Medicine and Health Sciences Commons^™

A Peculiar Presentation Of Cardiac Sarcoidosis As Third-Degree Atrioventricular Heart Block Complicated By Right Ventricle Perforation, Yash Suthar, Pooja Patel, Nikhita Kothari, Kristofer Hillegas

Rowan-Virtua Research Day

• Cardiac sarcoidosis is a rare, inflammatory multisystem disorder that manifests as noncaseating granulomas of multiple organs.

• The clinical presentation of sarcoidosis is variable and may be underrecognized by clinicians.

• Individuals may be asymptomatic during their lifetimes and may be incidentally diagnosed with the disease for the first-time during autopsy.

• Patients with cardiac involvement of sarcoidosis may initially present with complications including arrhythmias, heart block, bundle branch block, congestive heart failure, pericardial effusion, pulmonary hypertension, and/or sudden cardiac death.

A Novel Case Of Hhv-6 Meningoencephalitis In An Immunocompetent Adult, Justin Berkner, Kishan Patel

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We present a case of a 56-year-old female who presented with HHV6 encephalitis. She initially presented with altered mental status. Our patient ultimately made a full recovery several days later with only some mild intermittent episodes of confusion. Currently there are no other case reports of HHV6 encephalitis in the adult population.

A Holistic Approach To Physical And Mental Health: Associations Between Chronic Disease And Psychiatric Conditions, Pooja Patel, Alison Mancuso

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OBJECTIVE:

• To investigate the link between chronic medical conditions and psychiatric disorders

BACKGROUND

• Limited research has been done studying the relationship between chronic medical conditions and psychiatric disorders in patients comorbid with both types of conditions.

• Prior research studies have demonstrated that patients with chronic medical conditions are more likely to develop psychiatric disorders compared to healthy individuals without any medical conditions.

• As individuals develop chronic medical conditions, they may encounter additional obstacles in their lives,

Acute Flecainide Toxicity Treated With Intravenous Lipid Emulsion, Joseph S. Schreiner

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Flecainide is a Vaughn-Williams class IC antiarrhythmic used in the treatment of supraventricular tachycardias including atrial fibrillation. While overdose is rare, its negative effects on cardiac inotropy and conduction pathways can be readily fatal. This is further complicated by the redistribution of the drug out of the plasma and deposition in tissue, rendering reversal by sodium bicarbonate (the standard first line treatment agent) relatively ineffective. A case study of the successful treatment of hemodynamic collapse using sodium bicarbonate in conjunction with intravenous lipid emulsion (ILE) in a patient who ingested a large amount of flecainide in a suicide attempt will …

A Case Of Cocaine Toxicity From Body Stuffing, Justin Smith, James Lee, Alan Lucerna, James Espinosa

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Body stuffing refers to the ingestion of an illegal substance in an effort to conceal it and avoid prosecution. This is distinct from, and more common than, the practice of body packing in which large amounts of an illegal substance are carefully packaged and ingested to be transported discreetly by smugglers [1]. While body packers tend to ingest much larger quantities of a drug, they are less prone to developing symptoms of drug toxicity due to the meticulous packaging methods used when compared with those who ingest packets of drugs in haste to avoid prosecution [2]. Many substances have been …

Affiliative Social Interactions Activate Vasopressin-Responsive Neurons In The Mouse Dorsal Raphe, Tirth Patel, Hanna O. Caiola, Olivia Mallari, Benjamin D. Rood

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Social behavior is inextricably linked to human health, shaping both our susceptibility and resilience to disease and stress. Positive interactions as simple as maternal contact or friendships among children and adults can protect against emotional distress and improve treatment outcomes, whereas negative interactions such as abuse, social isolation, or bullying can increase aggression and precipitate mood disorders. Discovering the structure and function of neural circuits underlying social behavior is critical to understanding the link between social interaction and health. The neuropeptide vasopressin has been implicated in the regulation of multiple social interactions including social memory, aggression, mating, pair-bonding, and parental …

Adult Knowledge Of Childhood Head Injury Management At Home, Christian Muller, Adarsh Gupta, Joanna Petrides

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Adults are able to recognize concussion warning symptoms; however, they lack the knowledge on how to manage and treat a child’s head injury.

Alteplase Used In A Child With An Acute Ischemic Stroke, Shah Nawaz Chaudhary, James Espinosa, Alan Lucerna, Adam Richards

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Stroke, also known as cerebrovascular accident (CVA), is a neurological injury caused by inadequate brain perfusion due to either ischemia or hemorrhage. There is an abundance of literature on the management of ischemic strokes in adults and this has led to well-defined diagnostic and treatment guidelines. However, the management of pediatric ischemic strokes is currently based on clinical experience of experts, recommendations of consensus guidelines, case studies and extrapolation from adult clinical trials. In this case report, a pediatric patient suffering from an ischemic stroke is successfully treated with IV alteplase (tPA).

