the end of their career can be an important first step in identity formation.

Methods

A reflective exercise was used in the summer prior to beginning medical school as each class of students at a regional rural medical school began a summer prematriculation program from 2015-2019. Students wrote what they wished to be said about them at the end of their career using a “Career Eulogy.” Identifiers were removed and narratives were coded into recurring text …

When Treating Sick Joints Harms Lungs, Ixekizumab Induced Pleural Effusion, Rami Batarseh, Kyle Smith, Mohammed Al-Ourani, Amro K. Al-Astal

Marshall Journal of Medicine

Immunological therapies have provided a multitude of new and effective treatment strategies for various disease states. While monoclonal antibody therapy benefits many patients, side effects are widely variable. here we present a case of pleural effusion complicating psoriatic arthritis treatment.

Secondary Scoliosis From A Retroperitoneal Ganglioneuroma In A 9-Year-Old Female: Case Report, Andrew J. Weaver, Keitaro Nakamoto, Daniel A. Beals

Marshall Journal of Medicine

Ganglioneuromas are rare benign tumors that tend to be asymptomatic until large enough to compress adjacent structures. These tumors are often found during childhood during evaluations for other pathologies. Retroperitoneal ganglioneuromas may be a secondary cause of scoliosis. Here, we present a case of a child who was found to have a retroperitoneal ganglioneuroma during an evaluation for scoliosis.

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The Opioid Epidemic In The United States: A Call For Practice Change In Pediatric Outpatient Surgeries, Emma Bacharach, Osama Al-Omar

Marshall Journal of Medicine

No abstract provided.