Medical Specialties Commons^™

Case Report: Alpha Gal Syndrome, Eric Haljasmaa, David Parkes, Wayne Tamaska

Rowan-Virtua Research Day

We report a case of a 40-year-old male who presented with sensation of throat closing and shortness of breath while at work at a meat processing facility. The differential diagnosis of shortness of breath is throat closing includes, but is not limited to, allergic reactions to antibiotics in meat, allergy to food additives, Symptom triggers are useful in identifying causes and a good supporting history and exposures can help with diagnosis. In this case, the patient had a known diagnosis of Alpha-gal syndrome (AGS) which is a tick-bite associated, possibly life-threatening immunoglobin E-mediated (IgE) hypersensitivity to galactose-alpha-1,3-galactose (alpha-gal). The patient …

Case Report : Perilunate Fracture After A Fall On An Outstretched Hand, Meghna Kurup, Nicholas Tomasello, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

We report the case of a 44-year-old male that presented to the emergency department (ED) with a fall on his outstretched hand and was subsequently diagnosed to have a trans-scaphoid perilunate dislocation. He underwent closed reduction of the dislocation in the ED and operative management ten days later. While wrist injuries are common in the ED, it is important to diagnose perilunate and lunate dislocations early as they can often be associated with avascular necrosis, neurological injury and poor functional outcomes if not managed in a timely manner.

Case Report: Heating Pad Usage Leading To Rhabdomyolysis And Acute Kidney Injury, Meghna Kurup, Swet Patel, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

We report the case of a 26-year-old male with a significant psychiatric and substance use history who came to the emergency department (ED) with deep partial second degree burns to his back subsequent to using a heating pad for unknown periods of time prior to presentation. Rhabdomyolysis and acute kidney injury that occurred in this patient due to his burns. It is important to understand that although beneficial, if heating pads are misused or overused, they can cause injury.

A Case Report Of Primary Central Nervous System Lymphoma Presenting With Diabetes Insipidus, Lan Ngo, Adam Kandil

Rowan-Virtua Research Day

Diabetes insipidus (DI) is characterized by decreased secretion or action of antidiuretic hormone (ADH), resulting in polyuria, polydipsia, and potential electrolyte disturbances. Severe hypernatremia secondary to uncontrolled DI can manifest with neurologic symptoms including seizure-like activity. This case report discusses a case of central DI arising from damage to the pituitary gland as the first presentation of a brain tumor, in the context of a 56-year-old patient who presented with seizure-like activity and sensory changes.

Case Report: Lamotrigine-Induced Rash In An Adult Patient, Dhruvin Patel, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Lamotrigine (Lamictal®) is a commonly prescribed anticonvulsant and mood-stabilizing medication. One of the rare but serious adverse effects of lamotrigine is the development of a drug-induced rash, which can be potentially life-threatening. This case report highlights the occurrence of a drug-induced rash in a 33-year-old female patient who was prescribed lamotrigine for the management of bipolar disorder. The patient presented with a characteristic rash, and following timely intervention, the rash resolved without complications. This case emphasizes the importance of monitoring for early signs of rash in patients receiving lamotrigine and outlines management strategies.

Ultrasound-Guided Vs. Fluoroscopy Guided Steroid Injection For Lumbar Spine Pain On Functional And Pain Outcomes: A Systematic Review, Yashas Sattur, Akash Patel, Alec Birnbaum, Athena Nomula

Rowan-Virtua Research Day

Fluoroscopy-guided steroid injections are standard for lumbar spine pain but involve radiation. Ultrasound offers a safer, radiation-free alternative. Ultrasound-guided injections are non-inferior in improving pain and function. A systematic review of PubMed, Embase, Cochrane, Scopus, and Web of Science was conducted. Studies in adults comparing ultrasound and fluoroscopy-guided injections reporting VAS, NRS, or ODI were included. Fifteen studies showed both techniques significantly improved pain and function, with no consistent superiority. Ultrasound-guided injections are effective and safe, providing comparable outcomes to fluoroscopy while eliminating radiation exposure.