An Analysis Of Phenibut (Ss -Phenyl-Y-Aminobutyric Acid) Withdrawal, Michael Morris, James Espinosa, Robin Lahr, Alan Lucerna

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Phenibut (ß -phenyl-y-aminobutyric acid) is a psychoactive GABA analogue marketed as a nutritional supplement and “nootropic” online. Phenibut consumption poses a high risk of potential abuse. Withdrawal from Phenibut mimics benzodiazepine and alcohol withdrawal. Without proper management, Phenibut withdrawal may be equally as dangerous as benzodiazepine and alcohol withdrawal. Baclofen can be prescribed for outpatient symptomatic relief of Phenibut withdrawal.

Alzheimer's Patients’ Mental Health During The Covid 19 Pandemic, Maryanna Schweininger, Yvonne Maduka, Ajh'shana Collins

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Alzheimer’s disease (AD) is a degenerative brain disease caused by β Amyloid plaques and neurofibrillary tangles, which results in memory loss and cognitive decline. It is the sixth leading cause of death in the United States. Approximately 50% of those with AD experience some degree of depression during the course of the disease, which has been shown to accelerate functional decline, institutionalization, and even mortality.

Many who cannot care for themselves live in an assisted living facility or retirement home. Since the beginning of the COVID 19 pandemic, people have been urged to social distance in order to decrease the …

An Unusual Ed Case: Cardiac Tamponade Presenting As Hiccups, Devleen Baksi, Nicholas Tomasello, James Espinosa, Alan Lucerna

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Cardiac tamponade is an emergent life threating condition that depending on cause can quickly progress to death. The rate of accumulation of a pericardial effusion often can determine the clinical severity. Typically, shortness of breath and hypotension manifest; however, in this unusual case, the initial presenting complaint was persistent hiccups.

An Unusual Ed Case: Scrotal Edema From A Thoracic Aortic Aneurysm In A 58-Year-Old Male, Yevgeniy Polunin, Emily Nguyen, Bhumi Shah

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Scrotal edema is not an uncommon presentation in emergency medicine. We describe the case of a 58-year-old male with no prior medical history who presented to the emergency department (ED) due to progressive scrotal edema. The patient noted increased painless testicular enlargement, dry cough, and dyspnea on exertion over the course of several weeks. Scrotal edema was evaluated by an Ultrasound (US), showing bilateral testicular edema with concern for congestive heart failure (CHF). Computed tomography pulmonary angiography (CTPE) scan showed a large 6.51 cm thoracic aortic aneurysm (TAA), cardiomegaly with dilated left sided chambers, and a small pericardial effusion. Subsequently, …

An Unusual Ed Case: Aortic Aneurysm Presenting As Chf Exacerbation, Darren Finn, James Espinosa, Russell Mordecai, Kishan Patel

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There has been a significant increase in the incidence of thoracic aortic aneurysms, currently making aneurysmal disease the 18th most common cause of death within the United States. This disease is typically an insidious one, with the aorta growing an average of only 0.1 cm per year. Consequently, most patients remain asymptomatic until late stages of the disease when dissection or worse, rupture has occurred. Under extremely rare circumstances, thoracic aortic aneurysms can present clinically due to mass effect. Airway, esophageal and vascular compression, secondary to aortic arch dilation has been previously documented. The condition can be acquired or congenital, …

Assigning Level Of Care In Blunt Chest Trauma Patients: Applying Objective Scoring Systems, Alyssa Imperatore, Kaitlyn Oldewurtel, James Eakins

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25% of all traumatic deaths are related to blunt chest trauma and another 50% have in-hospital morbidity and mortality. Recognizing patients with high risk of mortality is just as important as recognizing the immediate severely injured patients. Atlanticare Regional Trauma Center developed a scoring system in an attempt to properly assign these patients to an appropriate level of care. The system was developed based on a literature review but has not yet been studied to review its effectiveness in improving outcomes in chest trauma patients. Therefore, the scoring system is used as a guideline and not an official document in …

Atypical Presentation Of Non-Aneurysmal Subarachnoid Hemorrhage, Aleks Spirollari, James Espinosa, Kevin Dwyer

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When most clinicians think of subarachnoid hemorrhages (SAH), they think of “most severe headache of my life” as the most common chief complaint. However, it is only reported in about 70% of patients with SAH. Other symptoms may include nausea and/or vomiting, stiff neck, visual disturbances, loss of consciousness, weakness, and seizures. Patient history may involve previous SAH, hypertension, oral contraceptives in women, recent trauma, family history of intracranial aneurysms, history of smoking, alcohol, and drug use. However, there are atypical causes of SAH that may be missed upon initial evaluation for patients that may not have the above mentioned …

Barriers To Alternative Narcotic Education And Treatment In Young Adults In New Jersey, Shubh Bhambri

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The purpose of this study is to determine alternative methods and programs that result in better outcomes for young adults dealing with opioid addiction in New Jersey while identifying potential barriers that prevent the implementation of these programs.

