Medical Specialties Commons^™

The Effect Of Elevated Blood Pressure And Stage One Hypertension On Perinatal Outcomes In Appalachian Gravidas: A Retrospective Cohort Study, Caroline Briggs, Austin L. Loop, Grace E. Montgomery, David G. Chaffin, Jesse Cottrell

Marshall Journal of Medicine

Introduction:  There is literature in the obstetric population that suggests any degree of hypertension (blood pressures greater than or equal to 120 systolic or 80 diastolic) can lead to adverse maternal and fetal outcomes.  We sought to determine if pregnant patients in our Appalachian population with elevated blood pressure or stage 1 hypertension have an increased risk of gestational hypertension and preeclampsia.

Methods:  A retrospective chart review was performed on patients who received obstetric care with the Marshall University OB/GYN department and delivered at Cabell Huntington Hospital.  Delivery outcomes were obtained for 233 deliveries from March 30, 2020 to September …

Clinical Pathway For Rhogam Administration In The Emergency Department, Lauren Kyzar, Amy Bigham

Appalachian Student Healthcare Research Review

Background: Clinical pathways in emergency departments (ED) are designed to standardize patient care and reduce variability in clinical practice. In a rural hospital setting, the ED management of RhoGAM administration in pregnant patients with vaginal bleeding varied by provider with no standard of care achieved. This approach raised concerns about potential patient safety issues.

Methods: In response, the local emergency department medical director, in conjunction with local perinatal providers developed a clinical pathway to standardize care and optimize RhoGAM administration. The clinical pathway was implemented to the local ED providers over a three-month period. Retrospective chart review for Type and …

Unlocking Hope: Mirtazapine's Promise In Obsessive-Compulsive Disorder Treatment, Rebecca K. Hicks, Iram Kingson, Jordan Gaal, Suzanne Holroyd

Marshall Journal of Medicine

Obsessive-compulsive disorder (OCD) is a chronic and debilitating psychiatric condition characterized by intrusive thoughts (obsessions) and repetitive behaviors (compulsions). While selective serotonin reuptake inhibitors (SSRIs) and cognitive-behavioral therapy (CBT) are first-line treatments for OCD, a significant proportion of patients remain refractory to these interventions. Mirtazapine, an atypical antidepressant with unique pharmacological properties, has emerged as a potential adjunctive therapy for treatment-resistant OCD. This review synthesizes existing evidence regarding the efficacy and safety profile of mirtazapine in OCD management. We analyze clinical trials, observational studies, and case reports, distinguishing high- vs. low-quality evidence, and discuss mechanisms underlying mirtazapine's therapeutic effects. Additionally, …

Hepatocyte Peroxisome Biogenesis And Phytol-Induced Metabolic Stress In Liver Disease, William Galloway

Theses, Dissertations and Capstones

Hepatocyte peroxisomes are required for metabolism of phytol-derived branched-chain fatty acids through the ACOX2-SCPx beta-oxidation pathway. This study tests whether hepatocyte-specific deletion of PEX16 (Pex16^Alb-Cre), which eliminates peroxisome biogenesis, sensitizes the liver to phytol-induced injury. The Pex16^Alb-Cre mice and their normal control Pex16^fl/fl mice were fed the Lieber-DeCarli liquid with or without 0.1 percent phytol for eight weeks. Serum alanine aminotransferase (ALT) and liver index were measured. Liver sections were stained with hematoxylin and eosin and Masson’s trichrome. Immunoblot analysis of peroxisomal enzyme expression was also performed. Phytol had no effect in Pex16^fl/fl mice as …

Nicotine Self-Administration And The Impacts On Medial Habenula And Interpeduncular Nucleus Neurophysiology, Nathan Alexander Olszewski

