Diseases Commons^™

Bullous Pemphigoid With Excoriation Disorder In A 59 Year Old Woman, Kaitlin Mcgowan, Stephen Poos, Nguyen Vo

Rowan-Virtua Research Day

Bullous pemphigoid is the most common autoimmune blistering disease. Classic symptoms include blisters overlying urticarial plaques on the torso and extremities. The condition can result in intense pruritus that begins during the prodromal period.

Excoriation disorder is related to obsessive compulsive disorder (OCD) and is characterized by recurrent skin picking that results in lesions, repeated attempts to stop or decrease the picking, and resultant mental distress or impairment in functioning.

We present a case of a 59-year-old Caucasian female who presented with diffuse rash on most of her body. This particular case is notable for its concurrent severe dermatological and …

A Case Of Akinetic Mutism In Patient With Unilateral Anterior Communicating Artery Stroke, David Ho, Or Shachar, James Espinosa, Alan Lucerna, James Lee

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Akinetic mutism, a rare neurological condition involving sensory, motor, language, behavior, and emotional changes, mimicking locked-in syndrome, should be considered in acute stroke patients presenting with speech deficits. This condition, although debilitating initially, does have prospects for recovery. In this case report, we present the case of a patient presenting to the ER for altered mental status, found to be in DKA, NSTEMI, suspected narcotic overdose, and unilateral acute ischemic stroke of the left anterior communicating artery (ACA), who was found to have Akinetic Mutism. In stroke patients presenting with aphasia and dysarthria, it is worth considering akinetic mutism in …

Case Report: Thyrotoxic Hypokalemic Periodic Paralysis, Kelly Schuitema, Wayne Tamaska, Robin Lahr

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Thyrotoxic crisis, or thyroid storm, is an acute, life threatening event caused by hyperthyroidism with mortality up to 8-25% that can present with multi-system organ involvement. It is a rare, but well studied complication in the emergency department but can lead to further, less common complications. In this study we will discuss a case of thyrotoxic hypokalemic periodic paralysis. Thyrotoxic hypokalemic periodic paralysis (TPP) most commonly affects Asian men. The key features of the syndrome include acute onset of hypokalemia and paralysis. The hypokalemic aspect of the disorder is secondary to the shift intracellularly by thyroid hormones’ sensitization of Na+/K+-ATPase …

Case Report: The Heart Breaking Tale Of Takotsubo In The Ed, Richard Baluyot, James Espinosa, Alan Lucerna, Sergey Medlenov, Joseph Pagano, Bhumi Shah

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Chest pain is one of the most common chief complaints that emergency room physicians deal with on a daily basis. Here we present a rare cause of chest pain on a patient diagnosed with takotsubo cardiomyopathy. This is a condition that has been on the rise since its initial discovery and therefore clinicians should consider this on their differential when assessing patients with chest pain, especially postmenopausal women.

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

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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

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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 …

Effect Of Uracil Dna Glycosylase Activity On The Efficacy Of Thymidylate Synthase Inhibitor/Hdac Inhibitor Combination Therapies In Colon Cancer, Rashmi Kulkarni, Brian P Weiser

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Human uracil DNA glycosylase (UNG2) is responsible for removing uracil bases from DNA and initiates base excision repair pathways. Accumulation of uracil or its fluorinated analogs in DNA is one of the killing mechanisms of thymidylate synthase (TS) inhibitors in cancer cells, and depletion of UNG2 often enhances the toxicity of these anticancer drugs. We tested the effect of UNG2 KO on the efficacy of multiple TS inhibitors (5-fluorouracil, fluorodeoxyuridine, and pemetrexed) and we determined that, except for 5-fluorouracil, all other TS inhibitors were significantly more potent in UNG2 KO cells compared to wild-type HT29 cells. Interestingly, UNG2 protein levels …

Effect Of Osteopathic Manipulative Treatment In Patients With Postural Orthostatic Tachycardia Syndrome (Pots): A Literature Review, Sidharth Sahni, Harrison Jordan, Binoy Desai, Danielle Cooley, Alexander King

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Postural Orthostatic Tachycardia Syndrome (POTS) is characterized by autonomic dysregulation resulting in diminished blood flow and excessive tachycardia.

POTS has been scarcely studied in the clinical setting. A review of literature generated only four articles, only one of which met the established criteria.

A follow up study to evaluate the effect of OMT on the quality of life for patients with POTS is planned. The hypothesis is that osteopathic manipulation plays a role in the management of POTS, as patients should experience improvement in their symptoms and their overall quality of life.

