Medicine and Health Sciences Commons^™

Outcomes Of Thoracic Endovascular Aortic Repair (Tevar) Procedure In Octogenarians, Nonagenarians And Centenarians: A Population-Based Study, Dakota B. Pastore, Tony Elias, Rafail Beshai, Kyrillos Girgis, Maziyar Daneshvar, Keith Anacker

Rowan-Virtua Research Day

Introduction: Limited data exists for patients undergoing a thoracic endovascular aortic repair (TEVAR) procedure who are older than or equal to 80 years old (YO). This study sought to examine the national inpatient sample (NIS) database to describe in-hospital outcomes among these older patients.

Methods: The NIS was searched for hospitalizations of adults who underwent a TEVAR procedure in 2019 and 2020. The study compared those aged 80 YO and over to those younger than 80 YO. The primary outcome was inpatient mortality. Secondary outcomes included hospital length of stay (LOS), and total hospital charges (TOTHCG).

Results: This study included …

Sex Differences In Outcomes Among Patients Undergoing Thoracic Endovascular Aortic Repair (Tevar) Procedure: A Retrospective Cohort Study, Dakota B. Pastore, Tony Elias, Rafail Beshai, Kyrillos Girgis, Maziyar Daneshvar, Keith Anacker

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Introduction: There is limited data about sex differences in patients undergoing a thoracic endovascular aortic repair (TEVAR) procedure. This study sought to examine the national inpatient sample (NIS) database to describe in-hospital outcomes by gender.

Methods: The NIS was searched for hospitalizations of adult patients who underwent TEVAR in 2019 and 2020. For this cohort, female patients were identified, and pregnant patients were excluded. The primary outcome was inpatient mortality. Secondary outcomes included hospital length of stay (LOS), and total hospital charges (TOTHCG).

Results: This study included 696 patients who underwent TEVAR. 255 (36.6%) females were identified, of which, 7 …

Evaluating The Effectiveness Of A School-Based Cognitive Behavioral Youth Depression Prevention Program In Improving Life Satisfaction, Roshani Patel, Steven M. Brunwasser, Alissa Hochman

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Depression is the leading cause of disability worldwide, known as the global burden of disease. Incident cases from 1990 to 2017 have increased by 49.86%. Additionally, rates have been seen to dramatically rise in adolescents aged 18-25 (17%) compared to rates in individuals aged 10-14 (1.1%). This makes it beneficial to have prevention programs for middle school aged children. The Penn Resiliency Program (PRP) is a youth depression prevention program focused on cultivating healthy thinking styles and behavioral coping skills. In our study, we used archival data from a randomized control trial of PRP to evaluate whether the program led …

Accessibility To Gender Affirming Treatments For Transgender Patients In New Jersey, Tara Young, Tara Pellegrino

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Background: The literature clearly indicates that gender affirming treatments, such as gender reassignment surgery, counseling, exogenous hormones, and feminization/masculinization surgery, are highly effective and beneficial for transgender patients.

Purpose: The purpose of this review was to assess the barriers to accessing gender affirming treatments in New Jersey.

Methods: This review utilized the PubMed database and Google searches to gather information. The search terms included LGBTQ healthcare, LGBTQ Medicaid, transgender treatment, transgender healthcare, top surgery New Jersey, New Jersey Medicare and Medicaid, and transgender Health Insurance in New Jersey.

Results: New Jersey State Medicaid covers both gender affirming surgery and …

Investigating Patient Barriers In Receiving Mammography Screenings Following The Covid-19 Pandemic, Nicole Clarke, Tara Pellegrino

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Current literature shows reduced breast cancer mortality is associated with compliance of mammographic screenings (Duffy, 2020), specifically increasing the survival rate an estimated 1-2% every year for the past thirty years (Giordano, 2004). However, during the Covid-19 pandemic, rates of basic cancer screenings, including breast cancer, all declined (Chen, 2021). Unfortunately, even in a “post-pandemic” world, years after the height of the pandemic, the Rowan-Virtua School of Osteopathic Medicine Family Medicine Office has noticed many female patients still have not kept up with their routine basic healthcare screenings. While there are many barriers in access to healthcare, this survey-based study …

Effects Of Exercise On The Cardiovascular Health Of Adolescents And Young Adults With Down Syndrome, Samarth Gupta

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Introduction: It is known that the incidence of Down Syndrome has increased over time and that this condition is associated with congenital heart defects, lower cardiorespiratory capacity, and increased rates of obesity and type 2 diabetes. It has been shown that individuals who have congenital heart defects but not Down Syndrome have increased cardiorespiratory function after engaging in exercise. Unfortunately, the role of exercise in improving cardiovascular health outcomes among individuals with DS is not yet fully understood.

