Medicine and Health Sciences Commons^™

Diversity In Osteopathic Medical School Admissions And The Compass Program: An Update, Nadege J. Dady, Steven M. Toplan, Jeffrey R. Gardere, Robin Moore, Lorreen Agandi, Ulcha Fergie Ulysse, Aida Aminpour, Mckensie Gelvin, Jemima Akinsanya, Kenneth J. Steier

Touro College of Osteopathic Medicine (New York) Publications and Research

In the United States, the 40 colleges of osteopathic medicine and 157 schools of allopathic medicine face challenges in recruiting candidates who are underrepresented in medicine (URiM), and gaps in racial disparity appear to be widening. In this commentary, the authors provide an analysis of the data collected from 8 years of conducting a URiM recruitment and welcoming social events. The event is sponsored by a student special interest group called Creating Osteopathic Minority Physicians Who Achieve Scholastic Success (COMPASS) at the Touro College of Osteopathic Medicine – New York (TouroCOM-NY). The results of the 8-year data analysis supports the …

Reduction And Resolution Of A Hiatal Hernia Using Osteopathic Manipulative Treatment: A Case Report, Mikhail Volokitin, Anthony Song, Meredith T. Peck, Susan Milani

Touro College of Osteopathic Medicine (New York) Publications and Research

No abstract provided.

The Association Between Anemia Of Chronic Inflammation And Alzheimer's Disease And Related Dementias, Alexander Andreev, Burak Erdinc, Kiran Shivaraj, Julia Schmutz, Olga Levochkina, Dhrity Bhowmik, Fady Farag, Kelli M Money, Louis H. Primavera, Vladimir Gotlieb, Sonu Sahni

Touro College of Osteopathic Medicine (New York) Publications and Research

Background: Dementia is a spectrum of neurological diseases characterized by memory impairment and cognitive decline with the pathogenesis and effective management remaining elusive. Several studies have identified a correlation between anemia and Alzheimer's disease and related dementias (ADRD); however, anemia subtypes and association with ADRD have yet to be studied conclusively.

Objective: To study an association between ADRD and anemia of chronic inflammation.

Methods: We conducted a retrospective case-control study of the patients, diagnosed with ADRD at Brookdale Hospital. Pair-wise comparisons between means of controls and cases in terms of iron studies and laboratory results were performed using a Mann-Whitney …

Disseminated Varicella-Zoster Virus Infection Complicated By Encephalitis And Ramsay Hunt Syndrome In An Hiv Patient, Amro Elshereye, Burak Erdinc, Sonu Sahni

Touro College of Osteopathic Medicine (New York) Publications and Research

Varicella-zoster virus (VZV) is a human α-herpesvirus which cause primary varicella infection (chicken pox) or herpes zoster infection (shingles) after reactivation of the dormant virus. VZV infection is usually self-limited but disseminated infection can be seen in immunocompromised individuals. It can also get complicated by central nervous system (CNS) involvement. We describe a case of a 51-year-old male with human immunodeficiency virus (HIV) who presented with altered mental status and deficits in his right-sided cranial nerves of VI, VII, and VIII. The patient also had disseminated vesicular-pustular rash all over his body at different stages of healing. A diagnosis of …

Complicated Isolated Liver Abscess Caused By Viridans Group Streptococci Leading To Right Hepatectomy, Muhammad F Ahmed, Zainab Abbasi, Sajan Das, Alok Aggarwal, Sonu Sahni

Touro College of Osteopathic Medicine (New York) Publications and Research

Pyogenic liver abscesses (PLAs) secondary to bacterial etiologies are most often seen in developing countries and are less common in North America. The predominant etiology is infection occurring in the setting of direct extension of hepatobiliary or intestinal infection. The most common pathogen isolated from a PLA in the United States is

Acute Kidney Injury Caused By Levetiracetam In A Patient With Status Epilepticus, Burak Erdinc, Snigdha Ghanta, Alexander Andreev, Karim O Elkholy, Sonu Sahni

