Subarachnoid hemorrhage (SAH) and subse- quent scarring can rarely precipitate syringo- myelia several years after the initial insult. We present a patient with a history of posterior circulation SAH six years prior who developed progressive lower limb weakness, numbness, low back pain, fecal retention, and sphincter dysfunction. Imaging revealed cervicothoracic syringomyelia associated with thoracic arach- noid scarring. Despite multiple surgical inter- ventions, the patient experienced persistent and progressive syringomyelia. This case demonstrates that posterior circulation SAH may warrant prolonged surveillance for arach- noiditis, which may not be readily evident on imaging. Furthermore, surgical management should be tailored to the underlying pathology, often necessitating multiple interventions to effectively manage symptom progression.
INTRODUCTION The Empowering Rural High School Students in West Virginia Through Interactive Preventive Health Modules study aimed to improve preventive healthcare literacy and student comfort discussing health topics with healthcare providers among high school students in a medically underserved area. METHODS Students were recruited from required health and physical education classes at Spring Valley High School in Wayne County, West Virginia. The intervention consisted of four interactive 45-minute modules: substance misuse, physical activity and obesity, adult education, and mental health services, delivered by the same medical students during four individual sessions over one month. Pre- and post-module surveys using a five-point Likert scale were administered anonymously to assess changes in knowledge, attitudes, and comfort discussing health topics. A two-tailed paired t-test was used for statistical analysis. RESULTS Analysis of 112, 111, 101, and 113 responses from modules 1 through 4, respectively, revealed a significant improvement in post-module surveys’ composite scores compared to pre-module survey scores (e.g., module 1: 3.19 vs. 4.22, p < 0.0001). This trend was consistent across all modules. The greatest improvement was observed in the mental health module. DISCUSSION Results support the effectiveness of interactive health modules in increasing comfort and knowledge among students in rural, underserved settings, especially for mental health. CONCLUSION Despite limitations such as small sample size and single-site design, this study indicates that the modules intervention may be a scalable and cost-effective approach to improving health literacy and communication with healthcare providers in rural communities.
Glucagon-like peptide 1 receptor agonists (GLP-1 RAs) are widely used for the management of type 2 diabetes mellitus (T2DM) and obesity, with growing evidence of their anti-inflammatory effects. We report the case of a 54-year-old woman with obesity, T2DM, and biopsy-confirmed plaque psoriasis who developed joint pain and stiffness consistent with psoriatic arthritis (PsA). Her symptoms persisted despite appropriate trials of topical corticosteroids, calcipotriene, and oral apremilast. She also declined methotrexate due to concerns about side effects. Imaging of her hands revealed distal interphalangeal joint space narrowing, marginal erosions, and periosteal reaction, supporting the diagnosis of PsA. The patient was initiated on semaglutide (0.25 mg weekly) to address metabolic comorbidities. Within two weeks, she experienced near-complete resolution of both joint and skin symptoms, sustained over six months along with a 20-pound weight loss and stable glycemic control. This case highlights the potential role of GLP-1 RAs in modulating inflammatory disease activity in PsA, particularly in patients with overlapping metabolic conditions. Further research is warranted to explore their therapeutic value in inflammatory arthropathies.
We present the case of a 19-year-old male with Gardner syndrome, status post total proctocolectomy and ileal pouch-anal anastomosis (IPAA) at 8 years of age, who developed an internal hernia and volvulus more than 10 years following ileostomy reversal. Patients with a history of total proctocolectomy and IPAA are at an increased risk for long-term complications such as internal hernias and volvulus due to altered anatomy and mesenteric defects. Early imaging and prompt surgical intervention were crucial in preventing ischemia of the J-pouch and the possible need for a permanent ileostomy in our teenaged patient. This case describes a medical condition that has not been well characterized in the literature and emphasizes the importance of prolonged clinical vigilance and surveillance in post-IPAA patients, as mild symptoms may signal serious complications requiring urgent intervention, even many years after ileostomy reversal.
