Medicine and Health Sciences Commons^™

Spontaneous Pneumothorax: A Rare Complication Of Neurofibromatosis Type 1 Associated Diffuse Lung Disease, Emma I. Sherfinski, Mark H. Cooper Md, Phd

Marshall Journal of Medicine

The visually striking neurocutaneous findings of neurofibromatosis type 1 (NF1) are well recognized and have been well documented throughout scientific literature. While not uncommon, the pulmonary manifestations of NF1 are unknown to many physicians. Complications of NF1 associated diffuse lung disease (NF-DLD) include pulmonary hypertension, pulmonary artery stenosis, subpleural cysts, and spontaneous pneumothorax. We present a case of a 34-year-old male with NF-DLD found incidentally in adolescence with previous apical bleb repair, presenting nearly twenty years later with spontaneous pneumothorax. In NF1 patients with pulmonary complaints, NF-DLD should be assessed with computed tomography (CT) and physicians should be familiar with …

A Rheumatoid Nodule At The Sternoclavicular Joint: An Uncommon Presentation Of A Common Problem, Patrick M. Thomas, Nathan J. Cockerill, Christina M. Arcand, Alan R. Koester, Mark H. Cooper Md, Phd

Marshall Journal of Medicine

Most rheumatoid nodules are found at joints or pressure points. They rarely require medical intervention and even fewer require surgery. A 78-year-old female developed a 7.2 x 3.2 x 2.8 cm rheumatoid nodule originating at the right sternoclavicular joint, a novel site for a common pathology. Management involved a complex differential diagnosis and surgical treatment was resection from adjacent vascular and neural structures. Following surgical excision, the patient maintained good mobility and sensation of the neck and surrounding areas.

Succenturiate Placental Lobe Abruption: A Placental Pathology Complicating A Dangerous Delivery, Morgan Stickler, Sydney M. Graham, Richard Conway, Adam M. Franks

Marshall Journal of Medicine

The development of a placenta is a complex process that occurs without a clinically significant issue in most pregnancies. At times, however, the process develops in a way that isolates an island of placental tissue away from the main body, connected only by unprotected vasculature within the amniotic membranes. The vessels of this succenturiate lobe of the placenta are vulnerable both to compression or laceration, threatening the antepartum period with poor weight gain or the peripartum period with fetal distress, hemorrhage or retained products of conception. A majority of the time, this pathology is undiagnosed until recognized innocuously following delivery …

The Expansion Of Lyme Disease: A Case Of Infection In The Absence Of Known Exposure, James C. Curry, Shane E. Cook Md

Marshall Journal of Medicine

Lyme disease is a systemic infection caused by the spirochete Borrelia burgdorferi often carried the Ixodes tick. It is associated with dermatologic manifestations, most notably the “bullseye rash” of erythema migrans. The disease can progress in stages to involve other organs such as joints, heart, and the nervous system. Lyme disease is continuing to spread, with West Virginia cases increasing dramatically in the last 2 decades. As a result, physicians are likely to encounter this disease more often, making recognition and early treatment a top priority in order to prevent potentially dangerous sequelae. We present a case of a 60-year-old …

Dream Enactment Behavior: A Documented Case Presenation With A Transition From Post Traumatic Stress Disorder To Rem Behavior Disorder, Sammar Atassi Md Faasm, Katherine A. Atassi Rn Phd

Marshall Journal of Medicine

Dream enactment behavior (DEB) contains the hallmark criteria for the diagnosis of REM behavior disorder (RBD) and it is attributed as the underlying mechanism with its distinct pathology and presentation. The recently described condition, trauma associated sleep disorder (TSD), is closely related to posttraumatic stress disorder (PTSD), and shares the same diagnostic criteria for RBD but they differ significantly in their underlying pathophysiology. The transition from one to another has not been described well (and only self-reported) in the medical literature. This article describes a case study of a patient with a history of PTSD in remission, who developed symptoms …

