Morgan Stickler, Sydney Graham, R. Conway, A. Franks
{"title":"Succenturiate Placental Lobe Abruption: a placental pathology complicating a dangerous delivery","authors":"Morgan Stickler, Sydney Graham, R. Conway, A. Franks","doi":"10.33470/2379-9536.1379","DOIUrl":"https://doi.org/10.33470/2379-9536.1379","url":null,"abstract":"","PeriodicalId":93035,"journal":{"name":"Marshall journal of medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49658749","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}
P. Thomas, N. Cockerill, Christina M Arcand, A. Koester, M. Cooper
Most rheumatoid nodules are found at joints or pressure points. They rarely require medical intervention or surgery. A 78-year-old female developed a 7.2 x 3.2 x 2.8 cm rheumatoid nodule originating at the right sternoclavicular joint, a novel site for a common pathology. Management involved a complex differential diagnosis, and surgical treatment was resection from adjacent vascular and neural structures. Follow-ing surgical excision, the patient maintained good mobility and sensation in the neck and surrounding areas. This case is especially unique in that it involves what is, to our knowledge, the first case of a rheumatoid nodule at the sternoclavicular joint. Though rheumatoid nodules are common, an uncommon presentation or location can present a challenge in managing a patient with a mass of unknown origin. This case demonstrates the need to consider uncommon presentations of common problems.
大多数类风湿性结节位于关节或压力点。他们很少需要医疗干预或手术。一名78岁的女性在右胸锁关节出现了一个7.2 x 3.2 x 2.8厘米的类风湿性结节，这是一个常见病理的新部位。治疗涉及复杂的鉴别诊断，手术治疗是切除邻近的血管和神经结构。手术切除后，患者颈部及周围区域保持良好的活动能力和感觉。这个病例特别独特，因为据我们所知，它涉及第一例胸锁关节类风湿性结节。尽管类风湿性结节很常见，但一个不常见的表现或位置可能会对治疗来源不明的肿块带来挑战。这个案例表明需要考虑常见问题的不常见表现。
{"title":"A Rheumatoid Nodule at the Sternoclavicular Joint: An uncommon presentation of a common problem","authors":"P. Thomas, N. Cockerill, Christina M Arcand, A. Koester, M. Cooper","doi":"10.33470/2379-9536.1376","DOIUrl":"https://doi.org/10.33470/2379-9536.1376","url":null,"abstract":"Most rheumatoid nodules are found at joints or pressure points. They rarely require medical intervention or surgery. A 78-year-old female developed a 7.2 x 3.2 x 2.8 cm rheumatoid nodule originating at the right sternoclavicular joint, a novel site for a common pathology. Management involved a complex differential diagnosis, and surgical treatment was resection from adjacent vascular and neural structures. Follow-ing surgical excision, the patient maintained good mobility and sensation in the neck and surrounding areas. This case is especially unique in that it involves what is, to our knowledge, the first case of a rheumatoid nodule at the sternoclavicular joint. Though rheumatoid nodules are common, an uncommon presentation or location can present a challenge in managing a patient with a mass of unknown origin. This case demonstrates the need to consider uncommon presentations of common problems.","PeriodicalId":93035,"journal":{"name":"Marshall journal of medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42731953","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":"\"A Path to Wisdom: Examining the Multi-Faceted Mentoring Journey.\"","authors":"A. Fornari","doi":"10.33470/2379-9536.1396","DOIUrl":"https://doi.org/10.33470/2379-9536.1396","url":null,"abstract":"","PeriodicalId":93035,"journal":{"name":"Marshall journal of medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44693796","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}
Rib fractures are among the most common injuries found in patients presenting from blunt trauma. They are associated with significant morbidity and mortality, largely due to pulmonary complications. Open reduction and internal fixation (ORIF) has been the mainstay treatment for patients with multiple rib fractures. In this report, we present a case of a patient that sustained blunt thoracic trauma with multiple anterolateral rib fractures, including a flail segment. This fail segment involved the costal cartilage and required fixation of ribs to the sternum in order to restore chest wall stabilization and integrity. This was achieved using the Zimmer Biomet rib plate system. The approach utilized should be considered in patients with rib fractures associated with segments of displaced costal cartilage.
