Articles

Case Report of Glanzmann Thrombasthenia

Posted by on Sep 18, 2017 in Articles, ePubs | 0 comments

Background

Glanzmann Thrombasthenia (GT) is a rare inherited genetic platelet disorder characterized by a qualitative, or quantitative mutation in GPIIb/IIIa receptor; which results in defective platelet aggregation and diminished clot retraction.

Case

A 19-year-old Arab descent female presented to emergency department with severe menorrhagia. On examination an ill looking pale patient in addition to generalized fatigue of one-week duration.

Conclusion

Acquired platelet disorders are more frequently encountered in practice than inherited ones, usually due to medical therapy or an underlying medical condition. GT, was previously known as hereditary hemorrhagic thrombasthenia, is an autosomal recessive disorder that is often disregarded as it has many clinical and laboratory findings similar to some acquired platelet disorders.

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Three Wishes Survey

Posted by on Sep 18, 2017 in Articles, ePubs | 0 comments

Purpose

In this study we assessed the underlying values and goals of current medical students by examining personal wishes. The authors also aimed to determine the impact of the increased financial burden of medical training on students‟ motivations by comparing current wishes to those of students from 1999. We also examined the relationships between types of wishes, choice of future medical specialty, and demographic characteristics.

Methods

An anonymous survey with the question: “If you had three wishes, what would you wish for?”, and items pertaining to specialization choice and demographics was completed by 418 medical students. Wishes were coded into seventeen categories. Results were compared to a previous survey conducted in 1999.

Results

The largest category of wishes was altruism (40% of students) followed by achievement (36%), and money (34%). Significantly more medical students in 2015 had altruistic and achievement wishes compared to 1999. However, there was no significant increase in money-related wishes in the 2015 cohort compared to students from 1999. Final year students were more likely to report power-related wishes and male medical students had significantly more wishes related to power, money, and self-esteem. Students who aspired to be surgeons had more affiliation wishes and fewer knowledge-related aspirations. Conversely, medical students planning to enter internal medicine training were more likely to have wishes related to power and self-esteem. Achievement wishes were more common among individuals wanting to enter family medicine.

Conclusion

There was no evidence that medical students are becoming less altruistic and more money-orientated. Further, individuals did not appear to become less altruistic or increasingly financially driven as they progressed through the medical course.

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Aerococcus Viridans

Posted by on Sep 17, 2017 in Articles, ePubs | 0 comments

In this case report we discuss splenic infarction as a presentation for infectious endocarditis. While not unheard of, splenic infarctions are usually incidental findings and are not usually used to diagnose infectious endocarditis. Since our patient was on hemodialysis, had AIDS and blood cultures tested positive for Aerococcus viridans and Streptococcus parasanguis, we propose that atypical presentations of IE should be considered in immunocompromised patients.

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MRI vs. CT in Diagnosing Acute Appendicitis in Children

Posted by on Sep 17, 2017 in Articles, ePubs | 0 comments

Purpose

Computed tomography (CT) has emerged as the gold standard test for the evaluation of suspected appendicitis in pediatric patients. It has been shown to have excellent accuracy and to decrease negative appendectomy rates. However, CT scans expose patients to ionizing radiation, which is of especially high concern in children. Magnetic resonance imaging (MRI) is a potential alternative that could be used to evaluate children while eliminating exposure to radiation. This systematic review tests the hypothesis that the sensitivity and specificity of MRI are not inferior to that of CT in the evaluation of suspected appendicitis in children.

Methods

A search of the Medline database was conducted to identify articles that used MRI to evaluate children with suspected appendicitis. Articles that focused on pediatric subjects and reported sensitivity and specificity of MRI in these subjects were included. Data for the calculation of sensitivity, specificity, and 95% confidence intervals for each were extracted from each study included. Pooled data for sensitivity and specificity of MRI were calculated and tested for significance compared to sensitivity and specificity of CT using Fisher’s exact test.

Results

Nine studies were found to be relevant to the question posed by this systematic review and met the inclusion criteria. The pooled sensitivity and specificity of MRI for the diagnosis of appendicitis were 0.96 (95% CI: 0.94-0.98) and 0.97 (95% CI: 0.96-0.98) as opposed to values of 0.94 (95% CI: 0.92-0.97) and 0.95 (95% CI: 0.94-0.97) for CT. The difference between MRI and CT was not statistically significant for sensitivity (p=0.11) or specificity (p=0.06) in the evaluation of suspected appendicitis in children.

Conclusion

In children with suspected appendicitis, the sensitivity and specificity of MRI are comparable to those of CT in terms of sensitivity and specificity. MRI is a viable choice for imaging in these patients and limits exposure to radiation.

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Hardware Repair

Posted by on Dec 16, 2016 in Articles, ePubs | 0 comments

Distal radius fractures are one of the most common fractures in the elderly. Falls and motor vehicle collisions lead to increased risk for this type of fracture. A seventy-three year-old female had a previous history of distal radius fracture with repair by open reduction and internal fixation. She was involved in a motor vehicle collision that re- fractured the distal radius. The plate was bent and required removal, which is a very rare but potentially serious complication. Surgery was done to fix the open reduction and internal fixation with volar locking plates while removing damaged hardware. Only a select few cases have reported hardware failure as a cause of complications. Among those cases, high-energy activities and maintained stress on the hardware were likely causes. Distal radius fractures are the most common upper extremity fracture in the elderly. We highlight a unique case of re-fracture in the setting of trauma with prior hardware failure and describe the strategy for hardware repair.

