Diseases Commons^™

Improving Diabetic Retinopathy Screening Practices With Qi Methodology In Family Medicine Offices, Rea Isaac, Anne Jones

Rowan-Virtua Research Day

Early detection and treatment of diabetic retinopathy (DR) is crucial in preventing vision loss and blindness in vulnerable diabetics. With around 7.7 million patients having DR, and the target population being 20 -75 years old, the potential for improving their quality of life is substantial (WHO, 2022). Despite the importance of timely and routine eye exams, 45% of diabetic patients do not complete an exam despite physicians recommendations (Lu, 2014). This project aims to standardize eye exams, improve process flow, and improve patient understanding of the urgency of timely and comprehensive eye exams for DR. Multiple PDSA cycles and QI …

Amenorrhea And Stress Fractures In Female New Jersey Division Iii Collegiate Runners: An Opportunity For Increased Health Education, Emily Forester, Tara Pellegrino

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Background: In the National Collegiate Athletic Association (NCAA), 9.1% of the injuries reported by Women’s cross country athletes between 2014-2019 were fractures. Although excessive exercise is a major contributor to the development of amenorrhea, there are currently no studies on the association between amenorrhea and stress fractures in NJ NCAA Division III Women’s cross country or track athletes. This study aims to determine if there is an association between incidence of amenorrhea and subsequent occurrence of stress fractures among this population.

Methods: This is a survey based study. Participants must be female athletes over the age of 18 who currently …

The Use Of Osteopathic Manipulative Medicine To Treat Common Pediatric Conditions: A Literature Review, Sonya Priven, Emily Meale, Danielle Cooley

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Context: Doctors of Osteopathic Medicine (DOs) are physicians who are trained in the practice of osteopathic manipulative treatment (OMT). OMT is a form of manual manipulation that can be applied to the patient’s body to aid the body in its own healing properties. The overprescribing and overuse of medication is currently a problem, as it can result in adverse consequences such as antibiotic resistance. Exploring OMT as either an alternative or as a complementary therapy in the pediatric population is beneficial in potentially curbing antibiotic use and improving symptoms and disease-related processes.

Objective: To explore OMT as a therapy for …

Association Of Maternal Biomarkers With Gestational Weight Gain And Pre-Eclampsia, Matthew Green, Xinhua Chen

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Background: There is convincing evidence that excessive gestational weight gain (GWG), based on the Institute of Medicine’s (IOM) 2009 guidelines, increases the risk of both maternal and neonatal complications.1-6 Although the association between excessive GWG and pre-eclampsia is well-established, the reason why this association exists remains unclear.

Methods: Previously collected data from a cohort of pregnant women in Camden, NJ between the years of 1998-2007 was used to examine the association between maternal serum biomarkers (C-peptide, IGF-1, Insulin and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR)) collected at entry (week 16) and 3rd trimester (week 28) and longitudinally assessed gestational …

Robotic Cholecystectomy Versus Laparoscopic Cholecystectomy: A Modern Analysis Of Outcomes And Efficiency, Samuel Durham, Aziz Sadiq

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Introduction/Purpose

Laparoscopic cholecystectomy was first performed in the United States in 1982, and by 1992 it became standard practice. The first robotic cholecystectomy was performed in 1997, yet it still has not been widely accepted as the standard of care. Many research papers early on in the development of robotic-assisted surgery concluded that robotically removing gallbladders would be more costly and less time efficient. We aim to compare the costs and operative time between laparoscopic and robotic cholecystectomy.

Methods

A study was performed on patients who underwent an elective robotic cholecystectomy over one year by a single primary surgeon. Operative …

Effect Of The Covid-19 Pandemic On Hpv Vaccination Rates, Jennifer Sepede, Kathy Chen

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Human papillomavirus (HPV) is a common sexually transmitted infection that potentiates cancer in both males and females. There are over 200 different types of HPV and while some strains, specifically HPV 6 and 11, may result in genital and skin warts, others remain clinically silent. High risk strains, HPV 16 and 18, are most associated with cervical cancer in women. During the COVID-19 pandemic, there was widespread hesitancy and rejection towards vaccination. Similarly, the Human Papilloma Virus (HPV) vaccine has also been met with distrust since it’s release. Studies have shown that there is a low vaccination rate due to …

