Diseases Commons^™

Moving On Up: A Case Study Of Hiv And Covid-Induced Guillain-Barre Syndrome, Victoria Wong Murray, Rebecca Chae, Isobel Moyer, Cindy Hou

Rowan-Virtua Research Day

COVID and HIV are both common diseases, with COVID affecting an estimated 775 million and HIV affecting 39 million people worldwide. Guillain-Barre is a rare but feared complication of immune stimulation in which the body generates autoantibodies against gangliosides, found in the nodes of Ranvier, in the myelin, and in the ganglia; causing ascending paralysis.

A mid-30s man with HIV maintained on Genvoya presented to the Jefferson Health New Jersey Early Intervention Program clinic with fatigue, fever, cough, and congestion and tested positive for SARS-CoV-2 on the following day. Two weeks later, he presented to the emergency department complaining of …

Ultrasound Versus Radiography For Evaluating Surgical Necrotizing Enterocolitis, Sayed H. Aftab, Santiago Martinez-Correa, Minh-Huy Huynh, Wondwossen T. Lerebo, Jorge Delgado, Rebecca Denis, Misun Hwang

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Purpose:

Necrotizing enterocolitis (NEC) is an abdominal inflammatory condition that is common in premature neonates. Although abdominal radiograph (AR) remains the imaging standard for NEC, it may miss up to 50% of early signs of NEC and has been described to have a sensitivity as low as 15.4% for detecting pneumoperitoneum. Abdominal ultrasound (US) is portable, non-invasive, and allows real-time bowel integrity, movement, and perfusion assessment. We aim to evaluate the concordance between US and AR in detecting NEC features and the diagnostic performance of both modalities in detecting pneumoperitoneum.

Methods and materials:

We conducted an IRB-approved retrospective, cross-sectional, single-center …

Addressing The Black Maternal Mortality Rate, Kennedy Sanders, Venkateswar Venkataraman, Kate Whelihan

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Introduction: As of 2021, the Black maternal mortality rate in the United States was 69.9 deaths per 100,000 live births as compared to the national average of 32.9 and the White American average of 26.61. It has been demonstrated that this discrepancy is not fully explained by socioeconomic status. Doulas are professionals who provide support and guidance throughout pregnancy, birth, and early parenthood. Encouraging the use of doulas may be an effective approach to improve the birth experience for Black mothers. Methods: A literature review was performed using PubMed and the following search strings: maternal mortality rate (+race, +race +ethnicity, …

Pediatric Neurotropic Infection Alters Synaptic Development In The Developing Brain, Anuoluwapo Grace Fadare, Yashika S. Kamte, Manish N. Chandwani, Lauren A. O'Donnell

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Many neurotropic viruses cause more significant pathology in younger hosts as their brains are still developing. This experiment asked how central nervous system (CNS) viral-infections affect the development of synapses in the pediatric brain during infection and post-infection. Synaptogenesis is at its peak in pediatric mice (10 days old) and we hypothesized that a neurotropic infection could disrupt synaptic proteins. We used a transgenic mouse model where measles virus (MV) infects only mature neurons, leading us to question whether synapses were impacted. We examined synaptic markers in the cerebellum and hippocampus in MV-infected and uninfected mice 9 days and 90 …

A Deep Dive Into The Relationship Between Sleep Deprivation And Pain Perception: A Cross-Population Analysis, Adam T. Friedman, Kevin Regan

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Background: Sleep deprivation and pain perception significantly impact one another through altered sleep parameters such as Total Sleep Time (TST) and Sleep Efficiency (SE). Particularly in neuropathic pain, disturbed sleep exacerbates pain by disrupting neurobiological mediators like opioids and serotonin. Our research examined how sleep loss affects pain in chronic conditions versus healthy individuals. This research underpins our analysis of how interventions, possibly nutritional, could improve sleep quality and modulate pain perception, exploring this relationship across diverse populations and conditions.

Methods: Our study reviewed peer-reviewed articles published since 2010 on sleep deprivation and pain perception. We searched PubMed, focusing on …

The Impact Of Vitamin Supplementation (D, B12, B9) On Behaviors Associated With Autism Spectrum Disorder, Rohan Mehra

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Background: One in 36 children in the United States are diagnosed with Autism Spectrum Disorder (ASD). Although heritability of the condition ranges from 40 to 80%, other factors such as vitamin levels, may have a significant impact on the risk of development. These vitamins include D, B12, and B9.

Purpose: To assess the impact vitamin supplementation has on behaviors associated with ASD, and to determine which specific aspects of ASD may be improved with vitamin supplementation.

