Medical Specialties Commons^™

Survey Of Primary Care Physicians’ And Pediatricians’ Competency In Identifying Prodromal Symptoms In Schizophrenia And Psychotic Disorders, Mark Shephard, Joanna Petrides

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• To address whether primary care physicians and pediatricians are equipped to recognize the prodromal symptoms of psychotic disorders

• Patients of primary care physicians exhibited increased help seeking behaviors prior to schizophrenia diagnosis [1]

• Primary care physicians in numerous countries have shown a lack of sufficient knowledge related to diagnosing and treating schizophrenia [2,3,4,5,6]

• Unclear if primary care physicians in the United States are adequately trained and prepared to recognize prodromal signs of schizophrenia, and diagnose and treat a variety of psychotic disorders

Correlation Of Chronic Conditions And Pain Scale With Varying Levels Of Obesity In The Geriatric Population, Shabbir Hossain, Adarsh Gupta

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The overall objective of this study was to establish whether obesity’s contribution to pain is stronger than vice versa – the medical debilities in elderly patients that contribute to obesity. In the process, this study will allow us to achieve whether different age samples with similar BMIs demonstrate the same level of medical complexities in geriatric patients. In summary, the purpose of this research study was to correlate a relationship between obesity and aging. We hypothesized that obesity will contribute to greater pain in the aging population, and that patients – regardless of their age groups in the aging population …

The Relationship Of Cardiovascular Disease To 30-Day Hospital Readmission Among Older Adults With Type 2 Diabetes Mellitus, Meet Shah, Shmilah Choudhary, Sanath Shetty, Terrie Ginsberg, Matthew H. Mclaughlin

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Reducing thirty-day hospital readmissions is a top healthcare priority. However, there is little research describing the risk factors of readmission among patients with diabetes, especially for older adults. Understanding what the risk factors are for 30-day hospital readmission for older adults with type 2 diabetes (T2DM) would help identify patients at risk of rehospitalization. The aim of this study was to identify factors associated with 30-day unplanned hospital readmissions among older adults with T2DM.Factors to be investigated are: patient demographics and whether the patient was hospitalized for cardiovascular disease. Participants were older adults>65 years old with T2DM, admitted to …

The Correlation Between Obesity, Food Addiction, Anxiety & Depression, Ayham Khrais, Adarsh K. Gupta

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Obesity is a multifaceted disease with physiological, psychological and social influences. While physiological factors, such as basal metabolic rate, can influence an individual’s BMI (Body Mass Index), obesity is primarily determined by behavior: excess food intake and a sedentary lifestyle greatly contribute to weight gain. An individual’s behavior is influenced by many factors, including their desires, perceptions, and social pressures. Therefore, psychological conditions can greatly impact an individual’s eating habits, thereby affecting that person’s BMI. This endeavor involved exploration of the potential effects of food addiction, anxiety, and depression on obesity. A survey consisting of an amalgamation of the Yale …

Case Report: Elbow Plica In A High School Pitcher, Steven Barrientos, Sunny Gupta, Mitesh Patel

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Elbow pain is a very common joint complaint with a variety of etiologies. Plica are often benign, asymptomatic and have no known function. Elbow plica may cause clinical symptoms in the elbow joint after they become hypertrophied or inflamed from repetitive activities or trauma. Symptomatic elbow plica may strike at any age but it is not a common radiographic finding among the pediatric population. In this case report, we are presenting a case of symptomatic left lateral hypertrophic elbow radiocapitellar plica in a 16 year old baseball thrower.

Mri Findings After A Subchondroplasty Procedure Of The Ankle: A Case Report, Michael E. Calderone, Mansi Patel, Matthew K. Brant

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Osteoarthritis (OA) of the ankle is a common disease and it is estimated that almost 1% of the world’s adult population have a painful ankle. Often in patients who fail conservative treatment, the use of an MRI is deemed necessary to identify pathologies. Bone marrow lesions (BMLs) seen on MRI have been recognized as a source of the ankle pain. Majority of the BMLs fluctuate in size over time and are seen as hyperintense lesions on MRI.We present MRI findings of a patient following arthroscopy with subchondroplasty.

