Diagnosis Commons^™

Blunt Cerebrovascular Injury (Bcvi): Universal Cta Neck Screening At Level 2 Trauma Center, Tamine Gogel

Doctor of Nursing Practice Projects

Blunt Cerebrovascular Injury (BCVI) refers to injuries to the vessels supplying blood to the brain, primarily carotid and vertebral arteries, and can result from trauma, resulting in stroke by vessel dissection, thrombus formation, embolization, and hemorrhage. Timely identification is crucial for effective intervention and improved outcomes. This doctoral project proposes the implementation of universal screening using Computed Tomography Angiography (CTA) of the neck during initial workup for blunt force trauma at a Level II ACS-verified trauma center. The primary objective is to mitigate potential delays in diagnosing and treating BCVI, thereby reducing the likelihood of complications. Patients ≥ 15 years …

Emotion Regulation Strategies And Perceived Emotional Intelligence: The Effect Of Age., Iwanna Sepiadou

Adultspan Journal

The aim of this study was to investigate the relationship between perceived emotional intelligence and the reported use of cognitive reappraisal and expressive suppression. We also investigated the possible effects of age on the aforementioned variables. The total sample consisted of 379 people (158 men, 220 women, 1 unreported). Across participants, 273 were young (20-39 years old) and 106 were middle-aged (40-65 years old). We found statistically significant positive correlations between the dimensions of perceived emotional intelligence and the reported use of cognitive reappraisal and negative primarily correlations between the dimensions of perceived emotional intelligence and the reported use of …

A Rare Case Report Of Hypoketotic Hypoglycemia Induced Seizures Due To Secondary Carnitine Deficiency In A 44-Year-Old Female, Ayrton Bangolo, Nicole Tesoro, Sonia Onyeka, Mary Bangura, Rekha Shrestha, Vignesh K. Nagesh, Roua Alrestom, Joshua Rathod, Eugenio L. Gomez, Youssef Laabidi, Imane Laabidi, Conrad Erikson, Aayat Sheikh, Sharon Maria, Mansi Naria, Erwin J. Tabucanon, Juilee V. Dongre, Auda Auda, Mohammed Jurri, Reshma Radhakrishnan, Hisham Alrefai, Simcha Weissman

Journal of Community Hospital Internal Medicine Perspectives

Carnitine deficiency is a rare metabolic condition that can result in fasting hypoglycemia. Carnitine deficiency could be primary or secondary to other conditions. Among secondary causes, antiepileptics such as valproic acid have been incriminated. Valproic acid is known to deplete carnitine stores and inhibit the process of β-oxidation. Herein we report the case of a 44-year-old female with epilepsy that presented with breakthrough seizures associated with hypoglycemia despite being on appropriate antiepileptic therapy. The patient was later found to have carnitine deficiency. Discontinuation of valproic acid and supplementation with L-carnitine resolved the patient’s hypoglycemia and breakthrough seizures. With this case …

Moving On Up: A Case Study Of Hiv And Covid-Induced Guillain-Barre Syndrome, Victoria Wong Murray, Rebecca Chae, Isobel Moyer, Cindy Hou

Rowan-Virtua Research Day

COVID and HIV are both common diseases, with COVID affecting an estimated 775 million and HIV affecting 39 million people worldwide. Guillain-Barre is a rare but feared complication of immune stimulation in which the body generates autoantibodies against gangliosides, found in the nodes of Ranvier, in the myelin, and in the ganglia; causing ascending paralysis.

A mid-30s man with HIV maintained on Genvoya presented to the Jefferson Health New Jersey Early Intervention Program clinic with fatigue, fever, cough, and congestion and tested positive for SARS-CoV-2 on the following day. Two weeks later, he presented to the emergency department complaining of …

Cva In Patient With Systemic Sclerosis On Aspirin Therapy: A Case Report, Rahyan Mahmud, Bianna Koutsenko, Kenneth Goich, Usaid Hasan

Rowan-Virtua Research Day

Introduction

Systemic sclerosis is an autoimmune disorder characterized by microvascular damage and multiorgan fibrosis. These patients have a higher risk of cerebrovascular events, but it is difficult to develop strategies for prevention due to limited understanding of underlying pathophysiology.

