Medicine and Health Sciences Commons^™

The Use Of Osteopathic Manipulative Medicine To Treat Common Pediatric Conditions: A Literature Review, Sonya Priven, Emily Meale, Danielle Cooley

Rowan-Virtua Research Day

Context: Doctors of Osteopathic Medicine (DOs) are physicians who are trained in the practice of osteopathic manipulative treatment (OMT). OMT is a form of manual manipulation that can be applied to the patient’s body to aid the body in its own healing properties. The overprescribing and overuse of medication is currently a problem, as it can result in adverse consequences such as antibiotic resistance. Exploring OMT as either an alternative or as a complementary therapy in the pediatric population is beneficial in potentially curbing antibiotic use and improving symptoms and disease-related processes.

Objective: To explore OMT as a therapy for …

Association Of Maternal Biomarkers With Gestational Weight Gain And Pre-Eclampsia, Matthew Green, Xinhua Chen

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Background: There is convincing evidence that excessive gestational weight gain (GWG), based on the Institute of Medicine’s (IOM) 2009 guidelines, increases the risk of both maternal and neonatal complications.1-6 Although the association between excessive GWG and pre-eclampsia is well-established, the reason why this association exists remains unclear.

Methods: Previously collected data from a cohort of pregnant women in Camden, NJ between the years of 1998-2007 was used to examine the association between maternal serum biomarkers (C-peptide, IGF-1, Insulin and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR)) collected at entry (week 16) and 3rd trimester (week 28) and longitudinally assessed gestational …

Mixed Beri’S: High Output Heart Failure From Severe Anemia And Thiamine Deficiency, Rohan Umrani, Hiral Amin, Ashley Pinckney, Charles Yang, Daniel Tran

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Background: Severe anemia and thiamine deficiency can independently result in high output heart failure (HOHF) through different mechanisms. Data on the threshold and timeframe at which these etiologies may precipitate HOHF is unclear.

Case: A 63-year-old male with alcohol use disorder consuming 18 drinks/week presented with progressive shortness of breath and lower extremity edema for a few months. Physical exam revealed tachycardia, anasarca, jugular venous distension, Lancisi’s sign, and a midsystolic murmur. Echocardiogram demonstrated EF of 30-35%, dilated left ventricle, and cardiac index of 4.2L/min/m2.

Decision-Making: Heart failure can independently precipitate anemia while severe alcoholism can induce myelosuppression and promote …

Focused Pocus: Cardiopulmonary Curriculum For Internal Medicine Residents, Daniel Tran, Krunalkumar Patel, Shivani Dalal, Umang Patel, Troy Randle

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Problem Statement: Point-of-care ultrasound (POCUS) is currently not a required core competency in internal medicine (IM) residency despite its inherent benefits, and many hospitalists are not equipped to confidently acquire nor interpret basic ultrasound images.

Background: POCUS is used at the bedside by physicians to answer directed clinical questions to help guide patient management. During the COVID-19 pandemic, the use of ultrasound for quick, accurate diagnosis of life-threatening pathology has been instrumental in early detection of acute cardiopulmonary failure, monitoring treatment response, and minimizing nosocomial spread. We aimed to determine interest in learning POCUS, confidence level, self-rated proficiency, and perceived …

Barriers To Doula Use In New Jersey After 2021 Medicaid Coverage Expansion, June Solow, Aashna Reddy, Natali Sharma, Jonathan Lewis

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Background: Doulas are trained non-clinical professionals that provide continuous support to a pregnant mother from the prenatal to postpartum period. Presence of a doula has been shown to benefit both mother and newborn health.

Purpose: To determine what prevents doula utilization in New Jersey.

Methods: A review of the current literature about doulas, mothers, clinicians, and legislation in other states was conducted. This included qualitative and quantitative data gathered in the United States.

Results: The most significant barrier from both the mother’s and doula’s perspectives is cost. Besides cost, diversity and number of doulas is low. A major barrier to …

The Clinical Definition And Characterization Of Field Of Cancerization In Patients With Actinic Keratoses, Stuti Prajapati, Christina Kontzias, Mallory Zaino, Steven Feldman

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Introduction: Chronic UV radiation affects the entire area of skin exposed, leading to visible actinic keratoses (AK) and subclinical changes in the surrounding skin. AKs are hyperkeratotic lesions, with a 0.025-16% risk of transforming into squamous cell carcinoma (SCC).1 Cellular atypia around AKs is the field of cancerization (FOC). Topical AK therapies can treat the FOC, while destructive treatments address visible lesions. FDA-approved products may be approved for field sizes up to 25 cm2.1,2

Objective: To characterize the FOC and assess the correlation between the FOC and number of AKs.

