Digital Commons Network^™

Recent Advances In The Prevention And Treatment Of Decompensated Cirrhosis And Acute-On-Chronic Liver Failure (Aclf) And The Role Of Biomarkers, Jonel Trebicka, Ruben Hernaez, Debbie Lindsay Shawcross, Alexander L Gerbes

Faculty, Staff and Students Publications

The progression of cirrhosis with clinically significant portal hypertension towards decompensated cirrhosis remains clinically challenging and the evolution towards acute-on-chronic liver failure (ACLF), with one or more extrahepatic organ failures, is associated with very high mortality. In the last decade, significant progress has been made in the understanding of the mechanisms leading to decompensation and ACLF. As portal hypertension advances, bacterial translocation across an impaired gut barrier culminates in endotoxaemia, systemic inflammation and cirrhosis-associated immune dysfunction (CAID). Gut-derived systemic inflammation and CAID have become the logical targets for innovative therapies that prevent hepatic decompensation episodes and the progression to ACLF.Furthermore, …

Mitochondria Regulate Proliferation In Adult Cardiac Myocytes, Gregory B Waypa, Kimberly A Smith, Paul T Mungai, Vincent J Dudley, Kathryn A Helmin, Benjamin D Singer, Clara Bien Peek, Joseph Bass, Lauren Nelson, Sanjiv J Shah, Gaston Ofman, J Andrew Wasserstrom, William A Muller, Alexander V Misharin, G R Scott Budinger, Hiam Abdala-Valencia, Navdeep S Chandel, Danijela Dokic, Elizabeth Bartom, Shuang Zhang, Yuki Tatekoshi, Amir Mahmoodzadeh, Hossein Ardehali, Edward B Thorp, Paul T Schumacker

Faculty, Staff and Student Publications

Newborn mammalian cardiomyocytes quickly transition from a fetal to an adult phenotype that utilizes mitochondrial oxidative phosphorylation but loses mitotic capacity. We tested whether forced reversal of adult cardiomyocytes back to a fetal glycolytic phenotype would restore proliferative capacity. We deleted Uqcrfs1 (mitochondrial Rieske iron-sulfur protein, RISP) in hearts of adult mice. As RISP protein decreased, heart mitochondrial function declined, and glucose utilization increased. Simultaneously, the hearts underwent hyperplastic remodeling during which cardiomyocyte number doubled without cellular hypertrophy. Cellular energy supply was preserved, AMPK activation was absent, and mTOR activation was evident. In ischemic hearts with RISP deletion, new cardiomyocytes …

Towards A Remote Patient Monitoring Platform For Comprehensive Risk Evaluations For People With Diabetic Foot Ulcers, Gozde Cay, M G Finco, Jason Garcia, Jill L Mcnitt-Gray, David G Armstrong, Bijan Najafi

Center on Aging Staff Publications

Diabetic foot ulcers (DFUs) significantly affect the lives of patients and increase the risk of hospital stays and amputation. We suggest a remote monitoring platform for better DFU care. This system uses digital health metrics (scaled from 0 to 10, where higher scores indicate a greater risk of slow healing) to provide a comprehensive overview through a visual interface. The platform features smart offloading devices that capture behavioral metrics such as offloading adherence, daily steps, and cadence. Coupled with remotely measurable frailty and phenotypic metrics, it offers an in-depth patient profile. Additional demographic data, characteristics of the wound, and clinical …

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 …

Prevalence Of Cardiovascular Conditions After Traumatic Brain Injury: A Comparison Between The Traumatic Brain Injury Model Systems And The National Health And Nutrition Examination Survey, Shanti Pinto, Bhaskar Thakur, Raj Kumar, Amanda Rabinowitz, Ross Zafonte, William C Walker, Kan Ding, Simon Driver, Umesh Venkatesan, Gilbert Moralez, Kathleen Bell

Department of Rehabilitation Medicine Faculty Papers

BACKGROUND: The purpose of this study is to compare the prevalence of self-reported cardiovascular conditions among individuals with moderate to severe traumatic brain injury (TBI) to a propensity-matched control cohort.