Case Presentation

A 76-year-old female with a history of systemic sclerosis presented to the emergency department with acute onset slurred speech, facial droop, and left arm pain with a National Institutes of Health (NIH) Stroke Scale of 1. She was outside the thrombolytic window. Other history includes hypertension and hyperlipidemia; both were well controlled. MRI confirmed right frontal lobe ischemic stroke …

Pituitary Adenoma Presenting As Cranial Nerve Iii Palsy And Hemifacial Pain, Yoona Choe, Justin George, Matthew Boyle, Peter Maduka

Rowan-Virtua Research Day

Pituitary adenomas are common neoplasms arising from the pituitary adenohypophyseal cell. They can be classified by cell type, size and as nonfunctioning or functioning based on the secretion of pituitary hormones. Of these, approximately 48% are macroadenomas (>10 mm) and approximately 53% are prolactinomas. For how common these adenomas are, only 1 of 1100 persons manifest clinical symptoms¹ rendering detection and clinical management challenging.

Non-functioning adenomas are slow growing like most pituitary adenomas and are usually detected due to their mass effect on neighboring structures.² The majority of the reported symptoms as a results of these mass …

A Deep Dive Into The Relationship Between Sleep Deprivation And Pain Perception: A Cross-Population Analysis, Adam T. Friedman, Kevin Regan

Rowan-Virtua Research Day

Background: Sleep deprivation and pain perception significantly impact one another through altered sleep parameters such as Total Sleep Time (TST) and Sleep Efficiency (SE). Particularly in neuropathic pain, disturbed sleep exacerbates pain by disrupting neurobiological mediators like opioids and serotonin. Our research examined how sleep loss affects pain in chronic conditions versus healthy individuals. This research underpins our analysis of how interventions, possibly nutritional, could improve sleep quality and modulate pain perception, exploring this relationship across diverse populations and conditions.

Methods: Our study reviewed peer-reviewed articles published since 2010 on sleep deprivation and pain perception. We searched PubMed, focusing on …

Cut The Pressure: Blood Pressure Screening In A Community Based Setting, Harold Kareem Knight Jr., Katharine Milani

Rowan-Virtua Research Day

This study addresses the pressing issue of cardiovascular health disparities in African American males through community-based interventions, specifically blood pressure screenings and surveys conducted in a local barbershop setting. Despite a preference among participants for clinical settings, an overwhelming 97.7% expressed high comfort levels in the community-based environment, highlighting the importance of culturally sensitive approaches in healthcare delivery. With 92.5% indicating willingness to return for future screenings, the study underscores the efficacy of non-traditional settings in fostering healthcare engagement. Findings suggest the potential for broader impact through scalable, community-centric initiatives, offering promising avenues for improving health outcomes in underserved populations.

Insurance Status And Its Effect On Mothers With Postpartum Depression In The United States, Sanjana Davuluri, Lillian J. Alonzo, Nikita Paranjape, Akshad Thirugnanam, Alexander Youssef

Rowan-Virtua Research Day

Postpartum depression (PPD) is a significant health issue in the US today: 1 in 8 new mothers experience symptoms of PPD. Understanding how social determinants of health impact the short and long-term health outcomes of patients with PPD is key to providing interventions that are effective, efficient, equitable, and patient-centered. In this literature review, we aimed to shed light on the association between discrepancies in health outcomes of mothers with PPD and their insurance status. A search was conducted across PubMed and ProQuest Central databases focusing on literature from 2014 onwards. Studies that explored factors contributing to PPD, the impact …

Potential Mechanisms For New Onset Atrial Fibrillation In Covid-19 Patients, Raghav Gupta, Yara Assadi, Shaniece Nicole Lawrence, Erika Jeanie Pitsker, Michael Scott Bickford Jr., Victoria Amber Saniko

Rowan-Virtua Research Day

Introduction: This study shows the prevalence of New-Onset Atrial Fibrillation in COVID-19 patients and highlights the most prevalent explanatory pathologic theories for the correlation.

Methods: The authors carried out a literature review over PubMed using the keywords “atrial fibrillation” and “long-term COVID.” 48 articles were reviewed. Articles relating to new onset of atrial fibrillation in COVID-19 patients were included while articles posted before 2020, not related to COVID and atrial fibrillation were excluded.