Touro College of Osteopathic Medicine (New York) Publications and Research

Levetiracetam is a widely used, effective and usually well-tolerated anti-epileptic medicine. It is mostly excreted by kidneys and requires dose adjustment according to the glomerular filtration rate. Very few case reports have been published in the literature about levetiracetam causing acute kidney injury (AKI). We present a case of a 26-year-old male with a seizure disorder on levetiracetam, presented with status epilepticus requiring intubation for airway protection. He received 4 g of intravenous levetiracetam as a loading dose and continued with a maintenance dose of 750 mg intravenous every 12 hours. He had signs of AKI on day two and …

Multivessel Coronary Artery Fistula Presenting As Coronary Steal Syndrome Leading To Cardiac Arrest, Muhammad F Ahmed, Anaam Mubin, Rumman Syed, Abdullah K Mahmood, Sonu Sahni

Touro College of Osteopathic Medicine (New York) Publications and Research

The coronary steal phenomenon refers to myocardial ischemia caused by the diversion of blood away from normal myocardial circulation. A coronary artery fistula (CAF) is an abnormality of the coronary anatomy characterized by the aberrant termination of a coronary artery or its branches into cardiac chambers or great vessels. Although CAFs are often thought to be asymptomatic, fistulas that diverge a significant amount of blood flow and decrease the normal perfusion of myocardial tissue can cause ischemia and can present with acute coronary syndrome. We describe a unique case of a 70-year-old woman with no coronary artery disease (CAD) undergoing …

Paraneoplastic Pemphigus: An Indication For Treatment In Chronic Lymphocytic Leukemia, Ifeanyichukwu Onukogu, Preethi Ramachandran, Joshua Narh, Sonu Sahni, Gardith Joseph

Touro College of Osteopathic Medicine (New York) Publications and Research

Paraneoplastic disorders are rare multiorgan diseases associated with hematological malignancies such as chronic lymphocytic leukemia (CLL). Some of these paraneoplasms manifest as cutaneous lesions, appearing as a simple rash, ulcers or skin thickening. The pathogenesis for this process has been described as development of certain autoimmune reactions against cell wall antigens and proteins. An example is paraneoplastic pemphigus (PNP) which manifests as cutaneous bullae. Bullae may occur anytime during the course of the malignancy i.e. acute phase or remission. Diagnosis involves evaluation of clinical findings, serology and presence of characteristic histological findings. Its pathogenesis is described as development of auto-antibodies …

Giant Left Main Coronary Artery Aneurysm Presenting As Multiple Implantable Cardioverter Defibrillator Shocks, Yury Malyshev, Asma Syed, Ricardo Castillo, Rumman A Syed, Sonu Sahni

Touro College of Osteopathic Medicine (New York) Publications and Research

Giant aneurysms of the left main coronary artery are one of the rarest findings in cardiology, encountered in less than 0.02% of patients. The presentation is usually the same as coronary artery disease since most coronary aneurysms in the western world are associated with atherosclerosis. Here we report the first case of giant aneurysm of the left main coronary artery presenting as ventricular tachycardia with multiple shocks of the defibrillator in a 57-year-old man with heart failure. We also review the etiology, pathology, and management of coronary aneurysms.

Narrow Escape: A Novel Approach To The Endovascular Treatment Of Superior Vena Cava Syndrome Secondary To Pacemaker Leads With Excellent Long-Term Outcomes, Yury Malyshev, Sergey Ayzenberg, Sonu Sahni, Mazin Khalid, Jeffrey Le

Touro College of Osteopathic Medicine (New York) Publications and Research

Pacemaker or defibrillator placement is a common procedure done in more and more patients due to increased longevity and the prominence of cardiac disease. With more indications for cardiac implantable electrode devices, the devices themselves have evolved into more complex structures with more leads. The mechanical stress, risk of infection, and decreased blood flow through the superior vena cava (SVC) put patients at risk for SVC obstruction. Herein, we present a rare case of complete SVC obstruction secondary to fibrosis due to pacemaker leads which was treated with venoplasty and showed excellent long-term results. We also review the current literature …

Perceptions Of The Osteopathic Profession In New York City's Chinese Communities, Justin Chin, Sarah Li, Gregory Yim, Yaqun Arlene Zhou, Peter Justin Wan, Emily R Dube, Mikhail Volokitin, Sonu Sahni, Mark A Terrell, Christine M Lomiguen

Touro College of Osteopathic Medicine (New York) Publications and Research

Objective: The purpose of this study was to assess knowledge of and barriers to osteopathic medicine in Chinese immigrant communities in New York City (NYC).

