Defining Bone Health and Fracture Risk in West Virginia: The World Health Organization FRAX® Assessment Tool

This article highlights the expanding burden of osteoporosis in West Virginia. WV ranks second nationally in the percentage of its population that is ≥ 65 years of age. Our older population increases the risk of osteoporosis and fracture; the most recent data indicates that 77% of our women age 50 and older have osteoporosis or low bone mass. The lifetime risk of osteoporotic related fracture is alarming and occurs in 50% of females and 25% of males age 50 and older. The risk of osteoporosis related hip fracture in women is equal to the combined risk of breast, uterine or ovarian cancer with the annual risk of osteoporotic fracture greater than the combined risk of breast cancer, stroke and heart attack. Detecting individuals at risk for fracture has been aided by an internationally validated fracture prediction tool from the World Health Organization -- FRAX®. The FRAX® tool can be incorporated into protocols to help minimize barriers to effective osteoporosis screening and treatment in WV

Medical Student Attitudes Toward Cell Phone Use on Rounds

Purpose: Mobile devices are ubiquitous and serve as an important resource for on-the-spot research about patient questions and conditions. However, even when a device is used to address patient needs, patients and members of the medical team may assume the student is using their phone for non-clinical activities and perceive the student as uninterested and disengaged. Medical students are aware of this potential for misperception, and as such, we designed a study to investigate the attitudes of third and fourth year medical students towards cell phone use on internal medicine rounds. Methods: Our target learner population was third and fourth year medical students on their internal medicine rotations. Voluntary and anonymous surveys generated data in aggregate assessing the attitudes of students towards cell phone use while on rounds. Results and Conclusions: The results of our study show that medical students have a strong desire to use smart phones for professional reasons on rounds. The data also show that despite this desire, students do not feel comfortable accessing their technology for fear of professional repercussions from both attendings and patients. An overwhelming 75% of students reported that they would use their smart phones more frequently if formal guidelines were in place encouraging professional cell phone use. We hope to develop an intervention to eliminate the fear of professional repercussions medical students currently experience as digital learners using smart phones. This intervention would seek to bolster medical education and patient care by adding transparency to cell phone use between medical students, attendings and the patients they treat

A Forty-Year-Old Woman with a History of Psychosis and a Seizure Disorder

In this issue of the Journal, we are introducing a new section. the Interdisciplinary Case Conference. Our goal will be to present psychiatric patients in whom pathology is demonstrable not only by interview, but also by physical examination,laboratory studies. and radiographic imaging techniques

Eruptive Lentigines Confined to Resolving Psoriatic Plaques Following Treatment with Guselkumab

Eruptive lentigines in the area of resolving psoriatic plaques has been well documented in the literature following successful treatment with multiple therapies. This is historically associated with light treatment but has been expanded to include other therapies such as anti-tumor necrosis factor therapies and, more recently, some biologics5. Guselkumab (Tremfya) is an IgG1λ monoclonal antibody used in the treatment of plaque psoriasis with only one case of eruptive lentigines confined to resolving psoriatic plaques (ELRP) noted as a side effect. We present the second such case of ELRP associated with successful treatment of plaque psoriasis with Guselkumab, as it is important to document potential side effects of medications regardless of their severity

Staged Laser Interstitial Thermal Therapy for the Surgical Treatment of Insular Glioma: a Case Series

Staged Laser Interstitial Thermal Therapy for the Surgical Treatment of Insular Glioma: a Case Series Introduction Insular gliomas pose one of the most significant challenges in neurosurgical oncology due to the complexity of the surrounding functional and microvascular anatomy. Despite current surgical and technological advancements, resection of insular gliomas can lead to potentially severe neurological morbidities. Laser Interstitial Thermal Therapy (LITT), either alone or combined with surgery, presents a less invasive cytoreductive approach for treating insular gliomas. Objective In this work we describe the first-ever reported series of patients with insular gliomas treated with staged LITT operations with or without subsequent craniotomy. Methods We reviewed a retrospective institutional database to identify patients with insular glioma who underwent staged LITT operations with or without subsequent craniotomy. From the compiled list of 11 patients, we obtained clinical, histopathological and volumetric lesion characteristics for each patient. Procedural characteristics, morbidity, overall survival (OS) and progression-free survival (PFS) were further assessed. Results From the 11 insular glioma patients included in this study the average age was 42 (SD = 12.5 years) with 8 (73%) patients that had left sided tumors and 6 (55%) patients had high grade insular gliomas. A total of 26 surgical procedures were performed with 21 ablations and 5 ablations that were followed by subsequent craniotomy. With regards to operative outcomes, the median tumor volume (cc) of our patient group was 31.5 (9.58-97) and the extent of tumor resection with laser ablation was on average 96.2% (SD = 8.5). Assessing post-operative morbidities, our group found OS to be 15.7 months (SD=10.3) and PFS to be 11.7 months (SD=7.5). Of the 21 ablation-only procedures performed, in the peri-operative period (3-5 days) neurological deficits were found in 9 (43%) post-ablation cases however there were 0 post-ablation cases with neurological deficits in the long-term (\u3e3months). Of the 5 procedures where laser ablation was followed with subsequent craniotomy, neurological deficits were found in the peri-operative period in all 5 post-resection cases (100%) and there were neurological deficits in the long-term period found in 2 of them (40%). Conclusions We present the first ever reported series of insular gliomas treated with staged LITT operations. Through conducting this study our group found that staged treatment of insular gliomas with LITT is safe, effective and a minimally invasive option that avoids the potentially severe neurological compromises associated with conventional surgical resection approaches. Usage of stages of LITT to directly target high-risk insular glioma regions presents a novel treatment approach that may facilitate the maximal safe treatment of these otherwise significantly surgically challenging lesions

Contact Dermatitis Awareness and Education through the Use of Online Platforms

Social media has become a popular means for raising awareness and providing education. Over the last several years, these modalities have been used more than ever by healthcare providers to increase networking opportunities, promote healthcare organizations, and engage with patients, caregivers, and students

Hygiene in the United States Brow Shaping Industry: A Benchmarking Report

Purpose: To provide a current benchmark of hand hygiene and brow cleansing in the brow shaping industry across the United States of America. Background: Brow abscesses have been linked to the microtrauma associated with brow shaping. This paper provides an understanding of normative standards of hand hygiene and brow cleansing in the brow shaping industry at both the regional and national levels. Methods: This project involved a phone survey of 255 brow salons across the United States – 5 from the most populous city in every state and Washington, D.C. Uni- and multivariate associations between regional and national brow hygiene practices were explored using chi-square testing and multinomial logistic regression modeling. Results: Of 255 brow salons included in this study, 137 performed waxing (54%), 72 performed threading (28%) and 46 performed both (18%). Hand hygiene was required at 97% of brow salons, most commonly using alcohol-based sanitizer (59%), hand washing (22%), or some combination of the two (16%). Brow cleansing was required at 80% of salons, with the vast majority using an alcohol-based cleanser (75%). Multinomial logistic regression analysis of hand and brow hygiene methods, including hand hygiene frequency and service type, failed to show regionally predictive differences. Hand hygiene was performed more routinely than brow hygiene nationwide (p\u3c0.01). Conclusions: The brow shaping industry is performing hand hygiene nearly across the board, but would benefit from increased rates of brow cleansing