Articles

Fall 2014 – A Review of the Psychological and Emotional Issues in Men with Prostate Cancer and their Partners

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

A Review of the Psychological and Emotional Issues in Men with Prostate Cancer and their Partners. Author: Dane E. Klett Author Affiliations: School of Medicine, Creighton University, Phoenix, AZ, USA Full Text Article PDF Corresponding Author: Dane E. Klett Key Words: sexual health; relationships; intimacy; radiotherapy; psycho-supportive treatment; hormone therapy. Abstract: Howard L. Harrod on his struggles with prostate cancer (PCa): ‘Not only had I a sense of having been mutilated, but I had lost the very capacities that were symbolically associated with manhood’.1 Many patients with PCa experience this jolt to their sense of manhood, thus making PCa unique among the various cancer diagnoses and worthy of independent discussion. In addition, PCa remains the most common male cancer and the third leading cause of all male cancer deaths.2 Most physicians are aware of the link between cancer and mental health issues, but many forget or overlook just how important it is to address a patient’s state of mental health. Published on date: September 31, 2014 Senior Editor: Caela Hesano Junior Editor: Regina Mater DOI: Pending Citation: Klett DE. A Review of the Psychological and Emotional Issues in Men with Prostate Cancer and their Partners. Medical Student Research Journal. 2014;4(Fall):4-7. References: Harrod HL. A piece of my mind. An essay on desire. JAMA. Feb 19 2003;289(7):813-814. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2013. CA Cancer J. Clin. Jan 2013;63(1):11-30. doi:10.3322/caac.21166 Watts S, Leydon G, Birch B, et al. Depression and anxiety in prostate cancer: a systematic review and meta-analysis of prevalence rates. BMJ Open. 2014;4(3):e003901. doi: 10.1136/bmjopen-2013-003901 Jayadevappa R, Malkowicz SB, Chhatre S, Johnson JC, Gallo JJ. The burden of depression in prostate cancer. Psychooncology. Dec 2012;21(12):1338-1345. doi: 10.1002/pon.2032 Sharpley CF, Bitsika V, Christie DR. Diagnosing ‘male’ depression in men diagnosed with prostate cancer: the next step in effective translational psycho-oncology interventions? Psychooncology. Apr 3 2014. doi: 10.1002/pon.3530 Zisman A, Leibovici D, Kleinmann J, Siegel YI, Lindner A. The impact of prostate biopsy on patient well-being: a prospective study of pain, anxiety and erectile dysfunction. J. Urol. Feb 2001;165(2):445-454. doi: 10.1016/S0022-5347(05)65543-7 Lintz K, Moynihan C, Steginga S, et al. Prostate cancer patients’ support and psychological care needs: Survey from a non-surgical oncology clinic. Psychooncology. Dec 2003;12(8):769-783. doi: 10.1002/pon.702 Kunkel EJ, Bakker JR, Myers RE, Oyesanmi O, Gomella LG. Biopsychosocial aspects of prostate cancer. Psychosomatics. Mar-Apr 2000;41(2):85-94. doi: 10.1176/appi.psy.41.2.85 Bergman J, Litwin MS. Quality of life in men undergoing active surveillance for localized prostate cancer. J. Natl. Cancer Inst. Monogr. Dec 2012;2012(45):242-249. doi: 10.1093/jncimonographs/lgs026 Chipperfield K, Fletcher J, Millar J, et al. Predictors of depression, anxiety and quality of life in patients with prostate cancer receiving androgen deprivation therapy. Psychooncology. Mar 11 2013(22):2169-2176. doi: 10.1002/pon.3269 Couper J, Bloch S, Love A, Duchesne G, Macvean M, Kissane D. Coping patterns and psychosocial distress in female partners of prostate cancer patients. Psychosomatics. Jul-Aug 2009;50(4):375-382. doi: 10.1176/appi.psy.50.4.375 Lilleby W, Fossa SD, Waehre HR, Olsen DR. Long-term morbidity and quality of life in patients with localized prostate cancer undergoing definitive radiotherapy or radical prostatectomy. Int. J. Radiat. Oncol. Biol. Phys. Mar 1 1999;43(4):735-743. doi: 10.1016/S0360-3016(98)00475-1 Dahn JR, Penedo FJ, Gonzalez JS, et al. Sexual functioning and quality of life after prostate cancer treatment: considering sexual desire. Urology. Feb 2004;63(2):273-277. doi: 10.1016/j.urology.2003.09.048 Kissane DW, McKenzie M, Bloch S, Moskowitz C, McKenzie DP, O’Neill I. Family focused grief therapy: a randomized, controlled trial in palliative care and bereavement. Am. J. Psychiatry. Jul 2006;163(7):1208-1218. doi: 10.1176/appi.ajp.163.7.1208 Couper JW, Love AW,...

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Fall 2014 – Broken

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

Broken. Author:  Timothy DeKoninck Author Affiliations: College of Human Medicine, Michigan State University, East Lansing, MI, USA Full Text Article PDF Corresponding author: Timothy DeKoninck; dekonin4[at]msu.edu Key Words: N/A Abstract: There are several elements symbolized in the mosaic that represent a doctor-patient relation- ship. This piece of work strives to piece together and serve as a reminder of the elements that make for a successful and impactful relationship. Published on date: September 31, 2014 Senior Editor: N/A Junior Editor: N/A DOI: pending Citation: DeKoninck T. Broken. Medical Student Research Journal. 2014;4(Fall):2-3....

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Fall 2014 – Letter from the Editors

Posted by on Sep 30, 2014 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 Fall 2014 issue, the first issue of the new academic year. We have been overwhelmed with amazing articles from medical students around the world and this has allowed us to publish our largest issue yet! This issue includes stimulating articles written by students from the University of Toronto, Creighton University School of Medicine, Saba University School of Medicine, Michigan State University College of Osteopathic Medicine, and Michigan State University College of Human Medicine. Published on date: September 31, 2014 Senior Editor: N/A Junior Editor: N/A DOI: Pending Citation: Wummel JL, Mettler JC. Letter From the Editors. Medical Student Research Journal. 2014;4(Fall):1. References:...

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Spring 2014 – Isolated Orbital Mucormycosis in an Immunocompetent Adolescent