The Clinical Definition And Characterization Of Field Of Cancerization In Patients With Actinic Keratoses, Stuti Prajapati, Christina Kontzias, Mallory Zaino, Steven Feldman

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Introduction: Chronic UV radiation affects the entire area of skin exposed, leading to visible actinic keratoses (AK) and subclinical changes in the surrounding skin. AKs are hyperkeratotic lesions, with a 0.025-16% risk of transforming into squamous cell carcinoma (SCC).1 Cellular atypia around AKs is the field of cancerization (FOC). Topical AK therapies can treat the FOC, while destructive treatments address visible lesions. FDA-approved products may be approved for field sizes up to 25 cm2.1,2

Objective: To characterize the FOC and assess the correlation between the FOC and number of AKs.

Methods: 100 patients with AKs were recruited. FOC was defined …

Comorbidities, Behaviors, And Socioeconomic Factors And Mortality From Diseases Of The Heart In New Jersey, Matthew Guariglia, Stephen Poos, Ahmed Gawash, David Lo, Aayush Visaria

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Mortality from diseases of the heart claimed the lives of 186,074 New Jerseyans from 2010 to 2019. This study aims to establish correlations between each of health-related risk factors and death from heart disease in each of six New Jersey counties. Each of the counties ranked by age-adjusted mortality per 100,000 from diseases of the heart. The six counties were divided by the least (Hunterdon, Somerset, Bergen) and greatest (Cape May, Salem, and Cumberland) mortality rates from heart disease. Additionally, this data was broken down into three main categories that include comorbidities, socioeconomic status, and behavior patterns. Each main category …

Impact Of Covid-19 Pandemic On Patients With Depression In Different Socioeconomic Status In Different Age Groups, Alexander Kowalski, Harsh Patel

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This study aimed to investigate the impact of COVID-19 on depression and how different age groups and socioeconomic classes were affected. The PHQ-9 survey was used to assess depression levels amongst 64 individuals of different age groups and socioeconomic statuses. Results indicated that the higher socioeconomic class had less impact on depression symptoms compared to lower socioeconomic classes. Younger age groups and lower socioeconomic classes were found to have a bigger impact on depression symptoms. However, the study acknowledges that numerous factors, such as lifestyle factors, financial stability, and social support, need to be considered while interpreting the results. Overall, …

Barriers To Dermatological Care In Patients Who Received Extensive Mohs Surgery - An In-Depth Qualitative Analysis, Stuti Prajapati, Mallory Zaino, Christina Kontzias, Laura Doerfler, Steven R. Feldman

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Background: Dermatological care needs to be accessible for the elderly, but they face prominent challenges contributing to delays in diagnosis and treatment. Prolonged management of may lead to widespread cutaneous malignancies, necessitating extensive Mohs surgery.

Objective: To identify areas for early intervention in the geriatric population who have undergone extensive Mohs surgery.

Methods: We performed a qualitative study on 10 patients 65 years and older (68-91) from Atrium Health Wake Forest Baptist dermatology clinics between December 2022 and February 2023, who had extensive Mohs surgery (3 or more layers removed).

Results: Three major areas for potential intervention for cutaneous carcinoma …

Herpesviriae Infection Of The Corneal Endothelium, Behnam Rabiee, Chandani Patel, Mansab Jafri, Hamad Hussain, Michael Gaspari, Muhamad Festok, Imtiaz Chaudhry, Iftikhar Chaudhry, Asim Farooq

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Background

- The corneal endothelium plays a vital role in maintaining corneal clarity by regulating the amount of fluid in the corneal stroma.

- Corneal endotheliitis is defined as inflammation of the corneal endothelial layer that leads to corneal edema and haziness, and subsequent loss of vision.

- Most common causes include cytomegalovirus (CMV), herpes simplex virus (HSV), and varicella zoster virus (VZV).

- Because corneal endothelial cells cannot regenerate following injury, early diagnosis is essential in proper management and preventing loss of corneal endothelial cells.

