Volume 7: Spring 2019 Issue

MSRJ Vol. 7 Spring 2019

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Malignant Chondroid Syringoma of the Foot – A Case Report

Authors: Megan Masten, MS41*, Raouf Mikhail, MD2

Author Affiliations:

1Michigan State University College of Human Medicine, Flint, Michigan, United States
2Surgical Oncologist, Hurley Medical Center, Flint, Michigan

Full Text Article PDF

*Corresponding Author: Megan Masten; mastenme@msu.edu

Key Words: Malignant; chondroid; syringoma; foot; adnexal cancer; cutaneous tumor

Abstract:

Background: This case report is about a very rare tumor – a malignant chondroid syringoma. The objective of this piece is to review both the case presented along with the current literature on cutaneous adnexal tumors.

Case Presentation: The patient is a 73-year-old Caucasian female with a past medical history of treated colon and breast cancer who presented with a 2-year history of a slow-growing, painful cutaneous lesion on the medial aspect of her right foot. The patient presented to her primary care physician (PCP) for right foot pain, which was attributed to bunions. The PCP encouraged the patient to see a podiatrist for this issue. Upon presentation to the podiatrist, the patient had a right foot biopsy. The pathology report showed a mixed malignant chondroid syringoma with positive margins. A re-excision to ensure complete removal was recommended. The patient presented to surgical oncology and subsequently she underwent complete excision of the right foot mass. At the time of her last visit, 7 months postoperatively, the patient continued to have issues with wound healing and continuous drainage of her surgical wound.

Discussion: This case differs from much of the current literature surrounding cutaneous adnexal tumors as it is a malignant chondroid syringoma of the foot, which is exceedingly rare. There are only three other published case reports of similar malignancies in similar places. This case study is important due to the uniqueness of the case. This case serves as a reminder of the importance of biopsy for diagnosis prior to management, as it is unlikely that such rare soft tissue tumors can be diagnosed without biopsy.

Conclusion: The take away lesson of the case is that it is important to biopsy unknown masses, and to have follow up with specific specialists.

Published: Spring, 2019

References:

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the looking glass: an examination of malignant cutaneous adnexal tumors. Arch Dermatol 2011; 147(9): 1058–62.
doi: 10.1001/archdermatol.2011.229

2. Malik R, Saxena A, Kamath N. A rare case of malignant chondroid syringoma of scalp. Indian Dermatol Online
J 2013; 4(3): 236–8.

3. Mayur K, Neha M, Rajiv K, Shubhada K. Malignant chondroid syringoma of thigh with late metastasis to lung:
a very rare case report. Indian J Pathol Microbiol 2017;
60(3): 428–30.

4. Shashikala P, Chandrashekhar HR, Sharma S, Suresh KK. Malignant chondroid syringoma. Indian J Dermatol Venereol Leprol 2004; 70: 175–6.

5. American Joint Committee on Cancer TNM staging system for cutaneous squamous cell carcinoma. AJCC cancer staging manual. 7th ed. New York: Springer; 2010.

6. Lu H, Chen L, Chen Q, Shen H, Liu Z. A rare large cutaneous chondroid syringoma involving a toe: a case report. Medicine 2018; 97(5): e9825.

7. Madi K, Attanasio A, Cecunjanin F, Garcia R, Vidershayn A, Lucido, J. Chondroid syringoma of the foot: a rare diagnosis.
J Foot Ankle Surg 2016; 55: 373–8.

8. Sundling R, Logan D. Chondroid syringoma: a case report in the foot and ankle. Foot Ankle Specialist 2016; 10: 167–9.

9. Kazakov DV, McKee PH, Michal M, Kacerovska D. Cutaneous adnexal tumors. 1st ed. Philadelphia, PA: Lippincott Williams & Wilkins Health; 2012.

10. Conill C, Toscas I, Morilla I, Mascaró JM. Radiation therapy as a curative treatment in extraocular sebaceous carcinoma. Br J Dermatol 2003; 149(2): 441–2.

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carcinoma: the Mayo Clinic experience. J Am Acad Dermatol 2015; 72(1): 195.