Results: The prevalence of atrial fibrillation in COVID patients is often reported to be around 17%, however 44% of patients within Intensive Care units (ICU) have atrial …

Identifying The Relationship Between Post-Concussion Mental Health And Athletic Status: Is It The Same For All Demographics?, Mary Lorraine Zsolway, Jamie Shoop

Rowan-Virtua Research Day

Purpose: The purpose of this study is to investigate whether athletic status was linked to fewer symptoms of anxiety and depression post-concussion, as well as to explore whether the impact of athletic status on mental health varied by demographics (i.e. age, sex, race, insurance status). The results of this study may assist in identifying at-risk individuals early to help prioritize those who may benefit from early referral to mental health resources.

Introduction: Mental health concerns post-concussion are relatively common, with roughly 1 in 3 individuals experiencing these symptoms. It has been previously shown that youth who participate in …

The Effects Of Sleep Quality, Covariates And A Possible Intervention, Pranav S. Reddy, Mia Tarditi, Adarsh Gupta, Richard Jermyn, Venkat Venkataraman

Rowan-Virtua Research Day

Sleep is an essential biological process needed to maintain adequate physiologic function. Research has provided growing evidence that chronic failure to get enough sleep is associated with increased risk for obesity, depression, diabetes, hypertension, stroke, cardiovascular disease, and mortality. Sleep deprivation is threatening the health of up to 45% of the world's population. Furthermore, sleep disorders were found to be associated with significantly higher rates of health care utilization and cost, accounting for $94.9 billion in costs each year in the United States. Earlier data from this project demonstrated a correlation between sleep quality and pain. METHODS: Patients were recruited …

Addressing Gaps In Care Through A Medical Student-Led Cancer Screening Project, Matthew Green, Hannah Ngo, Dakota B. Pastore, Jenna Zappetti, Olivia Siciliano, Meghan Mcquade, John Sauer, Anne Jones

Rowan-Virtua Research Day

Background: Colorectal cancer (CRC), breast cancer (BrCa), and cervical cancer are three of the most preventable cancers. Despite the known significance for early detection and treatment, barriers to screening remain. We developed a medical student-led project to improve adherence to national cancer screening guidelines in patients across Rowan-Virtua Family Medicine (FM) practices. This study assesses the initiative’s efficacy in improving adherence to CRC, BrCa, and cervical cancer screenings.

Methods: Rowan-Virtua FM patients between the ages of 21-75 (n=735) were identified as due or up-to-date on cancer screenings based on chart review. Student volunteers were trained to contact patients to discuss …

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: Wellens Syndrome In 28-Year-Old With Pleuritic Chest Pain, Tucker A. Ledo

Rowan-Virtua Research Day

We report a case of a 28-year-old male with months of diffuse, pleuritic, intermittent, non-exertional chest pain. He had an elevated troponin and ECG showing Wellens’ syndrome and was found to have 80% LAD coronary artery occlusion and 100% apical occlusion. Identification and proper management of Wellens’ syndrome relies on being familiar with its ECG patterns. Other information such as age, cardiac risk factors, chest pain with exertion and at rest, and elevated troponin, are all helpful supplemental information, but as demonstrated in the following case report, presentations may vary or even cause as distractors to the diagnosis.

Case Report: An Emergency Department Presentation Of An Ovarian Teratoma, David Marconi, Zamron Masih

Rowan-Virtua Research Day

A teratoma (from the Greek terato for “monster” and onkoma for “mass” or “swelling”) is a type of neoplasm composed of tissues from two or three germ layers. Mature cystic teratomas (MCTs) constitute 70% of all ovarian neoplasms. They typically present with nonspecific symptoms such as pain and nausea. They account for approximately 2% of all primary ovarian malignant cancers and are predominately diagnosed via ultrasound. Computed tomography may be necessary if malignancy is suspected. Larger size warrants a higher suspicion of malignancy. Management is symptom control and ultimately, surgical removal. Prognosis is generally excellent, provided there is no malignant …

Case Report: Dysphagia In Inclusion Body Myositis Leading To Respiratory And Gastrointestinal Complications, Veroneka Mikhail, James A. Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Inclusion Body Myositis (IBM) stands as a rare and complex neuromuscular disorder (NMD) characterized by progressive muscle weakness and atrophy. Among its cardinal symptoms are dysphagia and respiratory distress, which are the most common cause of death in this disease. While the differential diagnosis of respiratory distress is vast and includes aspiration, pneumonia, acute coronary syndrome, emphysema, and congestive heart failure, a clinician should recognize that respiratory distress can also be secondary to dysphagia in NMDs like IBM and can quickly become life threating. Here we present the case of a 68-year-old female with a history of IBM who presented …