Traumatic Compartment Syndrome Of The Foot: A Case Report, Mansi Patel, Asim Qureshi, Matthew K. Brant

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Compartment syndrome of the foot is a rare but limb threatening condition that is often difficult to diagnose. It is usually caused by traumatic injuries and the diagnosis requires a high clinical suspicion and timely management. Clinically, patients will present with an acute traumatic event followed by physical exam findings of non-palpable pulses, paralysis, pallor, pain out of proportion, and paresthesias. The foot contains nine compartments, which should be assessed independently for elevated pressures. The diagnostic threshold for each compartment is 30 mmHg. Pressures above this threshold require emergent fasciotomy to preserve the anatomical structures and thus the function of …

For Your Eyes Only, Herpes Zoster Ophthalmicus Case Study, Alexander Fishman, Jared Ward, Richard Pescatore

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Herpes Zoster Ophthalmicus is a reactivation of a latent Varicella Zoster Virus that specifically involves the eye. The reactivation often occurs during immunocompromised states which allows latent virus in the dorsal root ganglia of sensory nerves to begin viral replication an d s pread via peripheral axons. Diagnosis is based on two characteristic findings; herpetic lesions on the eyelids, forehead, or elsewhere within the V1 dermatome, and ocular findings. Symptoms can vary but are often quite painful. Some patients experience a prodrome of tingling sensation prior to the appearance of a zoster dermatitis . HZO can also present initially as …

Omt For The Treatment Of Depression And Anxiety, Zachary Winchell

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Osteopathic manipulative therapy (OMT) fundamentally aims to remedy somatic dysfunction through the manipulation of the patient. In this regard, OMT is a particularly viable non-pharmacological adjunct for patients with depressive and generalized anxiety disorder (GAD).

In both of these disorders, the hypothalamic-pituitary-adrenal axis has an interdependent relationship with physiological stress that feed one another to both increase symptomology and leave patients vulnerable to negative life events. Additionally, pro-inflammatory cytokines acting on the brain over long periods of time can lead to exacerbation of disease and the development of depression in susceptible individuals. Altered cytokine balance has also been found in …

Case Report: Holmium Laser Removal Of Antegrade Ureteral Stent Suture Via Ureteroscopy, Paul Chialastri, Jerome Pietras, Thomas Mueller

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Antegrade placement of ureteral stents is common after nephrostomy tube placement for obstruction in the septic patient and when retrograde placement fails. Ureteral stents have a nylon retaining suture attached to aid in placement. If left in place accidentally, these will not degrade and will become embedded in the renal parenchyma preventing stent removal and potentially leading to infection and stone formation. Ureteroscopic holmium ablation of the residual suture at the level of the parenchyma allows for stent removal and no urothelial defect was noted on repeat ureteroscopy 3 weeks later. Ureteroscopy with holmium lasering of retained suture appears safe …

Repetitive Mild Traumatic Brain Injury Impairs Performance In A Rodent Assay Of Cognitive Flexibility, Christopher P. Knapp, Doug P. Fox, Ramesh Raghupathi, Laura L. Giacometti, Stan B. Floresco, Barry D. Waterhouse, Rachel L. Navarra

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Mild traumatic brain injury (mTBI) occurs in almost 80% of the 3 million reported cases of TBI-related emergency department visits each year in the United States. The majority of mTBIs, sometimes classified as concussions, are due to sports-related activities and typically occur repeatedly over the course of an athlete’s career. mTBI symptoms are generally classified as either somatic or neuropsychiatric/cognitive in nature and include impairments in prefrontal cortex mediated functions, including attention, memory, processing speed, reaction times, problem solving, and cognitive flexibility. To date, there remains a major gap in our understanding of the behavioral manifestations, underlying neurobiology, and treatment …

