May-Thurner syndrome (MTS) is an unusual cause of intermittent lower extremity edema in pediatric patients. We present the case of a 10-year-old child who presented with gradual onset of intermittent headaches, hematuria, and intermittent worsening edema of his lower extremities. After extensive evaluation, the possible cause of the lower extremity edema was determined to be MTS. Since this diagnosis is usually considered in the differential diagnosis of teenagers and adults, our case raises awareness of this possible diagnosis in younger pediatric patients suspected of having deep vein thromboses.
{"title":"May-Thurner Syndrome in a Ten-Year-Old","authors":"Janani Narumanchi, MD, TaraChandra Narumanchi, MD, Naveena Yanamala, PhD","doi":"10.21885/wvmj.2021.17","DOIUrl":"https://doi.org/10.21885/wvmj.2021.17","url":null,"abstract":"May-Thurner syndrome (MTS) is an unusual cause of intermittent lower extremity edema in pediatric patients. We present the case of a 10-year-old child who presented with gradual onset of intermittent headaches, hematuria, and intermittent worsening edema of his lower extremities. After extensive evaluation, the possible cause of the lower extremity edema was determined to be MTS. Since this diagnosis is usually considered in the differential diagnosis of teenagers and adults, our case raises awareness of this possible diagnosis in younger pediatric patients suspected of having deep vein thromboses.","PeriodicalId":23032,"journal":{"name":"The West Virginia medical journal","volume":"39 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81795084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Benjamin J. Wendt, MD, Adam Franks, MD, Kenton L. Hess, MD, Sara L. O Dusing, MD, Kathleen M. O'Hanlon, MD, Stephen M. Petrany, MD
Thrombophlebitis of the superficial dorsal penile vein is an infrequently reported condition that presents with pain and induration at the base of the penis. Known clinically as the penile variant of Mondor's disease (PVMD), this rare pathology can elicit fear and embarrassment in patients, making it difficult for them to seek medical care. PVMD is also frustrating to clinicians, as its etiology can be varied, typical laboratory abnormalities are often absent, its presentation can be imitated by other diagnoses, and a consensus on treatment has not yet been reached. As depicted in this case report, this challenging diagnosis requires the collaboration of primary care physicians and urologists to optimize patient care.
{"title":"Penile Variant of Mondor's Disease: A Challenging Diagnosis Requiring Primary Care and Urologic Collaboration","authors":"Benjamin J. Wendt, MD, Adam Franks, MD, Kenton L. Hess, MD, Sara L. O Dusing, MD, Kathleen M. O'Hanlon, MD, Stephen M. Petrany, MD","doi":"10.21885/wvmj.2021.15","DOIUrl":"https://doi.org/10.21885/wvmj.2021.15","url":null,"abstract":"Thrombophlebitis of the superficial dorsal penile vein is an infrequently reported condition that presents with pain and induration at the base of the penis. Known clinically as the penile variant of Mondor's disease (PVMD), this rare pathology can elicit fear and embarrassment in patients, making it difficult for them to seek medical care. PVMD is also frustrating to clinicians, as its etiology can be varied, typical laboratory abnormalities are often absent, its presentation can be imitated by other diagnoses, and a consensus on treatment has not yet been reached. As depicted in this case report, this challenging diagnosis requires the collaboration of primary care physicians and urologists to optimize patient care.","PeriodicalId":23032,"journal":{"name":"The West Virginia medical journal","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75535144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Avoidant-restrictive food intake disorder (ARFID) is a feeding/eating disorder characterized by malnourishment due to highly restrictive eating patterns. Behaviors may be directly related to lack of interest in food, sensory/textural preferences, or fears of the aversive consequences of eating. The following is a case report of a 68-year-old woman who presented more than 30 times to a family medicine clinic within a 3.5 year time span for chronic nausea, abdominal pain, and weight loss. An extensive medical evaluation was unremarkable. Due to severely low body mass index and non-adherence with nutritional recommendations, the patient was referred to a specialty outpatient clinic that cared for individuals with disordered eating and was diagnosed with ARFID. In order to raise awareness about RFID, the diagnostic criteria and screening/assessment information are provided. Special emphasis is placed on screening and early detection by primary care clinicians to ensure individuals with RFID receive appropriate treatment in a timely manner.
