Analytical, Diagnostic and Therapeutic Techniques and Equipment Commons^™

Isolated Temazepam Overdose: A Unique Case Of An Unresponsive Female, Eric Doane

Rowan-Virtua Research Day

Cases of acute overdose presenting to the emergency department pose a great challenge given that history can sometimes be limited or at times be inaccurate. While naloxone is routinely given in the field to help reduce opiate’s sedating effects, the routine use of flumazenil has not been routinely adopted in cases of benzodiazepine overdose. This is because, unlike naloxone, there are many medications that act on the GABA receptor, and flumazenil is only specific for binding to the benzodiazepine/GABA receptor. This can lead to an unmasking of other medications that may be co-ingested that also effect the GABA receptor leading …

Design And Preliminary Testing Of A Multi-Use 3d-Printed Splint For Wilderness Medicine, Ryan Desrochers, John Desrochers

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Splinting devices are commonplace in emergency medicine, as musculoskeletal and soft tissue injuries account for a majority of nonfatal events in wilderness medicine. Current splint designs, such as the SAM splint, sacrifice site-specific stability for their portability. This leads to the need for a similarly portable, but more securely fitting splint device. This design aims to provide a lightweight, multi-use, reusable, biodegradable, and inexpensive solution for splinting in wilderness medicine. A thin plate constructed of polylactic acid extruded from a 3D printer becomes easily malleable after submersion in hot water and can be form fitted to almost any location on …

Mixed Beri’S: High Output Heart Failure From Severe Anemia And Thiamine Deficiency, Rohan Umrani, Hiral Amin, Ashley Pinckney, Charles Yang, Daniel Tran

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Background: Severe anemia and thiamine deficiency can independently result in high output heart failure (HOHF) through different mechanisms. Data on the threshold and timeframe at which these etiologies may precipitate HOHF is unclear.

Case: A 63-year-old male with alcohol use disorder consuming 18 drinks/week presented with progressive shortness of breath and lower extremity edema for a few months. Physical exam revealed tachycardia, anasarca, jugular venous distension, Lancisi’s sign, and a midsystolic murmur. Echocardiogram demonstrated EF of 30-35%, dilated left ventricle, and cardiac index of 4.2L/min/m2.

Decision-Making: Heart failure can independently precipitate anemia while severe alcoholism can induce myelosuppression and promote …

Management And Considerations In The Usage Of Txa In Hemorrhagic Trauma Patients, Matthew Petterson, James Espinosa, Alan Lucerna

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Tranexamic acid is a synthetic reversible competitive inhibitor that exerts its action on plasminogen, preventing plasmin formation and deterring fibrinolysis.1 Current FDA-approved indications of TXA include heavy menstrual bleeding and short-term blood loss prevention in patients with hemophilia following tooth extraction.1 TXA has more recently been utilized in the management of massive hemorrhagic trauma patients despite this being an off-label use. While TXA has shown promise as a hemostatic agent for this patient population, considerations in the pre-hospital and hospital settings must be examined for its integration into massive hemorrhage protocols.

A Rare Case Of Left Main Vasospasm Resulting In Sudden Cardiac Death, Trinava Roy, Anjeli Patel, Tania Maheshwari, Vasu Palli

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Background: Coronary artery vasospasm (CAV) is transient spasm of a coronary artery that can lead to cardiac ischemia. We present a case with left main (LM) CAV identified on electrocardiogram (ECG) and cardiac catheterization resulting in appropriate therapy.

Case: A 52 year old female with months of spontaneously resolving episodic neck pain, flushing, and diaphoresis presented to the emergency department after a resuscitated cardiac arrest. Initial ECG was without evidence of ischemia, however high-sensitivity troponin (522) was elevated. Telemetry monitoring and ECG showed transient ST elevations in V1 and diffuse ST depressions with left bundle branch block. LV Function was …

Dislodged Endovascular Heat-Induced Thrombus Resulting In Pulmonary Embolus Following Post-Operative Ultrasound Compression, Danielle Park, Aghilas Belkadi, Luke Perry, Michael Kachmar, Holly Graves

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Introduction: Venous insufficiency and consequent varicose veins are common problems faced by many patients. Fortunately, there are many treatment options available including a minimally invasive method known as radiofrequency ablation (RFA). RFA is not without complications; amongst those are endovascular heat induced thrombosis (EHIT). This rare complication is typically managed conservatively; however, in rare occasions, the thrombus can detach and embolize causing further issues for patients.