Postoperative Cholecystitis From Nathanson Liver Retractor During Robotic-Assisted Laparoscopic Partial Nephrectomy, Lauren D. Gleich, Mihir G. Thaker, Gordon A. Brown

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Proper visualization of the surgical field during any procedure is one of the most imperative elements of surgery. The tools used to obtain this goal come with their own set of risks. This report describes a patient who developed postoperative acalculous cholecystitis (PAC) after use of a Nathan liver retractor. PAC is a rare complication of urologic surgery and is often more severe than acalculous cholecystitis (AC), leading to significant morbidity.

Rare Case Of Hip Pain: Transiliac Lumbar Hernia, Daniel Tran, James Lee, Alan Lucerna, James Espinosa

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Bone grafts are essential to achieving a solid spinal fusion by encouraging osteoblastic activity and providing a scaffold to guide bone remodeling. The iliac crest, in particular, is a common site for autologous bone grafting and is still considered the gold standard due to its ease of access to cortical and cancellous bone.[1] However, autologous iliac crest bone grafting can be associated with significant morbidity especially when full thickness tricortical grafts are harvested. Common complications include donor site pain, hematoma, thigh dyesthesias, pelvic instability or fracture.[2] Gastrointestinal herniation on the other hand is a much rarer complication with an incidence …

Coronary No-Reflow Following Percutaneous Intervention, Yaser Khalid, Harsh Patel, Adam Levine

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Normally, coronary revascularization with a percutaneous coronary intervention (PCI) leads to restoration of normal coronary blood flow through the coronary arteries, with reperfusion of the myocardium. However, there is a group of patients who do not benefit from the prompt restoration of antegrade flow, as they fail to show resolution of the indirect signs of ischemia such as electrocardiographic (ECG) changes and improvements in perfusion abnormalities. This condition is referred to as the “no-reflow phenomenon.” In this case report, we will discuss the case of a patient who developed coronary no-reflow immediately following PCI.

Toothpick Perforation Of Colon Mimicking Acute Appendicitis, Jacob Wilson, Adeshola Fakulujo

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This study presents a case report of a rare complication of foreign body ingestion and offers a literature review of management options. Pre-operative imaging and clinical history was reviewed. During diagnostic laparoscopy the diagnosis of ascending colon perforation with a foreign body was made and managed with a Laparoscopic Right Hemicolectomy. Literature was reviewed for case of toothpick ingestion requiring intervention, foreign body ingestion causing perforation, and management of foreign body perforations.

The Relationship Of Risk Of Falls And Activities Of Daily Living To 30-Day Hospital Readmission Among Older Adults With Type 2 Diabetes, Sanath Shetty, Shmilah Choudhary, Meet Shah, Terrie Ginsberg, Matthew H. Mclaughlin

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Introduction: Reducing thirty-day hospital readmissions is a top healthcare priority. However, there is little research describing the risk factors of readmission among patients with diabetes, especially for older adults. Understanding what the risk factors are for 30-day hospital readmission for older adults with type 2 diabetes (T2DM) would help identify patients at risk of rehospitalization.

Objective: The aim of this study was to identify factors associated with 30-day unplanned hospital readmissions among older adults with T2DM. Factors to be investigated are: patient demographics, whether patients were at risk for falling, and patients’ activities of daily living (ADL) at discharge.

Methods: …

Amiodarone Induced Epididymo-Orchitis, Yaser Khalid, Neethi Dasu, Sravan Panuganti, Stephen Daly

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Amiodarone has a well-established and extensive side effect profile: pulmonary fibrosis, thyroid toxicity, corneal deposits, skin discoloration. However, in some rare instance, epididymitis/orchitis is a side effect of amiodarone. Amiodarone toxicity was first studied in (1, 2) Symptoms range from testicular pain to swelling and erythema (1,2) The mechanism of how this toxicity occurs is unknown. In this case report, we will discuss the case of an elderly patient who developed epididymitis and orchitis after several years of tolerating amiodarone without any adverse events. Our patient underwent a full workup with testicular ultrasound, evaluation by urology and cardiology specialists. Then …