Chronic Cavitary Pulmonary Aspergillosis: An Unusual Cause Of Chronic Cough, Pleuritic Chest Pain, And Hemoptysis In A 24-Year-Old Coal Mine Worker, Emma I. Sherfinski, Emily J. Vore, Mark H. Cooper Md, Phd, Peimei He Md

Marshall Journal of Medicine

Pulmonary Aspergillus infections are caused by the ubiquitous fungus mold when spores found in compost, dust, and plant material are inhaled. Manifestation of the disease is represented by a delicate balance between host and pathogen interactions, making Aspergillus infection more commonly observed in immunocompromised individuals. Chronic cavitary pulmonary aspergillosis (CCPA) is a subtype of pulmonary Aspergillosis associated with history of chronic or prior lung disease. Here we present the case of a non-immunocompromised 24-year-old male with a history of intermittent asthma with chronic pulmonary symptoms and finding of a lung mass on imaging. We describe the diagnostic challenge and surgical …

"A Path To Wisdom: Examining The Multi-Faceted Mentoring Journey.", Alice Fornari

Marshall Journal of Medicine

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Complications And Hospital Admissions Among Pregnant Women With Substance Abuse, Melissa A. Nehls, Jamila Iqbal Ranavaya, Sydney Smith-Graham, Micah Ray, Aryana Misaghi, Jennie Yoost, Kelly Cummings

Marshall Journal of Medicine

Introduction

In recent times, there has been an increase in drug abuse in the general population and in women of reproductive age. Our objectives were to identify, classify, and describe the spectrum of complications, the average number of admissions, and the length of hospital stay among pregnant women with substance abuse. The aim was to understand complication prevalence better to improve management in this ever-growing population.

Methods

A retrospective chart review was conducted of pregnant women ages 18-45 with a history of substance abuse from 2013-2018 in the tri-state area of West Virginia, Ohio, and Kentucky. We collected the following …

A Case Of Metastatic Melanoma Presenting As A Small Bowel Obstruction, Danielle Harris, Micah Ray, Andrew J Weaver, Stephen Wilson

Marshall Journal of Medicine

Small bowel obstructions are most commonly caused by adhesion. Less common causes arise from malignant pathology. Here we present a relatively rare case of a small bowel obstruction due to malignant melanoma. Melanoma involving the gastrointestinal tract is relatively rare with most cases occurring as metastatic spread from a cutaneous primary. The treatment typically requires a surgical resection or palliative bypass. When a patient presents with a small bowel obstruction but without prior abdominal surgeries or hernias a malignant obstruction must be on the differential.

Syphilis And Proteinuria In Pregnancy, Jay Jensen, Jesse Cottrell

Marshall Journal of Medicine

Syphilis has the potential to result in serious irreversible morbidity and mortality during pregnancy and has been increasing in incidence across the United States. While syphilis is a common disease and a known but rare cause of membranous nephropathy, it can complicate the clinical picture and obscure accurate diagnosis of women presenting with proteinuria during pregnancy. We report a case of proteinuria with syphilis in the second trimester of pregnancy as an educational review.

Treatment Of Tardive Dyskinesia With High Dose Vitamin B6 Associated With Depression, Marjorie Mccoy, Adam Schindzielorz, Suzanne Holroyd

Marshall Journal of Medicine

Tardive dyskinesia (TD) is a movement disorder associated with dopamine receptor blocking medications. Recommended treatments for TD include discontinuing the causative agent, adding vesicular monoamine transporter 2 (VMAT2) inhibitors, or adding vitamin B6. We present a 66-year-old Caucasian male with bipolar I disorder who developed TD while on lithium and quetiapine having been euthymic on this regimen for three years. He was initially treated with 1200 mg B6 daily. This failed to improve his TD and was associated with a depressive episode. He switched to valbenazine 40 mg daily which improved his TD and concurrently his mood, but months later …

Surgical Fixation Of Complex Rib Fractures To Sternum For Flail Chest: A Case Report, Andrew J Weaver, Wai Hau Bs, Mark H. Cooper Md, Phd