Design: A cross-sectional study was designed in which a culturally appropriate survey in Chinese and English versions was administered anonymously to measure immigrant perceptions and knowledge of osteopathic medicine.

Setting: Data collection occurred in the municipal delineations for the Chinatown neighbourhood within the New York, New York borough of Manhattan.

Participants: Community members were selected using convenience sampling from high-density areas to participate. Information gathered from the survey included demographics, education level, healthcare habits and …

A Broken Heart: Cardiac Arrest As The Initial Presentation Of Myasthenic Crisis, Alexander Andreev, Farhana Begum, Anjuli Singh, Sonu Sahni

Touro College of Osteopathic Medicine (New York) Publications and Research

Myasthenic crisis is a life-threatening condition commonly associated with respiratory failure and may present in unusual ways. However, there is paucity in the literature about the cardiac manifestations of myasthenia gravis. We present a case of a 61-year-old male who presented to the emergency room with upper respiratory infection symptoms who soon thereafter suffered sudden cardiac arrest. He was found to have shortened PR interval pre and post arrest onelectrocardiogram (EKG). Only past medical history, discovered post cardiac arrest, was myastenia gravis. All other causes of cardiac arrest were ruled out, and it was deemed to be due to a …

Wellens' Syndrome Presenting As Epigastric Pain And Syncope: An Unusual Presentation, Temitope Ajibawo, Alexander Andreev, Sonu Sahni

Touro College of Osteopathic Medicine (New York) Publications and Research

Wellens' syndrome, also regarded as left anterior descending coronary T-wave syndrome, is an electrocardiography (EKG) pattern that indicates critical proximal left anterior descending artery (LAD) stenosis. It is characterized by deeply inverted T-waves or biphasic T-waves in the anterior precordial chest leads in a patient with unstable angina. Patients typically present with symptoms consistent with acute coronary syndrome. We present a unique case of Wellens' syndrome with no angiographic findings of significant stenosis in the proximal LAD but with significant occlusion of the proximal circumflex artery and initial presentation with a chief complaint of epigastric pain and syncope. Physicians need …

Cholangiocarcinoma Presenting As Humoral Hypercalcemia Of Malignancy: A Case Report And Literature Review, Burak Erdinc, Preethi Ramachandran, Ruchi Yadav, Sonu Sahni, Gardith Joseph

Touro College of Osteopathic Medicine (New York) Publications and Research

Humoral hypercalcemia of malignancy (HHM) is most commonly encountered in squamous cell carcinoma (SCC) of different organs, and It is characterized by elevated parathyroid hormone-related peptide (PTHrP) levels. It may be seen as a manifestation of cholangiocarcinoma (CCC) at presentation and later in the course of the disease. However, HHM due to intrahepatic cholangiocarcinoma is a rare association and is associated with a poor prognosis. We herein report a case of hypercalcemia presenting as the first manifestation of an underlying rare variant of intrahepatic cholangiocarcinoma. Our patient is a 57-year-old male who presented to the emergency room with severe symptoms …

Resistant Hypertension: Renal Denervation Or Pharmacovigilance? Insights From A Renal Denervation Screening Program, Marcin Ojrzanowski, Jarosław D Kasprzak, Jan Zbigniew Peruga, Małgorzata Kurpesa, Łukasz Jankowski, Sonu Sahni, Michał Plewka

Touro College of Osteopathic Medicine (New York) Publications and Research

BACKGROUND: With emerging new therapeutic concepts including renal denervation (RDN), there is a renewed interest in resistant hypertension (ResH). Among patients suspected of having ResH, a definitive diagnosis needs to be established.

OBJECTIVES: This study presents observations from a standardized single-center screening program for RDN candidates, including medical therapy modification and reassessment.

