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:

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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

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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

4. Yu TC, Wilson NC, Singh PP, Lemanu DP, Hawken SJ, Hill AG. Medical students-as-teachers: a systematic review of peer- assisted teaching during medical school. Adv Med Educ
Pract 2011; 2: 157–72. doi: 10.2147/amep.s14383

5. Lockspeiser TM, O’Sullivan P, Teherani A, Muller J. Understanding the experience of being taught by peers:
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

7. Santee J, Garavalia L. Peer tutoring programs in health professions schools. Am J Pharm Educ 2006; 70(3): 70.
doi: 10.5688/aj700370

8. Swindle N, Wimsatt L. Development of peer tutoring services to support osteopathic medical students’ academic success. J Am Osteopath Assoc 2015; 115(11): e14–19. doi: 10.7556/jaoa.2015.140

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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8. Blank FS, Li H, Henneman PL, Smithline HA, Santoro JS, Provost D, et al. A descriptive study of heavy emergency department users at an academic emergency department reveals heavy ED users have better access to care than average users. J Emerg Nurs 2005; 31(2): 139–44. doi: 10.1016/j.jen.2005.02.008

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
10. Von Korff M, Lin EHB, Fenton JJ, Saunders K. Frequency and priority of pain patients’ health care use. Clin J Pain 2007; 23(5): 400–8. doi: 10.1097/AJP.0b013e31804ac020

11. Blyth FM, March LM, Brnabic AJM, Cousins MJ. Chronic pain and frequent use of health care. Pain 2004; 111(1–2): 51–8. doi: 10.1016/j.pain.2004.05.020

12. Hunt KA, Weber EJ, Showstack JA, Colby DC, Callaham ML. Characteristics of frequent users of emergency departments. Ann Emerg Med 2006; 48(1): 1–8. doi: 10.1016/j. annemergmed.2005.12.030

13. Mautner DB, Pang H, Brenner JC, Shea JA, Gross KS, Frasso 335 R, et al. Generating hypotheses about care needs of high
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2013; 16(Suppl 1): S26–33. doi: 10.1089/pop.2013.0033; 10.1089/pop.2013.0033

14. Resources H, Administration S. State-level projections 340 of supply and demand for primary care practitioners:
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Centralized care management support for ‘high utilizers’ in
primary care practices at an academic medical center. Care Manag J 2014; 15(1): 26–33.

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BMC Public Health 2005; 5: 94. doi: 10.1186/1471-2458-5-94

18. Kriegsman DMW, Penninx BWJH, Van Eijk JTM,
Boeke AJP, Deeg DJH. Self-reports and general practitioner
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J Clin Epidemiol 1996; 49(12): 1407–17. doi: 10.1016/ S0895-4356(96)00274-0

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.

2. Preamble to the Constitution of WHO as adopted by the International Health Conference, New York, 19 June–22 July 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of WHO, no. 2, p. 100) and entered into force on 7 April 1948.

3. Bollini P. Health policies for immigrant populations in the 1990s. A comparative study in seven receiving countries.
Int Migrat 1992; 30 (Special Issue: Migration and Health in
the 1990s): 103–19.

4. Summary Report on the MIPEX Health Strand & Country Reports. pp. 1–101, Rep. No. 52. 2016. Brussels: International Organization for Migration. Available from: https://publications. iom.int/system/files/mrs_52.pdf [cited 15 August 2016].

5. CooperB. Migrant quality, not quantity. Washington, DC: Migration Policy Institute. 2005. Available from: https://www.migrationpolicy.org/article/norway-migrant-quality-not- quantity [cited 16 July 2018].

6. Large diversity in little Norway. ssb.no. Available from: https://www.ssb.no/en/befolkning/artikler-og-publikasjoner/ large-diversity-in-little-norway. Published 2019 [cited 21 March 2019].

7. Abebe DS. Public health challenges of immigrants in Norway: a research review. NAKMI Report 2010; 2.

8. Eli K, Ytrehus S. Barriers to health care access among undocumented migrant women in Norway. Soc Health Vulnerability 2015; 6(1): 28668.

9. This is Norway 2016: what the figures say. pp. 1–2. Statistics Norway. Available from: https://www.ssb.no/a/histstat/norge/ this-is-norway-2016.pdf [cited 15 August 2016].

10. Heim T. Problems of general practitioner’s care of migrants. Misunderstandings – Not only because of language. MMW Fortschr Med 2004; 146: 4–6.

11. Priebe S, Sandhu S, Dias S, Gaddini A, Greacen T,
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.

12. Jensen NK, Nielsen SS, Krasnik A. Expert opinion on best practices “in the delivery of healthcare services to immigrants in Denmark”. Dan Med Bull 2011; 57(8): A4170.

