Medicine and Health Sciences Commons^™

Case Study Of Metformin-Induced Lactic Acidosis, Kajel Patel, Kishan B. Patel

Rowan-Virtua Research Day

Metformin induced lactic acidosis is when high levels of metformin cause dangerously high levels of lactic acid. Here is a case report of a 72-year-old female who came in for nausea, vomiting, and diarrhea found to have a high suspicion for metformin induced lactic acidosis. She stabilized in the emergency department, nephrology and ICU was contacted, and she went for emergent dialysis. For many patients the prognosis of metformin induced lactic acidosis is poor. This patient was made comfort care by her family.

Incidental Finding Of Unusually Large Renal Cyst During Point Of Care Ultrasound, David Ho, Jeffrey Gardecki

Rowan-Virtua Research Day

Renal cysts are common, and their frequency and size increase as patients age. Renal cysts are derived primarily from tubules and can occur anywhere between Bowman’s capsule to the renal papilla. The cysts are composed of abnormally differentiated epithelial cells encapsulating a cavity of fluid. These abnormally differentiated cells are due to defects in the structure and function of cilia, the structures responsible for detecting urine flow as well as the epithelial composition of the epithelial architecture and repair. According to Campbell Urology, there are three processes in which renal cysts increase in their size – proliferation of epithelial cells …

Interaction Of Fluorescent Probes With Sirtuin Proteins, James Fusco, Brian P Weiser

Rowan-Virtua Research Day

Sirtuins are a class of proteins belonging to the Sir2 (Silencing information regulator 2) family of NAD+ dependent protein lysine deacylases. Different Isoforms (SIRT1-SIRT7) differ in their specific deacylase activity and cellular location. They have roles in DNA repair, glucose metabolism, and cellular proliferation which make them highly desirable targets for carcinoma therapeutics. We previously used 1-aminoanthracene’s (AMA) fluorescent properties when bound with SIRT2 (Kd of 37 μM) to develop a high-throughput screen to identify novel ligands that inhibit SIRT2’s enzymatic activities. We hope to reveal other potential probes for future high-throughput screening with all the sirtuin isotopes. 1-AMA’s fluorescence …

Literature Review: Incidentalomas In Emergency Medicine - How Often Are They Reported And Are Patients Informed?, Mohammad Rattu, James Espinosa, Alan Lucerna, James Lee

Rowan-Virtua Research Day

The purpose of this proposed study is to look at the rate of incidental findings on CT scan in a community hospital setting, as well as to look at the rate of documentation of communication of the findings to the patient and referral for follow-up to primary care or to a specialty follow-up.

Literature Review: Palliative Care In The Emergency Department, Alice Chang, James Espinosa, Alan Lucerna, Neelesh Parikh

Rowan-Virtua Research Day

With current medical advances, our patient population continues to age. This poses new challenges for healthcare practitioners to provide for elderly patients with complex and multifactorial medical needs. Particularly, this is a growing challenge in the emergency department (ED), where patients often present towards the last months of their lives. A study conducted by UCSF indicates 75% of patients in their last 6 month of life visited the ED. 56% to 99% of older adults do not have advance directives available at ED presentation. Therefore, ED visits towards the end of life is an opportune teaching moment for physicians to …

Management Of Late-Stage Ewingoid Dedifferentiated Liposarcoma Of The Spermatic Cord With Emergent Complications: A Case Report, Raeann Dalton, Abdullah Junayed, Brian Thomas, Young Son, Megan Donlick, Kathryn Goettle, Lance Earnshaw, Thomas Mueller

Rowan-Virtua Research Day

Liposarcoma (LS), a malignant tumor of adipose origin, is the most common soft tissue sarcoma (STS), and can develop within any soft tissue. It rarely occurs in the paratesticular region, and accounts for 3-7% of spermatic cord tumors. Dedifferentiated liposarcoma (DDLS) and well-differentiated liposarcoma (WDLS) account for two of the five subtypes of LS, with dedifferentiation occurring in 20% of cases. There have been 66 cases of DDLS of the spermatic cord reported to date, but none present with a 22/22q trisomy without the fusion or rearrangement that commonly produces these aggressive tumors.

