Digital Commons Network^™

Case Study: 46-Year-Old Female With Auditory Hallucinations, Ahmed Aly, Tayeb Ahamed, Chien Y. Cepeda, Apn

Rowan-Virtua Research Day

The case study discusses a patient seen at a voluntary psychiatric unit. Patient has been prescribed benzodiazepine and bupropion; she became dependent on the benzodiazepine due to social difficulties that have not been addressed by her prescriber. The study highlights the dependency of benzodiazepine while being offered bupropion (which lowers seizure threshold), which can be deadly if accompanied with benzodiazepine withdrawal

Beyond Glycemic Control: A Comparative Analysis Of Dapagliflozin Vs Empagliflozin, Wesley Augustus Kim, Heaven Chu, Kayla Ancheta, Nicole Shellenbarger, Sophia Ginet, Akash Patel

Rowan-Virtua Research Day

SGLT2 inhibitors have emerged as a drug class with cardiorenal benefits beyond glycemic control in patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD). This review compares two widely used SGLT2 inhibitors dapagliflozin and empagliflozin across efficacy, safety, and cost-effectiveness outcomes in patients with comorbid CKD and T2DM. A systematic literature search of PubMed, Scopus, and Embase yielded 10 final articles after screening. Both agents demonstrated comparable cardiorenal benefits, with dapagliflozin showing advantages in weight, blood pressure, and glycemic markers, while empagliflozin proved more cost-effective for CKD-specific disease management. Neither drug demonstrated significant safety concerns over placebo …

Weight Loss Strategy Disparities Among Anti-Obesity Medication-Eligible Us Adults: A Cross-Sectional Nhanes Analysis, Harshal Parmar, Akhila Archakam, Hitesh Gowda, Leonard Powell

Rowan-Virtua Research Day

Background: Nearly half of US adults meet FDA criteria for anti-obesity pharmacotherapy (AOM), yet utilization remains low. Recent GLP-1RAs prescribing has intensified focus on access disparities, but how weight loss strategy selection varies by social determinants among AOM-eligible adults is poorly understood.

Hypothesis: Weight loss strategy selection among AOM-eligible adults varies by race/ethnicity and food security status, with food insecure populations likely to use maladaptive strategies.

Methods: Survey-weighted cross-sectional analysis of NHANES 2017–March 2020. AOM eligibility: BMI ≥30 or BMI ≥27 with cardiometabolic comorbidity. Among adults reporting past-year weight loss attempts (n=2,100; weighted N=59.5 million), 19 self-reported strategies were compared …

Irritability And Related Behavioral Adverse Events Associated With Levetiracetam: A Meta‑Analysis And Meta‑Regression Of Randomized Trials, Ana Leticia Fornari Caprara Md, Daarsh Goradia, Nishant Patel, Jarvish Shah, Pranaya Gade, Jamir Pitton Rissardo Md

Rowan-Virtua Research Day

Background: Levetiracetam is commonly used in epilepsy management but has been associated with irritability‑predominant aggressive behavioral adverse events, including irritability and aggression. Reported risks vary across trials, and the influence of comparator type and outcome definition remains unclear. We aimed to estimate the risk of irritability‑related aggressive behavioral adverse events associated with levetiracetam and to assess whether outcome definition or comparator subgroup modifies this risk. Methods: We searched ClinicalTrials.gov for interventional trials with posted results involving levetiracetam. Studies reporting irritability, aggression, agitation, or related irritability‑driven behaviors in comparisons with placebo or another antiseizure medication were included. Random‑effects Mantel–Haenszel meta‑analyses were …

Wearable And Technology‑Assisted Gait And Balance Interventions In Parkinson’S Disease: A Systematic Review And Meta‑Analysis, Jamir Pitton Rissardo Md, Nishant Patel, Jarvish Shah, Daarsh Goradia, Pranaya Gade, Ana Leticia Fornari Caprara Md

