Medicine and Health Sciences Commons^™

Health Benefits Of Saccharomyces Boulardii As A Probiotic, Devashri Parikh, Maftuna Kurbonnazarova, Ravij Upadhyay, Andrea Iannuzzelli

Rowan-Virtua Research Day

Saccharomyces boulardii (SB), a budding yeast, within the Saccharomyces genus. It commonly used as a probiotic that has been isolated from lychee and mangosteen fruit. S. boulardii is not known to acquire resistant genes and does not last in the intestine after 3-5 days of discontinuing the ingestion. The clinical efficacy of this probiotic yeast is known to improve various diarrhea such as pediatric diarrhea, antibiotic-associated diarrhea, acute diarrhea, and traveler’s diarrhea. Additionally, when used as an adjuvant to treatment for Helicobacter pylori and Clostridium difficile infections, it improves bacterial eradication, prevents relapse, reduces adverse reactions and treatment-associated diarrhea.

Several …

Comparative Analysis Of Health Outcomes In Gastric Cancer: Robotic Vs. Laparoscopic Gastrectomy, Maftuna Kurbonnazarova

Rowan-Virtua Research Day

Exploring the most effective surgical approach for gastrectomy is crucial for determining superior health outcomes in patients. This research compares robotic and laparoscopic techniques with the aim of pinpointing the optimal method, offering valuable insights for improved postoperative well-being.

A Case Of Esophagogastric Junction Outflow Obstruction Resulting To Megaesophagus In A 37-Year-Old Male, Dean Esma, Robin Lahr, James A. Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Esophagogastric junction outflow obstruction (EGJOO) is a major motility disorder characterized by an increase of > 15 mmHg in the integrated relaxation pressure (IRP) with or without problems in esophageal motility. This presents as dysphagia, chest pain, regurgitation, heartburn, cough, and a globus sensation, with dysphagia. Severe cases may lead to a megaesophagus causing compression of mediastinal structures.6 Its similarity to other esophageal disorders urge an investigation to improve its identification and treatment. This report presents a case of EGJOO in a 37-year-old cachectic male patient with dysphagia and vomiting, eventually determined to be EGJOO with diagnostic manometry.

Case Report: Diverticulitis Involving A Meckel’S Diverticulum, Samuel M. Thalathoti, Russell A. Mordecai

Rowan-Virtua Research Day

We report a case of a 65-year-old female who presented with abdominal pain and was diagnosed with diverticulitis involving a Meckel‘s Diverticulum. The differential diagnosis of abdominal pain is vast, in this age group includes, but is not limited to appendicitis, diverticulitis, cholecystitis, and small bowel obstruction. In the absence of complicated features, conservative management with oral antibiotics and close outpatient follow is advised. However, in the case of complicated diverticulitis and a rare manifestation such as a Meckel’s Diverticulum, careful management is indicated.

Gut Microbiota Changes After Cholecystectomy: Unraveling The Microbial Mysteries - A Systematic Review, Maftuna Kurbonnazarova, Arthi Rameshkumar, Olivia R. Siciliano, Samrat Gollapudi, Katarina Rusinak, Alissa Brotman O’Neill

Rowan-Virtua Research Day

Aims: This review aims to expand upon previous research examining change in gastrointestinal microbiota before and after cholecystectomy.

Methods: A systematic review, combined with a pooled analysis, was conducted to assess gut microbiota dysbiosis post-cholecystectomy, utilizing 71 articles retrieved from 3 databases, with 13 undergoing full-text appraisal. The publication dates ranged from 2018 to 2023.

Results: Results suggested a greater degree of microbiota alteration in symptomatic post-cholecystectomy patients, characterized by a decrease in the Firmicutes/Bacteroidetes ratio, Bifidobacterium and Lactococcus, alongside increased levels of harmful microbiota such as Prevotella, Sutterella, Proteobacteria, Verrucomicrobia, Blautia obeum, and Veillonella species. Interestingly, an increase in …

Dense Colon Scarring After Infliximab For Acute Severe Ulcerative Colitis, Rahul Patel, Sriya Vutukuru, Neethi Dasu, Charles Snyder

Rowan-Virtua Research Day

Introduction: Infliximab is a monoclonal antibody against tumor necrosis factor alpha used in the treatment of ulcerative colitis. It has been shown to be efficacious in patients with moderate to severe ulcerative colitis and/or those who have failed intravenous steroids. We present a unique finding of profoundly dense colonic scarring after a year of infliximab therapy in a patient with acute severe ulcerative colitis.