Results: Exercise has been found to improve several health outcomes among individuals with Down Syndrome. For example, moderate to vigorous treadmill exercises …

Impact Of Diabetic Education On Reducing Hospital Readmission Rates: A Literature Review Of Adults With Diabetes, Frank Camarda

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According to 2018 data from the Diabetes Institute Foundation, adults in the U.S. diagnosed with diabetes accounted for 17 million emergency department visits. The readmission rate for patients with diabetes far exceeds the general readmission rates for hospitalized patients. While there is recognition of the need for diabetic education to reduce hospital readmissions, optimizing long-term self-management of diabetics remains a focus of ongoing research.

Incorporating Ai Tools To Enhance Information Literacy And Critical Thinking In First Year Medical Students, James Martin Ii, Mercedes Byrd

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This study aims to evaluate the impact of an educational intervention incorporating medical databases, search engines, and generative artificial intelligence (GAI) tools on the critical thinking skills and confidence of first-year medical students at Rowan-Virtua School of Osteopathic Medicine (SOM). Approximately 125 students participating in a three-week pre-matriculation program will be subjects of the study. The intervention will consist of a curriculum focused on developing research questions, using search tools and GAI, evaluating sources, and writing a research paper. Pre- and post-tests, including a CARS assessment and a perceived knowledge and abilities questionnaire, will be administered to measure changes in …

The Correlation Of Consistent Exercise With Depressive Symptoms, John Gericke, Tara Pellegrino, Robert Steer

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Background: Depression is a major health issue that affects an estimated 350 million people worldwide. Typically, depression is associated with individuals who follow a poor diet and are physically inactive. Exercise is one form of treatment for depression and has been shown to reduce the risk of depression and protect against the onset of depression. The PHQ-9 Depression Score is a tool used to screen individuals for depression on a scale from 0-27. The goal of this study is to identify a relationship between consistent exercise and depression symptoms.

Methods: An original Qualtrics survey was created to be distributed with …

A Literature Review Of Pain Control In Osteoarthritis Patients Using Blood Flow Restriction Training, John Gericke, Dakota Pastore, Tyler Pigott

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Background: Osteoarthritis (OA) is a degenerative disease that mainly affects articular cartilage of joints. OA most commonly affects the knees and causes pain and reduces quality of life in older adults. Blood flow restriction (BFR) occludes arterial and venous flow during exercise using a blood pressure cuff placed on the proximal lower limb. This creates an intramuscular hypoxic environment which promotes muscle hypertrophy. High load training can cause pain and inflammation in knee OA patients due to increased stress. BFR can allow patients with knee OA to use lower loads to achieve beneficial effects of rehabilitation.

Methods: Data was ascertained …

Resection And Reconstruction Of Ewing Sarcoma Of The Cuboid Utilizing Vascularized Fibular Autograft: A Case Report, Brandon Cunha, Alexandre Arkader

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Ewing Sarcoma (EWS) rarely presents in the bones of the foot, and particularly in the cuboid, making it an exceedingly rare occurrence. We present the case of a 7-year-old female diagnosed with EWS of the right cuboid, detailing the management and outcomes of this rare presentation. The patient, now almost 5 years post-initial local control, exhibits restored foot function, a normalized gait, and no evidence of disease recurrence. This case underscores the potential for preserving lower extremity function and improving postoperative quality of life in rare presentations of EWS through innovative reconstruction strategies.

Diagnosis And Management Of A Patient With Chronic Lymphocytic Leukemia And A Concurrent Plasmacytoma: An Overview Of A Case Report, Danielle C. Thor, Rohan Umrani, Jack Bergal, Charles Yang, Richard Gordon

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Chronic lymphocytic leukemia (CLL) typically presents as an indolent disease with a benign disposition in most patients. In select patients, CLL can progress into a more aggressive disease via its original morphology, following a Richter transformation to an alternative non-Hodgkin lymphoma, or with the concomitant development of multiple myeloma. In an extremely rare subset of individuals with CLL, an extramedullary plasmacytoma may coexist. This presentation seeks to describe the diagnosis and treatment of a patient with concurrent CLL and a plasmacytoma.