Rowan-Virtua Research Day

Background: Wearable sensors and cue‑based technologies are increasingly used to augment rehabilitation in Parkinson’s disease (PD). However, the magnitude of benefit across clinical domains remains uncertain. Objective: This meta‑analysis aimed to quantify the effects of technology‑assisted interventions in PD. Methods: Randomized controlled trials evaluating wearable‑assisted interventions were systematically identified from PubMed. Outcomes included motor severity (Movement Disorders Society Unified Parkinson Disease Rating Scale Part III), balance (Berg Balance Scale, Mini‑BESTest, POMA balance), gait speed, walking endurance, freezing of gait (FOG‑Q/NFOG‑Q), fear of falling, and quality-of-life (PDQ‑39/PDQ‑8). Meta‑analyses were performed using random‑effects models to account for between‑study heterogeneity. Statistical heterogeneity was …

Trends And Disparities In Mortality Involving Epilepsy And Aspiration Pneumonia Among Older Adults In The United States, 1999–2020, Pranaya Gade, Jarvish Shah, Daarsh Goradia, Nishant Patel, Jamir Pitton Rissardo Md, Ana Leticia Fornari Caprara Md

Rowan-Virtua Research Day

Introduction: Epilepsy in older adults is frequently complicated by swallowing dysfunction, increasing the risk of aspiration pneumonia. Despite its clinical relevance, national trends and demographic disparities in deaths involving these conditions remain poorly characterized. Methods: We analyzed death certificate data from the CDC WONDER Multiple Cause of Death database (1999–2020) for individuals aged ≥65 years with epilepsy (ICD-10 G40, G41) and aspiration pneumonia (J69) listed as causes. Age-adjusted mortality rates (AAMRs) per 100,000 and annual percentage changes (APCs) with 95% confidence intervals were calculated using Joinpoint Regression. Analyses were stratified by sex, race/ethnicity, census region, and state. Results: From 1999 …

Cerebrospinal Fluid And Serum Manganese Levels In Parkinson’S Disease: A Method‑Stratified Meta‑Analysis, Jamir Pitton Rissardo Md, Daarsh Goradia, Jarvish Shah, Nishant Patel, Pranaya Gade, Ana Leticia Fornari Caprara Md

Rowan-Virtua Research Day

Background: Manganese (Mn) exposure can cause parkinsonism, but circulating and cerebrospinal fluid (CSF) Mn levels in idiopathic Parkinson’s disease (PD) have been reported inconsistently. This study aims to determine whether Mn concentrations differ between patients with PD. Methods: A systematic review of PubMed/Medline studies reporting CSF/serum Mn concentrations in PD was done. Random‑effects models with inverse‑variance weighting were used to pool mean differences (MDs). Studies were stratified a priori by analytical method. Results: For CSF Mn, the overall pooled effect showed no significant difference between PD and controls (MD 0.08 μg/L, 95% CI −0.31 to 0.47; I2=85.7%). Subgroup analysis revealed …

Efficacy And Safety Of Levetiracetam For Essential Tremor: A Systematic Review And Meta‑Analysis, Jamir Pitton Rissardo, Daarsh Goradia, Nishant Patel, Jarvish Shah, Pranaya Gade, Ana Leticia Fornari Caprara Md

Rowan-Virtua Research Day

Background: Essential tremor (ET) is a common movement disorder with limited therapeutic options. Levetiracetam has been proposed as a potential treatment, but published studies report inconsistent efficacy and safety findings. We performed a meta‑analysis to quantify the efficacy and safety of levetiracetam in patients with essential tremor using pooled effect estimates. Methods: A systematic review of PubMed was performed to identify clinical studies evaluating levetiracetam for ET. Continuous efficacy outcomes were pooled using standardized mean differences (SMD) with inverse‑variance random‑effects models. Binary adverse events were pooled using risk ratios (RR) with Mantel–Haenszel random‑effects models. Heterogeneity was assessed using I2 statistics. …

Effects Of Subthalamic Nucleus Deep Brain Stimulation On Depressive Symptoms In Patients With Parkinson’S Disease: A Meta‑Analysis, Jamir Pitton Rissardo Md, Jarvish Shah, Nishant Patel, Daarsh Goradia, Pranaya Gade, Ana Leticia Fornari Caprara Md