Case: A female in her early 60s presented to the hospital with a three month history of rectal bleeding and intermittent fevers. A colonoscopy was done which demonstrated severe Mayo 3 left-sided colitis, consistent with a …

Clinical Outcomes For Patients With Nafld And Acute Hepatitis: An Analysis Of The National Inpatient Sample, Dakota B. Pastore, Tony Elias, Peter Senatore

Rowan-Virtua Research Day

Introduction: Non-alcoholic fatty liver disease (NAFLD) is the most common form of chronic liver disease in the United States and has been found to play a significant role in cardiovascular disease risk through several mechanisms including dyslipidemia, insulin resistance, coagulability, and inflammation. Acute-on-chronic liver disease continues to contribute to worse health outcomes via acute hepatitis.

Methods: This case-control study investigated the relationship between NAFLD and acute hepatitis using data extracted from the National Inpatient Sample (NIS) Database for the years 2019 and 2020. The NIS was searched for hospitalizations of adult patients with acute hepatitis with and without NAFLD. Using …

Typhlitis In A Neutropenic Patient, Alice He Bs, Wern Lynn Ng Md, Lay She Ng Md, Si Yuan Khor Md, Chandi Garg Md

Tower Health Research Day

No abstract provided.

The Hidden Thief: Strongyloidiasis’ Understated Role In Anemia, Iman Waheed Khan Md, Daniel Weinblatt Do, Hira Hanif Md, Muhammad Umer Riaz Gondal Md, Parth Desai Do, Michael Francis Riverso Do

Tower Health Research Day

No abstract provided.

Considering The Histologic And Anatomic Features Of Pancreatic Heterotopia In Patient Disease Manifestation, Yeseena Alli B.S., Kelly Brenan M.D.

Tower Health Research Day

No abstract provided.

Microsporidiosis: Reviewing Clinical Presentation And Treatment Strategies, Julienne Zhou, Belinda Liu, Megan Dearmond, David Banach, Brad Haubrich

Annual Research Symposium

Microsporidiosis is an opportunistic infection caused by obligate intracellular pathogens within the taxon Microsporidia. Infection is zoonotic and has been associated with patients experiencing immunodeficiency, though incidence is increasing among other populations. Most commonly, the disease is gastrointestinal, typically by Enterocytozoon bieneusi and less commonly by Encephalitozoon intestinalis. Symptoms present with diarrhea and vomiting, and severe cases can lead to wasting and mortality. While the incorporation of anti-retroviral therapy for HIV patients has significantly decreased mortality in a subset of the vulnerable populations, treatment for microsporidiosis is still not standardized or well explored. Resistance to first-line treatment albendazole is increasing, …

Challenges In Diagnosing Hepatic Epithelioid Hemangioendothelioma: A Case Series, Aratara Nutcharoen, Elliott Beard, Anupa Thirmiya, Omar Taher, Jacob Adams, Mark Mortensen, John Pelham

Annual Research Symposium

Challenges in Diagnosing Hepatic Epithelioid Hemangioendothelioma

Early Onset Colorectal Cancer: Research, Trends & Challenges, Sarah E. Smith

Capstone Showcase

Early onset colorectal cancer (EOCRC) incidence and mortality are rising in a global trend, contrasting with improvements seen in late-onset colorectal cancer (LOCRC). EOCRC appears to differ in presentation, histology, and pathology from LOCRC painting concerns of a more aggressive tumor profile. With incidence steadily climbing, there is still lacking awareness and guidance on screening for EOCRC. This article aims to provide background on EOCRC including epidemiology, risk factors, and traits, as well as to explore methods for adjusting provider screening criteria to combat this concerning trend.

Prevalence Of Liver Cirrhosis And Its Association With Obesity Among Mexican Americans: An Evidence Synthesis, Alexa Perlick, Abaigeal Thompson, Colton Wayne, Angel Rendon, Jose E. Campo Maldonado

Research Colloquium

Introduction: Chronic liver disease is the 6^th and 7^th leading cause of death in Hispanic men and Hispanics, respectively.¹ In contrast to other causes of liver disease, the prevalence of nonalcoholic liver disease has been growing as is diabetes and obesity.²

Objective: There is a paucity of data regarding the prevalence of cirrhosis for Mexican Americans in South Texas. The aim of this evidence synthesis is to investigate the prevalence of cirrhosis in Hispanic populations and its relationship with obesity.

