Medicine and Health Sciences Commons^™

Acute Upper Gastrointestinal Bleeding–Impact Of Timing Of Endoscopy On Patient Outcomes: Impact Of Timing Of Endoscopy On Patient Outcomes, Abdullah Abbasi, Shima Ghavimi, Louis H. Lau, Cosmos Liutao Guo, Rashid Lui

Internal Medicine

Acute upper gastrointestinal bleeding (AUGIB) is one of the most common emergencies encountered by gastroenterologists across the world. Various medical and endoscopic therapies have evolved over time to improve patient outcomes. However, controversy still exists around the optimal time of endoscopy for patients with AUGIB. Recently, several studies have been published to answer this clinical question and we have reviewed one of these articles.

On 13th October 2021, @Gijournal, we discussed the latest high-impact article published to answer this clinical question. We critically appraised, ‘’Timing of endoscopy for acute upper gastrointestinal bleeding: a territory-wide cohort study’’ which was published in …

Help Patients Safely Handle Medications To Improve Adherence, Kenneth Maxik, Craig Kimble, Alberto Coustasse

Management Faculty Research

Medication nonadherence can cause many drug-related adverse effects (AEs), and pharmacists are in a prime position to use every patient interaction as an opportunity to address barriers, improve adherence, and increase the safe management of medications.

Covid-19 Disease And Viral Characteristics In A Long-Term Care Facility, Shauna Assadzandi, Emily Crocetti, Courtney S. Pilkerton, Amie M. Ashcraft, Carl D. Shrader

Marshall Journal of Medicine

Background

Due to the combination of age, comorbidities, and close living quarters, residents at long-term care facilities (LTCFs) are at particularly high risk of severe symptoms and death due to COVID-19.

Methods

This cross-sectional study examines the relationship between demographic characteristics, symptom severity, and length of viral shedding in 49 residents testing positive for SARS-CoV-2 at a LTCF in West Virginia (WV).

Results

Over half of the residents were asymptomatic, while nearly a quarter experienced severe symptoms. Women were more likely to be asymptomatic, and age was not associated with symptom severity. While no specific medical condition was associated with …

Dysfunctional Voiding: Does A Validated Urine Color Scale Correlate With Dysfunctional Voiding Severity Score?, Katharina Mitchell, Chad Crigger, Tyler Overholt, Tyler Trump, John Barnard, Osama Al-Omar, Hilary Morley

Marshall Journal of Medicine

Introduction

Dysfunctional voiding (DV), defined as abnormal coordination between the urinary sphincter and the detrusor muscle in a neurologically intact individual, affects approximately 40% of patients that populate pediatric urology clinics. Improper hydration affects the specific gravity and concentration of urinary irritants, resulting in symptoms similar to those seen in DV patients.

Methods

Herein, we administered a validated DV survey (the Dysfunctional Voiding Symptom Score [DVSS]) and a validated dehydration severity chart (the Urine Color Chart [UCC]) to toilet trained pediatric patients and compared DV patients to patients presenting with non-urologic concerns. Data was analyzed on an item-for-item basis and …

Utility And Yield Of Genetic Testing Leading To A Definitive Neuromuscular Or Neuropathic Diagnosis At A Rural Outpatient Neurology Clinic Affiliated With A University Health Center In West Virginia Over 4 Years., Holly Farkosh, Dominika Lozowska

Marshall Journal of Medicine

Introduction

Clinicians are increasingly relying on genetic testing to pinpoint definite diagnoses. A more general diagnosis of neuropathy or neuromuscular disease like myopathy can be narrowed down substantially using genetic testing. Because carrier status is of utmost importance in reproductive matters, pathogenic results can prognosticate the future course of the illness and help plan ahead for treatment and social supports. Given the expense of genetic testing, it is important to assess the cost-benefit ratio to determine whether it is worthwhile to collect genetic samples. The purpose of the study was to determine the likelihood of obtaining a conclusive confirmatory diagnosis …

A Rare Case Of Right Lower Lobe Intralobar Pulmonary Sequestration In An Adult, Andrew J. Weaver, Jenalee Corsello, Peter Chirico, Mark H. Cooper

Marshall Journal of Medicine

Pulmonary sequestration is a rare congenital abnormality which is often diagnosed in childhood. There are two types of sequestration which are differentiated by the presence, or lack of pleural lining dividing the aberrant lung tissue from functional lung. Data for the management of this pathology in adults remains scarce. Here we present a case of intralobar pulmonary sequestration in an adult. The management of this patient comprised of surgical treatment involving lobectomy and ligation of the feeding vessel. The patient had an uneventful recovery and final pathology revealed a chronic infection in the sequestration.

