Medicine and Health Sciences Commons^™

Case Report: Cavitary Pneumonia In A 28 Year Old Male, Dan Zaayenga, Katelyn Courtney

Rowan-Virtua Research Day

Cavitary pneumonia can be caused by several different mechanisms. Such causes include suppurative necrosis (pyogenic lung abscess), caseous necrosis (tuberculosis), ischemic necrosis (pulmonary infarction) cystic dilatation of lung structures (ball value obstruction and Pneumocystis pneumonia) as well as malignant processes. Causes are subject to both environmental factors and host susceptibility. The most common cause of infectious process is tuberculosis with its propensity to cause extensive caseous necrosis. The potential for secondary infection after an individual develops a cavitary pneumonia is also great as it provides a shelter for various pathogens the flourish in an environment otherwise usually well-guarded by host …

Case Study Of Horner Syndrome Due To Internal Carotid Artery Dissection, Kajel Patel

Rowan-Virtua Research Day

Carotid artery dissection can occur either spontaneously or because of trauma. It is usually the most common cause of stroke in middle-aged patients. The symptoms can be transient or persistent and typically occur a few days after the inciting traumatic event.

A 5-Year Clinical Course Of Phenocopy Syndrome Of Behavioral Variant Frontotemporal Dementia: Case Report And Literature Review, Joseph Melillo, Keyur Patel, Christian White

Rowan-Virtua Research Day

Frontotemporal dementia is a neurocognitive disease which affects language, behavior, or executive functioning. This disease includes a spectrum of presentations which includes multiple variants. The phenocopy syndrome of behavioral variant frontotemporal dementia is one which mimics the behavioral variant of frontotemporal dementia. Patients with this condition show a decline in personality, social conduct and cognitive ability but often display no signs of neurological imaging and exhibit slow progression. This case focuses on a now 70-year-old male who has shown signs of behavioral changes with a slowly progressive clinical course and minimal findings on PET scan, but moderate changes seen on …

Case Report: Abrupt Psychosis Or Nmda Receptor Encephalitis?, Alexis Dunn, Neelesh Parikh, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

We report a case of a 46-year-old female who was initially committed to a psychiatric facility for new onset schizophrenia symptoms. She later had an extensive workup in the hospital due to leukocytosis and was believed to have NMDA Receptor Encephalitis as the cause for her new behavioral symptoms. This case report aims to educate EM (emergency medicine) physicians to keep a broad differential diagnosis on patients who present with new onset, unprovoked psychosis later in life.

Case Report And Brief Review: A Case Of Erythema Ab Igne Due To A Space Heater, Adam Kandil, James Espinosa, Alan Lucerna, James Lee, Robin Lahr

Rowan-Virtua Research Day

A 35 year old male presented to the Emergency Department (ED) with a rash of his left lateral lower leg of a 2 months duration. The patient had been using an electric space heater and the affected area was the closest part of his body to the heater. A diagnosis of erythema ab igne was made. Here we discuss erythema ab igne in reference to the medical history of the diagnosis, pathophysiology, modern causative heat sources such as laptop computers and treatment.

Sigmoid Perforation Extending Into The Abdominal Wall, Zamran Masih, Wayne Tamaska, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Sigmoid colon perforation and spread into the abdominal wall is a rare condition that can occur due to various causes such as diverticulitis, trauma, malignancy, or iatrogenic injury during surgery. Although rare, sigmoid colon perforation into the abdominal wall can result in significant morbidity and mortality if not promptly diagnosed and treated. Most common cause of diverticular disease leading to perforation is diverticulitis, accounting for 60% of all colonic perforations.

New Onset Lichen Planus And Back Pain Leading To Discovery Of A Peri Aortic Abscess, Monica Diep, Wayne Tamaska, Philip Carhart, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Back pain is a common chief complaint in the emergency department. With the differential ranging from musculoskeletal pain to cauda equina, there are a plethora of diagnoses. Differentiating between benign back pain and back pain that warrants further evaluation and even possible emergent surgical intervention is often a challenge in the acute setting. In this case report, a strange combination of all new symptoms including lichen planus, fevers, chills and atraumatic back pain lead to the eerie and very unexpected diagnosis of a peri-aortic abscess.

