Medicine and Health Sciences Commons^™

Effect Of Osteopathic Manipulative Treatment In Patients With Postural Orthostatic Tachycardia Syndrome (Pots): A Literature Review, Sidharth Sahni, Harrison Jordan, Binoy Desai, Danielle Cooley, Alexander King

Rowan-Virtua Research Day

Postural Orthostatic Tachycardia Syndrome (POTS) is characterized by autonomic dysregulation resulting in diminished blood flow and excessive tachycardia.

POTS has been scarcely studied in the clinical setting. A review of literature generated only four articles, only one of which met the established criteria.

A follow up study to evaluate the effect of OMT on the quality of life for patients with POTS is planned. The hypothesis is that osteopathic manipulation plays a role in the management of POTS, as patients should experience improvement in their symptoms and their overall quality of life.

A Rare Case Of Acute Appendicitis In A 21-Year-Old Male With Midsternal Chest Pain, Muhammad Noman, James Espinosa, Alan Lucerna, Andrew Caravello

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Acute appendicitis is inflammation of the vestigial vermiform appendix. It is one of the leading causes of emergency department visits due to abdominal pain. The vermiform appendix is located at the base of cecum. The attachment does not change; however the tip may migrate to the retrocecal, subcecal, preileal, postileal and pelvic positions. Considering these normal anatomical positions, the pain presentation may vary in patients.

Even though this patient presented with midsternal chest pain, which was suspicious for GERD, it was crucial to perform a thorough head-to-toe exam to discover incidental findings that the patient did not report. In this …

Case Report: Glioblastoma Tumor Presenting With Mild Changes In Memory, Samuel Thalathoti, Nicholas Palladino, James Espinosa, Alan Lucerna

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We report a case of a 66-year-old female who presented to the ED with generalized headache and mild confusion, who was diagnosed with high-grade glial neoplasm. The differential diagnosis of headache is vast, but without red flags or symptoms is generally from a benign cause and easily treatable. However, even in the context of a normal neurologic physical exam, symptoms such as confusion, forgetfulness, and behavioral changes should merit imaging in the workup. Glioblastoma is the most common brain tumor, accounting for 47.7% of all cases, with an incidence of 3.21 per 100,000 population. Median age of diagnosis is 64 …

Myopericarditis In A Patient With Recent Covid-19 Mrna Vaccine, Zamran Masih, Wayne Tamaska, Nicholas Tomasello

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Myopericarditis after Covid-19 mRNA vaccination is not well described. However, there have been several cases described throughout the pandemic suggesting some correlation between Covid-19 vaccination and myopericarditis. We describe such a case where a patient developed myopericarditis after receiving Johnson & Johnson vaccine.

Diaphragmatic Adjacencies: Pulmonary Embolism Presenting As Abdominal Pain, Joseph Piraneo, Christopher Schwartz, Russell Mordecai

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Pulmonary embolism is a common yet potentially life-threatening diagnosis that should not be missed in the Emergency Department. Common presenting symptoms include dyspnea, pleuritic chest pain, cough, hemoptysis, syncope or pre-syncope. Less often, however, presenting symptoms can include abdominal pain. A clinician should recognize that pain adjacent to the diaphragm (including the lower chest and upper abdomen), can be secondary to underlying pathology either above or below the diaphragm. Here we describe an unusual case of pleuritic, post-prandial, right upper quadrant abdominal pain that was a result of pulmonary embolism.

Evaluating The Relationship And Outcomes Of Ischemic Stroke In Patients With Covid-19 While Also Reviewing Overall Incidence And Mortality Of Stroke In Vulnerable Populations In The Us, Jaime Dougherty

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COVID-19 has affected the worldwide population since early 2020 and has remained a health issue. Among the various symptoms and outcomes people are encountering when infected with COVID-19, this virus has also been connected to severe vascular insults involving large vessel occlusions.

Current stroke statistics indicate a nearly twice as high risk of stroke in African Americans when compared to whites. This brings into question how social determinants of health are affecting COVID-19 and stroke incidence.

