Articles

Fall 2014 – A Medical Student Elective Course in Business and Finance: A Needs Analysis and Pilot

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

A Medical Student Elective Course in Business and Finance: A Needs Analysis and Pilot. Author: Joseph B. Meleca1, Maria Tecos1, Abigail L. Wenzlick1, Rebecca Henry2, Patricia A. Brewer3. Author Affiliations: 1College of Human Medicine, Michigan State University, East Lansing, MI, US 2Office of Medical Education, Research and Development, College of Human Medicine, Mighigan State University, East Lansing, MI, USA 3Office of Preclinical Curriculum, College of Human Medicine, Michigan State University, East Lansing, MI, USA Full Text Article PDF Corresponding Author: Joseph B. Meleca; melecajo[at]msu.edu Key Words: curriculum reform; medical business; medical finance; student-led; course; elective; module; student debt. Abstract: Background:  As the knowledge needed by physicians expands past basic science and patient care, students are calling for their medical school education to do the same. At Michigan State University College of Human Medicine, students addressed this concern by developing a pilot elective, Medical Business and Finance (MBF). The goal of this student-led elective was to provide a basic understanding of personal finance, student debt handling, business management, and insurance reimbursement issues. Methods:  A preliminary needs assessment was conducted to discern if students wanted medical business and finance supplementation to the medical school curriculum.  Ninety percent of students reported interest in a business and finance elective. Once the course was instated, student satisfaction and knowledge-base in medical business and finance was analyzed through pre-elective, pre-session and post-elective survey. Results:  Results were analyzed on forty-eight students’ pre-survey and post-survey responses.  After the course, self-assessed student knowledge regarding finance and business nearly doubled.  The average pre-elective self-assessed knowledge of finance was 3.02 on a ten-point scale and knowledge of business was 2.61. This was compared to an average post-elective self-assessed knowledge of 5.75 and 5.44, respectively. Satisfaction in MSU CHM business and finance resources also slightly increased at the completion of the course.  Nearly 85% of students felt they benefited from participating in the elective.  Similarly, 85% felt that incoming students would also benefit from taking the course. Almost 30% of students believed the material covered in the MBF Elective should be in the required medical school curriculum. Conclusion:  A student led elective can be an effective way to introduce students to an array of topics related to medical business and finance. Students felt that their knowledge of these topics increased and they valued the addition of medical business and finance education to their curriculum. A student-led elective is one potential way for others to successfully incorporate these topics into medical school curricula across the country. Published on date: September 31, 2014 Senior Editor: Jon Zande Junior Editor: Ghadear Shukr DOI: Pending Citation: Meleca JB, Tecos M, Wenzlick AL, Henry R, Brewer PA. A Medical Student Elective Course in Business and Finance: A Needs Analysis and Pilot. Medical Student Research Journal. 2014;4(Fall):18-23. References: Cuckler GA, Sisko AM, Keehan SP, et al. National health expenditure projections, 2012-22: Slow growth until coverage expands and economy Improves.  Health Affairs. 2013; 32: 1820-31. doi: 10.1377/hlthaff.2013.0721 Asch DA, Nicholson S, Vujicic M. Are we in a medical education bubble market? N Engl J Med. 2013; 369: 1973-1975. doi: 10.1056/NEJMp1310778 Tilburt JC, Cassel CK. Why the ethics of parsimonious medicine is not the ethics of rationing. JAMA. 2013; 309: 773-744. doi: 10.1001/jama.2013.368 Wholey MH, Chapman JE. Business and managerial education in the medical school curriculum. South Med J. 1990; 83(2): 204-6. doi: 10.1097/00007611-199002000-00017 Hsu BS, Hosokawa MC, Maria...