MATERIAL AND METHODS: All patients referred to our center for RDN underwent a standardized screening protocol. Candidates were recruited from among patients receiving no less than 3 antihypertensive drugs, including diuretics with office blood pressure (BP) >140/90 mm Hg. The assessment included 2 measurements of BP and ambulatory …

Cannabis-Induced Acute Coronary Syndrome: A Coincidence Or Not?, Eric Landa, Erika Vigandt, Alexander Andreev, Yury Malyshev, Sonu Sahni

Touro College of Osteopathic Medicine (New York) Publications and Research

Marijuana, derived from the Cannabis sativa plant, is the most commonly abused illicit drug in the United States. Now, more than ever, due to changing regulations, marijuana is more readily available and is known to be habitually used by millions. The neuropsychiatric effects of marijuana are well-known which include chronic fatigue syndrome and polyphagia. However, marijuana is also known to exert cardiac effects, such as tachycardia, hypotension, and hypertension. Marijuana has also been described in association with atrial fibrillation, ventricular tachycardia, and cardiac arrest. However, acute coronary syndromes, such as myocardial infarction in the setting of marijuana use, is rare. …

Postpartum Psychosis In A Non-Native Language-Speaking Patient: A Perspective On Language Barriers And Cultural Competency., Tatsuhiko Naito, Justin Chin, Jun Lin, Pritesh J Shah, Christine M. Lomiguen

Touro College of Osteopathic Medicine (New York) Publications and Research

Postpartum psychosis is a condition characterised by rapid onset of psychotic symptoms several weeks after childbirth. Outside of its timing and descriptions of psychotic features, minimal research exists due to its relative rarity (1 to 2 per 1000 births in the USA), with greater emphasis on postpartum sadness and depression. With the existing literature, cultural differences and language barriers previously have not been taken into consideration as there are no documented cases of postpartum psychosis in a non-English-speaking patient. Correctly differentiating postpartum psychosis from other postpartum psychiatric disorders requires adeptly evaluating for the presence of psychotic symptoms with in-depth history …

Conversion Disorder (Functional Neurological Symptom Disorder) Masquerading As Multiple Sclerosis: A Case Report., Derman Ozdemir, Sonu Sahni

Touro College of Osteopathic Medicine (New York) Publications and Research

Conversion disorder, also referred to as functional neurological symptom disorder, is a DSM-5 identified somatic disorder that presents with one or more neurological symptoms that does not clinically correlate with recognized neurological or medical conditions brought on by intense stress, emotions, or an associated psychiatric disorder. Multiple sclerosis (MS) is the most common immune-mediated inflammatory demyelinating disease of the central nervous system and usually presents in young adults with clinical manifestations that range from cognitive abnormalities, eye movement problems, motor and sensory impairments such as weakness and numbness, bowel/bladder dysfunction, fatigue, and/or pain. This case report presents a patient with …

A Case Of Pneumomediastinum And Pneumoperitoneum With Concurrent Massive Subcutaneous Emphysema Due To Repositioning Of A Tracheostomy Tube., Karim O Elkholy, Hamza Akhtar, Eric Landa, Yury Malyshev, Sonu Sahni

Touro College of Osteopathic Medicine (New York) Publications and Research

Tracheostomy is a common procedure seen in critically ill patients that require long term ventilatory support. As with all airway access procedures, tracheotomy with prolonged tracheal tube placement comes with possible risks such as tracheal scarring, tracheal rupture, pneumothorax, tracheoesophageal fistula among others. Another possible complication, though rare, is escape of free air into the surrounding tissue, as well as pneumomediastinum (PM). This may occur due to various reasons, some of them being tracheal rupture, barotrauma or tracheal tube mispositioning. Pneumomediastinum may present with concurrent free air in other body cavities such as the peritoneum, thorax or subcutaneous tissue. Though …

12-Month Outcomes Of The Us Patient Cohort In The Sonata Pivotal Ide Trial Of Transcervical Ablation Of Uterine Fibroids., Joseph Hudgens, D. Alan Johns, Andrea S. Lukes, David A. Forstein, Dipak Delvadia

Touro College of Osteopathic Medicine (New York) Publications and Research

Objective: The prospective SONATA pivotal Investigational Device Exemption (IDE) trial was performed in the United States (US) and Mexico to examine the safety and effectiveness of transcervical fibroid ablation (TFA) in the treatment of symptomatic uterine fibroids. This is an analysis of 12-month clinical outcomes in the US cohort.

