Medicine and Health Sciences Commons^™

Endoscopic Ultrasound Guided Drainage Of Peri-Rectal Collections: A Salvage Approach, Yana Cavanagh, Kevin Hosein, Nihar Shah, Edward Milman, Sohail N. Shaikh

Marshall Journal of Medicine

Abdominal and pelvic abscesses can occur as a consequence of surgery and are associated with significant morbidity and mortality. It is well accepted that the primary treatment is antibiotic therapy and minimally invasive drainage. Surgical measures are typically reserved for patients with luminal perforations or those who do not respond to conservative measures. Previously available modalities of drainage involved percutaneous and computed tomography guided access. Recently, endoscopic ultrasound guided aspiration has emerged as a safe alternative for management of intra-abdominal abscesses.

Since its first application for peripancreatic drainage, endoscopic ultrasound techniques and technologies have significantly evolved. Endoscopic ultrasound interventions can …

Denosumab Use In A Patient With Bisphosphonate-Resistant Humoral Hypercalcemia Of Malignancy, Maali M. Milhem Md, Adeel Mahmood Md, John Leidy Md-Phd

Marshall Journal of Medicine

ABSTRACT

Objective: To describe the use of denosumab as an option for treating bisphosphonate-resistant humoral hypercalcemia of malignancy.

Methods: We present the clinical history and laboratory findings of a patient with a review of related literature.

Results: A 62 year-old male with stage IV laryngeal squamous cell carcinoma and lung metastases had multiple hospital admissions for asymptomatic hypercalcemia. The patient had no known bone metastases. His laboratory data showed a high calcium level, a low level of intact PTH and a high level of PTHrP, which confirmed the diagnosis of humoral hypercalcemia of malignancy. There was atypically an elevated level …

The Crisis Of Opiates In Appalachia, James B. Becker Md

Marshall Journal of Medicine

No abstract provided.

Marshall Journal Of Medicine: Communicating A Scholarship Of Engagement, Darshana Shah Ph.D

Marshall Journal of Medicine

Often, at the root of scholarly work, between the scientific and geographic communities we serve, exists the driver of conversation: the faculty. Grounded by first-hand knowledge of the areas in which they live, yet focused by an unyielding passion for academic and professional achievement, faculty provide a perspective that is at once familiar yet innovative. We must use our professional capabilities as well as our partnerships to create socially responsible, unified dialogue that is purposefully disseminated to educate and serve the needs of our rural society.

In order to survive and thrive in academic medicine, our work and our passion …

Serving The Mountain State, Appalachia And Beyond, Darshana T. Shah, Phd

Marshall Journal of Medicine

No abstract provided.

“Skin-Out” Health Care Research: A Case For Community-Based Outcomes Studies, Robert Walker, Md

Marshall Journal of Medicine

No abstract provided.

Phact Vs. Fiction, Hani Nazha, Md, Sneha Raghunath, Md, Gary Kanner, Md

Marshall Journal of Medicine

Introduction and objective: Prosthetic hip-associated cobalt toxicity (PHACT) is a rare cause of cobalt toxicity from metal-on metal (MoM) total hip prosthesis. There are few reports of PHACT and only one case report from our review that reported tremor as a presenting symptom (7).

Case presentation: This is a report of a 44 year old male with history of hip replacement. He presented to PCP with progressive worsening of muscle weakness, fatigue and tremor of two months duration. After an extensive work up was performed and reviewing current literature, serum cobalt level was eventually performed and was found to be …

Clinical Images - An Incidental Ekg, Ellen A. Thompson, Md, Mark A. Studeny, Md

Marshall Journal of Medicine

A routine employment stress test reveals Brugada syndrome, a rare abnormality.

Velamentous Cord: A Dangerous Case Complicated By A Rural Population, Adam Franks, Md, Carolyn Curtis, Md, Shawndra Barker, Md

Marshall Journal of Medicine

A velamentous cord insertion occurs when the umbilical cord’s Wharton jelly fails to reach the placenta, due to early placental atrophy around the insertion site, leaving a segment of unprotected vessels running through the thin membranes of the amniotic sac. This area of weakness exposes a threat to the well-being of the fetus through acute hemorrhage and both acute and chronic restriction of nutrition. With advances in technology, resolution capabilities of ultrasounds allow for antenatal diagnosis, when previously this was impossible. With this knowledge, considerations for screening and management of this pathology are essential when dealing with a rural population …

Pregnancy Induced Microangiopathy, Hellp Or Ttp!, Ahmed Amro, Md, Alaa Gabi, Md, Zeid J. Khitan, Md

Marshall Journal of Medicine

Introduction: Thrombotic thrombocytopenic purpura (TTP) in pregnancy is rare and can be fatal if misdiagnosed.Typically patients present with microangiopathic hemolytic anemia, thrombocytopenia, Altered mental status, fever, and renal abnormalities

Case Description:

We are presenting a case of 26 year old pregnant female presented with elevated BP. She had scattered Bruises in her legs, thighs and arms along with +2 bilateral pitting leg edema. Initial and subsequent laboratory studies showed features of microangiopathic hemolytic anemia (MAHA), which brought up the suspicion of HELLP (hemolysis, elevated liver enzymes, low platelets )syndrome initially. Labor was induced after transfusion of 2 units of PRBCs …

Alkali Therapy In Lactic Acidosis, Zeid J. Khitan, Md, Deepak Malhotra, Md, Dominic S. Raj, Md, Antonios H. Tzamaloukas, Md, Joseph I. Shapiro, Md

Marshall Journal of Medicine

This report attempts to frame the debate about clinical administration of sodium bicarbonate in the setting of lactic acidosis in terms of simple questions. Specifically, we address why we develop lactic acidosis in some circumstances, how acute lactic acidosis impairs cardiovascular function and why sodium bicarbonate may have deleterious effects which limit its utility. We also attempt to explore treatment alternatives to sodium bicarbonate.

The Challenges Of Exploring The Impact Of Genogram Construction On An Appalachian Family's Health Consciousness, Dilip Nair, Md, Indira Bhavsar, Nafeeza Hussain

Marshall Journal of Medicine

Abstract

Purpose

Appalachians exhibit high rates of chronic disease-related behaviors which might improve with heightened health consciousness. Knowing one's family history can be an important health maintenance tool. Appalachians' health attitudes are shaped in large, closely knit extended families in which matriarchs play central roles. We sought assistance from West Virginian grandmothers in a family medicine practice in engaging their extended families with their genogram to assess the impact on family members' level of health consciousness.

Methods

The family physician identified West Virginian grandmothers in his practice. We sent each of them invitations to participate, along with their extended family, …

Topical Administration Of Psychotropic Medications In Pluronic Lecithin Organogel To Treat Patients With Dementia: A Retrospective Observational Study, Cornelius W. Thomas, Md, Suzanne Holroyd, Md. Chair, Department Of Psychiatry

Marshall Journal of Medicine

OBJECTIVE: Treatment of mood and behavioral symptoms in geriatric patients with advanced dementia may be impeded by poor compliance with oral medications. Pluronic lecithin organogel (PLO) is a compounding substrate that can be used for the topical administration of psychotropic medications.

METHODS: Charts of patients treated with psychotropic medications compounded with PLO cream were reviewed for treatment outcomes. All patients were treated by a nursing home outreach service.

RESULTS: Records from twenty-four patients, mean age 86.8 + 5.9, were reviewed. Common psychiatric symptoms included agitation, aggressive behavior, and depression. Medications most commonly administered as a PLO cream included quetiapine and …

A Case Control Study Of Nutrient Intake Deficiencies In Patients Taking Warfarin, Philip Riley Iv, Kim Lucas Day, Md, George M. Yousef, Md, Sirisha Devabhaktuni, Md, Ashley N. Gaing, Lynne J. Goebel, Md

Marshall Journal of Medicine

Introduction

We previously published the case of a woman taking warfarin who was found to have scurvy, a disease caused by a deficiency of vitamin C. This led us to hypothesize that patients taking warfarin who consume a diet limited in vitamin K rich foods may be at risk for other nutrient deficiencies. To test our hypothesis, we studied dietary nutrient intake in patients taking warfarin compared to patients with heart disease not taking warfarin.

Methods

The warfarin (n=59) and control groups (n=24) comprised convenience samples of patients with heart disease over age 60 years. Patients completed a three-day food …

Cross-Sectional Survey Of Relevant Literatures As To The Current Proposed Disease Mechanisms And Treatments Of Amyotrophic Lateral Sclerosis (Als), Zachary Sanford

Marshall Journal of Medicine

Amyotrophic Lateral Sclerosis (ALS), more commonly referred to as Lou Gehrig’s disease, is a progressively degenerative neuromuscular disorder affecting both the upper and lower motor neurons and preferentially affecting males in their forties to seventies. Although the pathology of ALS has been clearly elucidated elsewhere, the precise mechanisms by which the disease progresses and the means by which it is acquired are still poorly understood areas of medicine. Current genomic and proteomic studies in human and animal models have yielded exciting and promising new findings that may help elucidate this pathology. It is the purpose of this review article to …

Interrater Variability In Identifying Ventilator Associated Pneumonia Using Six Different Definitions, Ahmad Nusair, Md, Balwinder Singh, Md, Ms., Shifang Ding, Md, Phd., Ognjen Gajic, Md, Guangxi Li, Md

Marshall Journal of Medicine

Objective

There is no widely accepted standard definition for Ventilator Associated Pneumonia (VAP). The reliability of the current definitions in use remains controversial. Our objective was to assess the reliability of six commonly used VAP definitions: The Loose, The Rigorous, The Modified Clinical Pulmonary Infection Score (CPIS), The Canadian Critical Care Trials Group (CCCTG), The International Sepsis Forum Consensus (ISFC) and The Center for Disease Control and Prevention (CDC).

Design

We examined the electronic health records of all the consecutively admitted adult patients at our institution who received invasive mechanical ventilation (IMV) for ≥ 48 hours, from January 2006 through …