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Scrotal Rupture

Posted by on Dec 16, 2016 in Articles, ePubs | 0 comments

Neonatal meconium periorchitis is a rare condition, with less than 60 cases described in the literature. Of the reported cases, only one describes the complication of a congenital rupture of the scrotum. We present a case of a Hispanic preterm neonate who was diagnosed with cystic fibrosis after scrotal rupture secondary to meconium periorchitis. The neonate was taken to the operating room for exploratory laparotomy and scrotal exploration. No calcification was noted and the patient’s left scrotum was surgically packed as well as creating a colostomy. The surgery proved successful and the patient was discharged home on day of life 79. This case of a neonate presenting with meconium periorchitis and scrotal rupture notes the varying degree of initial presentations for cystic fibrosis in a neonate. Successful outcomes for neonates presenting with a ruptured scrotum depend on early clinical assessment.

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Tonsillar Ectopia

Posted by on Aug 29, 2016 in Articles, ePubs | 0 comments

Purpose

Chiari Malformation Type I (CM I) is characterized by cerebellar tonsil ectopia and has varying symptomatology . Previous research has shown a relationship between tonsillar dominance and related conditions but few examined association with symptomatology. This study attempts to elucidate a relationship between cerebellar tonsil dominance, age, and symptomatology.

Methods

Data from CM I patients were extracted from the Conquer Chiari Patient Registry. Tonsillar dominance was determined using a ratio of right-to-left herniation length. Pearson’s correlation and one-tailed Student’s T-test were used for analysis.

Results

Length of tonsillar descent appears to be negatively correlated to age of onset (r = -0.266; p < 0.001; n = 113) and diagnosis (r = -0.323; p < 0.001; n = 113). No correlation was found between tonsillar dominance and symptom location, nor between tonsillar dominance and symptom severity bilaterally (p > 0.05). Symptom location and severity ratios appear to be correlated (r = 0.666; p < 0.001). Tonsillar descent length appears to be strongly correlated bilaterally (r = 0.972; p < 0.001; n = 50). Conclusion Inconsistency between tonsillar dominance as related to symptomatology suggests a multifactorial contribution to clinical presentation. The inverse relationship between tonsillar herniation length and age of symptom onset and diagnosis suggests herniation length may be an important predictor for clinical outcomes. Further research is needed to elucidate additional contributing factors and tonsillar dominance and symptomatology association.

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Wallis Implant

Posted by on Aug 29, 2016 in Articles, ePubs | 0 comments

Introduction: Degeneration of the lumbar motion segment is the primary cause of low back pain in many individuals. Therefore, new minimally invasive treatments are being sought.

Patient Profile: A 47-year old man presented with severe low back pain and radicular symptoms of several years duration. Lumbar MRI revealed severe desiccation, loss of disc height, and an annular tear with right lateral disc protrusion at L4-5.

Interventions/Outcomes: After conservative treatment failed, the patient received a Wallis® interspinous spacer at the affected level. 100% subjective pain relief was obtained at 3 months post-op. Nucleus pulposus rehydration on MRI was observed.

Discussion: Controversy exists over whether disc dehydration is a reliable indicator of low back pain; however, interspinous spacers seem to alter abnormal motion segment’s biomechanics in a way that results in alleviation of low back pain and increased range of motion. With the advent of biologic therapy, this may provide an intriguing minimally invasive treatment modality, although further research is needed.

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Time to Neurological Deterioration

Posted by on Mar 17, 2016 in Articles, ePubs | 0 comments

Background: Neurological deterioration (ND) is common, with nearly one-half of ND patients deteriorating within the first 24 to 48 hours of stroke. The timing of ND with respect to ND etiology and reversibility has not been investigated.

Methods: At our center, we define ND as an increase of 2 or more points in the National Institutes of Health Stroke Scale (NIHSS) score within 24 hours and categorize etiologies of ND according to clinical reversibility. ND etiologies were considered non-reversible if such causes may have produced or extended any areas of ischemic neurologic injury due to temporary or permanent impairment in cerebral perfusion.

Results: Seventy-one of 350 ischemic stroke patients experienced ND. Over half (54.9%) of the patients who experienced ND did so within the 48 hours of last seen normal. The median time to ND for non-reversible causes was 1.5 days (IQR 0.9, 2.4 days) versus 2.6 days for reversible causes (IQR 1.4, 5.5 days, p=0.011). After adjusting for NIHSS and hematocrit on admission, the log-normal survival model demonstrated that for each 1-year increase in a patient’s age, we expect a 3.9% shorter time to ND (p=0.0257). In addition, adjusting for age and hematocrit on admission, we found that that for each 1-point increase in the admission NIHSS, we expect a 3.1% shorter time to ND (p=0.0034).

Conclusions: We found that despite having similar stroke severity and age, patients with nonreversible causes of ND had significantly shorter median time to ND when compared to patients with reversible causes of ND.

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Does Traditional Chinese Medicine Matter?

Posted by on Mar 17, 2016 in Articles, ePubs | 0 comments

Introduction: With an aging, urbanizing population, China is home to the world’s largest number of adult diabetics. Although more diabetic patients currently live in cities, the prevalence of pre-diabetes is greater in the rural population due to changing dietary and physical habits, as well as the relative poverty. This demographic is thus an important target for public health intervention. As Traditional Chinese Medicine (TCM) is viewed in China as useful for treating chronic diseases and widely accepted, we sought to explore its use for rural diabetic patients.