Alpha-Gal Allergy: A New Threat To Appalachia, Adam M. Franks Md, Makala Murphy Bs, Madison Griffis Md, Rebekah Franks Ba, Cwr, Colin M. Franks, Gary Petty Md

Marshall Journal of Medicine

Abstract

Alpha-gal allergy, or mammalian meat allergy, is described as the development of IgE antibodies to the oligosaccharide galactose-a-1,3-galactose following a bite from the tick species Amblyomma americanum (Lone Star tick) or Dermacentor variabillis (Wood tick). Dermatologic or gastrointestinal symptoms are usually delayed by four to six hours after exposure, making the diagnosis difficult. Due to the use of mammalian proteins in many common medications, surgical equipment and prosthesis, unexpected reactions can occur. In the United States, this pathology is predominately seen in the southeast, but has been associated with other tick species on every continent except Antarctica. As the …

How One Nyc Hospital Handled The Covid-19 Pandemic- The Chief Residents’ Perspective, Sunny Arora, Krystyna Bronchard, Michaela Murphy, Stephen J. Peterson

Marshall Journal of Medicine

No abstract provided.

Potential Savings From Consumer-Driven Health Plans, William Ferguson, Brittany Smith, Jessica Mcnair, Sarah Miller, Bojing Wang, Alberto Coustasse

Management Faculty Research

Consumer Driven Health Plans (CDHPs) have been identified as a high-deductible insurance option that has increased consumer responsibility while healthcare expenditures have decreased. There has been an increasing need of these plans because they can help to control healthcare costs, and the increasing healthcare utilization. As the use of these plans have expanded, educated consumers have become more engaged in their healthcare services and have increased demands for transparency of healthcare costs. The methodology for this study was a literature review using 36 sources. The purpose of this study was to determine if CDHPs have created financial savings by increasing …

Where Epigenetics Meets Food Intake: Their Interaction In The Development/Severity Of Gout And Therapeutic Perspectives, Philippe T. Georgel, Philippe Georgel

Biological Sciences Faculty Research

Gout is the most frequent form of inflammatory arthritis in the world. Its prevalence is particularly elevated in specific geographical areas such as in the Oceania/Pacific region and is rising in the US, Europe, and Asia. Gout is a severe and painful disease, in which co-morbidities are responsible for a significant reduction in life expectancy. However, gout patients remain ostracized because the disease is still considered “self-inflicted”, as a result of unhealthy lifestyle and excessive food and alcohol intake. While the etiology of gout flares is clearly associated with the presence of monosodium urate (MSU) crystal deposits, several major questions …

Law Helps Ensure Safety Of The Supply Chain, Kenneth Maxik, Craig Kimble, Alberto Coustasse

Management Faculty Research

The Drug Quality and Security Act was signed into law on November 27, 2013, and included the Title 2 Drug Supply Chain and Security Act (DSCSA). This legislation was introduced to enact a federal prescription drug safety standard to decrease contamination, counterfeiting, diversion, and otherwise harmful illicit activities. It also improves the detection and elimination of potentially unsafe drugs from the drug supply chain to protect US consumers.

Contraception Choice And Compliance Among Mothers With Opioid Addiction: Identifying Barriers To Care, Robert C. Bowers, Catherine Waldron, Jennie Yoost, Hayley Weese, Amy Roy

Marshall Journal of Medicine

Introduction

West Virginia leads the nation in substance abuse deaths per capita. This epidemic has given rise to a novel population of high-risk, obstetric patients with opiate abuse. Appropriate education, counseling, and implementation of contraception are of extreme importance among this population, due to the risks of unintended pregnancy.

Methods

This study was a retrospective chart review to determine compliance and uptake of contraceptive methods by patients in a maternal buprenorphine maintenance program prior to and following implementation of standardized contraception education and Medicaid coverage of immediate postpartum long-acting reversible contraceptives (LARC). Rates of planned contraception and rates of actual …

Physician Burnout Among West Virginia Primary Care Providers, Kevin S. Mccann, Adam Baus, Joanna Bailey, Laura Boone, Jennifer Boyd, Martha Cook-Carter, Dan Doyle

Marshall Journal of Medicine

Introduction

Work related burnout is highly prevalent in US physicians and linked to adverse effects on patients, providers and organizations. This study measures burnout in West Virginia (WV) primary care providers, allowing for comparison of results to a similar, recent study of US physicians.