Posted by on May 31, 2014 in Articles | 0 comments

Isolated Orbital Mucormycosis in an Immunocompetent Adolescent. Author: Jolie Krystle H. Guevara Author Affiliations: University of the East Ramon Magsaysay Memorial Medical Center, Manila, Philippines Full Text Article PDF Corresponding Author: Jolie Krystle H. Guevara; Jolieg800[at]gmail.com Key Words: rhinocerebral; zygomycosis; pediatric; amphotericin B; corticosteroids; exenteration. Abstract: Introduction and patient profile: Mucormycosis is a life-threatening disease that usually affects patients with diabetes and other immunocompromised states. However, recent literature has shown an emergence of this disease in immunocompetent individuals. Here we are presenting a rare case of a healthy 13-year-old adolescent diagnosed to have isolated orbital mucormycosis, previously treated with oral and intravenous corticosteroids. The patient presented with a chief complaint of left eye swelling of 3 weeks’ duration, which progressed to proptosis and a visual acuity of no light perception. Interventions and outcomes: Diagnosis of mucormycosis was done using histopathological techniques supported by radiologic imaging. Successful treatment of mucorymycosis was achieved via amphotericin B administration and orbital exenteration in this case. Discussion: The use of corticosteroids may weaken the immune system of healthy patients and can cause rapid progression of the disease. Early clinical diagnosis is important because this infection can rapidly be fatal. Published on Date: May 31, 2014 Senior Editor: Jon Zande Junior Editor: Romina Kim DOI: Pending Citation: Guevara JKH. Isolated Orbital Mucormycosis in an Immunocompetent Adolescent. Medical Student Research Journal. 2014;3(Spring):55-9. References: 1. Venkatachalam VP, Anand N. Paranasal mucormycosis: unusual representation in otherwise healthy child. Indian J Otolaryngol Head Neck Surg 2007; 59: 2646. 2. De Mol P, Meis JM. Disseminated Rhizopus microsporus infection in a patient on oral corticosteroid treatment: a case report. Neth J Med 2009; 67(1): 258. 3. Grewal RK, Grewal SS, Zachariah RM. Orbital mucormycosis (phycomycosis). Indian J Ophthalmol 1985; 33(4): 23941. 4. Shinde RV, Karande GS, Mohite ST, Patil SR. Rhino-orbital mucormycosis in diabetes mellitus. J Clin Diagn Res 2013; 7(6): 11457. http://dx.doi.org/10.7860/JCDR/2013/5528. 3083. 5. Badiee P, Jafarpour Z, Alborzi A, Haddadi P, Rasuli M, Kalani M. Orbital mucormycosis in an immunocompetent individual. Iran J Microbiol 2012; 4(4): 21014. 6. Bharathi R, Arya AN. Mucormycosis in an immunocompetent patient. J Oral Maxillofac Pathol 2012;  16(2): 3089. http://dx.doi.org/10.4103/0973-029X.99100. 7. Shatriah I, Mohn-Amin N, Tuan-Jaafar TN, Khanna RJ, Yunus R, Madhavan M. Rhino-orbital cerebral mucormycosis in an  immunocompetent patient: case report and review of literature. Middle East Afr J Ophthalmol 2012; 19(2): 25861. http://dx.doi.org/10.4103/0974-9233.95269. 8. Mignogna M, Fortuna G, Leuci S, Adamo D, Ruoppo E, Siano M, et al. Mucormycosis in immunocompetent patients: a case-series of patients with maxillary sinus involvement and a critical review of the literature. Int J Infect Dis 2011; 15(8): e53340. http://dx.doi.org/10.1016/j.ijid.2011.02.005. 9. Petrikkos G, Skiada A, Lortholary O, Roilides E, Walsh TJ, Kontoyiannis DP. Epidemiology and clinical manifestations of mucormycosis. Clin Infect Dis 2012; 54(s1): s2334. http://dx.doi.org/10.1093/cid/cir866. 10. Roden MM, Zaoutis TE, Buchanan WL, Knudsen TA, Sarkisova TA, Schaufele RL, et al. Epidemiology and outcome of zygomycosis: a review of 929 reported cases. Clin Infect Dis 2005; 41: 63453. http://dx.doi.org/10.1086/432579. 11. Ferguson AD. Rhinocerebral mucormycosis acquired after a short course of prednisone therapy. J Am Osteopath Assoc 2007; 107(11): 4913. 12. Alsuhaibani AH, Thubaiti GA, Al Badr FB. Optic nerve thickening and infarction as the first evidence of orbital involvement with mucormycosis. Middle East Afr J Ophthal 2012; 19(3): 3402. http://dx.doi.org/10.4103/0974-9233. 97957. 13. Spellberg B, Walsh TJ, Kontoyiannis DP, Edwards J, Ibrahim AS. Recent advances in the management of mucormycosis: from bench to bedside. Clin Infect Dis 2009; 48(12): 174351. http://dx.doi.org/10.1086/599105. 14. Kontoyiannis DP, Lewis RE. Invasive zygomycosis: update on pathogenesis, clinical manifestations, and management. Infect Dis Clin North Am 2006; 20(3): 581607. 15. Schleimer...

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Spring 2014 – Leiomyosarcoma of Small Bowel Discovered by Double Balloon Enteroscopy: a Case Report

Posted by on May 31, 2014 in Articles | 0 comments

Leiomyosarcoma of Small Bowel Discovered by Double Balloon Enteroscopy: a Case Report Authors: Malika Gill*, Shabana F. Pasha, Matthew A, Zarka Author Affiliations: Royal College of Surgeons Ireland, Dublin, Ireland Division of Gastroenterology and Hepatology, Mayo Clinic Arizona, AZ, USA Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, AZ, USA Full Text Article PDF Corresponding Author: Malika Gill; malikagill[at]rcsi.ie Key Words: leiomyosarcoma; double balloon eneroscopy; small bowel tumors; balloon-assisted enteroscopy; deep enteroscopy; capsule endoscopy. Abstract: Introduction and Patient Profile: Introduction of deep enteroscopy (capsule endoscopy (CE), balloon-assisted enteroscopy, and spiral enteroscopy) has led to a significant improvement in diagnosis and management of obscure gastrointestinal bleeding (OGIB). Small bowel (SB) lesions are traditionally discovered by CE or double balloon enteroscopy (DBE). Leiomyosarcomas are rare SB tumors and must be diagnosed early to prevent the risk of metastasis and to improve prognosis. A 46-year-old previously healthy woman presented with 3 weeks of abdominal pain and OGIB. Interventions and Outcomes: Patient underwent usual endoscopic modalities in identifying the source of her gastrointestinal bleeding. Computerized tomography scan identified intussusception of the SB; however, conventional endoscopy and CE were negative for etiology of source of bleeding. Ultimately, DBE successfully located the site of gastrointestinal bleeding, confirmed by pathology as a leiomyosarcoma of the SB. Discussion: Conventional endoscopy and CE may miss some lesions, while DBE can navigate altered SB anatomy, take biopsies, and even provide therapy to the lesion. Although double balloon enteroscopies are expensive and require longer sedation than average endoscopic modalities, they may provide another tool for the diagnosis of SB lesions when other modalities are unsuccessful. Published on date: May 31, 2014 Senior Editor: Sahil Bobby Gambhir Junior Editor: Tina Chaalan DOI: Pending Citation: Gill M, Pasha SF, Zarka MA. Leiomyosarcoma of Small Bowel Discovered by Double Balloon Enteroscopy: a Case Report. Medical Student Research Journal. 2014;3(Spring):51-4. References: 1. Bilimoria KY, Bentrem DJ, Wayne JD, Ko CY, Bennett CL, Talamonti MS. Small bowel cancer in the United States: changes in epidemiology, treatment, and survival over the last 20 years. Ann Surg 2009; 249(1): 6371. http://dx.doi.org/10.1097/SLA.0b013e31818e4641. 2. Arts R, Bosscha K, Ranschaert E, Vogelaar J. Small bowel leiomyosarcoma: a case report and literature review. Turk J Gastroenterol 2012; 23(4): 3814. 3. Weaver MJ, Abraham JA. An introduction to leiomyosarcoma of the bone and soft tissue. 2007. Available from: http://sarcomahelp.org/leiomyosarcoma.html#tpm1_1 [cited 29 December 2013]. 4. Weiss SW. Smooth muscle tumors of soft tissue. Adv Anat Pathol 2002; 9(6): 3519. 5. Euchiasmus. Capsule endoscope. 2006. Available from: http://en.wikipedia.org/wiki/File:CapsuleEndoscope.jpg [cited 25 March 2014]. Licensed under CC BY 2.0. 6. Pasha SF, Leighton JA. Endoscopic techniques for small bowel imaging. Radiol Clin North Am 2013; 51(1): 17787. http://dx.doi.org/10.1016/j.rcl.2012.09.010. 7. Akyuz F, Mungan Z. Diagnostic capability of capsule endoscopy in small bowel diseases. Gastroenterology Res 2009; 2(2): 815. http://dx.doi.org/10.4021/gr2009.03.1281. 8. Gill M. Double balloon enteroscope and overtube. March 28, 2014. Licensed under Creative Commons Attribution 4.0 International License CC BY NC SA. 9. Moschler O, May A, Muller MK, EII C, German DBE Study Group. Complications in and performance of double-balloon enteroscopy (DBE): results from a large prospective DBE database in Germany. Endoscopy 2011; 43(6): 4849. http://dx.doi.org/10.1055/s-0030-1256249. 10. Patel MK, Horlsey-Silva JL, Gomez V, Stauffer JA, Stark ME, Lukens FJ. Double balloon enteroscopy procedure in patients with surgically altered bowel anatomy: analysis of a large prospectively collected database. J Laparoendosc Adv Surg Tech A 2013; 23(5): 40913. http://dx.doi.org/10.1089/lap. 2012.0502. 11. Kulkarni C, Moorthy S, Sreekumar K, Rajeshkannan R, Nazar P, Sandya C, et al. In the work-up of patients with obscure gastrointestinal...

