Digital Commons Network^™

Identifying Early Presentation Of Serotonin Syndrome In A 20-Year-Old Male Prescribed Clomipramine And Quetiapine: A Case Report, Veronica Alday, Justin Scarano, Jonathan Yuh, Christie Richardson

Rowan-Virtua Research Day

Serotonin syndrome, a potentially life-threatening condition, can be challenging to diagnose due to its diverse etiology and varied symptomatology. Despite its severity, serotonin syndrome may present from mild to fatal, with symptoms such as autonomic instability, altered mental status, and neuromuscular excitation (e.g. muscle rigidity, hyperreflexia). Here, we present a 20-year-old male with an extensive psychiatric history who was prescribed clomipramine and developed serotonin syndrome. Few cases of serotonin syndrome have been reported to date, exacerbating the difficulty in recognizing and quickly treating such cases. Cases of serotonin syndrome should continue to be reported, in order to familiarize clinicians with …

A Ticking Time Bomb: An Overview Of A Case Report Of Neutropenic Fever Secondary To Tick-Borne Illness, Yasemin Galiboglu, Danielle Thor, Joann Ha, Kristine Wong, Cindy Hou

Rowan-Virtua Research Day

The advent of immunomodulatory therapies and their ever-expanding number of treatment indications necessitates the understanding of their associated complications. Neutropenic fever serves as an example of these complications often encountered in clinical practice. Although neutropenic fever can result from virtually any pathogen, episodes of the syndrome secondary to tick-borne illness remain relatively undocumented in the scientific literature. In the case presented, a 77-year-old female with a pertinent past medical history of smoldering IgG multiple myeloma on active immunosuppressive therapy presented with a first-time episode of neutropenic fever likely secondary to tick-borne illness. Through this overview of a broader report, attention …

Takotsubo Syndrome: A Case Of Acute Altered Mental Status, Aphasia, And Weakness, Yue Chen, Ramza Rukia, Daniel Goldsmith

Rowan-Virtua Research Day

Background: Stress-induced cardiomyopathy (SICM), also known as Takotsubo syndrome, can mimic acute coronary syndrome despite the absence of obstructive coronary artery disease. This case report explores the diagnostic workup and management of a patient with potential SICM presenting with sudden onset altered mental status, aphasia, and weakness.

Case: A 46-year-old woman with no past medical history presented with acute altered mental status, aphasia, and weakness requiring intubation. Blood glucose level was 123 mg/dL. Initial workup for stroke was negative. Extensive neurological workup, including cranial imaging and electroencephalography, revealed no abnormalities.

Initial ECG was unremarkable, but elevated troponin levels and a …

The Anxiolytic Effects Of Ashwagandha Supplementation In Adults With Autism Spectrum Disorder And Anxiety, Jessica Mitchell, Andrea Iannuzzelli, Wendy Aita

Rowan-Virtua Research Day

BACKGROUND: The neuroendocrine system activates the hypothalamus-pituitary-adrenal (HPA) axis during stress,1 and individuals with autism spectrum disorder (ASD) may have atypical stress responses linked to HPA axis dysregulation.2 Prolonged activation of this system increases cortisol secretion, the body’s primary stress hormone.3 Withania somnifera (Ashwagandha) is a traditional herbal remedy believed to reduce stress by modulating the HPA axis and lowering cortisol levels.5

HYPOTHESIS: Following four weeks of Ashwagandha supplementation, the treatment group is expected to exhibit reduced cortisol levels, improved Aberrant Behavior Checklist (ABC) scores, and decreased stress-related behaviors, reflecting its anxiolytic effects.

METHODS: Forty-two adult participants with ASD and …

Case Report: A Case Of Tracheal Perforation, Cyrus Davati, Eric Maddock

Rowan-Virtua Research Day

Here we present the case of a 93-year-old female with a past medical history of arthritis and dementia who came to the hospital for a change in mental status and decreased responsiveness at home. The patient was intubated at home by EMS secondary to continued respiratory distress. The patient had a history of a productive cough over the past three days. The patient arrived at the emergency department with continued respiratory failure. During the ED evaluation, the patient was noted to have tracheal rupture. The patient was admitted to the ICU for severe sepsis and continued on broad spectrum IV …

The Use Of Glp-1 Agonists In Alcohol Use Disorder And Reducing Alcohol Consumption: A Scoping Review, Alec Birnbaum, Yashas Sattur, Akash Patel