In this review we aim to gather the most recent knowledge on viral corneal …

Chronic Headache Leading To The Diagnosis Of Empty Sella, Melissa Itidiare Locke, Rachel Burke

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Headaches are one of the most common chief complaints presenting to the Emergency Department. The differential is broad. The workup is tailored to the patient’s history. Here we present the case of a young female who developed headaches over the past year. After numerous imaging studies of her brain, the most recent revealed an Empty Sella diagnosis.

Is There A Role For Plant-Based “Meat” In Cardiovascular Disease Prevention?, Aziza Jadallah, Usmaan Al-Shehab, Adam Friedman

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Diet is an established risk factor for cardiovascular disease. The American Heart Association recommends following a whole-food, minimally processed diet emphasizing fruit and vegetables to reduce cardiovascular mortality. Recently, processed plant-based meat substitutes, such as Beyond Meat® and Impossible™ foods have become easily accessible to consumers and are advertised as a healthful addition to a plant-based diet. However, these products are highly processed and contain high amounts of saturated fat and sodium. The purpose of this research is to investigate the effect of processed plant-based meat diets on adverse cardiovascular events compared to animal-based meat diets and minimally processed healthful …

Stimulant Prescriptions For Adhd Treatment In Children, Victoria Murray, Miranda Reed, Sonya Priven, Dan Rios, Jan Widerman

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ADHD has become a much more common neurobehavioral disorder in the US, but access to both psychotherapy and medication remains limited, exacerbating socioeconomic disparities in multiple life domains, including education, employment, and substance use disorder. Equity in access to care is an opportunity to substantially improve care.

Awareness & Prevention Of Health Hazards For Americans Embarking In Space Tourism, Krzysztof Zembrzuski

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Since the beginning of spaceflight, keeping humans healthy has been a serious concern. Prior to 2021, astronauts had to undergo an elite selection process to embark in space travel. Now that commercial spaceflight is a reality, the criteria to experience space has been significantly loosened, raising health concerns to a larger and unhealthier pool of travelers. Most commercial spaceflight clients are anticipated to be middle-aged adults, which implies many will suffer from high blood pressure and heart disease, both of which are frequent ailments in this age group. Because of the massive compression the body undergoes during takeoff and return, …

The Effects Of Obesity And Diabetes On The Pediatric Population, Keyur Patel, Vrushank Shah, Zachary Harris, Kanad Mukherjee

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The World Health Organization has declared diabetes (DM) and Obesity to be epidemics due to their rising prevalence. Obesity plays a role in the aetiopathogenesis of type 2 diabetes, the most common type of diabetes in the world, as well as the development of its complications. Obesity and overweight play a growing role in type 1 diabetes. Weight gain is often thought of as a side effect of insulin therapy, but it also has a significant pathophysiological impact at different stages of the disease. (1) In the United States and other nations across the world, childhood obesity has become a …

Pregnancy Outcome With In Vitro Fertilization-Embryo Transfer According To Age In Women With Diminished Oocyte Reserve (Dor) Using A Follicle Stimulating Hormone Receptor Up-Regulation Technique, Brooke Neumann, Jerome Check, Carrie Wilson, Michael Sobel, Jung Choe

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Objective: About 18 years ago, one of the top IVF centers published a study and found that women with DOR did not have any live deliveries at any age in women with a day 3 serum FSH exceeding 18 mIU/mL. The failure to achieve a live delivery may have been related to the ovarian hyperstimulation regimen with possible down regulation of the FSH receptor needed to produce a key enzyme needed for successful implantation. The purpose of this 25-year retrospective review was to evaluate the efficacy of a specific type of mild stimulation referred to as the FSH receptor up-take …

Case Report: Use Of Bedside Handheld Ultrasound To Diagnose Finger Dislocation, Frank Wheeler, Philip Carhart, James Espinosa, Alan Lucerna, Henry Schuitema

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Here we present the case of a 37-year-old male with a finger injury in which finger dislocation was suspected clinically. A bedside pocket ultrasound was performed using a water submersion technique, which identified a posterior dislocated right 2nd digit at the PIP joint. This finding was confirmed with an x-ray. This case report demonstrates that ultrasonography can be utilized to correctly identify finger dislocation. Although larger studies need to be performed to validate the accuracy of this imaging technique, the implications may improve care of the patient. It would also be particularly beneficial for this technique to be applied to …

