Diseases Commons^™

Case Report: Vertebral Artery Dissection After Cervical Manipulation, Devin Hoover, Emily Bolinger, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

We report the case of a 22-year-old female who presented with dizziness and vomiting after recent cervical manipulation who was diagnosed with a dissection of the vertebral artery. Dizziness can have a variety of causes including vascular etiologies, cerebellar and brainstem lesions, ocular problems, trauma, and others. In the setting of a known trauma and acute vestibular symptoms, it is prudent to consider vascular injuries.

Persistent Hypotension Following Viral Illness- Pocus For Pericardial Effusion, Peter Killian, Kelsey Murray, James Espinosa, Alan Lucerna

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A pericardial effusion is defined as a build up of fluid in the pericardial space, the lining around the heart. Normal physiologic fluid can consist of approximately 15-50mL in an otherwise healthy adult . Larger amounts of fluid can be detected on radiographs, but are able to be seen on ultrasound when just exceeding physiologic conditions . Here we report a case of persistent hypotension assessed by point of care ultrasound (POCUS) in order to lead to a diagnosis.

Case Report: Necrotizing Pneumonia, Veroneka Mikhail Md

Rowan-Virtua Research Day

Necrotizing pneumonia is an uncommon but severe complication of community-acquired pneumonia (CAP), characterized by progressive parenchymal liquefaction, cavitation, and destruction of normal lung architecture, and associated with significant morbidity and mortality. Clinicaly, early presentations may be indistinguishable from uncomplicated pneumonia (pna), with fever, cough, pleuritic chest pain, and dyspnea, which can delay recognition in the emergency department. Differential diagnosis for these symptoms is broad and includes uncomplicated pneumonia, septic emboli, lung abscesses, and pleural effusion. However, patients effected with necrotizing pneumonia often exhibit more severe systemic toxicity, rapid progression of respiratory failure, and hemodynamic instability. In this case report, we …

Surviving Ph 7.0: Rapid Interprofessional Collaboration In Severe Metformin-Associated Lactic Acidosis With Refractory Shock, Karl J. Schlicht Md, Amaani Faizal, Vincent Macolino, Julian Coz

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Metformin-associated lactic acidosis (MALA) is a rare but life-threatening complication with mortality rates of 30-50%. Although metformin is the most widely prescribed antidiabetic medication, severe MALA requiring emergent hemodialysis remains uncommon, with an estimated incidence of 2-9 cases per 100,000 patient-years. Risk factors include acute kidney injury, dehydration, and tissue hypoxia. Early hemodialysis initiation is independently associated with improved survival. This case highlights how rapid interprofessional collaboration from the emergency department to the intensive care unit enabled in a patient presenting with profound acidemia and survival multiorgan dysfunction

Rethinking Gout Through An Inflammatory Lens, James Espinosa, Alan A. Lucerna

Rowan-Virtua Research Day

This review reframes gout not as a static disease of urate deposition, but as a dynamic inflammatory phenomenon. The emphasis is on immune activation, threshold behavior, and systemic inflammatory context rather than isolated joint pathology.

Air Quality, Atmospheric Pressure, And Migraine Presentations In The Emergency Department, James Espinosa, Alan Lucerna

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Background: Migraine is a leading cause of Emergency Department (ED) visits and global disability. Weather has long been reported by patients as a trigger, yet the literature remains inconsistent. Prior ED-based data demonstrated an association between higher mean barometric pressure and increased migraine presentations, without a relationship to short-term pressure change. Because high-pressure systems are frequently associated with atmospheric stagnation and pollutant accumulation, air quality may represent a biologically plausible mediator.

Objective: To examine the relationship between air quality and ED migraine presentations within the existing body of literature and to explore whether air quality may help explain previously observed …

Wildfires And Emergency Department Respiratory Surge: Brief Review, Systems Forecasting Implications And Recommendations For Research, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Background: Wildfire smoke produces abrupt increases in PM2.5 and Air Quality Index (AQI) levels. Event-based and multi-season studies demonstrate short-term increases in asthma-related Emergency Department (ED) visits, with additional evidence supporting increased utilization for broader respiratory disease and chronic lower respiratory disease (including COPD) (Reid et al., 2016; Liu et al., 2015; Stowell et al., 2025; CDC, 2023).