Investigating The Factors That Lead To Sports Related Injuries In Children, Kinjal Shah, Shawna Rotoli

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This project’s focus is to investigate if playing contact versus non-contact sports at a young age leads to more sports related injuries and to identify which factors correlate with increased injury rate in order to develop the most effective prevention and treatment methods. Data was collected through a survey including questions that delve deeper to quantify the amount of strain being put on the youth athlete’s body such as hours played a week, level of competitiveness, weeks played in a year, contact versus non-contact sport, and number of sports played. The following set of questions then addressed the actual injury …

Addressing Gaps In Care Through A Medical Student-Led Cancer Screening Project, Matthew Green, Hannah Ngo, Dakota B. Pastore, Jenna Zappetti, Olivia Siciliano, Meghan Mcquade, John Sauer, Anne Jones

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Background: Colorectal cancer (CRC), breast cancer (BrCa), and cervical cancer are three of the most preventable cancers. Despite the known significance for early detection and treatment, barriers to screening remain. We developed a medical student-led project to improve adherence to national cancer screening guidelines in patients across Rowan-Virtua Family Medicine (FM) practices. This study assesses the initiative’s efficacy in improving adherence to CRC, BrCa, and cervical cancer screenings.

Methods: Rowan-Virtua FM patients between the ages of 21-75 (n=735) were identified as due or up-to-date on cancer screenings based on chart review. Student volunteers were trained to contact patients to discuss …

The Effect Of Guided Meditation On Student Doctor-Patient Interactions, Aneela Rampersad, Samantha Plasner

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Healthcare students are under stress and can use different methods to cope with it. Mindfulness techniques such as guided meditation has been used as a way of helping these students reduce their stress levels. The purpose of this study was to investigate whether guided meditation has an effect on student doctors that translates into more positive interactions with patients. This study found that the student doctors who completed guided meditation felt less frustrated and less impatient while interacting with patients than student doctors who did not perform the guided meditation. Future studies on this topic should recruit more participants so …

Brief Review: Regional Anesthesia For Vaso-Occlusive Pain Crises, Oluwatomi Alade

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Vaso-occlusive pain crisis occurs with obstruction of blood vessels from sickled red blood cells. This results in ischemic injury causing in pain. Acute vasoocclusive pain crisis is one of the most common reasons for patients with sickle cell disease to present to the hospital for medical attention. Acute treatment involves IV opioid therapy, non-opioid therapy, and IV hydration. There is a known lack of trust between a patient in acute pain and a provider in the emergency department (ED) and hospital secondary to stereotypes regarding pain seeking behavior. Here we discuss a case of vasoocclusive pain crisis refractory to opioid …

Lower Extremity Weakness In The Setting Of Covid Myositis, Christopher Dellmyer, Frank Wheeler

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Bilateral lower extremity weakness has numerable causes including stroke, peripheral neuropathy, deconditioning, Guillain-Barre, Multiple Sclerosis, anterior cord syndrome, trauma, spinal epidural abscess and many more. It is imperative however, that we investigate and understand more rare causes of lower extremity weakness. Here we present the case of a 74-year-old female presented to the ED with a complaint of lower extremity weakness due to Covid myositis causing significant bilateral lower extremity weakness.

Brash Syndrome: A Deadly Pentad Of Symptoms, Peter Killian, Adam Kandil

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Here we present the case of a male in his 70’s who presented with diarrhea and a syncopal episode and was ultimately diagnosed with BRASH syndrome. The acronym BRASH is a novel way to describe the constellation of symptoms that result in unfortunate synergistic affects that can result in profound bradycardia. In the setting of hyperkalemia and concurrent use of atrioventricular nodal blockers, there is potential for a worsening bradycardia and inevitable cardiovascular collapse if not identified.

Case Report: Wellens Syndrome In 28-Year-Old With Pleuritic Chest Pain, Tucker A. Ledo

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We report a case of a 28-year-old male with months of diffuse, pleuritic, intermittent, non-exertional chest pain. He had an elevated troponin and ECG showing Wellens’ syndrome and was found to have 80% LAD coronary artery occlusion and 100% apical occlusion. Identification and proper management of Wellens’ syndrome relies on being familiar with its ECG patterns. Other information such as age, cardiac risk factors, chest pain with exertion and at rest, and elevated troponin, are all helpful supplemental information, but as demonstrated in the following case report, presentations may vary or even cause as distractors to the diagnosis.