Rowan-Virtua Research Day

Alcohol use disorder (AUD) reigns as one of the most pressing issues in the United States with high rates of complications, morbidity, and mortality. Recent studies have exhibited the potential for Glucagon-Like Peptide-1 (GLP-1) agonists to decrease alcohol cravings or alcohol-related adverse events through human and animal studies via reward and satiety signaling pathways. To investigate the ability of GLP-1 agonists to decrease alcohol use, alcohol cravings, and alcohol-related adverse events, this study conducted a scoping review of the current literature to uncover the potential benefit of GLP-1 agonists in patients with AUD. A systematic search across 6 databases was …

Case Report: Pigtail Suprapubic Catheter Placement In A Patient With Acute Urinary Retention And Abdominal Mesh, Clara Keum, Zamran Masih, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Acute urinary retention (AUR) is a urological emergency that requires immediate bladder decompression and management of the underlying condition to prevent further complications such as urinary tract infection and renal failure. When standard urethral catheterization is not feasible, a suprapubic catheter can be used to achieve adequate bladder drainage. However, in patients with structural or anatomical challenges, such as the presence of surgical mesh, suprapubic catheter placement can be difficult. This case report presents the successful placement of an 8.5 French pigtail catheter and urinary drainage in an 86-year-old male with abdominal mesh who presented with AUR.

Case Report: A Case Of Transient Dress Syndrome (Drug Rash With Eosinophilia And Systemic Symptoms), Dip Patel, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

We report a case of a 41-year-old female with a history of hypertension who presented with fever and a diffuse erythematous rash after taking trimethoprim-sulfamethoxazole (TMP-SMX) for an ear infection. Due to her symptoms, mild eosinophilia, and elevated liver function tests, Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) was suspected. Although the patient’s rash had resolved by the time of initial evaluation, it recurred overnight, reinforcing suspicion for DRESS syndrome. TMP-SMX was discontinued, and acetylcysteine was administered due to the patient’s high-dose use of acetaminophen in the days prior to her hospital presentation. Infectious and autoimmune workups were negative. …

A Case Of Choledocholithiasis In A Patient With A Recent History Of Hellp Syndrome And Pre-Eclampsia, Akhil Tumpudi

Rowan-Virtua Research Day

Jaundice in a patient presenting to the emergency department (ED) can be indicative of a range of conditions, and it's important to determine the underlying cause for proper management. Here we describe a case of an unusual presentation of choledocholithiasis in a 25-year-old female with a recent history of HELLP and preeclampsia.

An Unusual Cause Of Sepsis: Capnocytophaga Canimorsus, Capnocytophaga, Christopher Dellmyer, Kishan B. Patel

Rowan-Virtua Research Day

Septic shock can be caused by numerous different pathogens. A few of the more common causes are Streptococcus Pneumoniae, Staphylococcus Aureus, Escherichia Coli, Pseudomonas Aeruginosa, and Candida Albicans. Although these are the pathogens involved in the majority of septic shock cases, it is imperative to take the entire clinical picture into account when treating a patient with septic shock. Here we will discuss a seemingly unimpressive dog bite leading to Capnocytophaga canimorsus bacteremia, septic shock and end organ failure.

Case Report: Non-Ketotic Hyperglycemia Hemichorea-Hemiballismus In The Emergency Department, Veroneka Mikhail, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Non-ketotic hyperglycemia hemichorea-hemiballismus (NH-HC), also known as diabetic striatopathy, is a rare condition characterized by glucose levels greater than 200 mg/dL and continuous, involuntary, and irregular large amplitude jerky movements localized predominantly to one side of the body called hemichorea-hemiballismus. While the differential diagnosis of irregular movements is vast, including seizures disorder, stroke, tumors, Tourette’s syndrome and rheumatic fever, clinicians should also consider diabetic striatopathy as a differential as it has very good prognosis and is easily treatable if diagnosed early. Here we discuss the case of a 72 year-old male with history of non-insulin dependent type 2 diabetes (T2DM), …

Traumatic Cavernous Carotid Fistula Following A Motor Vehicle Accident, Alec Mirchandani

Rowan-Virtua Research Day

Traumatic cavernous carotid fistulas are a rare but serious complication following blunt trauma, such as motor vehicle accidents, where the internal carotid artery is damaged, creating an abnormal connection with the cavernous sinus. This case report describes a 32-year-old female who presented with pulsatile proptosis, conjunctival chemosis, and visual disturbances following a motor vehicle accident. Imaging confirmed the presence of a traumatic cavernous carotid fistula. The patient underwent successful endovascular embolization, resulting in resolution of her symptoms. This report highlights the importance of early diagnosis and timely intervention, particularly through endovascular techniques, as the treatment of choice is to prevent …