Theses, Dissertations and Capstones

Nicotine use is a tremendous public health issue in the United States, with over 23 million people being dependent on the substance. Low cessation rates associated with nicotine use are largely attributed to the withdrawal and craving symptoms that occur after abstinence of use from nicotine. The medial habenula (MHb) and interpeduncular nucleus (IPN) are two brain regions heavily associated and linked with nicotine withdrawal. Here, I sought to understand how these brain regions are altered in their physiology during nicotine intake. Utilizing E-Vape self-administration, mice were first taught to selfadminister nicotine of various, clinically relevant, dosages which correlate to …

Tele-Psychiatry Adoption And Its Effect On Rural Mental Health Service Availability, Anna Heineman, Kaylee Canterbury, Taylor Carpenter

Theses, Dissertations and Capstones

Purpose of study: This study examined the association between tele-psychiatry implementation and mental health service availability in rural healthcare settings. The analysis compared tele-psychiatry to traditional in-person psychiatric care among rural populations, focusing on access and utilization outcomes, including time to first psychiatric appointment, number of completed visits, and appointment no-show rates.

Methods: A qualitative literature review following a systematic approach was conducted using peer-reviewed articles published between 2016-2026. Databases included PubMed, ProQuest Health, CINAHL, Journal of Medical Internet Research, and the National Library of Medicine, with Google Scholar used as a supplemental source. The review followed PRISMA …

Developing Curcumin Analogues For Treating Breast Cancer, Tulasi Laxmi Nutalapati

Theses, Dissertations and Capstones

Breast cancer is still one of the most common types of cancer and one of the most common causes of cancer-related deaths in women around the world. Despite significant advances in early detection and treatment strategies, drug resistance, systemic toxicity, and poor outcomes in aggressive subtypes continue to limit the overall effectiveness of cancer therapy. Natural compounds have become promising anticancer agents because they can target many different things and are not very toxic. Curcumin has shown promise as an anticancer drug, but it cannot be used in the clinic because it does not absorb well, breaks down quickly, and …

Disruption Of The Placenta–Brain Axis In Transgenic Mice Lacking Serotonin Transporter (Sert) In Trophoblast Cells, David T. Ellenberger, Zhen Lyu, Rosalind T. B. Herrington, Jessica A. Kinkade, Gustavo W. Leone, Ji Ying Sze, Nathan J. Bivens, R. Frank Baker, R. Michael Roberts, Trupti Joshi, Cheryl S. Rosenfeld

Biomedical Sciences

Serotonin reuptake inhibitors (SSRIs) are commonly prescribed to pregnant women experiencing depression. Such drugs, however, might adversely affect placenta and fetal brain development. Parietal trophoblast giant cells (pTGCs) in the mouse placenta are postulated to internalize maternal serotonin (5-HT) via transport through SERT, encoded by Slc6a4, and to provide the initial source of 5-HT to the emerging brain via the placental–brain axis. Genetic deletion of Slc6a4 in pTGCs has been hypothesized to impact placental and fetal brain development. A transgenic mouse line with high-affinity SERT, encoded by Slc6a4, was selectively deleted by pairing mice with Cre recombinase linked …

Telepsychiatry For Substance Use Disorders: Evolution From Rapid Covid-19 Pandemic Adoption To Sustainable Integration, Jack Wang

Marshall Journal of Medicine

ABSTRACT

Introduction: Prior to the COVID-19 pandemic, telepsychiatry for substance use disorder (SUD) management was generally an underutilized modality, mainly due to regulatory constraints. Through the pandemic, governmental deregulations rapidly and massively expanded their adoption, bringing out their significant potential to expand access, overcome barriers, and mitigate stigma for individuals seeking addiction care, particularly for rural and underserved populations. This narrative review consolidates the recent research on the growing adoption of telepsychiatry in the management of SUDs. It aims to explore the evidence-based benefits, identify common challenges, and underscore key considerations for its effective and equitable integration into SUD treatment …

Lyme Disease Presenting As A Dermal Hypersensitivity Reaction, William T. Snider, Ian Depew, Rebecca Hicks, Shane Cook

Marshall Journal of Medicine

Background:

Lyme disease is a well-recognized illness commonly associated with skin manifestations such as erythema migrans. However, atypical presentations can complicate diagnosis, particularly when they deviate from classic clinical and histological findings.