Methods: A literature review was performed. The search was utilized PubMed, JSTOR and Web of Science. Keyword strings included: “Vitamin D B12 B9 folate …

Vitamin Level Differences Across The Asd Spectrum, Rohan Mehra, Wendy F. Aita, Andrea Iannuzzelli

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Background: In the United States, 2.7% of children are diagnosed with Autism Spectrum Disorder (ASD). Environmental factors such as vitamin levels, including D, B9, and B12, may have a significant impact on the risk of development. Children conceived in winter months, with low sunlight and Vitamin D levels, have a higher risk of developing ASD. Vitamin B12 deficiency is generally linked with an increased risk of neurodevelopmental disorders. Additionally, vitamin B9 deficiency of a mother during gestation is linked to a higher risk of her child developing ASD.

Purpose: To assess potential differences in vitamin levels between patients of differing …

Soluble Antimicrobial Peptide (Amp) Screening To Rationally Design Amp-Hydrogels That Selectively Prevent Biofilm Formation, Matthias Recktenwald, Muskanjot Kaur, Mohammed M. Benmassaoud, Aryanna Copling, Tulika Khanna, Michael Curry, Denise Cortes, Gilbert Fleischer, Valerie J. Carabetta, Sebastián L. Vega

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Staphylococcus aureus is an opportunistic pathogen that lives on surfaces and skin and can cause serious infections once inside the body. While antibiotics effectively kill bacteria, there are a growing number of infections with antibiotic-resistant strains. Antimicrobial peptides (AMPs) are part of the innate immune system and can eliminate pathogens including bacteria, fungi, and viruses, and are a promising alternative to antibiotics. Although studies have reported that AMP-functionalized hydrogels can prevent bacterial adhesion and biofilm formation, these materials generally consist of one AMP at an arbitrary concentration, and AMP dosing and the combined effects of multiple AMPs are not well …

Sunscreen Cost And Its Effect On Skin Cancer In Low-Income Communities: A Systemic Review, John Sauer

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This research examines the pivotal connection between sunscreen affordability and its impact on skin cancer prevalence, especially in low-income communities. Despite universal dermatological recommendations for daily sunscreen use, stringent criteria contribute to elevated prices, averaging around $10 for a 6 oz unit. This financial strain is compounded for families adhering to recommended application rates, leading to significant economic burdens. Outdoor laborers, less likely to follow guidelines, face heightened risks. Government programs' excluding sunscreen costs further exacerbate challenges for low-income communities, contributing to increased skin cancer incidence. This review aims to establish a correlation between sunscreen cost and skin cancer rates, …

The Benefits And Risks Of Pudendal Nerve Block And Dorsal Root Ganglion Stimulation In Pudendal Neuralgia, Pooja A. Patel

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Context: Pudendal neuralgia is a chronic neuropathic pain syndrome worsening throughout daily activities. Although temporarily relieved when standing or lying down, it is often misdiagnosed, improperly treated, and/or refractory to treatment leading to a negative impact on quality of life. The lack of research in proper diagnosis and interventional management (such as dorsal root ganglion stimulation (DRGS) and pudendal nerve block) further contributes to the delay in relief from the chronic pain. Objective: The goal of this scoping review is to assess if research exists on benefits and risks of pudendal nerve block and dorsal root ganglion and …

Utilizing Microwave Ablation In Combination With Vertebroplasty Is An Effective Method In Reducing Cancer Related Back Pain, Disability, And Opioid Use: A Systematic Review And Meta-Analysis, Jonathan Elias, Lothar Vidal, Richard Jermyn

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Background: It is estimated that metastases from primary malignant neoplasms affect the spine around 30%-70% of the time. Many times, these osteolytic tumors will cause the degradation of the vertebrae, leaving patients in a tremendous amount of pain, disability, and dependence on opioids as analgesics. Microwave ablation (MWA) followed by vertebroplasties (VP) has been a developing treatment for such a condition; however, there are no systematic reviews or meta-analyses examining the method’s effectiveness thus far.

Purpose: This systematic review and meta-analysis analyzes the 4-week and 12-week outcomes of patients with metastatic spinal cancer treated with the combinatorial treatment …

Analyzing The Effectiveness Of Transcutaneous Auricular Vagus Nerve Stimulation On Parkinson’S Disease Related Gait Function: A Systematic Review And Meta-Analysis, Sami Dakhel, Jonathan Elias, Alexander King

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Background: Those suffering from Parkinson’s Disease often experience a shuffling gait, alongside many other symptoms, due to the degradation of dopaminergic neurons in the substantia nigra. Transcutaneous auricular vagus nerve stimulation (taVNS) operates by non-invasively applying an electrical current to the cutaneous receptive field formed by the auricular branch of the vagus nerve in the outer ear. We sought to determine if taVNS would serve as a non-invasive alternative to addressing Parkinson’s related gait dysfunction.