Case Report And Brief Review: A Puzzling Case Of Leg And Ankle Swelling, Michael Morris, James Espinosa, Alan Lucerna, Robin Lahr, James Lee

Rowan-Virtua Research Day

Here we present the case of a medical student in his twenties who had experienced episodes of heat edema that had been previously evaluated at other EDs and thought to be possible DVT. An awareness of heat edema as a minor heat-related illness is important in order to avoid unnecessary testing and in order to help prevent future episodes

Perioperative Ketamine Use For Post Mastectomy Pain, Alessia Cooney, Jaylyn Thompson, Naomi Watkins-Granville

Rowan-Virtua Research Day

PMPS is defined as chronic neuropathic pain following breast cancer procedures in the ipsilateral arm, chest wall, axilla or shoulder.1-3 Approximately 20 to 50% of post mastectomy patients suffer from Post Mastectomy Pain Syndrome (PMPS).1 With more than 3.8 million breast cancer survivors, due to advances in treatment, there is increased importance in findings ways to better manage the quality of life of breast cancer survivors.1,4 Ketamine induces analgesic effects through its non-competitive antagonism of NDMA receptors.5 Low doses of ketamine infusion (20–30 mg x h−1) have been shown to produce analgesia in neuropathic pain states with benefits lasting up …

Dual Myristic Acid And Trans-Activator Of Transcription Conjugation Of Pkc Beta Ii Peptide Inhibitor Augments Cellular Delivery To Counteract Myocardial Ischemia/Reperfusion Injury, James Ramsarran, Logan Clair, Taurai Augustin, Zinya Talukder, Emily Andrews, Tameka Dean, Qian Chen, Robert J. Barsotti, Lindon H. Young

Research Day

INTRODUCTION: Dual conjugation of PKC Beta II peptide inhibitor (PKCβII-) with myristic acid (myr) and trans-activator of transcription (Tat) (Myr-Tat-CC-SLNPEWNET [myr-Tat-PKCβII-]) has been shown to enhance intracellular delivery and attenuate myocardial ischemia/reperfusion (I/R) injury in an ex-vivo rat model. Previously, myr-Tat-PKCβII- demonstrated significant cardioprotective effects from 100nM to the 1pM concentration.

OBJECTIVES: The lowest concentration at which myr-Tat-PKCβII- is still cardioprotective has yet to be determined; this study investigates the 100fM concentration.

METHODS: Isolated rat hearts from anesthetized male SD rats (275g to 300g) underwent global I(30-min)/R(50-min). Cardiac function was recorded via a pressure transducer. Treatments were infused during the …

Assessment Of The Impact Of Race And Proxies Of Socioeconomic Status On The Prevalence And Health Outcome Of Peripartum Cardiomyopathy (Ppcm) Using The “All Of Us” Databank, Nicole Blatt, Brian J. Balin Phd, Ahmad B. Cader, C. Scott Little, Eleonora Savio-Galimberti

Research Day

Background: Peripartum Cardiomyopathy (PPCM) is a form of cardiomyopathy occurring during the last month of pregnancy or within months after giving birth in women with previously normal hearts. PPCM is an idiopathic systolic dysfunction that causes a reduced left ventricle ejection fraction. The estimated incidence of PPCM worldwide is 1 diagnosis out of 2,000 live births, and the causes of PPCM remain unknown. A retrospective cohort study conducted at the University of Pennsylvania Health System by Getz et al. showed that black race and socioeconomic proxies (like neighborhood disadvantage index (NDI)) were independently associated with sustained cardiac dysfunction (Getz et …

A Rare Case Of Scalp Swelling In Infancy: Delayed Subaponeurotic Fluid Collection, Shreya Dundumalla