Accurate diagnosis of LS of the spermatic …

Long-Term Lithium Use In The Younger Population: Do The Benefits Outweigh The Risks? - A Case Report, Seema Shekar, Alexander Garcia, Rachel Shmuts

Rowan-Virtua Research Day

For decades lithium has been the mainstay treatment for bipolar disorder. While its side effect profile is extensive and varied its most notable adverse effect, and one most feared by treating clinicians, is nephrotoxicity/ end-stage renal disease (ESRD). While the link between long-term lithium use and ESRD has been accepted by the medical community at large for many years, more recent scientific studies call the association into question. In fact, newer studies on the association between Li use and ESRD have shown a negative/inconclusive correlation. Despite this controversy the consensus still remains that ESRD secondary to long-term Li use is …

Lung Hernia: An Uncommon Cause Of Pleuritic Chest Pain, Brittany Fera

Rowan-Virtua Research Day

Lung hernia is a rare but important consideration in the differential diagnosis of chest pain in patients with recent thoracic trauma or a history of thoracic surgery. Patients who undergo an anterior approach to thoracotomy, as was the case with our patient, are at a higher risk for developing lung herniation as a result of inherent anatomical weakness and wider intercostal spaces anteriorly and inferiorly.

Inclusive Approaches For Measuring Demographics Of Underrepresented Populations In Stem And Biomedical Research Training Programs, Stephanie E. Paris, Teala W. Alvord, Brandy Lentz, Mollie C. Marr, Angie Setthavongsack, Alexis Dinno, Jae Downing, Aaron Raz Link, Dawn M. Richardson, Shanthia N. Espinosa, Phuc T. Nguyen, Lisa K. Marriott

Student Research Symposium

Federal strategic plans call for increased diversity within the biomedical workforce. The National Institutes of Health (NIH) defined underrepresented populations in biomedical science (NOT-OD-20-031), though operationalization remains a challenge for training programs. Implementing inclusive demographic measures may help to identify key demographic groups facing barriers to participation and retention in STEM programs and the biomedical workforce. Approaches for measuring demographic variables were sourced from scientific literature and research stakeholders. Gender, race/ethnicity, disability, and disadvantaged background were prioritized for comparison given their focus by NIH, with opportunities for stakeholders to identify additional demographic variables important in their work. Gender minorities, sex …

Barriers And Supports For Stem Motivation For Pacific Islander High School And Undergraduate Students, Shanthia N. Espinosa, Alma M. O. Trinidad, Lisa K. Marriott

Student Research Symposium

Pacific Islander (PI) students disproportionately come from low socioeconomic backgrounds and are often first-generation college students. PI students have been historically underserved with limited access to educational resources and support. As a result, PI students face low student retention rates and have reported dissatisfaction with higher education student services. There is little research dedicated to understanding the STEM experiences of PI students related to access, success, and motivational resilience in higher education. This study examines barriers and facilitating factors for motivation among PI students using electronic surveys, focus groups, and group discussions. Participants comprise high school and undergraduates residing in …

Concurrent Malignant And Benign Nephrosclerosis In An Elderly Cadaver With Previously Diagnosed Cerebral Atherosclerosis, Destiny Sciuva, Jake Winchester, Emon Alavi, Sritha Moram, Dhruvi Patel, Alexander Cohen, Shiv Dhiman, Savita Arya

Research Day

We report histopathological features of concurrent malignant and benign nephrosclerosis in an 83-year-old elderly cadaver. Upon routine dissection in a medical school cadaveric anatomy lab, the abdomen of an 83-year-old female showed contracted and granular bilateral kidneys, with subsequent measurements identifying decreased size. Tissue samples were retrieved from the left anterior descending artery, left ventricle wall, bilateral kidneys and lungs. Histopathology slides were prepared using hematoxylin and eosin (H&E) stains. The samples were retrieved from a female cadaver in the Philadelphia College of Osteopathic Medicine, Georgia Body Donor Program. Histopathological findings in the kidneys included fibrinoid necrosis of arterioles, diffuse …

Case Report: Abdominal Aortic Aneurysm, Aishwarya Reddy, Jeffry Rima, Nick Morey, Jalisa Jones, Connor Lambert, Shiv Dhiman, S Arya

Research Day

Many research studies have demonstrated that age is a primary risk factor for the prevalence of diseases within developed countries, most notably concerning cardiovascular disease, which has been found to be the leading cause of death globally. Among the diseases that fall beneath this umbrella term of cardiovascular disease, aortic aneurysms (AA) and cerebrovascular accident (CVA; i.e. stroke) are two of the more prevalent and well-known diseases that are identified among the elderly population. However, despite the increasing prevalence of both AAs and CVAs within the elderly in tandem with their shared risk factors - hypertension, smoking, hyperlipidemia, etc. - …

Urothelial Carcinoma Arising Within Bladder Diverticulum Secondary To Benign Prostatic Hyperplasia: Report Of A Cadaveric Case And Review Of Literature, Lan Huynh, Zhi Kuat, Brandon Stevens, Shiv Dhiman, Savita Arya