METHODS AND RESULTS: A cross-sectional study described self-reported cardiovascular conditions (hypertension, congestive heart failure [CHF], myocardial infarction [MI], and stroke) from participants who completed interviews between January 2015 and March 2020 in 2 harmonized large cohort studies, the TBI Model Systems and the National Health and Nutrition Examination Survey. Mixed-effect logistic regression models were used to compare the prevalence of cardiovascular conditions after 1:1 propensity-score matching based on age, sex, …

Zinc-Containing Over-The-Counter Product Causing Sideroblastic Anemia And Neutropenia, Marshall Patrick Stagg, Jennifer Miatech, Baseera Majid, Ravali Polala

School of Medicine Faculty Publications

Sideroblastic anemia is characterized by anemia, granulocytopenia, and bone marrow findings of vacuolated precursors and ringed sideroblasts. Zinc-induced copper deficiency can present as sideroblastic anemia and neutropenia. We report the case of a previously healthy 74-year-old female who presented with newly discovered sideroblastic anemia as a result of an over-the-counter oral vitamin and mineral supplement. Serum analysis revealed increased zinc levels, decreased copper levels, and a decrease in ceruloplasmin. Bone marrow evaluation revealed ringed sideroblasts and cytoplasmic vacuolization in myeloid precursors. She demonstrated improvement in her hematologic profile with discontinuation of the over-the-counter product and administration of oral copper supplementation. …

Endotrophin, A Key Marker And Driver For Fibroinflammatory Disease, Kim Henriksen, Federica Genovese, Alexander Reese-Petersen, Laurent P Audoly, Kai Sun, Morten A Karsdal, Philipp E Scherer

Faculty, Staff and Student Publications

Our overview covers several key areas related to recent results obtained for collagen type VI and endotrophin (ETP). (1) An introduction to the history of ETP, including how it was identified, how it is released, and its function and potential receptors. (2) An introduction to the collagen family, with a focus on what differentiates collagen type VI from an evolutionary standpoint. (3) An overview of collagen type VI, the 6 individual chains (COL6A1, A2, A3, A4, A5, and A6), their differences and similarities, as well as their expression profiles and function. (4) A detailed analysis of COL6A3, including the cleaved …

Reducing The Burden Of Diabetes Mellitus: Is It Achievable?, Rafay Iqbal, Raheel Ahmad, Aisha Ambreen

Department of Family Medicine

Diabetes mellitus is rapidly on the rise globally, particularly in low- and middle-income countries. Pakistan has emerged with the highest prevalence of diabetes by percentage according to recent estimates. Evidence is available for different strategies to reduce this burden. Screening high-risk individuals can reduce burden of undiagnosed diabetes and improve outcomes. Although prediabetes can progress to type 2 diabetes, it has the potential to regress to normoglycaemia as well. Interventions like lifestyle modifications and metformin in high-risk individuals can reduce the risk of progression to diabetes. Furthermore, there is a potential to reverse diabetes in some individuals in the early …

Bronchopulmonary Dysplasia: Pathophysiology And The Effects Of The Microbiome, Anjali Jacob

Senior Honors Theses

Bronchopulmonary dysplasia (BPD) is a chronic neonatal lung disease that occurs in over 50% of premature infants. BPD is characterized by damage to the alveoli and bronchioles and improper vasculature formation. It is primarily caused by overexposure to oxygen through mechanical ventilation, but there are other risk factors that make infants more susceptible to BPD. Microbial composition impacts risk for developing BPD, and research is ongoing about the effects of the microbiome on BPD pathogenesis; this information is also valuable for preventative treatment. This paper reviews the normal function of the lungs, pathogenesis of BPD and how it affects normal …

Cardiovascular Disease Risk Reduction Program For Hispanics In The Us Midwest: A Culturally Adapted Intervention, Armando De Alba

Theses & Dissertations

Cardiovascular disease (CVD) represents the second leading cause of death in Nebraska (NE), accounting for approximately one in every five deaths. In the state, there are marked ethnic and rural-urban disparities in the prevalence of chronic diseases and resultant deaths. For instance, while the rates in NE of coronary heart disease and myocardial infarction between 2001 and 2010 decreased among non-Hispanic Whites, the rates for Hispanics almost tripled. There is little evidence of CVD risk factor reduction strategies being implemented in Midwestern areas and Hispanic populations.

One promising approach for reducing CVD risk involves health education and lifestyle modification programs …

Pricks And Pills, Anna A. Charles

Theses and Dissertations

"Pricks and Pills" is a collection of audio pieces designed for an online platform where individuals with diabetes can listen to and find emotional support from others who share their experiences. This audio project provides an intimate look into the lives of people navigating the challenges of diabetes. Through heartfelt interviews with individuals and their families, the podcast highlights their journeys, showcasing both their struggles and triumphs.