Methods: 100 patients with AKs were recruited. FOC was defined …

Occurrence And Trends Of Musculoskeletal Pain Among Ski Instructors, Denis Causevic, Erol Kovacevic, Semir Masic, Seth Spicer, Ahmed Gawash

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Musculoskeletal disorders (MSD) are incredibly common and are often related to work load. For any occupational or public health intervention, injury prevention is preferred to injury treatment. Occupational health and injury prevention research has the potential to help mitigate MSD in the workplace. The aim of this study was to determine how the work demands of ski instructors may affect the health of their musculoskeletal system.

Material and Methods

A cross-sectional study involved the participation of 87 ski instructors (age = 34.61 ±10.67) in Bosnia and Herzegovina (ATUS in Bosnia and Herzegovina). Observed variables were the prevalence of MSD measured …

Body Composition Of Young Soccer Players, Denis Causevic, Seth Spicer, Ahmed Gawash

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Purpose: The main aim of this study was to examine and analyze the body composition of young soccer players across different age groups.

Methods: A cross-sectional study was carried out among 126 young soccer players divided by age categories U15 – 53 players (age=14.68±0.47); U17 – 51 players (age=16.47±0.50); U19 – 22 players (age=18.05±0.38). Body height for all subjects was measured by anthropometer, while body composition was measured by digital scale TANITA BC-420MA.

Results: On average, soccer players in the U-15 group had significantly lower body height, weight, body mass index, and fat free mass than U-17 and U-19 players …

Impact Of Covid-19 Pandemic On Patients With Depression In Different Socioeconomic Status In Different Age Groups, Alexander Kowalski, Harsh Patel

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This study aimed to investigate the impact of COVID-19 on depression and how different age groups and socioeconomic classes were affected. The PHQ-9 survey was used to assess depression levels amongst 64 individuals of different age groups and socioeconomic statuses. Results indicated that the higher socioeconomic class had less impact on depression symptoms compared to lower socioeconomic classes. Younger age groups and lower socioeconomic classes were found to have a bigger impact on depression symptoms. However, the study acknowledges that numerous factors, such as lifestyle factors, financial stability, and social support, need to be considered while interpreting the results. Overall, …

Prevalence Of Disordered Eating In Female Athletes Of The New Jersey Athletic Conference, Desiree Brower, Joanna Petrides

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Background: In 2018, the American Academy of Child and Adolescent Psychiatry published that, 1 out of every 10 adolescent females suffer from an eating disorder in the United States. Although it is known that eating disorders have an impact on the entire population, there are currently no studies on the prevalence of disordered eating in female athletes of the New Jersey Athletic conference (NJAC). This study aims to determine how many athletes in this population are affected.

Methods: This IRB-approved project utilized a survey-based approach to assess the prevalence of disordered eating among female athletes within the NJAC. To participate, …

Barriers To Dermatological Care In Patients Who Received Extensive Mohs Surgery - An In-Depth Qualitative Analysis, Stuti Prajapati, Mallory Zaino, Christina Kontzias, Laura Doerfler, Steven R. Feldman

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Background: Dermatological care needs to be accessible for the elderly, but they face prominent challenges contributing to delays in diagnosis and treatment. Prolonged management of may lead to widespread cutaneous malignancies, necessitating extensive Mohs surgery.

Objective: To identify areas for early intervention in the geriatric population who have undergone extensive Mohs surgery.

Methods: We performed a qualitative study on 10 patients 65 years and older (68-91) from Atrium Health Wake Forest Baptist dermatology clinics between December 2022 and February 2023, who had extensive Mohs surgery (3 or more layers removed).

Results: Three major areas for potential intervention for cutaneous carcinoma …

Herpesviriae Infection Of The Corneal Endothelium, Behnam Rabiee, Chandani Patel, Mansab Jafri, Hamad Hussain, Michael Gaspari, Muhamad Festok, Imtiaz Chaudhry, Iftikhar Chaudhry, Asim Farooq

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Background

- The corneal endothelium plays a vital role in maintaining corneal clarity by regulating the amount of fluid in the corneal stroma.