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Primary Intestinal Lymphangiectasia: A Case Report

Authors: Ridwaan Albeiruti1*, MD, Patrick Gleeson2, MD, Theodore Kelbel3, MD, Tracy Fausnight, MD3

Author Affiliations:

1Department of Medicine, West Virginia University, Morgantown, WV; Department of Internal Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA; 2Department of Internal Medicine, Temple University, Philadelphia, PA, USA; 3Helen DeVos Children’s Hospital, Spectrum Health, Grand Rapids, MI, USA

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*Corresponding Author: Ridwaan Albeiruti; albeiru4@msu.edu

Key Words: primary intestinal lymphangiectasia; Waldmann’s disease; protein-losing enteropathy

Abstract:

Primary intestinal lymphangiectasia (Waldmann’s disease) is a rare protein-losing enteropathy which is mostly seen in young children. A 22-month-old male baby presented with a 1-week history of abdominal distension, chronic loose stools, recurrent ear infections, and failure to thrive. He had edematous eyelids and non-pitting edema of his hands and feet. The patient was diagnosed via endoscopic visualization and biopsy of the lymphangiectasia in the small bowel. He was managed through dietary restriction with a high-protein, low-fat diet. The patient subsequently had resolution of the diarrhea and an increase in albumin and total protein on labs. We describe a rare case of primary intestinal lymphangiectasia and highlight its clinical presentation, diagnosis, and treatment.

Published: Spring, 2019

References:

1. Vignes S, Bellanger J. Primary intestinal lymphangiectasia (Waldmann’s disease). Orphanet J Rare Dis 2008; 3: 5.
doi: 10.1186/1750-1172-3-5

2. Wen J, Tang Q, Wu J, Wang Y, Cai W. Primary intestinal lymphangiectasia: four case reports and a review of the literature. Dig Dis Sci 2010; 55(12): 3466–72. doi: 10.1007/ s10620-010-1161-1

3. Hokari R, Kitagawa N, Watanabe C, Komoto S, Kurihara C, Okada Y, et al. Changes in regulatory molecules for lymphangiogenesis in intestinal lymphangiectasia with enteric protein loss. J Gastroenterol Hepatol 2008; 23(7 Pt 2): e88–95. doi: 10.1111/j.1440-1746.2007.05225.x

4. Katoch P, Bhardwaj S. Lymphangiectasia of small intestine presenting as intussusception. Indian J Pathol Microbiol 2008; 51(3): 411–12.

5. Dierselhuis MP, Boelens JJ, Versteegh FG, Weemaes C, Wulffraat NM. Recurrent and opportunistic infections in children with primary intestinal lymphangiectasia. J Pediatr Gastroenterol Nutr 2007; 44(3): 382–5. doi: 10.1097/01. mpg.0000233192.77521.2f

6. Ingle SB, Hinge Ingle CR. Primary intestinal lymphangiectasia: minireview. World J Clin Cases 2014; 2(10): 528–33. doi: 10.12998/wjcc.v2.i10.528

7. Xinias I, Mavroudi A, Sapountzi E, Thomaidou A, Fotoulaki M, Kalambakas A, et al. Primary intestinal lymphangiectasia: is it always bad? Two cases with different outcome. Case Rep Gastroenterol 2013; 7(1): 153–63. doi: 10.1159/000348763

Comparing Student Satisfaction with Traditional and Modular Group Peer-Tutoring Session

Authors:

Jeff Cross, MD1, Rodney Nyland PhD2, Sarah Lerchenfeldt, PharmD, BCPS, BCOP3

Author Affiliations:

1Oakland University William Beaumont School of Medicine, Rochester, MI, USA
2Department of Organizational Leadership, School of Education and Human Services, Oakland University, Rochester, MI, USA
3Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI, USA

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*Corresponding Author: Jeff Cross; Jcross818@gmail.com

Key Words: education; medical; teaching; tutoring

Abstract:

Background: Our allopathic medical school has utilized a peer-tutoring program since inception in 2011, where second-year medical students teach first-year students in 2-h lecture-style review sessions. In 2015, an alternative format was implemented using four, repeating 30-min modules. This study was designed to compare student satisfaction with both approaches.

Methods: An online survey was emailed to students graduating in 2018 (n = 97) and 2019 (n = 127).

Results: A total of 72 (32.6%) responding students were included in the study, 35 from the class of 2018 (Co2018) and 37 from the class of 2019 (Co2019). Fewer Co2018 students, who received traditional instruction, were ‘very satisfied with the session timing’ compared with Co2019 students, who received the modular format (proportion difference: 0.42; P < 0.001, 95% confidence interval [CI] [0.21–0.63]). Co2018 students were more likely than Co2019 students to stop attending because their time was better utilized another way (proportion difference: 0.22; P = 0.054, 95% CI [-0.003 to 0.45]).

Conclusions: Students preferred the session length and timing of the modular format. Future studies are warranted to evaluate the effectiveness of this approach.

Published: Spring, 2019

References:

1. Benè KL, Bergus G. When learners become teachers:
a review of peer teaching in medical student education.
Fam Med 2014; 46(10): 783–7.

