Medicine and Health Sciences Commons^™

Breastfeeding Education Support Tool For Baby (Best4baby): Feasibility, Acceptability, And Preliminary Impact Of An Mhealth Supported Breastfeeding Peer Counselor Intervention In Rural India, Parth D. Lalakia, Vanessa L. Short, Roopa M. Bellad, Patricia J. Kelly, Yukiko Washio, Tony Ma, Katie Chang, Niranjana Majantashetti, Umesh S. Charantimath, Frances J. Jaeger, Shivaprasad S. Goudar, Richard J. Derman

Rowan-Virtua Research Day

Objective: To evaluate the feasibility of an mHealth-supported breastfeeding peer counselor intervention implemented in rural India and the preliminary impact of the intervention on maternal breastfeeding behaviors, including exclusive breastfeeding (EBF).

Methods: In this quasi-experimental pilot study, participants received either the intervention plus usual care (n = 110) or usual care alone (n = 112). The intervention group received nine in-home visits during and after pregnancy from peer counselors who provided education about and support for EBF and other optimal infant feeding practices and were aided with an mHealth tool. The control group received routine prenatal and postnatal health education. …

Metastatic Adenocarcinoma Of The Prostate To The Brain Initially Diagnosed As Meningioma By Craniotomy: A Case Report, Julia T. Scali, Young Son, Paul Chialastri, Thomas Mueller

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Prostate cancer is the second leading cause of cancer death in men after lung cancer. The most common site of prostate metastasis is bone (84%), lymph node (10.6%), liver (10.2%), and thorax (9.1%), with 18.4% to multiple metastatic sites [1]. Prostate metastasis to the brain is rare, with less than 1% documented cases from M.D. Anderson Cancer Center [2]. It is estimated that 1%-6% of prostate cancer metastasis is found in post mortem examination [3]. Parenchymal brain metastasis has a mean survival of 9.2 months after discovery of brain metastasis [4]. Acute neurological symptoms of metastatic prostate cancer are observed …

Physiological Response And Tissue Damage Following Different Depths Of Impact In A Rodent Model Of Mild Traumatic Brain Injury, Haven K. Predale, Christopher P. Knapp, Barry D. Waterhouse, Rachel L. Navarra

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Mild traumatic brain injury (mTBI) is a serious public health concern that can result in significant neurological and behavioral deficit. mTBI results from impact to the head and can be repetitive in nature, especially in sports and domestic violence cases. Our laboratory studies the effects of repetitive mTBI on risky choice behavior in rodents using a closed-head controlled cortical impact (CH-CCI) model of injury and a well-established probabilistic discounting task that assesses risk-based decision-making behavior. We have recently found that females, but not males, display transient increases in risky choice behavior following three CH-CI’s delivered at 5.5m/s velocity and 2.5 …

The Dopamine D3 Receptor Antagonist Vk4-40 Attenuates Morphine-Induced Hyperactivity But Not Cocaine-Induced Hyperactivity In Mice, Desta M. Pulley, Jessica J. Debski, Daniel Manvich

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In light of the increasing rates of opioid abuse in the US, the search for viable medications to treat opioid abuse disorder (OUD) has become ever more urgent. Opioids exert their abuse-related effects in part by indirectly increasing dopamine (DA) neurotransmission in the mesolimbic system, a dopaminergic projection arising in the ventral tegmental area and terminating in the nucleus accumbens. The DA D3 receptor (D3R), which belongs to the D2 family of dopamine receptors (D2, D3 , D4 receptor subtypes), is highly expressed in these brain regions and has shown strong potential as a pharmacotherapeutic target for the treatment of …

A Peculiar Presentation Of Cardiac Sarcoidosis As Third-Degree Atrioventricular Heart Block Complicated By Right Ventricle Perforation, Yash Suthar, Pooja Patel, Nikhita Kothari, Kristofer Hillegas

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• Cardiac sarcoidosis is a rare, inflammatory multisystem disorder that manifests as noncaseating granulomas of multiple organs.

• The clinical presentation of sarcoidosis is variable and may be underrecognized by clinicians.