Methods: The study population included 63 diabetic patients and two village doctors from four rural villages near Changsha, China. An initial survey was orally conducted with all 63 participants to collect demographics, financial situation, health-seeking behaviors, treatment beliefs, and medical expenditure. Three focus groups of six rural patients each were subsequently held at village health centers. For analysis, questionnaire data was summarized using means and standard deviations or medians and quartiles. Focus group sessions were voice-recorded and transcripts were coded for thematic analysis.

Results/Conclusions: Questionnaire data revealed that for the majority of participants, seeing a doctor is costly in terms of time and money. Patients often do not have the luxury of choosing their medical provider. Despite the benefits of TCM, its slow speed and cumbersome preparation methods do not fit a need for immediate results. Furthermore, TCM doctors are not as available or accessible as Western medicine doctors. As such, although 20% of rural patients rated higher trust in TCM than WM, no patient solely used TCM for their treatment. Instead, almost 40% of patients try to use both TCM and WM. Village practitioners similarly believed that although diabetes treatment should go towards integrative treatment, TCM’s development is hindered by its slow onset and inconvenience coupled with a more systemic lack of TCM infrastructure and research in China. In summary, the continued trust that rural patients place in TCM supports further research for better understanding the true economic, social, and health benefits of having combined TCM-WM treatment be part of diabetes standard of care.

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Combating Obstacles to Empathy

Posted by on Mar 17, 2016 in Articles, ePubs | 0 comments

The expression of humanism in patient encounters is a core component of the medical profession and evolving national medical student curriculum. Growing evidence suggests that empathetic care improves patient outcomes and diagnostic accuracy while decreasing physician stress and rates of litigation. Unfortunately, multiple recent studies using different scales and survey tools have consistently shown empathy to decrease during the third and fourth years of medical school. We developed a replicable, case-based, student and expert-driven, small-group discussion series designed to address this decline. Over two years, the series included four separate discussions over controversial topics seldom addressed by formal courses (Chronic Pain Management vs. Prescription Drug Abuse, Balancing Business and Medicine, and Domestic Violence). We utilized pre- and post-session surveys to qualitatively and quantitatively evaluate the program. Our results demonstrated significant improvement in participants’ comfort with the subject matter and desire to approach faculty and peers regarding humanistic patient care. Future and more frequent interactions, combined with optimization of the format could further uncover the utility of this program. Ultimately, we believe our discussion series could be replicated on other medical campuses.

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Medals 4 Mettle

Posted by on Mar 17, 2016 in Articles, ePubs | 0 comments

Introduction: Humanism is a necessary component of patient care. Medical schools are implementing strategies to educate students about humanism in medicine. The University of Louisville School of Medicine (ULSOM) encourages such practices through collaboration with Medals4Mettle (M4M), a non-profit organization that gives marathon medals to patients battling debilitating illnesses. The ULSOM’s chapter matches students participating in the Kentucky Derby Half/Full Marathon with pediatric patients, allowing students to establish a relationship with their “running buddies” prior to gifting their medals on race day as an act of support and acknowledgement of their struggle. The goal of this study was to evaluate the ULSOM chapter and to create a replicable model for other institutions to employ.

Methods: We conducted a survey for current and previous student and patient/parent participants. Participants were asked to complete six 5-point Likert scaled questions anchored with “Strongly Disagree” to “Strongly Agree” and three open-ended questions. The surveys were analyzed using the Mann-Whitney U test for quantitative analysis and Pandit’s variation of Glaser and Straus’ constant comparison for qualitative analysis.

Results: Data was collected from 62 medical students and 21 patients or parents (49% and 33% response rate, respectively). Five of the scaled questions had mean scores above 4.0, revealing that the majority of participants would recommend the M4M program to others and that M4M helped students relate to their patient on a personal level. The qualitative analysis identified four themes among participants: M4M is a wonderful program, it provides a patient benefit, people want to re-participate, and it allows you to connect with others.

Discussion: Findings from the survey suggest the implementation of programs like M4M will promote the integration of humanistic practices into medical school curricula. In the future, we plan to pair medical students with the patients earlier to create a longer-lasting, more meaningful relationship prior to the race.

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Winter 2015 – Care for Laotian Ethnic Minorities: A Cross-National Study of Medical Students in Laos and California