Methods: TFA with the Sonata System was performed on women with symptomatic uterine fibroids. The 12-month co-primary endpoints were reduction in menstrual blood loss and freedom from surgical reintervention. Symptom severity, quality of life, patient satisfaction, safety, and reductions in uterine and fibroid volumes were also evaluated.

Results: One hundred twenty-five …

Sarcoid-Like Reaction Associated With Renal Cell Carcinoma - A Case Report., Asma Iftikhar, Muhammad A I Cheema, Preethi Ramachandran, Sonu Sahni

Touro College of Osteopathic Medicine (New York) Publications and Research

Renal cell carcinoma (RCC) is a highly vascular tumor, which may spread to the lungs and other organs. It often presents with localized or systemic manifestation, including paraneoplastic syndromes. Sarcoidosis is a systemic granulomatous inflammatory disease characterized by non-caseating granulomas that typically afflicts the respiratory system. In the absence of any evidence of systemic sarcoidosis they are referred to as sarcoid-like reactions. Non-caseating epithelioid granulomas, also regarded to sarcoid-like granulomas have been described in association with certain malignancies such as carcinomas of the breast, colon, seminoma, and Hodgkin's lymphoma. However, sarcoid like reaction associated with renal cell carcinoma is uncommon. …

It's Getting Hot In Here: A Rare Case Of Heat Stroke In A Young Male., Oriana Ramirez, Yury Malyshev, Sonu Sahni

Touro College of Osteopathic Medicine (New York) Publications and Research

Heat stroke is a severe acute illness characterized by a core temperature greater than 40°C (104°F) and central nervous system manifestations, such as delirium, convulsions, or coma, resulting from exposure to environmental heat or strenuous physical activity. Early recognition and treatment including aggressive cooling and management of life-threatening systemic complications, such as cardiac arrest, rhabdomyolysis and acute renal failure, are essential to reduce morbidity and mortality. Herein we describe a case of heat stroke in a 23-year-old male who suffered cardiac arrest in which prompt initiation of cooling measures prevented permanent neurological sequelae, provided swift neurological recovery and resolution of …

Mycobacterium Tuberculosis Infection In The Setting Of Interstitial Lung Disease: Coincidence Or Bad Luck?, Christian Wong, Sonu Sahni, Muhammad Azaz I. Cheema, Asma Iftikhar

Touro College of Osteopathic Medicine (New York) Publications and Research

Mycobacterium tuberculosis (MTB) infection is the ninth leading cause of death worldwide, with many individuals with undiagnosed active or latent disease. The presence of parenchymal lung disease, such as interstitial lung disease (ILD), has been suggested to increase the risk of pulmonary tuberculosis (TB). In the clinical setting of ILD, the diagnosis of an underlying MTB infection may be challenging due to the interstitial process and underlying fibrosis, which may mask the infection. An atypical presentation and misleading radiological patterns may delay the diagnosis of the underlying MTB infection. Herein, we describe a unique case of ILD complicated by active …

Nephrocutaneous Fistula Due To Xanthogranulomatous Pyelonephritis, Simcha Weissman, Madeeha Ghaffar, Dana Safavian, Sharma Rubal, Anthony Khabut, Mohammad G. Maruf, Michael Krzyzak

Touro College of Osteopathic Medicine (New York) Publications and Research

While the development of a fistulous tract from the kidney to the proximal adjacent organs is relatively common, a tract leading to the skin is a rare occurrence. The primary cause of a fistula is prior surgical intervention or malignancy leading to abscess formation. Our case involves Xanthogranulomatous pyelonephritis (XGP) causing a longstanding lobulated abscess, ultimately leading to the formation of a fistulous tract.

Gender Disparities In Out-Of-Hospital Cardiac Arrests, Glenn Goodwin, Dyana Picache, Nicholas Gaeto, Brian J. Louie, Tarik Reid, Paxton P. Aung, Sonu Sahni

Touro College of Osteopathic Medicine (New York) Publications and Research

Background

Despite advances in resuscitation science and public health, out-of-hospital cardiac arrest (OOHCA) has an average survival rate of only 12% nationwide, compared to 24.8% of patients who suffer from cardiac arrest while in hospital. Additionally, gender is an important element of human health, and there is a clear pattern for gender-specific survivability in cardiac arrest. This study examined differences in presentations, treatment, management, and outcomes.