• Individuals may be asymptomatic during their lifetimes and may be incidentally diagnosed with the disease for the first-time during autopsy.

• Patients with cardiac involvement of sarcoidosis may initially present with complications including arrhythmias, heart block, bundle branch block, congestive heart failure, pericardial effusion, pulmonary hypertension, and/or sudden cardiac death.

Acute Flecainide Toxicity Treated With Intravenous Lipid Emulsion, Joseph S. Schreiner

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Flecainide is a Vaughn-Williams class IC antiarrhythmic used in the treatment of supraventricular tachycardias including atrial fibrillation. While overdose is rare, its negative effects on cardiac inotropy and conduction pathways can be readily fatal. This is further complicated by the redistribution of the drug out of the plasma and deposition in tissue, rendering reversal by sodium bicarbonate (the standard first line treatment agent) relatively ineffective. A case study of the successful treatment of hemodynamic collapse using sodium bicarbonate in conjunction with intravenous lipid emulsion (ILE) in a patient who ingested a large amount of flecainide in a suicide attempt will …

A Novel Case Of Hhv-6 Meningoencephalitis In An Immunocompetent Adult, Justin Berkner, Kishan Patel

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We present a case of a 56-year-old female who presented with HHV6 encephalitis. She initially presented with altered mental status. Our patient ultimately made a full recovery several days later with only some mild intermittent episodes of confusion. Currently there are no other case reports of HHV6 encephalitis in the adult population.

Adult Knowledge Of Childhood Head Injury Management At Home, Christian Muller, Adarsh Gupta, Joanna Petrides

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Adults are able to recognize concussion warning symptoms; however, they lack the knowledge on how to manage and treat a child’s head injury.

Alteplase Used In A Child With An Acute Ischemic Stroke, Shah Nawaz Chaudhary, James Espinosa, Alan Lucerna, Adam Richards

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Stroke, also known as cerebrovascular accident (CVA), is a neurological injury caused by inadequate brain perfusion due to either ischemia or hemorrhage. There is an abundance of literature on the management of ischemic strokes in adults and this has led to well-defined diagnostic and treatment guidelines. However, the management of pediatric ischemic strokes is currently based on clinical experience of experts, recommendations of consensus guidelines, case studies and extrapolation from adult clinical trials. In this case report, a pediatric patient suffering from an ischemic stroke is successfully treated with IV alteplase (tPA).

An Unusual Ed Case: Scrotal Edema From A Thoracic Aortic Aneurysm In A 58-Year-Old Male, Yevgeniy Polunin, Emily Nguyen, Bhumi Shah

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Scrotal edema is not an uncommon presentation in emergency medicine. We describe the case of a 58-year-old male with no prior medical history who presented to the emergency department (ED) due to progressive scrotal edema. The patient noted increased painless testicular enlargement, dry cough, and dyspnea on exertion over the course of several weeks. Scrotal edema was evaluated by an Ultrasound (US), showing bilateral testicular edema with concern for congestive heart failure (CHF). Computed tomography pulmonary angiography (CTPE) scan showed a large 6.51 cm thoracic aortic aneurysm (TAA), cardiomegaly with dilated left sided chambers, and a small pericardial effusion. Subsequently, …

Atypical Presentation Of Non-Aneurysmal Subarachnoid Hemorrhage, Aleks Spirollari, James Espinosa, Kevin Dwyer

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When most clinicians think of subarachnoid hemorrhages (SAH), they think of “most severe headache of my life” as the most common chief complaint. However, it is only reported in about 70% of patients with SAH. Other symptoms may include nausea and/or vomiting, stiff neck, visual disturbances, loss of consciousness, weakness, and seizures. Patient history may involve previous SAH, hypertension, oral contraceptives in women, recent trauma, family history of intracranial aneurysms, history of smoking, alcohol, and drug use. However, there are atypical causes of SAH that may be missed upon initial evaluation for patients that may not have the above mentioned …

Assessment Of Factors Preventing Adequate Decline In Cervical Cancer Rates Amongst Minority Women In New Jersey, Rosie Wenrich, Jillian Baker

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Background

• Nationally declining cervical cancer rates are still high amongst minority women in NJ, with Hispanic women being affected the most.