{"title":"Avoidant-Restrictive Food Intake Disorder in a 68-Year-Old","authors":"Blair Burnette, PhD, Adina Bowe, MD, Jessica Luzier, PhD, ABPP, CEDS-S","doi":"10.21885/wvmj.2021.18","DOIUrl":"https://doi.org/10.21885/wvmj.2021.18","url":null,"abstract":"Avoidant-restrictive food intake disorder (ARFID) is a feeding/eating disorder characterized by malnourishment due to highly restrictive eating patterns. Behaviors may be directly related to lack of interest in food, sensory/textural preferences, or fears of the aversive consequences of eating. The following is a case report of a 68-year-old woman who presented more than 30 times to a family medicine clinic within a 3.5 year time span for chronic nausea, abdominal pain, and weight loss. An extensive medical evaluation was unremarkable. Due to severely low body mass index and non-adherence with nutritional recommendations, the patient was referred to a specialty outpatient clinic that cared for individuals with disordered eating and was diagnosed with ARFID. In order to raise awareness about RFID, the diagnostic criteria and screening/assessment information are provided. Special emphasis is placed on screening and early detection by primary care clinicians to ensure individuals with RFID receive appropriate treatment in a timely manner.","PeriodicalId":23032,"journal":{"name":"The West Virginia medical journal","volume":"71 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76299001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Editor's Letter: Accessing the Early Years for Strong Peer Review","authors":"","doi":"10.21885/wvmj.2021.11","DOIUrl":"https://doi.org/10.21885/wvmj.2021.11","url":null,"abstract":"","PeriodicalId":23032,"journal":{"name":"The West Virginia medical journal","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73085236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Editor's Letter: Following the Guidelines in Public Health and Publication","authors":"L. Nield","doi":"10.21885/wvmj.2021.16","DOIUrl":"https://doi.org/10.21885/wvmj.2021.16","url":null,"abstract":"","PeriodicalId":23032,"journal":{"name":"The West Virginia medical journal","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90060411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Neuroendocrine tumors (NETs) of the gynecological tract are rare and aggressive tumors with no standardized management protocol. This group can be classified based on location of origin, morphologic features, and prognosis. In addition, NETs of the endometrium can co-occur with non-NET endometrial carcinoma. Our case concerns a 71-year-old female who was diagnosed with high-grade neuroendocrine carcinoma arising in conjunction with endometroid carcinoma with focal sarcomatoid features. We provide a succinct review of the literature in order to emphasize the development, diagnosis, management, and prognosis of NET of the endometrium.
{"title":"Neuroendocrine Tumor of the Gynecological Tract: A Case Report of High-Grade Neuroendocrine Carcinoma of the Endometrium","authors":"Sydney Graham, MPH, Lindsay Bias, APRN, Niru Nahar, MD, Nadim Bou Zgheib, MD","doi":"10.21885/wvmj.2021.19","DOIUrl":"https://doi.org/10.21885/wvmj.2021.19","url":null,"abstract":"Neuroendocrine tumors (NETs) of the gynecological tract are rare and aggressive tumors with no standardized management protocol. This group can be classified based on location of origin, morphologic features, and prognosis. In addition, NETs of the endometrium can co-occur with non-NET endometrial carcinoma. Our case concerns a 71-year-old female who was diagnosed with high-grade neuroendocrine carcinoma arising in conjunction with endometroid carcinoma with focal sarcomatoid features. We provide a succinct review of the literature in order to emphasize the development, diagnosis, management, and prognosis of NET of the endometrium.","PeriodicalId":23032,"journal":{"name":"The West Virginia medical journal","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87824229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
INTRODUCTION Little is known about the nature and frequency of telehealth services in rural settings, particularly those within West Virginia (WV) with historically limited access to speech and language services. The purpose of this work is to define these services in WV and to discuss how the 2019 coronavirus pandemic (COVID) precautions affected the need to use tele- health from the speech and language pathologist (SLP) perspective. METHODS An online survey was administered to WV SLPs exploring their feeding and swallowing expertise, service coordination, patient service utilization, and approaches, particularly post- COVID. Our approach yielded responses from 124 SLPs from 37 of the 55 WV counties. RESULTS The majority of the sample provided a variety of services across large regions of WV. SLP experiences were varied. Half of survey respondents cited a shortage of experienced clinicians as a primary reason for feeding and swallowing service denial. The majority of SLPs had incorporated telehealth into their approach since COVID; however, a subsample reported restrictions in access to technology, policies, and training. Many respondents were not sure of security risks and requested training in security and methods for active participation. CONCLUSIONS Our findings reveal the need for increased systematic and educational support for SLPs providing feeding services via telehealth. Provider access, training, and use of telehealth approaches are pivotal for reaching people with disabilities and are crucial for removing the isolation for this population.
