Vol 5: Fall 2017 Issue

MSRJ – Volume 5 – Fall 2017

The entire issue can be downloaded as a pdf here.

Excerpts from the abstract and links to individual articles are displayed below.

Salmonella.  Anna DiMaria. Salmonella typhimurium is a bacterium that is ingested through food and is typically found in the intestine which causes gastroenteritis in humans. This bacterium causes the ratio between absorption and secretion to become unbalanced which leads to a fever and diarrhea.
Re-fracture of Distal Radius and Hardware Repair in the Setting of TraumaBrandon P. Lucke-Wold, PhD, Patrick C. Bonasso, MD, and Glen Jacob, MD Distal radius fractures are one of the most common fractures in the elderly. Falls and motor vehicle collisions lead to increased risk for this type of fracture. A seventy-three year-old female had a previous history of distal radius fracture with repair by open reduction and internal fixation. She was involved in a motor vehicle collision that re- fractured the distal radius. The plate was bent and required removal, which is a very rare but potentially serious complication. Surgery was done to fix the open reduction and internal fixation with volar locking plates while removing damaged hardware. Only a select few cases have reported hardware failure as a cause of complications. Among those cases, high-energy activities and maintained stress on the hardware were likely causes. Distal radius fractures are the most common upper extremity fracture in the elderly. We highlight a unique case of re-fracture in the setting of trauma with prior hardware failure and describe the strategy for hardware repair.
Aerococcus Viridans Infectious Endocarditis Complicated by Splenic Infarction. Joshua Budhu M.S, Dorian Wood B.S, Marvin Crawford M.D, Khuram Ashraf M.D, Frederick Doamekpor M.D, Olufunke Akinbobuyi M.D. Background: Neurological deterioration (ND) is common, with nearly one-half of ND patients deteriorating within the first 24 to 48 h of stroke. The timing of ND with respect to ND etiology and reversibility has not been investigated. Methods: At our center, we define ND as an increase of 2 or more points in the National Institutes of Health Stroke Scale (NIHSS) score within 24 h and categorize etiologies of ND according to clinical reversibility. ND etiologies were considered nonreversible if such causes may have produced or extended any areas of ischemic neurologic injury due to temporary or permanent impairment in cerebral perfusion. Results: Seventy-one of 350 ischemic stroke patients experienced ND. Over half (54.9%) of the patients who experienced ND did so within 48 h of last seen normal. The median time to ND for nonreversible causes was 1.5 days (interquartile range (IQR) 0.9, 2.4 days) versus 2.6 days for reversible causes (IQR 1.4, 5.5 days, p 0.011). After adjusting for NIHSS and hematocrit on admission, the log-normal survival model demonstrated that for each 1-year increase in a patient’s age, we expect a 3.9% shorter time to ND (p 0.0257). In addition, adjusting for age and hematocrit on admission, we found that for each 1-point increase in the admission NIHSS, we expect a 3.1% shorter time to ND (p 0.0034). Conclusions: We found that despite having similar stroke severity and age, patients with nonreversible causes of ND had significantly shorter median time to ND when compared with patients with reversible causes of ND. Link here. 
Unexplained Bleeding: Case Report of Glanzmann Thrombasthenia. Ahmed Al Wahab, Alaa Nugud, M.D. , Shomous Nugud M.D., Zahran Alras.

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

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

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

Scrotal Rupture in a Premature Neonate with Cystic Fibrosis as a Consequence of Meconium PeriorchitisJMichael Bedgood BS, Christine Cortelyou MD, Cynthia Blanco, MD, MSc, Rafael Fonseca, MD, Alvaro Moreira, MD. Neonatal meconium periorchitis is a rare condition, with less than 60 cases described in the literature. Of the reported cases, only one describes the complication of a congenital rupture of the scrotum. We present a case of a Hispanic preterm neonate who was diagnosed with cystic fibrosis after scrotal rupture secondary to meconium periorchitis. The neonate was taken to the operating room for exploratory laparotomy and scrotal exploration. No calcification was noted and the patient’s left scrotum was surgically packed as well as creating a colostomy. The surgery proved successful and the patient was discharged home on day of life 79. This case of a neonate presenting with meconium periorchitis and scrotal rupture notes the varying degree of initial presentations for cystic fibrosis in a neonate. Successful outcomes for neonates presenting with a ruptured scrotum depend on early clinical assessment.
Systematic review of the accuracy of magnetic resonance imaging in the diagnosis of acute appendicitis in children: comparison with computed tomographyBenjamin Whitt.  Introduction: Degeneration of the lumbar motion segment is the primary cause of low back pain in many individuals. Therefore, new minimally invasive treatments are being sought. Patient profile: A 47-year-old man presented with severe low back pain and radicular symptoms of several years duration. Lumbar Magnetic Resonance Imaging (MRI) scan revealed severe desiccation, loss of disc height, and an annular tear with right lateral disc protrusion at L4 5. Interventions/outcomes: After conservative treatment failed, the patient received a Wallis† interspinous spacer at the affected level. A 100% subjective pain relief was obtained at 3 months postoperative. Nucleus pulposus rehydration on MRI was observed. Discussion: Controversy exists over whether disc dehydration is a reliable indicator of low back pain; however, interspinous spacers seem to alter abnormal motion segment’s biomechanics in a way that results in alleviation of low back pain and increased range of motion. With the advent of biologic therapy, this may provide an intriguing minimally invasive treatment modality, although further research is needed. 

Are Medical Students Becoming Less Altruistic and More Money-Oriented?  Anna I. Perera MSc, Anna Serlachius PhD, Roger J. Booth PhD & Keith J. Petrie PhD.

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

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

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

Citations for the articles:

DiMaria, A. Salmonella.  Medical Student Research Journal. 2017;5(Fall):1

Lucke-Wold B, Bonasso P, Jacob G. Re-fracture of Distal Radius and Hardware Repair in the Setting of Trauma. Medical Student Research Journal (2016). doi:10.15404/msrj/11.2016.0009

Budhu, J., Wood, D., Crawford, M., Ashraf, K., Doamekpor, F., & Akinbobuyi, O. Aerococcus Viridans Infectious Endocarditis Complicated by Splenic Infarction, Medical Student Research Journal (2017). doi:10.15404/msrj/07.2017.0002

Al Wahab, A., Nugud, A., Nugud, S., & Alras, Z. Unexplained Bleeding: Case Report of Glanzmann Thrombasthenia, Medical Student Research Journal (2017). doi:10.15404/msrj/09.2017.0127

Bedgood M, Cortelyou C, Blanco C, Fonseca R, & Moreira A. Scrotal Rupture in a Premature Neonate with Cystic Fibrosis as a Consequence of Meconium Periorchitis. Medical Student Research Journal (2016). doi:10.15404/msrj/11.2016.0008

Whitt, Benjamin. Systematic review of the accuracy of magnetic resonance imaging in the diagnosis of acute appendicitis in children: comparison with computed tomography, Medical Student Research Journal (2015), 4(3), 54-58. doi:10.15404/msrj/07.2017.0001

Perera, A., Serlachius, A., Booth, R., & Petrie K. Are Medical Students becoming Less Altruistic and More Money-Oriented? A Three Wishes Study, Medical Student Research Journal (2015). doi:10.15404/msrj/09.2017.0145



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