Case Study Of Metformin-Induced Lactic Acidosis, Kajel Patel, Kishan B. Patel

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Metformin induced lactic acidosis is when high levels of metformin cause dangerously high levels of lactic acid. Here is a case report of a 72-year-old female who came in for nausea, vomiting, and diarrhea found to have a high suspicion for metformin induced lactic acidosis. She stabilized in the emergency department, nephrology and ICU was contacted, and she went for emergent dialysis. For many patients the prognosis of metformin induced lactic acidosis is poor. This patient was made comfort care by her family.

Incidental Finding Of Unusually Large Renal Cyst During Point Of Care Ultrasound, David Ho, Jeffrey Gardecki

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Renal cysts are common, and their frequency and size increase as patients age. Renal cysts are derived primarily from tubules and can occur anywhere between Bowman’s capsule to the renal papilla. The cysts are composed of abnormally differentiated epithelial cells encapsulating a cavity of fluid. These abnormally differentiated cells are due to defects in the structure and function of cilia, the structures responsible for detecting urine flow as well as the epithelial composition of the epithelial architecture and repair. According to Campbell Urology, there are three processes in which renal cysts increase in their size – proliferation of epithelial cells …

Interaction Of Fluorescent Probes With Sirtuin Proteins, James Fusco, Brian P Weiser

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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 …

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

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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 …

Long-Term Lithium Use In The Younger Population: Do The Benefits Outweigh The Risks? - A Case Report, Seema Shekar, Alexander Garcia, Rachel Shmuts

Rowan-Virtua Research Day

For decades lithium has been the mainstay treatment for bipolar disorder. While its side effect profile is extensive and varied its most notable adverse effect, and one most feared by treating clinicians, is nephrotoxicity/ end-stage renal disease (ESRD). While the link between long-term lithium use and ESRD has been accepted by the medical community at large for many years, more recent scientific studies call the association into question. In fact, newer studies on the association between Li use and ESRD have shown a negative/inconclusive correlation. Despite this controversy the consensus still remains that ESRD secondary to long-term Li use is …

Investigating The Role Of The Basolateral Amygdala Plays In The Incubation Of Cue-Induced Cocaine Seeking Behavior, Claire Marie Corbett

Graduate School of Biomedical Sciences Theses and Dissertations

Cocaine use disorder is a chronic, relapsing brain disease. Sex and ovarian hormones are known to influence cocaine addiction liability and relapse vulnerability. However, little is known regarding the cellular and synaptic mechanisms contributing to sex differences in relapse vulnerability, including how these measures are influenced by hormonal fluctuations. To investigate sex differences in relapse vulnerability we use a rodent model of cocaine craving and relapse called the incubation model in which cue-induced seeking progressively increases or “incubates” during the first month of withdrawal from extended-access cocaine self-administration. Using this model, we have recently shown that females in the estrus …

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 …

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

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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.

Robotripping: The Dangers Of Abusing Dextromethorphan, Tiffany Sin, James Espinosa, Dana Fichter

Rowan-Virtua Research Day

Dextromethorphan (3-methoxy-N-methylmorphinan), also known as “DXM,” is a synthetically produced drug available in many over-the- counter (OTC) cough and cold medications as a centrally acting cough suppressant that binds to NMDA receptors. In a 2006 national survey of 50,000 students, 4, 5, and 7% of 8, 10, and 12th graders reported DXM abuse in the past year. In high doses, DXM can cause euphoria, hallucinations, dissociations, and distortion of cognition and perception. DXM abuse is also known as “Robotripping,” “Robodosing,” “Dexing,” “Tussin,” or “Triple Cs” because Robitussin® and Coricidin® Cough and Cold are most frequently abused. DXM has replaced codeine …

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

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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.

Rheumatoid Nodule Mimicker Mycobacterium Haemophilum: A Case Presentation, Elisa Griswold

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Mycobacterium haemophilum is a rare infection that can present in humans as subcutaneous nodules and cutaneous lesions. With a growing number of immunocompromised patients, M. haemophilum infections are becoming more common. Rheumatoid nodules in comparison are very common and can occur in approximately 25% of patients with Rheumatoid Arthritis (RA). Here we discuss a case in a patient with Rheumatoid Arthritis who developed subcutaneous nodules that mimicked rheumatoid nodules, but were later determined to be infectious nodules from Mycobacterium haemophilum.