Rowan-Virtua Research Day

Background: Depression is a prevalent non‑motor symptom of Parkinson’s disease (PD) and may adversely affect quality-of-life and overall treatment outcomes. Subthalamic nucleus deep brain stimulation (STN‑DBS) is an established therapy for motor symptoms, yet its impact on depressive symptoms remains controversial. This meta‑analysis aimed to evaluate the effect of STN‑DBS on depressive symptoms in PD. Methods: PubMed‑indexed studies meeting predefined eligibility criteria were identified and included. Random‑effects meta‑analyses were performed using REML. Mean differences (MDs) between STN‑DBS and control conditions were pooled separately for Beck Depression Inventory (BDI) and its revision (BDI-II), and the Hamilton Depression Rating Scale (HAMD). Heterogeneity …

Efficacy And Safety Of Droxidopa For Neurogenic Orthostatic Hypotension: A Systematic Review And Meta‑Analysis, Jamir Pitton Rissardo, Jarvish Shah, Nishant Patel, Daarsh Goradia, Pranaya Gade, Ana Leticia Fornari Caprara Md

Rowan-Virtua Research Day

Neurogenic orthostatic hypotension (nOH) causes disabling symptoms such as dizziness, impaired daily activities, and increased fall risk. Droxidopa is approved for symptomatic treatment, but individual trials have reported heterogeneous results across outcomes and populations. We aim to evaluate the efficacy of droxidopa on symptoms, functional impact, blood pressure, and safety outcomes in patients with nOH. Methods: We conducted a systematic review and meta‑analysis of randomized controlled trials comparing droxidopa with placebo in nOH. Continuous outcomes were pooled using random‑effects models with standardized mean difference (SMD) for symptom scales and mean difference (MD) for standing systolic blood pressure (SBP). Binary outcomes …

Rowan-Virtua School Of Osteopathic Medicine’S Planetary Pulse: Charting A Course For Planetary Health Excellence, Hope A. Beyer, Deborah Podolin

Rowan-Virtua Research Day

Objective: Despite international acceptance of climate change as the largest threat towards human health, American osteopathic institutions fall short of their allopathic colleagues in adopting a planetary health curriculum. This study (1) evaluates the desire of Rowan-Virtua School of Osteopathic Medicine (Rowan-Virtua SOM) students to learn about planetary health within their medical education, (2) assesses the current planetary health infrastructure supported by Rowan-Virtua SOM and their parent institution, Rowan University, and (3) proposes an adapted planetary health equity curriculum.

Methods: Medical student interest was gauged by use of a Qualtrics survey modeled off of Dr. Karly Hampshire’s 2020 survey of …

Comparative Efficacy Of Cognitive Behavioral Therapy And Intranasal Oxytocin In Adolescent Anorexia Nervosa, Nikhila P. Archakam, Akhila P. Archakam, Wesley A. Kim, Harshal Parmar, Iram Fatima

Rowan-Virtua Research Day

Anorexia nervosa (AN) is a severe and potentially life-threatening psychiatric disorder with the highest mortality rate among psychiatric illnesses affecting adolescents.¹ It is characterized by extreme restriction of caloric intake driven by an intense fear of weight gain or negative body image perception.¹ Mortality results from medical complications of starvation and an increased prevalence of suicide risk.¹ Although AN can occur at any point across the lifespan, it most commonly first presents during adolescence.¹ This developmental period is marked by significant hormonal, biological, and psychosocial changes. Early-onset AN is associated with stunted growth, pubertal delay, and long-term cognitive and emotional …

Barriers To Asthma Management And Specialty Care Among Low-Income Families In South Jersey, Sally Park, Courtney Ray-Fofana, Christal Onwuegbule

Rowan-Virtua Research Day

Asthma is a chronic respiratory condition that remains a significant public health concern, particularly among low-income and underserved populations. This poster presents a focused review of existing literature and publicly available data to examine barriers to asthma management and access to specialty care in South Jersey, with emphasis on counties such as Camden, Atlantic, and Cumberland.

Data were synthesized from sources including PubMed, the New Jersey Department of Health, and the National Institutes of Health to evaluate asthma prevalence, disease burden, and the impact of social determinants of health. Current estimates suggest that approximately 8.8%–9.0% of adults in New Jersey …

The Rowan University Wellness Village: An Innovative Community Advancing Health And Well-Being, Thomas Cavalieri Do, Brandi Dockett Ma, Matt Mclaughlin Bs

Rowan-Virtua Research Day

No abstract provided.