Objective: To synthesize current evidence linking wildfire smoke to ED respiratory surge and to propose a systems forecasting model that translates environmental signals into structured operational stabilization within a complex adaptive system (CAS).

Methods (Review & Model Development): Narrative synthesis of event-based …

Stroke Mimics And Stroke Chameleons: Leveraging The False Positive/False Negative Diagnostic Schema In Resident Teaching, James Espinosa, Alan Lucerna

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Background

Stroke mimics and stroke chameleons contribute significantly to diagnostic uncertainty in Emergency Medicine. Traditional teaching often relies on enumerating examples, yet residents struggle to internalize these distinctions.

Objective

To present a conceptual teaching framework that maps stroke mimics to false positives and stroke chameleons to false negatives, leveraging pre-existing diagnostic schemas.

Methods

Using representative cases—including hypoglycemic hemiparesis and spinal epidural lipomatosis presenting as stroke mimic—we developed an explanation for residents involving framing mimics as false positives and chameleons as false negatives.

Results

Framing mimics as false positives and chameleons as false negatives activates existing learner schemas related to sensitivity …

Unusual Etiology Of Cauda Equina Syndrome In An Aids Patient: A Case Report, Wesley Augustus Kim, Brandon Velazquez

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Patients with advanced HIV/AIDS are at high risk for primary central nervous system (CNS) lymphoma due to impaired immune surveillance and HIV-driven B-cell proliferation. While intracranial lesions are well recognized, spinal involvement remains underrecognized due to the scarcity of well documented report cases in current literature. In this patient,we describe the case of a 35-year-old male with a new HIV diagnosis who experienced acute bilateral lower extremity weakness and urinary retention during hospitalization for fever, perianal abscess, and urinary tract infection. Initial CD4 count revealed profound immunosuppression with a CD4 count less than 20 cells/μL and a viral load of …

Efficacy Of Repetitive Transcranial Magnetic Stimulation In Reducing Pain Intensity In Chronic Neuropathic Pain: A Sham-Controlled Analysis, Aprupa Alahari, Nathan Nhan, Cindy Nguyen, Samnit Gill, Simran Parmar, Annelisse Zara

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Background 

Chronic neuropathic pain (CNP) can be refractory to traditional pharmacologic therapies, giving rise to the investigation of non-invasive alternatives such as repetitive transcranial magnetic stimulation (rTMS). rTMS utilizes magnetic fields to modulate neuronal activity within specific brain regions, offering a targeted approach to analgesia without the side effects of systemic medication1,2,3,4.

Hypothesis 

rTMS produces a greater reduction in reported pain intensity compared to sham stimulation in adults diagnosed with CNP.

Methods 

A systematic review and analysis  were conducted, utilizing PubMed and Embase (2004–2025) for sham-controlled randomized controlled trials (RCTs) and relevant meta-analyses. The review focused on outcomes such as …

Mental Health Comorbidities And Ibd Outcomes In Patients Treated With Anti–Il-23 Therapy, Jashanveer S. Johal, Archana Salek, Mahmoud Al-Bataineh, Bianca Patel, Om Patel, Yecheskel Schneider, Jason Hyman, Abdallah Hussein

Rowan-Virtua Research Day

Background: Depression and anxiety are prevalent in inflammatory bowel disease (IBD) and may adversely influence outcomes. We evaluated the impact of comorbid mood disorders on clinical outcomes among IBD patients treated with anti–IL-23 agents.

Methods: Using a global de-identified electronic health record network, adults with Crohn's disease or ulcerative colitis initiating an anti–IL-23 agent were identified. Cohort 1 included patients with a documented mood disorder (depression and/or anxiety) at or prior to treatment initiation; Cohort 2 included those without mood disorders. Propensity score matching (1:1) on demographics and comorbidities yielded 3,546 patients per cohort. Primary outcomes included inpatient/ED encounters, abscess/fistula, …

Risk Of Colorectal And Gastrointestinal Neoplasia In Inflammatory Bowel Disease Treated With Infliximab Versus Vedolizumab And Ustekinumab: A 5-Year Multicenter Retrospective Cohort Study, Jashanveer S. Johal, Archana Salek, Mahmoud Al-Bataineh, Bianca Patel, Abdallah Hussein, Om Patel, Jason Hyman, Yecheskel Schneider

Rowan-Virtua Research Day

Background: Inflammatory bowel disease (IBD) confers elevated colorectal cancer (CRC) risk, but comparative long-term neoplastic risks between anti-TNF and gut-selective or IL-12/23–targeted biologics remain incompletely defined. We evaluated 5-year risks of CRC and GI neoplasia in IBD patients treated with infliximab versus vedolizumab and ustekinumab.