Aortic Dissection Triggered By Self Stimulation, Anna M. Delancy, Robin Lahr

Rowan-Virtua Research Day

Aortic dissection is a life-threatening condition requiring immediate diagnosis and intervention. Untreated aortic dissection has a mortality rate of 1-2% per hour. Misdiagnosis occurs in approximately 33.8% of cases, with common symptoms including chest pain, back pain, and syncope. It is important to have a high index of suspicion and utilize appropriate diagnostic tools, such as CT angiography, for prompt diagnosis. Here we describe a rare scenario of a patient with Marfan syndrome ultimately found to have a Stanford A/DeBakey I aortic dissection after a masturbation event. Prompt recognition and treatment of this lethal disease are essential to reduce the …

Case Report: Petersen Hernia, A Rare Cause Of Bowel Ischemia, Brian Lim, Dhara Patel, Adeshola Fakulujo, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

We report a case of a 52-year-old female with history Roux-en-Y gastric bypass (RYGB) three years ago prior to presentation to the emergency department (ED) with sudden onset epigastric abdominal pain with radiation into the back of two hours duration. She was diagnosed with bowel ischemia due to internal hernia through a Petersen’s mesenteric defect. A Petersen’s mesenteric defect is one of the three possible internal hernia sites and occurs between the Roux limb mesentery and a defect in the transverse mesocolon.

Abdominal complaints are common in the emergency department with wide differential ranging from benign to emergent with need …

Case Report: Hypercapnia's Hidden Dance: Myoclonus In A Patient With Co2 Retention, Kelsey Murray

Rowan-Virtua Research Day

Myoclonic jerking is a neurologic phenomenon characterized by sudden, involuntary muscle contractions. While often associated with neurological conditions, myoclonic jerking can also be observed in patients with significant carbon dioxide retention. This case report highlights the presentation of myoclonic jerking in a 77-year-old male with a history of sleep apnea and obesity, who presented to the emergency department with hypoxia and elevated carbon dioxide levels. Despite the lack of neurological deficits, the patient experienced intermittent myoclonic jerks of his hands, which were attributed to CO2 retention. The report underscores the importance of recognizing myoclonic jerking as a potential sign of …

Dural Venous Sinus Thrombosis: Be Careful When You Sneeze, Arsam F. Nadeem

Rowan-Virtua Research Day

Dural venous sinus thrombosis (DVST) is a rare but potentially life-threatening condition that accounts for approximately 0.5–1% of all strokes. It is often associated with hypercoagulable states, infections, malignancies, and systemic inflammatory diseases. Clinical presentations are highly variable and can include headaches, focal neurological deficits, seizures, and altered mental status. Given its nonspecific symptoms, DVST remains a diagnostic challenge. This report presents a case of a young male who developed a persistent headache and had transient speech changes and was ultimately diagnosed with a dural venous sinus thrombosis.

Case Report: Haemophilus Influenzae Meningitis In A 65 Year Old Female, Kaywan Saed, Russell Mordecai

Rowan-Virtua Research Day

We report a case of a 65-year-old female who presented with fever, altered mental status, and neck stiffness. Cerebrospinal fluid (CSF) analysis confirmed Haemophilus influenzae meningitis. The differential diagnosis of bacterial meningitis in older adults is broad and includes Streptococcus pneumoniae, Neisseria meningitidis, Listeria monocytogenes, and Haemophilus influenzae. However, in the post-Hib vaccine era, non-typeable H. influenzae has emerged as a significant cause of invasive disease in older adults, particularly in those with underlying comorbidities.

Older patients often present with atypical symptoms, which may delay diagnosis and treatment. In this case, early recognition and prompt administration of empiric antibiotic therapy …

Mitral Kombat: A Case Of Paravalvular Leak And Hemolysis After Tmvr, Isaac Su, Kishan B. Patel

Rowan-Virtua Research Day

A 71-year-old woman with prior TMVR presented with dyspnea, jaundice, and hypoxia. She was found to have severe anemia with lab evidence of mechanical intravascular hemolysis due to a paravalvular leak (PVL), a known TMVR complication. This case highlights the importance of recognizing post-operative complications in valve replacement patients, including PVL-related hemolysis.

