Medical Specialties Commons^™

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 …

Painless Scrotal Ulcers Become Something Unexpected: A Rare Case Of Scrotal Calciphylaxis, Riddhima Issar, Jinisha Patwa, Yvette Wang

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Calciphylaxis is a rare vascular disorder that presents with painful skin necrosis due to calcium accumulation in skin and adipose tissue. Most commonly, cutaneous manifestations of calciphylaxis are seen on the buttocks, thighs and extremities. Very few cases have presented unconventional locations of these calcified eschars and ulcers such as the penis and scrotum. Risk factors for this disease include chronic kidney disease, hyperparathyroidism, long-term hemodialysis and diabetes. This case presents an atypical presentation of painless scrotal ulcers.

A high degree of clinical suspicion in patients with ESRD on HD and T2DM is needed to effectively reach a diagnosis of …

Spontaneous Extraperitoneal Hematoma: An Unexpected Case Of Dysuria And Urinary Retention In A 77-Year-Old Male, Monica Diep, James Lee, James Espinosa, Joseph Pagano, Alan Lucerna

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Urinary problems are common complaints in the Emergency Department and can present with any combination of lower urinary tract symptoms such as dysuria, hematuria, urgency, frequency, incontinence, or retention. We describe the case of a 77-year-old male who presented to the Emergency Department for five days of worsening dysuria. Two days prior, the patient was seen and evaluated for the same chief complaint, where he received intravenous antibiotics and was admitted to the hospital overnight for observation. The following day, the patient’s urinalysis and cultures were not consistent with a urinary tract infection (UTI) and was subsequently discharged without antibiotics. …

The Effects Of The Covid-19 Stay-At-Home Orders On Pain And Mental Health In Omm Patients, Sylvia Orozco Silberman, Philip Collins, Danielle Cooley, James Bailey, Steven M. Brunwasser Phd, Nicholas Averell

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New Jersey was placed in a state of emergency and a statewide stay-at-home order during the COVID-19 pandemic

Very little has been published examining the effects of chronic pain after stopping osteopathic manipulative medicine (OMM), although it seems unethical to stop a treatment shown to work so well that is both minimally invasive and cost effective

We hypothesized OMM patients experienced an increase in pain since the onset of COVID-19 pandemic and closure of OMM/Family Medicine offices

The Utility Of An Inpatient Consult For Paradoxical Vocal Fold Motion, Pankti P. Acharya, Jason Cohn

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Paradoxical vocal fold motion (PVFM) is vocal fold adduction during inspiration

Patients often present with dyspnea, throat tightness, and cough

Common risk factors that predispose patients to PVFM include gastroesophageal reflux disease, psychiatric disease, chronic cough, airway irritation, and female gender

This study was conducted to identify possible risk factors and associated conditions for PVFM; additionally, a novel scoring system was developed to aid in diagnosis of PVFM

The Impact Of The Covid-19 Pandemic On Pediatric Obesity In School-Aged Children, Amaani Faizal, Maryanna Schweininger, Suzanna Hosein

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The prevalence of childhood obesity in those aged 2-19 in the United States was 19.3% in 2017-2018. Childhood obesity is a major health concern with growing rates of incidence. Being overweight or obese put children at risk for developing several chronic conditions such as coronary artery disease, type 2 diabetes mellitus, hypertension and asthma at a younger age. Studies have shown that higher BMI numbers in childhood added an increased risk of being obese as an adult.

The pathophysiology of developing obesity includes several complex factors ranging from nutrition, physical activity, genetic background and lifestyle preferences. Among children, nutrition and …

Appendiceal Diverticulum Masquerading As Acute Appendicitis, Aesha Patel, Asad Abbas, Ratul Bhattacharyya, Dana Galaktionova

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Appendiceal diverticula present as rare clinical findings and are most often confused with acute appendicitis due to similar presentation. The incidence in such cases is reported at a rate no greater than 1%.

We present a rare case of a 65-year-old female treated for acute appendicitis who was instead found to have acute sequelae of appendiceal diverticulosis.

