Category Archives: Articles

Individual Articles in MSRJ

Fall 2014 – Broken

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Broken.

Author:  Timothy DeKoninck

Author Affiliations: College of Human Medicine, Michigan State University, East Lansing, MI, USA

[button link=”http://msrj.chm.msu.edu/wp-content/uploads/2014/11/MSRJ-Fall-2014-Broken.pdf” type=”icon” icon=”download” color=green] Full Text Article PDF[/button]

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.

References: N/A

Fall 2014 – Letter from the Editors

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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

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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: N/A

Spring 2014 – Isolated Orbital Mucormycosis in an Immunocompetent Adolescent

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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

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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 RP, Kato A, Peters A, Conley D, Kim J, Liu MC, et al. Epithelium inflammation and immunity in the upper airways of humans: studies in chronic rhinosinusitis. Proc Am Thorac Soc 2009; 6(3): 28894. http://dx.doi.org/10.1513

 

 

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

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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

[button link=”http://msrj.chm.msu.edu/wp-content/uploads/2014/07/MSRJ-Spring-2014-Leiomyosarcoma-of-Small-Bowel.pdf” type=”icon” icon=”download” color=green] Full Text Article PDF[/button]

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 bleed, does 64-slice MDCT have a role? Indian J Radiol Imaging 2012; 22(1): 4753. http://dx.doi.org/10.4103/0971-3026.95404.

12. Bhattarai M, Bansal P, Khan Y. Longest duration of retention of video capsule: a case report and literature review. World J Gastrointest Endosc 2013; 5(7): 3525. http://dx.doi.org/10.4253/wjge.v5.i7.352.

13. Lewis BS, Eisen GM, Friedman S. A pooled analysis to evaluate results of capsule endoscopy trials. Endoscopy 2005; 35(10): 9605. http://dx.doi.org/10.1055/s-2005-870353.

14. Urbain D, Van Laer W, Mana F. Capsule endoscopy for detection of small bowel malignancies. Surg Technol Int 2008; 17: 12630.

15. Pasha SF. Obscure GI bleeding in the east or west: are capsule and double balloon enteroscopy the best? Gastrointest Endosc 2010; 72(2): 3013. http://dx.doi.org/10.1016/j.gie.2010.04.034.

 

Spring 2014 – Future Medical Practice and Genetics

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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

[button link=”http://msrj.chm.msu.edu/wp-content/uploads/2014/07/MSRJ-Spring-2014-Future-Medical-Practice-and-Genetics.pdf” type=”icon” icon=”download” color=green] Full Text Article PDF[/button]

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. Prohibiting genetic discrimination. N Engl J Med 2007; 356(20): 20213.  http://dx.doi.org/10.1056/NEJMp078033.

17. Clinical Sequencing Exploratory Research (CSER). 2013. Available from: https://www.genome.gov/27546194 [cited 20
April 2013].

 

Spring 2014 – The Anatomy of a Patient

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The Anatomy of a Patient.

Author: Scott C. Mauch

Author Affiliations: College of Human Medicine, Michigan State University, Grand Rapids, MI, USA

[button link=”http://msrj.chm.msu.edu/wp-content/uploads/2014/07/MSRJ-Spring-2014-The-Anatomy-of-a-Patient.pdf” type=”icon” icon=”download” color=green] Full Text Article PDF[/button]

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.

 

Spring 2014 – Letter from the Editors

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Letter From the Editors.

Author: Kevin C Patterson.

Author Affiliations: College of Human Medicine, Michigan State University, East Lansing, MI, USA

[button link=”http://msrj.chm.msu.edu/wp-content/uploads/2014/07/MSRJ-Spring-2014-Letter-from-the-Editors.pdf” type=”icon” icon=”download” color=green] Full Text Article PDF[/button]

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: N/A

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

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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

 

 
[button link=”http://msrj.chm.msu.edu/wp-content/uploads/2014/04/MSRJ-Winter-2014-Vemurafenib-Background-Patterns-of-Resistance-and-Strategies-to-Combat-Resistance-in-Melanoma.pdf” type=”icon” icon=”download” color=green] Full Text Article PDF [/button]

 
 
*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:
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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. COT drives resistance to RAF inhibition through MAP kinase pathway reactivation. Nature. 2010;468(7326):968-972. http://dx.doi.org/10.1038/nature09627.
 