Clinical Considerations And Outcomes Of Robotic Urologic Surgery In Obese Patients, Nazih Khater, Anna G. Morris, Delena M. Vanvalkenburg, Andrew J. Garcia, Kevin Jin, Shahab Ahmadzadeh, Sahar Shekoohi, Elyse M. Cornett, Alan David Kaye

School of Medicine Faculty Publications

Obesity is associated with many significant physiological changes. These considerations are important to surgery, especially in urological procedures. Obese patients often undergo surgical procedures and are at higher risk of complications. This investigation reviews physiological and anaesthesia considerations for obese and morbidly obese patients. In addition, urological surgeries and procedures should be considered for these higher risk patients. Clinical anaesthesiologists must use detailed assessment and, when appropriate, consultation in developing safe anaesthesia plans for these patients. Newer technologies have improved safety related to airway management, advanced airway devices, and regional anaesthesia with ultrasound-guided nerve blocks, which can reduce the need …

The Molecular Basis Of Maple Syrup Urine Disease, Chloe Jensen

Senior Honors Theses

Maple syrup urine disease (MSUD) is a rare metabolic disorder that is caused by mutations in the branched chain alpha keto acid dehydrogenase enzyme complex (BCKDC). There are three main genes, the BCKDHA, BCKDHB, and DBT, that affect the BCKDC, all contributing to the onset of the disease. MSUD causes encephalopathy, neural deficits, maple syrup scented urine, coma, and even death if not treated due to the aggregation of branched-chain amino acids (BCAAs). There is currently no known cure for patients with MSUD, but the condition can be managed to improve quality of life. This review serves to examine MSUD …

Implementing A Standardized Protocol For Early Detection Of Undiagnosed Hypertension Patients, Jenscena Hansen, Chris Bell

Doctor of Nursing Practice Projects: College of Nursing

Introduction: Hypertension is a preventable disease that frequently goes unrecognized and undertreated. Early diagnosis can prevent further comorbidities such as heart disease, stroke, and chronic kidney disease. Implementation of this protocol aims to decrease the number of patients with undiagnosed hypertension and increase the identification of patients with elevated blood pressure who did not have a pre-existing diagnosis of hypertension. The goal of implementing a standardized protocol would help eliminate the number of patients who go undiagnosed.

Methods: This quality improvement design had clinical staff flag patients with elevated blood pressure. Identified patients without a diagnosis of hypertension were educated …

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 …

Clinical Outcomes For Va-Ecmo Patients Associated With Hyperlipidemia: An Analysis Of The National Inpatient Sample, Dakota B. Pastore, Tony Elias, Rafail Beshai, Kyrillos Girgis, Maziyar Daneshvar, Keith Anacker

Rowan-Virtua Research Day

Introduction: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is considered the most advanced temporary life support which provides complete hemodynamic support in addition to gas exchange. There is limited data available on the impact of hyperlipidemia (HLD) on VA-ECMO patients. We sought to examine the national inpatient sample (NIS) database to describe in-hospital outcomes among these patients.

Methods: The NIS was searched for hospitalizations of adult VA-ECMO patients with and without a concomitant diagnosis of HLD for the years 2019 and 2020. The primary outcome was inpatient mortality.

Results:This study included 3,885 VA-ECMO patients, of which 1,082 (27.8%) patients had HLD. …

Impact Of Diabetic Education On Reducing Hospital Readmission Rates: A Literature Review Of Adults With Diabetes, Frank Camarda

Rowan-Virtua Research Day

According to 2018 data from the Diabetes Institute Foundation, adults in the U.S. diagnosed with diabetes accounted for 17 million emergency department visits. The readmission rate for patients with diabetes far exceeds the general readmission rates for hospitalized patients. While there is recognition of the need for diabetic education to reduce hospital readmissions, optimizing long-term self-management of diabetics remains a focus of ongoing research.