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Fall 2014 – A Case of Severe, Refractory Antipsychotic-induced Orthostatic Hypotension

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

A Case of Severe, Refractory Antipsychotic-induced Orthostatic Hypotension. Author: 1Sahil Gambhir, 2Nicholas Sandersfeld, DO, 2Dale D’Mello, MD Author Affiliations: 1College of Human Medicine, Michigan State  University, East Lansing, MI, USA; 2Department of Psychiatry, College of Human  Medicine, Michigan State University, East Lansing, MI Full Text Article PDF Corresponding Author: Sahil Gambhir, Gambhir1[at]msu.edu Key Words: Orthostatic hypotension; antipsychotics; refractory; side effects; schizophrenia; management guidelines. Abstract: Introduction: Antipsychotics have many adverse effects including orthostatic hypotension. Orthostatic hypotension is ideally treated with non-pharmacological strategies; however, these often fail leading to utilization of pharmacological methods. Currently, there is no agreed upon management or protocol for addressing antipsychotic-induced orthostatic hypotension and research in this area is limited. Patient profile: A 60-year-old man with a long history of schizophrenia who was receiving Haldol† Deconoate 200 mg injections every 4 weeks due to previous non-compliance. He was admitted to the inpatient psychiatric service due to worsening psychosis and suicidal behavior. Intervention: Despite use of medications, the patient was switched to risperidone with a goal of transition to an atypical long-acting injectable. The psychosis improved, but the patient developed orthostatic hypotension. After his medications were held, his blood pressure continued to be grossly abnormal. A number of different tests were completed followed by standard non-pharmacological treatment, which proved unsuccessful. Despite receiving intravenous fluid boluses to maintain his blood pressure, the patient required pharmacological treatment. This included midodrine and fludrocortisones, and concluded with Adderall† as his blood pressure stabilized. Conclusion: This case of a 60-year-old man with antipsychotic-induced orthostatic hypotension elucidates the frustration healthcare professionals and patients face with this common treatment-resistant condition. A treatment algorithm for managing drug-induced orthostatic hypotension is proposed and is a nidus for development of future protocols. Published on date: September 31, 2014 Senior Editor: Kaitlyn Vitale Junior Editor:Mike Klinger DOI: Pending Citation: Gambhir S, Sandersfeld N, D’Mello D. A Case of Severe, Refractory Antipsychotic-Induced Orthostatic Hypotension. Medical Student Research Journal. 2014;4(Fall): 15-7. References: Cardiac side effects of psychiatric drugs. Mackin, P. Hum Psychopharmacol, 2008 Jan; 23 (1): 3-14. doi: doi: 10.1002/hug.915 Stahl, S. Chapter 10. Antipsychotic Agents. In: Stahl’s Essential Psychopharmacology: Neuroscientific Basis and Practical Applications, 3e. New York: Cambridge University Press; 2008. Effect of midodrine on chlorpromazine-induced orthostatic hypotension in rabbits: comparison with amezinium, etilefrine, and droxidopa. Kurihara, J; Takata, Y; Suzuki, S; Okubo, Y; Kato, H. Biological Pharmacology Bulletin, 2000 Dec; 23(12):1445-9. Evaluation and Management of Orthostatic Hypotension. Lanier, Jeff; Mole, Matt; Clay, Emily. American Family Physicians, 2011 Sept 1; 84(5): 527-536. Antipsychotic pharmacotherapy and orthostatic hypotension: identification and management. Gugger, JJ. CNS Drugs, 2011 Aug; 25(8): 659-71 Freeman R. Chapter 20. Syncope. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson J, Loscalzo J. eds. Harrison’s Principles of Internal Medicine, 18e. New York: McGraw-Hill; 2012. Crawford MH. Chapter 16. Syncope. In: Crawford MH. eds. Current Diagnosis & Treatment: Cardiology, 4e. New York: McGraw-Hill;...

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Fall 2014 – Sebaceous Carcinoma of the Abdominal Wall: A Potential Indicator of Muir Torre Syndrome