- Corneal endotheliitis is defined as inflammation of the corneal endothelial layer that leads to corneal edema and haziness, and subsequent loss of vision.

- Most common causes include cytomegalovirus (CMV), herpes simplex virus (HSV), and varicella zoster virus (VZV).

- Because corneal endothelial cells cannot regenerate following injury, early diagnosis is essential in proper management and preventing loss of corneal endothelial cells.

In this review we aim to gather the most recent knowledge on viral corneal …

Chronic Headache Leading To The Diagnosis Of Empty Sella, Melissa Itidiare Locke, Rachel Burke

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Headaches are one of the most common chief complaints presenting to the Emergency Department. The differential is broad. The workup is tailored to the patient’s history. Here we present the case of a young female who developed headaches over the past year. After numerous imaging studies of her brain, the most recent revealed an Empty Sella diagnosis.

The Effects Of Obesity And Diabetes On The Pediatric Population, Keyur Patel, Vrushank Shah, Zachary Harris, Kanad Mukherjee

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The World Health Organization has declared diabetes (DM) and Obesity to be epidemics due to their rising prevalence. Obesity plays a role in the aetiopathogenesis of type 2 diabetes, the most common type of diabetes in the world, as well as the development of its complications. Obesity and overweight play a growing role in type 1 diabetes. Weight gain is often thought of as a side effect of insulin therapy, but it also has a significant pathophysiological impact at different stages of the disease. (1) In the United States and other nations across the world, childhood obesity has become a …

A Rare Case Of Left Main Vasospasm Resulting In Sudden Cardiac Death, Trinava Roy, Anjeli Patel, Tania Maheshwari, Vasu Palli

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Background: Coronary artery vasospasm (CAV) is transient spasm of a coronary artery that can lead to cardiac ischemia. We present a case with left main (LM) CAV identified on electrocardiogram (ECG) and cardiac catheterization resulting in appropriate therapy.

Case: A 52 year old female with months of spontaneously resolving episodic neck pain, flushing, and diaphoresis presented to the emergency department after a resuscitated cardiac arrest. Initial ECG was without evidence of ischemia, however high-sensitivity troponin (522) was elevated. Telemetry monitoring and ECG showed transient ST elevations in V1 and diffuse ST depressions with left bundle branch block. LV Function was …

Dislodged Endovascular Heat-Induced Thrombus Resulting In Pulmonary Embolus Following Post-Operative Ultrasound Compression, Danielle Park, Aghilas Belkadi, Luke Perry, Michael Kachmar, Holly Graves

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Introduction: Venous insufficiency and consequent varicose veins are common problems faced by many patients. Fortunately, there are many treatment options available including a minimally invasive method known as radiofrequency ablation (RFA). RFA is not without complications; amongst those are endovascular heat induced thrombosis (EHIT). This rare complication is typically managed conservatively; however, in rare occasions, the thrombus can detach and embolize causing further issues for patients.

Case Description: A 48-year-old male underwent an uneventful RFA procedure for a CEAP 4a venous insufficiency. On the post-operative ultrasound venous duplex evaluation, the patient was found to have EHIT type 2 in the …

Pregnancy Outcome With In Vitro Fertilization-Embryo Transfer According To Age In Women With Diminished Oocyte Reserve (Dor) Using A Follicle Stimulating Hormone Receptor Up-Regulation Technique, Brooke Neumann, Jerome Check, Carrie Wilson, Michael Sobel, Jung Choe

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Objective: About 18 years ago, one of the top IVF centers published a study and found that women with DOR did not have any live deliveries at any age in women with a day 3 serum FSH exceeding 18 mIU/mL. The failure to achieve a live delivery may have been related to the ovarian hyperstimulation regimen with possible down regulation of the FSH receptor needed to produce a key enzyme needed for successful implantation. The purpose of this 25-year retrospective review was to evaluate the efficacy of a specific type of mild stimulation referred to as the FSH receptor up-take …

Evaluation Of Outcome Following Oocyte Retrieval In Women With Marked Diminished Oocyte Reserve (Dor) Where The Only Oocyte Retrieved Was In A Metaphase I State, Brooke Neumann, Jerome Check, Carrie Wilson, Donna Summers, Kathleen Hollahan