Case Report: Dysphagia In Inclusion Body Myositis Leading To Respiratory And Gastrointestinal Complications, Veroneka Mikhail, James A. Espinosa, Alan Lucerna

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Inclusion Body Myositis (IBM) stands as a rare and complex neuromuscular disorder (NMD) characterized by progressive muscle weakness and atrophy. Among its cardinal symptoms are dysphagia and respiratory distress, which are the most common cause of death in this disease. While the differential diagnosis of respiratory distress is vast and includes aspiration, pneumonia, acute coronary syndrome, emphysema, and congestive heart failure, a clinician should recognize that respiratory distress can also be secondary to dysphagia in NMDs like IBM and can quickly become life threating. Here we present the case of a 68-year-old female with a history of IBM who presented …

A Rare Intervention: Perimortem Hysterotomy In An Obstetric Emergency In A 32-Year-Old Female, Alec Mirchandani

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In the realm of obstetric emergencies, perimortem hysterotomy stands as a rare but crucial intervention, employed in dire circumstances to salvage both maternal and fetal lives. This procedure, involving the surgical delivery of a fetus from a mother in cardiac arrest, presents a unique set of challenges and ethical considerations for healthcare providers. This case report delves into the intricate details surrounding a perimortem hysterotomy performed under emergent conditions, exploring the clinical decision-making process, procedural intricacies, and outcomes. Through this narrative, we aim to shed light on the complexities of managing obstetric emergencies, emphasizing the critical role of timely intervention …

Can Nutritional Supplements Benefit Patients Receiving Treatment For Neurodegenerative Disorders?, Russell Levi, Saad Ahmed, Zachary Harris

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As the prevalence of neurocognitive disorders rises globally, developing new methodologies of prevention and treatment is crucial. This literature review examines the efficacy of adding nutritional supplements, specifically nootropics, with traditional pharmacological regimens on various neurocognitive and neurodegenerative disorders. Primary, peer-reviewed research, including both human and animal studies, was assesed to determine if there was a benefifical, minimal, or detrimental effect on symptom progression. The inclusion criteria focused on studies that evaluated the reduction in disease markers or symptoms following supplement use. The findings reveal that natural supplements generally support disease management. Significant improvements were noted with specific combinations like …

What Is The Impact Of Marijuana Usage On Sexual Dysfunction Among Individual And How Do Factors Such As Frequency Of Use, Dosage, And Duration Of Marijuana Consumption Influence Sexual Function, Zachary A. Harris, Russell Levi, Saad Ahmed

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Sexual health is an integral piece of human vitality, encompassing a multitude of psychological & physiological factors. There has been an unprecedented amount of interest surrounding cannabis and its impact on sexual function in the past decade. The interplay between the acceptance of cannabis and its widespread use presents the need for research into the correlation between cannabis and sexual health outcomes. The primary components of cannabis, cannabidiol (CBD) and tetrahydrocannabinol (THC) have attracted scrutiny for their potential effects on sexual function. Anecdotal accounts suggest heightened sexual desire and pleasure, however there are conflicting reports raising concerns regarding performance issues …

Variables Contributing To The Psychosocial Strain On Caregivers Of Patients With Autism Spectrum Disorder, Maduka Gunasinghe, Krisha S. Patel, Usmaan Al-Shehab, Brian Joseph Mathew, Maithri Goud, Andrea Iannuzzelli

Rowan-Virtua Research Day

This research, conducted at the Rowan-Virtua Integrated Special Needs (RISN) Center, Sewell, New Jersey, explores the psychosocial strain on caregivers of patients with Autism Spectrum Disorder (ASD). Utilizing the Caregiver Burden Inventory (CBI), we assessed multiple psychosocial dimensions, including time dependency, emotional health, development, social relationships, and physical health. Data was extracted from a total of 295 patient charts; this poster analyzes the initial sample of 99 patients by incorporating demographic variables and caregiver burden scores into a tailored database for comprehensive analysis. Our findings reveal a statistically significant correlation between the age of patients and increased developmental scores in …

Case Report: Hidden Posterior Dislocation Of The Clavicular Head, David F. Koziel

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Reported is a case of a 24-year-old male who presented with left shoulder pain and decreased range of motion of the same shoulder upon awakening, diagnosed with a posterior dislocation of the proximal clavicle, with the clavicular head residing in the mediastinum. In the conscious, ambulatory, young adult it is arguably much more common for major bony trauma involving the upper extremity and shoulder to present with pain, deformity, and a known mechanism. This is an example that lacks all three of these characteristics and highlights the importance of details in the physical examination as well as clinical gestalt.