INTRODUCTION West Virginia has had an exceedingly high rate of deaths due to all-terrain vehicle (ATV) accidents over the last several decades. Likely contributors to the high mortality include poor helmet compliance and substance use. MATERIALS & METHODS Using West Virginia University’s Jon Michael Moore Trauma Center registry, ATV crash data from 2008-2020 were reviewed to analyze outcomes for patients aged 0 to 17 years and adults. RESULTS Three thousand thirty-seven crash victims were seen in the trauma center. Of these, 738 (24.3%) were pediatric patients aged 1 year to 17 years. Helmet use was noted in 41.7% of all patients; children under the age of 4 years (6.2%) were the least likely group to wear helmets. Of the pediatric patients, there were four fatalities and only one of these was wearing a helmet at the time of the accident. Helmet use in adult patients was 17.7%; the highest rate was in the patients aged 18-25 and lowest in those older than 60. Of 26 deaths in the adult cohort, only one wore a helmet. Substance use was also frequently associated with ATV injuries. In the pediatric patients, tetrahydrocannabinol (THC) was the most common substance found on urine drug screening (46 cases). Twenty-five (3.3%) of the pediatric patients also had a detectable blood alcohol content with the youngest being 12 years. For adult patients, ethanol (EtOH) was the most frequently associated substance (37.9%) with THC being second (13.4%). Substance use of any kind was highest among adults aged 22-58. CONCLUSION Lack of helmet use and the presence of substance use are associated with increased mortality and severity of injury in ATV accidents across all ages. Additional research into helmet compliance behavior and the effectiveness of substance use education is needed. Injury prevention strategies addressing these risks should be enhanced.
A 77-year-old woman with a long-standing hiatal hernia presented to the emergency department with complaints of epigastric abdominal pain and shortness of breath. Abdominal computed tomography revealed a large diaphragmatic hernia containing portions of the stomach, transverse colon, pancreas, and abdominal fat. Intraoperatively, the entire stomach, half of the transverse colon, the splenic flexure, the pancreas neck, and a portion of the pancreas body were intrathoracic, which is an extremely unusual finding. We describe this rare case of the herniation of the neck of the pancreas into the thoracic cavity.
INTRODUCTION There are similar misconceptions surrounding both human papillomavirus (HPV-9) and coronavirus (COVID-19) vaccinations, including vaccine development, side effects, and impact on fertility. The purpose of this study was to evaluate a large cohort of West Virginia (WV) adolescents to determine if patients who did not receive the HPV-9 vaccination were less likely to also receive the COVID-19 vaccination. MATERIALS AND METHODS A retrospective chart review was conducted among subjects aged 13-16 years presenting to Marshall Health Department of Pediatrics between May 2021 and June 2022 for either a well child or immunization visit. Data were obtained on vaccine uptake of HPV-9 and COVID-19 along with tetanus-diphtheria-pertussis (Tdap) and the meningococcal vaccine (MenACWY). RESULTS A total of 1,484 subjects were included and completion rates of HPV-9, COVID-19, Tdap, and MenACWY were 70.1%, 54.2%, 96.6%, and 97.5%, respectively. COVID-19 vaccination rates were not significantly different among subjects who did and did not receive the HPV-9 vaccine (45.3% vs. 47.1%, p = 0.52). When evaluating subjects who did not receive any HPV-9 vaccination, there were more females than males who also did not receive the COVID-19 vaccination (44.4% vs. 33.8%, p = 0.068). CONCLUSION This study demonstrates that there is not an observed difference between HPV-9 and COVID-19 vaccination, but other individualized factors may impact a patient’s decision to receive these vaccines.