Research Day

Delayed subaponeurotic fluid collection (DSFC) is a rare cause of scalp swelling in infants presenting weeks to months after birth. DSFC is described as a mobile and soft swelling which crosses suture lines in healthy infants with no recent history of trauma or fall. A literature search in the National Library of Medicine revealed fewer than 15 publications on the topic since 2007. The exact etiology and long term consequences of DSFC remain unclear although birth trauma has been implicated as the main mechanism. A healthy 2 month old male infant presented to the ED with a one-day history of …

Comparison Of The Inhibition Of An Oct3 Transporter Inhibitor, Nilotinib, On Doxorubicin’S Effects On Cardiac And Cancer Cell Lines, Zachary G. Tan, Juliet Melnik, Aakash Belsare, James Huang, Meagan Lyons, Kimberly Dowes, Gurpreet Kaur, Lindon H. Young, Robert J. Barsotti, Qian Chen

Research Day

Introduction

Doxorubicin (DOX)-induced cardiotoxicity remains a significant barrier limiting its clinical application due to a lack of effective resolution. Targeting how DOX enters cardiac and cancer cells is a promising new strategy. Research suggests that an OCT3 transporter significantly contributes to DOX entry into the heart tissue. By contrast, it expresses much lower on breast cancer cell lines. Moreover, Nilotinib (NIB) can suppress OCT3 transporter function by 80%. Therefore, exploring the impact of NIB on the DOX’s effects on cardiac and cancer cell lines by altering DOX intracellular accumulation is intriguing.

Objective

First, we would establish a dose-response curve of …

Review Of Telemedicine Use As It Expands Since The Covid-19 Pandemic, Michael P. Perra, Frederick J. Goldstein

Research Day

INTRODUCTION: As new technology advances and the world becomes increasingly connected, medical care and physician-patient interactions have changed. Telemedicine, though present in different forms for many decades, has grown, and its use is changing at a faster-than-ever pace. The COVID-19 pandemic highlighted the utility of different telemedicine platforms and has led to an expansion in its capabilities.

OBJECTIVES: To explore the evolution of telemedicine, its multiple functions, and how this technology has continued to develop since the COVID-19 pandemic in various medical specialties.

METHODS: PubMed was used to assess published studies that either incorporated telehealth resources in their research or …

Prolonged Length Of Stay In Illeal Conduit Compared To Neobladder Diversion In Radical Cystectomy Patients For Bladder Cancer, Ryan J. Moriarty, Young Son, Brian Thomas, Ronald Clearie, Lance Earnshaw, Dayna Devincentz, Thomas Mueller

Research Day

Background:

Radical cystectomy and urinary diversion has become the standard treatment for invasive and complicated malignancies of the bladder, urethra, and ureters. [1] Robotic-assisted radical cystectomy (RARC), introduced in the last decade, has been associated with favorable perioperative outcomes when compared to open radical cystectomy. Yet little is known about how different urinary diversion types compare in regards to length of hospital stay, readmission rates, and perioperative course. This data analysis seeks to identify the statistically significant differences in postoperative course of ileal conduit versus neobladder among patients with staged bladder cancer.

Methods:

The American College of Surgeons National Surgical …

Treatment Of Bullous Pemphigoid With Dupilumab: A Case Report, Margaret C. Hurley, Jocelynn F. Dillon, Harold J. Milstein

Research Day

Introduction: Bullous Pemphigoid (BP) is an autoimmune blistering condition that results from formation of autoantibodies against basement membrane hemidesmosome proteins, specifically BP180 and BP230. Classic BP presents as pruritic, tense blisters on the trunk and extremities, most commonly in the elderly. BP’s pathophysiology involves IL4/IL5/IL13 and eosinophils. Dupilumab is an IgG monoclonal antibody targeted at the IL4-α receptor that works to attenuate the IL4/IL13 pathway involved in T2 differentiation. Dupilumab has clinical applications for T2 mediated disease and shows promise in the therapy of BP.

