Medical Specialties Commons^™

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. …

Male Breast Enlargement After Automated Implantable Cardioverter-Defibrillator Placement, Anisha Valluri, Lynne J. Goebel

Marshall Journal of Medicine

Placement of implantable cardioverter-defibrillators (ICDs) are increasing in frequency due to their indication for the prevention of sudden cardiac death in patients prone to life-threatening arrhythmias. Primary care physicians should be aware of the possible complications so they can treat their patients appropriately. This article describes a rare case of chronic unilateral breast enlargement after the placement of an ICD in a male patient with Tetralogy of Fallot.

A Case Of Recurrent Breast Cancer Diagnosed From Symptomatic Metastasis To Bladder, Reagan M. Stafford, Andrew J. Weaver, Mary Legenza, Douglas Henson

Marshall Journal of Medicine

Abstract:

Women in the United States have an approximate 1 in 8 chance of developing breast cancer in their lifetime. The main cause of death from breast cancer is from metastatic spread of the disease; with the most frequent sites of spread being to the bone, brain, and lungs. The urinary bladder is a rare site of metastasis that has been rarely reported on in the literature. Here we present a case of recurrent metastatic breast cancer found in the urinary bladder without findings of any other sites of metastasis.

The U-Net-Based Active Learning Framework For Enhancing Cancer Immunotherapy, Vishwanshi Joshi

Theses, Dissertations and Capstones

Breast cancer is the most common cancer in the world. According to the U.S. Breast Cancer Statistics, about 281,000 new cases of invasive breast cancer are expected to be diagnosed in 2021 (Smith et al., 2019). The death rate of breast cancer is higher than any other cancer type. Early detection and treatment of breast cancer have been challenging over the last few decades. Meanwhile, deep learning algorithms using Convolutional Neural Networks to segment images have achieved considerable success in recent years. These algorithms have continued to assist in exploring the quantitative measurement of cancer cells in the tumor microenvironment. …

Potential Counter Regulatory Effects Of A Gut Microbiota Metabolite In Alleviating Down-Regulation Krüppel-Like Factor 4 In Intestinal Inflammation, Ylva Forslund

Theses, Dissertations and Capstones

Inflammatory bowel disease (IBD) is a medical condition characterized by chronic inflammation of the intestinal epithelium. Krüppel-like factor 4 (KLF4), a zinc finger transcription factor, is vital for maintaining intestinal epithelial homeostasis. KLF4 promotes differentiation of goblet cells that generate the protective mucus layer. Reduced goblet cell number and defective mucus layer are associated with IBD. Shortchain fatty acids (SCFA) are known to play an important role in the maintenance of a strong and healthy intestinal epithelial layer and also in goblet cell differentiation. However, whether the positive effects of SCFAs on goblet cells are mediated, at least partly, via …

The Epigenetic Effects Of Omega-3 Fatty Acids In Diffuse Large B-Cell Lymphoma, Tanner Jeffrey Bakhshi

Theses, Dissertations and Capstones

Diffuse large B-cell lymphoma (DLBCL) is the most common type of lymphoma. It is an aggressive cancer, with 50-70% of patients diagnosed at an advanced stage and 30-50% of patients not cured by chemoimmunotherapy. DLBCL is almost always caused by genetic damage sustained during the germinal center (GC) reaction. The mechanisms that govern the GC reaction bear a striking resemblance to those that drive DLBCL. Genomic studies have shown that some of its most common mutations occur in genes that encode epigenetic modifiers, including the lysine (histone) acetyltransferases CREBBP and p300. These mutations prevent the acetylation of multiple histone residues, …

Mechanisms Of Apoptosis Induced By Actinomycin D In Aerodigestive Tract Cancers, Adeoluwa Ayodeji Adeluola

Theses, Dissertations and Capstones

Upper aerodigestive tract cancers including cancers of the oral cavity, pharynx, larynx, esophagus, and lungs are the most prevalent cancers and leading causes of cancer-related deaths. Collectively, over 300,000 new cases and 146,500 deaths are projected within the US in the year 2021. Drug-associated toxicities, as well as resistance to therapy (intrinsic and acquired), are big challenges for successfully treating these cancers. Recent studies have shown that combining low-dose actinomycin D with existing therapies is a promising strategy to reduce toxicity (cyclotherapy) and to overcome resistance. The development of these treatment strategies however requires an understanding of the molecular mechanisms …

Crippling Rapid Evolution Of Metastasis And Drug Resistance In A549 Non-Small Cell Lung Cancer Cells With The Clinically Relevant Hsp90 Inhibitor Auy922, Nickolas Anthony Bacon

Theses, Dissertations and Capstones

The ability for species to evolve new features in response to changing circumstances in order to survive and propagate is a ubiquitous observation on both the macroscopic and microscopic levels of living systems. It should be no surprise, then, that diseases such as cancer utilize their own forms of adaptation to perpetuate themselves when exposed to external threats. Indeed, concepts drawn from Darwinian evolution are now widely accepted to help explain certain aspects of carcinogenesis and malignant progression, the sum of which have come to be known as the theory of tumor evolution. Since metastasis and drug resistance are features …