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Spring 2014 – Future Medical Practice and Genetics

Posted by on May 31, 2014 in Articles | 0 comments

Future Medical Practice and Genetics. Author: Alec J. Beaney Author Affiliations: Norwich Medical School, Faculty of Medicine and health Sciences, University of East Anglia, Norwich, United Kingdom Full Text Article PDF Corresponding Author: Alec J. Beaney; A.Beaney[at]uea.ac.uk Key Words: medical student; breast cancer; single nucleotide polymorphisms; genome-wide association studies. Abstract: Significant progress has been made in the rapidly evolving sub specialty of medical genetics. In this article, breast cancer has been used as an example to highlight recent developments in this field of medicine, with a discussion on the implications this has on medical practice and policy. The potential of medical genetics is staggering but not without its limitations, and we must consider all aspects of use before advancing further. Consequently, students and physicians alike need to have a thorough understanding of all components of clinical genetics in order to be ready for this new era of healthcare. Published on date: May 31, 2014 Senior Editor: Michelle Dwyer Junior Editor: Tina Chaalan DOI: Pending Citation: Beaney AJ. Future Medical Practice and Genetics. Medical Student Research Journal. 2014;3(Spring):47-50. References: 1. Turnpenny P, Ellard S. Chapter 1: history and impact of genetics in medicine. In: Emery’s elements of medical genetics. 14th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2012, p. 3. 2. McCrimmon, O. NHGRI celebrates 10th anniversary of the Human Genome Project. 2013. Available from: http://www.genome.gov/27553526 [cited 20 April 2013]. 3. Chui RW, Akolekar R, Zheng YW, Leung TY, Sun H, Chan KC, et al. Non-invasive prenatal assessment of trisomy 21 by multiplexed maternal plasma DNA sequencing: large scale validity study. BMJ 2011; 342: c7401. 4. DNA DTC. 2013. Available from: http://dnadtc.com/ [cited 20 April 2013]. 5. Ripperger T, Gadzicki D, Meindl A, Schlegelberger B. Breast cancer susceptibility: current knowledge and implications for genetic counselling. Eur J Hum Genet 2009; 17(6): 72231. http://dx.doi.org/10.1038/ejhg.2008.212. 6. Bradbury AR, Olopade OI. Genetic susceptibility to breast cancer. Rev Endocr Metab Disord 2007; 8(3): 25567. http://dx.doi.org/10.1007/s11154-007-9038-0. 7. Laronga C, Harness JK, Dixon M, Borgen PI. The role of the breast cancer surgeon in personalized cancer care: clinical utility of the 21-gene assay. Am J Surg 2012; 203(6): 7518. http://dx.doi.org/10.1016/j.amjsurg.2011.07.024. 8. Lo SS, Mumby PB, Norton J, Rychlik K, Smerage J, Kash J, et al. Prospective multicenter study of the impact of the 21-gene recurrence score assay on medical oncologist and patient adjuvant breast cancer treatment selection. J Clin Oncol 2010; 28: 16716. http://dx.doi.org/10.1200/JCO.2008.20.2119. 9. Antoniou AC, Easton DF. Models of genetic susceptibility to breast cancer. Oncogene 2006; 25: 5898905. http://dx.doi.org/10.1038/sj.onc.1209879. 10. Bartkova J, Tommiska J, Oplustilova L, Aaltonen K, Tamminen A, Heikkinen T, et al. Aberrations of the MRE11RAD50NBS1 DNA damage sensor complex in human breast cancer: MRE11 as a candidate familial cancer-predisposing gene. Mol Oncol 2008; 2(4): 296316. http://dx.doi.org/10.1016/j.molonc.2008.09.007 11. Petherick A. Environment and genetics: making sense of the noise. Nature 2012; 485: S645. http://dx.doi.org/10.1038/485S64a. 12. Chan IS, Ginsburg GS. Personalized medicine: progress and promise. Annu Rev Genomics Hum Genet 2011; 12: 217 44. http://dx.doi.org/10.1146/annurev-genom-082410-101446. 13. McClellan KA, Avard D, Simard J, Knoppers B. Personalised medicine and access to health care: potential for inequitable access? Eur J Hum Genet 2013; 21(2): 1437. http://dx.doi.org/10.1038/ejhg.2012.149. 14. Beauchamp TL, Childress JF. Chapter 1: moral norms. In: Principles of biomedical ethics. 5th ed. New York, NY: Oxford University Press; 2001, pp. 125. 15. Amir E, Freedman OC, Seruga B, Evans DG. Assessing women at high risk of breast cancer: a review of risk assessment models. J Natl Cancer Inst 2010; 102(10): 68091. http://dx.doi.org/10.1093/jnci/djq088. 16. Hudson KL....

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Spring 2014 – The Anatomy of a Patient

Posted by on May 31, 2014 in Articles | 0 comments

The Anatomy of a Patient. Author: Scott C. Mauch Author Affiliations: College of Human Medicine, Michigan State University, Grand Rapids, MI, USA Full Text Article PDF Corresponding author: Scott C. Mauch; scott.mauch[at]gmail.com Key Words: N/A Abstract: My grandfather passed away the day after Christmas in 2012. He was a brilliant man who practiced medicine for several decades. During that time, he delivered thousands of babies, and even performed the amniocentesis on my mother when I was a fetus. Yet, in his last months, his failing health did not convey this brilliance. Parkinson’s disease and other neurological issues prevented my grandfather from speaking quickly or coherently. This was tough to witness, but it taught me an important lesson: there is much more to a patient than just the information contained in his/her medical file. This concept was the inspiration for my artwork. Published on date: May 31, 2014 Senior Editor: N/A Junior Editor: N/A DOI: pending Citation: Mauch SC. Anatomy of a Patient. Medical Student Research Journal. 2014;3(Spring):45-6. References: Original artwork inspired by “Study of an Older Man” by John Norman Stewart, 2010 and Musculature of the face with the orbit of the eye” by Nicolas Henri Jacob, 1831....