Case Description: We report a case of an 83-year-old Asian male who presented in the …

Maternal Psychiatric Functioning And Maternal-Infant Attachment Among Mothers Of Infants In The Neonatal Intensive Care Unit (Nicu), Elizabeth Greco, Alexa Bonacquisti

Research Day

Introduction: A growing body of research suggests that an infant’s admission to a neonatal intensive care unit (NICU) may adversely impact maternal psychiatric functioning, affecting quality of life, well-being, and patient outcomes. Additionally, there is accumulating evidence that stressful reproductive events related to a NICU admission) may even exacerbate pre-existing maternal psychiatric symptoms. The purpose of the current study was to examine the relationships between maternal mental health symptoms, including anxiety and stress, and maternal-infant attachment among mothers of infants in the NICU. By examining the psychiatric functioning measures both at the time of initial NICU admission and again 2-4 …

Revisiting The Global Measures Of Overall Neuropsychological Function And The Impact Of Race-Based Normative Data In Clinical And Forensic Populations, Zachary Dipasquale, Donald Masey, Robert A. Ditomasso, Gabriel Stanziano

Research Day

This study aims to examine the impact of race-based normative data on global measures of overall neuropsychological functioning. Further, it examines the changes made to the Average Impairment Rating (AIR) in the context of race-based norming and the dismissal of a previously included measure, Picture Arrangement. The AIR is a commonly used index to classify the severity of diffuseness related to brain injury. Despite its use, the AIR has a very limited body of research describing the impact of racial norming on the index. Based on a review of the literature, the Picture Arrangement subtest removal was never researched in …

Effects Of Sudarshan Kriya Yoga On Sleep: A Systematic Review, Paulo Castro, Hrday Kowdley, Sadhvika Ramji, Robert Joyner, Gopal Kowdley

Research Day

Introduction: Sudarshan Kriya Yoga (SKY) is a sequence of four breathing techniques used to calm the body and mind. Each breath component plays a role in producing a state of peace and is followed by rest and meditation to enhance one’s focus and feeling of connectedness. Recently, SKY has been evaluated as a possible adjunct treatment for some mental health disorders and for its role in promoting lifestyle changes, with a number of studies attempting to identify the impact of SKY techniques on sleep. In this study, we sought to assess the current literature regarding the effectiveness of SKY and …

Cardioprotective Effects Of Naltrindole In Rat Myocardial Ischemia/Reperfusion Injury Are Concentration-Dependent, Logan Clair, Tanoh Boakye, James Ramsarran, Zinya Talukder, Nikola Maricic, Ukoha Kalu, Juliet Melnik, Tameka Dean, Qian Chen, Robert J. Barsotti, Lindon H. Young

Research Day

Myocardial infarction remains a major cause of mortality and morbidity globally and infarct size is a major determinant of prognosis. Early and successful restoration of myocardial reperfusion is effective to reduce final infarct size and improve clinical outcomes. However, reperfusion induces further damage to the myocardium, hence the need for adjunctive therapy. Cardioprotective therapies to limit myocardial hypercontracture that occurs during prolonged ischemia and is associated with ischemia-reperfusion (I/R) injury are an important clinical goal. Previously, naltrindole (NTI, 5µM), when given prior to ischemia, exerted cardioprotective effects in ex-vivo, rat myocardial I/R, in part, by attenuating ischemic hypercontracture that occurred …

Racial Differences In New-Onset Cardiovascular Disease In Men With Prostate Cancer Treated With Hormone Therapy, Tyler Gaines, Adedayo Adetunji, Elizabeth Blackman, Camille Ragin, Phillip Abbosh

Research Day

INTRODUCTION

Cardiovascular disease is the leading cause of death in patients with prostate cancer. Despite its efficacy in the treatment of advanced prostate cancer, androgen deprivation therapy (ADT) has been associated with increased cardiovascular disease mortality. Given black men have elevated risk of cardiovascular disease mortality compared to other racial groups, this study sought to evaluate the relationship of race with ADT-associated cardiotoxicity.