Purpose: This systematic review and meta-analysis analyzes the effectiveness of taVNS on the reduction of gait dysfunction caused by Parkinson’s Disease.

Methods: The systematic review …

Comparing The Effectiveness Of Hyaluronic Acid And Dextrose Prolotherapy Injections In The Treatment Of Lateral Epicondylitis: A Systematic Review And Meta-Analysis, Sara Ragab, Sami Dakhel, Jonathan Elias, Hesham Abdelfattah

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Background: Lateral epicondylitis (LE), commonly referred to as tennis elbow, is characterized by micro-tears to the tendon origin that attaches to the outer portion of the elbow, with the extensor carpi radialis brevis being the most commonly affected tendon. It presents most often amongst manual workers and athletes that participate in repetitive movements. Patients may experience burning and aching sensations that can potentially radiate down to the wrist. Hyaluronic acid is a primary component of synovial fluid and has anti-inflammatory properties and also provides lubrication to joints. Prolotherapy involves injection of an irritant, most commonly dextrose, into the common extensor …

Intra-Accumbens Microinfusion Of The Dopamine D3 Receptor Partial Agonist (±)Vk4-40 Does Not Affect Basal Locomotion In Mice, Yeonwoo Sim, Nicole M. Hinds, Amy Hauck Newman, Daniel F. Manvich

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The opioid epidemic remains a pressing public health crisis, prompting the search for alternative pharmacotherapies for Opioid Use Disorder (OUD). This study explores the potential of the dopamine D3 receptor (D3R) partial agonist, (±)VK4-40, as a novel treatment option. We investigated the impact of intra-nucleus accumbens (NAc) microinfusion of VK4-40 on basal locomotion in mice. Results indicate that VK4-40 did not significantly alter basal locomotion, suggesting that its therapeutic effects may not be mediated through disruptions in generalized motor function. Future research will focus on elucidating the neuropharmacological mechanisms underlying VK4-40's therapeutic actions and exploring its effects on psychostimulant-induced hyperlocomotion. …

Doxazosin Immediate Release As Alternative Treatment For Nightmares In Post-Traumatic Stress Disorder: A Case Report, Danyaal Khan, Christie Richardson, Martin Forsberg

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Nightmares and flashbacks are common debilitating symptoms of post-traumatic stress disorder (PTSD) that can disrupt daily functioning in patients. Prazosin, an alpha-1 adrenergic antagonist, has been commonly used off-label for the treatment of PTSD intrusion symptoms, although its short half-life is limiting. Doxazosin, another alpha-1 antagonist, is starting to be investigated in the treatment of PTSD-related nightmares due to its smaller side effect profile and longer half-life. In our case report, we present a case of a patient with PTSD-related nightmares who was successfully treated with doxazosin following relapse of symptoms after discontinuation of prazosin. The success of doxazosin immediate …

Efficacy Of Osteopathic Manipulative Medicine As A Non-Pharmacological Approach For Alleviating Pain And Muscle Stiffness In Patients With Multiple Sclerosis And A Comparison To Conventional Medical Interventions, Maduka Gunasinghe, Shannon Mckee

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Multiple Sclerosis (MS) is a progressive neurological condition characterized by a range of debilitating symptoms, including muscle stiffness, fatigue, spasticity, tremors, and gait disturbance. Traditional treatments often face adherence challenges and escalating costs, prompting the exploration of alternative interventions like Osteopathic Manipulation Techniques (OMT). While the effectiveness of OMT in MS remains underexplored, initial studies suggest promising outcomes, such as improved mobility, reduced fatigue, and enhanced range of motion. Specifically, indirect OMT techniques like counterstain, myofascial release, and muscle energy techniques have shown efficacy in addressing muscle tension, spasticity, and gait abnormalities. Integrating OMT into MS management may offer a …

Case Report: Post-Obstructive Pneumonia Secondary To Foreign Body Aspiration, Aashna Chaudhry, Andrew Vasta