Research Day

Bladder diverticulum, which can be present in 1% to 10% of the general population, is an outpouching of the bladder urothelium through the muscular bladder wall. The vast majority of bladder diverticula are acquired and occur more commonly in men with neurogenic dysfunction or bladder outlet obstruction. Due to the lack of a muscular layer, bladder diverticulum loses its contractility and ability for effective urine emptying, which increases the risks of chronic inflammation and malignant transformation. Neoplasms arising within diverticula are uncommon, which vary from 0.8% to 13% of vesical diverticulum cases reported and have the potential to invade perivesical …

Racial Discrepancies In Pulse Oximetry Reading And Their Effects On Self-Monitoring Devices Usage And Clinical Decision-Making, Lola Sewo, Anthony Dove, Justice Dove, Dana Marie-Gould, Destandreana Norwood, Laurie'l Latimer, Robert Walker

Research Day

INTRODUCTION: As technology use rises and the use of pulse oximetry data increases, the demand for accurate oxygen saturation (SpO2) readings is paramount to ensure health equity among all populations. Pulse oximetry is a non-invasive tool used to monitor SpO2. Self-monitoring devices, such as SMART devices, allow for portable and cost-effective utilization; therefore, self-monitoring device usage and pulse oximetry data are quickly becoming more available to patients and their providers. Pulse oximetry is a critical component used when evaluating the severity of arterial deoxygenation. Providers often use data from pulse oximetry to determine treatment options. Recent studies have found …

Superficial Ulnar Artery And Its Clinical Significance, Lola Sewo, Maxwell Dacquel, Sumbal Irshad, Vinayak Narayan, Sager Pattani, Shiv Dhiman

Research Day

We present a case with an atypical variation of the ulnar artery discovered while examining a cadaver in our routine Gross Anatomy lab dissection. A superficial ulnar artery was found in a 55-year-old male cadaver originating directly from the brachial artery. This is a rare variation where the route of the ulnar artery runs superficially to the flexor compartment in the forearm. Based on previous cadaver studies, the incidence of such variation in the adult population appears to be approximately 3.75%. Deviations in the ulnar artery can lead to a potential risk of injury to patients during surgery. The superficial …

Colorectal Metastasis Within An Adult Male Cadaver: Case Report And Review Of Literature, Destandreana Norwood, Dana-Marie Gould, Laurie'l Latimer, Georgina Boateng, Brigitte Cochran, Shiv Dhiman, Savita Arya

Research Day

INTRODUCTION:

During a routine lab dissection, lesions were found to be scattered along the mesentery of the colon and small intestines, as well as the abdominal peritoneum. Due to its presentation and histological analysis, a diagnosis of adenocarcinoma was made. Adenocarcinomas are mucus-secreting cells that are found within and near the glands of organ (Nakhaie, Mohsen et al., 2020). One of the most common clinical manifestations of adenocarcinomas is within the colorectal region due to the numerous mucous secreting cells found within these sites. Literature reviews have indicated that different metastasis patterns that can differentiate between adenocarcinomas of various histological …

Gross Anatomy Of Bifid Xiphoid Process, Shahrzad Zamani, Sara Meawad, Tamryn Van Der Horn, Shiv Dhiman

Research Day

Introduction: Xiphoid process is the ossified extension of the lower sternum in the chest midline of human adults. Natural variance in this process results in the less common bifurcated morphology.

Objective: The primary objective of this study was to explore the distribution of the bifid variant. As a secondary objective, we aimed to compare bifurcated Xiphoid processes to other possible variations.

Methods: A case study was designed to explore the distribution of bifid variants in a sample of cadavers (n=30) at a large medical education institution. The dependent variable was binarized (bifid or normal) and univariate analyses were performed based …

Refractory Herpes Virus Pseudotumor In An Immunocompromised Patient, Pavan Patel, Smera Saikumar, David York

Research Day

Background: HSV infections can characteristically present as pseudotumor in patients with uncontrolled HIV infection. Herpes simplex virus type 2 (HSV-2) infection rates range from 60% to 90% in individuals who are co-infected with HIV.

Case Presentation: A 48-year-old patient who presented with large fungating mass near her right inferior vulva with hardness and induration. The mass was 4 cm x 3 cm in size and was excised in the operating room. The pathology was negative for malignancy, however, it showed lymphoplasmacytic proliferation with immunostaining positive for HSV virus.