Pediatric Cannabis Exposure Rates In Southern New Jersey: One Hospital’S Experience, Shay Greco

Rowan-Virtua Research Day

Background:

Cannabis legalization in New Jersey (NJ), made recreationally available in April 2022, has increased accessibility through 254 dispensaries in state. The products distributed from these dispensaries often resemble candy and present a risk to the pediatric population. The pediatric endocannabinoid system's developmental characteristics, with CB1 receptors localizing in neurovegetative brainstem regions, make exposure to cannabis dangerous. Severe exposures may present with respiratory depression and coma.  Previous studies from other states demonstrated a five-fold increase in pediatric exposures following state recreational legalization.

Methods:

We conducted a retrospective epidemiological study of ED encounters for cannabis exposure using ICD-10 codes F12.1 and …

Determinants Of Successful Completion In The Rowan-Virtua Dual Cprs/Chw Program: Literature Review & A Work In Progress, Timothy Breiner, Donato F. Tassoni, Richard Jermyn, Venkat Venkataraman, Alexander Abbott, Kenneth Stagliano

Rowan-Virtua Research Day

Background: Certified Peer Recovery Specialists (CPRS) and Community Health Workers (CHWs) expand access to behavioral health and social care through training, credentialing, and community-based support. Although these programs improve knowledge, skills, and workforce readiness, retention and completion remain important barriers to program scale-up. Evidence on predictors of successful completion in dual-role CPRS/CHW pathways is limited.

Objective: To identify participant, programmatic, and contextual factors associated with successful completion of the Rowan-Virtua Dual CPRS/CHW Program.

Methods: This work-in-progress combines a focused literature review with ongoing program analysis. The review examined English-language studies from 2010 onward related to CPRS and CHW training, program …

Mental Health Vs Substance Misuse: Predicting Restraint Use In The Emergency Department, Chloe Lafosse Bs, Michael Witt Md, Mph

Rowan-Virtua Research Day

Introduction: Violence in the emergency department affects approximately 30% of hospital staff every 6 months. Presenting complaints may contribute to violence risk, particularly in those with mental health or substance misuse issue where there are heightened risks of cognitive impairment and involuntary holds.

Methods: We conducted a systematic review of literature published between 1957-2025 using multiple databases, identifying studies that observed physical restraint use on adult emergency department patients. All relevant data was recorded and imputed into SPSS for a chi-square test.

Results: Thirteen studies (2019-2025) met inclusion criteria, with sample sizes ranging from 58 to 1,035,522 participants. All studies …

What Are The Effects Of Exposure To Green Spaces On Attention, Adhd Symptoms, Depression, And Overall Mental Health?, Emily Marie Hackett

Rowan-Virtua Research Day

This poster is a literature review examining the relationship between green space exposure and mental health outcomes. Examples of green spaces include nature, hiking trails, city parks, tree cover, and gardens. This literature review finds that green space exposure has positive effects on the symptoms of ADHD, depression, and anxiety. Nature exposure may serve as a complementary intervention to improve patient well-being.

A Conserved Role For Cyclin C In Regulated Cell Death Across Yeast And Humans, Samar Emami, David Stieg, Daniel Smethurst, Justin Bauer, Randy Strich

Rowan-Virtua Research Day

Background: Programmed cell death (PCD) is a tightly regulated process that maintains tissue homeostasis and eliminates damaged, infected, or malignant cells. A key regulator of this process is Cyclin C (CCNC), which functions as a component of the mediator complex to regulate gene transcription. During cellular stress, CCNC translocates from the nucleus to the mitochondria, where it associates with Dnm1 to promote mitochondrial fragmentation and  apoptosis.