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Post-obstructive pneumonia is described as a pulmonary infiltrate that occurs proximal to the site of an obstructed bronchus. Studies show that post-obstructive pneumonia most commonly secondary to obstruction caused by neoplasms. According to a study done on post obstructive pneumonia in lung cancer, most cases of post obstructive pneumonias are associated with advanced neoplasms with up to 50% of those with advanced cancer getting endobronchial compromise. While neoplasms are the most common cause of post obstructive pneumonia, research is scarce on other potential causes of post obstructive pneumonia. This case reports presents a unique clinical case in which an adult …

Case Report: Overdrive Pacing In Refractory Ventricular Tachycardia, Alyssa A. Baldini, Kishan B. Patel

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We report a case of a 67-year-old male who presented to the emergency department (ED) for palpitations and complaint of his automated implantable cardioverter defibrillator (AICD) firing at home who had multiple episodes of persistent ventricular tachycardia (VT) during his course of stay in the ED. Patients with pacemakers and AICDs can present an additional layer of complexity when treating these conditions. Temporary overdrive pacing (TOP) should be considered as a treatment to correct refractory ventricular tachycardia in patients with implanted pacemakers and AICDs presenting to the ED.

Case Report: What’S That Smell? Olfactory Seizures, Devin Hoover, Neelesh Parikh, James A. Espinosa, Alan Lucerna

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We report a case of a 64-year-old male who presented with transient episodes of near syncope followed by a noxious odor and was diagnosed with olfactory seizures. The differential diagnosis for near syncope is broad. This case demonstrates that unusual olfactory symptoms can lead to a diagnosis of seizure disorder in the emergency department.

Case Report: An Emergency Department Presentation Of An Ovarian Teratoma, David Marconi, Zamron Masih

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A teratoma (from the Greek terato for “monster” and onkoma for “mass” or “swelling”) is a type of neoplasm composed of tissues from two or three germ layers. Mature cystic teratomas (MCTs) constitute 70% of all ovarian neoplasms. They typically present with nonspecific symptoms such as pain and nausea. They account for approximately 2% of all primary ovarian malignant cancers and are predominately diagnosed via ultrasound. Computed tomography may be necessary if malignancy is suspected. Larger size warrants a higher suspicion of malignancy. Management is symptom control and ultimately, surgical removal. Prognosis is generally excellent, provided there is no malignant …

Spontaneous Intracranial Hemorrhage In A 29-Year-Old Male: A Case Report, Md Fateha, Caroline Nguyen, Michael A. Morris

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Spontaneous intracranial hemorrhage is rare, especially in a young patient population. Signs and symptoms of intracranial hemorrhage include facial droop, vision loss, motor deficits with extraocular movements, deficits with tongue movement, weakness in the arms or legs, sensation loss, and mental status change. This is a case report of a 29-year-old male with no past medical history who presented for a spontaneous intracranial hemorrhage. This patient's only neurologic deficit was the loss of visual field on the left inferior quadrant of his field of vision. The patient obtained a CT head non-contrast which showed 21 mm acute right occipital hemorrhage …

Atypical Case Of Recurrent Saddle Pulmonary Embolism With Associated Chronic Hypoxia, Karl Schlicht

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A saddle pulmonary Embolism (PE) represents a blood clot within the pulmonary artery vasculature that lodges itself between both the left and right pulmonary artery. They can be described as being massive or sub-massive. Massive PE’s cause large clot burden that puts the patient risk for sudden hemodynamic collapse, while sub-massive saddle PE’s typically do not cause hemodynamic collapse nor significant cardiac effects, such as right heart dysfunction. As clinicians, we need to be vigilant about whether a patient is placed into that criteria of sub-massive or massive and act quickly to start management that could be lifesaving.

“Lupus, Marijuana, And Takotsubo: A Perfect Storm”: An Unusual Presentation Of Takotsubo Cardiomyopathy, Matthew Orap, Parth Patel, Haitham Dib

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Takotsubo cardiomyopathy is a type of myocardial injury that is marked with left ventricular contraction dysfunction. Various regions of the left ventricular wall may exhibit hypokinetic or hypercontractile activity. There is no exact mechanism elucidated for Takotsubo cardiomyopathy, but it is often associated with a triggering stressful event that leads to a catecholamine surge. We describe a 38-year-old female who presented with typical Takotsubo cardiomyopathy, likely in the setting of worsening systemic lupus erythematosus (SLE) exacerbations and excessive cannabis use. The patient described her pain as a tight burning sensation that started on her right side and traveled to the …

Complications Following Hemivertebrectomy For Congenital Scoliosis, Sanjana Davuluri, Taemin Oh, Kyrillos Akhnoukh, Zachary Weingrad, Michael Lesgart, Terrence Ishmael, Joshua Pahys, Amer Samdani, Steven Hwang

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Introduction:

Hemivertebrae are rare congenital anomalies that can cause severe scoliosis requiring surgical correction. We aimed to determine whether severity of deformities is associated with more long-term surgical complications following surgical correction.

