Medicine and Health Sciences Commons^™

The "M" Word: Accusations Of Malingering Are Harmful To Patient Care, Joshua S. Ellis

Cooper Rowan Medical Journal

It starts as a small seed of doubt. It can be planted by anyone: the physician, the nurse, a family member, or even the patient. But once the seed gets planted in the minds of those involved in caring for the patient, every word and action from the patient function as water and sunshine, encouraging the seed to grow. The seed of doubt grows into a small tree of criticism which blooms into a collection of judgment and prejudice that prevent the patient from receiving the care that he or she deserves. All of this can happen after a patient …

Assessment Of Physical Fitness After Bariatric Surgery And Its Association With Protein Intake And Type Of Cholecalciferol Supplementation, Hendrika J M Smelt, Sjaak Pouwels, Alper Celik, Adarsh Gupta, Johannes F Smulders

Rowan-Virtua School of Osteopathic Medicine Faculty Scholarship

Background: Several studies showed that there is a relationship between vitamin and mineral status and muscle strength. In particular this is the case for handgrip strength (HS) and vitamin D deficiency. In bariatric surgery there is a risk of decrease in muscle strength after surgery and also vitamin and mineral deficiencies are not uncommon. The aim of this study is to assess the effect of low vitamin 25 (OH) cholecalciferol levels, high dose cholecalciferol supplementation regime and protein intake on physical fitness, measured using handgrip strength (HS) and the shuttle walk run test (SWRT). Methods: For this retrospective …

Chemotherapy Is Avoided During The First Trimester Of Pregnancy, When Is The Safest Time To Start Treatment During The Second Or Third Trimester?, Elyce Cardonick, Emily Eicheldinger, John P. Gaughan

Cooper Medical School of Rowan University Faculty Scholarship

ABSTRACT

Background

Cancer occurs in approximately 1:1000 pregnancies. When chemotherapy cannot be delayed until postpartum, beginning chemotherapy is based on presumed safety after organogenesis is completed during the first trimester. The safest gestational age to start chemotherapy after the first trimester is unknown.

Patients and Methods

In an observational cohort of pregnant women diagnosed and treated for cancer at multiple centers, pregnancy outcomes for the mother, and clinical outcomes for the neonate were analyzed according to the gestational age in weeks of pregnancy at first chemotherapy cycle. Outcomes including birth weight, fetal growth restriction, congenital malformations, and perinatal complications for …

Individual Free Fatty Acids Have Unique Associations With Inflammatory Biomarkers, Insulin Resistance And Insulin Secretion In Healthy And Gestational Diabetic Pregnant Women., Xinhua Chen, T Peter Stein, Robert A Steer, Theresa O Scholl

Rowan-Virtua School of Osteopathic Medicine Faculty Scholarship

Objective: We investigated the relationships of maternal circulating individual free fatty acids (FFA) with insulin resistance, insulin secretion and inflammatory biomarkers during mid-pregnancy.

Research design and methods: The data were drawn from a prospective cohort of generally healthy pregnant women (n=1368, African-American 36%, Hispanic 48%, Caucasian 16%) in Camden, NJ. We quantitatively determined 11 FFAs, seven cytokine/adipokine, homeostatic model assessment of insulin resistance (HOMA-IR) and C-peptide levels from the fasting blood samples that were collected at 16 weeks of gestation. Multivariate analyses were performed along with separate analyses for each individual FFA.

Results: High HOMA-IR (p

Conclusion: Our results suggest …

Visual And Verbal Serial List Learning In Patients With Statistically-Determined Mild Cognitive Impairment., Victor Wasserman, Sheina Emrani, Emily F Matusz, David Miller, Kelly Davis Garrett, Katherine A Gifford, Timothy J Hohman, Angela L Jefferson, Rhoda Au, Rod Swenson, David J Libon, Consortium For Clinical And Epidemiological Neuropsychological Data Analysis (Cenda).