Wide Awake Local Anesthesia No Tourniquet (Walant) Is More Effective At Decreasing Pain Compared To Distal Nerve Block With A Tourniquet During Carpal Tunnel Release Surgery: A Systematic Review And Pooled Analysis, Jonathan Elias, Uzay Cagatay, Usmaan Ahmed Al-Shehab, Alexander King

Rowan-Virtua Research Day

Background: Carpal tunnel release (CTR) is one of the most common upper extremity procedures, reaching 400,000 - 600,000 procedures yearly in the United States. With such a common procedure, it is pertinent that every step is as comfortable for the patient as possible. Many patients report discomfort due to the usage of a tourniquet during the anesthesia process. However, a growing number of physicians are beginning to use the wide awake local anesthesia no tourniquet (WALANT) approach. WALANT utilizes a distal nerve block (commonly Ropivacaine), Lidocaine, Epinephrine, but no tourniquet. The more commonly used approach utilizes the same distal …

Standardization Of Discharge Instructions For Mild Traumatic Brain Injury/Concussion In Children Presenting To Ed: A Qi Project, Niralee K. Rana, Nicole Gerber, Michael Alfonzo, Snezana Osorio, Deborah Levine

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Background: Mild traumatic brain injuries (mTBI) or concussions account for high rates of emergency department (ED) visits. Concussion diagnoses are used less often in young children leading to a variability in parental education and discharge instructions. Lack of discharge guidance may increase parental anxiety, impact recovery, and increase ED visits.

Objectives: To increase the proportion of ED patients discharged with age-appropriate instructions for mTBI by 50% by June 1, 2024, and to determine the impact age-appropriate instructions have on decreasing parental anxiety.

Methods: This observational time series with planned sequential experimentation is in progress at a Pediatric ED affiliated with …

Case Report: A Case Of Ttp In The Ed, Brian F. Lim, Andrew Caravello, James A. Espinosa, Alan Lucerna

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We report a case of a 54-year-old female who presented with mild shortness of breath, lower chest discomfort, fatigue, and weakness ongoing for several days and was diagnosed with thrombotic thrombocytopenic purpura (TTP). TTP is characterized by microangiopathic hemolytic anemia and thrombocytopenia due to either an inherited or immune-mediated reduction in von Willebrand Factor (VWF) cleaving protease ADAMTS13.

Patients presenting with non-specific symptoms is becoming increasingly common and initial bias could be to attribute symptoms to viral syndrome or upper respiratory tract infection. However, the differential for non-specific complaints is extensive and thorough review of labs and re-evaluations of patients …

Unmasking A Silent Threat: Early Detection Of Elevated Hbco Levels When The Story Doesn’T Add Up, Anna M. Delancy, Eric Maddock, James A. Espinosa, Alan Lucerna

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Carbon monoxide (CO) is difficult to detect in the surrounding environment due to its colorless, odorless, and tasteless properties. Patients acutely poisoned with CO can have a myriad of presentations including headache, dizziness, and critical illness— all with a mortality rate up to 3%. When concerned for CO poisoning, blood co-oximeter testing should be performed, with treatment surrounding the idea of providing supplemental oxygen The efficacy of hyperbaric oxygen (HBO) treatment remains unclear. Here we describe an atypical scenario of a patient ultimately found to have CO poisoning, and the importance of early identification and treatment of this elusive diagnosis …

Case Report: Erysipelas Diagnosed In The Emergency Department, Arsam Nadeem, James A. Espinosa, Alan A. Lucerna

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Here we present a case of erysipelas. Erysipelas is a common and potentially dangerous infection. It involves the dermal layer of the skin but may also extend to the superficial cutaneous lymphatics. It is characterized by a relatively fast onset and a well-defined border. The most common sites are lower extremities with face being second. Much feared and often fatal in the pre-antibiotic era, it responds well to antibiotics today and most people have a full recovery without complications.