The purpose of this review is to investigate the relationship between COVID-19 and ischemic stroke while advocating for a more robust primary prevention approach …

Case Report: Octreotide Associated Hyperkalemia, Darren Finn, Eric Maddock, James Espinosa, Andrew Caravello, Alan Lucerna, Henry Schuitema

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78-year-old female with past medical history of acromegaly status post pituitary adenoma status post resection presents to the emergency department with abdominal pain. ED workup was not significant for any acute intra-abdominal abnormalities; however, incidental finding of hyperkalemia was pertinent to the visit. Patient was treated in the ED for her condition but her potassium levels remained elevated despite repeated saline infusions. Patient was ultimately admitted to the hospital where it was discovered that she had recently been switched from octreotide injections to an oral somatostatin analogue Mycapssa. We believe that this patient’s hyperkalemia was caused by octreotide-induced insulin suppression …

Incidental Finding Of Unusually Large Renal Cyst During Point Of Care Ultrasound, David Ho, Jeffrey Gardecki

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Renal cysts are common, and their frequency and size increase as patients age. Renal cysts are derived primarily from tubules and can occur anywhere between Bowman’s capsule to the renal papilla. The cysts are composed of abnormally differentiated epithelial cells encapsulating a cavity of fluid. These abnormally differentiated cells are due to defects in the structure and function of cilia, the structures responsible for detecting urine flow as well as the epithelial composition of the epithelial architecture and repair. According to Campbell Urology, there are three processes in which renal cysts increase in their size – proliferation of epithelial cells …

Syncope Masquerading As Pulmonary Embolism, Melissa Itidiare Locke, Andrew Caravello, Melanie Angelo, Andrew Vasta

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Syncope is a clinical syndrome that occurs due to a period of inadequate cerebral blood flow that cause a transient loss of consciousness that usually resolves within 8-10 seconds) [1] Our case demonstrates a 56-year-old female who experienced syncope for the first time. The patient had an unwitnessed fall and subsequently had imaging studies performed. A discovery of a Sub-Massive Pulmonary embolism was revealed.

Factors And Outcomes Contributing To Pelvic Lymph Node Dissection In Non-Muscle Invasive Bladder Cancer, Young Son, Brian Thomas, Lance Earnshaw, Mark Quiring, Erica Martel, Benjamin Fink, Raeann Dalton, Thomas Mueller, Philip Dorsey

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Bladder cancer represents the 6th most common for men and is classified into muscle-invasive bladder cancer (MIBC) and non-muscle-invasive bladder cancer (NMIBC). NMIBC (T1, Ta, Tis), accounting for approximately 75% of new bladder cancer diagnoses, is limited to the mucosa, submucosa, and lamina propria. Studies have approximated the rate of recurrence in NMIBC between 50 - 70%, which sometimes progresses to muscle invasive disease. Management of NMIBC ranges from surveillance, intravesical chemotherapy to radical cystectomy (RC) and is dependent upon the TNM staging and grading of the tumor. Clinically, staging is determined via imaging, physical exam, and histology on transurethral …

Wernicke’S Encephalopathy Secondary To Hyperemesis Gravidarum, Mohammad Rattu, Alexander Norinsky, James Espinosa, Alan Lucerna, Henry Schuitema

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Wernicke’s encephalopathy (WE) is a neurological disorder secondary to thiamine deficiency that is precipitated by administration of glucose-containing fluids prior to thiamine supplementation. Though WE is typically diagnosed among alcoholics (12.5%), the prevalence among nonalcoholics can vary from 0.04-0.13%. Around 30-40% of patients with underlying thiamine deficiency will only experience one of the symptoms from the typical triad, with the complete triad (encephalopathy, oculomotor dysfunction/nystagmus, and ataxia) only evident among 5-16% of the population. Among the non-alcoholic patient population presenting with WE, a history of vomiting is more frequent. While nausea affects around 80% of pregnant women, an extreme form …

Effect Of Uracil Dna Glycosylase Activity On The Efficacy Of Thymidylate Synthase Inhibitor/Hdac Inhibitor Combination Therapies In Colon Cancer, Rashmi Kulkarni, Brian P Weiser