10. Kudchadkar R, Paraiso KH, Smalley KS. Targeting mutant BRAF in melanoma: current status and future development of combination therapy strategies. Cancer J. 2012;18(2):124-131. http://dx.doi.org/10.1097/PPO.0b013e31824b436e.
 
11. Fedorenko IV, Paraiso KH, Smalley KS. Acquired and intrinsic BRAF inhibitor resistance in BRAF V600E mutant melanoma. Biochem Pharmacol. 2011;82(3):201-209. http://dx.doi.org/10.1016/j.bcp.2011.05.015.
 
12. Hanahan D, Weinberg RA. Hallmarks of cancer: the next generation. Cell. 2011;144(5):646-674. http://dx.doi.org/10.1016/j.cell.2011.02.013.
 
13. Skorokhod A, Capper D, von Deimling A, Enk A, Helmbold P. Detection of BRAF V600E mutations in skin metastases of malignant melanoma by monoclonal antibody VE1. J Am Acad Dermatol. 2012;67(3):488-491. http://dx.doi.org/10.1016/j.jaad.2012.03.022.
 
14. Poulikakos PI, Rosen N. Mutant BRAF melanomas–dependence and resistance. Cancer Cell. 2011;19(1):11-15. http://dx.doi.org/10.1016/j.ccr.2011.01.008.
 
15. Wilson TR, Fridlyand J, Yan Y, et al. Widespread potential for growth-factor-driven resistance to anticancer kinase inhibitors. Nature. 2012;487(7408):505-509. http://dx.doi.org/10.1038/nature11249.
 
16. Dummer R, Flaherty KT. Resistance patterns with tyrosine kinase inhibitors in melanoma: new insights. Curr Opin Oncol. 2012;24(2):150-154. http://dx.doi.org/10.1097/CCO.0b013e32834fca92.
 
17. Aplin AE, Kaplan FM, Shao Y. Mechanisms of resistance to RAF inhibitors in melanoma. J Invest Dermatol. 2011;131(9):1817-1820. http://dx.doi.org/10.1038/jid.2011.147.
 
18. Yadav V, Zhang X, Liu J, et al. Reactivation of mitogen-activated protein kinase (MAPK) pathway by FGF receptor 3 (FGFR3)/Ras mediates resistance to vemurafenib in human B-RAF V600E mutant melanoma. J Biol Chem. 2012;287(33):28087-28098. http://dx.doi.org/10.1074/jbc.M112.377218.
 
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Winter 2014 – Substance Use Among Physicians and Medical Students

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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.
 

 
[button link=”http://msrj.chm.msu.edu/wp-content/uploads/2014/04/MSRJ-Winter-2014-Substance-Use-Among-Physicians-and-Medical-Students.pdf” type=”icon” icon=”download” color=green] Full Text Article PDF [/button]
 
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.
 
 
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Winter 2014 – Morphine-induced Myoclonus in a Patient with End-stage Renal Disease

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Morphine-Induced Myoclonus in a Patient with End-Stage Renal Disease.
 
Victoria L. Stahl1*, Hassan I. Ahmad2, and James E. Novak3
 
Author Affiliations:
1School of Medicine, Wayne State University, Detroit, MI, USA.
2Department of Medicine, Henry Ford Hospital, Detroit, MI, USA.
3Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, MI, USA.

 

 
[button link=”http://msrj.chm.msu.edu/wp-content/uploads/2014/04/MSRJ-Winter-2014-Morphine-induced-Myoclonus-in-a-Patient-with-End-stage-Renal-Disease.pdf” type=”icon” icon=”download” color=green] Full Text Article PDF [/button]
 
*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:
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