Objective: This study aimed to unravel conservation of CCNC’s function between yeast and humans by investigating whether human CCNC can induce apoptosis in yeast and whether it does so through interaction with …

Case Report: Dandy-Walker Malformation In An Adolescent Presenting With Aggressive Behavior, Kristen Arulsamy, Wayne Tamaska, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

We report a case of a 15-year-old male who presented to the Emergency Department(ED) for agitation and was subsequently diagnosed with Dandy-Walker malformation (DWM). DWM is a rare congenital abnormality of the posterior fossa characterized by hypoplasia of the cerebellar vermis, cystic dilation of the fourth ventricle, and enlargement of the posterior fossa. It is typically diagnosed during infancy due to hydrocephalus, developmental delay, or neurologic abnormalities. Late presentations in adolescence are uncommon and may occur incidentally during evaluation for unrelated conditions.

Collet–Sicard Syndrome Secondary To Internal Carotid Artery Dissection Following Cervical Self-Manipulation, Ryan K. Alali, James Espinosa Md, Alan Lucerna

Rowan-Virtua Research Day

We report a case of a 40-year-old male presenting with progressive dysphagia who was ultimately diagnosed with Collet–Sicard syndrome secondary to internal carotid artery (ICA) dissection. While most reported cases are associated with trauma, this case highlights an atypical etiology following cervical self-manipulation. The patient presented with dysphagia to solids, liquids, and saliva, along with several days of ipsilateral headache and neck pain. Neurologic examination revealed tongue deviation, prompting advanced imaging. CTA demonstrated left ICA dissection, which was further characterized on MRI. The patient was managed with dual antiplatelet therapy and multidisciplinary care, including neurology, neurosurgery, and speech-language pathology, and …

A Stemi That Wasn’T: Staphylococcus Aureus Bacteremia Presenting With Troponin Elevation And Pericardial Involvement, Taqi A. Khan, Kelsey A. Murray, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

A 75-year-old female presented to the emergency department (ED) with vomiting, weakness, and altered mental status. Initial evaluation revealed a markedly elevated troponin level and an electrocardiogram (ECG) demonstrating diffuse ST-segment depressions with relative ST elevation in lead aVR, prompting activation of a STEMI alert. After cardiology consultation, emergent catheterization was deferred. Computed tomography (CT) imaging demonstrated an anterior mediastinal fluid collection extending toward the pericardial space with a loculated pericardial effusion. Splenic infarctions were also identified. Blood cultures later grew Staphylococcus aureus. The patient was treated with broad-spectrum antibiotics and transferred to a tertiary care center for further management. …

Gram-Negative Infective Endocarditis : A Rare Case Of Escherichia Coli Pulmonic Valve Endocarditis, Caroline Nguyen, Philip Willsie, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Infective endocarditis (IE) is most commonly caused by gram-positive organisms, while Escherichia coli accounts for less than 1% of reported cases. Pulmonic valve involvement is particularly rare, representing fewer than 2% of IE cases. We report a case of E. coli infective endocarditis involving the pulmonic valve complicated by spinal epidural abscess and ascending cholangitis in a patient with intravenous drug use. Blood cultures demonstrated persistent E. coli bacteremia, and further evaluation with echocardiography and MRI revealed pulmonic valve vegetations and epidural abscess. This case highlights the importance of evaluating persistent gram-negative bacteremia for infective endocarditis and metastatic infection.

Case Report: Postpartum Ovarian Vein Thrombosis Without Abdominal Pain, Moshammat Nishu, Russell Mordecai, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

We report a case of a 27-year-old woman (2 prior pregnancies: 1 term birth, 1 preterm birth, 2 living children)  who presented with right ovarian vein thrombosis (OVT) in the absence of abdominal pain on postpartum day 5 after spontaneous vaginal delivery. Although OVT is classically associated with abdominal pain, this case illustrates that OVT may present without abdominal pain and should be considered as a differential to prevent a delay of diagnosis in the emergency department. This case also highlights the diagnostic challenge in postpartum fever when an alternative infectious source may lead to premature closure and prevent the …

Case Report: Reverse Takotsubo Cardiomyopathy, Aveen Saed, Dhara Patel, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Reverse Takotsubo cardiomyopathy (rTTC) is a rare variant of stress-induced cardiomyopathy characterized by basal and mid–left ventricular (LV) akinesis with apical sparing. It may mimic acute coronary syndrome and can present with cardiogenic shock. We present a 32-year-old female with substance use disorder who presented with severe abdominal pain and hypertensive emergency (SBP >240 mmHg), found to have reverse Takotsubo cardiomyopathy with an ejection fraction (EF) decline to 25% complicated by cardiogenic shock requiring inotropic support. Her course was notable for dynamic LV mid-cavity obstruction during recovery and complete normalization of LV systolic function (EF 65%) within two weeks. This …