Methods: Using the TriNetX federated research network, two parallel 5-year propensity score–matched cohort analyses were conducted among adults with Crohn's disease or ulcerative colitis initiating infliximab, vedolizumab, or ustekinumab between 2018–2024. Patients with prior CRC, colectomy, or baseline comparator biologic exposure were excluded. The infliximab–vedolizumab analysis matched 13,111 patients per cohort; the infliximab–ustekinumab analysis matched …

Sodium-Glucose Cotransporter-2 Inhibitor Use In Patients With Cirrhosis And Type 2 Diabetes: Impact On Hepatic Decompensation And Hospitalization, Jashanveer S. Johal, Archana Salek, Mahmoud Al-Bataineh, Bianca Patel, Abdallah Hussein, Om Patel, Jason Hyman, Yecheskel Schneider

Rowan-Virtua Research Day

Background: SGLT2 inhibitors improve cardiovascular and renal outcomes in type 2 diabetes mellitus (T2DM), but their safety in cirrhosis remains uncertain given risks of volume depletion, infection, and decompensation. We evaluated the association between SGLT2 inhibitor use and hepatic decompensation and healthcare utilization in cirrhotic patients with T2DM.

Methods: A retrospective cohort study was performed using the TriNetX multicenter electronic health record network. Adults with cirrhosis and T2DM between 2018–2024 were classified as SGLT2 inhibitor-treated versus untreated. Propensity score matching (1:1) yielded 23,234 patients per group. Primary outcomes included new ascites, hepatic encephalopathy (HE), ED visits/inpatient admissions, and all-cause mortality. …

Bone Health And Healthcare Utilization Outcomes In Crohn’S Disease Patients Without Baseline Fracture Or Vitamin D Deficiency Treated With Infliximab Versus Adalimumab: A Propensity-Matched Cohort Study, Jashanveer S. Johal, Bianca Patel, Archana Salek, Mahmoud Al-Bataineh, Abdallah Hussein, Om Patel, Jason Hyman, Yecheskel Schneider

Rowan-Virtua Research Day

Background: Biologic therapies are central to Crohn's disease (CD) management, yet the comparative effects of infliximab and adalimumab on bone health and healthcare utilization remain poorly characterized in patients without baseline vitamin D deficiency or prior fractures.

Methods: A retrospective cohort study was conducted using the TriNetX U.S. Collaborative Network. Adult CD patients (≥18 years) initiating infliximab or adalimumab between 2018–2024 were included. Patients with ulcerative colitis, indeterminate colitis, or positive pregnancy tests were excluded. All patients had normal baseline vitamin D (≥20 ng/mL) and no history of pathological fracture. Propensity score matching (1:1) yielded 7,340 patients per cohort. Outcomes …

Health Disparities In Pediatric Epilepsy: A Narrative Review Of Barriers To Equitable Care, Nikhila Archakam, Akhila Archakam, Wesley Kim, Harshal Parmar

Rowan-Virtua Research Day

Epilepsy affects approximately 1% of children in the United States, representing over 456,000 pediatric patients with active seizure disorders. Despite advances in antiseizure medications and surgical interventions, the benefits of these developments are not distributed equally across racial, socioeconomic, and geographic groups. A narrative review of the literature was conducted using PubMed, Scopus, Embase, and Medline using search terms including "pediatric epilepsy," "health disparities," "health equity," "social determinants of health," "race," "socioeconomic status," and "access to care." Articles were included if they focused on pediatric populations aged 0 to 17, addressed at least one disparity domain, and were published between …

When Biomarkers Disagree: Diagnostic Challenges In Alzheimer’S Disease, Hayya Ali, Omar C. Chishti