Case Report And Brief Review: Co-Infection Covid-19 Virus And Influenza A Virus, James Espinosa, Umar Sannoh, Alan Lucerna

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We report the case of a 45 year old male who presented to the an emergency department with a complaint of myalgias, chills and sore throat of a two day duration. The patient tested positive for COVID-19 virus as well as Influenza A virus. The purpose of this brief review is to discuss what is known about co-infection of COVID-19 and influenza A.

Case Report And Review: Promethazine ("Purple Drank") Abuse, Riya Tandra, James Espinosa, Alan Lucerna

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A 23 year old female was brought to the Emergency Department by EMS for confusion and aggressive behavior. The friends told EMS that the patient had been ingesting "purple drank" and that she had told her friends that she made the concoction with promethazine and opiate cough syrup with some vodka added. She mixed it in a carbonated soda. “Purple Drank” or “Lean” is a combination of codeine promethazine hydrochloride and soda or alcohol that has frequently been misused since the 1990s. This paper aims to highlight the recent resurgence of promethazine abuse occurring in the United States as well …

Case Report: Facial Mask-Induced Acne ("Maskne"), Gabriel Meister, James Espinosa, Alan Lucerna

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A 42 year old male health care worker presented with complaints of severe mask related acne vulgaris predominately to the cheeks, chin and nose Here we present the case of a N95 and surgical facial mask use has been a requirement for many occupations during the Covid-19 pandemic. Patient states their current position requires use of an N95 respirator to be worn throughout their shift which can range from 9-14 hours, 6 days per week. Extended daily use of such masks may lead to changes in the skin which can induce irritation and precipitate infection.

End Of Life Symptom Management In The Emergency Department, Alice Chang, James Espinosa, Alan Lucerna

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The Emergency Department is at times the only place patients can turn to for symptom relief. In an aging population, this means that more patients are presenting to the ED towards the end of life (EOL). Emergency medicine (EM) prides itself as a specialty that handles disease-directed treatment for a variety of acute conditions. In contrast, palliative care (PC) is focused on improving the quality of life (QOL). It has become essential for EM physicians to care for patients who are not seeking life-sustaining measures, but instead quality of life interventions. Patients with serious illness, even hospice patients, present to …

Outcomes In Type Ii Diabetes Patients Through The Covid 19 Pandemic A Retrospective Chart Review, Zurwa Nishat, Tara Pellegrino, Robert Steer

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Context: The COVID-19 pandemic provided a unique opportunity for urgent expansion of telemedicine services as providers continued to supply longitudinal care to patients. Patients with type II diabetes were vulnerable to serious infection with COVID-19 as well as disruption in management of their chronic disease.

Objective: To delineate the outcomes in type II diabetes patients through the COVID-19 pandemic by a retrospective chart review in which disease management was evaluated through HbA1c levels and BMI.

Methods: This retrospective chart review included adult T2DM patients receiving care from five university family medicine offices in NJ. HbA1c levels and BMI values were …

The Vaginal Microbiome Post-Menopause And Urinary Tract Infections, Rifke Anolik, Julia Kiffel, Venkateswar Venkataraman

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Background: Urinary Tract Infection (UTI) is a condition where pathogens invade the urinary tract and can travel up the urethra and into the bladder. UTIs occur more commonly in females compared to males and in the post-menopausal population this rate increases significantly. While these infections may be asymptomatic, they can also cause severe discomfort and lead to serious and even life threatening complications. Recent investigation into the vaginal microbiome has opened the doors to a possible mechanism behind the increased incidence of UTIs after menopause. Understanding the pathogenesis behind the increased risk of UTIs in the postmenopausal state will allow …

Breaking Down Barriers: Investigating Structural And Systemic Factors That Contribute To Covid-19 Disparities In African American Communities In New Jersey, Fazal Choudhary, Suraj Pothineni

