Medicine and Health Sciences Commons^™

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.

A Mathematical Investigation On Tumor-Immune Dynamics: The Impact Of Vaccines On The Immune Response, Jonathan Quinonez, Neethi Dasu, Mahboobi Qureshi

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Mathematical models analyzing tumor-immune interactions provide a framework by which to address specific scenarios in regard to tumor-immune dynamics. Important aspects of tumor-immune surveillance to consider is the elimination of tumor cells from a host’s cell-mediated immunity as well as the implications of vaccines derived from synthetic antigen. In present studies, our mathematical model examined the role of synthetic antigen to the strength of the immune system. The constructed model takes into account accepted knowledge of immune function as well as prior work done by de Pillis et al. All equations describing tumor-immune growth, antigen presentation, immune response, and interaction …

Stimulating Interest In Medicine Assisted Manipulation (Mam)/Manipulation Under Anesthesia (Mua) As A Complementary Treatment Modality For Chronic Pain And Opioid Use, David Abend Do, Alexis Dunn, Guy K. Guibilato, J. Scott Lazaro, Bharani Pusukur, Teymur Aliyev, Anthony Ascione, Michael Mcaree

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The objective of this clinical review is to stimulate interest in medicine assisted manipulation (MAM), also known as manipulation under anesthesia (MUA). By providing evidence from published studies regarding the use of MUA, as well as identifying its benefits and limitations, our group hopes to increase awareness of this technique and contribute to its implementation to assist in overall pain reduction and reduce opioid medication dosing. A retrospective literature review was undertaken to investigate the extent of published information on the topic in order to compile evidence based data and provide the reader with a summary of both the benefits …

Mental Health Symptom Severity In Cannabis-Using And Non-Using Veterans With Probable Ptsd, Matthew J. Johnson, John D. Pierce, Shahrzad Mavandadi, Johanna Klaus, Diana Defelice, Erin Ingram, David W. Oslin

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BACKGROUND:

Posttraumatic Stress Disorder (PTSD) is a disabling illness suffered by many veterans returning from war. Some veterans believe that cannabis may be therapeutic for PTSD. The purpose of this study was to better understand the association between cannabis use and PTSD symptoms.

METHODS:

The study was a matched case-control cross-sectional evaluation of the psychiatric and sociocultural associations of cannabis use in veterans with probable PTSD. Patient self-report measures were examined comparing cannabis users (cases) to non-users (controls) who were case-matched on age and gender.

RESULTS:

Results indicated that there were no significant differences between cases and controls in mean …

Amphotercin Washout Of Fungal Peritonitis In Liver Transplant Recipient: A Novel Approach, Ann Thompson Do, Mara Piltin Do, Alyssa Imperatore Do, Ely Sebastian Md, Sandra Paluzzi Md

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Invasive fungal infection has a significant prevalence among organ transplant patients and is associated with high rates of morbidity and mortality. Fungal infection is difficult to identify early and subsequently difficult to effectively treat. In this case presentation we have a 45 y/o orthotopic liver transplant recipient who was profoundly sick from fungal peritonitis and due to the appearance of her abdomen and intestines, with the help of infectious disease, decided to proceed with direct amphotercin washout of the abdomen in the operating room. The patient had complete resolution of her fungal peritonitis and is doing well.

Torsion Does Not Affect Early Vein Graft Patency In The Rat Femoral Artery Model, Amro Harb, Maxwell Levi, Akio Kozato, Robert J. Strauch Md

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BACKGROUND:

Torsion of vein grafts is a commonly cited reason for graft failure in clinical setting. Many microsurgery training courses have incorporated vein graft procedures in their curricula, and vein graft torsion is a common technical error made by the surgeons in these courses. To improve our understanding of the clinical reproducibility of practicing vein graft procedures in microsurgery training courses, this study aims to determine if torsion can lead to early vein graft failure in nonsurvival surgery rat models.