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 …

Can Nutritional Supplements Benefit Patients Receiving Treatment For Neurodegenerative Disorders?, Russell Levi, Saad Ahmed, Zachary Harris

Rowan-Virtua Research Day

As the prevalence of neurocognitive disorders rises globally, developing new methodologies of prevention and treatment is crucial. This literature review examines the efficacy of adding nutritional supplements, specifically nootropics, with traditional pharmacological regimens on various neurocognitive and neurodegenerative disorders. Primary, peer-reviewed research, including both human and animal studies, was assesed to determine if there was a benefifical, minimal, or detrimental effect on symptom progression. The inclusion criteria focused on studies that evaluated the reduction in disease markers or symptoms following supplement use. The findings reveal that natural supplements generally support disease management. Significant improvements were noted with specific combinations like …

Brief Review: The Refeeding Syndrome, Jose Gerald Aragon, Mohammed A. Rattu, Alex Gechlik, Nicholas Coan, James A. Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Here we briefly review the definition, epidemiology, pathophysiology, clinical risk scenarios, prevention and treatment of the refeeding syndrome. Refeeding syndrome is a condition which arises when a severely malnourished individual has been restarted with increased nutrition in a relatively short period of time. The refeeding process can lead to shifts in a number of fluids and electrolytes. The hallmark feature is hypophosphatemia. The true incidence of refeeding syndrome is unknown. This is said to be partly due to the lack of a universally accepted definition. Populations that are likely to experience this syndrome include patients with maladaptive eating disorders, chronic …

Relationship Between Gut Microbiota And Dementia, Saad Ahmed, Zack Harris, Russell David Levi

Rowan-Virtua Research Day

This paper explores the complex relationship between gut microbiota, dietary habits, and dementia, focusing particularly on Alzheimer's disease (AD). Growing evidence suggests a significant link between the composition of gut bacteria, dietary choices, and susceptibility to dementia. Notably, individuals with dementia demonstrate a noticeable reduction in gut bacteria diversity, highlighting the crucial role of a balanced microbiome in maintaining cognitive health. Conversely, dietary preferences characterized by excessive consumption of processed foods and sugars are associated with an increased risk of dementia, emphasizing the critical influence of diet on shaping gut microbiota and subsequent neurocognitive outcomes. Importantly, dietary interventions featuring a …

Investigating Risk Factors Contributing To The High Incidence Of Covid-19 Among The Diné People Of The Navajo Nation, Elizabeth Lila Reynolds

Rowan-Virtua Research Day

Background: COVID-19 became international news in December 2019 and subsequently impacted global health. The research shows that the Diné people of the Navajo Nation were one of the most severely impacted populations¹. The Navajo Nation is a region spanning Arizona, New Mexico, and Utah that is composed of North American indigenous people known as the Diné. Purpose: To explore the risk factors contributing to the increased rates of COVID-19 infection and severity of infection among the Diné people. Methods: This literature review research process utilized PubMed and JAMA to find scholarly articles on this topic. Search terms …

The Impact Of Stress During Adolescence And The Prevalence Of Pediatric Obesity, Olatunbosun Olakunri, Venkat Venkataraman

Rowan-Virtua Research Day

Obesity is a chronic condition that can be attributed to myriad factors including socioeconomic status, biological risk factors, and various environmental factors. These factors can be considered stress factors, and exposure to various levels of stress can impact the development of stress within the pediatric patients. The purpose of this study is to assess the association between the environmental, mental, social, physical, and psychological stress adolescents are exposed to and how they contribute to the prevalence of pediatric obesity throughout the United States. Understanding these risk factors can help us as a community and most importantly as clinicians develop better …

Nutrition And Exercise Resources For Uninsured Patient Populations, Sabrina Marie Paparo, Samantha Plasner, Runi Patel, Wendy Briaguez

Rowan-Virtua Research Day

Proper nutrition and exercise is integral for the prevention and management of chronic diseases such as type two diabetes, hypertension, high cholesterol, and cardiovascular disease. However, health care disparities in the United States, such as lack of access to primary health care, has been an ever growing problem. The purpose of this study is to determine if there is a correlation between being uninsured and having worse health outcomes, and to determine if there is a need for accessible nutrition and/or exercise resources for this population. To conduct this research, a survey was distributed at the Cherry Hill Free Clinic …

Diabetes Health Education For South Jersey Communities, Heaven Chu, Sarah Tamous, Ashhabal Kavvi, Amin Khan

Rowan-Virtua Research Day

Diabetes is a chronic health condition that hinders the body’s metabolic process using insulin to maintain glycemic homeostasis. It is prevalent worldwide, with about 10% of the global adult population affected. Socio-economic and cultural factors and determinants make diabetes and diabetes management more of a health risk for certain populations rather than others. The prevalence of diabetes in the United States is higher than the global average and the risk factors disproportionately affect disadvantaged communities.