Methods: PubMed was used to perform a thorough literature search on September10, 2020. The terms “liver …

Hepatopulmonary Syndrome In A 22 Year Old Gentleman With Liver Cirrhosis, Blesset Alexander, Joseph Caporusso, Priyasha Suri

Research Symposium

Background: Hepatopulmonary syndrome is a severe complication of end-stage liver disease characterized by triad of liver disease, intrapulmonary vascular dilatation, and arterial hypoxemia. Although the pathogenesis is not completely understood, pulmonary vascular dilatation occurs due to imbalance between vasodilators and vasoconstrictors. Liver injury is thought to increase endothelin production and cause bacterial translocation, causing increased nitric oxide production, causing vasodilation of pulmonary vasculature. History and physical examination are important in leading the physician to the correct diagnosis as the majority of these patients present with non-specific clinical manifestations and imaging. Identification of specific physical exam findings is important in not …

Antigen Staining For Detection Of Muc13 And Mcu16 In Carcinoma Tissue, Jose A. Benitez

Research Symposium

MUC13 and MUC16 are mucosal epithelial expressed proteins associated with various carcinomas. Overexpression of these biomarkers appear to play a role in tumor growth; this discovery has paved a road for multiple studies discussing the potential of targeting mucin proteins and optimize immunotherapy approaches against carcinomas. Our study serves to investigate the level of expression of MUC13 and MUC16 in cancerous and normal tissue and to discuss the implications our findings may have for the utilization of these biomarkers for cancer therapy.

Management Of Patient With Impaction Secondary To Undigested Sunflower Seed Bezoar: A Case Report, Sufia Ahmed, Anthony Adetomiwa

Research Day

Introduction: Bezoars are aggregates of undigested plant fibers, hair, or seeds that may impact in any portion of the GI tract. These bezoars if left can lead to significant complications, including perforation and peritonitis.

Methods: We report a case of a 4-year-old female patient who presented to the emergency department with constipation and severe lower abdominal pain following unsupervised consumption of a large unknown volume of sunflower seeds. Initial radiograph revealed an undigested bezoar of seeds in the sigmoid colon and rectum. The patient was managed with mineral oil enema and manual disimpaction under conscious sedation. Subsequent radiographs revealed a …

Colonic Stenosis In An Elderly Female, Tiffany R. Pittman, Kylie A. Parrish, Grace M. Perry, Oyindamola C. Orekoya, Shiv Dhiman, Savita Arya

Research Day

Introduction

Colonic stenosis is commonly caused by chronic inflammation and is a known side effect of inflammatory conditions, such as diverticulitis and irritable bowel syndrome. Diverticulosis is a common condition where parts of the colon wall become weakened, forming outpouches. These outpouchings may become inflamed, leading to diverticulitis. This chronic inflammation can cause scarring and fibrosis of the colon, resulting in colonic stenosis. Inflammatory bowel diseases, such as Crohn’s disease and ulcerative colitis, may also result in scarring and colonic stenosis. The incidence rate of patients developing colonic stenosis is 8-13.5% for Crohn's disease and 1-11% for ulcerative colitis. Patients …

When Constipation Becomes Lethal: Septic Shock Induced By Stercoral Colitis In A 77-Year-Old Female, Anna Delancy, Nicholas Tomasello, Joan Wiley, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Stercoral colitis is a form of colitis caused by fecal impaction distending the colon and causing fecaloma formation. Fecalomas lead to pressure necrosis of the colon and eventual perforation. The increased intraluminal pressure from the distention of the colon causes vascular compromise and ischemia. The most common locations of necrosis are in the sigmoid colon and rectum . When progressed to perforation, the mortality rate is as high as 60%. The most common cases of stercoral colitis occur in nursing home patients, mentally impaired patients, or those with chronic constipation. Here we describe an unusual case of stercoral colitis causing …

Sigmoid Perforation Extending Into The Abdominal Wall, Zamran Masih, Wayne Tamaska, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Sigmoid colon perforation and spread into the abdominal wall is a rare condition that can occur due to various causes such as diverticulitis, trauma, malignancy, or iatrogenic injury during surgery. Although rare, sigmoid colon perforation into the abdominal wall can result in significant morbidity and mortality if not promptly diagnosed and treated. Most common cause of diverticular disease leading to perforation is diverticulitis, accounting for 60% of all colonic perforations.

Effects Of Nstemi On Patients With Eating Disorders: Insights From The National Inpatient Sample, Rafail Beshai, Keri Anacker, Keith Anacker, Tony Elias, David Halim-Banoub, Maziyar Daneshvar, Howard Weinberg

Rowan-Virtua Research Day

Introduction: Eating disorders (ED) such as bulimia and anorexia nervosa have detrimental implications on the health and wellbeing of children and young adults across the country. Cardiovascular implications are known to accompany these conditions, however there is a paucity of data looking specifically on the effects of NSTEMI on patients with these disorders. We sought to analyze this relationship further by examining these disorders within the national inpatient sample database to describe in-hospital trends and outcomes among those patients.

Methods: Data were extracted from the National Inpatient Sample (NIS) Database for the years 2019 and 2020. The NIS was searched …

Case Report: Proximal Large Bowel Obstruction Due To Constipation Requiring Subtotal Colectomy And Ileostomy, Brian Lim, Russell Mordecai, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Large bowel obstructions are an abdominal emergency with morbidity and mortality dependent on early diagnosis . This case is of a 58-year-old male who presented with large bowel obstruction due to constipation. Differential diagnosis of large bowel obstruction ranges from benign to emergent should include conditions such as Ogilvie’s syndrome, paralytic ileus, small bowel obstruction to toxic megacolon. This male with only a risk factor of opioid use after spinal surgery. Attempts at medical management were made but the patient ultimately needed definitive management through exploratory laparostomy.