13. Mladovsky P. Migrant health in the EU. Eurohealth London 2007; 13(1): 9.

14. Wachtler C, Brorsson A, Troein M. Meeting and treating cultural difference in primary care: a qualitative interview study. Fam Pract 2005; 23(1): 111–15.

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
9. Tilley JC, Ingram V. 2016 overdose fatality report. Kentucky Office of Drug Control Policy. 2016. Available from: https:// odcp.ky.gov/Documents/2016%20ODCP%20Overdose%20 Fatality%20Report%20Final.pdf [cited 10 August 2018].

Advance Directive Status in >65yo ED Population

Advance Directive Status in the Greater Than 65-Year-Old Emergency Department Population

Author: Kelsey Grace , Michelle Carson MD, August Grace, David Betten MD

Author Affiliations: Sparrow Hospital Department of Emergency Medicine

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Corresponding Author: Kelsey Grace, gracekel@msu.edu

 

Abstract:

Advance directives are an important aspect of medical care for the elderly given the uncertainty of health and longevity. In their absence, family and physicians are often left with questions regarding what patient’s wishes would entail if they become incapacitated. Individuals >65 years presenting to the ED were surveyed during the months of June-September 2015 by study investigators regarding their knowledge and utilization of advance directives. 168 patient surveys were completed with a mean age of 77.2 (SD ±7.45 years; range 65-97). Of those, 91% were either ―very familiar‖ or ―somewhat familiar‖ with Advance Directives with 76.1% having some form of documented advance directives in place. Of those who felt family were aware of their wishes, 84.9% had assigned a Medical Durable Power of Attorney. Only a small minority had developed advance directives with their physician’s assistance (6.8%). The majority of patients stated that they had prepared their end of life documents with a Lawyer (72%). Only 35.8% of patients sampled had even mentioned the topic or their specific wishes with their primary care or ED physician. Overall rates of formalized advance directives would appear to be highly utilized in this patient population with little variation based upon respondents’ self-assessment of physical health. A surprising finding was how minor of a role physicians appear to play in the development of ADs. This provides an opportunity to enhance the physician-patient relationship and improve patient education regarding end of care discussions. Physicians should take initiative and begin having these conversations, in order to ensure that patients are making educated decisions and that proper documentation is occurring.

Published on date: February, 2018

DOI: 10.15404/msrj/02.2018.0152

Citation: Grace, K., Carson, M., Grace, A. et al. Advance Directive Status in the Greater Than 65-Year-Old Emergency Department Population, Medical Student Research Journal (2018). doi:10.15404/msrj/02.2018.0152

References:

1. Koch, K. Patient Self-Determination Act. J Fla Med Assoc. 1992. 79:240–243.

2. O’Sullivan, R., Malio, K., Angeles, R., Agarwal, G. Advance directives: survey of primary care patients. Can Fam Physicians. 2015. 61(4):353-356.

3. Oulton, J., Rhodes, S., Howe, C., et al. Advanced directives for older adults in the emergency department: a systematic review. J Pallait Med. 2015. 18(6):500-505.

4. Llovera, I., Ward, M., Ryan, J., et al. Why don’t emergency department patients have Advanced directives? Academic Emergency Medicine. 1999. 6(10):1054-1060.

5. Ishihara KK, Wrenn K, Wright SW, Socha CM, Cross M. Advance directives in the emergency department: too few, too late. Acad Emerg Med. 1996. 3:50–53.

6. Emanuel LL, Barry MJ, Stoeckle JD, Ettelson LM, Emanuel EJ. Advance directives for medical care—a case for greater use. New Engl J Med. 1991;324(13):889–895.

7. Spoelhof GD, Elliott B. Implementing Advance directives in office practice. Am Fam Physician. 2012. 85(5):461–466.

8. Edinger W, Smucker DR. Outpatients’ attitudes regarding Advance directives. J Fam Pract. 1992. 35(6):650–653.

9. Tierney WM, Dexter PR, Gramelspacher GP, Perkins AJ, Zhou XH, Wolinsky FD. The effect of discussions about Advance directives on patients’ satisfaction with primary care. J Gen Intern Med. 2001;16(1):32–40. (Patient satisfaction with physicians increases if directives are discussed).