Septic Pulmonary Emboli Revealing Tricuspid Valve Endocarditis In A Patient Presenting With Opioid Withdrawal Symptoms, Dong Shin, Dhara Patel, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Septic embolism is a serious complication of systemic infection, most commonly arising from infective endocarditis. In patients with intravenous drug use (IVDU), right-sided endocarditis may lead to septic pulmonary emboli, often presenting with nonspecific or misleading symptoms. A 36-year-old female with recent intravenous fentanyl use presented with presumed opioid withdrawal, along with chest pain, dyspnea, and systemic symptoms. Initial evaluation revealed leukocytosis and bilateral pulmonary nodules on imaging. Computed tomography angiography demonstrated multiple cavitary and non-cavitary nodules consistent with septic pulmonary emboli. Blood cultures grew Staphylococcus aureus, and echocardiography revealed tricuspid valve vegetations with severe regurgitation. The patient required escalation …

Case Report: Primary Appendiceal Cancer Presenting As Acute Appendicitis, Armeet Singh, Wayne Tamaska, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

We report a case of a 46‐year‐old male who presented to the emergency department with right lower quadrant abdominal pain and was initially suspected to have acute appendicitis. Further evaluation and surgical pathology revealed primary appendiceal adenocarcinoma. Appendiceal cancer is rare and often presents with nonspecific symptoms that mimic common abdominal conditions such as appendicitis or diverticulitis. Early diagnosis can be challenging, and many cases are discovered incidentally during surgery or imaging for suspected appendicitis. This case highlights the importance of maintaining a broad differential diagnosis for right lower quadrant pain.

Case Report: Acute Encephalopathy Revealing Severe Babesiosis With Lyme Co-Infection, Czarina Gebrelle K. Soriano, James Espinosa, Alan Lucer

Rowan-Virtua Research Day

Acute confusion in older adults is a common emergency department presentation with a broad differential diagnosis. Tick-borne illnesses can cause significant systemic disease and may present with nonspecific neurologic or constitutional symptoms, making early recognition challenging. Babesiosis is a tick-borne parasitic infection transmitted by Ixodes ticks and may occur concurrently with other infections such as Lyme disease, further complicating diagnosis. We present a case of a 67-year-old male who presented with acute confusion and was found to have concurrent babesiosis and Lyme disease. This case highlights the importance of maintaining a high index of suspicion for tick-borne co-infections in patients …

When Venom Isn’T The Only Threat: Roseomonas Mucosa Bacteremia Following A Snake Bite, Cyrus Davati, Kishan Patel, James A. Espinosa Md, Alan Lucerna

Rowan-Virtua Research Day

Snake bites in the ED  overall are rare in the United States. While mortality is low due to modern interventions, the sequelae - including tissue necrosis, digit amputation, and subsequent infection  remain a significant concern.  Here we present the case of a  presumptively non-venomous snakebite, which  was associated with R. mucosa bacteremia.

A Neck Too Tight: Emergent Cricothyrotomy For Airway Collapse From Expanding Post Anterior Cervical Discectomy And Fusion (Acdf) Hematoma, Nicole R. Eregha, Kishan Patel, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Anterior cervical discectomy and fusion (ACDF) is a commonly performed surgical procedure used to treat cervical spine pathology including radiculopathy and spinal cord compression. Although generally safe, postoperative complications can occur. One of the most feared complications is expanding neck hematoma, which may lead to rapid airway obstruction due to tracheal compression and soft tissue swelling. The reported incidence of postoperative hematoma after ACDF ranges from 0.2–1.9%, with a subset of patients requiring emergent airway intervention or surgical evacuation [1]. Patients with postoperative hematoma typically present with neck swelling, dysphagia, hoarseness, dyspnea, and inability to tolerate secretions, symptoms that may …