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

Sebaceous Carcinoma of the Abdominal Wall: A Potential Indicator of Muir Torre Syndrome Author: Stacie L. Clark Author Affiliations: College of Human Medicine, Michigan State University, Grand Rapids, MI, USA Full Text Article PDF Corresponding Author: Stacie L. Clark, clarkst[at]msu.edu Key Words: sebaceous gland; sebaceous carcinoma; abdominal wall; Muir-Torre syndrome; colorectal cancer; HNPCC. Abstract: Introduction: Sebaceous carcinoma is a rare dermatologic tumor affecting the pilosebaceous apparatus of the skin. While the majority of sebaceous carcinomas arise from sebaceous glands in the ocular area, extraocular sebaceous carcinomas, arising from any region populated with sebaceous glands have also been reported. Sebaceous carcinoma can present as a single lesion or in association with secondary malignancies, most commonly with those found in Muir Torre syndrome (MTS), an autosomal dominant condition associated with several types of sebaceous neoplasms as well as a variety of visceral malignancies. The most common form of MTS has been described as a variant of hereditary non polyposis colorectal cancer (Lynch syndrome). Patient profile: Here, we describe the case of a 55-year-old male, with a known history of colorectal cancer, presenting with a rapidly enlarging abdominal wall mass. Interventions and outcomes: Surgical excision of the mass histologically demonstrated sebaceous carcinoma. This diagnosis, the incidental discovery of a papillary thyroid carcinoma and the patient’s history of colorectal cancer, prompted referral for genetic counseling, the results of which are still pending. Discussion: Sebaceous carcinoma is one of several diagnostic criteria of MTS and its presence should prompt a complete evaluation for underlying internal malignancies. Published on date: September 31, 2014 Senior Editor: Timothy Smith Junior Editor: Joginder Singh DOI: Pending Citation: Clark SL. Sebaceous Carcinoma of the Abdominal Wall: A Potential Indicator of Muir Torre Syndrome. Medical Student Research Journal. 2014;4(Fall):12-4. References: Nelson BR, Hamlet KR, Gillard M, Railan D, Johnson TM. Sebaceous carcinoma. Journal of the American Academy of Dermatology. July 1995;33(1):1-15. doi: 10.1016/0190-9622(95)90001-2 Ponti G, Ponz de Leon M. Muir-Torre Syndrome. The Lancet Oncology. Dec 2005;6(12):980-987. doi:10.1016/S1470-2045(05)70465-4 Dores GM, Curtis RE, Toro JR, Devesa SS, Farumeni JF. Incidence of cutaneous sebaceous carcinoma and risk of associated neoplasms: insight into Muir-Torre Syndrome. Cancer. July 2008;113(12):3372-3381. doi: 10.1002/cncr.23963 Schwartz RA, Torre DP. The Muir-Torre syndrome: a 25-year retrospect. Journal of the American Academy of Dermatology. July1995;33(1):90-104. doi:10.1016/0190-9622(95)90017-9 Cohen PR, Kohn SR, Kurzrock R. Association of sebaceous gland tumors and internal malignancy: the Muir-Torre syndrome. The American Journal of Medicine. May 1991;90:606-613. doi:10.1016/S0002-9343(05)80013-0 Srivastava D, Taylor R. Appendage Tumors and Hamartomas of the Skin. In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K. eds. Fitzpatrick’s Dermatology in General Medicine, 8e. New York, NY: McGraw-Hill; 2012:1337-1362. Dasgupta T, Wilson LD, Yu JB. A retrospective review of 1349 cases of sebaceous carcinoma. Cancer. July 2008;115(1):158-165. doi: 10.1002/cncr.23952...

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Fall 2014 – Acute Bronchiolitis – Case Report and Review of Management Guidelines