Ethnic And Demographic Differences In Colectomy Rates And Timing For Ulcerative Colitis: 2007-2014, Daniel Bodek, Alana Persaud, Brian Blair, Ahlawat Sushil

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Ulcerative Colitis (UC) is a chronic inflammatory disease of the bowel, with one third of patients requiring a colectomy for fulminant disease and tissue dysplasia. In 2007, infliximab was approved for induction and maintenance of remission in UC, with some evidence to suggest a potential reduction in colectomies. The aim of this study is to examine relative colectomy rates for UC among different ethnicities from 2007 to 2014 in order to evaluate for development of new trends or disparities.

Discrepancies in colectomy rates and timing are seen in our models which mirror closely findings in a prior study from 1999-2003 …

The Effects Of Antenatal Betamethasone On Late Preterm Infants, Jennifer Hummel, Abigail Prest, Xinhua Chen

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Administration of steroids to mothers expected to deliver in the late preterm period has previously been found to decrease neonatal respiratory morbidity. In this retrospective chart review, there were no significant differences between groups in the primary outcome of required respiratory support for the neonate, incidence of periventricular hemorrhage or neonatal death. However, this study found that their rate of hyperbilirubinemia, need for phototherapy, and NICU stays were longer than their counterparts whose mothers did not receive steroids or who only received one dose.These findings may provide support for future protocols directed to improve neonatal morbidity secondary to jaundice.

Chronic Renal Failure, But Why? A Case Report., Palak Patel, Michael Rothberg

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Renal failure, both acute and chronic, can present from many different etiologies and if diagnosed with diabetes mellitus, it is commonly assumed to be due to diabetic nephropathy. Monoclonal gammopathy of renal significance (MGRS) is a disorder that combines monoclonal gammopathy of undetermined significance with end stage renal disease. Monoclonal immunoglobulins are secreted by B or plasma cells leading to deposition in the kidney causing end organ damage. Several different subtypes fall under this category of renal diseases including, but not limited to, amyloidosis, C3 glomeruopathy, and light chain proximal tubulopathy, or better known as Fanconi syndrome1. Fanconi syndrome, which …

Something Has Fallen: Pelvic Organ Prolapse Or Vaginal Cuff Dehiscence And Evisceration? A Case Report., Alexandra Nutaitis, Laurie Kane

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="/">Learning Objectives: 1) Recognize late presenting complications of hysterectomy. 2) Include vaginal cuff dehiscence with evisceration (VCDE) in the differential diagnosis of women suspected of having acute pelvic organ prolapse (POP).3) Appreciate the relative rarity of VCDE in younger women.
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/="/">Case Summary: A 36 year old G0P0 female presented to the ED with a chief complaint of sudden onset excruciating epigastric pain, followed by diarrhea and visible vaginal bulge. Pertinent past medical and surgical history includes breast cancer diagnosed 15 months prior, status post bilateral mastectomy, radiation, chemotherapy, and robotic-assisted prophylactic hysterectomy and BSO 6 months prior. …

Pre-Operative Risk Of Medical Complications Varies By Health Insurance Carrier In Moderately Obese Women: Medicaid V Medicare V Private V Self-Pay, Paul Osterdahl, Melissa Gott, Amanda Sundling, Gus J. Slotman

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Introduction: Clinical variation by health insurance status in mixed sex bariatric surgery populations is reported, but such variation among moderately obese women is unknown.

Objective: to identify pre-operative variation by health insurance in female surgical patients.

Conclusions: Pre-operative characteristics of moderately obese women vary by insurance. Medicare’s highest risk for cardiopulmonary problems and diabetes, and Medicaid’s highest asthma, abdominal-hepatobiliary, and psychological/behavioral complications should be considered in managing moderately obese women subscribing to these carriers.