Methods:

We report a potential case of Lyme disease presenting as a dermal hypersensitivity reaction (DHR), with clinical findings resembling urticaria rather than urticarial vasculitis. Skin biopsy findings were reviewed, and Lyme serology testing was performed.

Results:

The biopsy did not demonstrate the characteristic superficial perivascular lymphocytic infiltrate typically seen with erythema migrans. The patient's history included prior tick exposures, but while Lyme IgM was positive, the Lyme …

Unusual Wave Morphologies In Ulnar Neuropathy With Marinacci Anastomosis: A Case Report, Micaela Owens

Marshall Journal of Medicine

Marinacci anastomosis is a normal but rare anatomic variant of the median and ulnar nerves, consisting of an interconnection from the ulnar nerve to the median nerve within the proximal forearm. This is a case of Marinacci anastomosis occurring in the presence of both median and ulnar neuropathies, producing unusual waveform characteristics. Knowledge of normal anatomic variation can improve diagnostic accuracy in nerve conduction studies.

Use Of Naltrexone For Treating Binge Eating And Food Obsession Related To Trauma: A Case Report And Literature Review, Rebecca K. Hicks, Iram Kingson, Jordan Gaal, Suzanne Holroyd

Marshall Journal of Medicine

Impulse-control disorders, including those related to eating behaviors, are complex conditions with limited pharmacologic treatment options. While naltrexone is primarily used for opioid and alcohol dependence, emerging research suggests it may also be effective in managing a variety of impulse-driven conditions. As a pure opioid antagonist, naltrexone’s mechanism of action involves the inhibition of opioid receptors on dopaminergic neurons involved in the reward pathway of the brain, thereby reducing the reinforcing effects of substances such as alcohol and opioids. Research suggests that through this mechanism of action, naltrexone shows promise in treating impulsive behaviors also driven by the reward pathway, …

Utility Of Ebus-Tbna In Evaluating Mediastinal And Hilar Lymphadenopathy In Patients With Silica Exposure: A Retrospective Single-Center Study, Tarake M. Aljarod, Atul C. Mehta, Saroj Sigdel, Mark Jason Akers, John L. Saylor, Caleb S. Clark, Yousef Shweihat

Pulmonology

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is used effectively in staging lung cancer and in the evaluation of benign causes of mediastinal and/or hilar lymphadenopathy (MHL), such as sarcoidosis. However, evidence for its utility in the diagnostic workup of silicosis is limited.

Methods: This single-center retrospective study included patients with occupational silica exposure who underwent EBUS-TBNA to evaluate MHL on computed tomography (CT). Cytology specimens were re-examined by an independent pathologist under polarized microscopy, and cytologic criteria for the diagnosis of LN silicosis were formulated from the findings. Primary outcomes were the determination of the diagnostic yield (DY) of …

Childhood Asthma Biomarkers Derived From Plasma And Saliva Exosomal Mirnas, Abdelnaby Khalyfa, Mohit Verma, Meghan M. Alexander, Zhuanhong Qiao, Tammy Rood, Ragini Kapoor, Trupti Joshi, David Gozal, Benjamin D. Francisco

Biomedical Sciences

Asthma, the most common chronic respiratory condition in children, involves airway inflammation, hyper-responsiveness, and frequent exacerbation that worsen the airflow and inflammation. Exosomes, extracellular vesicles carrying microRNAs (miRNAs), play a key role in cell communication alongside other types of communication and are promising markers of asthma severity. This study compares exosomal miRNA and long non-coding RNA (lncRNA) profiles in boys with asthma, focusing on differences between those with normal lung functions and those with severe airflow obstruction. This study enrolled 20 boys aged 9–18 years with asthma, split into two groups based on their lung function. Ten had normal lung …

Integrating Positive Psychology And Spirituality To Foster Meaning And Well-Being In Older Adults, Crystal Morris

Adultspan Journal

This perspective article explores the integration of positive psychology interventions (PPIs) and spirituality in therapy to foster meaning and well-being in older adults. It highlights exercises such as the positive introduction, positive legacy, character strengths, mindfulness, mindful-based yoga, and a manifestation prayer journaling. The interventions presented are tools to support older adults that may experience depression, difficult life transitions, and the search for renewed meaning. Therapists who integrate PPIs and spirituality into therapy can promote a holistic, non-pathological approach to treatment.