Spontaneous Intracranial Hemorrhage In A 29-Year-Old Male: A Case Report, Md Fateha, Caroline Nguyen, Michael A. Morris

Rowan-Virtua Research Day

Spontaneous intracranial hemorrhage is rare, especially in a young patient population. Signs and symptoms of intracranial hemorrhage include facial droop, vision loss, motor deficits with extraocular movements, deficits with tongue movement, weakness in the arms or legs, sensation loss, and mental status change. This is a case report of a 29-year-old male with no past medical history who presented for a spontaneous intracranial hemorrhage. This patient's only neurologic deficit was the loss of visual field on the left inferior quadrant of his field of vision. The patient obtained a CT head non-contrast which showed 21 mm acute right occipital hemorrhage …

Case Report: Pneumoperitoneum In The Setting Of Altered Mental Status, Aloysius C. Ibe, Neelesh Parikh, Robin Lahr

Rowan-Virtua Research Day

We report a case of an 80-year-old female who presented to the emergency department as altered mental status and diagnosed with pneumoperitoneum requiring immediate surgical intervention. The differential for altered mental status is vast but for a patient who was initially hypoglycemic on ED arrival, suspected drug overdose was at the forefront until the patient was intubated for airway protection and chest radiograph for confirmatory endotracheal tube placement showed pneumoperitoneum.

A Rare Presentation: Intracranial Hemorrhage As A Symptom Of Acute Leukemic Transformation In A 23-Year Old Male, Kelsey M. Murray, Kishan Patel

Rowan-Virtua Research Day

This case highlights the urgency of considering acute leukemic transformation in young patients presenting with neurological deficits, emphasizing the importance of prompt evaluation and management to optimize patient outcomes. The case depicted is a tragic complication of Chronic Myeloid Leukemia (CML) and its acute blast crisis. Remarkably, the patient exhibited none of the typical constitutional symptoms associated with CML.

‘Not So Atypical’: An Atypical Presentation Of West Nile Virus And Guillain-Barre Syndrome, Matthew Orap, Sana Tahir, Ugonna Ononuju, Naresh Kumar

Rowan-Virtua Research Day

Guillain-Barre Syndrome (GBS) is defined by acute areflexic paralysis, usually starting in the distal lower extremities, and ascending to the upper extremities. It is associated with albuminocytologic dissociation, which involves elevated protein levels and normal cell counts in the cerebrospinal fluid. One of the types of GBS, called Miller-Fischer Syndrome (MFS), is characterized by ophthalmoplegia, ataxia, and areflexia. This case report focuses on a 49-year-old male with an atypical presentation of Guillain-Barre syndrome. Guillain-Barre syndrome can be classically caused by Campylobacter jejuni. However, there can be other infectious causes as well, namely Cytomegalovirus, Epstein-Barr virus, Varicella-Zoster virus, …

Case Report: Varicella Zoster Virus Encephalitis Presenting With Monochorea, Chetna Thawani, Frank Wheeler

Rowan-Virtua Research Day

Meningoencephalitis is a broad range of symptoms as a sequela of inflammation of the CNS system. It is a diagnosis that is often missed, especially in atypical presentations. We describe a case of HSV encephalitis that presented to the ER afebrile with atypical arm movements, most similar to a monochorea, and discuss other cases in the literature of atypical presentations of this disease.

Morel Lavallee Lesion: A Shear Fascia-Nating Soft Tissue Injury, Isaac F. Su, James A. Espinosa, Alan A. Lucerna

Rowan-Virtua Research Day

Morel-Lavallée lesions (MLLs), first described by their namesake, French physician Victor-Auguste-François Morel-Lavallée, in 1863, represent a distinct category of soft-tissue degloving injuries. These injuries occur when a shearing force disrupts the connection between subcutaneous tissue and fascia, severing lymphatic vessels and capillaries, and leading to an encapsulated collection of lymph, blood, and necrotic fat. Because this space is deep and enclosed, the fluid accumulation cannot easily drain or resolve spontaneously and often an inflammatory capsule develops, further inhibiting resorption. Undiagnosed, patients go on to develop chronic pain, infection, skin necrosis, progressive neurovascular deficits, and, in severe cases, potential loss of …