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Spring 2014 – Letter from the Editors

Posted by on May 31, 2014 in Articles | 0 comments

Letter From the Editors. Author: Kevin C Patterson. Author Affiliations: College of Human Medicine, Michigan State University, East Lansing, MI, USA Full Text Article PDF Corresponding Author: Kevin C. Patterson; patte297[at]gmail.com Key Words: N/A Abstract: With the wrap-up of the 2013-2014 academic year, we are proud of the strides that Medical Student Research Journal (MSRJ) has made. The journal has grown in the number of issues as well as in the number of articles published per issue. In addition, the breadth of article types and topics has greatly increased. This spring issue includes works from the Royal College of Surgeons in Ireland, University of the East Ramon, University of East Anglia Norwich Medical School, and Michigan State University College of Human Medicine. Published on date: May 31, 2014 Senior Editor: N/A Junior Editor: N/A DOI: Pending Citation: Patterson KC. Letter From the Editors. Medical Student Research Journal. 2014;3(Spring):44. References:...

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Winter 2014 – Vemurafenib: Background, Patterns of Resistance, and Strategies to Combat Resistance in Melanoma

Posted by on Jan 1, 2014 in Articles | 0 comments

Vemurafenib: Background, Patterns of Resistance, and Strategies to Combat Resistance in Melanoma.   Arjun Dupati* and Liza Gill   Author Affiliations: College of Human Medicine, Michigan State University, East Lansing, MI, USA     Full Text Article PDF     *Corresponding author: Arjun Dupati; dupatiar[at]gmail.com Arjun Dupati and Liza Gill contributed equally to the production of this manuscript.   Key Words: Vemurafenib; Molecular Targeted Therapy; Melanoma Drug Resistance; Metastatic Melanoma; Tyrosine Kinase Inhibitor; Melanoma Treatment.   Abstract: Introduction: Finding an effective treatment for metastatic melanoma has posed a series of challenges. Vemurafenib, a B-RAF tyrosine kinase inhibitor, has been one of the most successful medications to date in the treatment of metastatic melanoma. B-RAF is a serine/threonine kinase that is a part of the RAS-RAF-MEK-ERK signal transduction pathway, which plays a pivotal role in cellular proliferation, differentiation, and survival. Mutations in the B-RAF protein lead to a deregulated activation of MAPK and ERK. The focus of this review article is resulting resistance to vemurafenib and its clinical implications on the treatment of metastatic melanoma. This paper aims to highlight mechanisms of vemurafenib resistance that have been observed so far and offer potential clinical approaches to overcome resistance. Methods: PubMed, Google Scholar, and EMBASE were searched using the following free text terms: “vemurafenib,” “vemurafenib resistance,” “vemurafenib tyrosine-kinase inhibitor,” “vemurafenib metastatic melanoma,” “vemurafenib alternatives,” and “vemurafenib cancer.” The Cochrane database was searched for randomized controlled trials and systematic reviews using the same search terms above. Two independent reviewers analyzed the search results and corresponding articles. Discussion: Research over the last decade, most notably in the past two years has revealed a multitude of mechanisms of resistance to vemurafenib. Resistance to therapy with vemurafenib in metastatic melanoma could be explained by the presence of cancer stem cells. Conclusion: In order to effectively circumvent resistance, it would behoove clinicians to approach metastatic melanoma with a cocktail of inhibitors as opposed to monotherapy.   Published: January 1, 2014   Senior Editor: Kailyne Van Stavern   Junior Editor: Kaitlyn Vitale   DOI: Pending   Citation: Dupati A, Gill L. Vemurafenib: Background, Patterns of Resistance, and Strategies to Combat Resistance in Melanoma. Medical Student Research Journal. 2014;3(Winter):36-43.     References: 1. Lemech C, Infante J, Arkenau HT. The potential for BRAF V600 inhibitors in advanced cutaneous melanoma: rationale and latest evidence. Ther Adv Med Oncol. 2012;4(2):61-73. http://dx.doi.org/10.1177/1758834011432949.   2. Dahlman KB, Xia J, Hutchinson K, et al. BRAF(L597) mutations in melanoma are associated with sensitivity to MEK inhibitors. Cancer Discov. 2012;2(9):791-797.   3. Castellani E, Covarelli P, Boselli C, et al. Spontaneous splenic rupture in patient with metastatic melanoma treated with vemurafenib. World J Surg Oncol. 2012;10:155. http://dx.doi.org/10.1186/1477-7819-10-155.   4. De Mello RA. Metastatic melanoma and vemurafenib: novel approaches. Rare Tumors. 2012;4(2):e31. http://dx.doi.org/10.4081/rt.2012.e31.   5. Kim J, Lazar AJ, Davies MA, et al. BRAF, NRAS and KIT sequencing analysis of spindle cell melanoma. J Cutan Pathol. 2012;39(9):821-825. http://dx.doi.org/10.1111/j.1600-0560.2012.01950.x.   6. Fisher R, Larkin J. Vemurafenib: a new treatment for BRAF-V600 mutated advanced melanoma. Cancer Manag Res. 2012;4:243-252. http://dx.doi.org/10.2147/CMAR.S25284.   7. Flaherty KT, Yasothan U, Kirkpatrick P. Vemurafenib. Nat Rev Drug Discov. 2011;10(11):811-812. http://dx.doi.org/10.1038/nrd3579.   8. Ascierto PA, Kirkwood JM, Grob JJ, et al. The role of BRAF V600 mutation in melanoma. J Transl Med. 2012;10:85. http://dx.doi.org/10.1186/1479-5876-10-85.   9. Johannessen CM, Boehm JS, Kim SY, et al....

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Winter 2014 – Substance Use Among Physicians and Medical Students

Posted by on Jan 1, 2014 in Articles | 0 comments

Substance Use Among Physicians and Medical Students.   Catalina I. Dumitrascu1*, Philip Z. Mannes2, Lena J. Gamble3, Jeffrey A. Selzer4   Author Affiliations: 1Creighton University School of Medicine, Omaha, NE, USA. 2Dartmouth College, Hanover, NH, USA. 3National Institutes of Health, Department of Perioperative Medicine, Bethesda, MD, USA. 4Committee for Physician Health, Albany, NY, USA.     Full Text Article PDF   Corresponding author: Catalina I. Dumitrascu, BS, MS; catalinadumitrascu[at]creighton.edu   Key Words: Substance-related disorders; Alcohol abuse; Physician Health Programs.   Abstract: Background: Physicians and medical students whose substance use causes impairment pose a risk to both themselves and their patients. Drug abuse is a documented problem in physicians, however few studies have investigated the rates of drug abuse in medical students. While treatment plans may be tailored for both students and attending physicians, there is often a reluctance to refer one’s self or a colleague due to a variety of reasons related to fear of repercussions, belief the problem has already been addressed, failure to recognize, or ignorance. This review provides a brief background on common signs and symptoms of potential abuse and resources available to doctors in training at various stages of their career, along with providing a clear picture of the literature as it pertains to physician and medical student substance abuse. Methods: Extensive search of the literature utilized physical and electronic resources available at the National Institutes of Health Library and the National Library of Medicine with search results limited to the topics of physician or medical student substance use, substance abuse, impairment, and treatment. Results: Sparse recent data regarding physician and medical student substance abuse are available. Studies completed two decades ago demonstrate that drug abuse was a significant problem for doctors and medical students at that time. Conclusion: Due to outdated, and/or incomplete data on substance abuse in physicians and especially medical students, it is difficult to report the current extent of substance abuse in these groups. Nonetheless, it is important to recognize substance abuse in these populations and promote referral to substance abuse programs. Early rehabilitation and treatment improves both career and patient outcomes. This study highly suggests the need for up to date information regarding substance abuse in the medical community so that appropriate resources can be developed and effectively utilized.   Published: January 1, 2014   Senior Editor: Kevin C. Patterson   Junior Editor: Caela Hesano   DOI: Pending   Citation: Dumitrascu CI, Mannes PZ, Gamble LJ, Selzer JA. Substance Use Among Physicians and Medical Students. Medical Student Research Journal. 2014;3(Winter):26-35.     References: 1. Hasin DS, O’Brien CP, Auriacombe M, et al. DSM-5 criteria for substance use disorders: recommendations and rationale. Am J Psychiatry. Aug 2013;170(8):834-851. http://dx.doi.org/10.1176/appi.ajp.2013.12060782.   2. Federation of State Medical Boards Policy on Physician Impairment. Euless, TX: House of Delegates of the Federation of State Medical Boards of the United States;2011.   3. World Drug Report 2013. United Nations Office on Drugs and Crime;2013. Sales No. E.13.XI.6.   4. Results from the 2011 National Survey on Drug Use and Health: Summary of National Findings. Rockville, MD: Substance Abuse and Mental Health Services Administration;2012. HHS Publication No. (SMA) 12-4713.   5. CDC. Policy impact: prescription painkiller overdoses. Atlanta, GA, USA: US Department of Health and Human Services, CDC; 2011.   6. The sick physician. Impairment by psychiatric disorders,...