Successful Flexible Bronchoscopic Extraction Of A Dental Foreign Body Aspirated Into The Left Mainstem Bronchus, Alexys Bolden, Hayden Cooper, Lynnetta Payne, Mark Coomes, Mark Cooper

Marshall Journal of Medicine

Foreign body aspiration (FBA) is a potentially life-threatening emergency that commonly occurs in children but varies widely in clinical presentation. Rapid diagnosis and intervention are of the utmost importance to prevent complications such as airway obstruction, infection, and lung injury. While uncommon in adults, most encountered causes occur in the setting of intoxication, neuromuscular weakness, or iatrogenic dental work. Those with dental prostheses are especially susceptible due to the partially attached nature, rendering the risk of accidental dislodgement. This report discusses an uncommon case wherein an 82-year-old male aspirated a dental bridge into his left mainstem bronchus during routine dental …

Ai In Radiology: Bridging The Gap Between Technology And Patient Care, Jordan Watts, Jeffrey Larson, Kasi Gorli, Alberto Coustasse

Management Faculty Research

Artificial Intelligence (AI) integration in healthcare, particularly within radiology, has grown rapidly, with 400 out of 520 FDA-approved AI algorithms explicitly designed for radiological applications as of 2023. AI has shown significant potential for enhancing healthcare delivery and improving patient outcomes (AHA, 2023); however, understanding the barriers, facilitators, and implications of AI implementation in radiology remains fragmented across existing studies. This study investigates AI's impact on radiology in three critical areas: diagnostic accuracy, interpretation times, and clinical workflow efficiency. We synthesize key findings regarding AI's contributions to radiology practices through a comprehensive literature review of 29 articles published between 2015 …

Cancer Of Unknown Primary With Squamous Cell Carcinoma Phenotype Presenting As Isolated Axillary Mass, Nicole Liang, Mohamed Ashal, Lynne J. Goebel

Internal Medicine

Cancer of unknown primary (CUP) is a rare metastatic malignancy where no primary tumor can be found. We report the case of a 71-year-old female with a strong family history of breast cancer presenting with isolated axillary lymphadenopathy after a tick bite. A biopsy of the axillary mass revealed poorly differentiated squamous cell carcinoma and after extensive evaluation, she was diagnosed with metastatic squamous cell carcinoma with unknown primary tumor. We present this case because of the role of confounding history complicating her initial diagnosis and bringing awareness to a rare disease.

Ignatzschineria Species Bacteremia: A Case Report And Review Of The Literature, Katherine Sandomirsky, Mark Sayegh, Priscila Lopez, Yone Lwin, Sharon Mannheimer

Marshall Journal of Medicine

Ignatzschineria species, a member of the Gammaproteobacteria class of bacteria, is a gram-negative, aerobic, non-spore forming rod. This emerging human pathogen has been found in the digestive tract of the parasitic Wohlfarhtia magnifica fly. Infections in humans are uncommon and are usually associated with maggot infestation (wound myiasis). Rare cases of Ignatzschineria species bacteremia have been reported in individuals with myiasis of chronic skin wounds. Current literature describes 4 known species of Ignatzschineria: I. indica, I. larvae, I. ureiclastica, and I. cameli. An additional 2 cases of Ignatzachineria bacteremia were caused by Ignatzschineria species that were “unable to …

Atypical Presentation Of Non-Small Cell Lung Carcinoma With Metastasis To Breast Tissue, Tylar P. Seckman, Diane Krutzler-Berry, Mohamed Ashal, Waqas Mahmud, Krista L. Denning, Logan M. Lawrence