Rowan-Virtua Research Day

Alzheimer’s disease (AD) is commonly diagnosed using a combination of clinical evaluation and biomarkers, including amyloid positron emission tomography (PET) imaging and tau protein levels. However, discordant biomarker findings can complicate diagnosis and clinical decision-making. We present a case study of a patient with progressive cognitive decline who demonstrated positive amyloid PET imaging but negative tau biomarkers. The objective of this case report is to demonstrate key diagnostic challenges in Alzheimer’s disease and highlight the need for a comprehensive, multimodal diagnostic approach. This case underscores the limitations of relying on a single biomarker modality and highlights the potential for overlap …

Tuberculosis In Long-Term Asian American Immigrant Residents: Trends And Risk Factors In Cases Diagnosed ≥10 Years After U.S. Arrival, Katherine Xie, Kai Mon Lee, Todd Schachter

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Tuberculosis in Long-Term Asian American Immigrant Residents: Trends and Risk Factors in Cases Diagnosed ≥10 Years After U.S. Arrival

Katherine Xie, MSc¹, Kai Mon Lee, PhD¹, Todd Schachter, DO¹

¹Rowan-Virtua School of Osteopathic Medicine, 1 Medical Center Dr, Stratford, NJ 08084

Background

In the U.S., TB cases are largely due to reactivation of latent TB infections (LTBI) of immigrants from high-burden countries. The CDC and U.S. Preventive Services Task Force currently recommend screening newer immigrant populations, especially those born in highly-burdened areas with TB. This guideline mostly targets newly immigrated populations, defined as those …

Developing A Computational Pipeline For Biomarker Discovery In Ischemic Reperfusion Injury, Surabhi Panda, Kaitlyn Insana, Dimitri Pestov

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Background: Ischemia-reperfusion injury (IRI) contributes significantly to tissue damage in cardiovascular disease. During IRI, stressed and dying cells release ribosomal RNA, which exhibits distinct fragmentation patterns that may serve as potential diagnostic biomarkers. Although these patterns have been observed using low-resolution biochemical techniques, there is currently no standardized computational approach to quantify and visualize RNA fragmentation for clinical interpretation.

Hypothesis: A computational pipeline can be developed to visualize and analyze ribosomal RNA fragmentation patterns, enabling identification of distinct fragmentation hotspots associated with ischemic conditions and potential biomarker discovery.

Methods: RNA fragmentation datasets generated from ribosomal RNA experiments in a Saccharomyces …

Addressing Diabetes Risk Through Preventative Education In Multicultural And Economically Underserved South Jersey Communities, Bavly Nagy Halaka, Janet Jimenez-Merino, Izayah Diaz

Rowan-Virtua Research Day

BACKGROUND: Diabetes and prediabetes affect a substantial and growing portion of the U.S. population, with adolescent prediabetes rates more than doubling from 11% in 1999 to 28% in 2018. In multicultural and economically underserved South Jersey communities, structural barriers including food insecurity, limited access to preventive healthcare, and language gaps make early detection and prevention particularly difficult. We aimed to assess diabetes risk, management behaviors, and preferred education formats among a Camden-area bilingual community, and to identify culturally responsive intervention strategies.

METHODS: We conducted a literature review utilizing data from the CDC, NJ Department of Health, NJSHAD, and the U.S. …

Acute Necrotizing Pancreatitis Due To Hypertriglyceridemia: A Case Report, Samantha Alyse Walkow, Pranaya Gade, Marina Bastawross, Ayesha Ain, Antonios Tsompanidis

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Title: Acute Necrotizing Pancreatitis due to Hypertriglyceridemia: A Case Report

Background: Necrotizing pancreatitis is a severe complication of acute pancreatitis with a high risk of morbidity and mortality. Hypertriglyceridemia (HTG) is an uncommon but increasingly recognized etiology, often associated with more severe disease compared to biliary or alcoholic pancreatitis. Early recognition and targeted management are critical to prevent multiorgan failure.