Posted by on Jan 1, 2015 in Articles | 0 comments

Care for Laotian Ethnic Minorities: A Cross-National Study of Medical Students in Laos and California Author: Katherine Crabtree1,Oanh L. Meyer2, Tonya L. Fancher3 Author Affiliations: 1UC Davis College of Medicine, Sacramento, CA, USA 2UC Davis School of Medicine, Alzheimer’s Disease Center, Department of Neurology, Sacramento, CA, USA 3UC Davis School of Medicine, Division of General Internal Medicine, Sacramento, CA, USA Full Text Article PDF Corresponding Author: Katherine Crabtree, katcrabtree[at]gmail.com Key Words: Hmong; Mien; Laos, refugees; cross-cultural healthcare; medical education. Abstract: Background: In both the United States and Laos, Lao ethnic minority patients face cultural and linguistic challenges to adequate medical care. We may be able to learn from Lao experiences to improve care for patients in the United States. This study explored Laotian and American medical students’ experiences in care for these patients. Methods: Laotian and American medical students (n_19) participated in five interview groups discussing barriers to health care and strategies for addressing barriers for Laotian ethnic minority patients. Results: The students identified similar barriers to care. Laotian students identified unique strategies to address barriers to care. American students focused on general approaches to cross-cultural care. Discussion: The strategies that Laotian medical students learn in their training reflect their extensive exposure to Hmong and other Laotian ethnic minority patients, while American students learn broad strategies to care for many minority groups. Further work is needed to determine if their experience can be translated into the domestic context. Published on date: January 1, 2015 Senior Editor: Ghadear Shukr Junior Editor: Nadine Talia DOI: Pending Citation: Crabtree K, Fancher TL, Meyer TL. Care for Laotian Ethnic Minorities: A Cross-National Study of Medical Students in Laos and California. Medical Student Research Journal. 2015;4(Winter):66-70. References: Ghent A. Overcoming migrants’ barriers to health. Bull World Health Org 2008; 8: 583-4. Habarad J. Refugees and the structure of opportunity: transitional adjustments to aid among U.S. resettled Lao Iu Mien, 1980-1985. Center Migrat Stud Spec Issues 1987; 5: 66-87. Yeung B. We are the people: the history of the Iu-Mien. SF Weekly 2001; 20. Lum T. Laos: background and U.S. relations. Congressional Research Service Report for Congress 2008. Available from: http://www.fas.org/sgp/crs/row/RL34320.pdf [cited 20 December 2011]. US Census Bureau, 2010 United States Census. 2010. Available from: http://www.census.gov/2010census [cited 20 December 2011]. Catanzaro A. Health status of refugees from Vietnam, Laos, and Cambodia. JAMA 1982; 247: 1303-8. Laos overview. World directory of minorities and indigenous peoples. 2005. Available from: http://www.minorityrights.org/4014/laos/laos-overview.html [cited 20 January 2014]. Depke J. Coalition building and the intervention wheel to address breast cancer screening in Hmong women. Clin Med Res 2011; 9: 1-6. Murphy-Thalacker K. Hypertension and the Hmong community: using the health belief model for health promotion. Health Promot Pract 2010; 13: 6. Johnson S. Hmong health beliefs and experiences in the western health care system. J Transcult Nurs 2002; 13: 126-32. Culhane-Pera K. ‘We are out of balance here’: a Hmong cultural model of diabetes. J Immigr Minor Health 2007; 9:179-90. BBC. Thai army deports Hmong to Laos. 2009. Available from: http://news.bbc.co.uk/2/hi/8432094.stm [cited 7 January 2013]. de Boer H, Lamxay V. Plants used during pregnancy, childbirth and postpartum healthcare in Lao PDR: a comparative study of the Brou, Saek and Kry ethnic groups. J Ethnobiol Ethnomed 2009; 5: 25. Sydara K. Use of traditional medicine in Lao PDR. Complement Ther Med 2005; 13: 199_205. Douangphachanh X. Availability and use...

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Winter 2015 – Sticking to the Plan: Patient Preferences for Epidural Use During Labor

Posted by on Jan 1, 2015 in Articles | 0 comments

Sticking to the Plan: Patient Preferences for Epidural Use During Labor Author: Lauren Ann Gamble1, Ashley Hesson1, Tiffany Burns2. Author Affiliations: 1College of Human Medicine, Michigan State University, East Lansing, MI, USA 2Department of Family Medicine, Michigan State University, East Lansing, MI, USA Full Text Article PDF Corresponding Author: Lauren Ann Gamble, gambleL2[at]msu.edu Key Words: epidural; birth plan; labor analgesia; patient preference, decision making. Abstract: Background: Women have been shown to value control in the labor experience, a desire that is often formalized into an explicit birth plan. Epidural preferences are a primary component of this plan. Despite this specification, women’s plans are not always carried out. This may be due to patient factors (e.g., dissatisfaction with labor), provider behaviors (e.g., frequent epidural offers), or situational variables (e.g., prolonged labor). Purpose: The current study investigates the relative impact of patient preference for epidural use as compared to provider suggestion and circumstances of labor. It hypothesizes that providing an epidural preference in a birth plan and receiving frequent epidural offers will predict epidural administration. Methods: Adult, postpartum women were surveyed about their labor experience at a high-volume obstetrics unit in a medium-sized community hospital. Responses to a structured survey instrument focused on prelabor preferences and labor characteristics. Descriptive statistics and multiple logistic regression modeling were used to analyze participant responses. Results: Eighty-three postlaboring women completed surveys, of which 79 surveys were analyzed. Eighty-four percent (N_66) received an epidural during their labor process, while 73% (N_58) desired an epidural as a part of their birth plan. Women were offered an epidural at a mean frequency of 0.2790.48 times per hour (median_0.14). The significant predictors of epidural administration were desire for an epidural in the birth plan (pB0.01) and the frequency of epidural offers (pB0.01). Wanting an epidural was associated with receiving an epidural. Conversely, increased frequency of being offered an epidural negatively correlated with epidural administration. Conclusions: Our findings indicate that personal preference is the most influential factor in determining whether or not a laboring woman will receive an epidural. Increasing provider attempts to offer an epidural – as represented by increased frequency of queries- decreased the likelihood that an epidural would be received. Published on date: January 1, 2015 Senior Editor: Tina Chaalan Junior Editor: Jennifer Monacelli DOI: Pending Citation: Gamble LA, Hesson A, Burns T. Sticking to the Plan: Patient Preferences for Epidural Use During Labor. Medical Student Research Journal. 2015;4(Winter):59-65. References:     Pilnick A, Dingwall R. On the remarkable persistence of asymmetry in doctor/patient interaction: a critical review. Soc Sci Med 2011; 72: 1374-82. Simkin P. Birth plans: after 25 years, women still want to be heard. Birth 2007; 34(1): 49-51. Namey EE, Lyerly AD. The meaning of ‘‘control’’ for childbearing women in the US. Soc Sci Med 2010; 71(4): 769-76. Miller AC, Shriver TE. Women’s childbirth preferences and practices in the United States. Soc Sci Med 2012; 75(4):709-16. Pennell A, Salo-Coombs V, Herring A, Spielman F, Fecho K. Anesthesia and analgesia_related preferences and outcomes of women who have birth plans. J Midwifery Women’s Health 2011; 56(4): 376-81. Horowitz ER, Yogev Y, Ben-Haroush A, Kaplan B. Women’s attitude toward analgesia during labor – a comparison between 1995 and 2001. Eur J Obstet Gynecol Reprod Biol 2004; 117(1): 30-32. Thompson R, Miller YD. Birth control: to what extent do women report being informed...