Assessment Of Factors Preventing Adequate Decline In Cervical Cancer Rates Amongst Minority Women In New Jersey, Rosie Wenrich, Jillian Baker

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Background

• Nationally declining cervical cancer rates are still high amongst minority women in NJ, with Hispanic women being affected the most.

• The Human Papilloma Virus (HPV) is the most common sexually transmitted infection and can lead to cervical cancer

• Administration of the 9-valent HPV vaccine can prevent infection and progression to cancer

• Regular cervical cancer screenings allow for better outcomes

• Various barriers prevent people with a cervix receiving the vaccine

• Various barriers prevent people with a cervix aged >/= 30 from receiving regular cervical cancer screenings

Conclusions

• Improved physician recommendation is required for the …

Association Between Childhood Obesity And Lack Of Healthy Food Access In Urban Food Deserts, Nicholas Averell, Rushali Desai, Archana Menon, Ayushi Naik, Arpun Shah

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Background

Childhood Obesity: growing epidemic affecting almost 20% of children and adolescents in the United States

● Characterized by BMI greater than 95^th percentile of their age and gender

● Often leads to chronic medical conditions: high blood pressure, Type II Diabetes and heart diseases

● Low socioeconomic status(SES), lack of healthy food access and urban neighborhood

Barriers To Lung Cancer Screening Among African American Males Aged 50-70 In The United States, Edward Marines

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Objectives:

• Identify the different barriers to lung cancer screening among African American males
• Examine potential methods of increasing access and participation within this population

Brachial Artery Aneurysm After Arteriovenous Fistula Ligation Status Post-Kidney Transplant, Alyssa Imperatore, Justin Adibi, Rahul Sharma, Yury Bak

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Arteriovenous fistulas (AVF) are the most common and effective method of receiving hemodialysis; However, these access techniques do not come without consequence. Aneurysmal degeneration after creation and even years after ligation of such AVF can occur. This is still considered a rare complication. A true brachial artery aneurysm has an overall incidence of 0.17% among peripheral artery aneurysms. Factors that increase incidence of this complication include trauma, age and immunosuppression. Research on this topic is becoming more prevalent, but more answers are still needed. Below is a case of brachial artery aneurysm presenting years after AVF ligation in a patient …

Bilateral Lower Extremity Ischemia Following Cardiac Catheterization, Moses Avedikian, Alan Lucerna, Trent Malcolm

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Acute limb ischemia is a rare yet limb-threatening presentation where rapid diagnosis and intervention is warranted. Bilateral lower extremity ischemia can be a rare complication following procedures, such as a cardiac catheterization with access obtained in the groin. We describe a case of a 79-year-old female who presented with bilateral lower extremity ischemia following a cardiac catheterization 2 weeks prior. The patient underwent CT angiography, which demonstrated occlusion with no contrast present in the bilateral femoral arteries.

Case Report: Splenic Infarct S/P Sleeve Gastrectomy, Dhara Patel, James Espinosa, Kishan Patel

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A case of splenic infarct s/p sleeve gastrectomy is presented. A 28-year-old female presented with LUQ pain s/p sleeve gastrectomy POD7. CT scan with IV contrast revealed an area of nonenhancement at the superomedial aspect of the spleen consistent with a small splenic infarct. She was transferred out to the hospital under the service of the surgeon who had performed her sleeve gastrectomy. Splenic infarction is a rare post-op complication s/p sleeve gastrectomy. The spleen has dual blood supply via the splenic artery and short gastric arteries making complete infarction rare. It is usually diagnosed via CT with IV contrast. …

Case Report: Repeated Use Of Tetrahydrocannabinol Associated With Severe Cerebral Vasoconstriction, Pooja Patel, Ryna Then, Dena Little

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Reversible Cerebral Vasoconstriction Syndrome (RCVS) is a rare neurological syndrome. The classic presentation consists of recurrent, severe, ”thunderclap” headaches with neuroimaging findings consistent with segmental vasoconstriction of cerebral arteries. Sympathomimetics including cannabinoids have been found to be triggers in many cases of RCVS. Complications include subarachnoid hemorrhage, intracerebral hemorrhage, cerebral edema and ischemic infarction.

This case highlights the potential devastating and irreversible effects of RCVS precipitated by exposure to a sympathomimetic agent. The case emphasizes the importance of patient counseling regarding abstinence from agents that may provoke RCVS.