Case Report: Hyperkalemia Secondary To Acute Respiratory Acidosis, Chetna Thawani

Rowan-Virtua Research Day

Hyperkalemia is a potentially life-threatening electrolyte disturbance, commonly associated with renal dysfunction, medication effects, and acid-base imbalances. While metabolic acidosis is a well-known cause of transcellular potassium shifts, respiratory acidosis is a less recognized but significant contributor. This case report presents a 74-year-old female with hyperkalemia in the setting of acute respiratory acidosis secondary to impaired ventilation from rib fractures. This case highlights the importance of recognizing respiratory acidosis as a potential cause of hyperkalemia and tailoring management to address the underlying issue

Mapping Fat Embolism As A Complication Of Liposuction And Fat Grafting: A Systematic Review Of Anatomical And Technical Risk Factors, Jared Garfinkle, Jack Hennen, Wen Luo

Rowan-Virtua Research Day

Fat grafting (FG) and liposuction are widely performed aesthetic procedures with associated fat embolism risks. However, no comprehensive review has specifically mapped the anatomical distribution and technical causes of fat embolism events across these procedures. This review aims to characterize regional and procedural frequencies of fat embolism to inform safer surgical practices. A review was conducted using PubMed, Embase, Scopus, and Cochrane. Included studies were English-language case reports/series, retrospective reviews, and systematic analyses reporting fat embolism following liposuction or FG. Among 227 FG cases, the most frequent regions were the face (n=120), gluteal region (n=91), genitalia (n=9), and chest (n=7). …

Exploring Intracellular Signaling Responses To Ks18, A Potent Mcl-1 Inhibitor, In Multiple Myeloma, Emily Nelson, Omar S Al-Odat, Dhruti A. Brahmbhatt, Tulin Budak-Alpdogan, Subash Jonnalagadda, Manoj Kumar Pandey

Rowan-Virtua Research Day

Multiple myeloma (MM), a cancer of plasma B cells, is a hematological malignancy in which patients inevitably relapse and develop drug resistance. Mcl-1, a member of the anti-apoptotic subgroup of Bcl-2 family proteins, plays a critical role in the progression of multiple myeloma and contributes significantly to drug resistance. Elevated Mcl-1 expression is observed in approximately 52% of MM patients at diagnosis, increasing to 81% at relapse. Given its driving role in disease progression and therapy resistance, Mcl-1 inhibition has emerged as a promising therapeutic target, prompting ongoing research into the development and clinical evaluation of Mcl-1 inhibitors, particularly for …

Impact Of St-Elevation Myocardial Infarction (Stemi) On Patients With Celiac Disease, Rahul Patel, Darshan Patel, Tirth Patel, Trinava Roy, Shashank Gupta, Rafail Beshai, Joshua Soliman, C. Jonathan Foster, Brian Blair

Rowan-Virtua Research Day

Background

Celiac Disease has links to inflammatory bowel disease (IBD), rheumatoid arthritis (RA), sarcoidosis. The latter 3 have cardiovascular manifestations There are limited studies on the hospital outcomes of Celiacs with cardiac manifestations. The aim of this study was to evaluate the economic burden and hospital outcomes of Celiacs with concomitant ST elevation myocardial infarction (STEMI).

Methods

Patients aged 18 years and older with Celiac disease and STEMI versus Celiac Disease alone were identified from the US Nationwide Inpatient Sample (NIS), from the years 2019-2020. ICD 10 codes were utilized, multivariate regression analysis was used to estimate the odds ratios …

Reviewing The Effect Of Antiplatelet Therapy On Lumbar Puncture Complications, John Andre Socci

Rowan-Virtua Research Day

Reviewing The Effect of Antiplatelet Therapy on Lumbar Puncture Complications aims to assess literature that discusses the possible risks of undergoing lumbar puncture while on antiplatelet therapy. Lumbar punctures offer vital information that can help guide making accurate diagnosis and creating appropriate treatment plans. However, a large portion of the population is on antiplatelet therapy for cardiovascular and cerebrovascular disease prevention. While there are many benefits to being on these medicines, patients are at increased risk for bleeding. Thus the clinical question as to whether or not proceed with lumbar puncture on patients taking antiplatelet therapy involves weighing risks and …

The Impact Of Emergency Room Overcrowding On The Incidence Of Healthcare-Acquired Infections Among Patients, Hayya Ali

Rowan-Virtua Research Day

Emergency department (ED) visits are vital components of healthcare delivery, serving as the primary site for acute medical care, particularly for individuals with urgent medical needs. The ED is among the most crowded hospital units. The fast-paced setting and over-crowdedness of an emergency room have become the reality of every hospital across the United States. Overcrowding causes problems for patients and staff, which include the risk of contracting healthcare-acquired infections. This is due to several factors that in most cases lead to an increase in the number of people within the ED, an increase in mortality and morbidity, and a …