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Winter 2015 – In Situ Thrombosis of the Pulmonary Arteries: An Emerging New Perspective on Pulmonary Embolism

Posted by on Jan 1, 2015 in Articles | 0 comments

In Situ Thrombosis of the Pulmonary Arteries: An Emerging New Perspective on Pulmonary Embolism Author: Virginia Corbett1, Houria Hassouna2, Reda Girgis3 Author Affiliations: 1College of Human Medicine, Michigan State University, East Lansing, MI, USA 2Division of Thrombosis, Department of Internal Medicine, College of Human Medicine, Michigan State University, East Lansing, MI, USA 3Department of Pulmonary Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA Full Text Article PDF Corresponding Author: Virginia Corbett, corbettv[at]msu.edu Key Words: pulmonary embolism; in situ pulmonary artery thrombosis; deep vein thrombosis (DVT); pulmonary circulation; Virchow’s triad Abstract: The annual incidence of pulmonary embolism(PE) in the United States is reported to be 0.69 per1,000 persons with mortality of up to 30% depending upon the size of the emboli.1 PE and deep venous thrombosis (DVT) are both considered manifestations ofthe same disease of venous thromboembolism. Virchowpostulated that dysfunction of vessel walls, alternationsin blood flow and hypercoagulability of theblood triggered inappropriate thrombus formation.2 DVT most commonly occurs as local clot formation in the deep calf veins. PE arises when clots break off from a peripheral DVT and become lodged within the pulmonary arterial vasculature. PE is routinely diagnosed when filling defects are found in the pulmonary arteries on computed tomography angiogram (CTA). Among the general population of patients presenting to emergency rooms, absence of DVT may occur in up to 57% of those diagnosed with PE.3 A high prevalence of isolated PE may suggest localized thrombus formation in the pulmonary arteries instead of embolization from peripheral clots. Published on date: January 1, 2015 Senior Editor: Kailyne Van Stavern Junior Editor: Garrett Roe DOI: Pending Citation: Corbett V. Hassouna H. Girgis R. In Situ Thrombosis of the Pulmonary Arteries: An Emerging New Perspective on Pulmonary Embolism . Medical Student Research Journal. 2015;4(Winter):54-8. References: Office of the Surgeon General (US); National Heart, Lung, and Blood Institute (US). The surgeon general’s call to action to prevent deep vein thrombosis and pulmonary embolism. 2008. Available from: http://www.ncbi.nlm.nih.gov/books/NBK44181/ [cited 15 February 2014]. Kyrle PA, Eichinger S. Deep vein thrombosis. Lancet 2005; 365(9465): 1163_74. doi: 10.1016/S0140-6736(05)71880-8 Sohns C, Amarteifio E, Sossalla S, Heuser M, Obenauer S. 64-Multidetector-row spiral CT in pulmonary embolism with emphasis on incidental findings. Clin Imaging 2008; 32(5): 335_41. doi: 10.1016/j.clinimag.2008.01.028 Van belle A, Bu¨ ller HR, Huisman MV, Huisman PM, Kaasjager K, Kamphuisen PW, et al. Effectiveness of managing suspected pulmonary embolism using an algorithm combining clinical probability, D-dimer testing, and computed tomography. JAMA 2006; 295(2): 172_9. doi: 10.1001/jama.295.2.172 Kumar NG, Clark A, Roztocil E, Caliste X, Gillespie DL,Cullen JP. Fibrinolytic activity of endothelial cells from different venous beds. J Surg Res 2015; 194(1): 297_303. doi: 10.1016/j.jss.2014.09.028 Rosenhek R, Korschineck I, Gharehbaghi-schnell E, Jakowitsch J, Bonderman D, Huber K, et al. Fibrinolytic balance of the arterial wall: pulmonary artery displays increased fibrinolytic potential compared with aorta. Lab Invest 2003; 83(6): 871_6. doi: 10.1097/01.LAB.0000073127.46392.9D Ryan US. Metabolic activity of pulmonary endothelium: modulations of structure and function. Annu Rev Physiol 1986; 48(1): 263_77. doi: 10.1146/annurev.ph.48.030186.001403. Goodman LR. Small pulmonary emboli: what do we know? Radiology 2005; 234(3): 654_8. doi: 10.1148/radiol.2343041326 Ryan US. Structural bases for metabolic activity. Annu Rev Physiol 1982; 44(1): 223_39. doi: 10.1146/annurev.ph.44.030182.001255 Key NS, Bach RR. Tissue factor as a therapeutic target. Thromb Haemost 2001; 85(3): 375_6. doi: 10.1517/14728222.6.2.159 Martinelli I. Unusual forms of venous thrombosis and thrombophilia. Pathophysiol Haemost Thromb 2002; 32(5_6): 343_5. doi: 10.1159/000073595...