• The Human Papilloma Virus (HPV) is the most common sexually transmitted infection and can lead to cervical cancer

• Administration of the 9-valent HPV vaccine can prevent infection and progression to cancer

• Regular cervical cancer screenings allow for better outcomes

• Various barriers prevent people with a cervix receiving the vaccine

• Various barriers prevent people with a cervix aged >/= 30 from receiving regular cervical cancer screenings

Conclusions

• Improved physician recommendation is required for the …

Barriers To Alternative Narcotic Education And Treatment In Young Adults In New Jersey, Shubh Bhambri

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The purpose of this study is to determine alternative methods and programs that result in better outcomes for young adults dealing with opioid addiction in New Jersey while identifying potential barriers that prevent the implementation of these programs.

Case Report: Splenic Infarct S/P Sleeve Gastrectomy, Dhara Patel, James Espinosa, Kishan Patel

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A case of splenic infarct s/p sleeve gastrectomy is presented. A 28-year-old female presented with LUQ pain s/p sleeve gastrectomy POD7. CT scan with IV contrast revealed an area of nonenhancement at the superomedial aspect of the spleen consistent with a small splenic infarct. She was transferred out to the hospital under the service of the surgeon who had performed her sleeve gastrectomy. Splenic infarction is a rare post-op complication s/p sleeve gastrectomy. The spleen has dual blood supply via the splenic artery and short gastric arteries making complete infarction rare. It is usually diagnosed via CT with IV contrast. …

Case Report: Repeated Use Of Tetrahydrocannabinol Associated With Severe Cerebral Vasoconstriction, Pooja Patel, Ryna Then, Dena Little

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Reversible Cerebral Vasoconstriction Syndrome (RCVS) is a rare neurological syndrome. The classic presentation consists of recurrent, severe, ”thunderclap” headaches with neuroimaging findings consistent with segmental vasoconstriction of cerebral arteries. Sympathomimetics including cannabinoids have been found to be triggers in many cases of RCVS. Complications include subarachnoid hemorrhage, intracerebral hemorrhage, cerebral edema and ischemic infarction.

This case highlights the potential devastating and irreversible effects of RCVS precipitated by exposure to a sympathomimetic agent. The case emphasizes the importance of patient counseling regarding abstinence from agents that may provoke RCVS.

Case Presentation: Lower Back Pain Or Chronic Acetaminophen Overdose?, Meghan Whitt, Christopher Schwartz, Bhumi Shah

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Unintentional ingestions can pose a difficult challenge to diagnose in the setting of the Emergency Department. Many may present with vague symptoms that are not consistent with classic overdose prodromes. Many patients do not identify or disclose over the counter medications, such as analgesics, with which acute/chronic ingestion in large quantities can result in life threatening medical emergencies. Their underlying symptoms may also cloud their clinical picture, further complicating workup within the ED.

Covid-19 Resources For Speakers Of Other Languages (Covid Resol), Ali Harb, Irvin Santiago-Bautista, Sulleymarie Sanchez

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Objectives

• identify barriers to COVID 19 testing and vaccination in NJ Hispanics with limited English proficiency (LEP)
• develop resources targeted towards vaccination for Hispanic NJ residents and communities in Atlantic, Camden, and Cumberland counties
• share evidence based information regarding the COVID 19 pandemic and disease spread prevention

Conclusions

• Barriers to equitable COVID 19 care for NJ Hispanics with LEP may include but is not limited to resource availability in Spanish, misinformation about COVID 19, a lack of understanding about where and how to get tested and/or vaccinated, and transportation accessibility
• Increased efforts for providing equitable access to vaccination and testing …

Case Report: Covid-19 Associated Guillain-Barre Syndrome, Matthew Aharonov, Neelesh Parikh, James Espinosa, Alan Lucerna

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We report a case of a 72-year-old female who presented to the emergency department with a complaint of generalized weakness. The patient was found to have ascending muscle weakness and subsequently diagnosed with Covid-19 related Guillain-Barre Syndrome. Our patient was negative for Campylobacter jejuni. It is noteworthy that the patient did not have fever, respiratory symptoms or loss of the sensation of taste.