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Winter 2014 – Morphine-induced Myoclonus in a Patient with End-stage Renal Disease

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Morphine-Induced Myoclonus in a Patient with End-Stage Renal Disease.   Victoria L. Stahl1*, Hassan I. Ahmad2, and James E. Novak3   Author Affiliations: 1School of Medicine, Wayne State University, Detroit, MI, USA. 2Department of Medicine, Henry Ford Hospital, Detroit, MI, USA. 3Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, MI, USA.     Full Text Article PDF   *Corresponding author: Victoria Stahl, BS; vstahl[at]med.wayne.edu   Key Words: End-Stage Renal Disease; Dialysis; Myoclonus; Morphine; Opioid Rotation.   Abstract: Introduction and Patient Profile: Pain is a common complaint, and pain control is frequently challenging. End-stage renal disease (ESRD) patients constitute a special population in whom commonly-prescribed medications, including pain medications, must be adjusted or discontinued for safety. We describe a patient with ESRD in whom myoclonus developed after he received 60 days of morphine. Interventions and Outcomes: Morphine was discontinued, and symptoms resolved. Discussion: Morphine is hepatically metabolized to morphine-3-glucuronide (M3G), which is renally cleared. In patients with ESRD, M3G and other metabolites are neither renally cleared nor easily removed by dialysis, increasing the risk of neuroexcitatory symptoms such as myoclonus. The use and dosing of renally-cleared medications in ESRD patients should be carefully reviewed by prescribers and pharmacists.   Published: January 1, 2014   Senior Editor: Jack Mettler   Junior Editor: Margaret Chi   DOI: Pending   Citation: Stahl VL, Ahmad HI, Novak JE. Morphine-Induced Myoclonus in a Patient with End-Stage Renal Disease. Medical Student Research Journal. 2014;3(Winter):023-5.     References: 1. Munar M, Singh H. Drug Dosing Adjustments in Patients with Chronic Kidney Disease. American Family Physician. May 2007;75(10):1487-1496.   2. Pauli-Magnus C, Hofmann U, Mikus G, Kuhlmann U, Mettang T. Pharmocokinetics of Morphine and its Glucuronides Following Intravenous Administration of Morphine in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis. Nephrology Dialysis Transplantation. April 1999;14(4):903-909. http://dx.doi.org/10.1093/ndt/14.4.903.   3. Dean M. Opioids in Renal Failure and Dialysis Patients. Journal of Pain and Symptom Management. November 2004;28(5):497-504. http://dx.doi.org/10.1016/j.jpainsymman.2004.02.021.   4. Andersen G, Christrup L, Sjøgren P. Relationships Among Morphine Metabolism, Pain and Side Effects During Long-Term Treatment: An Update. Journal of Pain and Symptom Management. January 2003;25(1):74-91.   5. Hemstapat K, Monteith G, Smith D, Smith MT. Morphine-3-Glucuronide’s Neuro-Excitatory Effects Are Mediated via Indirect Activation of N-Methyl-D-Aspartic Acid Receptors: Mechanistic Studies in Embryonic Cultured Hippocampal Neurones. Anesthesia and Analgesia. August 2003;97(2):494-505. http://dx.doi.org/10.1213/01.ANE.0000059225.40049.99.   6. Indelicato RA, Portenoy RK. Opioid Rotation in the Management of Refractory Cancer Pain. Journal of Clinical Oncology. January 2002;20(1):348-352.   7. Narabayashi M, Saijo Y, Takenoshita S, Chida M, Shimoyama N, Miura T, Tani K, Nishimura K, Onozawa Y, Hosokawa T, Kamoto T, Tsushima T. Opioid Rotation from Oral Morphine to Oral Oxycodone in Cancer Patients with Intolerable Adverse Effects: An Open-Label Trial. Japanese Journal of Clinical Oncology. April 2008;38(4):296-304. http://dx.doi.org/10.1093/jjco/hyn010.   8. Gagnon DJ, Jwo K. Tremors and Agitation Following Low-Dose Intravenous Hydromorphone Administration in a Patient with Kidney Dysfunction. Annals of Pharmacotherapy. July/August 2013;47(7-8);e34. http://dx.doi.org/10.1345/aph.1R784.   9. Paramanandam G, Prommer E, Schwenke DC. Adverse Effects in Hospice Patients with Chronic Kidney Disease Receiving Hydromorphone. Journal of Palliative Medicine. September 2011;14(9):1029-1033. http://dx.doi.org/10.1089/jpm.2011.0103.   10. King S, Forbes K, Hanks GW, Ferro CJ, Chambers EJ. A Systemic Review of the Use of Opioid Medication for Those with Moderate to Severe Cancer Pain and Renal Impairment: A European Palliative Care Research Collaborative Opioid Guidelines Project. Palliative Medicine. July...

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Winter 2014 – Declaration of Helsinki: What Does the Future Hold?