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

Acute Bronchiolitis – Case Report and Review of Management Guidelines. Author: Neil D. Dattani, Clare M. Hutchinson Author Affiliations: Norwich Medical School, Faculty of Medicine and health Sciences, University of East Anglia, Norwich, United Kingdom Full Text Article PDF Corresponding Author: Clare M. Hutchinson, claremhutchinson[at]gmail.com Key Words: Bronchiolitis; Case reports; Pediatrics; Practice guidelines; Therapeutics. Abstract: Introduction: The treatment of acute bronchiolitis is controversial, despite the fact that several well-designed trials have been conducted on the subject. Patient profile: A 10-month-old boy presented to the emergency department with a 3-day history of upper respiratory tract symptoms and an expiratory wheeze. Chest X-ray showed right upper lobe atelectasis. He was diagnosed with acute bronchiolitis. Interventions: He received nebulized salbutamol (albuterol) and oral dexamethasone in the emergency department. He was admitted to hospital overnight for continued salbutamol treatment via a metered-dose inhaler. Discussion: Five main treatment regimens exist for acute bronchiolitis nebulized epinephrine (adrenaline), other bronchodilators, nebulized hypertonic saline, glucocorticoids, and combinations of these. Nebulized epinephrine decreases the rate of hospitalization, other bronchodilators improve symptoms, and nebulized hypertonic saline reduces the length of hospitalization. There is no strong evidence for glucocorticoids or combinations of these treatments. Combined treatment with epinephrine and dexamethasone reduces rate of hospitalization. Published on date: September 31, 2014 Senior Editor: Kevin Patterson Junior Editor: Patrick Roach DOI: Pending Citation: Dattani ND, Hutchinson CM. Acute Bronchiolitis – Case Report and Review of Management Guidelines. Medical Student Research Journal. 2014;4(Fall):8-11. References: Zorc JJ, Hall CB. Bronchiolitis: recent evidence on diagnosis and management. Pediatrics. 2010 Feb;125(2):342-9. doi: 10.1542/peds.2009-2092 Hartling L, Bialy LM, Vandermeer B, Tjosvold L, Johnson DW, Plint AC, Klassen TP, Patel H, Fernandes RM. Epinephrine for bronchiolitis. Cochrane Database of Systematic Reviews 2011, Issue 6. Art. No.: CD003123. doi: 10.1002/14651858.CD003123.pub3 Skjerven HO, Hunderi JO, Brügmann-Pieper SK, et al. Racemic adrenaline and inhalation strategies in acute bronchiolitis. New England Journal of Medicine2013 June 13;368(24):2286-93. doi: 10.1016/j.jemermed.2013.10.022 Gadomski AM, Scribani MB. Bronchodilators for bronchiolitis. Cochrane Database of Systematic Reviews 2014, Issue 6. Art. No.: CD001266. doi: 10.1002/14651858.CD001266.pub4 Zhang L, Mendoza-Sassi RA, Wainwright C, Klassen TP. Nebulised hypertonic saline solution for acute bronchiolitis in infants. Cochrane Database of Systematic Reviews 2013, Issue 7. Art. No.: CD006458. doi: 10.1002/14651858.CD006458.pub3 Fernandes RM, Bialy LM, Vandermeer B, Tjosvold L, Plint AC, Patel H, Johnson DW, Klassen TP, Hartling L. Glucocorticoids for acute viral bronchiolitis in infants and young children. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD004878. doi: 10.1001/jama.2013.284921 Ducharme FM. Management of acute bronchiolitis. British Medical Journal 2011 Apr 6;342:d1658. doi: 10.1136/bmj.d1658 Plint AC, Johnson DW, Patel H, et al. Epinephrine and Dexamethasone in Children with Bronchiolitis. New England Journal of Medicine 2009 May 14;360(20):2079-89. doi: 10.1056/NEJMoa0900544 Enriquez A, Chu IW, Mellis C, Lin WY. Nebulised deoxyribonuclease for viral bronchiolitis in children younger than 24 months. Cochrane Database of Systematic Reviews 2012, Issue 11. Art. No.: CD008395. doi: 10.1002/14651858.CD008395.pub2 Roqué i Figuls M, Giné-Garriga M, Granados Rugeles C, Perrotta C. Chest physiotherapy for acute bronchiolitis in paediatric patients between 0 and 24 months old. Cochrane Database of Systematic Reviews 2012, Issue 2. Art. No.: CD004873. doi: 10.1002/14651858.CD004873.pub4 Beggs S, Wong Z, Kaul S, Ogden KJ, Walters JAE. High-flow nasal cannula therapy for infants with bronchiolitis. Cochrane Database of Systematic Reviews 2014, Issue 1. Art. No.: CD009609. doi: 10.1002/14651858.CD009609.pub2 Umoren R, Odey F, Meremikwu MM. Steam inhalation or humidified oxygen for acute bronchiolitis in children up to three years of age. Cochrane Database of Systematic Reviews 2011, Issue 1. Art. No.: CD006435....

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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

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

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

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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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