Methods:

We performed a retrospective, single-institution review on patients who underwent hemivertebrectomy and spinal fusion for congenital scoliosis between 2008-2020. We extracted pertinent data on demographics, radiographic parameters, operative details, and complication rates. Subgroup analyses were also done by complication severity, deformity complexity, and construct length.

Results:

In our series, 30 patients underwent hemivertebrectomy and fusion. Mean age was 9±4.2 years and there was 2:1 male preponderance, with …

‘Not So Atypical’: An Atypical Presentation Of West Nile Virus And Guillain-Barre Syndrome, Matthew Orap, Sana Tahir, Ugonna Ononuju, Naresh Kumar

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Guillain-Barre Syndrome (GBS) is defined by acute areflexic paralysis, usually starting in the distal lower extremities, and ascending to the upper extremities. It is associated with albuminocytologic dissociation, which involves elevated protein levels and normal cell counts in the cerebrospinal fluid. One of the types of GBS, called Miller-Fischer Syndrome (MFS), is characterized by ophthalmoplegia, ataxia, and areflexia. This case report focuses on a 49-year-old male with an atypical presentation of Guillain-Barre syndrome. Guillain-Barre syndrome can be classically caused by Campylobacter jejuni. However, there can be other infectious causes as well, namely Cytomegalovirus, Epstein-Barr virus, Varicella-Zoster virus, …

Case Report: Varicella Zoster Virus Encephalitis Presenting With Monochorea, Chetna Thawani, Frank Wheeler

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Meningoencephalitis is a broad range of symptoms as a sequela of inflammation of the CNS system. It is a diagnosis that is often missed, especially in atypical presentations. We describe a case of HSV encephalitis that presented to the ER afebrile with atypical arm movements, most similar to a monochorea, and discuss other cases in the literature of atypical presentations of this disease.

Wellen’S Syndrome: An Infamous Example Of Occlusive Myocardial Infarction (Omi), Joseph Maxwell Piraneo, Joseph Pagano, James A. Espinosa, Alan Lucerna

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Wellen’s syndrome is a condition with characteristic ECG changes that can be highly specific for acute myocardial infarction involving the left anterior descending (LAD) artery. Acute myocardial infarctions are one of the leading causes of death in the developed world. Its estimated annual prevalence is nearly 3 million worldwide, with more than 1 million in the United States [1]. The importance of timely diagnosis cannot be understated. Here we describe a case of myocardial infarction secondary to LAD occlusion which presented with the atypical ECG pattern known as Wellen’s syndrome.

Case Report: Babesiosis Presenting To The Emergency Department, Daniel M. Zaayenga, Daniel A. Weeks

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Babesiosis is a tick-borne illness caused by the parasitic protozoa Babesia transmitted by the Ixodes tick. Babesia infect the red blood cell of its host and requires the cell for its replication. It is a disease process that can range from asymptomatic infection to organ failure and death. This case presentation reviews a 68-year-old male who presented to the emergency department with flu like symptoms and was found to have babesiosis.

Clinical Outcomes For Impella Patients Associated With Hyperlipidemia: An Analysis Of The National Inpatient Sample, Tony Elias, Sonika Vatsa, Kyrillos Girgis, Taha Syed, Rafail Beshai

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The Impella, a ventricular assist device, is crucial for managing severe heart failure and cardiogenic shock. Despite its widespread use, there's scant information on how hyperlipidemia affects Impella patients. To address this gap, we delved into the National Inpatient Sample Database from 2019 and 2020. Our aim was to scrutinize in-hospital outcomes among these patients. We identified 8233 Impella patients, among whom 1012 (12.3%) had hyperlipidemia. Those with hyperlipidemia displayed higher rates of hypertension, diabetes mellitus, and chronic kidney disease compared to their counterparts without hyperlipidemia. Shockingly, in-hospital mortality was notably elevated in the hyperlipidemia group, emphasizing its clinical significance. …

Pseudogout, A Case Of Rejection-Associated Pain, Emily Clark, Ziqian Wang

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Pseudogout, known as calcium pyrophosphate deposition disease (CPPD), is an arthritis caused by the deposition of calcium pyrophosphate dihydrate crystals within the joint space. Certain medications have been implicated in the development of pseudogout. This case report examines a patient who developed pseudogout thought to be caused by the use of the immunosuppressant medication tacrolimus.