METHODS:

Sprague-Dawley rats were divided into five cohorts with five rats per cohort for a total of 25 rats. Cohorts …

The Evolving Long-Term Outcome Of Heart Transplantation In Amyloid Patients, Avish Jain, Sadia Dimbil, Ryan Levine, Michele Hamilton, Jon A. Kabashigawa

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Background: Both amyloid light chain (AL) amyloidosis and transthyretin-related (TTR) amyloid are expanding indications for heart transplantation (HTx). In the past, AL amyloid, in particular, had been a contraindication to HTx given its systemic nature and the increased risk for mortality. Modern treatments including proteasome inhibitors have allowed amyloid patients to receive heart transplants at an increasing rate. We sought to assess long-term post-transplant outcome in amyloid patients in the current era.

Methods: Between 2010 and 2015, we assessed 27 patients (5 AL, 10 TTR-wildtype (wt), 12 TTR-mutant (m)) underwent heart transplant for cardiac amyloidosis at our single center. A …

Assessment Of The Perceived Access To Health Care By Migrant And Seasonal Farm Workers In Southern New Jersey, Karen Custodio, Xitlalichomiha O'Dell Do, Lori Talbot Md

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Migrant and seasonal farm workers (MSFW) are one of the most economically disadvantaged populations in the United States. MSFW confront numerous health challenges as a result of occupational hazards, poor living conditions, and inadequate nutrition, in addition to common health concerns like diabetes and hypertension. The objective of this study was to identify major barriers to health care for individuals working in the agriculture industry in southern New Jersey. Though there are numerous factors which impact health for migrant farmers, we hypothesized that language, financial burden, and fear from immigration status will be the most significant. Research was conducted using …

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

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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

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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

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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

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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 …

An Industrial Hygiene Assessment Of Lead In Potable Water Outlets At Rowan University, Tyra Thomas, Rosemary Roberto, Thomas Boyle

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The Office of Environmental Health and Safety (EHS) discovered lead in the water of a number of buildings on the Glassboro campus. This finding triggered the need for a comprehensive study to determine if lead was in the drinking water on the main campus.

Rowan University then partnered with an independent consultant to create a Lead Sampling Plan, collect water samples and to find a certified laboratory to provide water sample analysis.

A comprehensive plumbing survey of the campus also took place to determine how water is supplied to campus and how it is distributed to and throughout each building. …

Omt For The Treatment Of Depression And Anxiety, Zachary Winchell

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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 …

Retrospective Analysis On The Susceptibility Of Opiate Addiction Based On Prescribed Medications And Chronic Pain Diagnoses, Momna Ayub, Richard Jermyn D.O.

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Introduction: Opioid medications have been increasingly prescribed in recent years, particularly to treat individuals with chronic pain. In the U.S., opioid abuse has been declared an epidemic by the Department of Health and Human Services as the number of opioid-related overdoses in 2010 exceeded 16000 and alarmingly continued to rise 15% from 2015 to 2016. Due to opioid dependence and abuse, opioids are a gateway to subsequent drug addiction.

Objective: The goal of this project was to identify a link between certain prescribed opiates and a susceptibility for abuse or misuse in patients with chronic pain through a retrospective analysis. …

Rare Case Of Hip Pain: Transiliac Lumbar Hernia, Daniel Tran D.O., James Lee D.O., Alan Lucerna D.O., James Espinosa M.D.

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Bone grafts are essential to achieving a solid spinal fusion by encouraging osteoblastic activity and providing a scaffold to guide bone remodeling. The iliac crest, in particular, is a common site for autologous bone grafting and is still considered the gold standard due to its ease of access to cortical and cancellous bone.[1] However, autologous iliac crest bone grafting can be associated with significant morbidity especially when full thickness tricortical grafts are harvested. Common complications include donor site pain, hematoma, thigh dyesthesias, pelvic instability or fracture.[2] Gastrointestinal herniation on the other hand is a much rarer complication with an incidence …

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

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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.

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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.

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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.

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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.

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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

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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.

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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.

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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

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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 …

Physician Comfort And Competence In Treating The Lgbtq Population, Deborah White D.O., Emma White D.O.

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There are multiple studies showing that the LGBTQ population is a minority population with special healthcare considerations. Our underlying hypothesis was that OBGYN physicians feel they could provide better healthcare treatment to the LGBTQ population if they had more training. To gain more information, we sent asurvey to obstetrician/gynecologists asking questions about their own patient population, amount of training, and desire for further education regarding the LGBTQ community. We found that a majority of OBGYN physicians would use more information on the LGBTQ population if it were available to them. This information could be used in planning future continuing medical …