Analytical, Diagnostic and Therapeutic Techniques and Equipment Commons^™

Understanding Changes In Mortality With Implementation Of Safe Injection Sites, Shubh Bhambri

Rowan-Virtua Research Day

The purpose of this study is to analyze mortality due to overdose in areas that have implemented supervised injection sites and understand what factors these facilities affect that can lead to a change in outcomes.

Complications Of Fitz-Hugh-Curtis Syndrome In A Teenage Female: A Case Presentation, Marina Cugliari, Trupti Pandit

Rowan-Virtua Research Day

Fitz-Hugh-Curtis Syndrome is a manifestation of Pelvic Inflammatory Disease (PID) associated with Chlamydia trachomatis infections and less frequently with Neisseria gonorrhea.

PID affects sexually active women (15-30 years old) and accounts for 750,000 cases each year.

The case presented illustrates a female who presented with a small bowel obstruction and appendicitis, who was incidentally found to have Fitz-Hugh-Curtis Syndrome on laparoscopic exam.

Appendiceal Diverticulum Masquerading As Acute Appendicitis, Aesha Patel, Asad Abbas, Ratul Bhattacharyya, Dana Galaktionova

Rowan-Virtua Research Day

Appendiceal diverticula present as rare clinical findings and are most often confused with acute appendicitis due to similar presentation. The incidence in such cases is reported at a rate no greater than 1%.

We present a rare case of a 65-year-old female treated for acute appendicitis who was instead found to have acute sequelae of appendiceal diverticulosis.

Cpap And Epistaxis: Is There A Connection In Osa Patients?, Aesha Patel

Rowan-Virtua Research Day

Nasal continuous positive airway pressure (CPAP) has become a standard form of therapy for patients with obstructive sleep apnea (OSA). There are reports of patients suffering from episodes of epistaxis within the initial few weeks of starting CPAP therapy, believed to be due to the high flow rate of air during use, nasal CPAP purportedly dries the nasal mucosa, leading to an increased risk of scabbing, ulceration, and ultimately epistaxis. This study seeks to analyze whether epistaxis is common in patients following CPAP initiation and then compare this rate of epistaxis amongst OSA patients that received upper airway stimulation (UAS) …

A Brief Literature Review On Heparin: To Bolus Or Not To Bolus, That Is The Question, Alex Gechlik, James Espinosa, Alan Lucerna, Kishan Patel

Rowan-Virtua Research Day

Heparin is an anticoagulant medication, used to inhibit the formation of thrombi that pose arteriolar and vein-occlusive risk. The choice between starting a heparin infusion with or without an initial bolus is case dependent based on whether a patient is already anticoagulated and if so, foregoing an initial bolus. In contrast, both anticoagulated and non-anticoagulated patients share the same goal when receiving Heparin for various thromboembolic syndromes, and that is to be within aPTT target range of 1.5-2.5 or 45 to 75 seconds. Falling below goal range leads to a 20-25% recurrence of VTE, and aPTT above goal range has …

A Suspected Case Of Vaccine Induced Thrombosis With Thrombocytopenia Following Sars Cov2 Vaccine, Maryam Soliman

Rowan-Virtua Research Day

With the new development of the SARS-CoV vaccine and the majority of the population receiving this vaccine, it is important to recognize some of the rare side effects associated with it.

VITT is a rare complication of the COVID vaccine

Diagnostic criteria: COVID vaccine 4-24 days prior to symptom onset, any venous or arterial thrombosis, thrombocytopenia < 150, positive PF4 HIT ELISA, markedly elevated D-dimer >4x ULN.

Vaccine Induced Thrombosis with Thrombocytopenia is a potentially life-threatening diagnosis that must be recognized and treated correctly to prevent poor outcomes.

Alternate Site Pacing And The Impact On Intracellular Calcium Handling During The Post-Extrasystolic Cardiac Cycle, Kent Ozcan, Lawrence Mulligan

Rowan-Virtua Research Day

Objective: Previous work has shown that alternate site (RV apex) results in myocardial dysfunction. With the development of tools to place endocardial pacing leads in locations that create physiological pacing activation, we sought to evaluate how ventricular trans-septal or left ventricular apical placement pacing differs from right atrial pacing. We will evaluate how these chronic pacing modes impact the PR and RF at baseline, 0, and 16 weeks in the canine heart.

Methods: Quantitative analysis will be performed on previously generated data. The data set includes pacing of 15 dogs total (8 with trans-septal leads & 7 with left ventricular …

Association Of Perceived Early Adequate Analgesia And Chronic Pain Severity, Sean Coulson, Sameer Akhtar, Brian Thomas, Aleesa Mobley

Rowan-Virtua Research Day

Purpose: Establish if early adequate pain control is protective in the development of chronic pain syndromes.