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Background: The COVID-19 pandemic has affected the lives of millions of Americans; however, minority communities have been hit the hardest as infection rates continue to sky rocket and new variants arise. As of October 5, 2021, the CDC reports that African Americans make up a similar share of cases relative to the overall population, at about 12%, but have a significantly higher rate of deaths compared to the population, at approximately14%. African American communities are being disproportionately affected because of higher incidence of chronic diseases, inadequate access to health care, and poorer living and working conditions, which increases their vulnerability …

The Role Of Food Accessibility In Weight Loss In A Rat Model Of Parkinson’S Disease, Anjali Kikkisetti, Nicole Charles, Francois Gould

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Parkinson’s disease (PD) is a neurodegenerative disorder that causes a variety of motor and non-motor symptoms. The goal of this project was to understand whether the weight loss seen with Parkinson’s disease was due to the lack of being able to access the food because of the food placement or because of inability to chew the food due to degeneration of muscles required for chewing food. Both treatment groups, Adjusted Diet and Unadjusted Diet, lost weight after injections started, whereas control weights were stable throughout the experiment. There is no statistically significant difference in weight loss between adjusted and unadjusted …

Impact Of Draft Order On Stress Sonography Of The Ulnar Collateral Ligament Of The Elbow In Professional Baseball Pitchers: An 18-Year Study, Adeeb Hanna, John Sonnier, Brian Fliegel, Matthew Sherman, Michael Ciccotti, Robert Jack, Steven Cohen

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Background: The MLB draft is a common route for players to enter professional baseball in the United States. Individuals taken in earlier rounds are typically higher-performing players. When looking at pitchers specifically, higher performance at the amateur level may be associated with increased frequency of adaptive change in the throwing elbow.

Purpose/Hypothesis: To determine if players taken in earlier rounds of the MLB draft have a greater frequency or extent of pathological change in the elbow, as measured by dynamic stress ultrasound.

Study Design: Retrospective Cohort Study Methods: Dynamic stress ultrasounds (SUS) were performed over an 18-year period on the …

Ureterocutaneous Fistula In Setting Of Recurrent Gluteal Abscesses: A Case Report, Catherine Alapatt, Young Son, Benjamin Fink, Brian Thomas, Sean Coulson, Shawon Akanda, Jacob Thatcher, Thomas Mueller

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Ureteral fistulas are a rare occurrence that can arise from iatrogenic trauma, radiation, malignancy, and inflammation. Treatment options of urinary tract fistulas are handled on a case-by-case basis and can necessitate a surgical approach. We present the case of an 85-year-old patient with a ureterocutaneous fistula where conservative management with PCN is a viable alternative to surgical intervention.

Adaptive Changes Of The Ulnar Collateral Ligament Of Professional Baseball From Different Climates Over Multiple Seasons: An 18-Year Study, Adeeb Hanna, Brian Fliegel, John Sonnier, Matthew Sherman, Michael Ciccotti, Robert Jack, Steven Cohen

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Background: The ulnar collateral ligament (UCL) is put under high levels of stress through the overhead throwing motion typical of professional baseball pitchers. In response to repetitive stress the UCL undergoes adaptive changes including thickening of the ligament and increased joint laxity under valgus stress. Studies examining the adaptive changes in the elbows of professional pitchers over multiple seasons are limited. Investigations such as this one offer insight into the changes in the UCL of professional pitchers over multiple years of professional play as well as the risk for injuries that may be associated with these changes.

Purpose/Hypothesis: The purpose …

The Efficacy Of Osteopathic Manipulative Treatment In Reducing Pain Medication Usage In Chronic Pain Patients: A Brief Literature Review, Catherine Alapatt, Kinjal Shah

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Chronic pain is one of the most common complaints for adult patients. Chronic pain almost always includes a pharmacological approach which can involve opioids and non opioids. Non-pharmacological approaches are less commonly used by patients with chronic pain, despite the significant misuse of opioids in the treatment of chronic pain. There is a need for nonpharmacological therapies in the treatment of chronic pain patients to lessen the misuse of opioids. One underused form of nonpharmacological therapy for chronic pain is OMT. There have been several studies demonstrating OMT to be effective in treating chronic pain conditions. In addition, there is …