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OBJECTIVE: To determine if there is value in culturing a metaphase I oocyte to metaphase II followed by intracytoplasmic sperm injection (ICSI), fertilization, then embryo transfer (ET) in women with marked DOR. MATERIALS AND METHODS: A follicle stimulating hormone (FSH) receptor up-regulation technique was used in women whose day 3 serum FSH levels were >12 mIU/mL and/or the serum anti-mullerian (AMH) level was <1ng/mL to mature antral follicle(s) to the dominant follicle stage (average diameter >18) and serum estradiol (E2) >200pg/mL when 10,000 IU human chorionic gonadotropin (hCG) would be given followed by oocyte retrieval 32 hours later. The basic tenet of this follicle maturation technique is to 1) use very little …

Case Report: Uterine Torsion – A Rare Cause Of Right Lower Quadrant Pain, David Ho, James Jung Lee, James Espinosa

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Uterine torsions are very rare. In an article by Matsumoto et al published in 2021, only 25 cases have been documented on PubMed in non-gravid females in the past 20 years. Uterine torsion is defined as rotation of the uterus greater than 45 degrees in the long axis. Rotation can occur anywhere between 45 degrees to 180 degrees. The torsion can be due to a congenital anomaly or an obstetrics emergency such as with an ovarian torsion. Uterine torsions presenting as an obstetrics emergency carries the potential for irreversible ischemic damage to the uterus, and just as in ovarian torsion, …

Case Report: Use Of Bedside Handheld Ultrasound To Diagnose Finger Dislocation, Frank Wheeler, Philip Carhart, James Espinosa, Alan Lucerna, Henry Schuitema

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Here we present the case of a 37-year-old male with a finger injury in which finger dislocation was suspected clinically. A bedside pocket ultrasound was performed using a water submersion technique, which identified a posterior dislocated right 2nd digit at the PIP joint. This finding was confirmed with an x-ray. This case report demonstrates that ultrasonography can be utilized to correctly identify finger dislocation. Although larger studies need to be performed to validate the accuracy of this imaging technique, the implications may improve care of the patient. It would also be particularly beneficial for this technique to be applied to …

Case Report And Brief Review: Co-Infection Covid-19 Virus And Influenza A Virus, James Espinosa, Umar Sannoh, Alan Lucerna

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We report the case of a 45 year old male who presented to the an emergency department with a complaint of myalgias, chills and sore throat of a two day duration. The patient tested positive for COVID-19 virus as well as Influenza A virus. The purpose of this brief review is to discuss what is known about co-infection of COVID-19 and influenza A.

Case Report And Review: Promethazine ("Purple Drank") Abuse, Riya Tandra, James Espinosa, Alan Lucerna

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A 23 year old female was brought to the Emergency Department by EMS for confusion and aggressive behavior. The friends told EMS that the patient had been ingesting "purple drank" and that she had told her friends that she made the concoction with promethazine and opiate cough syrup with some vodka added. She mixed it in a carbonated soda. “Purple Drank” or “Lean” is a combination of codeine promethazine hydrochloride and soda or alcohol that has frequently been misused since the 1990s. This paper aims to highlight the recent resurgence of promethazine abuse occurring in the United States as well …

Bedside Teaching In Emergency Medicine Brief Review And Practical Suggestions, James Espinosa, Alan Lucerna, Frank Wheeler, Sergey Medlenov, Robin Lahr, James Lee

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Bedside teaching has been a tradtional practice and value in medicine. There is literature attesting the positive role of bedside teaching in medicine in general---and in emergency medicine in particular. The value proposition is centered around teaching overall clinical skills, communication skills and procedural skills. There is very little actual data concerning the outcomes of various bedside teaching approaches in EM. There are a number of very interesting suggestions In this review, we will discuss practical strategies to support bedside teaching in the speciality of emergency medicine.

Case Report: Facial Mask-Induced Acne ("Maskne"), Gabriel Meister, James Espinosa, Alan Lucerna

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A 42 year old male health care worker presented with complaints of severe mask related acne vulgaris predominately to the cheeks, chin and nose Here we present the case of a N95 and surgical facial mask use has been a requirement for many occupations during the Covid-19 pandemic. Patient states their current position requires use of an N95 respirator to be worn throughout their shift which can range from 9-14 hours, 6 days per week. Extended daily use of such masks may lead to changes in the skin which can induce irritation and precipitate infection.