Marshall Journal of Medicine

Rib fractures are among the most common injuries found in a patient presenting from blunt trauma. They are associated with significant morbidity and mortality, largely due to pulmonary complications. Open reduction and internal fixation (ORIF) has been the mainstay treatment for patients with multiple rib fractures. In this report, we present a case of a patient that sustained blunt thoracic trauma with multiple anterolateral rib fractures, including a flail segment. This fail segment involved the costal cartilage and required fixation of ribs to the sternum in order to restore chest wall stabilization and integrity. This was achieved using the Zimmer …

Retention And Career Success Of Faculty: The Case For Building A Sense Of Belonging To The Academic Medicine Community, Wendy L. Ward

Marshall Journal of Medicine

As attrition in the healthcare workforce rises, factors that positively impact retention, engagement, work satisfaction, and vitality for faculty in Colleges of Medicine are of critical importance. One important factor that is less often discussed is the need to develop a sense of belonging and connectedness to the institutional community. Underrepresented minority faculty particularly feel the benefit of feeling like they belong. Recommendations for enhancing faculty connectedness to a community in support of developing a sense of belonging to that community are offered.

Analysis Of Blood Borne Pathogen Exposure Monitoring Protocol Adherence In An Academic Medical Center: A Seven Year Analysis And Literature Review, Natavoot N. Chongswatdi Md, Callie Seaman Md, Diane Harman Rn, Bsn, William Rollyson Md, Adam M. Franks Md

Marshall Journal of Medicine

Introduction

Health care workers (HCW) are at risk for occupational blood borne pathogen exposures (BBPE). Effective prevention and management of BBPEs relies upon reporting and post-exposure follow-up protocol adherence. As post-exposure monitoring completion is largely unexplored, seven years of a university healthcare system’s BBPE exposure data was explored and compared to documented rates.

Methods

The Marshall Health Occupational Health and Wellness division collected seven years (2012-2018) of BBPE follow-up monitoring adherence rates and demographic data. Data for HCW occupation, exposure incident, and source patient disease status were evaluated. Differences were analyzed with Chi square, Fischer Exact and logistic regression tests. …

Appalachian Parent And Provider Views On The Use Of Pharmacies For Human Papillomavirus Vaccination In Adolescents, Niccia Ditrapano, Katherine Redmond, Jamila Ranavaya, Jennie Yoost

Marshall Journal of Medicine

Introduction

The human papillomavirus (HPV) vaccine uptake in West Virginia is lagging despite being highly protective against HPV-related diseases.

Methods

This study aimed to determine parent and provider perceptions on using pharmacies for HPV vaccination in adolescents. The study surveyed both parents and providers in a rural academic institution. Providers were surveyed before and 6 months after an educational intervention that instructed providers on local legislation and the logistics of prescribing the HPV vaccine through pharmacies. The provider survey assessed awareness of pharmacy vaccine access and prescribing practices. Parents of adolescents were surveyed to determine what patients might benefit most …

Psychiatric Disorder Induced By Twiddler's Syndrome May Pose Treatment Challenges In Clinical Practice, Mohamed Tashani, Laura Given, Jason Mader

Marshall Journal of Medicine

Twiddler’s syndrome is a rare condition caused by coiling of the leads, leading to a malfunction in the pacemaker or automated implantable cardioverter-defibrillator (AICD). It was first described by Bayliss in 1968 as a rare, but potentially fatal complication of pacemaker treatment¹. Inappropriate shocks due to malfunctioning of the AICD can be devastating, traumatic, or fatal to the patient.

With traumatic inappropriate shocks, patients can develop stress or anxiety disorders in association with their AICD. Treatment for anxiety or acute stress disorder with medications can be difficult due to a patient’s underlying pro-arrhythmic conditions.