Conclusion: Any patient that presents with a tumor-like mass in their perineum …

A Paraurethral Aggressive (Deep) Angiomyxoma, Smera Saikumar, Pavan Patel, Christian Edwards, Geosette Garcia, Daniel York, Hyder Naqvi

Research Day

Background: Aggressive angiomyxomas (AAs) are rare mesenchymal tumors that are histologically composed of myxoid stroma and vasculature. AAs are typically located in the pelvis and perineum and occur more frequently in females of reproductive age. Although a complete resection of the AA is the definitive cure, it is often difficult to achieve due to a lack of capsule in the tumor.

Case Presentation: In this report, we outline a patient who had a paraurethral tumor for eight months before symptoms were observed. The mass measured 3.55 cm x 2.0 cm x 1.5 cm and was excised in the operating room …

Hypersensitivity Pneumonitis: A Clinical Case With Rapid Resolution On Imaging, Jordan Erdfrocht, Max Kabolowsky, Lyndsey Nguyen, Alyson Meyer, Christine Sykalo

Research Day

Introduction

Hypersensitivity pneumonitis is a rare interstitial disorder characterized by an immune reaction of the lung parenchyma, usually to a sensitized allergen. Pneumonitis is a common cause of respiratory decline among those with comorbid conditions such as chronic obstructive pulmonary disease and congestive heart failure. The use of corticosteroids in patients with pneumonitis is well documented, but their role in the treatment is not clearly understood.

Case Presentation

Patient is a 58-year-old female with past medical history of polymyalgia rheumatica, osteoporosis, and current smoker who presented with a three day history of progressive shortness of breath, dyspnea on exertion, orthopnea, …

Covid-19 In Children: A Pediatric Case Of Multisystem Inflammatory Syndrome And Shock, Max Kabolowsky, Lyndsey Nguyen, Jen Petar, Ravi Raman

Research Day

Multisystem inflammatory syndrome in children (MIS-C) is a severe hyperinflammatory condition characterized by fever, systemic inflammation, and multiorgan dysfunction that manifests late in the course of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). MIS-C generally occurs 2 to 6 weeks after SARS-CoV-2 infection. The incidence of MIS-C is unknown, although it appears to occur in less than 1 percent of children with confirmed SARS-CoV-2 infection. MIS-C has overlapping clinical features of toxic shock syndrome and Kawasaki disease, although the pathogenesis is unclear. Epidemiologists, researchers, and clinicians are struggling to describe and characterize the disease phenomenon while treating patients at the …

Benign Cyst In The Popliteal Fossa: A Cadaveric Case Study, Rachel Sackett, Morgan Ivey, Terrance Orange, Randall Sheffield, Nabeel Siddiqi, Shiv Dhiman, Savita Arya

Research Day

During routine dissection of 10 cadavers that originated from the Body Donor Program at Philadelphia College of Osteopathic Medicine South Georgia, an 82-year-old female with a Baker's cyst anomaly located medially in the right popliteal fossa was encountered. The Baker's cyst contained synovial fluid in a thick bursal covering. This finding is suggestive of pathology in the knee joint, such as arthritis or a tear in cartilage or ligaments. This case study analyzes the Baker's cyst found during dissection and its clinical significance.

Feeding And Swallowing Disorders In 100 Children With 22q11.2 Syndrome, Jana Ghulmiyyah

Research Days

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Background: 22q11.2 deletion syndrome (22q11DS) is the most common microdeletion syndrome. The syndrome includes a wide range of variable features including congenital heart disease, palatal abnormalities, immune deficiency and learning difficulties. Otolaryngologic manifestations include hearing loss, characteristic facial features and laryngotracheal abnormalities. A few studies have reported dysphagia as a common feature of this syndrome however little is known about the specific feeding and swallowing difficulties that occur in children with 22q11DS.

Objectives/Goal: The aim of the study is to identify the frequency of feeding and swallowing disorders in a large cohort of pediatric patients …

Evaluation Of A Modified Pre-Medication Algorithm For Non-Emergent Intubation In A Neonatal Intensive Care Unit, Lilah Melzer

Research Days

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Background: The use of pre-medication for elective non-emergent intubation in neonates and infants has been suggested to minimize physiologic instability, decrease oral/pharyngeal trauma and decrease time and attempts to successful intubation. A pre-medication algorithm including the use of Fentanyl + Atropine was modified to include a higher dose of fentanyl with addition of muscle relaxant and benzodiazepine in a level IV neonatal intensive care unit.

Objective: The objective of this study was to compare first attempt success of intubation pre- vs post-modification of the pre-medication algorithm.