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Declaration of Helsinki: What Does the Future Hold?   Margaret D. Chi* and Michelle A. Dwyer   Author Affiliations: College of Human Medicine, Michigan State University, East Lansing, MI, USA     Corresponding author: Margaret D. Chi MPH; chimarga[at]msu.edu   Key Words: Research Ethics; Medicine; Human Research Subject Protection; Informed Consent; Helsinki Declaration; Bioethics   Full Text Article PDF   Corresponding author: Margaret D. Chi MPH; chimarga[at]msu.edu   Key Words: Research Ethics; Medicine; Human Research Subject Protection; Informed Consent; Helsinki Declaration; Bioethics   Abstract: Within the world of medical research, the Declaration of Helsinki (DoH) has long been considered the cornerstone document explaining the “rules” of ethical human research. Developed in 1964 by the World Medical Association to protect the rights of research subjects, it originally contained a set of 11 articles explaining the basic ethical duties of physicians in regards to research. The original version took aspects of the Nuremburg Code and Declaration of Geneva to incorporate human experimentation with the physician’s ethical role in the process and delineated a patient’s rights of informed consent, privacy and safety1,3. Since then, it has undergone seven revisions and grown in length from 11 to now 37 articles, with categories ranging from General Principles to Risks to Informed Consent (http://www.wma.net/en/30publications/10policies/b3/index.html)2. Though considered comprehensive and accurate in some aspects, it has not been without controversy over the years. Therefore, this year, which commemorates the 50th anniversary of the document, we must ask, how has the relevance of DoH changed, and will it change further in the future?   Published: January 1, 2014   Senior Editor: N/A   Junior Editor: N/A   DOI: Pending   Citation: Chi MD, Dwyer MA. Declaration of Helsinki: What Does the Future Hold?. Medical Student Research Journal. 2014;3(Winter):20-2.     References: 1. Carlson, RV, Boyd KM, Webb, DJ. The Revision of the Declaration of Helsinki: Past, present and future. British Journal of Clinical Pharmacology. 2004; 57(6):695-713. http://dx.doi.org/10.1111/j.1365-2125.2004.02103.x.   2. Nbebele, P. The Declaration of Helsinki, 50 years later. JAMA. 2013; 310(20):2145-6. http://dx.doi.org/10.1001/jama.2013.281316.   3. World Medical Association. World Medical Association Declaration of Helsinki: ethical principles form medical research involving human subjects. JAMA. 2013; 310(20):2191-4. http://dx.doi.org/10.1001/jama.2013.281053.   4. Millium, J, Wendler, D, Emmanuel E. The 50th Anniversary of the Declaration of Helsinki: progress but many remaining challenges. JAMA. 2013; 310(20):2143-4. http://dx.doi.org/10.1001/jama.2013.281632.   5. Coyne, J. Revised Ethical Principles Have Profound Implications for Psychological Research. PLOS Blogs. 2013. http://blogs.plos.org/mindthebrain/2013/10/20/revised-ethical-principles-have-profound-implications-for-psychological-research/ [cited 30 November, 2013]....

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Winter 2014 – Spirit Queen

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Spirit Queen.   Masaki Nagamine   Author Affiliations: College of Human Medicine, Michigan State University, Grand Rapids, MI, USA     Full Text Article PDF   Corresponding Author: Masaki Nagamine; masakinagamine[at]gmail.com   Key Words: N/A   Abstract: Preface: In my childhood, I lived with a family member suffering from paranoid schizophrenia. The painting is my interpretation of the inner turmoil that this family member faces regularly. It is my hope that the viewers of this painting can gain some insight into the difficulties involved in living with a chronic mental illness that cannot be fully understood. The painting depicts a person with paranoid schizophrenia attempting to balance her perceived reality between cultural beliefs, logical reasoning, and schizophrenic delusion. The image shows a young child looking down on her brain encased in a coiled golden ribbon to illustrate the dichotomy of the body and mind. The four corners of the painting are weathered and deteriorating to demonstrate the progressive nature of the disease/illness.   Published: January 1, 2014   Senior Editor: N/A   Junior Editor: N/A   DOI: Pending   Citation: Nagamine M. Spirit Queen. Medical Student Research Journal. 2014;3(Winter):18-9.     References:...

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Winter 2014 – Letter From the Editors

Posted by on Jan 1, 2014 in Articles | 0 comments

Letter From the Editors.   Kevin C. Patterson and Jessica L. Wummel   Author Affiliations: College of Human Medicine, Michigan State University, East Lansing, MI, USA   Full Text Article PDF   Corresponding Author: Kevin C. Patterson; patte297[at]gmail.com   Key Words: N/A   Abstract: The editors of MSRJ would like to extend our warm wishes in the winter season and hope that it has been filled with joy, family, and good fortune. We are very excited to introduce the first issue of 2014, as well as the second issue of the 20132014 academic year. As medical students around the world return to their books and clinic duties, we present educational and stimulating new articles. The published works in this issue highlight the efforts of students from Creighton University School of Medicine, Wayne State University School of Medicine, and Michigan State University College of Human Medicine.   Published: January 1, 2014   Senior Editor: N/A   Junior Editor: N/A   DOI: Pending   Citation: Patterson KC, Wummel JL. Letter From the Editors. Medical Student Research Journal. 2014;3(Winter):17.     References:...

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Fall 2013 – Direct Access to Physical Therapy in Michigan is Overdue

Posted by on Sep 30, 2013 in Articles | 0 comments

Direct Access to Physical Therapy in Michigan is Overdue.   Kevin C. Patterson1*, Rachel A. Patterson2   1College of Human Medicine, Michigan State University, Grand Rapids, MI, USA 2College of Health Professions, Grand Valley State University, Grand Rapids, MI, USA   Full Text Article PDF   *Corresponding Author: Kevin C. Patterson; patte297[at]gmail.com   Key Words: Direct Access; Physical Therapy; Primary Care; Healthcare; Utilization   Abstract: Direct access to physical therapists (PTs), the ability for a patient to seek care from a PT without physician referral, has been contested for many years. The traditional gatekeeper model of access to physical therapy has changed throughout the nation and only two states remain without direct access. Michigan is one of those states, and the state legislature has not advanced direct access legislation despite numerous opportunities over the past 12 years. However, no evidence exists to show that direct access causes harm to patients and the healthcare system and, on the contrary, easy and early access to physical therapy by patients has been shown to improve outcomes and decrease costs of care. Direct access to physical therapy is long overdue in Michigan and should be reconsidered in order to better serve our patients and the healthcare system.   Published: September 30, 2013     Senior Editor: N/A   Junior Editor: N/A   Citation: Patterson KC, Patterson RA. Direct Access to Physical Therapy in Michigan is Overdue. Medical Student Research Journal. 2013;3(Fall):13-16.     References: 1. Brooks G, Dripchak S, Vanbeveren P, Allaben S. Is a prescriptive or an open referral related to physical therapy outcomes in patients with lumbar spine-related problems? J Orthop Sports Phys Ther. 2008; 38(3):109-15. http://dx.doi.org/10.2519/jospt.2008.2591. 2. American Physical Therapy Association (2013). Direct access at the state level. Available from: http://www.apta.org/ StateIssues/DirectAccess. [cited 20 September 2013]. 3. American Physical Therapy Association (2013). Who are physical therapists? Available from: http://www.apta.org/AboutPTs [cited 20 September 2013]. 4. Rose SJ. Physical therapy diagnosis: role and function. Phys Ther. 1989; 69:535-7. http://physther.net/content/69/7/535.short. 5. Shah N, Nakamura Y. Case report: schizophrenia discovered during the patient interview in a man with shoulder pain referred for physical therapy. Physiother Can. 2010; 62:308-15. http://utpjournals.metapress.com/content/31rt02094252713t/. 6. Stowell T, Cioffredi W, Greiner A, Cleland J. Abdominal differential diagnosis in a patient referred to a physical therapy clinic for low back pain. J Orthop Sports Phys Ther. 2005; 35(11):755-64. http://dx.doi.org/10.2519/jospt.2005.35.11.755. 7. Boissonnault WG, Ross MD. Physical therapists referring patients to physicians: a review of case reports and series. J Orthop Sports Phys Ther. 2012; 42(5):446-54. http://dx.doi.org/10.2519/jospt.2012.3890. 8.Childs JD, Whitman JM, Sizer PS, Pugia ML, Flynn TW, Delitto A. A description of physical therapists’ knowledge in managing musculoskeletal conditions. BMC Musculoskelet Disord. 2005; 6:7. http://dx.doi.org/10.1186/1471-2474-6-32. 9. Davenport TE, Watts HG, Kulig K, Resnik C. Current status and correlates of physicians’ referral diagnoses for physical therapy. J Orthop Sports Phys Ther. 2005; 35(9):572-9. http://dx.doi.org/10.2519/jospt.2005.35.9.572. 10. Davenport TE, Sebelski CA. The physical therapist as a diagnostician: how do we, should we, and could we use information about pathology in our practice? Phys Ther. 2011; 91(11):1694-5. http://dx.doi.org/10.2522/ptj.2011.91.11.1694. 11. Moore JH, McMillian DJ, Rosenthal MD, Weishaar MD. Risk determination for patients with direct access to physical therapy in military health care facilities. J Orthop Sports Phys Ther. 2005; 35(10):674-8. http://dx.doi.org/10.2519/jospt.2005.35.10.674. 12. Pinnington MA, Miller J, Stanley I. An evaluation of prompt access to physiotherapy in the management...