Colon Cancer Screening And The Association With Colon Cancer Incidence And Mortality Rates In Ethnic Minority Groups, Jovonne Smith

Student Scholar Showcase

Colorectal cancer (CRC) continues to be a public health burden and is the second leading cause of American cancer deaths. Strides have been made in the medical community, and there has been an overall decrease in CRC rates. This decrease is primarily due to a cumulative decline in late-onset colorectal cancer diagnosis (LOCRC), defined as CRC cancer in adults over the age of 50 years. CRC continues to burden American Indians and Alaska Natives (AIAN) and Non-Hispanic Black individuals (NHB) disproportionately. The incidence and mortality rates remain disproportionately higher than other ethnic groups, and the survival rate is lower than …

Diagnosis And Management Of Cyclic Vomiting Syndrome, Sara Read

Capstone Showcase

Cyclic vomiting syndrome (CVS) is a chronic and debilitating condition that can be encountered in a multitude of clinical settings. It is classified as a functional gastrointestinal disorder and is often misdiagnosed. Proper identification and management of this condition are crucial to patient care and quality of life. This article reviews the hypothesized etiologies, clinical presentation, and diagnosis of CVS as well as recommendations for management in a variety of settings. As an understudied and underdiagnosed condition, it is important that clinicians have a basic understanding of this disorder.

Alternative Precautionary Measures Yielding Lower C. Diff Infection Rates In Healthcare Facilities, Matthew Kramer

Symposium of Student Scholars

Background: An international healthcare concern is the persistent spread of Clostridium difficile, a Gram-positive spore forming bacterium that is responsible for the most common hospital-acquired infection, amongst patients.

Objective: A systematic review was performed to summarize evidence that the interventions utilized in healthcare facilities which indicate a patient’s precautionary status are insufficient, outdated, and commonly lead to infection in neighboring patient rooms. Databases such as PubMed, NCBI, Google Scholar, and APHA’s Medical Care were searched, covering the period from 2017-2022. Studies were included if their focus concentrated on C. diff and the precautionary measures taken by employees at healthcare …

When Carbohydrates Are Not Enough: Acute Intermittent Porphyria Treated With Givosiran, Shoja Rahimian, Akanksha Kushwah, Yugandhara Kate, Andrew Rettew

Tower Health Research Day

No abstract provided.

Hemosuccus Pancreaticus As An Initial Presentation Of Decompensated Alcoholic Cirrhosis., Aamir Shahzad, Anish Paudel, Zohaib Yousaf

Tower Health Research Day

No abstract provided.

High Dose Opioid Administration For Adults Hospitalized With Acute Pancreatitis, Sharaya Hundeby, Brenda Senger, Teresa Bigand

2022 Providence Nurse Research Conference

No abstract provided.

Improving Advanced Therapeutic Endoscopy Performance At An Academic Children's Hospital, Julia Snodgrass, Thomas M. Attard, Donna Ditsch, John Colgan, Amanda Weston, Jessica Koch, Nadia Ibrahimi, Pang Krasaelap, Voytek Slowick, Laura Shroyer

Research Days

Problem Statement/Question: Advanced therapeutic endoscopy is infrequently needed but critical in the management of children with complex gastroenterology disorders. Hands-on experience in specific advanced techniques, set up of endoscopy equipment and familiarity with new ancillary equipment for use during endoscopy have been intra-departmentally identified as potential areas for improvement.

Background/Project Intent: Our aim is to improve provider scoring on an endoscopy practice test based on technical aspects of therapeutic techniques, indications and set up of standard and new endoscopic equipment by 20% over pre-practice session testing.

Methods: The Model for Improvement framework was utilized. A multidisciplinary team was created including …

Perforating Gastric/Duodenal Ulcer Development Following Roux-En-Y Gastric Bypass Surgery: A Case Series, Sugosh Anur, Michael A. Coscia Iii, Louis Balsama

Rowan-Virtua Research Day

Roux-en-Y gastric bypass is a well-studied procedure resulting in long term weight loss. Due to countless years of study, the morbidity and mortality associated with a Roux en Y gastric bypass has been greatly decreased. However, there are still several rare, yet serious, complications that may arise in the post-operative period. Anastomotic leaks and ulcers are just two of those complications. We describe a case of a 41 year old female developing postoperative perforated duodenal ulcer. A laparoscopic repair was performed using a Graham patch technique. This review aims to identify factors contributing to the ulcer development as well as …