Male Breast Enlargement After Automated Implantable Cardioverter-Defibrillator Placement

Placement of implantable cardioverter-defibrillators (ICDs) are increasing in frequency due to their indication for the prevention of sudden cardiac death in patients prone to life-threatening arrhythmias. Primary care physicians should be aware of the possible complications so they can treat their patients appropriately. This article describes a rare case of chronic unilateral breast enlargement after the placement of an ICD in a male patient with Tetralogy of Fallot

Update on Adolescent Tobacco Cessation

Adolescent tobacco use is decreasing in West Virginia, a state which features the Not on Tobacco (NOT) and RAZE programs. This manuscript gives an overview of recent studies in adolescent tobacco cessation, what works and what doesn’t. More research is needed to improve cessation rates in adolescents

Rural Disparities in Cancer Care: A Review of Its Implications and Possible Interventions

Cancer care has greatly improved in the last few decades, as evidenced by a 22% decline in the overall cancer-related death rate in the United States since 1991. However, the question presents itself whether rural residents, for whom the latest advancements are not as accessible, are also realizing these benefits as much as their urban counterparts. The aim of this study is to provide are view of the literature regarding the disparities in cancer care facing rural Appalachia and specifically West Virginia (WV) as well as possible solutions towards bridging this gap. We find that WV has a higher cancer incidence and mortality rate with fewer oncologists per resident, while rural areas in general have lower clinical trial participation and different treatment regimens. Though programs have been put in place such as mobile mammography clinics and local outreach, more work can be done in WV in the realms of teleoncology, virtual tumor boards, patient support groups, and physician training programs

E-cigarettes: An Up to Date Review and Discussion of the Controversy

Electronic cigarettes (e-cigarettes) present a novel method for nicotine delivery that is reportedly advantageous when compared to traditional cigarette usage. Manufacturers and consumers claim reduced chemical exposure, decreased symptom profiles, and efficacy in smoking reduction and cessation greater than conventional nicotine replacement therapies (NRT). However these products present new challenges and concerns to legislators, clinicians, and public health advocates. Questions of authority in state and federal legislation, establishing product quality control, assessing long-term studies on e-cigarettes and quantifying usefulness in harm reduction represent only a portion of the many unanswered topics being discussed. The purpose of this article is to assess the literature on e-cigarettes and establish perceptions and attitudes on this controversial subject

An Unusual Pulmonary Complication of Statin Medication

Statins or hydroxyl-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors have proven efficacy at decreasing cardiovascular morbidity and mortality. Although statins have been prescribed safely, there should be more awareness of the possible adverse effects. Recently, we encountered a patient who had unexplained dyspnea, weakness, and immobility. The patient’s symptoms were alleviated after discontinuing the statin medication. Although we have no concrete evidence that her symptoms were due to the medication, the temporal relationship of symptom improvement upon discontinuation of the statin, led us to the conclusion that it could potentially have been the cause. Unexplained dyspnea is not listed as an adverse effect in the prescribing information, but interstitial lung disease is listed as a possible complication of statins and there are a few other case reports of statin related unexplained dyspnea in the literature. Physicians should be aware of statins as a possible cause of unexplained dyspnea and consider a drug holiday as a therapeutic trial

An Intervention to Improve the Evaluation of Clerkship Students

Background: Effective feedback is an important part of formative evaluation of clerkship students, improving student performance by increasing awareness to weaknesses and strengths. Aim: The aim of this study was to obtain more helpful feedback. Setting: Internal Medicine third year clerkship rotation at Joan C Edwards School of Medicine, Huntington, WV. Participants: The Internal Medicine department has fifty-nine general and subspecialty faculty physicians. Program Description: We changed the structure of the existing feedback form by requesting written comments at the beginning and asking for specific strengths and areas for improvement, educated faculty, and gave them a milestones card. Three reviewers independently ranked written feedback according to a rubric. We compared the quantity of either helpful or unhelpful feedback obtained during the 2016 and 2017 academic years with that obtained in the first rotation of 2018-2019. Program Evaluation: With our intervention, helpful comments increased from 33.8% to 79.2%. A Kappa statistic revealed a lack of bias of the reviewers. Discussion: A small change in the evaluation form along with an educational intervention and milestones card improved the quantity of helpful feedback given to students in the Internal Medicine clerkship

Bilateral Extracranial Carotid Artery Aneurysms: A Rare Complication of Marfan Syndrome

Marfan Syndrome (MFS) is an autosomal dominant connective tissue disorder caused by a mutation in the FBN1 gene that encodes for the extracellular matrix protein fibrillin-1. The clinical manifestations of MFS which lead to morbidity and mortality are primarily those involving aortic disease, such as aneurysmal dilation, aortic regurgitation, and aortic dissection. Despite 60-80% of adults with MFS having some degree of aortic disease, carotid artery aneurysms are rare and usually represent extensions of aortic dissections.1 We report a 70-year-old female with a history of ectopia lentis and family history of MFS who presented to the ED with epistaxis and anemia. An arteriogram revealed an incidental finding of bilateral carotid artery aneurysms a rare phenomenon even in the presence of connective tissue disease. Review of the literature reveals very little data on the clinical presentation, treatment, and outcome of MFS patients with extracranial carotid artery aneurysms (ECAAs). We discuss presentation, etiology, and management options reported for these rare occurrences

The Impact of Alzheimer’s Disease in an Aging Rural Population

West Virginia already has a large elderly population, and it is expected to increase along with the elderly population of the nation as a whole. Since the most important risk factor for Alzheimer’s disease is older age, it is not surprising that the prevalence of Alzheimer’s disease is projected to increase significantly over the next thirty-five years. This paper discusses the prevalence of Alzheimer’s disease in West Virginia, programs available to assist people and caregivers affected by the disease, and the associated economic burden of the disease

Chronic Abdominal Pain In A Geriatric Patient: A Rare Case Of A Spigelian Hernia

We present a case of Spigelian hernia in a 77-year-old patient to highlight the difficulty in making this diagnosis and to raise awareness of this rare condition among physicians who care for geriatric patients with chronic bouts of abdominal pain. The patient presented to the emergency department with a two-day complaint of abdominal pain after three years of similar recurrent attacks. Results of the physical examination and computed tomography (CT) of the abdomen were consistent with a left-sided Spigelian hernia. Operative repair was performed using robotic-assisted reduction and the patient recovered without any complications

Acute Marjolin Ulcer From A Dog Bite

Marjolin ulcers are cancers, usually of squamous cell carcinoma pathology, that occur in scars or wounds. They are classically described in burn victims but can occur with other types of trauma and are rarely seen in association with bite wounds. Marjolin ulcers typically have a latent period of many years post-injury until the development of malignancy, but there are a few case reports of an exceedingly rare acute form. We present a case of a 78-year-old female who developed a Marjolin ulcer one month after sustaining a dog bite to the left index finger