2. Sobral DT. Cross-year peer tutoring experience in a medical school: conditions and outcomes for student tutors. Med Educ 2002; 36(11so): 1064–70. doi: 10.1046/j.1365-2923.2002. 01308.x

3. Buckley S, Zamora J. Effects of participation in a cross year peer tutoring programme in clinical examination skills on volunteer tutors’ skills and attitudes towards teachers and teaching. BMC Med Educ 2007; 7(1): 20. doi: 10.1186/ 1472-6920-7-20

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the value of social and cognitive congruence. Adv Heal Sci Educ 2008; 13(3): 361–72. doi: 10.1007/s10459-006-9049-8

6. Ten Cate O, Durning S. Peer teaching in medical education: twelve reasons to move from theory to practice. Med Teach 2007; 29(6): 591–9. doi: 10.1080/01421590701606799

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9. Brown G, Manogue M. AMEE medical education guide
no. 22: refreshing lecturing: a guide for lecturers. Med Teach 2001; 23(3): 231–44. doi: 10.1080/01421590120043000

A Needs Assessment Pilot Study of Patients with High Utilization in an Academic Inpatient Setting

Authors:

Alexander S. Roseman, M.D.1*, Hannah Thompson, M.D.1, Audrey Jiang, BS1, Lisa Obasi, BA1, Andrew M. Pattock, BS1, Jamie P. Schlarbaum, BS1, Daniel R. Wells, BS1, Andrew P.J. Olson, M.D.2,3

Author Affiliations:

1University of Minnesota Medical School, Minneapolis, MN, USA
2Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
3Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA

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*Corresponding Author: Alexander S. Roseman; alexander.rosemanMD@baystatehealth.org

Key Words: needs assessment; high utilization; super utilizers; high utilizers; academic medical centers

Abstract:

Background: A disproportionate amount of health care spending in the United States is attributed to a small subset of patients who employ inpatient and emergency department (ED) services. While patients with high ED utilization have previously been well- described, patients seen in an inpatient academic medical setting may differ with regard to demographics, medical conditions, and social factors.

Objectives: We aimed to characterize patients with high utilization in an academic inpatient setting for the purpose of identifying unmet needs.

Setting and Patients: Adults aged 18–80 were eligible for inclusion if they had more than three admissions to a general medicine service of an academic medical center within a large health care system. Patients who were admitted for pregnancy, oncology, trauma, or surgical procedures for acute conditions or were diagnosed with dementia or encephalopathy were excluded. Twenty-six patients met inclusion/exclusion criteria and were approached to be interviewed, of which 13 agreed to be interviewed. Measurements: Face-to-face administration of a self-reported survey assessing unmet needs regarding services for medical or mental health needs, access to health care, housing, transportation, or legal services, and any other barriers to health the respondent identified.

Results: All of those surveyed had health insurance and regular visits with primary care providers (mean 14 visits per 12 months). The most prevalent medical conditions identified were depression (85%) and chronic pain (77%). In addition, patients self-identified having an average of 2.2 chronic conditions. Financial struggles were common as 62% of the respondents reported annual incomes of <$12,000, and 77% were unemployed over the previous 12 months.

Conclusion: These results indicate unique clinical and social characteristics associated with high readmission rates at one academic medical center, suggesting the need for additional patient-centered research of this population to aid in the development of novel strategies to reduce over-utilization and improve health.

Published: Spring, 2019

References:

1. LaCalle E, Rabin E. Frequent users of emergency departments: the myths, the data, and the policy implications. Ann Emerg Med 2010; 56(1): 42–8. doi: 10.1016/j.annemergmed.2010.01.032
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9. Stockbridge EL, Suzuki S, Pagan JA. Chronic pain and health care spending: an analysis of longitudinal data from the Medical Expenditure Panel Survey. Health Serv Res 2015; 50(3): 847–70. doi: 10.1111/1475-6773.12263
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Expert Opinions on Healthcare for Immigrants in Norway

Authors:

Andrea Kubicki1, Haben Debessai1, Megan Masten1, Reena Pullukat1, Kirsten Salmela1

Author Affiliations:

1College of Human Medicine, Michigan State University, East Lansing, MI, USA

Full Text Article PDF

*Corresponding Author: Megan Masten; mastenme@msu.edu

Key Words: Norway; healthcare; immigrant; barriers to care; language

Abstract:

Background: Documented immigrants eligible to stay in Norway for more than 6 months can enroll in the universal healthcare system for full healthcare services, such as acute, chronic, and preventative care.1 All other non-citizens only have access to emergency services. With an increasing influx of immigrants to Norway, it is advantageous to evaluate the Norwegian healthcare system, how documented and undocumented immigrants utilize the system, and any barriers they may face when doing so. The aim of this study is to identify barriers to healthcare for immigrants in Norway in order to better address them in the future.

Methods: Sixteen subjects with knowledge of immigrant healthcare in Norway were interviewed. Participants were asked the same standardized four questions; answers were audio-recorded, transcribed, and analyzed.