Case Description: A 48-year-old male underwent an uneventful RFA procedure for a CEAP 4a venous insufficiency. On the post-operative ultrasound venous duplex evaluation, the patient was found to have EHIT type 2 in the …

Evaluation Of Outcome Following Oocyte Retrieval In Women With Marked Diminished Oocyte Reserve (Dor) Where The Only Oocyte Retrieved Was In A Metaphase I State, Brooke Neumann, Jerome Check, Carrie Wilson, Donna Summers, Kathleen Hollahan

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OBJECTIVE: To determine if there is value in culturing a metaphase I oocyte to metaphase II followed by intracytoplasmic sperm injection (ICSI), fertilization, then embryo transfer (ET) in women with marked DOR. MATERIALS AND METHODS: A follicle stimulating hormone (FSH) receptor up-regulation technique was used in women whose day 3 serum FSH levels were >12 mIU/mL and/or the serum anti-mullerian (AMH) level was <1ng/mL to mature antral follicle(s) to the dominant follicle stage (average diameter >18) and serum estradiol (E2) >200pg/mL when 10,000 IU human chorionic gonadotropin (hCG) would be given followed by oocyte retrieval 32 hours later. The basic tenet of this follicle maturation technique is to 1) use very little …

The Effect Of Graft Selection On Patients’ Subjective Readiness To Return To Sport After Acl Reconstruction, Adeeb Hanna, William Johns, Emma Johnson, Bryson Kelmer, Gabriel Onor, Kevin Freedman, Christopher Dodson, Michael Ciccotti

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Background: Patients who undergo ACL reconstruction with allografts may have an easier functional recovery compared to autograft patients. This is due to decreased donor site morbidity and less muscle atrophy compared to autograft patients. This “easier” recovery may be perceived by patients and may result in a subjective earlier readiness for return to sports.

Hypothesis/Purpose: To determine if there is a difference in perceived readiness to return to sport (RTS) in the first year postoperative period between individuals who undergo ACL reconstruction utilizing bone-patellar tendon-bone (BTB) autografts or allografts.

Study Design: Prospective Cohort Study, Level II Methods: This was a …

Association Of Prematurity And Urogenital Comorbidities With Postoperative Outcomes Of Ureteroneocystostomy For Vesicoureteral Reflux, Raeann Dalton, Young Son, Edward Wu, Leah Anderton, Matthew Eximond, Lance Earnshaw, Katelyn Klimowich, Gregory Dean

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Background: It is estimated that 20-30% of congenital anomalies involve the kidney and ureter, and these rates are even higher in infants with low birth weights. Vesicoureteral reflux (VUR) occurs when there is a backflow of urine from the bladder to the kidney. Depending on severity, this condition may require surgical correction with ureteroneocystostomy (UNC). The impact of premature birth and presence of urogenital comorbidities on outcomes of UNC is not known. The objective of this study is to determine the relationship between premature birth and urogenital comorbidities with operative outcomes of UNC for VUR.

Methods: The 2020 American College …

The Impact Of Covid-19 On Post-Recovery Memory, Chelsea Mcnamara, Alison Mancuso

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The SARS-CoV-2 virus, responsible for the covid-19 pandemic, has had profound effects on countries worldwide. As the pandemic progressed, clinical and patient data continued to mount. A subset of symptoms named “Long Covid Syndrome” persisted in patients after recovering from infection. One commonly reported but understudied symptom was a deficit in memory function. Although commonly reported, prevalence of ‘brain fog’ has yet to be characterized using patient data. Using Rowan Medicine electronic patient data, we were able to collect information on patients before and after the emergence of the coronavirus. Data was collected on reported memory-related symptoms as well as …

Purple Urine Bag Syndrome (Pubs) In A Patient With A Chronic Indwelling Foley, Kelsey Murray, Kishan B. Patel

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Purple urine bag syndrome (PUBS) is a rare medical condition characterized by the appearance of purple discoloration in the urine collection bag of patients who use catheters for urinary drainage. PUBS is primarily seen in elderly, female, and institutionalized patients who have chronic indwelling catheters. The discoloration occurs due to the presence of certain bacteria that produce pigments, which react with the plastic materials of the catheter and urine collection bag, leading to the formation of a purple color. In addition to the aesthetic concerns, PUBS may also indicate an underlying urinary tract infection or other medical conditions that require …

Obstructive Hydrocephalus Caused By A Colloid Cyst Presenting As A Transient Ischemic Attack (Tia), Muhammad Nadeem

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Colloid cysts are benign growths commonly found in the third ventricle or at the Foramen of Monroe. They are composed of epithelial lining filled with gelatinous material that contain cholesterol, mucin, old blood and ions. Most colloid cysts are asymptomatic but can present with a variety of symptoms that range from headaches, diplopia, memory problems, and vertigo. They can also present as an obstructive hydrocephalus with the classic “Wet, wacky and wobbly” triad. Rarely colloid cysts have been reported to cause sudden death. They can present to the ED with any spectrum of these symptoms.