Aim

The primary focus of this study was to shed light on differences in presentations, treatments, and outcomes between men and women suffering from an out-of-hospital cardiac arrest and the accompanying contributing factors.

Methods …

Non-Insidious Large Joint Manifestation Of Severe Cachectic Rheumatoid Arthritis., Simcha Weissman, Mira Alsheikh, Khalil Kamar, Joshua Breslin, Anthony Khabut, Mohammad G Maruf

Touro College of Osteopathic Medicine (New York) Publications and Research

Rheumatoid arthritis (RA) is an autoimmune disorder in which constitutional symptoms typically occur before joint swelling becomes a true clinical phenomenon. Weight loss, although common, is generally mild in nature and occurs after long standing inflammation. While large joints do become inflamed, RA has a much stronger predilection for the small joints. Our case is a rarity in the fact that there was initial large joint swelling without long standing inflammation. Additionally, the weight loss was cachectic in nature and extreme. Furthermore, while extra-articular manifestations do commonly occur, spontaneous pneumothorax is certainly atypical. The content of this manuscript serves to …

Optimal Scene Time To Achieve Favorable Outcomes In Out-Of-Hospital Cardiac Arrest: How Long Is Too Long?, Glenn Goodwin, Dyana Picache, Brian J. Louie, Nicholas Gaeto, Tarik Zeid, Paxton P. Aung, Sonu Sahni

Touro College of Osteopathic Medicine (New York) Publications and Research

Despite advances in resuscitation science and public health, out-of-hospital cardiac arrest (OOHCA) cases have an average survival rate of only 12% nationwide, compared to 24.8% of cases occurring in hospital. Many factors, including resuscitation interventions, contribute to positive patient outcomes and have, therefore, been studied in attempts to optimize emergency medical services (EMS) protocols to achieve higher rates of return of spontaneous circulation (ROSC) in the field. However, no consensus has been met regarding the appropriate amount of time for EMS to spend on scene.

Evaluation Of Concussion Incidence And Modulating Factors In The 2013-2017 Australian Football League, Ryan Adams, George K. Lau, Jennifer B. Dai, Adam Y. Li, Kevin P. Cheung, Syed Haider, Alex Gometz

Touro College of Osteopathic Medicine (New York) Publications and Research

The increasing awareness and popularization of concussions in the research realm over the last few years have begun to shed more light on the detrimental effects associated with repetitive head trauma. While the majority of the current literature focuses on the National Football League (NFL) and National Hockey League (NHL), several other high-impact sports have been implementing concussion management protocols to protect their players. The Australian Football League (AFL) is a prime example of a major contact sport that has undertaken recent changes to its concussion assessment and management modalities. We recognize the benefit of reporting potential changes in concussion …

The Effectiveness Of Anatomy Laboratory Videos On Osteopathic Medical Students’ Performance, Sumathilatha Sakthi Velavan, Bedia Castellanos

Touro College of Osteopathic Medicine (New York) Publications and Research

Introduction: The usage of audio-visual aids in medical education has always been rewarding. This study aimed at evaluating the efficacy of supplementing traditional dissection based laboratories with the video demonstration of specimens.

Methods: The study was conducted among first-year osteopathic medical students of two consecutive years. The laboratory demonstration videos were recorded and provided to the experimental group and the previous class served as the historical controls. Two Likert scale based questionnaires were completed by the experimental group before and after their final examination. The students' performance in the Anatomy practical examinations were compared between the two groups. …

Pregnancy-Associated Spontaneous Pneumomediastinum: A Contemporary Review, Sonu Sahni, Narcisse Amine

Touro College of Osteopathic Medicine (New York) Publications and Research

Spontaneous pneumomediastinum (SPM), also referred to as mediastinal emphysema, is defined as the presence of free air in the mediastinal cavity without a clear and identifiable cause. Spontaneous pneumomediastinum, in general, is a relatively rare condition, more so in the setting of pregnancy or labor. Clinically, SPM may present as dyspnea, chest pain, and subcutaneous swelling, which may be of serious concern in the setting of pregnancy. A comprehensive literature review revealed that the majority of patients are primiparas, of a younger age, and have term or longer durations of pregnancy. The second stage of labor was found to be …