Methods

Anonymous survey through email that included Maslach Burnout Inventory, demographic, workload, and practice characteristics. Responses were analyzed using JMP Pro 13. Analysis used JMP Pro 13 for descriptive statistics, chi-square and regression modeling.

Results

Subjects = 110, female/male ratio 1.4, all primary care physicians (PCP), or advanced practice registered nurses or physician assistants (APRN/PA). PCP …

The Role Of Stenting In Management Of Isolated Symptomatic Basilar Artery Stenosis, Amrita Valluri, Morgan Aguirre, James Reynolds, Justin Nolte

Marshall Journal of Medicine

Isolated basilar artery stenosis (BAS) is a rare etiology of ischemic neurologic conditions. First-line treatment of symptomatic stenosis is typically medical therapy as outlined in the Warfarin–Aspirin Symptomatic Intracranial Disease (WASID) trial and the Stenting versus Aggressive Medical Therapy for Intracranial Arterial Stenosis (SAMMPRIS) trial.1,2 We present the case of a male in his 60s with isolated BAS who failed maximal medical treatment but experienced a decrease in transient ischemic attacks and acute ischemic stroke occurrences after angioplasty and stenting.

Anti-N-Methyl-D-Aspartate Receptor Encephalitis: A Diagnosis Obscured By Concomitant Recreational Drug Use, Paige Lester Ms Ii, Adam M. Franks Md, William Rollyson Ms Iv, Jenna K. Barbour Md, Matthew B. Curry Md

Marshall Journal of Medicine

Anti-NMDA receptor encephalitis (aNMDAre) is a relatively newly discovered autoimmune and inflammatory disorder affecting the limbic system. It has a clinical course that includes Prodromal, Psychiatric, Unresponsive and Hyperkinetic stages. These stages are often confused with mental health issues in the medical literature, but they also share symptoms of various drug intoxication and withdrawal states. Implicit bias in physicians regarding substance use disorder and patient demographics can impair delivery of care and outcomes in patients with aNMDAre, especially in an environment of recreational drug use. When clinical presentation aligns, this diagnosis should be investigated as soon as possible, even in …

Bethlem Myopathy Demonstrated In Three Generations Of A Rural West Virginia Family Carrying An Autosomal Dominant Col6a3 Mutation, Holly Farkosh, Dominika Lozowska Md

Marshall Journal of Medicine

Mutations in the genes that code for type VI collagen can lead to what are known as the collagenopathies (collagen VI myopathies), such as Bethlem myopathy (BTHLM1), which affect structural tissues like muscles and tendons. We present the case of a young female and her two relatives, who were discovered to share the autosomal dominant COL6A3 mutation and whose presentation in clinic varied from mild to severe. Type VI collagenopathies represent a clinically and genetically heterogeneous spectrum of disorders generally characterized by muscle weakness and joint contractures. We highlight the importance of examining close relatives whenever possible and documenting a …

Plasmablastic Lymphoma Of The Kidney In A Previously Undiagnosed Hiv Patient, Amrita Valluri, Adarsh Sidda, Anisha Valluri, Gurusidda Manu, Niru Nahar

Marshall Journal of Medicine

We present the case of a 61-year-old male who presented with flank pain and dysuria. A biopsy and histopathological analysis of a mass found in the left kidney led to the diagnosis of plasmablastic lymphoma (PBL). The kidney is not a commonly reported site of presentation for PBL in the current literature.^1,2 As a part of routine workup, HIV testing was ordered resulting in positive preliminary and confirmatory results. The patient denied awareness of his HIV status. Chemotherapy with uricosuric agents and antiretroviral therapy was initiated, but the patient developed tumor lysis syndrome with phosphate nephropathy leading to discontinuation …

Rem Behavior Disorder And Sleep Related Hallucinations: A Case Study, Sammar Atassi Md, Katherine Atassi Phd, Megan Sandberg Ms4

Marshall Journal of Medicine

This is a case study of Idiopathic REM Behavior Disorder (RBD) lasting 5 years with superimposed Idiopathic Complex Nocturnal Visual Hallucination Disorder (CNVHD).

The coexistence of these two distinct idiopathic sleep disorders has not been reported in the literature, even though they both carry similar etiologies and strong association with neurodegenerative diseases. Greater awareness, education, and further research are warranted.

Hospitalists Stare Down The Covid-19 Pandemic, Sutoidem Akpanudo

Marshall Journal of Medicine

Hospital medicine is the country's fastest growing medical specialty. The role of hospitalists has evolved greatly in the past few decades. Hospitalists have become the quarterbacks in the effort to fight against the COVID-19 pandemic. The pandemic has brought about a transformational change to the practice of Hospital Medicine.