Is Blood Flow Restriction Training Superior For The Limitation Of Hamstring And Quadriceps Atrophy After Anterior Cruciate Ligament Reconstruction? A Review Of Randomized Controlled Trials, Joshua M. Spada, Ryan W. Paul, Bradford S. Tucker

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Post operative recovery from Anterior Cruciate Ligament Reconstruction (ACLR) includes extensive rehabilitation of 6-9 months with return to sport/activity at 12 months

Rehabilitation is initiated shortly following surgery to limit quadriceps and hamstring atrophy, maximizing long term tibiofemoral joint stability and functional outcomes

The best way to achieve improved muscle strength and prevent atrophy is progressive overload training, however, these activities cannot be performed post operatively without risk to the reconstructed knee

Blood Flow Restriction Training (BFR) involves impairing the blood supply for short periods through the application of an air-filled bladder or cuff to restrict the venous drainage of …

Cpap And Epistaxis: Is There A Connection In Osa Patients?, Aesha Patel

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Nasal continuous positive airway pressure (CPAP) has become a standard form of therapy for patients with obstructive sleep apnea (OSA). There are reports of patients suffering from episodes of epistaxis within the initial few weeks of starting CPAP therapy, believed to be due to the high flow rate of air during use, nasal CPAP purportedly dries the nasal mucosa, leading to an increased risk of scabbing, ulceration, and ultimately epistaxis. This study seeks to analyze whether epistaxis is common in patients following CPAP initiation and then compare this rate of epistaxis amongst OSA patients that received upper airway stimulation (UAS) …

Latarjet Surgery Leads To Decreased Rates Of Subjective Instability Compared To Bankart Repair With Concomitant Remplissage, Joshua Spada, Ryan W. Paul, Manoj Reddy, Gabriel Onor, John Hayden Sonnier, Ari Clements, Meghan E. Bishop, Brandon J. Erickson

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Background: Predictive factors for performing remplissage concomitantly with arthroscopic Bankart repair include the presence of humeral or glenoid defects >11% and/or revision surgery. International and societal consensus statements support these findings, as surgeons recommend the Latarjet procedure for patients with significant glenoid bone loss (>15-20%) while remplissage is recommended for patients with off-track or engaging Hill-Sachs lesions without significant glenoid bone loss. While several studies have compared outcomes between Latarjet surgery and remplissage, these studies have only evaluated patients with engaging Hill-Sachs lesions, not consecutive patient cohorts indicated for each surgery.

Purpose: To compare rates of recurrent instability, re-operation, …

Impact Forces And Patterns Of Axonal Injury Differ Between Two Models Of Tbi, Edward Lai, David M Devilbiss

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Traumatic brain injury (TBI) affects approximately 3.8 million Americans a year and results in complex neuropathological and neurocognitive sequelae. Animal models of TBI attempt to replicate the impact forces and pathology of injury in humans. However, in these models, the forces generated at the time of impact are poorly understood. Nonetheless, a variety of shear and strain forces generated at the time of impact can produce diffuse axonal injury. Injury to axons and neurons across a variety of brain regions resulting from axonal injury underlies the cognitive and behavioral impairments observed after TBI. Three critical brain regions, the corpus callosum …

A Case Of Acute Disseminated Encephalomyelitis In An Adult Male With Bipolar Disorder, Jinisha Patwa, Tracey Harris

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Acute disseminated encephalomyelitis (ADEM) is a rare demyelinating disease characterized by inflammation of the brain and spinal cord. The rapidly progressive inflammation in the central nervous system is known to occur in response to a prior infection or immunization.

The clinical signs of ADEM may manifest up to 60 days post illness or vaccination. Some develop encephalopathy and neurologic symptoms which include confusion, psychosis, and tetraparesis. Paresthesia of the limbs and muscular atrophy indicate a worse prognosis and higher risk of relapse as opposed to those with only CNS involvement. A predominantly psychiatric presentation is also possible.