Case Presentation: We present the case of a 39-year-old Hispanic male with a history of chronic hypertriglyceridemia and epilepsy who presented with acute onset of severe epigastric pain, nausea, and vomiting. Laboratory evaluation revealed markedly elevated serum triglycerides (TG) levels …

A Case Of Successful Survival In A High-Risk Elderly Patient With Copd After Endotracheal Intubation, Julia Cueto Oms-Ii

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Exacerbations of chronic obstructive pulmonary disease (COPD) leading to acute respiratory failure (ARF) is one of the major causes of mortality worldwide, thus typically having poor outcomes. Risk factors such as the need for invasive mechanical ventilation (IMV), severity of disease, comorbidities, and increased age are predictors of increased mortality rates in COPD patients. Noninvasive ventilation (NIV), like bilevel positive airway pressure (BiPAP) or high flow nasal cannula (HFNC), is the initial standard of care for acute exacerbations of COPD. However, longer periods of NIV and failure of NIV therapy can lead to delayed endotracheal intubation and higher mortality rates. …

Isolation And Quantification Of Rna From Extracellular Vesicles Derived From A549 Human Non-Small Cell Lung Cancer Cells Using Ultracentrifugation, Yousef Dimian, Vanessa Pizutelli, Dimitri Pestov

Rowan-Virtua Research Day

Extracellular vesicles (EVs) have gained attention as potential diagnostic tools due to their presence in body fluids and their ability to carry nucleic acids, including RNA. EV-derived RNA, particularly ribosomal RNA (rRNA), may reflect cellular stress and disease states, making it a promising biomarker1, 2. This project focuses on optimizing methods to isolate EVs and quantify their RNA content using human cell culture models. Differential ultracentrifugation was used to separate vesicle populations based on size, followed by RNA extraction and quantification using a high-sensitivity assay. Initial experiments using media from three 150 mm culture dishes yielded no detectable RNA, whereas …

Impact Of Routine Yoga Practice On Metabolic And Hormonal Outcomes In Women With Polycystic Ovary Syndrome, Priya Patel

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Polycystic Ovary Syndrome (PCOS) is a prevalent endocrine disorder affecting approximately 8–12% of reproductive-aged women and is commonly associated with insulin resistance, hyperandrogenism, and metabolic dysfunction¹. Lifestyle modification remains first-line therapy; however, adherence to conventional interventions is often limited²,³. As a result, there has been growing interest in complementary approaches such as yoga, which integrates physical activity, breath control, and stress reduction⁴.

This focused literature review evaluates the impact of routine yoga practice on metabolic and hormonal outcomes in women with PCOS. A comprehensive search of PubMed, Scopus, CINAHL, and Embase was conducted, identifying 201 articles. After screening and applying …

Acute Coronary Syndrome Presenting As Pericarditis, Oliwia A. Dalek, Zamin Kazmi, James Espinosa, Alan Lucerna

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We report a case of a 71-year-old male with a past medical history of myocardial infarction (MI) who initially presented to the emergency department (ED) with a chief complaint of chest pain and shortness of breath.  After consultation with Cardiology in the ED, the presumed diagnosis was pericarditis, and heparin drip was not initiated.  The patient subsequently developed a complete heart block indicating an atrioventricular (AV) nodal knock out, likely due to an ischemic event.  This case highlights the importance of identifying acute coronary syndrome (ACS) as early as possible in order to intervene and achieve the best possible outcomes …

Resensitization Of Clinical Isolates Of Mdr-Acinetobacter Baumannii To Antibiotics Using Bacteriophage Therapy, Zainab Mubasher, Valerie J. Carabetta

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Acinetobacter baumannii is a Gram-negative, opportunistic pathogen notorious for causing severe infections in immunocompromised patients, particularly those with prolonged hospitalizations or invasive procedures1. Originally susceptible to many antibiotics in the 1970s, this bacterium has since evolved extensive resistance, making it one of the most challenging members of the ESKAPE group of multidrug-resistant (MDR) pathogens2. Its ability to survive in harsh environments and acquire resistance determinants has led to its classification as a “red alert” pathogen by health authorities worldwide. The increasing prevalence of MDR A. baumannii infections in healthcare settings underscores an urgent need for alternative treatment strategies as conventional …

Quantifying Qtc Prolongation Risk At Scale: Cardiac Safety Implications Of Moxifloxacin-Based Tb Regimens, Wesley Augustus Kim, Nikhila Arcakam, Brandon Velazquez