Case Report: Ruptured Infrarenal Abdominal Aortic Aneurysm, Jenna Rapone

Rowan-Virtua Research Day

A ruptured abdominal aortic aneurysm (AAA) is a life-threatening vascular emergency with high mortality rates. We report a case of a 79-year-old male with no reported past medical history but a significant lifelong smoking history who presented to the emergency department with generalized weakness, lower abdominal pain, hypotension, tachycardia, and a reported syncopal episode. Emergency medical services (EMS) found the patient at home during a welfare check, appearing pale and weak. Upon movement from his bed to a stretcher, he experienced a syncopal episode, became tachycardic, and was transiently hypoxic. Initial laboratory studies revealed a hemoglobin of 13 g/dL, hematocrit …

Case Report: Idiopathic Intracranial Hypertension With Venous Sinus Stenosis In A Young Female, Zain Raza

Rowan-Virtua Research Day

We report a case of a 19-year-old female who presented with transient, painless left eye vision loss and left-sided headache for 2 weeks. The patient, a known carrier of TTN mutation, which is a gene code for titin (mutations are inherited in an autosomal dominant pattern). The patient was diagnosed with idiopathic intracranial hypertension secondary to bilateral transverse sigmoid venous sinus stenosis. The differential diagnosis included ocular migraine, transient ischemic attack) and optic neuritis, but subsequent imaging and lumbar puncture revealed elevated intracranial pressure and significant venous stenosis. This case highlights the importance of an early identification and intervention to …

Unusual Path: Gallstone Ileus With Pneumobilia And Jejunal Obstruction, Kristine Rubi, Kelly Schuitema, Russell Mordecai, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

We present a case of a 48-year-old female with two-day history of diffuse abdominal pain, nausea and vomiting. She was diagnosed with small bowel obstruction due to gallstone ileus. Diagnosis is usually challenging due to its nonspecific presentation, but computed tomography reveals the classic findings of Rigler’s triad -- pneumobilia, bowel obstruction, and an ectopic gallstone. The patient underwent laparoscopy with enterolithotomy with subsequent resolution of symptoms. Prompt diagnosis through imaging and timely surgical intervention is critical for in preventing complications and improving patient outcomes.

Case Report: When Confusion Signals A Crisis: Rethinking The Diagnosis Of Meningitis In Geriatric Sepsis, Asma Zahid

Rowan-Virtua Research Day

We report the case of an 88-year-old female who presented with altered mental status, initially suspected to have urosepsis but ultimately diagnosed with streptococcal meningitis. The patient had a history of lethargy and anorexia over the past few days and was found to have sepsis. Despite initial focus on urosepsis, blood cultures revealed Streptococcus, and cerebrospinal fluid analysis confirmed bacterial meningitis. This case highlights the potential for meningitis to be overlooked in elderly patients with suspected sepsis, underscoring the importance of broad diagnostic considerations and early intervention. This case highlights the importance of considering meningitis in elderly patients presenting with …

Case Report: Todd’S Paralysis In A Patient With An Extensive Stroke History, Thuc Vu, Kishan B. Patel

Rowan-Virtua Research Day

Here we present the case of a 70-year-old patient who presented to the emergency department with altered mental status, left-sided gaze preference, left-sided hemineglect, and inability to follow commands. He had a past medical history of seizure activity and cerebrovascular accident (CVA) with residual dysarthria and was on apixaban. His symptoms began after seizure activity and improved gradually. He was ultimately diagnosed by stroke neurology as having had an episode of Todd’s Paralysis. The differential diagnosis for patients for altered mental status with neurological deficits can be vast, but, in general, Todd’s Paralysis can be an ischemic stroke mimic upon …

Anabolic Steroid Induced Cardiomyopathy, Oluwatomi Alade

Rowan-Virtua Research Day

Anabolic steroids including testosterone are commonly used as performance-enhancing agents. Its use is predominantly seen in young and middle-aged males. Endogenous testosterone is necessary for cardiac health; however, synthetic anabolic steroids are more potent and associated with adverse effects. These adverse effects include cardiomyopathy and coronary artery disease. The cardiomyopathy, however, can be reversible with discontinuation of the anabolic steroids. This case describes a middle-aged male who had new onset cardiomyopathy and ultimately went into cardiogenic shock secondary to anabolic steroid use.

Case: Pituitary Mass In A Pediatric Patient, Alyssa Baldini, Carla Calvo

Rowan-Virtua Research Day

We report a case of a 16-year-old female presented to the pediatric emergency department for intermittent visual disturbance and was diagnosed with a pituitary mass resulting in episodic complete bilateral vision loss. Pediatric neurologic complaints can be challenging for a number of reasons. It is important as much as possible to obtain a detailed history from the patient and parent, conduct a relevant chart review, and identify if there have been any recent medication changes. Seeking expert consultation may also be helpful in establishing a diagnosis.

Out Of The Blue: A Case Of Acute Limb Ischemia In A Healthy Young Woman, Julian Coz, Melanie Angelo

Rowan-Virtua Research Day

Acute limb ischemia (ALI) is a critical condition caused by arterial occlusion, often due to thrombotic or embolic events in atherosclerotic vessels. Early diagnosis and intervention are essential to prevent limb loss and complications. While typically seen in patients with known vascular risk factors, ALI can also affect individuals without them.