{"title":"Surgical Fixation of Complex Rib Fractures to Sternum for Flail Chest: A Case Report","authors":"Andrew J. Weaver, Wai-kin Hau, M. Cooper","doi":"10.33470/2379-9536.1359","DOIUrl":"https://doi.org/10.33470/2379-9536.1359","url":null,"abstract":"Rib fractures are among the most common injuries found in patients presenting from blunt trauma. They are associated with significant morbidity and mortality, largely due to pulmonary complications. Open reduction and internal fixation (ORIF) has been the mainstay treatment for patients with multiple rib fractures. In this report, we present a case of a patient that sustained blunt thoracic trauma with multiple anterolateral rib fractures, including a flail segment. This fail segment involved the costal cartilage and required fixation of ribs to the sternum in order to restore chest wall stabilization and integrity. This was achieved using the Zimmer Biomet rib plate system. The approach utilized should be considered in patients with rib fractures associated with segments of displaced costal cartilage.","PeriodicalId":93035,"journal":{"name":"Marshall journal of medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47951301","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}
D. Harris, Micah Ray, Andrew J. Weaver, Stephen K. Wilson
{"title":"A Case of Metastatic Melanoma Presenting as a Small Bowel Obstruction","authors":"D. Harris, Micah Ray, Andrew J. Weaver, Stephen K. Wilson","doi":"10.33470/2379-9536.1366","DOIUrl":"https://doi.org/10.33470/2379-9536.1366","url":null,"abstract":"","PeriodicalId":93035,"journal":{"name":"Marshall journal of medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69500775","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}
Successful retention of faculty ensures that engaged, talented, and high-performing faculty are cultivated and retained.1 Yet recent changes have thwarted retention efforts such as reduced salaries, increased clinical loads, administrative burdens, budget cuts, transitions in care models, and more.2 In fact, a 2020 study by The Chronicle and Fidelity Investments found that more than half of all faculty members surveyed were seriously considering leaving higher education by either changing careers entirely or retiring early.3 Attrition is particularly a concern for underrepresented minority (URM) faculty.4 Others have chosen to disengage from their work rather than quit outright.5 Attrition and disengagement of faculty in academic medicine are quite costly. One analysis estimated that replacing a generalist costs approximately $120,000, a subspecialist $290,000, and a surgeon $590,000.1 Faculty Affairs offices are charged with building retention programs that are effective and cost-efficient in support of faculty career success, work satisfaction, and retention.
{"title":"Retention and Career Success of Faculty: The Case for Building a Sense of Belonging to the Academic Medicine Community","authors":"W. Ward","doi":"10.33470/2379-9536.1382","DOIUrl":"https://doi.org/10.33470/2379-9536.1382","url":null,"abstract":"Successful retention of faculty ensures that engaged, talented, and high-performing faculty are cultivated and retained.1 Yet recent changes have thwarted retention efforts such as reduced salaries, increased clinical loads, administrative burdens, budget cuts, transitions in care models, and more.2 In fact, a 2020 study by The Chronicle and Fidelity Investments found that more than half of all faculty members surveyed were seriously considering leaving higher education by either changing careers entirely or retiring early.3 Attrition is particularly a concern for underrepresented minority (URM) faculty.4 Others have chosen to disengage from their work rather than quit outright.5 Attrition and disengagement of faculty in academic medicine are quite costly. One analysis estimated that replacing a generalist costs approximately $120,000, a subspecialist $290,000, and a surgeon $590,000.1 Faculty Affairs offices are charged with building retention programs that are effective and cost-efficient in support of faculty career success, work satisfaction, and retention.","PeriodicalId":93035,"journal":{"name":"Marshall journal of medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49388890","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}
Syphilis has the potential to result in serious, irreversible morbidity and mortality during pregnancy and has increased in incidence across the United States. While syphilis is a common disease and a known but rare cause of membranous nephropathy, it can complicate the clinical picture and obscure accurate diagnosis of women presenting with proteinuria during pregnancy. We report a case of proteinuria with syphilis in the second trimester of pregnancy as an educational review.
{"title":"Syphilis and Proteinuria in Pregnancy","authors":"Jay Jensen, J. Cottrell","doi":"10.33470/2379-9536.1371","DOIUrl":"https://doi.org/10.33470/2379-9536.1371","url":null,"abstract":"Syphilis has the potential to result in serious, irreversible morbidity and mortality during pregnancy and has increased in incidence across the United States. While syphilis is a common disease and a known but rare cause of membranous nephropathy, it can complicate the clinical picture and obscure accurate diagnosis of women presenting with proteinuria during pregnancy. We report a case of proteinuria with syphilis in the second trimester of pregnancy as an educational review.","PeriodicalId":93035,"journal":{"name":"Marshall journal of medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44972219","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}
Tardive dyskinesia (TD) is a movement disorder associated with dopamine receptor blocking medications. Recommended treatments for TD include discontinuing the causative agent, adding vesicular monoamine transporter 2 (VMAT2) inhibitors, or adding vitamin B6. We present a 66-year-old Caucasian male with bipolar I disorder who developed TD while on lithium and quetiapine, having been euthymic on this regimen for three years. He was initially treated with 1200 mg B6 daily, which failed to improve his TD and was associated with a depressive episode. He switched to valbenazine 40 mg daily, which improved his TD and concurrently his mood, but months later, the TD symptoms worsened again. Our case adds to the literature by demonstrating that some patients with TD will not respond to vitamin B6. To our knowledge, ours is the first case suggesting the association of high-dose vitamin B6 with depression. This case also demonstrates that response to valbenazine may not last, and further studies are needed.