METHODS

We conducted a retrospective chart review of patients with locally advanced and metastatic prostate cancer who received androgen deprivation therapy at a single institution from 2017 to 2022. Methods of ADT included gonadotropin-releasing hormone agonists/antagonists, non-steroidal …

A Rare Case Of Scalp Swelling In Infancy: Delayed Subaponeurotic Fluid Collection, Shreya Dundumalla, Jamie Cashell

Research Day

Delayed subaponeurotic fluid collection (DSFC) is a rare cause of scalp swelling in infants presenting weeks to months after birth. DSFC is described as a mobile and soft swelling which crosses suture lines in healthy infants with no recent history of trauma or fall. A literature search in the National Library of Medicine revealed fewer than 15 publications on the topic since 2007. The exact etiology and long term consequences of DSFC remain unclear although birth trauma has been implicated as the main mechanism. A healthy 2 month old male infant presented to the ED with a one-day history of …

Spontaneous Retroperitoneal Hematoma In A Patient On Lifelong Anticoagulation With Secondary Femoral Neuropathy: A Case Report, Briana D. Ward, Catherine Linh, Ronald Lincow

Research Day

Setting: Outpatient pain management office

Case Diagnosis: A 52-year-old man presents with spontaneous retroperitoneal hematoma and secondary femoral neuropathy.

Introduction: While traumatic retroperitoneal injury is common, spontaneous retroperitoneal hematoma (SRH) is relatively rare with a documented rate of 0.6-6.6%. Spontaneous retroperitoneal hematoma typically presents with pain of the abdomen, hip, or leg. Rarely, symptoms associated with lumbosacral plexus compression are present. Leg numbness and weakness are present in less than 10% of cases. Today, treatment remains largely conservative with a low percentage of patients requiring angioembolization.

Case Description: A 52-year-old male with significant past medical history of mechanical aortic valve …

Does Low-Grade Follicular Lymphoma With High Proliferation Index Require A Different Treatment Strategy? A Single Center Experience., Urwat T. Vusqa, Brooke Arner, Rahim Jiwani, Georgia Gagianas, Cyrus Khan, John Lister, Yazan Samhouri

Research Day

Background:

Follicular lymphoma is the most common indolent non-Hodgkin lymphoma (NHL). It accounts for 35% of all NHL. FL is divided into three grades based on the proportion of centroblasts. The clinical aggressiveness increases from grade 1 to 3a, but this does not translate to a different therapeutic approach. Some FL patients have a high proliferation index despite having low grade. We assume patients with high proliferation index FL have a more aggressive disease requiring a different therapeutic approach. Here, we examine this theory in a cohort of 145 patients with follicular lymphoma

Methods:

This is a retrospective study of …

Mindfulness And Acceptance In The Neonatal Intensive Care Unit: A Trauma-Informed Approach, Chloe Hriso, Alexa Bonacquisti

Research Day

Preterm labor or other medical conditions resulting in Neonatal Intensive Care Unit (NICU) admission has an immense potential to be a traumatic event for both parents and their babies. Birth trauma in the context of the NICU may lead to a heightened stress response, decreasing one’s ability to cope with those stressors. This experience may have long-lasting effects for both parents and infants, necessitating a better understanding of interventions that can be offered during NICU admission and beyond to address trauma responses from both a physical and psychological perspective. The positive effects of mindfulness and acceptance-based interventions have the potential …

Machine Operator With Central Cord Syndrome: A Case Report, Catherine Linh, Ronald Lincow

Research Day

Setting: Outpatient pain management office

Case Diagnosis: A 30-year-old man presents with central cord syndrome (CCS) after cervical spine trauma.

Introduction: Central cord syndrome (CCS) is most commonly caused by cervical spine trauma with an incidence of 11,000 cases annually in the United States. Despite CCS being the most common type of incomplete spinal cord injury, treatment is still controversial and varies from conservative management to early surgical intervention.