Back From Baclofen: A Case Report Of Baclofen Overdose, Alexis M. Dunn, Andrew M. Vasta, James A. Espinosa, Alan Lucerna

Rowan-Virtua Research Day

We report a case of a 45-year-old female who presented with intentional Baclofen overdose. The patient was lethargic and then quickly unresponsive and hypotensive, intubated by EMS in the field. By the time the patient was admitted to the Intensive Care Unit (ICU), the patient was clinically brain dead. After several days of supportive care, patient slowly, and miraculously, regained full neurologic functioning and was admitted to the Psychiatric Unit.

Use Of Point-Of-Care Ultrasound In The Diagnosis Of Postpartum Cardiomyopathy, Muhammad Noman, Frank A. Wheeler, James A. Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Postpartum cardiomyopathy (PPCM), also known as peripartum cardiomyopathy is a rare form of heart failure (HF) that occurs in the late stages of pregnancy or in the early postpartum period. For it to be classified as PPCM, it must occur in the absence of another identifiable cause for HF and have left ventricular (LV) systolic dysfunction with an LV ejection fraction (LVEF) less than 45%. Here we present the case of a 46-year-old female G3P2 presented 5 days postpartum cesarean section delivery in acute respiratory distress where point of care ultrasound was used for assessment of the lungs to visualize …

Over The Counter Overdose: A Case Of Tylenol Toxicity, Swet M. Patel, James A. Espinosa, Alan Lucerna

Rowan-Virtua Research Day

We report a case of a 51-year-old man presenting to the Emergency Department (ED) with suicidal ideations (SI) endorsing an intentional overdose of acetaminophen. Just as important is the clinical presentation; it is equally important to obtain a detailed history of patient's presentation leading to the ED visit when evaluating a suicide attempt. Tylenol (acetaminophen) is a common over the counter (OTC) medication available to the public. Management of Tylenol overdose follows a standard outline of things to observe and intervene on. In this case, we discuss how Tylenol overdose is managed in a clinical setting through a patient who …

Wellen’S Syndrome: An Infamous Example Of Occlusive Myocardial Infarction (Omi), J. Maxell Piraneo, Joseph Pagano, James A. Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Wellen’s syndrome is a condition with characteristic ECG changes that can be highly specific for acute myocardial infarction involving the left anterior descending (LAD) artery. Acute myocardial infarctions are one of the leading causes of death in the developed world. Its estimated annual prevalence is nearly 3 million worldwide, with more than 1 million in the United States [1]. The importance of timely diagnosis cannot be understated. Here we describe a case of myocardial infarction secondary to LAD occlusion which presented with the atypical ECG pattern known as Wellen’s syndrome.

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.

Pneumocephalus – Epidural Injection Nightmare, Mohammad A. Rattu, Frank A. Wheeler

Rowan-Virtua Research Day

Pneumocephalus (pneumatocele or intracranial aerocele) is defined as the presence of air in the intracranial space and most commonly occurs after a traumatic event (most commonly head or facial injury), epidural injection, cranial surgery, However, it may also be spontaneous. Classified into simple and tension types, the presentation varies based on severity and progression. Pneumocephalus with onset less than 72 hours prior to presentation is defined as acute, in contrast to a delayed presentation greater than the given timeframe. Symptoms vary based on the amount of air that is present as well as the exact location within the cranial cavity. …

A Case Of Hhv-6 Viral Meningitis, Mohammad A. Rattu, Wayne Tamaska

Rowan-Virtua Research Day

Meningitis is the inflammation of the meninges and associated with abnormal cell count in the cerebrospinal fluid (CSF). The lack of bacterial growth in cultures, most commonly referred to as aseptic meningitis, is frequently caused by viruses [2]. Viruses have become more common as the prevalence of bacterial meningitis has decreased secondary to vaccination use, with viral meningitis being the most common form among countries. Viral meningitis will present with fever, headache, photophobia, neck stiffness and nausea and vomiting. Younger children however may not show any signs of meningeal irritation. Viral meningitis is usually self-limiting and with good prognosis; however, …