A Novel Backward Stepwise Logistic Regression And Classification And Regression Tree Model To Predict 180-Day Clinical Outcomes In Hepatitis B Virus-Acute-On-Chronic Liver Failure Patients, Shima Ghavimi

Internal Medicine

As the era of precision and personalized medicine is gaining exponential positive gain in the field of medicine, there is a positive shift towards a more evidence-based patient care approach for patients with hepatological diseases. One factor that is crucial in any physician’s decision-making efforts involves the application of novel innovative approaches that can enhance predicting survival outcome. Acute-on-chronic liver failure (ACLF) is a perfect example of how liver can rapidly deteriorate, and the hepatitis B virus (HBV) is one crucial culprit. Patients can experience organ failure that leads to their mortality, and in this article the authors clearly described …

Factors Associated With Mutations: Their Matching Rates To Cardiovascular And Neurological Diseases, Hannah B. Lucas, Ian Mcknight, Regan Raines, Abdullah Hijazi, Christoph Hart, Chan Lee, Do-Gyoon Kim, Wei Li, Peter H. U. Lee, Joon W. Shim

Biomedical Engineering Faculty Research

Monogenic hypertension is rare and caused by genetic mutations, but whether factors associated with mutations are disease-specific remains uncertain. Given two factors associated with high mutation rates, we tested how many previously known genes match with (i) proximity to telomeres or (ii) high adenine and thymine content in cardiovascular diseases (CVDs) related to vascular stiffening. We extracted genomic information using a genome data viewer. In human chromosomes, 64 of 79 genetic loci involving >25 rare mutations and single nucleotide polymorphisms satisfied (i) or (ii), resulting in an 81% matching rate. However, this high matching rate was no longer observed as …

Detect Adverse Events And Medication Errors Using Technology, Kenneth Maxik, Craig Kimble, Alberto Coustasse

Pharmacy Practice & Administration

Technology has changed the practice of pharmacy. Many systems are now part of an ever increasingly interfaced or integrated health care system allowing the electronic exchange of prescriptions from electronic health records (EHRs) to the pharmacy information system and bidirectional data exchange for many items, such as lab results and test information. With meaningful use of automated distribution cabinet databases, EHR efforts, electronic data exchange, and smart pump technology, the availability of data to use for addressing and preventing adverse medication events has grown. Use of these systems has allowed a data-rich environment to store and retrieve reporting. Mining data …

Can The Conventional Cytology Technique Be Sufficient In A Center Lacking Rose?: Retrospective Study During The Covid-19 Pandemic, Mohamed Hammad, Nader Alwifati, Mohamed Ajala, Nour Keshlaf, Dalia M.Khair, Marwan Alsari, Yousef M. Hasen, Ali Tumi, Mohamed Sultan

Marshall Journal of Medicine

Introduction

While rapid on-site evaluation (ROSE) is considered to be an additional tool to optimize the yield of tissue acquisition during EUS-guided FNA of the gastrointestinal tract,^1,2 it is not readily available at all times while performing these procedures.

Methods

We reviewed twenty-seven EUS-guided FNA procedures done at our institution in Tripoli central hospital with general working center restrictions due to local COVID-19 prevention protocols. This is a small-size retrospective chart review study to illustrate the optimal tissue adequacy during EUS-guided FNA of the upper gastrointestinal tract in a suboptimal hospital setting, lack of ROSE and merely utilizing visual …

Impact Of A Faculty Development Course On Promotion At A Health Sciences Center, Sanja Kupesic Plavsic, Valerie Osland Paton Ph.D., Christiane Herber-Valdez, Consuelo Rosales, Martín D. García, Zuber D. Mulla

Marshall Journal of Medicine

Introduction

The objective of this study was to quantify the association between graduation from our annual comprehensive Institutional Faculty Development Course (IFDC) and being promoted from assistant professor to associate professor at our health sciences center.

Methods

A retrospective cohort study (October 2008-October 2019) was conducted using publicly-available faculty data. A total of 148 IFDC graduates were compared to 87 non-graduates. Subjects were full-time assistant professors at Texas Tech University Health Sciences Center El Paso at the start of follow-up. The binary outcome was promotion to associate professor. The outcome was measured annually from 2008 to 2019. Follow-up ended when …

Non-Selective Primary Human Tumor Cell Line Generation From Surgical Resections To Be Paired With Flash Frozen And Paraffin Embedded Tissue: Advancements In Democratizing Translational Research Materials To Rural Institutions, Jennifer Hawkins, Rebecca Russell, Logan M. Lawrence, Amrita Valluri, Jessica Wellman, Krista Denning