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Tuberculosis treatment is undergoing its most significant transformation in decades. In recent years, updated ATS/CDC/ERS/IDSA guidelines introduced a new 4-month drug-susceptible TB regimen that incorporates moxifloxacin as a core component. These landmark guideline shifts mean that moxifloxacin exposure among TB patients globally is set to expand dramatically. This drug replaces the ethambutol component of standard TB regiment commonly associated with optic neuritis as a side effect. Yet there is a critical blind spot: while individual studies have documented moxifloxacin’s QT interval-prolonging effects, no research has modeled what happens when this drug is rolled out to millions of patients who simultaneously …

Ketamine With Opioids Vs. Ketamine With Non-Opioid Analgesics For Vaso-Occlusive Crisis In Sickle Cell Disease: A Prisma-Style Scoping Review, Akhil Tumpudi

Rowan-Virtua Research Day

Vaso-occlusive crises (VOCs) are the hallmark of Sickle Cell Disease (SCD) and a leading cause of hospitalization. Pain management relies heavily on opioids, but repeated exposure carries risks including tolerance, hyperalgesia, and adverse effects. Ketamine, an NMDA receptor antagonist, has emerged as an adjunctive agent with potential opioid-sparing effects (1–3,7). Systematic reviews suggest ketamine may reduce pain scores and possibly opioid requirements, though pooled results remain inconsistent (5,6,8). While ketamine + opioid regimens have been studied, the feasibility, efficacy, and safety of ketamine combined with non-opioid analgesics for VOC remain largely unknown. Understanding the comparative effectiveness of these approaches is …

Facial Skin Discoloration After Topical Silver Sulfadiazine: A Case Report, Hannah Culleny, Philip Carhart, James Espinosa, Neel Parikh, Alan Lucerna, Henry Schuitema

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Silver sulfadiazine (Silvadene) is a topical antimicrobial commonly used in burn management. Although generally well tolerated, excessive or prolonged application may result in cutaneous pigmentation changes due to silver deposition.

Here we present the case of a a 45-year-old woman who presented with diffuse gray-blue facial discoloration five days after sustaining a minor thermal injury. She had been prescribed topical silver sulfadiazine but applied the medication to her entire face and continued use after wound resolution. Physical examination demonstrated asymptomatic hyperpigmented gray-blue macules confined to areas of application. There were no signs of inflammation or systemic involvement. Discontinuation of the …

Sleep Architecture And Delirium In Patients With Intracerebral Hemorrhage: A Preliminary Observational Study, Lily Roessler, Kevin Eaise, Jamie Feinour Msn, Crnp, Jennifer Jond Ms, Pa-C, Vanessa Salasky Md, Mikel Shea Ehntholt Md, Bethany C. Young

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Background: Delirium is common among ICU stroke patients and could possibly be associated with disrupted sleep. However, the relationship between specific sleep characteristics and delirium remains unclear.

Objective: To evaluate the association between sleep architecture and delirium in intracerebral hemorrhage (ICH) patients in the ICU.

Methods: We performed a primary analysis of 14 ICU ICH patients who underwent polysomnography. Sleep variables included total sleep time, sleep efficiency, sleep stages (N1, N2, N3, REM), arousal index, and sleep latency. Delirium was assessed using the Confusion Assessment Method for the ICU (CAM-ICU). Patients were categorized by presence or absence of delirium. Continuous …

Point-Of-Care Intestinal Ultrasound Is Associated With Reduced Colonoscopy Utilization And Improved Clinical Decision-Making In Ibd, Lakumi Dias, Ashlyn Mcclelland, Amy Glasofer, Charalampos Papachristou, Yecheskel Schneider, Sanket Patel

Rowan-Virtua Research Day

Background:

Point-of-care intestinal ultrasound (IUS) enables real-time assessment of bowel inflammation, and it is underutilized in the United States. IUS provides visualization of bowel wall thickness, vascularity, and complications without radiation or bowel preparation. Prior studies demonstrate that IUS changes management and reduces reliance on invasive testing. This study hypothesizes that IUS will impact downstream clinical decision-making in a U.S. outpatient IBD cohort by decreasing invasive procedures and supporting appropriate treatment decisions.

Methods:

A retrospective cohort study was performed. Logistic regression and chi-square tests assessed associations between IUS use, colonoscopy referral, hospital utilization, and treatment modification. A derived “surveillance-due” variable …