Genetic And Epigenetic Determinants Of Diffuse Large B-Cell Lymphoma, Tanner Bakhshi, Philippe T. Georgel

Biomedical Sciences

Diffuse large B-cell lymphoma (DLBCL) is the most common type of lymphoma and is notorious for its heterogeneity, aggressive nature, and the frequent development of resistance and/or relapse after treatment with standard chemotherapy. To address these problems, a strong emphasis has been placed on researching the molecular origins and mechanisms of DLBCL to develop effective treatments. One of the major insights produced by such research is that DLBCL almost always stems from genetic damage that occurs during the germinal center (GC) reaction, which is required for the production of high-affinity antibodies. Indeed, there is significant overlap between the mechanisms that …

Can Charcoal Improve Outcomes In Covid-19 Infections?, Zeid J. Khitan, Imran Khawaja, Maurice A. Mufson, Juan R. Sanabria, Nader G. Abraham, Stephen J. Peterson, Uma Sundaram, Joseph I. Shapiro

Internal Medicine

COVID-19 infection causes considerable morbidity and mortality, especially to those who are aged, have impaired renal function and are obese. We propose to examine the potential utility of oral activated charcoal with the hypothesis that such treatment would lower absorption of microbiome derived toxins and ameliorate systemic oxidant stress and inflammation.

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 …

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.

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 …

Post-Influenza Vaccine Subdeltoid Bursitis, Marenda Jenkins, David Rupp, Lynne J. Goebel

Internal Medicine

A 61-year-old female presented three months following an influenza vaccination with ongoing pain since the injection and was diagnosed by MRI with subdeltoid bursitis. The patient received a short course of prednisone and several months of physical therapy before returning to pain-free function. The primary reason for injection-related subdeltoid bursitis is improper administration. It is a preventable issue, and improved training of healthcare workers on proper vaccine administration may decrease its occurrence.

Therapeutic Efficacy Of Antioxidants In Ameliorating Obesity Phenotype And Associated Comorbidities, Steven Tun, Caleb James Spainhower, Cameron Lee Cottrill, Hari Vishal Lakhani, Sneha S. Pillai, Anum Dilip, Hibba Chaudhry, Joseph I. Shapiro, Komal Sodhi

Pharmacology, Physiology and Toxicology

Obesity has been a worldwide epidemic for decades. Despite the abundant increase in knowledge regarding the etiology and pathogenesis of obesity, the prevalence continues to rise with estimates predicting considerably higher numbers by the year 2030. Obesity is characterized by an abnormal lipid accumulation, however, the physiological consequences of obesity are far more concerning. The development of the obesity phenotype constitutes dramatic alterations in adipocytes, along with several other cellular mechanisms which causes substantial increase in systemic oxidative stress mediated by reactive oxygen species (ROS). These alterations promote a chronic state of inflammation in the body caused by the redox …

Management And Treatment Of Hepatocellular Carcinoma With Immunotherapy: A Review Of Current And Future Options, Shima Ghavimi, Tehila Apfel, Hamed Azimi, Alana Persaud

Internal Medicine

With mortality rates of liver cancer doubling in the last 20 years, this disease is on the rise and has become the fifth most common cancer in men and the seventh most common cancer in women. Hepatocellular carcinoma (HCC) represents approximately 90% of all primary liver cancers and is a major global health concern. Patients with HCC can be managed curatively with surgical resection or with liver transplantation, if they are diagnosed at an early stage. Unfortunately, most patients with HCC present with advanced stages of the disease and have underlying liver dysfunction, which allows only 15% of patients to …

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 …

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.

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.

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 …

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.

Complete Response To Stage Iv Colorectal Adenocarcinoma With Disease-Free Survival At 24 Months: Case Report And Overview Of The Literature, Madison N. Crank 6746693, Arslan Iqbal, Michael Abdelmasseh, Mohamed Alsharedi, Doreen Griswold, Alysia Browne, Juan R. Sanabria

Marshall Journal of Medicine

Over 150,000 new cases of colon cancer were diagnosed in the US in 2019. Stage and age at diagnosis are important prognostic factors for overall survival (OS). For the age group 70-79, the OS for females with poorly differentiated stage IV colon cancer at 1, 2 and 5 years after surgery is 39%, 15%, and 2%, respectively. We present a case of a 77-year-old female with significant cardiac history. She was diagnosed with stage IV colorectal cancer complicated with enteric fistula. Due to her initial performance status and comorbidities, she was not a candidate for surgery or systemic chemotherapy. Nonetheless, …

Macrophage Activation Syndrome As A Complication Of Systemic Lupus Erythematosus In An Adult Male, Rajesh Gopalarathinam, Vamsee Chirumamilla, Balachandran Vaidyanathan

Marshall Journal of Medicine

Macrophage activation syndrome (MAS) is a rare life-threatening complication that sometimes occurs in patients with systemic lupus erythematosus (SLE) and other connective tissue diseases. This syndrome is universally fatal without treatment, and therefore, prompt diagnosis and initiation of treatment is of vital importance.