Investigating Pinch-1 In Glioblastoma Multiforme: A Potential Adjuvant Therapy Target To Improve Treatment Outcomes, Saikrishna Gaddam, Dianne Langford

Rowan-Virtua Research Day

Gliomas account for approximately 80% of all brain cancers and 30% of central nervous system tumors. Glioblastoma multiforme (GBM), the most common, is unfortunately, the most aggressive glioma cancer type. Despite treatment efforts such as surgery, radiation, and chemotherapy, nearly all low-grade astrocytoma progress to GBM without complete surgical resection. Achieving full surgical removal is typically impossible, leading to an almost 100% recurrence rate of GBM after 9 months with a median survival of approximately 15 months. This poor prognosis is due to its high invasiveness and resistance to therapy. Therefore, improved therapeutic approaches are needed to reduce recurrence and …

The Impact Of Obesity On The Risk Of Venous Thromboembolism In Users Of Combined Oral Contraceptives: A Comprehensive Literature Review, Adeena Javed

Rowan-Virtua Research Day

Background: Combined oral contraceptives (COCs) are a widely used method of birth control in the U.S., particularly among women aged 15–44. COCs are known to increase the risk of venous thromboembolism (VTE). Obesity, which affects over 40% of adult women in the U.S., is also a recognized independent risk factor for VTE. However, the compounded risk posed by the simultaneous presence of obesity and COC use has not been thoroughly explored.

Hypothesis: Obesity significantly elevates the risk of VTE in women using COCs, demonstrating a synergistic interaction between these two factors.

Methods: A systematic literature review was conducted using PubMed, …

Exploring Anticoagulant Prescription Disparities: A Focus On Hispanic Patient Care, Michael Acevedo, Vanessa Veltre

Rowan-Virtua Research Day

Anticoagulants play a critical role in preventing thromboembolic events, yet disparities persist in their prescription among minority populations. This presentation explores inequities in anticoagulant prescribing patterns, with a specific focus on Hispanic patient care. Using retrospective electronic health record data, we analyzed the prescription rates of warfarin versus direct oral anticoagulants (DOACs) among adults with clinical indications for anticoagulation. Our findings reveal that Hispanic patients are significantly less likely to receive DOACs compared to non-Hispanic White patients, even after adjusting for demographics, comorbidities, and insurance status. Contributing factors include language barriers, lack of insurance, and potential implicit bias in provider …

Does Sports-Specialization Increase The Risk Of Injury In Youth Athletes?, Kinjal Shah

Rowan-Virtua Research Day

Sports specialization, defined as intensive, year-round training in a single sport for more than eight months per year, has become increasingly prevalent among youth athletes. While it is often pursued with the goal of elite performance, early specialization may increase the risk of both physical injuries and psychological strain. This risk is especially pronounced in individual sports such as swimming and tennis, where early and focused training is frequently encouraged. This study explores the association between early sports specialization and injury risk in young athletes, with the goal of identifying contributing factors and informing prevention strategies. Evidence suggests that while …

Laser Atherectomy For Complex Cad In Ischemic Heart Failure: A Systematic Review Of Revascularization Outcomes, Avneet Chawla, Jared Aftel, Moiuz Chaudhri, Mohamad Hammad, Ahmed Al Mahrizi, John Socci, Aditya Mehra

Rowan-Virtua Research Day

This review evaluates how laser atherectomy compares to angioplasty and stenting for revascularization in patients with heart failure and complex coronary artery disease (CAD). The review explored whether laser atherectomy could improve procedural success and reduce the risk of restenosis, major cardiovascular events (MACE), and other complications. A search across multiple medical databases yielded six studies directly comparing these treatment methods. Findings showed that procedural success rates were similar between laser atherectomy (ranging from 80% to 95%) and angioplasty/stenting (85% to 98%). Restenosis rates at six and twelve months were also generally equivalent, although laser atherectomy showed potential advantages in …

A Twist Of Fate: A Case Of Spiral Humerus Fracture After Arm Wrestling, Alec Mirchandani, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Fractures of the humerus are relatively uncommon, with spiral fractures typically resulting from rotational forces. This case report describes a 25-year-old male who sustained a right-sided spiral humerus fracture during an arm-wrestling match. The diagnosis was confirmed through radiographic imaging, and the fracture was successfully managed with closed reduction and posterior long arm splinting. This case highlights the importance of recognizing less common mechanisms of injury, like arm wrestling, in the context of humeral fractures. It also emphasizes the effective non-operative treatment of such fractures in young, healthy individuals.