Rowan-Virtua School of Osteopathic Medicine Faculty Scholarship

Background and Objective: Prior research with patients with mild cognitive impairment (MCI) suggests that visual versus verbal episodic memory test performance may be more sensitive to emergent illness. However, little research has examined visual versus verbal episodic memory performance as related to MCI subtypes.

Research Design and Methods: Patients were diagnosed with non-MCI, amnestic MCI (aMCI), and combined mixed/dysexecutive MCI (mixed/dys MCI). Visual and verbal episodic memory were assessed with the Brief Visuospatial Memory Test-Revised (BVMT-R) and the 12-word Philadelphia (repeatable) Verbal Learning Test (P[r]VLT), respectively.

Results: BVMT-R and P(r)VLT scores yielded similar between-group patterns of performance. Non-MCI patients scored …

Impact Of The Affordable Care Act On The Cooper Women’S Care Center, Amanda Malik, Natali Franzblau

Cooper Rowan Medical Journal

Background: The Affordable Care Act (ACA) increased access to women’s health care by expanding Medicaid eligibility and requiring that insurance plans cover many gynecologic preventive services at no cost to patients. Before implementation of the ACA, pregnant women with low incomes qualified for Medicaid but childless adults of the same income did not, and though prenatal obstetrical visits were covered by plans at no or low cost to patients, most gynecologic services required out of pocket payments.

Objective: This study aimed to identify changes in the types of visits (gynecologic or obstetric) and patient demographics (including age, race, …

Arthroscopic Medial Meniscus Transplant Utilizing A Multi-Technique Fixation, Elizabeth Ford, Michael Defrance, Sean Mcmillan D.O.

Rowan-Virtua Research Day

Arthroscopic medial meniscus transplantation can be a daunting procedure for even the most skilled surgeon. While all-inside suture fixation devices have improved, the ability to successfully perform this procedure via arthroscopy is reliant upon the surgeon's ability to utilize a variety of fixation techniques. Based upon the review of the literature, this paper is the first of it's kind describing the methodology and algorithm for completing an arthroscopic medial meniscus transplant using four techniques.

Case Report: Elbow Plica In A High School Pitcher, Steven Barrientos Do, Sunny Gupta Do, Mitesh Patel Md

Rowan-Virtua Research Day

Elbow pain is a very common joint complaint with a variety of etiologies. Plica are often benign, asymptomatic and have no known function. Elbow plica may cause clinical symptoms in the elbow joint after they become hypertrophied or inflamed from repetitive activities or trauma. Symptomatic elbow plica may strike at any age but it is not a common radiographic finding among the pediatric population. In this case report, we are presenting a case of symptomatic left lateral hypertrophic elbow radiocapitellar plica in a 16 year old baseball thrower.

Traumatic Compartment Syndrome Of The Foot: A Case Report, Mansi Patel, Asim Qureshi, Matthew K. Brant

Rowan-Virtua Research Day

Compartment syndrome of the foot is a rare but limb threatening condition that is often difficult to diagnose. It is usually caused by traumatic injuries and the diagnosis requires a high clinical suspicion and timely management. Clinically, patients will present with an acute traumatic event followed by physical exam findings of non-palpable pulses, paralysis, pallor, pain out of proportion, and paresthesias. The foot contains nine compartments, which should be assessed independently for elevated pressures. The diagnostic threshold for each compartment is 30 mmHg. Pressures above this threshold require emergent fasciotomy to preserve the anatomical structures and thus the function of …

Referral Patterns, Procedures, And Outcomes Of A Large Community- Based Urology Group: A Retrospective Chart Review, Hassan A. Al Saleh, Gregory C. Mcmahon, Michael Douglas, Michael Console, Mihir Thaker, Gordon A. Brown

Rowan-Virtua Research Day

In 2012 The United States Preventive Services Task Force (USPSTF) recommended against prostate cancer (Pca) screening. The purpose of our study is to assess the effects of the USPSTF grade D recommendation for PSA based screening on new PCa diagnoses within a large-community based private practice setting. We completed a retrospective chart review of men with an elevated PSA seen in our clinic between May 2009–May 2015 who had undergone a prostate biopsy and were diagnosed with PCa. We observed that following the 2012 USPSTF recommendations, there was a significant increase in patients with clinically significant prostate cancer GG ≥ …