Case Description: After sustaining a closed head trauma by 350 lb lead object at work, the patient presented with weakness, numbness, and tingling in the bilateral upper and lower extremities and …

Strategic Use Of Wellness Ambassadors To Increase Attendance Of Initial Mental Health Appointments, Kaitlyn Blair, Mirna Law, Bettina Bernstein

Research Day

Background

Many adults and children with mental health conditions in the US do not receive treatment, and in Philadelphia alone, there were 174 suicide deaths in 2017. The shortage of mental health professionals and long wait times are significant barriers to accessing mental health care. Executive function difficulties can make it challenging for individuals to maintain a schedule for mental health appointments. A study found that reminder phone calls result in an increased rate of mental health appointment keeping. The goal of this project is to increase attendance of first mental health appointments by patients referred to mental health services …

Reasons For Not Refilling Medications: A Research Proposal, Tori E. Abdalla, Frederick J. Goldstein

Research Day

INTRODUCTION:

It is estimated that medication non-adherence costs the United States approximately 528 billion dollars annually. Of that amount, it is estimated that only 50% of medications are adhered to for treatment of chronic diseases. Targeting improvement of a single aspect of medication non-adherence, e.g., refill compliance, could increase successful treatment of any medical condition where this a problem. Several broad solutions have been proposed, such as provider education, increased communication, and technology-based interventions; however, without knowing why patients do not refill their medications, providers might not know which solution(s) to initiate.

OBJECTIVES:

The aim of the proposed study is …

In Vitro Naltrindole Mitigates Phorbol 12-Myristate 13-Acetate Induced Superoxide Release In Polymorphonuclear Leukocytes Independent Of Delta Opioid Receptor Antagonism, Devani A. Johnson, Taylor A. Dilisi, Juliet Melnik, Denise Pinto, Alexandra Barrera, Arjun Nair, Zinya Talukder, Tameka Dean, Qian Chen, Robert J. Barsotti, Lindon H. Young

Research Day

Introduction:

Naltrindole (NTI) is a selective delta opioid receptor antagonist that recently has been shown to be cardioprotective in both in vivo and ex vivo studies. In vivo, NTI showed cardioprotective effects that were dose-dependent significantly reducing infarct size up to 82% compared to control (p<0.05). In ex vivo isolated rat hearts, NTI significantly reduced infarct size compared to controls (p<0.01). NTI restored cardiac left ventricular end diastolic pressure to near baseline values compared to controls or other general opioid receptor antagonists in ex vivo hearts, suggesting a tissue salvaging mechanism independent of opioid delta receptor antagonism. Polymorphonuclear leukocytes (PMNs) do not express opioid receptors. In this study, we investigated NTI attenuation of PMN superoxide (SO) release in vitro. We hypothesized that NTI would attenuate SO release in PMNs via a calcium handling mechanism, a similar mechanism that explained cardioprotective effects of NTI pretreatment that mitigated ischemic hypercontracture that is due to an increase in intracellular calcium.

Methods:

Rat PMNs (5x 106) were incubated for 15 min at 37oC in the presence or absence (dH2O vehicle control) of NTI (10μM, 50μM, or 200 μM). PMN SO release was calculated by the change in absorbance at 550 nm over 420 sec via ferricytochrome c reduction after phorbal 12-myristate-13 acetate (PMA) stimulation (100nM). …

Atraumatic Hamstring Tendon Rupture Causes Massive Lower Extremity Pyomyositis; Initially Read As Neoplasm, Anthony Cappellino, David Sevitski

Research Day

INTRODUCTION: Pyomyositis is a rare bacterial infection of skeletal muscle resulting in pain, tenderness, fever, and abscess formation, most commonly caused by staphylococcus aureus. Risks factors of pyomyositis include muscle trauma, skin infection, injections, and diabetes. Pyomyositis arises from hematogenous seeding predominately affecting immunocompromised patients in moderate climates.

CASE DESCRIPTION: A 53 year old female with a past medical history of HTN, HLD, OSA, and obesity initially presented to her PCP with atraumatic right sided lower back pain. The PCP referred the patient for x-ray imaging at L5-S1 that came back negative for fracture. Two weeks after the patient’s initial …