Risk factors include …

A Puzzling Case Of Normal Pressure Hydrocephalus In The Outpatient Setting, Shadi Shams, Asim Shafique, Marym Khan, James Bailey

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Normal Pressure Hydrocephalus (NPH) is a disease of adulthood characterized by the triad of gait disturbance, dementia, and urinary incontinence. Since NPH shares a lot of characteristics with other disorders including neurodegenerative disorders and degenerative-dystrophic spine, it is usually underdiagnosed and undertreated. Combination of ventriculomegaly seen on a computerized tomography (CT) scan or magnetic resonance imaging (MRI) with clinical findings could be used in diagnosis of NPH. However, improvement of symptoms post spinal tap procedure would be a better indication of diagnosis. Currently, shunt placement is the best available modality of treatment for NPH. Here we present a case of …

A Preliminary Report: The Hippocampus And Surrounding Temporal Cortex Of Patients With Schizophrenia Have Impaired Blood-Brain Barrier, Eric L. Goldwaser, Randel L. Swanson, Edgardo J. Arroyo, Venkat Venkataraman, Mary C. Kosciuk, Robert G. Nagele, L. Elliot Hong, Nimish K. Acharya

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Schizophrenia (SZ) is one of the most severe forms of mental illness, yet mechanisms remain unclear. A widely established brain finding in SZ is hippocampal atrophy, and a coherent explanation similarly is lacking. Epidemiological evidence suggests increased cerebrovascular and cardiovascular complications in SZ independent of lifestyle and medication, pointing to disease-specific pathology. Endothelial cell contributions to blood-brain barrier (BBB) compromise may influence neurovascular unit and peripheral vascular function, and we hypothesize that downstream functional and structural abnormalities may be explained by impaired BBB.

An Herbal Liver Effect: Ashwagandha-Induced Hepatotoxicity, Mohammad Rattu, Eric Maddock, James Espinosa, Alan Lucerna, Neeharika Bhatnagar

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Ashwagandha is a popular Ayurvedic herb that is derived from the extracts of the roots of Withania somnifera, an evergreen shrub endemic to India and Southeast Asia. It is generally utilized as a tonic to increase one’s energy and reduce stress levels. Often referred to as “Indian ginseng”, it provides neuroprotective and anti-inflammatory properties that address stress, pain, and fatigue. Additionally, it may assist in dealing with rashes, diabetes, and arthritis. It has also been shown to counteract the effects of aging. Though these properties have not been shown in prospective studies, it has become a popular product among western …

Case Report: Glioblastoma Tumor Presenting With Mild Changes In Memory, Samuel Thalathoti, Nicholas Palladino, James Espinosa, Alan Lucerna

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We report a case of a 66-year-old female who presented to the ED with generalized headache and mild confusion, who was diagnosed with high-grade glial neoplasm. The differential diagnosis of headache is vast, but without red flags or symptoms is generally from a benign cause and easily treatable. However, even in the context of a normal neurologic physical exam, symptoms such as confusion, forgetfulness, and behavioral changes should merit imaging in the workup. Glioblastoma is the most common brain tumor, accounting for 47.7% of all cases, with an incidence of 3.21 per 100,000 population. Median age of diagnosis is 64 …

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: Covid Arm (Covid Vaccine Arm), Joseph Pagano, James Espinosa, Alan Lucerna, Henry Schuitema

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We report the case of a 38-year-old male physician who was vaccinated with the Pfizer vaccine. He experienced arm pain and swelling on the vaccinated arm as well as systemic symptoms, including fever, chills, headache and weakness. The systemic symptoms improved after the use of oral prednisone. A review of the literature on the COVID vaccine is presented.