This study was designed to investigate health disparities in diabetes among a diverse population sample. The study included researching the disparities of diabetes patients in …

Effects Of Obesity On Patients Undergoing Cardiomems Procedure: Retrospective Cohort Study, Tony Elias, Mena Elmalh, Priya Brahmbhatt, Kyrillos Girgis, Taha Syed, Michael Valderrama, Rafail Beshai

Rowan-Virtua Research Day

★ Remote hemodynamic monitoring (CardioMEMs) is becoming increasingly important for management of chronic heart failure patients.

★ There is limited data looking specifically for obese patients who undergo CardioMEMs implantation.

★ We sought to examine the national inpatient sample database to describe in-hospital outcomes for this demographic

Exploring Hypertension Prevalence Among Ill-Housed Individuals In Urban Environments, Lia Summer Goldberg, Sameer Shah, Nikhila Archakam, Murod Khikmatov, Kesha Choksi, Anddee White

Rowan-Virtua Research Day

This study explores the interrelations of hypertension, homelessness, and access to healthcare in urban ill-housed populations. It was found that conditions such as heart disease and diabetes significantly exacerbate hypertension, which remains highly prevalent due to the population's limited access to consistent medical care. Homelessness further complicates the management of hypertension due to unstable living conditions, making adherence to treatment and follow-up with healthcare providers challenging. Additionally, factors like higher rates of substance abuse and malnutrition among homeless populations contribute to worsening hypertension, which, if untreated, can lead to severe health crises including heart attacks and strokes.

The research underscores …

Gut Microbiome And Nutrition Interplay In Regulating And Improving Autism Spectrum Disorder Related Social Symptoms, Irenonsen Juliet Eigbe, Christian Moya Gamboa, Jana Gjini, Jaydeep Mukherjee, Susrut Dube

Rowan-Virtua Research Day

The composition of the gut microbiome has been shown to play a role in the onset of neurological disorders, including Autism Spectrum Disorder(ASD). A small variety of recent research articles identify a possible link between onset and severity of ASD related behaviors and the composition of the gut microbiome. The purpose of this review is to identify gaps in the current understanding of the role that nutrition plays in changing the gut microbiome and subsequently altering the onset and severity of behavioral phenotypes in children with ASD. Inclusion criteria comprises peer-reviewed publications relating to children with autism. Exclusion criteria consists …

Barriers In Health Care Leading To High Maternal Mortality Rates In Southern New Jersey, Katarina Rusinak, Muznah Khan, Ava Dinardo, Nayarith Lopez

Rowan-Virtua Research Day

Maternal mortality remains a significant issue in New Jersey, particularly in the Southern counties where rates are alarmingly high. This study investigates barriers faced by mothers in these areas, utilizing data from state health departments, as well as the CDC. Findings reveal clear disparities in healthcare access and resources, exacerbated by high poverty and rural settings. Proposed interventions include educational posters and community workshops to empower expecting mothers and families. However, challenges such as low attendance and limited effectiveness of interventions underscore the need for comprehensive, sustainable solutions to tackle maternal mortality in Southern New Jersey.

Community Healthcare Workers (Chw) High-Risk Stabilization Study: Does The Ability Of Chws At Mobile Covid Clinics To Link Patients With Uncontrolled Diabetes To A Physician Improve Short Term Outcomes?, Mo Hadaya, Venkateswar Venkataraman, Jaimy D. Jabon, Kenneth W. Stagliano, Richard T. Jermyn

Rowan-Virtua Research Day

Uncontrolled diabetes may cause preventable but significant effects. One major preventative measure is early screening; there are hopes that community healthcare workers can increase awareness and screening availability, especially in underserved populations. We hosted and recorded logs of patients at mobile COVID health clinics, educating those with uncontrolled diabetes and connecting them to healthcare. We then looked to see if any patients had improvements in blood glucose to non-diabetic levels. 378 patients were logged, but only 138 were in events that had a significant amount of repeat visits. Twenty-five of them had blood sugar indicative of uncontrolled diabetes. Out of …