Proliferative myositis is an uncommon benign soft tissue lesion characterized by rapid growth within skeletal muscle tissue. We describe a case of proliferative myositis in a 2-month-old male who presented with a painless, rapidly enlarging mass in his right sternocleidomastoid muscle. A biopsy of the mass rendered the diagnosis of proliferative myositis. The mass was observed with full resolution after four months, highlighting the importance of considering proliferative myositis in the differential diagnosis of rapidly enlarging soft tissue masses and emphasizing successful non-surgical management. Further understanding and awareness of this rare diagnosis are crucial for appropriate management strategies. To our understanding, our patient is the youngest reported with this disorder.
Cat Eye Syndrome (CES) is a rare genomic condition characterized by supernumerary chromosome 22 derivatives or intrachromosomal duplication or triplication. Clinical features vary and include coloboma of the irises, anal atresia, cardiac anomalies, urogenital anomalies, craniofacial anomalies, and varying degrees of developmental delay. The variable expressivity of this condition, combined with its infrequent incidence, makes CES a challenging diagnosis, even among affected members of the same family. In our case, we present a mother and son with non-identical features, and genetic testing revealed a quadruplication in the chromosome 22q11.1q11.21 regions for both individuals. No features of this condition are invariably present, so a high index of clinical suspicion is necessary to make the diagnosis. Recognition of this syndrome and identification of the molecular basis for each individual is essential for appropriate medical management, surveillance, and genetic counseling for affected patients and families.
INTRODUCTION Pre-medical students seek advice from physicians about applying to medical school, including information about gap years. Detailed information about experiences in which medical students engage during their gap years is not available in current literature. To increase the available information for physicians who may advise medical school applicants, we determined the frequency of gap years and details about the types of experiences in which matriculated medical students engaged during that time. METHODS Data from American Medical College Application Service applications to West Virginia University School of Medicine (WVU SoM) from 2019 to 2021 were extracted. Data included year of college graduation, year of medical school application, and details of experiences occurring during gap years. The frequency of gap years and the range, mean, median, and modes of the gap length were determined, along with details about gap experiences of matriculants. The Institutional Review Board of WVU SoM approved of this project (Protocol Number 2112491909). RESULTS A total of 15,676 applications were reviewed. The gap frequency was 42% (N=50), 45% (N=51), and 54% (N=60) for application years 2019, 2020, and 2021, respectively. Lengths ranged from one to 13 years. Gap experiences fit in one of six categories: education, research, medically related employment, non-medically related employment, volunteerism, and military service. CONCLUSION Physicians can incorporate this new information about the frequency and details of the six broad categories of gap year experiences into their advice given to their pre-medical advisees.
Recurrent respiratory papillomatosis is a rare but devastating disease. It is often characterized by numerous recurrences that are often refractory to surgical and adjunctive treatments. We present the case of a 5-year-old male with tracheostomy dependence from recurrent respiratory papillomatosis with distal seeding who was successfully treated with systemic cidofovir and palliative debulking procedures after failing treatment with intralesional and systemic bevacizumab.
INTRODUCTION Type 3c or pancreatogenic diabetes mellitus (DM) refers to diabetes associated with disease of the exocrine pancreas such as pancreatitis, cystic fibrosis, or hemochromatosis. It is very commonly misdiagnosed as type 2 DM. We present a case of a 36-year-old female who presented in diabetic ketoacidosis secondary to untreated type 3c DM following an episode of severe acute necrotizing pancreatitis. To our knowledge, this is the first reported case of type 3c DM due to acute necrotizing pancreatitis presenting in this manner. This case demonstrates the need for prompt recognition and early management of type 3c DM among patients affected by pancreatic pathologies as well as the need for consideration of discharge with home diabetic testing supplies of patients with acute pancreatitis.
A review of cystic fibrosis (CF), including epidemiology, pathogenesis, screening, diagnosis, and treatment is provided, along with a brief introduction to the Mountain State Cystic Fibrosis Center. Treatment challenges in the management of pediatric and adult patients with CF in rural areas, such as West Virginia, and the future directions of CF care are also described.