We are presenting a …

Use Of Mandibular Distraction Osteogenesis To Correct Micrognathia And Airway Obstruction In Newborn Female With Pierre Robin Sequence And Neonatal Abstinence Syndrome In Rural Appalachia, Seneca Williams, Adam Van Horn Md

Marshall Journal of Medicine

We present a case of Pierre Robin sequence and Neonatal Abstinence Syndrome (NAS) in a newborn female patient to highlight the surgical technique of mandibular distraction osteogenesis to correct airway obstruction due to micrognathia. The patient presented as a transport after delivery due to respiratory distress. She was noted to have a cleft palate and micrognathia. The absence of other dysmorphic features diagnosed her with non-syndromic Pierre Robin sequence. To solve her upper airway obstruction, mandibular distraction osteogenesis was performed. This procedure allowed the patient to be weaned from all respiratory support and nasogastric tube feeds by the end of …

Embryonal Rhabdomyosarcoma In The Pelvis Of A 22-Year-Old Female: A Case Report, Amber Wright Md, Nadim Bou Zgheib, Niru Nahar

Marshall Journal of Medicine

Embryonal rhabdomyosarcoma is a rare soft-tissue sarcoma that is responsible for less than 1% of malignancies in the adult population. We present a case of a 22-year-old female with a six-month history of abnormal uterine bleeding that was found to have an exophytic mass within the cervix. Magnetic resonance imaging was performed and revealed a large pelvic mass. Further workup included biopsies and surgical removal of the tumor, leading to the diagnosis of embryonal rhabdomyosarcoma. PET scan showed no FDG-avid malignancy, aiding in the decision-making process for adjuvant treatment to include vincristine, actinomycin D, cyclophosphamide, and mesna. This case is …

Allyship For The Rural Health Care Workforce, Nancy D. Spector, Barbara Overholser

Marshall Journal of Medicine

The COVID-19 pandemic revealed a lot about the American impressive yet fragile and overtaxed health care system. Our support systems – both institutional and human- were taxed. Building our network through a variety of methods can help to strengthen our support system while also helping to dismantle the structural inequities that have negative consequences for our workforce and for patient care. Seeking allies in medicine has become an integral component of building one’s network and becoming an ally for those communities that are isolated or under resourced and for those who are underrepresented in medicine has become an important way …

The War On Drugs, Moral Panics, And The Groundhog Day Effect: Confronting The Stereotypes That Perpetuate The Cycle Of Disparity, Tasha Withrow

The Mid-Southern Journal of Criminal Justice

There has been a specter haunting America for over 400 years. That specter is an insidious and destructive beast that has found its way into every crevice and layer of all American institutions. Racism, racial stereotypes, racial stigma, biases, and White supremacy has infiltrated every power structure since the foundation of America and has created a system of social control that has perpetually oppressed, marginalized, and disenfranchised generations of people of color. One of the most catastrophic by-products generated from America’s historic racist ideology has been that of the over-criminalization of people of color for drug crimes justified by discriminatory …

Do Medical Residents With Rural Upbringing Show Less Decline In Empathy During Training? A Report From A Rural Family Medicine Residency, William J. Crump, Craig H. Ziegler, R. Steve Fricker

Marshall Journal of Medicine

Purpose

Our focus in this study was to determine if demographic variables, including specifically rural upbringing, showed any association with a measure of empathy among family medicine residents at a rural site.

Methods

We surveyed 40 residents annually using the Jefferson Scale of Empathy (JSE) from 2016 to 2020 and compared scores between residents with rural vs urban hometowns. The response rate was 98/99 (99%) of completed survey opportunities.

Findings

There was no significant difference in JSE scores of rural vs urban residents at baseline, and both groups showed a decline after the PG-1 year. However, the rural-raised residents showed …

Over-The-Counter Analgesic Use Patterns In Appalachian Older Adults, Focusing On Non-Steroidal Anti-Inflammatory Drugs, Courtney Wellman Md, Jordan Ratcliffe Bs, William Rollyson Md, Adam M. Franks Md, Mike Grome Pa-C, Robert Walker Md

Marshall Journal of Medicine

Introduction

Over-the-counter (OTC) medications are commonly used by elderly patients to self-manage pain symptoms. Medications such as non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen and topical analgesics are readily available and therefore may seem harmless to patients. In the growing population of those 65 years and older, providers need to inquire about OTC medication use due to the increased risk for adverse reactions in this population. Complications related to these medications can be worsened by chronic disease, variable metabolism, polypharmacy, etc. which become more common in the older adults.