For Your Eyes Only, Herpes Zoster Ophthalmicus Case Study, Alexander Fishman, Jared Ward, Richard Pescatore

Rowan-Virtua Research Day

Herpes Zoster Ophthalmicus is a reactivation of a latent Varicella Zoster Virus that specifically involves the eye. The reactivation often occurs during immunocompromised states which allows latent virus in the dorsal root ganglia of sensory nerves to begin viral replication an d s pread via peripheral axons. Diagnosis is based on two characteristic findings; herpetic lesions on the eyelids, forehead, or elsewhere within the V1 dermatome, and ocular findings. Symptoms can vary but are often quite painful. Some patients experience a prodrome of tingling sensation prior to the appearance of a zoster dermatitis . HZO can also present initially as …

Omt For The Treatment Of Depression And Anxiety, Zachary Winchell

Rowan-Virtua Research Day

Osteopathic manipulative therapy (OMT) fundamentally aims to remedy somatic dysfunction through the manipulation of the patient. In this regard, OMT is a particularly viable non-pharmacological adjunct for patients with depressive and generalized anxiety disorder (GAD).

In both of these disorders, the hypothalamic-pituitary-adrenal axis has an interdependent relationship with physiological stress that feed one another to both increase symptomology and leave patients vulnerable to negative life events. Additionally, pro-inflammatory cytokines acting on the brain over long periods of time can lead to exacerbation of disease and the development of depression in susceptible individuals. Altered cytokine balance has also been found in …

The Relationship Of Creatinine, Sodium, Hematocrit And Hemoglobin A1c To 30-Day Hospital Readmission Among Older Adults With Type 2 Diabetes, Shmilah Choudhary, Meet Shah, Sanath Shetty, Terri Ginsberg, Matthew H. Mclaughlin

Rowan-Virtua Research Day

Introduction:Reducing thirty-day hospital readmissions is a top healthcare priority. However, there is little research describing the risk factors of readmission among patients with diabetes, especially for older adults. Understanding what the risk factors are for 30-day hospital readmission for older adults with type 2 diabetes would help identify patients at risk of rehospitalization.

Objective:The aim of this study was to identify factors associated with 30-day unplanned hospital readmissions among older adults with T2DM. Factors to be investigated are: patient demographics and three admission laboratory values.

Methods:Participants were older adult s>65 years old with T2DM, admitted to a community hospital …

The Correlation Between Obesity, Food Addiction, Anxiety & Depression, Ayham Khrais, Adarsh K. Gupta D.O.

Rowan-Virtua Research Day

Obesity is a multifaceted disease with physiological, psychological and social influences. While physiological factors, such as basal metabolic rate, can influence an individual’s BMI (Body Mass Index), obesity is primarily determined by behavior: excess food intake and a sedentary lifestyle greatly contribute to weight gain. An individual’s behavior is influenced by many factors, including their desires, perceptions, and social pressures. Therefore, psychological conditions can greatly impact an individual’s eating habits, thereby affecting that person’s BMI. This endeavor involved exploration of the potential effects of food addiction, anxiety, and depression on obesity. A survey consisting of an amalgamation of the Yale …

Coronary No-Reflow Following Percutaneous Intervention, Yaser Khalid D.O., Harsh Patel D.O., Adam Levine D.O.

Rowan-Virtua Research Day

Normally, coronary revascularization with a percutaneous coronary intervention (PCI) leads to restoration of normal coronary blood flow through the coronary arteries, with reperfusion of the myocardium. However, there is a group of patients who do not benefit from the prompt restoration of antegrade flow, as they fail to show resolution of the indirect signs of ischemia such as electrocardiographic (ECG) changes and improvements in perfusion abnormalities. This condition is referred to as the “no-reflow phenomenon.” In this case report, we will discuss the case of a patient who developed coronary no-reflow immediately following PCI.