Incidental Malrotation In Adolescent Diagnosed With Appendicitis, David Ho, Jinsy Jacob, Russell Mordecai, Adam Richards

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17-year-old male patient with a history of autism presenting with right lower quadrant pain that started in the morning. The appendix was not able to be visualized by ultrasonography. An abdominal and pelvic CT with contrast showed a dilated appendix with surrounding inflammation. Malrotation was not identified on CT Scan. Patient was transferred to a nearby Children’s Hospital for laparoscopic appendectomy. During the procedure, the pediatric surgeon noted that initially, neither the appendix nor cecum was present in the right lower quadrant. This case represents an uncommon finding for a patient in the adolescent age group.

Breastfeeding Education Support Tool For Baby (Best4baby): Feasibility, Acceptability, And Preliminary Impact Of An Mhealth Supported Breastfeeding Peer Counselor Intervention In Rural India, Parth D. Lalakia, Vanessa L. Short, Roopa M. Bellad, Patricia J. Kelly, Yukiko Washio, Tony Ma, Katie Chang, Niranjana Majantashetti, Umesh S. Charantimath, Frances J. Jaeger, Shivaprasad S. Goudar, Richard J. Derman

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Objective: To evaluate the feasibility of an mHealth-supported breastfeeding peer counselor intervention implemented in rural India and the preliminary impact of the intervention on maternal breastfeeding behaviors, including exclusive breastfeeding (EBF).

Methods: In this quasi-experimental pilot study, participants received either the intervention plus usual care (n = 110) or usual care alone (n = 112). The intervention group received nine in-home visits during and after pregnancy from peer counselors who provided education about and support for EBF and other optimal infant feeding practices and were aided with an mHealth tool. The control group received routine prenatal and postnatal health education. …

Case Presentation: Lower Back Pain Or Chronic Acetaminophen Overdose?, Meghan Whitt, Christopher Schwartz, Bhumi Shah

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Unintentional ingestions can pose a difficult challenge to diagnose in the setting of the Emergency Department. Many may present with vague symptoms that are not consistent with classic overdose prodromes. Many patients do not identify or disclose over the counter medications, such as analgesics, with which acute/chronic ingestion in large quantities can result in life threatening medical emergencies. Their underlying symptoms may also cloud their clinical picture, further complicating workup within the ED.

Covid-19 Resources For Speakers Of Other Languages (Covid Resol), Ali Harb, Irvin Santiago-Bautista, Sulleymarie Sanchez

Rowan-Virtua Research Day

Objectives

• identify barriers to COVID 19 testing and vaccination in NJ Hispanics with limited English proficiency (LEP)
• develop resources targeted towards vaccination for Hispanic NJ residents and communities in Atlantic, Camden, and Cumberland counties
• share evidence based information regarding the COVID 19 pandemic and disease spread prevention

Conclusions

• Barriers to equitable COVID 19 care for NJ Hispanics with LEP may include but is not limited to resource availability in Spanish, misinformation about COVID 19, a lack of understanding about where and how to get tested and/or vaccinated, and transportation accessibility
• Increased efforts for providing equitable access to vaccination and testing …

Case Report: Covid-19 Associated Guillain-Barre Syndrome, Matthew Aharonov, Neelesh Parikh, James Espinosa, Alan Lucerna

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We report a case of a 72-year-old female who presented to the emergency department with a complaint of generalized weakness. The patient was found to have ascending muscle weakness and subsequently diagnosed with Covid-19 related Guillain-Barre Syndrome. Our patient was negative for Campylobacter jejuni. It is noteworthy that the patient did not have fever, respiratory symptoms or loss of the sensation of taste.

A Case Of Spinal Epidural Lipomatosis Presenting As A Stroke Mimic, Jonas Salna Iv, James Lee, Eric Maddock, James Espinosa, Alan Lucerna

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Spinal Epidural Lipomatosis (SEL) an excess of normal adipose tissue in the epidural space of the spinal canal, typically becoming symptomatic when cord compression results. First described in 1975 by Lee et al (Lee M, 1975), it is a relatively rare disease. Unfortunately, it is often diagnosed once patients have developed marked symptoms and can have dire complications. Oftentimes SEL is completely asymptomatic, and symptoms on initial presentation are vague. Mostly commonly it presents as worsening chronic back pain (Daniel R. Fassett M.D. M.B.A., 2004) with progressive lower extremity weakness and occasional cauda equina syndrome (Wells AJ, 2014), but this …

Consequence Of Patient Education On Health Habits, Esha M. Patel, Adarsh Gupta

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Hypothesis: Patients who participate in an specific health habit do so due to a lack of knowledge about the consequences of that choice.

Goal: Correlate patient participation in specific health habits with their knowledge of the consequences of these choices. Understand why patients continue to participate in specific habits and what influences their decision. The end goal of my project is to provide insight to encourage physicians to evaluate patient’s health education and get physicians to try to apply consequences of these habits on the patient’s life to help them understand health outcomes.

Conclusion: This study showed more correlations between …