Methods

A survey was created to determine the prevalence and habits of OTC …

Adult Pulmonary Langerhans Cell Histiocytosis With Osseous Involvement: Understanding This Rare Mimic Of Malignancy, Samantha A. Smith Ms Iii, Adam M. Franks Md, William Rollyson Ms Iv, Doreen Griswold, Tammy Bannister Md

Marshall Journal of Medicine

Langerhans cells are dendritic cells that form the antigenic barrier of the human body. They occur in nearly any tissue but are most prevalent in the skin, submucosa of the bronchial tree, and other mucosae. Langerhans Cell Histiocytosis (LCH) develops when these cells damage the tissues in which they reside through a combination of inflammatory and monoclonal stimulation. The pulmonary variant of LCH involves the lung parenchyma and creates a wide variety of disturbances: pulmonary hypertension and both obstructive and restrictive lung disease. Osseous involvement, in addition to the pulmonary variant, presents with pulmonary masses and lytic bone lesions, which …

Motor Symptoms As A Prodrome To Schizophrenia, Adam Schindzielorz, Hunter Edwards, Kelly Melvin

Marshall Journal of Medicine

Schizophrenia occurs in 1% of the population and is severely impairing to those afflicted. Thereby, it is of the utmost importance to recognize and treat the disorder as early as possible. For the last several decades research has attempted to elucidate a variety of predictive factors in order to aid in the identification of patients at high risk of developing a schizophrenia spectrum disorder. These factors have included premorbid or prodromal movement symptoms. The literature has identified motor aberrations beginning early in life, in some cases even in infancy, ranging from neonatal hypotonicity to facial and upper body dyskinesia. …

A Tribute To Franklin Shuler, M.D., Ph.D., C.I.M.E. (1967-2021), Abigail Tolbert, Dipali Nemade

Marshall Journal of Medicine

Dr. Franklin Shuler was a well-known Orthopaedic Surgeon amongst Marshall Health. He made breakthroughs in research, was a phenomenal mentor, and took care of his community and family.

For 4 years, Dr. Shuler fought HLH, a rare autoimmune disorder, that eventually took his life on January 5, 2020. He made his mark at the West Virginia School of Medicine being the first student to graduate with an M.D. and Ph. D with honors. Additionally, he was prestigious in research with accepted publications for 11 consecutive years. Dr. Shuler took pride in his community as well as medical student education as …

In Appreciation: A Thank-You To Our Industrious Reviewers, Darshana T. Shah

Marshall Journal of Medicine

The reputation of the Marshall Journal of Medicine depends on the authors' contribution; however, the standard of the Journal's level of excellence is also a consequence of the efforts of expert peer reviewers. We are grateful to the more than 530 individual reviewers who have contributed to the success of our Journal and enhanced the quality of 260 published papers. It is impossible to overstate the importance of their labor to ensure both the quality and relevance of work published in the Journal. On behalf of the Marshall Journal of Medicine editorial board, I want to express my sincere gratitude …

Using The Protection Motivation Theory To Understand The Mental Health Impact Of Surviving Covid-19, Kaprea Johnson, Angel Spence, Yousef Sherif, Dana Brookover, Adrienne White

Adultspan Journal

Due to the widespread effects of COVID-19, mental health professionals need to understand the lived experiences of survivors. Data were collected from YouTube videos (N = 52), which contained firsthand perspectives from COVID-19 survivors. Survivors understood the high stakes of COVID-19, reported the dual threat to physical and mental health, entered “survival mode,” and had both positive and negative reflections on the experience. Implications for mental health professionals and future research directions are included.