Musical Hallucinations in an Elderly Female With Hearing Loss.

Musical hallucinations (MH) are rare auditory phenomena in which patients perceive music without a known source. Risk factors for MH include hearing loss, older age, female gender, epilepsy, and certain medications. This case report details the presentation, diagnosis, and treatment of an 82-year-old woman who developed MH following the onset of hearing loss.

Atypical Lyme Disease Rash: A Case Report.

Lyme disease (LD), caused in the United States primarily by sensu lato, is a tick-borne illness characterized by a spectrum of clinical manifestations depending on the stage of illness. Most clinicians are familiar with the classic bullseye appearance of the erythema migrans (EM) rash that occurs in the early stage of the disease. However, many providers may not be aware of alternate appearances for the rash.

Written Communication From Pharmacy Benefit Managers: Is It Helpful?

Introduction: Physicians are experiencing greater burnout due to excessive time spent on paperwork. Pharmacy benefit managers (PBMs) are adding to this problem by sending excessive mail to physicians. This study examined these mailed communications to determine their frequency and if the physician acted upon them.

Validity and Accuracy of the Tilburg Frailty Indicator Part B for Identification of Frailty in Older Adults Consulting a Rural Geriatric Medicine Clinic.

The Tilburg Frailty Indicator (TFI) is a validated tool for determining frailty in older adults. This study examined the validity and accuracy of the TFI Part B (TFI-B) in a North American context. Seventy-two individuals ≥ 65 years of age recruited from a rural geriatric medicine clinic completed a set of self-reported and performance-based measures, including TFI-B.

Sclerosing Mesenteritis: A Rare Cause of Abdominal Pain.

Sclerosing mesenteritis (SM) is a rare inflammatory fibrotic disease of the small intestine mesenteric fat often discovered incidentally on a CT scan. Clinical manifestations depend on the mass effect on the viscera and vessels. The most common symptoms are abdominal pain, bloating, and nausea.

A Randomized Open-Label Study of Two Methods of Proton Pump Inhibitors Discontinuation.

Background Proton pump inhibitors (PPIs) are effective in treating gastroesophageal reflux disease (GERD). Unfortunately, they are often inappropriately prescribed and long-term use has potential adverse effects. A single best method for discontinuation of PPIs does not currently exist.

Post-Influenza Vaccine Subdeltoid bursitis.

A 61-year-old female presented three months following an influenza vaccination with ongoing pain since the injection and was diagnosed by MRI with subdeltoid bursitis. The patient received a short course of prednisone and several months of physical therapy before returning to pain-free function. The primary reason for injection-related subdeltoid bursitis is improper administration.

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.

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 a review 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.

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.

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.

Vitamin C deficiency in an anticoagulated patient.

A 64-year-old woman presented with a hemorrhagic perifollicular rash on her legs while taking warfarin. After biopsy, vitamin C deficiency was suggested as the diagnosis, which ascorbic acid assays later confirmed. Clinical resolution of the rash followed supplementation with vitamin C.

Screening mammograms in Alzheimer's disease patients.

Very little guidance exists to help clinicians and families decide whether mammograms are useful in elderly women with Alzheimer's Disease (AD). We present a case of a patient with moderate AD who had a positive mammogram and discuss the dilemma faced by the family and clinician in deciding what was best to do for the patient. In this case, the family opted for breast conserving surgery (BCS) followed by palliative care which brought up the question of whether screening was appropriate with this treatment goal in mind.

Chronic paracetamol treatment influences indices of reactive oxygen species accumulation in the aging Fischer 344 X Brown Norway rat aorta.

Previous reports have demonstrated that increased levels of reactive oxygen species (ROS) and alterations in cell signaling characterize aging in the Fischer 344 X Brown Norway (FBN) rat aorta. Other work has suggested that increases in ROS may be related to vascular wall thickening and the development of hypertension. Paracetamol (acetaminophen) is a potent antioxidant that has been found to diminish free radicals in ischemia-reperfusion studies.

Barriers to vaccinating the elderly with H1N1 vaccine.

Introduction: The development of a monovalent 2009 H1N1 influenza (swine flu) vaccine for the 2009-2010 season prompted a nationwide campaign of vaccination. The authors assessed the frequency of influenza vaccine usage among 3858 elderly patients with their practice and the most common barriers to receiving vaccine.

Methods: The authors calculated the usage of seasonal and 2009 H1N1 vaccines among seniors with their university practice and surveyed a cohort of 64 patients to determine whether they had received the 2009 H1N1 vaccine and their reasons for not receiving it.

Physician and patient barriers to adherence with cholesterol guidelines.

Several national studies have shown poor compliance with National Cholesterol Education Program II (NCEP) goals. A study we conducted of patients in the General Internal Medicine Clinic at the Marshall University Joan C. Edwards School of Medicine in Huntington showed that 46% of them were not at NCEP goals.

Influenza season triggers pneumococcal vaccination.

Objectives: To investigate the frequency with which influenza and pneumococcal vaccines are administered alone and together.

Design: Retrospective review.

Setting: Marshall University internal medicine practice, Huntington, West Virginia.

Standing orders in an ambulatory setting increases influenza vaccine usage in older people.

Objectives: To determine whether standing orders for influenza vaccine increase its usage in an ambulatory setting in elderly patients.

Design: Retrospective analysis of influenza vaccine usage over 4 years (1999-2002).

Setting: University ambulatory setting.