Case Report of Glanzmann Thrombasthenia

Unexplained Bleeding: Case Report of Glanzmann Thrombasthenia

Author: Ahmed Al Wahab1 , Alaa Nugud, M.D.2 , Shomous Nugud M.D.3, Zahran Alras1

Author Affiliations:

1College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
2Department of Pediatrics, Dubai Health Authority, Dubai, United Arab Emirates
3Department of Research, Sharjah Institute for Medical Research, Sharjah, United Arab Emirates

[button link=”http://msrj.chm.msu.edu/wp-content/uploads/2017/09/GlanzmannEPub.pdf” type=”big” color=”green” newwindow=”yes”] Full Text Article PDF[/button]

Corresponding Author: Ahmed Al Wahab, a7md13@gmail.com

Key Words: Glanzmann Thrombasthenia, inherited platelet disorder, the disorder of hemostasis

Abstract:

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.

Published on date: September, 2017

DOI: 10.15404/msrj/09.2017.0127

Citation: 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

References:

  1. Stevens, R. & Meyer, S. (2002). Fanconi and Glanzmann: the men and their works. British Journal Of Haematology, 119(4), 901-904. http://dx.doi.org/10.1046/j.1365-2141.2002.03812.x
  2. Nurden, A., Ruan, J., Pasquet, J., Gauthier, B., Combrié, R., Kunicki, T., & Nurden, P. (2002). A novel 196 Leu to Pro substitution in the β3 subunit of the αIIbβ3 integrin in a patient with a variant form of Glanzmann thrombasthenia. Platelets, 13(2), 101-111. http://dx.doi.org/10.1080/09537100220122466
  3. Solh, M., Solh, T., & Botsford, A. (2015). Glanzmann&#39;s thrombasthenia: pathogenesis, diagnosis, and current and emerging treatment options. Journal Of Blood Medicine, 219. http://dx.doi.org/10.2147/jbm.s71319
  4. Di Minno, G., Zotz, R., d’Oiron, R., Bindslev, N., Di Minno, M., & Poon, M. (2015). The international prospective Glanzmann Thrombasthenia Registry: treatment modalities and outcomes in non-surgical bleeding episodes in Glanzmann thrombasthenia patients. Haematologica. http://dx.doi.org/10.3324/haematol.2014.121475
  5. iore, M., Nurden, A., Nurden, P., & Seligsohn, U. (2012). Clinical utility gene card for: Glanzmann thrombasthenia. European Journal Of Human Genetics, 20(10), 1102-1102. http://dx.doi.org/10.1038/ejhg.2012.178
  6. George, J., Caen, J., & Nurden, A. (1990). Glanzmann’s thrombasthenia: the spectrum of clinical disease. Blood, 75(7), 1383-1395.
  7. Seligsohn, U. (2003). Glanzmann thrombasthenia: a model disease which paved the way to powerful therapeutic agents. Pathophysiology Of Haemostasis And Thrombosis, 32(5-6), 216-217. http://dx.doi.org/10.1159/000073569.

Three Wishes Survey

Are medical students becoming less altruistic and more money-oriented? A three wishes survey

Author: Anna I. Perera MSc1, Anna Serlachius PhD1, Roger J. Booth PhD2 & Keith J. Petrie PhD1

Author Affiliations:

1Department of Psychological Medicine, University of Auckland, NZ

2Department of Molecular Medicine and Pathology, University of Auckland, NZ

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Corresponding Author: Anna I. Perera, anna.perera@auckland.ac.nz

Key Words: undergraduate, motivations, altruism, money, specialization

Abstract:

Purpose

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

Methods

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

Results

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

Conclusion

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

Published on date: September, 2017

DOI: 10.15404/msrj/09.2017.0145

Citation: 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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Aerococcus Viridans

Aerococcus Viridans Infectious Endocarditis Complicated by Splenic Infarction

Author: Joshua Budhu M.S, Dorian Wood B.S, Marvin Crawford M.D, Khuram Ashraf M.D, Frederick Doamekpor M.D, Olufunke Akinbobuyi M.D

Author Affiliations: Morehouse School of Medicine, GA, USA

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Corresponding Author: Joshua Budhu, jbudhu@gmail.com

Key Words: splenic infarct, infectious endocarditis, aercoccus viridans, HIV, immunocompromised, hemodialysis

Abstract:

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

 

Published on date: September, 2017

DOI: 10.15404/msrj/07.2017.0002

Citation: : 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

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MRI vs. CT in Diagnosing Acute Appendicitis in Children

Systematic review of the accuracy of magnetic resonance imaging in the diagnosis of acute appendicitis in children: comparison with computed tomography

Author: Benjamin Whitt

Author Affiliations: Saba University School of Medicine, MA, USA

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Corresponding Author: Benjamin Whitt, btwhitt22@gmail.com

Key Words: Appendicitis; Diagnostic Imaging; Sensitivity; Specificity; Children

Abstract:

Purpose

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

Methods

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

Results

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

Conclusion

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

 

Published on date: September, 2017

DOI: 10.15404/msrj/07.2017.0001

Citation: 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

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