We present a case of a 49-year-old female with sudden-onset left foot pain and paresthesia, highlighting the importance of recognizing ALI in seemingly healthy patients. Despite the absence of typical risk factors, imaging revealed significant atherosclerosis and arterial occlusion, leading to the diagnosis of ALI. This case emphasizes the …

Case Report: Spontaneous Aortic Dissection In A 63-Year Old Male Presenting As Left Abdominal, Flank And Back Pain, Dean Austin Esma

Rowan-Virtua Research Day

Aortic dissection is a life-threatening condition in which the inner walls of the aorta tears, compromising its ability to supply blood to organs. The classic presentation involves sudden, severe, “tearing” chest pain, but subtle presentations are often overlooked as symptoms of another condition, leading to missed diagnoses. This report presents a case of spontaneous aortic dissection who presented with sudden onset of left upper abdominal pain, left flank and upper back pain while brushing his teeth.

Case Report: Recurrent Miller Fisher Syndrome, Devin Hoover, Andrew Vasta, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

We report the case of a 47-year-old male who presented with numbness and difficulty speaking and was diagnosed with Miller Fisher Syndrome, a variant Guillain-Barré Syndrome. The differential diagnosis for numbness and speech difficulty is broad and includes brain stem stroke, Wernicke encephalopathy, botulism, myasthenia gravis, among others. Although Miller Fisher Syndrome is rare, certain factors such as the of tumor necrosis factor-alpha antagonists may predispose a patient to the disease and its recurrence. As discovery of new tumor necrosis factor-alpha antagonists continues it will likely result in more presentations of Guillain-Barré Syndrome and its variants to the emergency department.

Miller Fisher Variant Of Guillain- Barré Syndrome, Peter Killian, Kishan B. Patel

Rowan-Virtua Research Day

We present a case of a man in his 50s who was evaluated in the emergency department for right facial droop, myalgias, and right lower extremity weakness. The patient required multiple interdisciplinary specialists for treatment and diagnosis of Guillain-Barré Syndrome (GBS). The differential for weakness and facial droop is primarily aimed at ruling out an irreversible neurological cause while investigating a potential infectious etiology. Multiple variants of GBS exist and clinical presentations can vary, including the Miller Fisher Variant. This variant features a unique presentation, affecting the corticobulbar tract, evident with the ptosis commonly seen following a gastrointestinal infection.

Case Report: Herba Epimedium (Horny Goat Weed) Toxicity With Severe Muscle Spasms And Elevated Creatine Kinase And Creatinine, Tucker A. Ledo, Dhara Patel, Wayne Tamaska, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Here we present the case of a 33-year-old male who presented to the emergency department (ED) with a complaint of severe muscle spasms of a ten-hour duration. He noted that he took a supplement which he purchased over the internet called Epimedium, also known as Horny Goat Weed, for the purpose of improving his mood and sense of energy and reducing his sense of anxiety. He noted that he started this supplement one month prior to ED presentation, coincident with the first episodes of muscle cramps. In the ED, he had elevations of his CK and creatinine and required hospital …

Case Report: Pulmonary Infarction Following Recent Pulmonary Embolism, David Marconi, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

A 57-year-old man with chronic obstructive pulmonary disease (COPD), obstructive sleep apnea, and a recent pulmonary embolism (PE) on anticoagulation presented with acute pleuritic chest pain and worsening dyspnea. Computed tomographic angiography (CTA) of the chest revealed a small distal segmental PE in the left lower lobe and an adjacent irregular consolidation, raising concern for pulmonary infarction versus pneumonia. The patient was empirically started on antibiotics for possible pneumonia and admitted for anticoagulation and supportive care. He left the hospital against medical advice (AMA) before completing treatment, but returned days later with exacerbated symptoms. This case highlights the diagnostic challenge …

Case Report: Dysphagia In Inclusion Body Myositis Leading To Respiratory And Gastrointestinal Complications, Veroneka Mikhail, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Inclusion body Myositis (IBM) stands as a rare and complex neuromuscular disorder (NMD) characterized by progressive muscle weakness and atrophy. Among its cardinal symptoms are dysphagia and respiratory distress, which are the most common cause of death in this disease. While the differential diagnosis of respiratory distress is vast and includes aspiration, pneumonia, acute coronary syndrome, emphysema, and congestive heart failure, a clinician should recognize that respiratory distress can also be secondary to dysphagia in NMDs like IBM and can quickly become life threating. Here we present the case of a 68-year-old female with a history of IBM who presented …