Characterization Of Antibiotic Susceptibility Profiles Of Extensively- And Pan-Drug Resistant Acinetobacter Baumannii Clinical Isolates, Rachel Carr, Justin Halim, Rebecca Fliorent, Henry Fraimow, Dejan Nikolic, Valerie Carabetta

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Acinetobacter baumannii is an opportunistic pathogen common in intensive care units (ICUs), particularly among immunocompromised individuals. Nosocomial A. baumannii infections have become increasingly problematic in recent years, as these bacteria rapidly acquire antibiotic resistance, leading to the emergence of multidrug, extensively drug and pan drug-resistant (MDR, XDR, and PDR, respectively) isolates. Recently, Cooper University Hospital (CUH) experienced a large increase in highly drug-resistant A. baumannii infections, which had a mortality rate of 60%. Oftentimes, physicians had to turn to combinations of drugs with no experimental verification or historically shelved antibiotics, such as the polymyxins, in a desperate attempt to save …

Chemical Restraints In The Emergency Department, Nicholas Noffsinger

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Chemical restraint is a critical intervention used in emergency departments to manage acutely agitated or violent patients. It involves the administration of medication to induce sedation and control behavior, with the goal of ensuring patient and staff safety while allowing necessary medical interventions to be performed. However, the use of chemical restraints necessitates close observation of vital signs and any potential side effects, as well as careful consideration of patient-specific considerations.

An Unusual Ed Case: Spontaneous Necrotizing Fasciitis Presenting As Hypoxic Pneumonia, Chetna Thawani, Kishan Patel

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We present a case of necrotizing fasciitis initially presenting as septic hypoxic pneumonia, and discuss imaging modalities and diagnostic evaluation. Necrotizing soft tissue infection (NSTI) is a rapidly progressive surgical emergency with a mortality rate of 30%. In approximately 80% of cases, it is introduced through a break in the skin. It can also occur after any invasive procedure or surgery. It is most commonly associated with skin flora including staph and strep, though polymicrobial infections are most common. It usually presents with signs of systemic infection, including fever, chills, sepsis, altered mental status - and signs of cutaneous involvement …

Importance Of Serial Ekgs In The Emergency Room Setting, Swet Patel, James Espinosa, Alan Lucerna

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Chest pain is one of the most common chief complaints that presents to the emergency department. More than 8 million patients with chest related complaints present each year with about 10% of all ED visits comprise of cardiovascular emergencies. Immediate evaluation is the standard of care to differentiate between life threatening conditions and non-life threatening ones with the use of 12-lead electrocardiograph (EKG) and bedside monitors. The 12 lead EKG remains gold standard for initial screening and evaluating patients with chest pain and angina equivalents. The test is fairly inexpensive and noninvasive with providing vital information about cardiac rhythm. The …

Brash Syndrome Case Report And Brief Review, Kelly Schuitema

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BRASH syndrome is an acronym that stands for bradycardia, renal failure, AV node blocker, shock and hyperkalemia. The syndrome is precipitated by synergism from AV nodal blocking agents and hyperkalemia. The combination of the AV nodal blockade and renal failure leads to a cycle of severe bradycardia and hyperkalemia. We will discuss a case of BRASH syndrome with a 68 year old female who presented with generalized weakness and was found to be hypotensive, bradycardia, in acute renal failure with hyperkalemia likely related to metoprolol and amlodipine use.