Marshall Journal of Medicine

Malignant neoplasms of the lung commonly metastasize to lymph nodes, bone, brain, and liver via hematogenous and lymphatic routes. Much less commonly, metastasis occurs in the breast. Secondary metastatic disease of the breast is very rare, with a reported incidence ranging from 0.4-1.3%­­—with primary lung cancer being one of the most anomalous sources. This case details non-small cell lung cancer metastasis to the breast with proven primary contralateral lung origination. This atypical finding prompts medical professionals to consider these malignant cells' immunologic, histologic, and pathologic makeup to understand further and treat the neoplasm.

In Vivo Evaluation Of Novel Nanoparticles And Repurposed Pharmaceuticals To Combat Antimicrobial Resistance, Sarah E. Evans

Theses, Dissertations and Capstones

In a 2019 report by the Centers for Disease Control and Prevention (CDC), infections resistant to antibiotic treatment amount to about three million infections and 48,000 deaths. Antimicrobial resistance is an escalating global threat as existing antibiotics lose efficacy over time. The project described is focused on partnering with pharmaceutical researchers and producers to test new nanoparticle-based or repurposed compounds. The central hypothesis of this thesis is that pharmaceutical formulations such as nanoparticles may provide a cost-effective means of combating the emerging antimicrobial resistance. The nanoparticle compounds allowed for a wide range of customization for the pharmaceutical design, since the …

Burnout In The Emergency Room: Corrective Measures Vs. The Absence Of Solutions, Zane Walters, Zachary Woodall

Theses, Dissertations and Capstones

Introduction: Physician burnout has become an increasingly prevalent and critical issue in healthcare systems worldwide, particularly among emergency room physicians who face high-stress, high-demand working conditions. Burnout manifests as emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment, leading to negative outcomes for physicians’ mental health, job satisfaction, and overall career longevity. This phenomenon not only threatens the well-being of physicians but also compromises patient care quality and contributes to costly turnover within healthcare organizations.

Purpose of the Study: The aim of this study was to systematically investigate the impact of burnout interventions on emergency room physicians. …

Evaluating The Effectiveness Of Teledermatology For Undeserved Populations During And Post-Covid-19, Jakob Gibbs, Sean Hanshaw

Theses, Dissertations and Capstones

Introduction: Teledermatology, a subset of telemedicine, has gained prominence as a means to increase access to dermatologic care while reducing costs and improving patient satisfaction. The swift expansion of teledermatology during the COVID-19 pandemic was driven by the necessity to limit physical contact and adapt to public health restrictions. This technological shift aimed to address longstanding disparities in dermatology access, especially in rural and underserved populations, and to respond to the rising demand for dermatologic services amid provider shortages.

Purpose of the Study: The purpose of this study was to analyze the effects that teledermatology following the COVID-19 pandemic had …

The Impacts Of Artificial Intelligence In Radiology, Misty Farmer, Wendy Trzyna

Theses, Dissertations and Capstones

Introduction: There has been significant growth in the use of Artificial Intelligence (AI) in the healthcare industry, especially in Medical Imaging. Radiology has been the clear frontrunner in the adoption of AI in medicine, due in part to the massive amount of digital data available for use in Deep Learning (DL) AI integration has the potential to solve multiple challenges in radiology, address workload issues and transform the field.

Purpose of the Study: The purpose of the research was to evaluate the impact of implementing Artificial Intelligence in radiology to determine if these technologies have had an impact …

Systemic Challenges In Pediatric Healthcare: Exploring Reimbursement Disparities And Their Impact On Healthcare Equity, Jessica Ford-Davis, Alexandra Gillette

Theses, Dissertations and Capstones

Introduction: Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP) have provided health coverage for over 135 million Americans, with Medicaid playing a significant role in financing pediatric healthcare. Medicaid covers a wide range of services for children, particularly those from low-income families or with special healthcare needs, including preventive care, immunizations, vision and dental services, and mental health treatments. However, Medicaid reimbursement rates are lower compared to Medicare and private insurance, in some cases 30.6% lower, and have often been insufficient to cover the full cost of care, contributing to financial losses for children's hospitals. Despite these challenges, nearly …