{"title":"Treatment of Tardive Dyskinesia with High Dose Vitamin B6 Associated with Depression","authors":"M. McCoy, A. Schindzielorz, S. Holroyd","doi":"10.33470/2379-9536.1372","DOIUrl":"https://doi.org/10.33470/2379-9536.1372","url":null,"abstract":"Tardive dyskinesia (TD) is a movement disorder associated with dopamine receptor blocking medications. Recommended treatments for TD include discontinuing the causative agent, adding vesicular monoamine transporter 2 (VMAT2) inhibitors, or adding vitamin B6. We present a 66-year-old Caucasian male with bipolar I disorder who developed TD while on lithium and quetiapine, having been euthymic on this regimen for three years. He was initially treated with 1200 mg B6 daily, which failed to improve his TD and was associated with a depressive episode. He switched to valbenazine 40 mg daily, which improved his TD and concurrently his mood, but months later, the TD symptoms worsened again. Our case adds to the literature by demonstrating that some patients with TD will not respond to vitamin B6. To our knowledge, ours is the first case suggesting the association of high-dose vitamin B6 with depression. This case also demonstrates that response to valbenazine may not last, and further studies are needed.","PeriodicalId":93035,"journal":{"name":"Marshall journal of medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41530914","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}
Melissa A Nehls, Jamila Ranavaya, Sydney Smith-Graham, Micah Ray, Aryana Misaghi, J. Yoost, Kelly F Cummings
In recent times, there has been an increase in drug abuse in the general population and in women of reproductive age. Our objectives were to identify, classify, and describe the spectrum of complications, the average number of admissions, and the length of hospital stay among pregnant women with substance abuse. The aim was to understand complication prevalence better to improve management in this ever-growing population. A retrospective chart review was conducted of pregnant women ages 18-45 with a history of substance abuse from 2013-2018 in the tri-state area of West Virginia, Ohio, and Kentucky. We collected the following data: demographics, medical history, specific substances abused, inpatient admission dates and diagnoses, and delivery information. A total of 411 patients met the inclusion criteria, comprising 525 pregnancies. Out of 525 pregnancies, 71.6 % used buprenorphine (i.e., Subutex), 43.4% used opiates (excluding heroin), and 35% of patients used heroin. Out of the 525 pregnancies, there were 714 inpatient antepartum admissions. Of these, 376 were admissions due to withdrawal symptoms (52.7%). A total of 263 pregnancies had at least one admission for withdrawal, drug abuse, overdose, or buprenorphine/ methadone conversion (50%). The average hospital stay for withdrawal admissions was 3.4 days (SD). There were 62 admissions for infectious causes, 24 due to pyelonephritis (38.7%). The findings highlight multiple areas for future studies and areas for quality improvement in managing this population.
{"title":"Complications and Hospital Admissions among Pregnant Women with Substance Abuse","authors":"Melissa A Nehls, Jamila Ranavaya, Sydney Smith-Graham, Micah Ray, Aryana Misaghi, J. Yoost, Kelly F Cummings","doi":"10.33470/2379-9536.1369","DOIUrl":"https://doi.org/10.33470/2379-9536.1369","url":null,"abstract":"In recent times, there has been an increase in drug abuse in the general population and in women of reproductive age. Our objectives were to identify, classify, and describe the spectrum of complications, the average number of admissions, and the length of hospital stay among pregnant women with substance abuse. The aim was to understand complication prevalence better to improve management in this ever-growing population. A retrospective chart review was conducted of pregnant women ages 18-45 with a history of substance abuse from 2013-2018 in the tri-state area of West Virginia, Ohio, and Kentucky. We collected the following data: demographics, medical history, specific substances abused, inpatient admission dates and diagnoses, and delivery information. A total of 411 patients met the inclusion criteria, comprising 525 pregnancies. Out of 525 pregnancies, 71.6 % used buprenorphine (i.e., Subutex), 43.4% used opiates (excluding heroin), and 35% of patients used heroin. Out of the 525 pregnancies, there were 714 inpatient antepartum admissions. Of these, 376 were admissions due to withdrawal symptoms (52.7%). A total of 263 pregnancies had at least one admission for withdrawal, drug abuse, overdose, or buprenorphine/ methadone conversion (50%). The average hospital stay for withdrawal admissions was 3.4 days (SD). There were 62 admissions for infectious causes, 24 due to pyelonephritis (38.7%). The findings highlight multiple areas for future studies and areas for quality improvement in managing this population.","PeriodicalId":93035,"journal":{"name":"Marshall journal of medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42347046","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":"Allyship for the Rural Health Care Workforce","authors":"N. Spector, B. Overholser","doi":"10.33470/2379-9536.1373","DOIUrl":"https://doi.org/10.33470/2379-9536.1373","url":null,"abstract":"","PeriodicalId":93035,"journal":{"name":"Marshall journal of medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48515695","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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