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Fall 2013 – Public Stroke Knowledge – Those Most at Risk, Least Able to Identify Symptoms

Posted by on Sep 30, 2013 in Articles | 0 comments

Public Stroke Knowledge – Those Most at Risk, Least Able to Identify Symptoms.   Zachary Jarou*, Nathaniel Harris, Liza Gill, Meena Azizi, Shayef Gabasha, Robert LaBril.   College of Human Medicine, Michigan State University, East Lansing, MI, USA   Full Text Article PDF   *Corresponding author: Zachary Jarou; zachjarou[at]gmail.com   Key Words: Stroke; CVA; Risk Factors; Warning Signs; Patient Education; Public Health.   Abstract: Background and purpose: Fewer than 1 in 20 patients with acute ischemic stroke are treated with thrombolytic drugs, with three quarters of otherwise eligible patients being excluded secondary to delay in seeking medical treatment. Lack of symptom recognition may contribute to low treatment rates and is an important focus of public health education. The purpose of this study was to determine if an individual’s cumulative number of stroke risk factors correlated with their ability to identify stroke symptoms. Methods: We surveyed adults about their stroke risk factors and knowledge of stroke symptoms at grocery stores and malls in a medium-sized university town in the Midwestern US. Results: In total, 245 adults completed surveys. Self-reported risk factors included high blood pressure (25%), high cholesterol (22%), diabetes (12%), tobacco use (11%), alcohol use (7%), heart disease (7%), and prior stroke (3%). Cumulatively, 56% of respondents had no risk factors, 41% had 13 risk factors, and 4% had 4risk factors. When administered a six-point stroke symptom knowledge test, respondents with 4 risk factors were significantly less knowledgeable, receiving a mean score of 3.2, compared to those with 13 risk factors, who scored a mean of 4.6. Those with four or more years of college were significantly more knowledgeable than those with only a high-school education, receiving mean scores of 4.6 and 3.9, respectively. There was no association between stroke knowledge and use of a primary care physician. Conclusions: Although it is known that individuals with more risk factors are more likely to have a stroke, in our study these respondents were less able to recognize stroke symptoms compared to respondents with fewer risk factors. Future public stroke awareness campaigns should be targeted toward those most at risk so they learn to recognize stroke symptoms and thus seek treatment in a timely manner.   Published: September 30, 2013   Senior Editor: Jack Mettler   Junior Editor: Tim Smith   DOI: Pending   Citation: Jarou Z, Harris N, Gill L, Azizi M, Gabasha S, LaBril R. Public Stroke Knowledge – Those Most at Risk, Least Able to Identify Symptoms. Medical Student Research Journal. 2013;3(Fall):3-8.     References: 1. Roger VL, Go AS, Lloyd-Jones DM, et al. Heart disease and stroke statistics-2011 update a report from the American Heart Association. Circulation. 2011; 123:e18-e209. http://dx.doi.org/10.1161/CIR.0b013e3182009701. 2. Wechsler LR. Intravenous thrombolytic therapy for acute ischemic stroke. N Engl J Med. 2011; 364:2138-46. http://dx.doi.org/10.1056/NEJMct1007370. 3. Hacke W, Kaste M, Bluhmki E, et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med. 2008; 359:1317-29. http://dx.doi.org/10.1056/NEJMoa0804656. 4. California Acute Stroke Pilot Registry (CASPR) Investigators. Prioritizing interventions to improve rates of thrombolysis for ischemic stroke. Neurology 2005; 64(4):654-9. http://dx.doi.org/10.1212/01.WNL.0000151850.39648.51. 5. Barber PAM, Zhang J, Demchuk AM, Hill MD, Buchan AM. Why are stroke patients excluded from TPA therapy? An analysis of patient eligibility. Neurology. 2001; 56(8):1015-20. http://dx.doi.org/10.1212/WNL.56.8.1015. 6. Katzan IL, Hammer MD, Hixson ED, et al. Utilization of intravenous tissue...

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Fall 2013 – A Rare Case of Breast Carcinosarcoma with Lymphatic Metastasis

Posted by on Sep 30, 2013 in Articles | 0 comments

A Rare Case of Breast Carcinosarcoma with Lymphatic Metastasis.   Megan C. Hamre1*, Jennifer M. Eschbacher2, Frances Hahn2, Tilina Hu2   1School of Medicine, Creighton University, Omaha, NE, USA 2St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA   Full Text Article PDF   *Corresponding Author: Megan C. Hamre; Meganhamre1[at]creighton.edu   Key Words: Breast Cancer; Carcinosarcoma; Clinical Protocols; Treatment Protocols; Lymphatic Metastasis.   Abstract: Introduction and Patient Profile: Carcinosarcoma of the breast is a rare malignancy composed of two cell lines described as a ductal-type carcinoma with a sarcoma-like component. It is an aggressive neoplasm that is usually larger in size than epithelial breast cancers and characterized by a rapid increase in size. A 32-year-old woman presented with a palpable lump in the left upper outer breast. Imaging findings and an ultrasound-guided biopsy demonstrated a malignant neoplasm with chondroid differentiation. Interventions and Outcomes: The patient underwent a modified radical left breast mastectomy with sentinel node biopsy. Pathology report from the mastectomy demonstrated an infiltrating metaplastic carcinoma (MPC) with positive lymph nodes. Discussion: The most unusual feature of this case is the lymph node positivity, as lymphatic spread is uncommonly associated with carcinosarcoma or any subtype of metaplastic carcinoma of the breast. This case is important because it illustrates the potential future need for treatment guidelines for this uncommon tumor.   Published: September 30, 2013   Senior Editor: Skyler Johnson   Junior Editor: Alex Golec   DOI: Pending   Citation: Hamre MC, Eschbacher JM, Hahn F, Hu T. A Rare Case of Breast Carcinosarcoma with Lymphatic Metastasis. Medical Student Research Journal. 2013;3(Fall):9-12.     References: 1. Beatty JD, Atwood M, Tickman R, Reiner M. Metaplastic breast cancer: clinical significance. Am J Surg. 2006; 191(5):657-64. http://dx.doi.org/10.1016/j.amjsurg.2006.01.038. 2. Esses KM, Hagmaier RM, Blanchard SA, Lazarchick JJ, Riker AI. Carcinosarcoma of the breast: two case reports and review of the literature. Cases J. 2009; 2:15. http://dx.doi.org/10.1186/1757-1626-2-15. 3. SEER Cancer Statistics Factsheets: Breast Cancer. National Cancer Institute. Bethesda, MD, Available from: http://seer.cancer.gov/statfacts/html/breast.html [cited 8 September 2013]. 4. Leddy R, Irshad A, Rumboldt T, Cluver A, Campbell A, Ackerman S. Review of metaplastic carcinoma of the breast: imaging findings and pathologic features. J Clin Imaging Sci. 2012; 2:21. http://dx.doi.org/10.4103/2156-7514.95435. 5. Al Sayed AD, El Weshi AN, Tulbah AM, Rahal MM, Ezzat AA. Metaplastic carcinoma of the breast clinical presenta- tion, treatment results and prognostic factors. Acta Oncol. 2006; 45(2):188-95. http://dx.doi.org/10.1080/02841860500513235. 6. Shin HJ, Kim HH, Kim SM, Kim DB, Kim MJ, Gong G, et al. Imaging features of metaplastic carcinoma with chon- droid differentiation of the breast. AJR Am J Roentgenol. 2007; 188(3):691-6. http://dx.doi.org/10.2214/AJR.05.0831. 7. Smith TB, Gilcrease MZ, Santiago L, Hunt KK, Yang WT. Imaging features of primary breast sarcoma. AJR Am J Roentgenol. 2012; 198(4):W386-93....