{"title":"Speech Language Pathology Perceptions in the Time of COVID-19: Telehealth and Dysphagia Services in West Virginia","authors":"Catherine M. Ray, MS, CCC/SLP, Cassaundra Corbett Miller, EdD, CCC/SLP, Lesley Cottrell, PhD","doi":"10.21885/wvmj.2021.14","DOIUrl":"https://doi.org/10.21885/wvmj.2021.14","url":null,"abstract":"INTRODUCTION Little is known about the nature and frequency of telehealth services in rural settings, particularly those within West Virginia (WV) with historically limited access to speech and language services. The purpose of this work is to define these services in WV and to discuss how the 2019 coronavirus pandemic (COVID) precautions affected the need to use tele- health from the speech and language pathologist (SLP) perspective. METHODS An online survey was administered to WV SLPs exploring their feeding and swallowing expertise, service coordination, patient service utilization, and approaches, particularly post- COVID. Our approach yielded responses from 124 SLPs from 37 of the 55 WV counties. RESULTS The majority of the sample provided a variety of services across large regions of WV. SLP experiences were varied. Half of survey respondents cited a shortage of experienced clinicians as a primary reason for feeding and swallowing service denial. The majority of SLPs had incorporated telehealth into their approach since COVID; however, a subsample reported restrictions in access to technology, policies, and training. Many respondents were not sure of security risks and requested training in security and methods for active participation. CONCLUSIONS Our findings reveal the need for increased systematic and educational support for SLPs providing feeding services via telehealth. Provider access, training, and use of telehealth approaches are pivotal for reaching people with disabilities and are crucial for removing the isolation for this population.","PeriodicalId":23032,"journal":{"name":"The West Virginia medical journal","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82378073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Editor's Letter: Type 3c Diabetes, Moses, and Practice-Based Learning and Improvement","authors":"","doi":"10.21885/wvmj.2021.6","DOIUrl":"https://doi.org/10.21885/wvmj.2021.6","url":null,"abstract":"","PeriodicalId":23032,"journal":{"name":"The West Virginia medical journal","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88632570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Diabetes of the exocrine pancreas, also known as type 3c diabetes, is caused by a variety of underlying mechanisms, most commonly chronic pancreatitis. Type 3c diabetes leads to chronic inflammation of the pancreas and results in frequent episodes of hypo- or hyper-glycemia, and patients are commonly misdiagnosed as having type 2 diabetes. We report the case of a 52-year-old man from rural West Virginia (WV) who presented with a five-year history of chronic abdominal pain and recurrent pancreatitis. His physical examination, laboratory, and radiologic studies revealed an acute pancreatitis flare, and his elevated serum glucose level indicated new-onset diabetes, leading to a diagnosis of type 3c diabetes. Given the disproportionate rate of diabetes in WV, it is critical for healthcare providers to learn to recognize patients with diabetes with underlying pancreatic disease and to treat those patients appropriately.