Methods: This is a single site retrospective chart review. …

Inpatient Outcomes For Children Receiving Empiric Methicillin-Resistant Staphylococcus Aureus Coverage For Complicated Pneumonia, Sophia Hackman

Research Days

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Background: Pediatric community acquired pneumonia is responsible for an estimated 124,000 hospitalizations annually in the United States, with up to 40% of hospitalized children subsequently developing a complicated pneumonia (i.e., effusion/empyema). Children with complicated pneumonia commonly require increased numbers of procedures, have exposure to broad-spectrum antibiotics, and have prolonged hospitalizations. While the prevalence of pneumonia has overall declined with childhood vaccination, the number of children with complicated pneumonia has remained stable. Current guidelines do not adequately address antibiotic management of pediatric complicated pneumonia specifically when to utilize methicillin-resistant Staphylococcus aureus (MRSA) coverage, likely contributing to …

Improving Antibiotic Durations For Skin And Soft Tissue Infections In Pediatric Urgent Care Clinics, Megan Hamner

Research Days

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Problem Statement/Question: Although national guidelines recommend 5-7 days of oral antibiotics for most skin and soft tissue infections (SSTIs), in 2019, CMH urgent care clinics (UCCs) prescribed > 7-day courses for 42% of patients diagnosed with SSTIs. Prolonged antibiotic courses result in increased patient burden, cost and adverse events which could be prevented by prescribing shorter courses.

Background/Project Intent (Aim Statement): To increase the percentage of patients receiving 5- 7 days of oral antibiotics for SSTIs from 58% to 75% by December 31st, 2021, in CMH UCCs.

Methods (include PDSA cycles): We formed a multidisciplinary team …

A Novel Approach To Triosephosphate Isomerase Deficiency, Kyra Mccarty

Research Days

Background: Triosephosphate isomerase deficiency (TPID) is a glycolytic pathway enzymopathy causing hemolytic anemia and neurologic dysfunction. TPID is caused by mutations in the TPI1 gene. These patients experience severe hemolytic anemia in infancy followed by progressive neurodegeneration. Diagnosis of TPID is made by measuring decreased TPI enzyme activity elevated dihydroxyacetone phosphate (DHAP) levels in the blood. The diagnosis is confirmed by molecular genetic testing. Neurological involvement typically manifests between 6 and 24 months of age, causing progressive motor dysfunction. Chronic axonal neuropathy is often present on nerve biopsy, and peripheral neuropathy is evident on electrophysiologic studies. Splenectomy and blood transfusions …

Supraclavicular Neck Mass In A 14 Month Old Boy, Jana Ghulmiyyah

Research Days

Background: Lipoblastoma is a rare benign tumor arising from embryonic fat cells in children younger than 3 years of age. They rarely present in the neck and usually do not have spindle cell appearance. We therefore present a case of neck lipoblastoma with review of the literature.

Case Description: We present the case of a 14-month-old male who presented with 1 month history of a right supraclavicular neck mass that was enlarging gradually. On physical exam, it was non tender, mobile with no overlying skin changes. Patient did not have any respiratory distress. A fine needle aspirate (FNA) showed spindle …

Diagnostic Features And Clinical Outcomes Of Children With Tubulointerstitial Nephritis And Uveitis Syndrome (Tinu), Christian Oliveros

Research Days

Background: Tubulointerstitial nephritis and uveitis (TINU) syndrome is an inflammatory disease that affects the kidneys and eyes. TINU is rare, but likely under-recognized due to variable clinical presentation, nonspecific symptoms, and lack of universally accepted diagnostic criteria. The optimal treatment approach in children with TINU remains unknown.

Objectives/Goal: The purpose of this case series is to contribute further knowledge to this rare disease by describing disease features and treatment response of patients with TINU treated at a single center.

Methods/Design: A retrospective chart review was performed of children diagnosed with TINU at a single tertiary care children’s hospital since January …

Primary Venous Thromboprophylaxis In Pediatric Oncology Patients, Kyra Mccarty

Research Days

Background: The Virchow’s Triad principles of venous stasis, endothelial damage, and hypercoagulability are all features of malignancy and contribute to the increased risk venous thromboembolism (VTE) seen in oncology patients. Additionally, certain chemotherapy treatments, presence of a central venous catheter and immobility are also intrinsically associated with malignancy diagnoses and exacerbate this risk. However, much debate exists over the use of thromboprophylaxis in the pediatric population, primarily due to lack of evidence regarding safety and efficacy, primarily the risk of major bleeding. Multiple retrospective studies have attempted to identify the primary risk factors for VTE in this pediatric oncology patient …