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Fall 2013 – Incomplete Storytelling

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Incomplete Storytelling.   Alexander S. Golec.   College of Human Medicine, Michigan State University, East Lansing, MI, USA   Full Text Article PDF   Corresponding Author: Alexander S. Golec; golec@msu.edu   Key Words: N/A   Abstract: Our interviews, physical exams, and laboratory tests only uncover select words of a patient’s story. Some days we may be lucky enough to stumble upon a phrase or complete sentence in their life’s tome. We base our diagnoses on these incomplete discoveries and hope for the best. Some of us may act like we have the Rosetta Stone in our pocket, granting us the ability to translate everything into our noble medical language. Others may focus too much time on the details of the letters and completely miss the story behind them. Deciphering the story of each patient requires not only a stellar medical acumen but also an ability to comprehend stories in languages that may seem foreign to us.   Published: September 30, 2013   Senior Editor: N/A   Junior Editor: N/A   DOI: Pending   Citation: Golec AS. Incomplete Storytelling. Medical Student Research Journal. 2013;3(Fall):2.     References:...

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Fall 2013 – Letter From the Editors

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Letter From the Editors.   Kevin C. Patterson, Jessica L. Wummel.   College of Human Medicine, Michigan State University, Grand Rapids, MI, USA   Full Text Article PDF   Corresponding Author: Kevin C. Patterson; patte297[at]gmail.com   Key Words: N/A   Abstract: In the third MSRJ issue of 2013 and the first of the 2013-2014 academic year, we are very excited to present enlightening and thought-provoking articles. We are publishing the work of students from Michigan State University’s College of Human Medicine and Creighton University School of Medicine. This journal has seen large growth since the Spring 2013 issue, and we have bigger plans for the future.   Published: September 30, 2013   Senior Editor: N/A   Junior Editor: N/A   DOI: Pending   Citation: Patterson KC, Wummel JL. Letter from the Editors. Medical Student Research Journal. 2013;2(Fall):1.     References:...

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Spring 2013 – Funding the Future

Posted by on May 31, 2013 in Articles | 0 comments

Funding the Future.   David L. Ortiz.   Author Affiliations: College of Human Medicine, Michigan State University, East Lansing, MI, USA   Full Text Article PDF   Corresponding author: David Ortiz; ortizdav[at]msu.edu   Key Words: N/A   Abstract: The problems facing healthcare training today are not simple. Predictions about future demand for physicians have a poor track record, as the GMENAC studies of the 1980s showed. Even if one could predict perfectly the demand for physicians in the future, history has shown that it takes 10-40 years for the full effects of increased medical school enrollment to be felt. The rate of GME must rise. In its present state, GME could sustain reductions as great as 10% of funding without the loss of total residency slots, but any decrease in GME funding will undoubtedly perpetuate the inadequacy of the physician workforce. By 2016, without increased GME funding, there will be a substantial increase in the number of unmatched US seniors and a substantial decrease in the number of foreign medical grads.   Published: May 31, 2013     Senior Editor: N/A   Junior Editor: N/A   DOI: Pending   Citation: Ortiz DL. Funding the Future. Medical Student Research Journal. 2013;2(Spring):36-39.     References: 1. National Resident Matching Program. NRMP post-match press release. Washington, DC: National Resident Matching Program; 2013. http://www.nrmp.org/wp-content/uploads/2013/08/pressreleasepostmatch2013.pdf 2. Education USSGCG on M, Bane F. Physicians for a growing America: report. Washington, DC: Public Health Service, U.S. Department of Health, Education, and Welfare; 1959. 3. Ruhe CW. Present projections of physician production. JAMA. 1966; 198(10):1094-100. http://dx.doi.org/10.1001/jama.1966.03110230110024. 4. National Residency Matching Program. Results and data: 2012 main residency match SM. Washington, DC: National Residency Matching Program; 2012. http://sls.downstate.edu/student_affairs/documents/NRMP2012Results_Data.pdf 5. Health Resources Administration, Office of Graduate Medical Education. Report of the Graduate Medical Education National Advisory Committee, Volumes I-VII. Washington, DC: Health Resources Administration, Office of Graduate Medical Education; 1980. 6. Nicholson S. Will the United States have a shortage of physicians in 10 years? 2009. Available from: http://hdl.handle.net/1813/15101. Accessed May 1, 2013. 7. Office of Inspector General. Medicare hospital prospective payment system how DRG rates are calculated and updated; Washington, DC: U.S. Department of Health & Human Services; 2001. https://oig.hhs.gov/oei/reports/oei-09-00-00200.pdf. 8. Reinhardt UE. Analyzing cause and effect in the U.S. physician workforce. Health Aff. 2002; 21(1):165-6. http://dx.doi.org/10.1377/hlthaff.21.1.165. 9. Center for Workforce Studies. Results of the 2011 Medical School Enrollment Survey. Washington, DC: Association of American Medical Colleges; 2011. https://www.aamc.org/download/281126/data/enrollment2012.pdf. 10. Center for Workforce Studies. 2011 State physician workforce data book. Washington, DC: Association of American Medical Colleges; 2011. https://www.aamc.org/download/263512/data/statedata2011.pdf. 11. National Resident Matching Program. NRMP residency match 2013 results. Washington, DC: National Resident Matching Program; 2013. http://www.nrmp.org/match-data/main-residency-match-data/. 12. Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (2003H.R. 1). GovTrack.us. Available from: http://www.govtrack.us/congress/bills/108/hr1 [cited 15 May 2013]. 13. Chen C, Xierali I, Piwnica-Worms K, Phillips R. The redistribution of graduate medical education positions in 2005 failed to boost primary care or rural training. Health Aff. 2013; 32(1):102-10. http://dx.doi.org/10.1377/hlthaff.2012.0032. 14. Local hospital CEOs want private fund for more residencies Jacksonville Business Journal. Available at: http://www.bizjournals.com/jacksonville/print-edition/2011/11/18/local-hospital-ceos-want-private-fund.html?pageall [cited 6 May 2013] 15. Porter S. Federal dollars launch National Family Medicine Residency Program. AAFP. Available at: http://www.aafp.org/online/en/home/ publications/news/news-now/education-professional-development/20130307ntlfmresidency.html. Accessed May 6, 2013. 16. Innovative funding opens new residency slots amednews.com; 2006. Available from: http://www.amednews.com/article/20060130/profession/301309963/2/#minb [cited 1 May 2013]. 17. Privately Funded Residency....

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