Marshall Journal of Medicine

Translational cancer research relies on the availability of human patient tissue demonstrating the specific disease process under investigation. Biobanks of human tissue have historically been and remain to date the primary access point for cancer research samples. Biorepositories routinely supply researchers with varying sample types for use in biomedical studies; most commonly formalin-fixed and paraffin-embedded (FFPE) tissue, or fresh snap-frozen tissue. In conjunction with preserved tissue samples, viable tumor cell lines derived from patient tissue have emerged to be a new gold standard in cancer research particularly in drug discovery and functional prognostic assays. Tissue banks providing these samples are …

Mr. Watson, Come Here-I Want To See You: One Rural Residency Program’S Rapid Pivot To Telemedicine During The Pandemic, William J. Crump, Diana M. Nims, Douglas J. Hatler

Marshall Journal of Medicine

Introduction

Telemedicine has been used for over a generation, but application has been limited in rural areas due to lack of payment, licensure issues, cumbersome video equipment, and challenges with digital communications. Early in the COVID-19 pandemic, our rural family medicine residency made a rapid shift to all telemedicine services for our patients.

Methods

We collected data over a four-week period in April 2020 as we transitioned to 100% telemedicine consultations. We compare that to a four-week period prior to mid-March when COVID-related shutdowns began. We collected detailed visit summaries, patient feedback, and physician feedback to compare these two periods. …

Comparison Of Direct Staffing Costs Of Advanced Practice Providers And Residents In A High Acuity Area Of A Community Emergency Department, Kyle B. Smith, Christopher Kiefer, Erica Shaver, Kimberly D. Quedado, Thomas Marshall, Jerome Kerwin, Christopher Goode

Marshall Journal of Medicine

Introduction

Resident physicians and advanced practice providers (APPs) both have roles in providing care within emergency departments (ED). While both bring unique skill sets and capabilities to the health care team, little is known about the comparative financial impact of APPs and residents in a community ED. The objective of this study was to compare direct staffing costs per relative value unit (RVU) generated of emergency medicine (EM) residents and APPs in a community ED setting.

Methods

This was a retrospective, observational analysis of RVU productivity of resident physicians and APPs in the high acuity area of a community ED. …

Arthritis Post-Immunotherapy For Endometrial Cancer: A Case Report And Review Of Literature On The Acute Onset Of Inflammatory Arthritis Following Pd-I Inhibitor Therapy In A Patient With Recurrent Endometrial Cancer, Sydney Graham, Emily Sloane, Nadim Bou Zgheib

Marshall Journal of Medicine

Since gaining FDA approval in 2014, pembrolizumab, a PD-1 immune checkpoint inhibitor, has been utilized in the management of cancers that progress following first-line therapy.While the pathological response to pembrolizumab is favorable, immune related adverse events (irAEs) can be elicited and require prompt diagnosis and management based on grading and severity, which can include discontinuation of immunotherapy.Our case concerns a 66-year-old female with recurrent endometrial cancer who was treated with pembrolizumab, and developed inflammatory arthritis following therapy. We provide a succinct review of the pathogenesis and risk factors associated with irAEs, as well as diagnosis and management strategies.

Recurrent Spontaneous Pneumothorax During Pregnancy; A Case Report, Andrew J. Weaver, Wai Hau, Mark H. Cooper

Marshall Journal of Medicine

Spontaneous pneumothorax is a rare but potentially life-threatening condition during pregnancy. We discuss a case of recurrent spontaneous pneumothorax during a single pregnancy. The pneumothorax occurred twice during the pregnancy, first in the second trimester and again in the third trimester with both times being managed conservatively. Due to the low prevalence of this condition management guidelines are few. We report our management of recurrent spontaneous pneumothorax during pregnancy to support the literature and current guidelines.

Acquired Aorto-Atrial Fistula From Intravenous Drug Use With Underlying Congenital Heart Disease., Mohamed Tashani, Laura Given, Emhemmid Karem, Mahmoud Abualayem

Marshall Journal of Medicine

The development of an aorta-atrial fistula secondary to mechanical aortic valve infective endocarditis, is a rare, serious complication. The fistula is an aberrant intra-cardiac shunt that occurs between the aorta and either the left or right atrium.

An aorta-atrial fistula can be congenital or acquired. In the case of infective endocarditis, the infection’s expansion beyond the valvular structure, may result in an aorto-cavitary fistula (ACF or AAF) with an estimated incidence of 1-2% (1). No clinical trials have been conducted for the best approach of management for this condition. Therefore, treatment strategies are applied to a case-by-case basis by expert …