Case Report: Segmental Testicular Infarction, Nicholas Coan, Ronald Clearie, Amanda Maciag, Joseph Pagano, James Espinosa, Alan Lucerna, Neelesh Parikh

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We report a case of a 45-year-old male who presented to the Emergency Department with acute onset left testicular pain and was diagnosed with left sided segmental testicular infarction. The differential diagnosis of acute onset testicular/scrotal pain can include critical urological diagnoses such as testicular torsion and testicular tumors. In the absence of global flow disruption on ultrasound Doppler, emergent surgical intervention is not needed. While ultrasound aids in the Emergency Department’s management of acute testicular pain, it does not rule out the need for an additional outpatient work-up or imaging. Conservative management with pain control, outpatient scrotal MRI, and …

Wernicke’S Encephalopathy Secondary To Hyperemesis Gravidarum, Mohammad Rattu, Alexander Norinsky, James Espinosa, Alan Lucerna, Henry Schuitema

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Wernicke’s encephalopathy (WE) is a neurological disorder secondary to thiamine deficiency that is precipitated by administration of glucose-containing fluids prior to thiamine supplementation. Though WE is typically diagnosed among alcoholics (12.5%), the prevalence among nonalcoholics can vary from 0.04-0.13%. Around 30-40% of patients with underlying thiamine deficiency will only experience one of the symptoms from the typical triad, with the complete triad (encephalopathy, oculomotor dysfunction/nystagmus, and ataxia) only evident among 5-16% of the population. Among the non-alcoholic patient population presenting with WE, a history of vomiting is more frequent. While nausea affects around 80% of pregnant women, an extreme form …

Digoxin Toxicity And Acute Renal Failure In A 75 Year-Old Female, Daniel Zaayenga, Andrew Caravello, Nicholas Tomasello

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Digoxin toxicity can present with varying manifestations. While pathognomonic symptoms such as xanthopsia (object appearing yellow) are a board favorite it is not a required finding and is in fact not seen with most patients. Rather digoxin toxicity presents with more non-specific symptoms such as GI distress (anorexia, N/V) neurological distress (lethargy, fatigue, delirium, confusion, disorientation, weakness. EKG findings are varied and include premature ventricular contractions, bradycardia, atrial tachyarrhythmias with AV block, ventricular bigeminy, junctional rhythms, various degrees of AV nodal blockade, ventricular tachycardia, and ventricular fibrillation. Although rarely seen, digoxin is one of the only causes of bidirectional ventricular …

Comparing The Relapse Rate Between Medication Assisted-Only Treatment And Medication-Assisted Treatment With An Osteopathic Manipulative Treatment Regimen In Patients With Musculoskeletal Pain, Karen Huang, Danielle Cooley

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Since the opioid crisis first began in 1991, opioid-related overdoses in the United States have continued to increase dramatically, killing nearly 47,000 people in 2018, and making it one of the most pressing issues in healthcare. The most reported reason for misuse of pain relievers was to relieve physical pain. The increase in opioid abuse has also led to an increase in patients seeking medication-assisted treatment (MAT).

Osteopathic manipulative treatment (OMT) has been shown to have efficacy in relieving both chronic and acute pain. No current studies have investigated the use of OMT as an adjunct treatment to MAT for …

Charles Bonnet Syndrome: A Case Report, Christian Scouarnec, Martin M. Forsberg

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Charles Bonnet syndrome (CBS) involves nonthreatening hallucinations in patients who have no neurological and no psychological abnormalities but with significant visual impairment secondary to ocular disease, such as macular degeneration, cataracts and diabetic retinopathy. When a patient loses vision, their visual system doesn’t process new images. Without data coming through the eyes, the brain fills the void and makes up images or recalls stored images for you to see and this is what causes the hallucinations in CBS.