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Human uracil DNA glycosylase (UNG2) is responsible for removing uracil bases from DNA and initiates base excision repair pathways. Accumulation of uracil or its fluorinated analogs in DNA is one of the killing mechanisms of thymidylate synthase (TS) inhibitors in cancer cells, and depletion of UNG2 often enhances the toxicity of these anticancer drugs. We tested the effect of UNG2 KO on the efficacy of multiple TS inhibitors (5-fluorouracil, fluorodeoxyuridine, and pemetrexed) and we determined that, except for 5-fluorouracil, all other TS inhibitors were significantly more potent in UNG2 KO cells compared to wild-type HT29 cells. Interestingly, UNG2 protein levels …

Examining The Relationship Between Adolescent Obesity Rates And School Health Programs In Grades 9-12 In The United States, Joseph Melillo, Alison Mancuso

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- In the United States, it was found that the prevalence of obese adolescents ages 12-19 was 21.2%.1

- According to a study by Ward et. al published in the New England Journal of Health (NEJH), the researchers estimated 88.2% of obese 19-year-olds would still be obese by the age of 35.2

- The purpose of this study was to evaluate school provided health programs and their impact on BMI values of students within these schools.

- This study aimed to compare health outcomes between different schools across the United States and identify aspects of school programming that can be …

Association Between Leg Adiposity & Hypertension Subtypes In Young & Middle-Aged American Adults, David Lo, Aayush Visaria, Pranay Maniar

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Our research aim was to determine the association between appendicular adiposity and hypertension to better elucidate the role of body fat distribution on blood pressure (BP).

Many studies have provided evidence for the inverse association between leg adiposity and metabolic syndrome criteria.

Hypertension (HT) subtypes have unique age distributions and associated risk factors. BMI ± triglycerides are major risk factors for isolated diastolic hypertension (IDH).

Lead Poisoning, Education, And Advocacy For Prevention (L.E.A.P.) Study, Stephen Acheampong, Britney Aderinto, Zander Turcich, Ali Harb

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Lead poisoning has been regarded as a major threat due to its irreversible and harmful effects. This includes severe cognitive and developmental impairments, especially in children.

Over the years, the CDC has reduced the benchmark for acceptable blood lead levels (BLL) from 10 μg/ml to 3.5 μg/ml to allow for earlier intervention and prevention.

Despite increased awareness and government programs that lead to a decline in mean blood levels across the country, testing for elevated BLLs, especially in low-income households, continues to be disproportionately lower.

Secondary Stroke Prevention Retrospective Analysis, Mansi Panse, Samantha Plasner, Nasrine Bendjilali

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Stroke is the leading cause of serious long-term disability among adults in the United States, and there are well recognized modifiable risk factors for stroke. Secondary prevention efforts to reduce the likelihood of recurrent stroke should be top priority in this high-risk patient population. The role of the primary care team in implementing and assisting patients with adherence to secondary prevention efforts is critical. The objective of this retrospective analysis is to examine how successful primary care providers are at implementing secondary stroke prevention guidelines.

Preventing secondary stroke is critical to the welfare of this high-risk population and ultimately saves …

Improvement Of Memory Loss Through Dietary Intervention In The Assisted Living And Rehabilitative Settings, Alexander Swartz, Martin Forsberg

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• The ketogenic diet is a popular, controversial diet that fuels the brain through beta-oxidation of fatty acids and production of ketone bodies, the most populous of which is betahydroxybutyrate (BHB).

• The ketogenic diet consists of 70-80% fats, 20-25% protein, and 5-10% carbohydrates.

• Medically, the ketogenic diet is utilized in patients with epilepsy and recommended by some physicians to improve general health through weight loss and insulin sensitivity.

• Key factors of neurodegeneration include glucose hypometabolism, oxidative damage, and neuroinflammation.

• Studies have shown that with ingestion of exogenous ketones alone, or endogenous ketonemia through a ketogenic diet, there is: …

Migratory Dermatographic Urticaria Following Covid-19 Vaccine Booster In Young Adult Male, Richard A. Maiella, Kelly Staples, Ashok Veldanda

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With the recent approval of booster vaccinations in the United States for adults who already received their primary vaccinations, millions of adults have been administered the Pfizer-BioNTech or Moderna booster vaccines.

Adverse events related to these vaccines continue to be reported and are majority self-limited. In this case report, we present a young male who acquired chronic, migratory dermatographic urticaria two weeks after administration of the Moderna mRNA-1273 COVID-19 vaccine booster.