Dazed And Confused: A Complex Migraine Variant, David Parkes, Christopher Schwartz, Alan Lucerna, James Espinosa, Bhumi Shah

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While most migraine headaches are benign, easily treatable, and able to be discharged home, there is a small percentage that blur the lines and raise concern for neurological compromise. We describe one such rare case of a 26-year-old male with no known history of migraine that presented to the emergency department with acute onset obtundation, confusion, aphasia, and weakness. Labs and imaging of the patient were grossly unremarkable. Treatment with a migraine cocktail and valproate led to full recovery within 24 hours of initial presentation. Infrequently, complex migraines can present with significant and concerning mental status changes. Early imaging, neurologic …

Case Study Of Pulmonary Embolism With Unusual Chief Complaint, Kajel Patel

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Pulmonary embolism (PE) is a serious diagnosis that needs to be made in the Emergency department (ED). There are different categories of PE ranging from massive to non-massive/sub-segmental. Regardless of the categorization, the patient will need to be placed on anticoagulation. It is important to catch this diagnosis in the ED so further complications do no arise. Here is a case from the ED with a patient coming in with the chief complaint of acute right lower quadrant abdominal pain and was diagnosed with a pulmonary embolism.

Identification Of The E3 Ligase That Directs The Degradation Of Proteins That Control Cell Fate Decisions In Yeast, Prasanna Tati, Stephen D Willis, Katrina F. Cooper

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The ubiquitin–proteasome system (UPS) and autophagy pathways are distinct, highly conserved proteolytic systems that play important roles in maintaining cellular homeostasis in response to environmental cues [1]. The goal of this project is to identify the E3 ligase that mediates the degradation of cyclin C following nitrogen starvation in yeast using quantitative Western blot analysis of cyclin C-myc following nitrogen starvation in mutants of known Ubc4/5 interacting E3 ligases. No potential E3 ligases were identified as stable after 4 hours of nitrogen starvation, suggesting redundancy in function.

Posterior Reversible Encephalopathy Syndrome (Pres), Brittany Fera, Andrew Caravello

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Posterior reversible encephalopathy syndrome (PRES) is a clinical and radiographic syndrome that describes certain neuroimaging findings in association with clinical symptoms such as headache, seizure, encephalopathy and vision changes. Classically, PRES is associated with poorly controlled hypertension, and patients present with elevated blood pressure in addition to their symptoms. Most importantly, imaging findings and symptoms are typically reversible, and are a separate entity from ischemic or hemorrhagic cerebrovascular accidents or autoimmune causes of similar symptoms, such as multiple sclerosis.

A Holistic Approach To Physical And Mental Health: Associations Between Chronic Disease And Psychiatric Conditions, Pooja Patel, Alison Mancuso

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OBJECTIVE:

• To investigate the link between chronic medical conditions and psychiatric disorders

BACKGROUND

• Limited research has been done studying the relationship between chronic medical conditions and psychiatric disorders in patients comorbid with both types of conditions.

• Prior research studies have demonstrated that patients with chronic medical conditions are more likely to develop psychiatric disorders compared to healthy individuals without any medical conditions.

• As individuals develop chronic medical conditions, they may encounter additional obstacles in their lives,

Affiliative Social Interactions Activate Vasopressin-Responsive Neurons In The Mouse Dorsal Raphe, Tirth Patel, Hanna O. Caiola, Olivia Mallari, Benjamin D. Rood

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Social behavior is inextricably linked to human health, shaping both our susceptibility and resilience to disease and stress. Positive interactions as simple as maternal contact or friendships among children and adults can protect against emotional distress and improve treatment outcomes, whereas negative interactions such as abuse, social isolation, or bullying can increase aggression and precipitate mood disorders. Discovering the structure and function of neural circuits underlying social behavior is critical to understanding the link between social interaction and health. The neuropeptide vasopressin has been implicated in the regulation of multiple social interactions including social memory, aggression, mating, pair-bonding, and parental …