Many physicians are unaware of CBS and its prevalence, and with proper detection, physicians can help treat their patients with a frequently …

Atypical Presentation Of Ankylosing Spondylitis, Chandni Patel, Milvin Shroff, Maleeha Memon, Shideh Doroudi, Christine Leroy

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Radiographic axial spondyloarthritis axSpA ) or typical ankylosing spondyloarthritis (AS) is a classification of axial spondyloarthritis with the classic radiographic features of sacroiliitis. Axial spondyloarthritis is a disabling spondyloarthropathy of the spine that presents with chronic back pain usually before the age of 45. It may be associated with extraspinal features including dactylitis , synovitis, and enthesitis in addition to other nonarticular signs. Chronic back pain is one of the most common presenting symptoms for AS , but frequently there is a 5-7 year delay between the onset of symptoms and diagnosis of the disease . A standard AP plain …

Improvement Of Memory Loss Through Dietary Intervention In The Assisted Living And Rehabilitative Settings, Alexander Swartz, Martin Forsberg

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• The ketogenic diet is a popular, controversial diet that fuels the brain through beta-oxidation of fatty acids and production of ketone bodies, the most populous of which is betahydroxybutyrate (BHB).

• The ketogenic diet consists of 70-80% fats, 20-25% protein, and 5-10% carbohydrates.

• Medically, the ketogenic diet is utilized in patients with epilepsy and recommended by some physicians to improve general health through weight loss and insulin sensitivity.

• Key factors of neurodegeneration include glucose hypometabolism, oxidative damage, and neuroinflammation.

• Studies have shown that with ingestion of exogenous ketones alone, or endogenous ketonemia through a ketogenic diet, there is: …

Perforating Gastric/Duodenal Ulcer Development Following Roux-En-Y Gastric Bypass Surgery: A Case Series, Sugosh Anur, Michael A. Coscia Iii, Louis Balsama

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Roux-en-Y gastric bypass is a well-studied procedure resulting in long term weight loss. Due to countless years of study, the morbidity and mortality associated with a Roux en Y gastric bypass has been greatly decreased. However, there are still several rare, yet serious, complications that may arise in the post-operative period. Anastomotic leaks and ulcers are just two of those complications. We describe a case of a 41 year old female developing postoperative perforated duodenal ulcer. A laparoscopic repair was performed using a Graham patch technique. This review aims to identify factors contributing to the ulcer development as well as …

Complications Of Fitz-Hugh-Curtis Syndrome In A Teenage Female: A Case Presentation, Marina Cugliari, Trupti Pandit

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Fitz-Hugh-Curtis Syndrome is a manifestation of Pelvic Inflammatory Disease (PID) associated with Chlamydia trachomatis infections and less frequently with Neisseria gonorrhea.

PID affects sexually active women (15-30 years old) and accounts for 750,000 cases each year.

The case presented illustrates a female who presented with a small bowel obstruction and appendicitis, who was incidentally found to have Fitz-Hugh-Curtis Syndrome on laparoscopic exam.

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.

Treating Trichotillomania With Olanzapine, Christopher Lee

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Trichotillomania (TTM) is characterized by repetitive pulling of one’s hair leading to hair loss and problems in social, occupational, or other important areas of functioning. Often individuals with TTM try to decrease or stop hair pulling, however are often unsuccessful without treatment. Community prevalence studies suggest that TTM is a common disorder with point prevalence estimate of 0.5% to 2.0% and with significant psychological comorbidity. Of note, people with TTM are often embarrassed about their condition, so epidemiology data may be underestimated compared to the true prevalence of this condition. The female to male ratio for this condition is 4:1. …

Plasmalogen Deficiency: A Risk Factor For Dementias And Potential Treatment Target, Mitchel A. Kling, Mallika Mendu, Rima F. Kaddurah-Daouk, Sheldon Jordan, Dayan B. Goodenowe

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Altered lipid metabolism is implicated in the risk of sporadic Alzheimer’s disease (AD) and related dementias (ADRD); however, the precise mechanisms accounting for findings from observational studies remains to be fully elucidated.

Plasmalogens are a subclass of integral membrane phospholipids with unique properties that appear to play important roles relevant to the pathophysiology of AD and ADRD, including vesicle fusion necessary for synaptic neurotransmitter release, modulation of membrane fluidity and microdomain dynamics, membrane antioxidant functions, and neuroprotection. Like the more familiar phosphatides, plasmalogens are synthesized on a 3-carbon glycerol backbone; however, they differ from phosphatides by the presence of a …