Toothpick Perforation Of Colon Mimicking Acute Appendicitis, Jacob Wilson D.O., Adeshola Fakulujo M.D.

Rowan-Virtua Research Day

This study presents a case report of a rare complication of foreign body ingestion and offers a literature review of management options. Pre-operative imaging and clinical history was reviewed. During diagnostic laparoscopy the diagnosis of ascending colon perforation with a foreign body was made and managed with a Laparoscopic Right Hemicolectomy. Literature was reviewed for case of toothpick ingestion requiring intervention, foreign body ingestion causing perforation, and management of foreign body perforations.

The Relationship Of Risk Of Falls And Activities Of Daily Living To 30-Day Hospital Readmission Among Older Adults With Type 2 Diabetes, Sanath Shetty, Shmilah Choudhary, Meet Shah, Terrie Ginsberg D.O., Matthew H. Mclaughlin

Rowan-Virtua Research Day

Introduction: Reducing thirty-day hospital readmissions is a top healthcare priority. However, there is little research describing the risk factors of readmission among patients with diabetes, especially for older adults. Understanding what the risk factors are for 30-day hospital readmission for older adults with type 2 diabetes (T2DM) would help identify patients at risk of rehospitalization.

Objective: The aim of this study was to identify factors associated with 30-day unplanned hospital readmissions among older adults with T2DM. Factors to be investigated are: patient demographics, whether patients were at risk for falling, and patients’ activities of daily living (ADL) at discharge.

Methods: …

Correlation Of Chronic Conditions And Pain Scale With Varying Levels Of Obesity In The Geriatric Population, Shabbir Hossain, Adarsh Gupta D.O.

Rowan-Virtua Research Day

The overall objective of this study was to establish whether obesity’s contribution to pain is stronger than vice versa – the medical debilities in elderly patients that contribute to obesity. In the process, this study will allow us to achieve whether different age samples with similar BMIs demonstrate the same level of medical complexities in geriatric patients. In summary, the purpose of this research study was to correlate a relationship between obesity and aging. We hypothesized that obesity will contribute to greater pain in the aging population, and that patients – regardless of their age groups in the aging population …

The Relationship Of Cardiovascular Disease To 30-Day Hospital Readmission Among Older Adults With Type 2 Diabetes Mellitus, Meet Shah, Shmilah Choudhary, Sanath Shetty, Terrie Ginsberg D.O., Matthew H. Mclaughlin

Rowan-Virtua Research Day

Reducing thirty-day hospital readmissions is a top healthcare priority. However, there is little research describing the risk factors of readmission among patients with diabetes, especially for older adults. Understanding what the risk factors are for 30-day hospital readmission for older adults with type 2 diabetes (T2DM) would help identify patients at risk of rehospitalization. The aim of this study was to identify factors associated with 30-day unplanned hospital readmissions among older adults with T2DM.Factors to be investigated are: patient demographics and whether the patient was hospitalized for cardiovascular disease. Participants were older adults>65 years old with T2DM, admitted to …

Amiodarone Induced Epididymo-Orchitis, Yaser Khalid D.O., Neethi Dasu D.O., Sravan Panuganti D.O., Stephen Daly D.O.

Rowan-Virtua Research Day

Amiodarone has a well-established and extensive side effect profile: pulmonary fibrosis, thyroid toxicity, corneal deposits, skin discoloration. However, in some rare instance, epididymitis/orchitis is a side effect of amiodarone. Amiodarone toxicity was first studied in (1, 2) Symptoms range from testicular pain to swelling and erythema (1,2) The mechanism of how this toxicity occurs is unknown. In this case report, we will discuss the case of an elderly patient who developed epididymitis and orchitis after several years of tolerating amiodarone without any adverse events. Our patient underwent a full workup with testicular ultrasound, evaluation by urology and cardiology specialists. Then …

Chronic Renal Failure, But Why? A Case Report., Palak Patel, Michael Rothberg M.D.