Omm As A Complementary Therapy For Chronic Shoulder Overuse Injury In A Division Iii Softball Pitcher, Drew Saltzman, Ruchir Nanavati, Taylor Parsons, Seungkyu Park, David Abend Do

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At the height of the season, baseball and softball pitchers are playing 4-5 games a week and practicing on days without games. As a result, they put tremendous additive stress on their throwing shoulder and elbow joint.

This case utilized a novel, non-invasive osteopathic approach to improving shoulder mobility in a Division III athlete. If used on a regular basis, the shoulder mobility technique shows utility for athletes suffering from overuse injury. Our patient showed mild qualitative improvement, however they continue to use OMM as complementary treatment and describe a moderate qualitative improvement.

Long-Term Lithium Use In The Younger Population: Do The Benefits Outweigh The Risks? - A Case Report, Seema Shekar, Alexander Garcia, Rachel Shmuts

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For decades lithium has been the mainstay treatment for bipolar disorder. While its side effect profile is extensive and varied its most notable adverse effect, and one most feared by treating clinicians, is nephrotoxicity/ end-stage renal disease (ESRD). While the link between long-term lithium use and ESRD has been accepted by the medical community at large for many years, more recent scientific studies call the association into question. In fact, newer studies on the association between Li use and ESRD have shown a negative/inconclusive correlation. Despite this controversy the consensus still remains that ESRD secondary to long-term Li use is …

Safety And Efficacy Of Silver-Coated Biomaterials In Vivo, Megan Klem, Darien L. Seidman, Rahyan Mahmoud, Manuella Adu, Lei Yu, Jeffrey Hettinger, Renee M Demarest

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Overtreatment and overuse of antibiotics in healthcare and agricultural settings have contributed to the selective pressure on bacterial strains to develop resistance. Resistance can develop as a result of mutations and subsequent resistance genes that allow bacteria to survive against antibiotics. Novel silver-oxide coatings were developed and were previously demonstrated to prevent adhesion of gram-negative bacteria (Escherichia Coli and Pseudomonas Aeruginosa) to the disc, but did not prevent gram-positive bacterial adherence (Streptococcus Aureus). In order to determine whether the silver-oxide coatings are bacterial static and may be preventing progression to biofilm formation, in vivo analysis of S. Aureus attached to …

Spontaneous Extraperitoneal Hematoma: An Unexpected Case Of Dysuria And Urinary Retention In A 77-Year-Old Male, Monica Diep, James Lee, James Espinosa, Joseph Pagano, Alan Lucerna

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Urinary problems are common complaints in the Emergency Department and can present with any combination of lower urinary tract symptoms such as dysuria, hematuria, urgency, frequency, incontinence, or retention. We describe the case of a 77-year-old male who presented to the Emergency Department for five days of worsening dysuria. Two days prior, the patient was seen and evaluated for the same chief complaint, where he received intravenous antibiotics and was admitted to the hospital overnight for observation. The following day, the patient’s urinalysis and cultures were not consistent with a urinary tract infection (UTI) and was subsequently discharged without antibiotics. …

Paradoxical Dat In A Term Newborn With Physiological Jaundice, Abiram Sivanandam, Tomas Rotschild

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The Direct Antigen Test (DAT) is used to find out if a newborn has maternally-produced antibodies against the newborn’s red blood cells. We discuss the case of a term newborn male with an O+ blood type born to a mother whose blood type is A+. As a part of routine screening, DAT of umbilical cord blood was obtained, which resulted positive. While the neonate had jaundice, the overall clinical picture pointed more toward neonatal physiological jaundice rather than a potential hemolytic anemia expected with a positive DAT. This discrepancy prompted us to review literature to explain our findings.

Stroke In Hfref Without Atrial Fibrillation And Concurrent Protein S Deficiency: What Is The Best Treatment?, Rohan Umrani, Trinava Roy, Bhavana Kadiyala, Yvette Wang

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Hypercoagulable disorders are often the culprit for repeated strokes in young patients, with or without other comorbidities

Medications typically used for stroke prophylaxis:

• Warfarin
• Aspirin
• Direct Oral Anticoagulants (DOACs)

Warfarin is the preferred method of anticoagulation for stroke prophylaxis in patients with hypercoagulable disorders

A deficiency of protein S increases the risk of pro coagulation due to a relative deficiency of anticoagulants.