Do Patients Who Receive Dexmedetomidine As An Adjunct To Spinal Anesthesia For Cesarean Delivery Achieve Longer Block Duration Compared To Those Who Receive Spinal Anesthesia With Local Anesthetic Alone?, Liana S. Garrison

Theses, Dissertations and Capstones

Problem Statement: Cesarean delivery is associated with significant postoperative pain, typically managed with spinal anesthesia using a local anesthetic. While opioids are often added as adjuncts, the addition of dexmedetomidine, an alpha-2 agonist, has emerged as a potential alternative that may enhance the efficacy of the spinal block in terms of pain management, potentially improving block duration and quality compared to local anesthetic alone.

Methodology: A literature review was conducted on the use of dexmedetomidine as an adjunct to spinal anesthesia for patients undergoing cesarean sections. Databases used for the search included PubMed, CINAHL Complete, and MEDLINE. The keywords used …

Artificial Intelligence In Radiology, Olivia Sweeney

Theses, Dissertations and Capstones

Introduction: Artificial intelligence (AI) has increasingly transformed radiologic practice by improving diagnostic accuracy, streamlining workflows, and reducing interpretation errors. As AI integration has expanded across imaging modalities, questions have emerged regarding its effectiveness compared to traditional radiologist-only interpretation.

Purpose of Study: The purpose of this study has been to evaluate the impact of AI-assisted radiology on diagnostic accuracy, efficiency, and error reduction, while also assessing clinician perceptions of AI as a collaborative tool in imaging analysis.

Methodology: This qualitative study has used a systematic review of peer-reviewed literature published between 2015 and 2025, following PRISMA guidelines, combined with an interview …

Factors Affecting The Joy Of Life In Old Age: A Scale Development Study, Yalçın Karagöz, Yusuf Karaşi̇n, Mustafa Filiz, Mehmet Ateş

Adultspan Journal

This study aims to introduce a measurement tool into the literature that can reveal the factors affecting the joy of life in older adulthood. Participants included 266 individuals aged 55 and over living in Izmir, Turkey. The process of developing the scale includes the following stages: problem identification, item pool creation, expert opinion, form shaping, pilot application, and finalizing the scale. The exploratory factor analysis revealed that the scale consists of 6 different dimensions, and the variance explained by these dimensions was found to be 65.184%. The acceptable values for the scale's fit indicators are as follows: χ²/df0.90, IFI > 0.90, …

"The Perfect Storm": Weathering Black Racial Trauma Across The Lifespan And The Impact Of Covid-19, Taryne M. Mingo, Kiauhna Haynes

Adultspan Journal

Descendants of Africans Enslaved in the United States (DAEUS), who lived in the South prior to 1965 and experienced decades of legalized discrimination, were found to have been disproportionately impacted by the COVID-19 pandemic. Arline Geronimus (1992) coined the term “weathering” to acknowledge the accumulation of racial trauma stored within the body over extended periods of time. The purpose of this interpretive phenomenological study, aligned by the tenets of Critical Race Theory, explores how continuous racial trauma impacted DAEUS citizens’ well-being and trust in the COVID-19 vaccine. Three Group Experiential Themes emerged during this study, all connected with the experiences …

Musical Hallucinations In An Elderly Female With Hearing Loss, Jacqueline Cavendish, Lynne J. Goebel

Internal Medicine

Musical hallucinations (MH) are rare auditory phenomena in which patients perceive music without a known source. Risk factors for MH include hearing loss, older age, female gender, epilepsy, and certain medications. This case report details the presentation, diagnosis, and treatment of an 82-year-old woman who developed MH following the onset of hearing loss. Despite treatment attempts with gabapentin, quetiapine, and donepezil, the symptoms persisted, demonstrating the difficulty in treating this condition.