Rowan-Virtua Research Day

Renal failure, both acute and chronic, can present from many different etiologies and if diagnosed with diabetes mellitus, it is commonly assumed to be due to diabetic nephropathy. Monoclonal gammopathy of renal significance (MGRS) is a disorder that combines monoclonal gammopathy of undetermined significance with end stage renal disease. Monoclonal immunoglobulins are secreted by B or plasma cells leading to deposition in the kidney causing end organ damage. Several different subtypes fall under this category of renal diseases including, but not limited to, amyloidosis, C3 glomeruopathy, and light chain proximal tubulopathy, or better known as Fanconi syndrome1. Fanconi syndrome, which …

Atypical Presentation Of Stemi With Cardiac Tamponade Related To Malignancy, Matthew J. Johnson, Rohan Penmetcha

Rowan-Virtua Research Day

Cardiac tamponade and myocardial infarction are rare as the initial presentation of a malignancy. Here, we describe a case with an atypical presentation of a myocardial infarction due to a thrombus in the right coronary artery occurring in the setting of a pericardial effusion causing tamponade physiology related to malignancy. We present this unique case of myocardial infarction and cardiac tamponade as this was not caused by a type-A aortic dissection. In conclusion, we suggest that malignancy be considered in the differential diagnosis when these findings present together.

Something Has Fallen: Pelvic Organ Prolapse Or Vaginal Cuff Dehiscence And Evisceration? A Case Report., Alexandra Nutaitis, Laurie Kane M.D.

Rowan-Virtua Research Day

SOMETHING HAS FALLEN: PELVIC ORGAN PROLAPSE OR VAGINAL CUFF DEHISCENCE AND EVISCERATION? A CASE REPORT.

Learning Objectives: 1) Recognize late presenting complications of hysterectomy. 2) Include vaginal cuff dehiscence with evisceration (VCDE) in the differential diagnosis of women suspected of having acute pelvic organ prolapse (POP).3) Appreciate the relative rarity of VCDE in younger women.

Case Summary: A 36 year old G0P0 female presented to the ED with a chief complaint of sudden onset excruciating epigastric pain, followed by diarrhea and visible vaginal bulge. Pertinent past medical and surgical history includes breast cancer diagnosed 15 months prior, status post bilateral …

Pre-Operative Risk Of Medical Complications Varies By Health Insurance Carrier In Moderately Obese Women: Medicaid V Medicare V Private V Self-Pay, Paul Osterdahl D.O., Melissa Gott D.O., Amanda Sundling D.O., Gus J. Slotman M.D.

Rowan-Virtua Research Day

Introduction: Clinical variation by health insurance status in mixed sex bariatric surgery populations is reported, but such variation among moderately obese women is unknown.

Objective: to identify pre-operative variation by health insurance in female surgical patients.

Conclusions: Pre-operative characteristics of moderately obese women vary by insurance. Medicare’s highest risk for cardiopulmonary problems and diabetes, and Medicaid’s highest asthma, abdominal-hepatobiliary, and psychological/behavioral complications should be considered in managing moderately obese women subscribing to these carriers.

A Rare Case Of A Non- Functioning Pancreatic Neuroendocrine Tumor, Yaser Khalid, Neethi Dasu, Richard Gordon

Rowan-Virtua Research Day

Pancreatic neuroendocrine tumors (PNET) are very rare and represent about 1–2% of all pancreatic tumors. Non-functional PNET (NF-PNET) is incidentally discovered in most cases. Most NF-PNETs are found at an advanced stage because patients are mostly asymptomatic. We present a case of 32-yr-old female who initially presented with increasing abdominal girth, decreased mobility, and lower extremity swelling up to the hip and was found to have an advanced NF-PNET with metastatic disease to the pelvis and liver. There have been few studies directed toward early detection and management; Computed tomography (CT) is the imaging modality of choice as well as …

Maternal Morbidity Outcomes In Idiopathic Moyamoya Syndrome In New York State, Hajere J. Gatollari Mph, Amelia K. Boehme Ph.D., E. Sander Connolly M.D., Alexander M. Friedman M.D., Mitchell S.V. Elkind M.D., Joshua Z. Willey M.D., Eliza C. Miller M.D.