An Analysis Of Phenibut (Ss -Phenyl-Y-Aminobutyric Acid) Withdrawal, Michael Morris, James Espinosa, Robin Lahr, Alan Lucerna

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Phenibut (ß -phenyl-y-aminobutyric acid) is a psychoactive GABA analogue marketed as a nutritional supplement and “nootropic” online. Phenibut consumption poses a high risk of potential abuse. Withdrawal from Phenibut mimics benzodiazepine and alcohol withdrawal. Without proper management, Phenibut withdrawal may be equally as dangerous as benzodiazepine and alcohol withdrawal. Baclofen can be prescribed for outpatient symptomatic relief of Phenibut withdrawal.

Alzheimer's Patients’ Mental Health During The Covid 19 Pandemic, Maryanna Schweininger, Yvonne Maduka, Ajh'shana Collins

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Alzheimer’s disease (AD) is a degenerative brain disease caused by β Amyloid plaques and neurofibrillary tangles, which results in memory loss and cognitive decline. It is the sixth leading cause of death in the United States. Approximately 50% of those with AD experience some degree of depression during the course of the disease, which has been shown to accelerate functional decline, institutionalization, and even mortality.

Many who cannot care for themselves live in an assisted living facility or retirement home. Since the beginning of the COVID 19 pandemic, people have been urged to social distance in order to decrease the …

An Unusual Ed Case: Cardiac Tamponade Presenting As Hiccups, Devleen Baksi, Nicholas Tomasello, James Espinosa, Alan Lucerna

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Cardiac tamponade is an emergent life threating condition that depending on cause can quickly progress to death. The rate of accumulation of a pericardial effusion often can determine the clinical severity. Typically, shortness of breath and hypotension manifest; however, in this unusual case, the initial presenting complaint was persistent hiccups.

An Unusual Ed Case: Aortic Aneurysm Presenting As Chf Exacerbation, Darren Finn, James Espinosa, Russell Mordecai, Kishan Patel

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There has been a significant increase in the incidence of thoracic aortic aneurysms, currently making aneurysmal disease the 18th most common cause of death within the United States. This disease is typically an insidious one, with the aorta growing an average of only 0.1 cm per year. Consequently, most patients remain asymptomatic until late stages of the disease when dissection or worse, rupture has occurred. Under extremely rare circumstances, thoracic aortic aneurysms can present clinically due to mass effect. Airway, esophageal and vascular compression, secondary to aortic arch dilation has been previously documented. The condition can be acquired or congenital, …

Association Between Childhood Obesity And Lack Of Healthy Food Access In Urban Food Deserts, Nicholas Averell, Rushali Desai, Archana Menon, Ayushi Naik, Arpun Shah

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Background

Childhood Obesity: growing epidemic affecting almost 20% of children and adolescents in the United States

● Characterized by BMI greater than 95^th percentile of their age and gender

● Often leads to chronic medical conditions: high blood pressure, Type II Diabetes and heart diseases

● Low socioeconomic status(SES), lack of healthy food access and urban neighborhood

A Case Of Spinal Epidural Lipomatosis Presenting As A Stroke Mimic, Jonas Salna Iv, James Lee, Eric Maddock, James Espinosa, Alan Lucerna

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Spinal Epidural Lipomatosis (SEL) an excess of normal adipose tissue in the epidural space of the spinal canal, typically becoming symptomatic when cord compression results. First described in 1975 by Lee et al (Lee M, 1975), it is a relatively rare disease. Unfortunately, it is often diagnosed once patients have developed marked symptoms and can have dire complications. Oftentimes SEL is completely asymptomatic, and symptoms on initial presentation are vague. Mostly commonly it presents as worsening chronic back pain (Daniel R. Fassett M.D. M.B.A., 2004) with progressive lower extremity weakness and occasional cauda equina syndrome (Wells AJ, 2014), but this …