Data collected via survey to patients being treated for chronic pain at the Neuromuscular Institute at RowanSOM

Data (small n) suggests patients with chronic pain have poorly controlled pain levels at the time of the acute event.

Anticipate with increased sample size will see a correlation between chronic pain prevalence and severity and perceived early adequate analgesia following the acute event.

Syncope Masquerading As Pulmonary Embolism, Melissa Itidiare Locke, Andrew Caravello, Melanie Angelo, Andrew Vasta

Rowan-Virtua Research Day

Syncope is a clinical syndrome that occurs due to a period of inadequate cerebral blood flow that cause a transient loss of consciousness that usually resolves within 8-10 seconds) [1] Our case demonstrates a 56-year-old female who experienced syncope for the first time. The patient had an unwitnessed fall and subsequently had imaging studies performed. A discovery of a Sub-Massive Pulmonary embolism was revealed.

Celiac Artery Aneurysm: A Rare Cause Of Abdominal Pain, Duwayne Campbell, Wayne Tamaska, Kevin Dwyer

Rowan-Virtua Research Day

Celiac artery aneurysm is a very rare vascular lesion accounting for only 5.1% of all splanchnic artery aneurysms. Etiology for celiac artery aneurysm includes, but not limited to, infectious diseases, atherosclerosis, trauma, congenital conditions such as median arcuate ligament syndrome and iatrogenic causes.

Etiology for abdominal pain is extensive. Patients should be evaluated for both intra-abdominal and extra-abdominal causes for pain, as presentations of a different pathophysiology vary widely. CT scan has become a mainstay part of the work for abdominal pain in the Emergency department, and often elicit pathologies that would otherwise be missed on blood work and other …

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.

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 …

Differentiating The Mechanistic Role And Chemotherapeutic Potential Of Src And Podoplanin In Oncogenic Transformation, Edward P. Retzbach

Graduate School of Biomedical Sciences Theses and Dissertations

There were an estimated 20 million new cancer cases worldwide in 2020, resulting in nearly 1000 deaths per hour [1]. Oral cancer exemplifies the difficulties of treating cancer patients. The first line for oral cancer treatment is surgery and radiation that can lead to patient disfigurement and decreased quality of life in cancer survivors [2-4]. Though there have been many developments in chemotherapy in the last 30 years, the 50% mortality rate associated with oral cancer has not changed [4, 5]. Longitudinal studies that track survival rates in oral cancer patients demonstrate a 3-fold reduction in patient deaths when patients …

Investigations In The Cellular And Molecular Biology Of Human Airway Mucociliary Tissue, Vincent Manna

Graduate School of Biomedical Sciences Theses and Dissertations

Our laboratory has integrated the use of a human-derived, in vitro model of airway mucociliary tissue. We isolate human nasal epithelial cells (HNECs) from the nasal mucociliary tissue of donors with a small brush and expand the airway progenitor cells in culture. The HNECs are then seeded onto semi-permeable transwell inserts. The inserts are in contact with the media in the lower chamber but don’t contain media in the upper chamber therefore the cells are exposed to the air while drawing nutrients from the media below, this is called the Air-Liquid Interface (ALI). HNECs cultured at the ALI initiate a …

Minimally Invasive Surgery For Septic Arthritis Of The First Metatarsophalangeal Joint: An Uncommon Approach Utilizing Small Joint Arthroscopy, Michael Thomas, Hinal Patel, Jeffrey Belancio

Rowan-Virtua Research Day

Small joint arthroscopy can be utilized for septic arthritis, synovitis, osteochondral lesions, arthritis, and various other pathologies. However, information regarding arthroscopy of the first metatarsophalangeal joint (MTPJ) is limited in the literature. This case report discusses the use of arthroscopy for septic arthritis of the 1st MTPJ.

Ring Based Wearable Bioelectrical Impedance Analyzer For Body Fat Estimation, Muhammad Usman, Adarsh Gupta, Wei Xue

Rowan-Virtua Research Day

Introduction

• Obesity is the most serious public health problem because it is linked to cardiovascular diseases.
• Measuring fat mass is necessary to study the obesity epidemic.
• Fat mass can be estimated by measuring impedance of the human body.

Conclusions

• A novel bioelectrical impedance analyzer for body fat estimation.
• Device validated for 40 healthy human subjects against commercial analyzer.
• Great potential to replace commercial analyzers for wearable real-time body fat monitoring.

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

Rowan-Virtua Research Day

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.