Replication Protein A (Rpa) Targeting Of Uracil Dna Glycosylase (Ung2), Derek Chen, Brian P Weiser

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Replication Protein A (RPA) is a single stranded DNA binding protein which stabilizes ssDNA for replication and repair. One function of RPA is to bind the DNA repair enzyme uracil DNA glycosylase (UNG2) and direct its activity towards ssDNA dsDNA junctions.

UNG2 removes uracil bases from DNA which can appear through dUMP misincorporation or through cytosine deamination. If uracil is present instead of a cytosine, then the original GC pair becomes a GU pair. The uracil will then base pair to adenine in the replicated daughter strand. This results in a GC → AT mutation that could contribute to cancer …

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 …

Spontaneous Splenic Laceration Presenting As Stable Angina In The Ed, Lea Rowson, James Baird

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We present a case of a 62-year-old female who presented to the emergency department complaining of classic cardiac chest pain and was ultimately diagnosed with hemoperitoneum due to a splenic laceration sustained during recent colonoscopy. The signs and symptoms between these two diagnoses can be vaguely similar, and a missed diagnosis of either leads to increased morbidity and mortality. To make an appropriate diagnosis, a thorough history and physical examination is imperative. Observation of non-musculoskeletal left shoulder pain in addition to abdominal tenderness should lead the astute clinician down a different path towards diagnosis. Kehr’s sign is present in many …

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

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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.

The Impact Of Exercise On Pregnant Women Aged 18-40 And Fetal Development, Jinisha Patwa

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68% of those who performed minimum level exercise prior to pregnancy stopped completely during early pregnancy.

Women stop exercising during pregnancy due to worries about the impact it may have on the development of the fetus.

Starting moderate-intensity, weight-bearing exercise early in pregnancy increases placental growth rate and volume.

Exercise reduces the risks of excess gestational weight gain and high maternal body weight before pregnancy.

Physical exercise reduces the risk of gestational diabetes mellitus.

The Effect Of Carfilzomib And Bortezomib Based Regimes On Cardiotoxicity In Multiple Myeloma Patients At Cooper University Hospital, Ami Patel, Tulin Budak-Alpdogan, Stalam Tapati

Rowan-Virtua Research Day

Introduction

• Multiple myeloma (MM) is a cancer of plasma cells, which is a white blood cell that normally produces antibodies
• Treatment in patients younger than 65 years old is typically high dose chemotherapy, usually with bortezomib based regimens or lenalidomide dexamethasone, followed by a stem cell transplant
• For patients with relapsed myeloma, carfilzomib is usually the treatment of choice
• Carfilzomib is a highly selective, irreversible proteasome inhibitor that binds to the 20 S proteasome. Several studies have illustrated that carfilzomib has been associated with cardiovascular adverse events (CVAE).
• Current literature on the role and effect of bortezomib on cardiotoxicity is …

Pain And Sleep Are Associated In Fibromyalgia Patients, Rahul Patel, Robert A Steer, Richard Jermyn, Venkat Venkataraman

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This poster explores whether a correlation exists between lack of sleep and fibromyalgia pain.

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

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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 …

Terson-Like Syndrome Associated With Familial Retinal Arteriolar Tortuosity (Frat) And A Spontaneous Spinal Hemorrhage, Peter Maduka, David R. Lally

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Background: Familial retinal arteriolar tortuosity (fRAT) is an autosomal dominant disorder that is characterized by tortuosity of the second and third order retinal arterioles in the macular and peripapillary areas. The genetics of fRAT are incompletely understood but have been associated with a missense mutation in the COL4A1 gene in some cases. fRAT is not typically associated with visual loss and prognosis is good. However, the tortuous arterioles can bleed, causing intraretinal, preretinal, and/or subretinal hemorrhages.

Objective: To describe a case of Terson-like syndrome associated with familial retinal arteriolar tortuosity (fRAT) in the setting of spontaneous spinal hemorrhage.

Results: A …

Phyllodes Tumor Containing Invasive Ductal Carcinoma: A Rare Case Description & Review Of Literature, Kathryn Eckert, John Ground, Alyssa Imperatore, Victoria Tiedemann, Linda Szczurek

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Phyllodes tumors are uncommon, often benign, malignancies of the breast and account for approximately 0.5% of all breast malignancies. These tumors were first described in 1838 by Johannes Muller as cystosarcoma phyllodes and were later more aptly renamed phyllodes tumors (as they were neither cystic nor sarcomatous).(1) As a mixed connective tissue and epithelial tumor, these behave similar to benign fibroadenomas, though their growth is much more rapid and they tend to occur in older patients.(2) Hallmarked by their large size at presentation, these tumors average between 4 and 7 cm at the time of diagnosis. The only known risk …