{"title":"Appalachian Constellation: Type 3C Diabetes as the Link Between Diabetes and Chronic Pancreatitis","authors":"Justin Fletcher, MD, Kendra Unger, MD, FAAMA","doi":"10.21885/wvmj.2021.10","DOIUrl":"https://doi.org/10.21885/wvmj.2021.10","url":null,"abstract":"Diabetes of the exocrine pancreas, also known as type 3c diabetes, is caused by a variety of underlying mechanisms, most commonly chronic pancreatitis. Type 3c diabetes leads to chronic inflammation of the pancreas and results in frequent episodes of hypo- or hyper-glycemia, and patients are commonly misdiagnosed as having type 2 diabetes. We report the case of a 52-year-old man from rural West Virginia (WV) who presented with a five-year history of chronic abdominal pain and recurrent pancreatitis. His physical examination, laboratory, and radiologic studies revealed an acute pancreatitis flare, and his elevated serum glucose level indicated new-onset diabetes, leading to a diagnosis of type 3c diabetes. Given the disproportionate rate of diabetes in WV, it is critical for healthcare providers to learn to recognize patients with diabetes with underlying pancreatic disease and to treat those patients appropriately.","PeriodicalId":23032,"journal":{"name":"The West Virginia medical journal","volume":"35 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91440297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abigail Tolbert, Dipali Nemade, MD, MPH, Jo Ann Raines, MA, C-TAGME, Mitch Charles, MD, Paulette Wehner, MD, Franklin Shuler, MD, PhD
INTRODUCTION Due to having atypical presentations, women with potential cardiac disease may be approached and treated less aggressively than male patients. Differences in care along gender lines have been described at a university affiliated hospital in West Virginia (WV) in the past three decades. The purpose of this study is to determine if differences along gender lines in the care of patients with chest pain persists. METHODS From July-December of 2015, a retrospective chart review was performed at Cabell Huntington Hospital in WV. Data from 375 patients with a diagnosis of chest pain presenting to the emergency department (ED) was compared to data from 25 years prior. Symptoms, risk factors, medical history, medications, physical examination, laboratory, and electrocardiogram results, treatment in the emergency department, and ultimate diagnoses were studied. RESULTS Women had less reproducible musculoskeletal pain and more use of over-the-counter medicines, hormones, and pulmonary medications before presenting to the ED. Treatment with nitroglycerin and gastrointestinal medications occurred more commonly in women. Regarding evaluations of symptoms, women received more electrocardiograms, cardiac monitoring, and laboratory testing in comparison to 25 years prior. Cardiology consultations and emergency catheterization as well as the use of aspirin, heparin, antibiotics, anxiolytics, and thrombolytic agents were more commonly used in the treatment of women in comparison to 25 years prior. CONCLUSIONS In comparison to 25 years prior, there were documented improvements in the management of women presenting to the ED and experiencing new-onset, non-traumatic chest pain.
{"title":"Gender Bias in Chest Pain Evaluation in the Emergency Department: A 25-Year Update","authors":"Abigail Tolbert, Dipali Nemade, MD, MPH, Jo Ann Raines, MA, C-TAGME, Mitch Charles, MD, Paulette Wehner, MD, Franklin Shuler, MD, PhD","doi":"10.21885/wvmj.2021.7","DOIUrl":"https://doi.org/10.21885/wvmj.2021.7","url":null,"abstract":"INTRODUCTION Due to having atypical presentations, women with potential cardiac disease may be approached and treated less aggressively than male patients. Differences in care along gender lines have been described at a university affiliated hospital in West Virginia (WV) in the past three decades. The purpose of this study is to determine if differences along gender lines in the care of patients with chest pain persists. METHODS From July-December of 2015, a retrospective chart review was performed at Cabell Huntington Hospital in WV. Data from 375 patients with a diagnosis of chest pain presenting to the emergency department (ED) was compared to data from 25 years prior. Symptoms, risk factors, medical history, medications, physical examination, laboratory, and electrocardiogram results, treatment in the emergency department, and ultimate diagnoses were studied. RESULTS Women had less reproducible musculoskeletal pain and more use of over-the-counter medicines, hormones, and pulmonary medications before presenting to the ED. Treatment with nitroglycerin and gastrointestinal medications occurred more commonly in women. Regarding evaluations of symptoms, women received more electrocardiograms, cardiac monitoring, and laboratory testing in comparison to 25 years prior. Cardiology consultations and emergency catheterization as well as the use of aspirin, heparin, antibiotics, anxiolytics, and thrombolytic agents were more commonly used in the treatment of women in comparison to 25 years prior. CONCLUSIONS In comparison to 25 years prior, there were documented improvements in the management of women presenting to the ED and experiencing new-onset, non-traumatic chest pain.","PeriodicalId":23032,"journal":{"name":"The West Virginia medical journal","volume":"2017 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86774586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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