Rowan-Virtua Research Day

Background: Pregnancy is associated with an increased risk of stroke in young women. Idiopathic moyamoya syndrome (IMMS) is a rare condition characterized by progressive narrowing of large cerebral arteries resulting in flimsy collaterals prone to rupture or thrombosis. Data are limited on pregnancy outcomes in women with IMMS. We hypothesized that IMMS would be associated with increased pregnancy morbidity, including stroke.

Conclusion: Pregnancies within 1 year prior or any time after IMMS diagnosis did not have increased maternal morbidity compared to unexposed pregnancies after adjusting for age and clustering of women with multiple pregnancies. Prospective studies are needed to better …

Occult Renal Cell Carcinoma Presenting As A Palpable Supraclavicular Virchow's Node, Luke Perry, Jandie Schwartz, Gus Slotman, Omar Al Ustwani, Nandini Kulkarni

Rowan-Virtua Research Day

Occult papillary renal cell carcinoma (RCC) is a rare disease process in which there is evidence of metastatic kidney cancer, but no primary kidney tumor can be found on physical exam or imaging. The papillary subtype of RCC accounts for 10-15% of RCC’s. These lesions infrequently present as occult disease. A Virchow’s node can be positive for multiple cancer types, most notably gastric cancer, but also gallbladder, pancreas, kidneys, testicular, and prostate cancer. We describe a case of occult papillary renal cell carcinoma diagnosed by biopsy of a Virchow’s node.

Ethnic And Demographic Differences In Colectomy Rates And Timing For Ulcerative Colitis: 2007-2014, Daniel Bodek, Alana Persaud, Brian Blair, Ahlawat Sushil

Rowan-Virtua Research Day

Ulcerative Colitis (UC) is a chronic inflammatory disease of the bowel, with one third of patients requiring a colectomy for fulminant disease and tissue dysplasia. In 2007, infliximab was approved for induction and maintenance of remission in UC, with some evidence to suggest a potential reduction in colectomies. The aim of this study is to examine relative colectomy rates for UC among different ethnicities from 2007 to 2014 in order to evaluate for development of new trends or disparities.

Discrepancies in colectomy rates and timing are seen in our models which mirror closely findings in a prior study from 1999-2003 …

The Effect Of Omm On Opioid Users With Chronic Low Back Pain, Danielle Cooley D.O., James Bailey D.O., Deanna Janora M.D., Catherine Fusco D.O., Kishan Patel

Rowan-Virtua Research Day

In the United States, approximately 100 million adults are affected by chronic pain, which reduces their quality of life and productivity, while accounting for billions in health care costs and lost revenue. (1) Opioids are considered the gold standard in the pharmacological treatment for chronic pain conditions, and prescriptions for opiates/opioids increased by 400% from 1999 to 2010. (1,2) Although opioid treatment is warranted during postsurgical and active cancer pain, physicians still commonly overprescribe opioids, which has led to addiction, high deaths rates by overdose, and the spread of communicable diseases. (1)

Since chronic pain is sustained by noxious sensory …

Panniculectomy Performed In Conjunction With Gynecologic Surgery In The Morbidly Obese Patient - A Nsqip Analysis And Meta-Analysis Of The Literature, Shayoni Nag, Tirth Patel, Steven C. Bonawitz M.D.

Rowan-Virtua Research Day

Purpose: Panniculectomy is a common procedure in plastic surgery, often performed following massive weight loss and in morbidly obese patients. It can be performed in combination with various gynecologic procedures based on the rational that it will reduce complication rates.^{1, 2, 3} These studies fail to provide proof of these claims for reasons including study design and the lack of inclusion of both morbidly obese and non-morbidly obese patients. Recent medical practice has focused increasingly on minimizing patient morbidity and trends in reimbursement are moving towards penalizing practices which increase complications.

Methods/Results:We reviewed the NSQIP database to assess …