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Winter 2015 – White Coat Sparty

Posted by on Jan 1, 2015 in Articles | 0 comments

White Coat Sparty. Author:  Carter Anderson Author Affiliations: College of Human Medicine, Michigan State University, East Lansing, MI, USA Full Text Article PDF Corresponding author: Carter Anderson; carterbanderson[at]yahoo.com Key Words: N/A Abstract: Professional responsibility, compassion, honesty, respect for others, competence, and social responsibility are the characteristics that the Michigan State University College of Human Medicine strives to instill in every student. Published on date: January 1, 2015 Senior Editor: N/A Junior Editor: N/A DOI: pending Citation: Anderson C. White Coat Sparty. Medical Student Research Journal. 2015;4(Winter):52-53. References: N/A  ...

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Winter 2015 – Letter from the Editors

Posted by on Jan 1, 2015 in Articles | 0 comments

Letter From the Editors. Author: Jessica L Wummel1, Jack C Mettler2 Author Affiliations: 1College of Human Medicine, Michigan State University, East Lansing, MI, USA, 2College of Human Medicine, Michigan State University, Flint, MI, USA Full Text Article PDF Corresponding Author: Jessica L Wummel; Jessica[at]msrj.org, Jack C Mettler; Jack[at]msrj.org Key Words: N/A Abstract: The editors of MSRJ are excited to announce our Winter 2015 issue. As always, we were incredibly impressed by the caliber of submissions. This issue includes interesting articles written by medical students from UC Davis College of Medicine and Michigan State University College of Human Medicine. Published on date: January 1, 2015 Senior Editor: N/A Junior Editor: N/A DOI: Pending Citation: Wummel JL, Mettler JC. Letter From the Editors. Medical Student Research Journal. 2015;4(Winter):51. References: N/A  Share...

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Fall 2014 – The Growth of Medical Student Opportunities in Global Health

Posted by on Sep 30, 2014 in Articles | 0 comments

The Growth of Medical Student Opportunities in Global Health. Author: Johnathan Kao, MPH Author Affiliations: College of Human Medicine, Michigan State University, Flint, MI, USA Full Text Article PDF Corresponding Author: Johnathan Kao; johnathan.kao[at]msrj.org Key Words: sexual health; relationships; intimacy; radiotherapy; psycho-supportive treatment; hormone therapy. Abstract: Since the establishment of the World Health Organization on April 7, 1948,1 global health has grown in prominence and popularity among health care workers at all levels of training. International clinical rotation electives have been available to students for over half a century2 and interest in these programs has risen steadily over the decades. During this period, many organizations established programs for students and faculty interested in global health research and service. In 2006, these organizations united under the WHO’s Global Health Workforce Alliance to assist students and faculty in becoming more involved in global health activities.3 Despite these Changes, in 2007, Drain et al recognized a lack of global health education in medical schools and growing student interest, calling for more opportunities to fill the gap.4 Published on date: September 31, 2014 Senior Editor: N/A Junior Editor: N/A DOI: Pending Citation: Kao J. The Growth of Medical Student Opportunities in Global Health. Medical Student Research Journal. 2014;4(Fall):48-50. References: World Health Organization. History of WHO. 2014. Accessed from: http://www.who.int/about/history/en/ [cited 21 June 2014]. Bissonette R, Route C. The Educational Effect of Clinical Rotations in Nonindustrialized Countries. Fam Med 1994; 26(4):226-31. World Health Organization. Global Health Education Consortium. 2014. Accessed from: http://www.who.int/workforcealliance/members_partners/member_list /ghec/en/ [cited 21 June 2014]. Drain PK, Primack A, Hunt DD, Fawzi WW, Holmes KK, Gardner P. Global Health in Medical Education: A Call for More Training and Opportunities. Acad Med 2007; 82(3):226-30. doi: 10.1097/ACM.0b013e3180305cf9 Hag C, Rothenberg D, Gjerde C, Bobula J, Wilson C, Bickley L, Cardelle A, Joseph A. New World Views: Preparing Physicians in Training for Global Health Work. Fam Med 2000; 32(8):566-72. Medical School Graduation Questionnaire: All School Summary Report. 2013. Accessed from: https://www.aamc.org/download/350998/data/2013 gqallschoolssummaryreport.pdf [cited 21 June 2014]. Imperato PJ. A Third World International Health Elective for U.S. Medical Students: The 25-year Experience of the State University of New York, Downstate Medical Center. J Community Health 2004; 29(5):337-73. doi:10.1023/b:johe.0000038652.65641.0d Pust RE, Moher SP. A Core Curriculum for International Health: Evaluating Ten Years’ Experience at the University of Arizona. Acad Med 1992; 67(2):90-4. doi:10.1097/00001888-199202000-00007 Haq C, Rothenberg D, Gjerde C, Bobula J, Wilson C, Bickley L, Cardelle A, Joseph A. New World Views: Preparing Physicians in Training for Global Health Work. Fam Med 2000; 32(8):566-72. Suchdev P, Ahrens K, Click E, Macklin L, Evangelista D, Graham E. A Model for Sustainable Short-Term International Medical Trips. Ambul Pediatr 2007; 7(4):317-20. doi: 10.1016/j.ambp.2007.04.003 Montgomery LM. Short-Term Medical Missions: Enhancing or Eroding Health? Missiology 1993; 21(3):333-41. doi: 10.1177/009182969302100305 Crump JA, Sugarman J, Working Group on Ethics Guidelines for Global Health Training (WEIGHT). Ethics and Best Practice Guidelines for Training Experiences in Global Health. Am J Trop Med Hyg 2010; 83(6):1178-82. doi: 10.4269/ajtmh.2010.10-0527 AAMC GSA Steering Committee. Guidelines for Premedical and Medical Students Providing Patient Care During Clinical Experiences. AAMC 2011. Accessed from: https://www.aamc.org/download/181690/data/guidelinesforstudentsprovidingpatientcare.pdf [cited 21 June 2014]. DeCamp M, Enumah S, O’Neill D, Sugarman J. Perceptions of a Short-Term Medical Programme in the Dominican Republic: Voices of Care Recipients. Glob Public Health 2014; 9(4):411-25. doi: 10.1080/17441692.2014.893368 Accreditation Council of Graduate Medical Education. Common Program Requirements. ACGME 2013. Accessed from: https://www.acgme.org/ acgmeweb/Portals/0/PFAssets/ProgramRequirements/CPRs2013.pdf [cited 21 June 2014]. Thompson MJ, Huntington MK, Hunt DD, Pinsky LE,...