Syncope Or Seizure?, Joseph Heron, Kevin Dwyer

Rowan-Virtua Research Day

Syncope is a common complaint in the emergency departments, accounting for 1-2% of visits, and can approach admission rates of a staggering 85%. The causes and conditions can be numerous, ranging from benign to life threatening. A good background history can go a long way in determining the etiology of the patient’s syncope. We describe a case of an elderly male who presented with a reported chief complaint of seizures, another syncope-mimic seen in the emergency department. He had a history of CAD, HTN, AAA, and osteoarthritis but no prior history of cardiac arrhythmia, MI, or structural heart disease. The …

Use Of Point Of Care Ultrasound In The Emergency Department For Diagnosis Of Femoral Pseudoaneurysm, Stephen Janssen, Jeffrey Gardecki, Giovanna Finocchio

Rowan-Virtua Research Day

Iatrogenic pseudoaneurysm after puncture or intervention of the femoral artery is a rare complication of arterial surgical intervention occurring in 0.05-0.50% of diagnostic and therapeutic catheterizations and can present weeks after initial presentation. Today we present a 57-year-old gentleman 3 months status post femoral artery stent who presented with swelling to his right groin. Point of care ultrasound was used to diagnose an actively bleeding pseudoaneurysm with hematoma that ultimately led to repeat stenting. This case shows how point of care ultrasound can expedite diagnosis and intervention and is a useful tool for the emergency physician at initial presentation.

Novel Technology Enables Diagnostic Ultrasound Machine To Treat Hepatocellular Carcinoma In Mice, Ryan Morrison, Mrigendra B. Karmacharya, Chandra M. Sehgal

Rowan-Virtua Research Day

An off-the-shelf diagnostic transducer (ULTRASONIX C5-2) was modified with custom-built circuitry to enable the transducer to produce therapeutic ultrasound in order to ablate hepatocellular carcinomas grown in immunodeficient athymic nude mice (25-35 g; Charles River Laboratories, Wilmington, MA, USA). The therapeutic antivascular ultrasound (AVUS) produced by the off-the-shelf abdominal transducer was unfocused, continuous 2.8MHz ultrasound targeting contrast-enhancing perflutren lipid microbubbles within tumor vasculature. Previous research with a dedicated physiotherapy ultrasound machine (D150 Plus, Dynatronics Corp., Salt Lake City, UT, USA) targeting similar hepatocellular carcinomas showed disrupted tumor neovasculature and irreparable dilation of tumor capillaries with subsequent intercellular edema and hemorrhage.1-3 …

Rare Variant Of Porokeratosis: A Case Report, Nardin Awad

Rowan-Virtua Research Day

There are 5 clinically distinct variants of porokeratosis, including classic porokeratosis of Mibelli, disseminated superficial (actinic) porokeratosis, linear porokeratosis, punctate porokeratosis, and porokeratosis palmaris et plantaris disseminate. Porokeratosis ptychotropica (PP) is the sixth, lesser-known variant of the spectrum. PP is characterized by verrucous plaques, often resembling psoriasis plaques, that affect the buttocks, most commonly the gluteal cleft, and can also involve the extremities, most commonly the lower legs and feet. Due to its characteristic verrucous appearance, designations such as verrucous or hyperkeratotic porokeratosis are occasionally used. Besides its predilection for specific locations, PP also has a significant predilection for men …

The Coumadin Ridge: Incidental Finding Mimicking Thrombus On Echocardiogram, Keith Brown Jr., Matthew Everwine, Keith R. Anacker, Jose Nieves

Rowan-Virtua Research Day

The left atrial ridge or “coumadin ridge” is a cardiac anatomic structure located between the left pulmonary vein and the orfice of the left atrial appendage. Historically, patients were misdiagnosed with intra-atrial thrombus and were incorrectly placed on anticoagulation with warfarin, ultimately acquiring the name of the “coumadin ridge”. Fortunately this anatomical variant is now more commonly recognized, however when improperly identified can lead to unnecessary testing, cost, diagnosis anxiety, and inappropriate treatment for the patient. This purpose of this case is to bring awareness to this common clinical dilemma in an attempt to reduce ambiguity and unnecessary workups surrounding …

The Application Of Point-Of-Care Ultrasound In Ed Intubations And Airway Access: A Systematic Review, Frank Wheeler, James Espinosa, Alan Lucerna, Jeffrey Gardecki

Rowan-Virtua Research Day

Intubation is an essential procedure performed on a routine basis in the emergency room. Unsuccessful intubations are associated with deleterious outcomes. A systematic review was performed to investigate the accuracy of point of care ultrasound (POCUS) in successful Endotracheal Tube (ET) tube confirmation, utilizing ultrasonography, identification of the cricothyroid membrane utilizing ultrasound, and dynamically during use of ultrasonography in the process of intubation. This review demonstrated high sensitivity and specificity for ultrasound confirmation of ET tube placement, high success rate in ultrasound-guided intubation, and lower than expected accuracy in identifying the cricothyroid membrane. Ultrasonography should be considered for ET tube …