A Rare Case Of Diffuse Alveolar Hemorrhage In The Setting Of Iga Nephropathy, Vasculitis And Atypical Hemolytic Uremic Syndrome In A Previously Healthy Young Adult, Karl Schlicht, Nancy Kaura

Rowan-Virtua Research Day

IgA Nephropathy, also known as Berger disease, can precipitate acute renal failure in patients. IgA Nephropathy (IgAN) is deposition of protein from IgA into the renal tissue with subsequent renal dysfunction. IgA vasculitis (IgAV) is another condition where similarly the protein of IgA is deposited into the vessels. There are some cases of co-existing atypical hemolytic uremic syndrome (aHUS) with IgAN. However, rare combinations seen with all three IgAN, IgAV, and aHUS without any pre-existing conditions nor medical history. Patients that develop any one of these conditions are looking at life long changes with hemodialysis (HD) and organ transplants being …

Tricyclic Antidepressant (Tca) Overdose Causing Diffuse Alveolar Hemorrhage: A Case Report, Md Fateha, Jose Aragon, Joan Wiley

Rowan-Virtua Research Day

Tricyclic antidepressant (TCA) overdose is an uncommon complication that results from excessive administration of TCAs. Signs and symptoms include bradycardia, fever, dry mouth, and altered mental status. Patients can develop cardiac arrhythmia and diffuse alveolar hemorrhage, which can be fatal. This case report details a 65-year-old female who experienced a suspected TCA overdose as a suicide attempt. She had a history of depression and a previous suicide attempt. The patient was unresponsive with declining oxygen saturation, necessitating emergent intubation. Important lab findings included a decreased partial pressure of oxygen to fraction of inspired oxygen ratio (P/F ratio) and prolonged QRS …

Case Report: Dissecting Retroperitoneal Abscess With Gas Formation, David F. Koziel Jr.

Rowan-Virtua Research Day

Presenting as a case to the emergency department was a 53-year-old male with a complaint of diffuse abdominal pain and focal right flank pain at site of recent percutaneous abscess drain site performed exactly one month prior. This followed hospitalization in the preceding year for complicated multifocal intra-abdominal infections requiring surgical interventions including exploratory laparotomy and surgical debridement for intra-abdominal abscess and scrotal abscess formation. Despite prior aggressive management and extensive coverage with broad-spectrum antibiotics, this patient was found to have fulminant recurrance of infection in the right retroperitoneal space with an expanding abscess dissecting through the retroperitoneal structures into …

Assessing The Safety And Effectiveness Of Endovascular Treatment Vs. Surgical Repair Of Aortic Aneurysms In Patients With Marfan Syndrome: A Literature Review, Noor Baig, Zainab Mubasher, Nassos Tziviskos, Joseph Pernini, Marcus Fariello, Ryan Hickey

Rowan-Virtua Research Day

Background: This review compares the safety and effectiveness of thoracic endovascular aortic repair (TEVAR) versus open surgical repair in patients with Marfan Syndrome (MFS) and thoracic aortic aneurysms. We assessed differences in mortality, length of hospital stay, renal impairment, and stroke incidence between the two techniques. Currently, open surgical repair is the gold standard treatment.

Hypothesis: As the gold standard treatment, we expect open surgical repair to have more favorable outcomes than TEVAR.

Methods: A systematic literature search was performed using studies from 2000-2024 across PubMed, Scopus, Embase, Cochrane, and Web of Science. Studies were included if they involved adult …

Preliminary Assessment For Quality Improvement Of Hypertension Management In Kenya, Shubhangi Singh

Honors Theses

Hypertension is a leading contributor to cardiovascular disease (CVD) morbidity and mortality worldwide, with a disproportionate burden in low- and middle-income countries (LMICs). Despite relatively low rates of common behavioral risk factors, the Kasigau region of Kenya experiences high prevalence of hypertension and hypertension-related complications. This study explores self-efficacy, health beliefs, and management behaviors among adults in Kasigau to provide pilot quality improvement data for providers and future intervention planning. A cross-sectional, randomized survey of 45 adults was conducted at the Bughuta Clinic in southeastern Kenya. Participants completed a five-question hypertension-specific, self-efficacy assessment and a health belief model-based survey, with …

Targeting Bard1 Suppresses A Myc-Dependent Transcriptional Program And Tumor Growth In Pancreatic Ductal Adenocarcinoma, Sohum Patel, Eleanor Jenkins, Rutuj P. Kusurkar, Sherry Lee, Wei Jiang, Avinoam Nevler, Matthew Mccoy, Michael J. Pishvaian, Rosalie C. Sears, Jonathan R. Brody, Charles J. Yeo, Aditi Jain