Results: Major themes that emerged included the following: (1) universal access is a benefit once accepted into the system, (2) timeliness is an issue, (3) chronic disease and mental health are common immigrant-specific health issues, and (4) language and lack of cultural competency are major barriers to care.

Conclusion: There is a need for improved translation services and cultural competency as the immigrant population in Norway increases.

Published: Spring, 2019

References:

1. Goth UG, Berg JE. Migrant participation in Norwegian health care. A qualitative study using key informants.
Eur J Gen Pract 2010; 17(1): 28–33. doi:10.3109/1381478 8.2010.525632.

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Ioannidis E, et al. Good practice in health care for migrants: views and experiences of care professionals in 16 European countries. BMC Public Health 2011; 11(1): 187.

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Opioid Safety Education in Adolescent Students

Authors:

Alexandra K. Feiertag, B.A.1*, Catherine A. Martin, M.D.1,2, Gregory E. Guenthner, M.L.I.S.2

Author Affiliations:

1College of Medicine, University of Kentucky, Lexington, KY, USA
2Department of Psychiatry, University of Kentucky, Lexington, KY, USA

Full Text Article PDF

*Corresponding Author: Alexandra K. Feiertag; alex.feiertag@uky.edu

Key Words: opioid; overdose; safety; education; adolescent

Abstract:

Purpose: Opioid overdoses profoundly impact thousands of families across the United States. Behind this issue lies the accessibility of opioid prescriptions right inside our medicine cabinets. Our goal was to educate adolescent students in Kentucky schools about this matter because they comprise a vulnerable population.

Methods: Pre- and posttestings were used to analyze 26 adolescents’ knowledge, attitudes, and awareness regarding opioid overdoses pre- and post-intervention.

Results: Adolescents displayed significantly improved results from pre-test to post-test. Overdose Knowledge scores improved by 16% from pre- to post-intervention (p = 0.01). Attitude to Act scores improved by 35% (p = 0.03). Drug Disposal Awareness scores improved by 54% (p < 0.01).

Conclusions: This study demonstrates that education improves adolescents’ opioid overdose knowledge, attitudes, and awareness. The evidence shows that there are educational gaps that should be filled by teaching adolescents about the opioid epidemic and providing them with resources.

Published: Spring, 2019

References:

1. Overdose death rates. National Institute on Drug Abuse. August 2018. Available from: https://www.drugabuse.gov/ related-topics/trends-statistics/overdose-death-rates [cited 10 August 2018].
2. Drugs of abuse. U.S. Department of Justice Drug Enforcement Administration. June 16, 2017. Available from: https://www.dea.gov/sites/default/files/sites/ getsmartaboutdrugs.com/files/publications/DoA_2017Ed_ Updated_6.16.17.pdf#page=40 [cited 10 August 2018].
3. Curtin SC, Tejada-Vera B, Warner M. Drug overdose deaths among adolescents aged 15–19 in the United States: 1999– 2015. Centers for Disease Control and Prevention. August 16, 2017; Available from: https://www.cdc.gov/nchs/products/ databriefs/db282.htm [cited 10 August 2018].
4. Slavova S, Bunn TL, Gao W. Drug overdose deaths in Kentucky, 2000–2013. Kentucky Injury Prevention and Research Center. March 6, 2015; Available from: http:// www.mc.uky.edu/kiprc/projects/ddmarpdak/pdf/ KyDrugOverdoseDeaths-2000-2013.pdf [cited 10 August 2018].
5. Seth P, Rudd RA, Noonan RK, Haegerich TM. Quantifying the epidemic of prescription opioid overdose deaths. Am J Public Health 2018; 108(4): 500–2. doi: 10.2105/ AJPH.2017.304265
6. Williams AV, Strang J, Marsden J. Development of Opioid Overdose Knowledge (OOKS) and Attitudes (OOAS) Scales for take-home naloxone training evaluation. Drug Alcohol Depend 2013; 132(1–2): 383–6. doi: 10.1016/j. drugalcdep.2013.02.007
7. Whiteside LK, Walton MA, Bohnert ASB, Blow FC, Bonar EE, Ehrlich P, et al. Nonmedical prescription opioid and sedative use among adolescents in the emergency department. Pediatrics 2013; 132(5): 825–32. doi: 10.1542/peds.2013-0721 8. Frank D, Mateu-Gelabert P, Guarino H, Bennett A, Wendel T, Jessell L, et al. High risk and little knowledge: overdose experiences and knowledge among young adult nonmedical prescription opioid users. Int J Drug Policy 2015; 26(1): 84–91. doi: 10.1016/j.drugpo.2014.07.013
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