Spontaneous Conus Medullary Infarction In The Absence Of Cardiovascular Risk Factors, Bavica Gummadi, Jaffer Ahmed, Swarna Rajagopalan

Rowan-Virtua Research Day

Spinal cord infarction (SCI) is rare and most often occurs in individuals with predisposing cardiovascular risk factors and traumatic injuries

As there are no distinct diagnostic criteria for SCI, diagnosis is difficult in patients presenting without predisposing factors and is often mistaken for transverse myelitis.

Delay in early diagnosis contributes to the high case fatality rate of SCI.

This case highlights the importance of including SCI in the differential of a patient with acute paraparesis even in the absence of co-existing risk factors.

Triad Of Acute Pancreatitis Coexisting With Diabetic Ketoacidosis And Very Severe Hypertriglyceridemia Successfully Resolved With Insulin Therapy Alone, Akash Patel, Monica Patel, Yvette Wang

Rowan-Virtua Research Day

Diabetic ketoacidosis (DKA) is known to cause mild elevations in triglyceride levels.

Severe hypertriglyceridemia (HTG) is a well-known cause of acute pancreatitis; however, in unique cases, DKA has been shown to cause severe HTG leading to the development of acute pancreatitis (AP).

HTG causing AP only accounts for 1-4% of cases of AP

From the few cases in literature that have reported this triad of DKA, HTG, and AP, even fewer have shown to be successfully treated with insulin therapy alone with the severe degree of HTG that we discuss.

In our case, we have treated a triad of DKA, …

Meralgia Paresthetica As A Complication Of Laparoscopic Cholecystectomy In A Post Partum Teenager, Puthenmadam Radhakrishnan, Wajihah Memon, Prasanna Tati

Rowan-Virtua Research Day

An 18 year old G1P1 female, 3 months postpartum presented to the emergency department with abdominal pain that was diagnosed as cholelithiasis and choledocholithiasis. Following a cholecystectomy surgery, the patient developed weakness and gait abnormality that was diagnosed as neuralgia.

Meralgia paresthetica is such an understudied diagnosis that its incidence is unknown. Patients who are 30-85 years old, obese, diabetic, and/or pregnant are at an increased risk for the condition. This case calls attention to the underdiagnosis of meralgia paresthetica in pediatric patients with comorbidities. As aforementioned risk factors increase in the pediatric population due to societal and environmental factors, …

Case Report: The Value Of Vigilance And Iterative Evaluations With An Uncooperative Patient In The Emergency Department, Duwayne Campbell

Rowan-Virtua Research Day

Discussion

A Flexible and Vigilant Approach: The initial presenting information from EMS could have led to anchoring bias. A flexible approach led to new information, which led to interative testing.

Iterative physical examination. There are cases, as seen in this case report, where the physical examination was unreliable or even impossible. Iterative evaluations ultimately led to appropriate imaging and accurate diagnosis.

Iterative testing: In the case presented, the radiologist reported a finding as being present on a prior CXR; however, given the patient’s clinical presentation, further imaging studies were necessary.

From Left Arm Numbness To Incidental Pituitary Macroadenoma, Melissa Itidiare Locke

Rowan-Virtua Research Day

Pituitary adenomas are the most common tumors in the sella turcica. The symptoms of vision loss or change is due to the anatomical location of the pituitary tumor beneath the optic nerve. (2) As the tumor grows in size it can compress the optic nerve and vision changes will occur. Our case demonstrates a 40 year old male who had one brief 1 time episode of blurry vison and dull intermittent headaches that was not debilitating in nature. A discovery of pituitary adenoma prior to onset of symptoms of constant vision changes or elevated hormones are crucial to a more …

Septic Arthritis With Concomitant Pseudogout, Ravin Patel, James Schuck, Nicole Zucconi, David Aderholdt

Rowan-Virtua Research Day

Monoarticular joint pain is a common complaint, however it demands a broad differential diagnosis. These differentials include fracture, dislocation, septic arthritis, gout, pseudogout and several others. The diagnosis of septic arthritis requires a high index of suspicion as early diagnosis is a vital part of initial treatment.

We present a case with multifactorial joint pathology contributing to a patient’s presentation, specifically septic joint and pseudogout. The incidence of these entities being present in the same patient, let alone the same joint, is not well documented in the literature.

The presentation of these diseases have a multitude of similarities and differences, …