Whole Body Cryotherapy As A Novel Treatment For Long Covid Syndrome Associated Brain Fog, James Mack, Brandon Goodwin, Paras Patel, Kyra Herman, Daniel Casal, Emily Levenson

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SARS-CoV-2, which causes coronavirus disease 2019 (COVID-19), was first discovered in December 2019 in Wuhan, China when adults began presenting with severe pneumonia of an unknown cause. SARS-CoV-2 can cause a wide range of clinical manifestations. SARS-CoV-2 can penetrate the olfactory mucosa and may enter the brain through the cribriform plate along the olfactory tract, through vagal or trigeminal pathways, or pass through the blood-brain barrier. Once inside the brain, levels of inflammatory cytokines are increased and can lead to altered learning, memory, neuroplasticity, hallucinations, nightmares, cognitive and attention deficits, new-onset anxiety and depression, and psychosis. A theoretical treatment for …

The Effectiveness Of Cleaning Protocols In Medical School Omm Labs By Medical Students, Harrison Patrizio, Riley Phyu, Thomas Boyle, Todd Schachter

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In light of the COVID-19 pandemic, disinfection in healthcare has taken center stage. Healthcare has adjusted workflows to accommodate for more robust cleaning regimens to help protect the community. This has resulted in the need for medical institutions to reevaluate the current cleaning protocols down to the student level. Osteopathic Manipulative Medicine (OMM) lab provides an optimal avenue for assessing medical student’s examination table cleaning effectiveness. With OMM labs being an activity with a high level of interaction, the quality of examination table cleaning is important for the health and safety of students and teaching faculties. Our study highlights that …

Arthroscopic Treatment Of Shoulder Stiffness With Rotator Cuff Repair Yields Similar Outcomes To Isolated Rotator Cuff Repair, Ruchir Nanavati, Parker L. Brush, Adrian Santana, Gregory R. Toci, Tariq Z. Issa, Daniel J. Fletcher, Joshua Hornstein

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Purpose: To compare patient-reported and surgical outcome measures in patients with and without secondary shoulder stiffness (SSS) undergoing rotator cuff repair (RCR).

Methods: Patients undergoing rotator cuff repair from 2014 to 2020 with complete patient-reported outcome measures (PROMs) by the short-form 12 survey (SF-12) were retrospectively reviewed to identify if operative intervention for SSS was performed alongside the RCR. Those patients with operative intervention for SSS were propensity matched to a group without prior intervention for stiffness by age, sex, laterality, body mass index, diabetes mellitus status, and the presence of a thyroid disorder. The groups were compared by rotator …

The Virtues Of Osteopathic Manipulative Treatments In Patients With Opioid Use Disorder, Rachel Shmuts, Heather Soled, Kyle Street, David Abend

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As America continues to face the opioid epidemic, numerous people have made great strides in receiving formal treatment for their opioid use disorder (OUD). This research seeks to examine the effects providing OMT along with traditional OUD pharmacological methods in providing results for patients. By utilizing prior research on OMT techniques, we were able to uncover how effective OMT can be in reducing the time and discomfort associated with seeking opioid recovery. OMT in combination with traditional pharmacology was associated with reduction of somatic pain, higher success with MAT, as well as lowered costs. This research also highlights the importance …

Barriers To Colorectal Cancer Screening For Low-Income Hispanic Men In Urban Areas Between 50-75, Alex Vega

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Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in the United States. Although CRC screening rates have improved in non-Hispanic whites (NHW), Hispanic adult males (HAM) aged 50-75 in urban areas continue to experience low screening rates and higher CRC morbidity and mortality. This review aims to identify the barriers to CRC screening among HAM and propose targeted interventions to increase screening rates. A comprehensive literature review was conducted using databases such as PubMed, Scopus, and Google Scholar. Key search terms included "colorectal cancer", "screening", "Hispanic adult males", "urban", "barriers", and "interventions". Factors identified include poverty, language …

The Angiovac® Device Limits Lethal Complications Of Sepsis And Severe Infective Endocarditis With A Large Tricuspid Valve Vegetation: A Case Report, Dua Xiao, Raeann Dalton, Adam Fineman, Michael Benz, Antonios Tsompanidis

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Introduction: Infectious endocarditis of the tricuspid valve is a common complication of intravenous drug use. Endocarditis caused by viridans streptococci can lead to heart valve vegetations which may be life threatening due to the potential for embolism and obstruction. Management of large valvular vegetations is often difficult due to the risks involved with open heart surgery, especially in patients with comorbid conditions. The AngioVac® device has been shown in rare cases to be effective at debulking vegetations without the need for invasive surgery.