Department of Surgery Faculty Papers

Pancreatic ductal adenocarcinoma (PDAC) remains one of the deadliest cancers demanding better and more effective therapies. BARD1 or BRCA1-Associated -Ring Domain-1 plays a pivotal role in homologous recombination repair (HRR). However, its function and the underlying molecular mechanisms in PDAC are still not fully elucidated. Here, we demonstrate that BARD1 is overexpressed in PDAC and its genetic inhibition suppresses c-Myc and disrupts c-Myc dependent transcriptional program. Mechanistically, BARD1 stabilizes c-Myc through ubiquitin-proteasome system by regulating FBXW7. Importantly, targeting BARD1 using either siRNAs or CRISPR/Cas9 deletion blocks PDAC growth in vitro and in vivo, without any signs of toxicity to mice. …

Clinical Implications Of Mismatch Repair Deficiency In Pancreatic Ductal Adenocarcinoma, Zachary Kaplan, Elizabeth Prezioso, Aditi Jain, Harish Lavu, Charles Yeo, Wilbur Bowne, Avinoam Nevler

Kimmel Cancer Center Faculty Papers

BACKGROUND: Pancreatic cancer is a highly aggressive and lethal disease, characterized by a limited response to chemotherapy and overall poor prognosis. Pancreatic cancers with a distinct mismatch repair deficiency, although relatively rare, have been shown to be associated with markedly better outcomes in comparison. Furthermore, whereas pancreatic cancers are generally unresponsive to current immunotherapy, this specific group of tumors has been shown to have a notable susceptibility to immune checkpoint inhibitors.

AIMS: In this review, we aim to summarize the relevant literature regarding mismatch-repair associated pancreatic cancers, the impacted biological mechanisms, and the resulting vulnerabilities for potential opportunistic immunotherapeutic treatment …

Exercise As An Intervention For Postpartum Depression (Ppd), Kylie P. Mistretta

Honors Scholar Theses

Objective: To illustrate the applications of exercise for preventing the development of postpartum depression (PPD) and addressing associated risk factors identified in the literature. Data Sources: PubMed and EBSCO: Academic Search Premier were accessed using the search terms exercise OR physical activity OR yoga AND postpartum depression OR postnatal depression. A secondary search of PubMed was conducted using the search terms exercise AND pregnancy AND depression OR gestational diabetes OR weight gain OR sleep quality.

Study Selection: Studies selected for inclusion were peer-reviewed, published after January 2012, written in English, and relevant to the PPD risk factors examined. Only clinical …

Normative Variability In Retinal Nerve Fiber Layer Thickness: Does It Matter Where The Peaks Are?, Sowjanya Gowrisankaran, Ashkan Abbasi, Xubo Song, Joel Schuman, Gadi Wollstein, Bhavna Antony, Hiroshi Ishikawa

Wills Eye Hospital Papers

PURPOSE: Retinal nerve fiber layer thickness (RNFLT), a glaucoma biomarker, has a wide normative range affecting its sensitivity and specificity for abnormality detection. The interindividual RNFLT peak location variability contribution to this wide normative range has not been directly evaluated. The purpose of this study is to assess the effect of RNFLT peak normalization (PN) on normative variability.

METHODS: Circumpapillary RNFLT profiles at 1.7 mm radius from the optic nerve head (ONH) were re-sampled from optical coherence tomography (OCT) volumes (Cirrus HD-OCT, 200 × 200) obtained from one eye of 83 healthy individuals. Fovea-ONH axis (FOA) was calculated from corresponding …

The Infected Diabetic Foot: Bacteraemia And Endocarditis Complicating Moderate And Severe Foot Infections, Mario C Reyes, Arthur N Tarricone, Mathew J Sideman, Michael C Siah, Bijan Najafi, Edgar J G Peters, Lawrence A Lavery

Center on Aging Staff Publications

To identify the incidence of blood stream infections (BSIs) and endocarditis in patients with diabetic foot infections (DFIs), risk factors and clinical outcomes. A post hoc analysis of 280 patients using pooled patient level data from three RTCs. Blood cultures were drawn at time of admission for DFI. Deep intraoperative cultures were obtained from infected foot wounds. Data from the 12-month follow-up were used to determine clinical outcomes. 77.1% (N = 216) had blood cultures of which 15.7% (n = 34) had BSI. One patient (3.3%) had endocarditis. Risk factors for BSI included Charcot Neuroarthropathy history (20.6% vs. 7.1%, p …