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Fall 2014 – Comparing Current Screening Modalities for Colorectal Cancer and Precancerous Lesions: Is Colonoscopy the Method of Choice?

Posted by on Sep 30, 2014 in Articles | 0 comments

Comparing Current Screening Modalities for Colorectal Cancer and Precancerous Lesions: Is Colonoscopy the Method of Choice? Author: Puneet K. Singh Author Affiliations: Saba University School of Medicine, Saba, Dutch Caribbean Full Text Article PDF Corresponding Author: Puneet K. Singh; pun33t.singh[at]gmail.com Key Words: Colonoscopy; colorectal neoplasms; sigmoidoscopy; CT colonography; mass screening. Abstract: Colorectal cancer (CRC) is the third most common form of cancer and the second leading cause of cancer death in the Western world. Presently, screening tools such as colonoscopy, sigmoidoscopy, fecal occult blood test (FOBT) and computed tomographic colonography (CTC) are available for CRC screening. The debate over which screening tool is most effective in detecting CRC and precancerous lesions is ongoing. Many recent studies have identified colonoscopy as the most sensitive and specific screening modality for CRC. However, a number of factors have prevented colonoscopy from being widely accepted. Less invasive techniques such as sigmoidoscopy and CTC are growing in popularity among physicians and patients who are apprehensive about colonoscopy screening; although many still are yet to experience the procedure first-hand. This literature review will attempt to validate the growing theory that colonoscopy is superior to other modalities for the diagnosis and screening of CRC and reduces the risk of CRC mortality. In order to do so, the paper will compare the risks and benefits of colonoscopy to sigmoidoscopy and CTC. It will further look at the different aspects that encompass a patient’s decision to partake in screening, such as basic knowledge about CRC, history of CRC in the family, advice from physicians and individual beliefs about what screening entails. Finally, this paper will propose ways in which colonoscopy screening can be improved and thus surpass other screening modalities to universally become the first choice for CRC screening. Published on date: September 31, 2014 Senior Editor: Jack Mettler Junior Editor: David Carr DOI: Pending Citation: Singh PK. Comparing Current Screening Modalities for Colorectal Cancer and Precancerous Lesions: Is Colonoscopy the Method of Choice? Medical Student Research Journal. 2014;4(Fall):34-47. References: Holt PR, Kozuch P, Mewar S. Colon cancer and the elderly: from screening to treatment in management of GI disease in the elderly. Best Pract Res Clin Gastroenterol. 2009;23:889-907. doi: 10.1016/j.bpg.2009.10.010 Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA Cancer J Clin. 2012;62:10-29. doi:  10.3322/caac.20138 Manne U, Shanmugam C, Katkoori VR, Bumpers HL, Grizzle WE. Development and progression of colorectal neoplasia. Cancer Biomark. 2010;9:235-265. doi: 10.3233/CBM-2011-0160 Qaseem A, Denberg TD, Hopkins RH, Jr., et al. Screening for colorectal cancer: a guidance statement from the American College of Physicians. Ann Intern Med. 2012;156:378-386. doi: 10.7326/0003-4819-156-5-201203060-00010 Centers for Disease C, Prevention. Vital signs: Colorectal cancer screening, incidence, and mortality–United States, 2002-2010. MMWR Morb Mortal Wkly Rep. 2011;60:884-889. Lieberman D. Colorectal cancer screening: practice guidelines. Dig Dis. 2012;30 Suppl 2:34-38. doi: 10.1159/000341891 Centers for Disease C, Prevention. Vital signs: colorectal cancer screening test use – United States, 2012. MMWR Morb Mortal Wkly Rep. 2013;62:881-888. Kahi CJ, Anderson JC, Rex DK. Screening and surveillance for colorectal cancer: state of the art. Gastrointest Endosc. 2013;77:335-350. doi: 10.1016/j.gie.2013.01.002 Rabeneck L, Paszat LF, Saskin R, Stukel TA. Association between colonoscopy rates and colorectal cancer mortality. Am J Gastroenterol. 2010;105:1627-1632. doi: 10.1038/ajg.2010.83 Manser CN, Bachmann LM, Brunner J, Hunold F, Bauerfeind P, Marbet UA. Colonoscopy screening markedly reduces the occurrence of colon carcinomas and carcinoma-related death: a closed cohort study. Gastrointest Endosc. 2012;76:110-117. doi: 10.1016/j.gie.2012.02.040 Singh H, Nugent Z, Demers AA, Kliewer EV, Mahmud SM, Bernstein CN. The reduction in...