Case Report: Nosocomial Digital Eczema From Surface Cleansing Bleach, James Espinosa, Umar Sannoh, Alan Lucerna

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We report the case of a healthcare provider who developed hand eczema, predominantly on the first digit and thumb of the right hand, in association with contact with the surface of a desk and mouse pad at work. The eczema abated on days off and was exacerbated within hours of work. The diagnosis was made of hand eczema from surface cleaning bleach. It was noted that several other healthcare providers had developed similar symptoms. The patient's eczema was confirmed by a dermatologist and was successfully treated with topical triamcinolone and emollient cream to the affected areas. Prevention by adhesive strip …

Hearing, Cognitive Decline, And The Value Of Hearing Interventions, Lisa M. Price, Jennifer Ren, Victoria Wong Murray, Dylan Trawinski, Ethan Zerpa-Blanco, Sheam Jahan

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The term “dementia” includes a wide array of diseases. Millions of Americans are affected by these diseases, especially with aging. Its prevalence makes dementia a candidate for exploratory research in understanding its various etiologies and cause-effect relationships in hopes of developing treatment. Numerous studies have been conducted in an attempt to discern whether a causal relationship exists between hearing loss and dementia, as hearing loss frequently precedes dementia. Some publications have reported a correlation between hearing loss treatment and a decreased dementia incidence rate. This review seeks to investigate the associations between hearing loss and dementia, the efficacy of hearing …

The Vaginal Microbiome Post-Menopause And Urinary Tract Infections, Rifke Anolik, Julia Kiffel, Venkateswar Venkataman

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Background: Urinary Tract Infection (UTI) is a condition where pathogens invade the urinary tract and can travel up the urethra and into the bladder. UTIs occur more commonly in females compared to males and in the post-menopausal population this rate increases significantly. While these infections may be asymptomatic, they can also cause severe discomfort and lead to serious and even life threatening complications. Recent investigation into the vaginal microbiome has opened the doors to a possible mechanism behind the increased incidence of UTIs after menopause. Understanding the pathogenesis behind the increased risk of UTIs in the postmenopausal state will allow …

Impact Of Draft Order On Stress Sonography Of The Ulnar Collateral Ligament Of The Elbow In Professional Baseball Pitchers: An 18-Year Study, Adeeb Hanna, John Sonnier, Brian Fliegel, Matthew Sherman, Michael Ciccotti, Robert Jack, Steven Cohen

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Background: The MLB draft is a common route for players to enter professional baseball in the United States. Individuals taken in earlier rounds are typically higher-performing players. When looking at pitchers specifically, higher performance at the amateur level may be associated with increased frequency of adaptive change in the throwing elbow.

Purpose/Hypothesis: To determine if players taken in earlier rounds of the MLB draft have a greater frequency or extent of pathological change in the elbow, as measured by dynamic stress ultrasound.

Study Design: Retrospective Cohort Study Methods: Dynamic stress ultrasounds (SUS) were performed over an 18-year period on the …

Ureterocutaneous Fistula In Setting Of Recurrent Gluteal Abscesses: A Case Report, Catherine Alapatt, Young Son, Benjamin Fink, Brian Thomas, Sean Coulson, Shawon Akanda, Jacob Thatcher, Thomas Mueller

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Ureteral fistulas are a rare occurrence that can arise from iatrogenic trauma, radiation, malignancy, and inflammation. Treatment options of urinary tract fistulas are handled on a case-by-case basis and can necessitate a surgical approach. We present the case of an 85-year-old patient with a ureterocutaneous fistula where conservative management with PCN is a viable alternative to surgical intervention.

Biopsychosocial Impacts Of Social Distancing Due To Covid-19 In People Over 65: A Literature Review, Nicole Lacap

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Background: Since the beginning of the Covid-19 pandemic in January 2020, elderly populations aged 65+ have been deemed at-risk for severe symptoms and poor prognosis. Because it is important to protect this vulnerable population, policies such as social distancing and shelter-in-place orders have been implemented in the United States in order to prevent the spread of Covid-19. However, many older citizens may live alone or may not have access to technology, and therefore may be limited in their ability to maintain important relationships and social interactions throughout shelter-in-place orders and social distancing. Therefore, it is important to understand the cost …