Case Presentation: We present a patient with a history of intravenous heroin use disorder, hepatitis C, spinal …

A Clinician's Guide To 23andme: A Survey-Based Study On People’S Attitudes And Actions Towards Direct-To-Consumer Genetic Testing, Julia Kiffel, Rifke Anolik, Alexander Kowalski

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Background: While direct-to-consumer (DTC) at-home genetic testing like 23andMe provides users with potentially valuable information about their genetics and health risks, consumers might not have the background or knowledge to fully comprehend and interpret the results. This concept is a pressing issue because of the rise in popularity of these DTC genetic tests.

Purpose: The goal of this study is to elucidate the beliefs and attitudes of 23andMe users and determine the relationship between their test results and likelihood for taking medical action. The results from the study will give clinicians and primary care providers (PCPs) insight into how to …

The Blurred Lines Between Medicine And Wellness: A Historical Approach Comparing Osteopathic Physicians, Chiropractors, And Physical Therapists, Heather Soled, Dylan Trawinski, Sonya Priven, Sheam Jahan

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In modern society, there stands a large number of medical titles with nuances that complicate the layperson’s ability to differentiate standard of care and capabilities. As the world evolves, new job opportunities in the medical and related fields are being constructed to provide positions with various levels of certifications that qualify many caregivers to provide similar and often coexisting levels of care. Some disciplines may agree or disagree on principle; this is just one point of confusion for the mass. Furthermore, disciplines that disagree on principle may still apply analogous treatment models. Such confusion has yielded several challenges for less …

Correlation Between Gut Biomarkers And Depression, Jianle Gao

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The correlation between the gut-microbiota- brain axis and mental state in the context of mental disorders such as Major Depressive Disorder (MDD), Schizophrenia, etc. has been well studied. Production of inflammatory and non-inflammatory metabolites by the gut- microbiota directly and indirectly affects the brain and mood. Therefore, colonization by maladaptive, pro-inflammatory bacteria may cause mood dysregulation and depressive features. Metabolites from these bacteria can be quantitatively analyzed for use as biomarkers of Major Depressive Disorder. Biomarkers studied include: serotonin, dopamine, butyrate, acetate, and propionate.

Cellular Metabolism Therapy Slowing Growth Rate Of Glioblastomas, Heet Patel

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Glioblastoma Multiforme (GBM), more commonly known as glioblastomas, are a form of specialized brain tumors called gliomas. Glioblastomas most commonly occur in glial cells of the central nervous system and the average age of diagnosis is 64. Treatment methods implemented currently are surgery of the removable masses followed by courses of chemotherapy and radiotherapy. These methods can only prolong the life span by a few months and as such, new research focused on tumor cell metabolism is being conducted to determine its impact on the progression of this tumor. Tumor masses, such as Glioblastomas, modify their metabolism via the Warburg …

Mesenchymal Stem Cell Therapy For Amyotrophic Lateral Sclerosis, Vrushank Shah, Usmaan Al-Shehab, Keyur Patel, Alexander King

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Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig disease, is a fatal neurodegenerative disease affecting motor neurons in the brain and spinal cord. Progressive muscle weakness, atrophy, and spasticity characterize the condition, which eventually leads to paralysis and respiratory failure. There is currently no cure for ALS, and the standard of care is supportive, with riluzole being the only approved medication that has been shown to slightly slow disease progression (1).

However, the use of mesenchymal stem cells (MSCs) in the treatment of ALS is a new area of research in regenerative medicine. MSCs are multipotent stem cells that …

Standardizing Sti Screening In Child Sexual Abuse Cases At The Cares Institute, Usha Modukuru, Sarah Kleinle, Laura Brennan

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Children who are sexually abused have a higher risk of contracting STIs and/or becoming pregnant. CDC STI testing guidelines should be adhered to in order to provide the safest outcomes for patients. Physician compliance with testing guidelines plays a significant role in ensuring patient safety, which highlights the importance of ensuring high physician compliance. Identifying ways physicians can improve compliance can enhance patient care. In order to determine compliance rates of the CARES Institute physicians, data was extracted from 275 patient charts from 2017 and 100 patients charts from 2021, before and after a continuing medical education (CME) training was …

Case Report: Anaphylactic Reaction To Magnesium Sulfate, Nicholas Coan, Kelly Schiers, James Espinosa, Alan Lucerna

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We report a case of a 65-year-old female who prior to being discharged from the hospital developed an anaphylactic reaction after receiving an intravenous magnesium sulfate infusion. After extensive literature review, there are few documented hypersensitivity reactions documented. This case report is to highlight a known human response, anaphylaxis, but in response to the repletion of an essential electrolyte to human life, magnesium.