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Fall 2014 – Alzheimer’s Disease: A Clinical and Basic Science Review

Posted by on Sep 30, 2014 in Articles | 0 comments

Alzheimer’s Disease: A Clinical and Basic Science Review.  Author: Igor O. Korolev Author Affiliations: College of Osteopathic Medicine and Neuroscience Program, Michigan State University, East Lansing, MI, USA Full Text Article PDF Corresponding Author: Igor O. Korolev; korolevi[at]msu.edu Key Words: Alzheimer’s disease; mild cognitive impairment; dementia; neurodegeneration; neuroimaging; biomarkers. Abstract: Alzheimer’s disease (AD) is the most common cause of dementia in older adults and an important public health problem. The purpose of this review article is to provide a brief introduction to AD and the related concept of mild cognitive impairment (MCI). The article emphasizes clinical and neurobiological aspects of AD and MCI that medical students should be familiar with. In addition, the article describes advances in the use of biomarkers for diagnosis of AD and highlights ongoing efforts to develop novel therapies. Published on date: September 31, 2014 Senior Editor: Liza Gill Junior Editor: Timothy Smith DOI: Pending Citation: Korolev IO. Alzheimer’s Disease: A Clinical and Basic Science Review.  Medical Student Research Journal. 2014;4(Fall):24-33. References: Alzheimer A. About a Peculiar Disease of the Cerebral Cortex. Allg Z Psychiatr. 1907; 64: 146-148. Alzheimer A. About a Peculiar Disease of the Cerebral Cortex. Alzheimer Dis Assoc Disord. 1987; 1: 3-8. Maurer K, Volk S, Gerbaldo H. Auguste D and Alzheimer’s Disease. Lancet. May 1997; 349(9064): 1546-1549. doi: 10.1016/S0140-6736(96)10203-8 Gilman, S. Oxford American Handbook of Neurology. Oxford, England: Oxford University Press; 2010. McKhann GM, Knopman DS, Chertkow H, Hyman BT, Jack CR, et al. The diagnosis of dementia due to Alzheimer’s disease: Rocommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement. May 2011; 7(3): 263-269. doi: 10.1016/j.jalz.2011.03.005 Shadlen M, Larson E (2012) Evaluation of cognitive impairment and dementia. In: Basow D, editor. UpToDate. Waltham, MA: UpToDate. Plassman BL, Langa KM, Fisher GG, Heeringa SG, Weir DR, et al. Prevalence of Dementia in the United States: The Aging, Demographics, and Memory Study. Neuroepidemiology. 2007; 29: 125–132. doi:10.1159/000109998 Thies W, Bleiler. 2013 Alzheimer’s disease facts and figures. Alzheimers Dement. 2013; 9: 208–245. doi:10.1016/j.jalz.2013.02.003 Prince M, Bryce R, Albanese E, Wimo A, Ribeiro W, et al. The global prevalence of dementia: a systematic review and metaanalysis. Alzheimers Dement. 2013; 9: 63–75.e2. doi:10.1016/j.jalz.2012.11.007 Ott A, Breteler MM, van Harskamp F, Claus JJ, van der Cammen TJ, et al. Prevalence of Alzheimer’s disease and vascular dementia: association with education. The Rotterdam study. BMJ 1995; 310: 970–973. Querfurth HW, LaFerla FM. Alzheimer’s disease. N Engl J Med. 2010; 362: 329–344. doi:10.1056/NEJMra0909142 Holtzman DM, Morris JC, Goate AM. Alzheimer’s disease: the challenge of the second century. Sci Transl Med. 2011; 3: 77sr1. doi:10.1126/scitranslmed.3002369 Reiman EM, Chen K, Alexander GE, Caselli RJ, Bandy D, et al. Correlations between apolipoprotein E epsilon4 gene dose and brain-imaging measurements of regional hypometabolism. Proc Natl Acad Sci. USA 2005; 102: 8299–8302. doi:10.1073/pnas.0500579102 Hebert LE, Scherr PA, McCann JJ, Beckett LA, Evans DA. Is the Risk of Developing Alzheimer’s Disease Greater for Women than for Men? Am J Epidemiol. 2001; 153: 132–136. doi:10.1093/aje/153.2.132 Stern Y. Cognitive reserve in ageing and Alzheimer’s disease. Lancet Neurol 2012; 11: 1006–1012. doi:10.1016/S1474-4422(12)70191-6 Barnes DE, Yaffe K. The projected effect of risk factor reduction on Alzheimer’s disease prevalence. Lancet Neurol. 2011; 10: 819–828. doi:10.1016/S1474-4422(11)70072-2 Mann DM. Pyramidal nerve cell loss in Alzheimer’s disease. 1996; 5: 423–427. Norfray JF, Provenzale JM. Alzheimer’s disease: neuropathologic findings and recent advances in imaging. AJR Am J Roentgenol. 2004; 182: 3–13. doi:10.2214/ajr.182.1.1820003 Selkoe DJ. Alzheimer’s disease is a synaptic...

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