Patients with protein S deficiency tend to have recurrent venous thromboses and pulmonary emboli

The Effectiveness Of Culturally Relevant Obesity Programs On Decreasing Bmi Of Hispanic Children, Cindy Nativi

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Obesity epidemic a public health concern in the United States

• significantly increases health burden in affected individuals
• linked to increased risk of diabetes, cardiovascular disease and cancer
• childhood obesity linked to earlier onset or presence in adulthood of the same diseases
• crucial to address this disease at the preventative level

Centers for Disease Control and Prevention reports obesity affects 19.3% of children and adolescents in the United States

• affects all ethnicities, but increased burden on minority populations of low socioeconomic status
• 1 in 5 Hispanic children considered obese

Latinos one of the fastest growing minority populations

• comprise approximately 17% of …

Substrate-Specific Effect On Sirtuin Conformation And Oligomerization, Jie Yang, Shannon L. Dwyer, Nathan I. Nicely, Brian P. Weiser

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Human sirtuins are a family of nicotinamide adenine dinucleotide (NAD +)-dependent enzymes that are responsible for removing acyl modifications from lysine residues. Sirtuins are involved in the formation and proliferation of cancers and are thought to regulate the progression of neurodegenerative diseases. Although sirtuins can be pharmacologically targeted by small molecules, it is not easy to modulate the substrate selectivity of sirtuins despite the chemical diversity of their substrates. Here, we report substrate-specific effects on sirtuin conformation and oligomerization that regulate enzyme deacylase activity. We used fluorescent acyl peptide probes to study substrate interactions with two sirtuin isoforms: SIRT2 and …

The Effect Of Covid-19 On Postpartum Depression Rates In Nj, Kyra Herman

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• Postpartum Depression (PPD) is defined as depressive symptoms that last >2 weeks after delivery and that interfere with activities of daily living
• Pre-Covid: 13% of women nationwide experienced postpartum depressive symptoms with an estimated 50% of these women not being treated
• Edinburgh Postnatal Depression Scale (EPDS) is the standard survey administered in postpartum period.
• Retrospective chart review of 186 patients
• The pre-Covid timeframe was defined as July 2019 to January 2020 and the intra-Covid timeframe was defined as July 2020 to January 2021.
• While it was hypothesized that the Covid-19 pandemic would cause the risk of PPD to increase, as …

The Effects Of The Covid-19 Stay-At-Home Orders On Pain And Mental Health In Omm Patients, Sylvia Orozco Silberman, Philip Collins, Danielle Cooley, James Bailey, Steven M. Brunwasser Phd, Nicholas Averell

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New Jersey was placed in a state of emergency and a statewide stay-at-home order during the COVID-19 pandemic

Very little has been published examining the effects of chronic pain after stopping osteopathic manipulative medicine (OMM), although it seems unethical to stop a treatment shown to work so well that is both minimally invasive and cost effective

We hypothesized OMM patients experienced an increase in pain since the onset of COVID-19 pandemic and closure of OMM/Family Medicine offices

Complications Of Fitz-Hugh-Curtis Syndrome In A Teenage Female: A Case Presentation, Marina Cugliari, Trupti Pandit

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Fitz-Hugh-Curtis Syndrome is a manifestation of Pelvic Inflammatory Disease (PID) associated with Chlamydia trachomatis infections and less frequently with Neisseria gonorrhea.

PID affects sexually active women (15-30 years old) and accounts for 750,000 cases each year.

The case presented illustrates a female who presented with a small bowel obstruction and appendicitis, who was incidentally found to have Fitz-Hugh-Curtis Syndrome on laparoscopic exam.

Trends In Pediatric Obesity Of School-Aged Children During The Covid-19 Pandemic, Maryanna Schweininger, Amaani Faizal, Suzanna Hosein

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Since the start of the COVID-19 pandemic, children have been more sedentary due to nationwide school closures resulting in classes being held virtually. Due to restrictions, children could no longer participate in physical education classes and after school activities at the same frequency. The pandemic also placed a disproportionate burden on low-income families thus, potentially amplifying food insecurity. The aim of this study was to identify the impact of the COVID-19 pandemic on childhood obesity.