The Effect Of Omm On Opioid Users With Chronic Low Back Pain, Danielle Cooley, James Bailey, Deanna Janora, Catherine Fusco, Kishan Patel

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In the United States, approximately 100 million adults are affected by chronic pain, which reduces their quality of life and productivity, while accounting for billions in health care costs and lost revenue. (1) Opioids are considered the gold standard in the pharmacological treatment for chronic pain conditions, and prescriptions for opiates/opioids increased by 400% from 1999 to 2010. (1,2) Although opioid treatment is warranted during postsurgical and active cancer pain, physicians still commonly overprescribe opioids, which has led to addiction, high deaths rates by overdose, and the spread of communicable diseases. (1)

Since chronic pain is sustained by noxious sensory …

A Case Of Atraumatic Posterior Thigh Compartment Syndrome, Nailah Mubin, Brian Katt

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Compartment syndrome(CS) occurs when intra-compartmental pressures exceeds to a point where arterial, venous and lymphatic circulation of local tissues, muscles and nerves is compromised. CS is most common after a traumatic injury and usually occurs in the leg or forearm and less commonly in the thigh. Thigh compartment syndrome is rare due to its larger size and more compliant borders. We present a case of nontraumatic compartment syndrome in the posterior thigh associated with rhabdomyolysis and a sciatic nerve palsy which then required emergent fasciotomy. The patient's course was further complicated by acute renal failure due to the rhabdomyolysis and …

A Mathematical Investigation On Tumor-Immune Dynamics: The Impact Of Vaccines On The Immune Response, Jonathan Quinonez, Neethi Dasu, Mahboobi Qureshi

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Mathematical models analyzing tumor-immune interactions provide a framework by which to address specific scenarios in regard to tumor-immune dynamics. Important aspects of tumor-immune surveillance to consider is the elimination of tumor cells from a host’s cell-mediated immunity as well as the implications of vaccines derived from synthetic antigen. In present studies, our mathematical model examined the role of synthetic antigen to the strength of the immune system. The constructed model takes into account accepted knowledge of immune function as well as prior work done by de Pillis et al. All equations describing tumor-immune growth, antigen presentation, immune response, and interaction …

A Rare Manifestation Of A Bleeding Tubulovillous Duodenal Polyp Presenting As An Upper Gastrointestinal Hemorrhage, Neethi Dasu, Yaser Khalid, Herman Suga, Michael Itidiare, Richard Walters

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• Duodenal polyps are a group of polyps that are fairly uncommon to find on endoscopic evaluation (1).

• They are histologically classified according to mucin phenotype into intestinal and gastric subtypes; the intestinal-type polyps are morphologically subdivided into tubular and tubulovillous adenomas (2)

• We present a case of a 76-year-old male with recurrent hematemesis who was found to have an intestinal-type pedunculated tubulovillous adenoma (TVA) in the descending duodenum • An isolated occurrence of non-ampullary sporadic duodenal adenomas (SDA)’s are a rare finding and presentation as an upper GI hemorrhage is extremely uncommon (3)

• Furthermore, our patient’s …

What Are The Ods? A Case Of Osmotic Demyelination Syndrome Associated With Hemodialysis In End-Stage Renal Disease, Ellen Colleen Bradley, Yvette Wang

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Osmotic demyelination syndrome (ODS) is the irreversible demyelination of the central pons, among other areas of the brain, that is most often associated with rapid correction of hyponatremia. Per contra, reversible ODS is a rare state that can be seen in patients with end-stage renal disease (ESRD) on hemodialysis (HD). This clinical case offers an alternative problem representation for acute altered mental status in a patient with ESRD on HD.

A Rare Case Of A Non- Functioning Pancreatic Neuroendocrine Tumor, Yaser Khalid, Neethi Dasu, Richard Gordon

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Pancreatic neuroendocrine tumors (PNET) are very rare and represent about 1–2% of all pancreatic tumors. Non-functional PNET (NF-PNET) is incidentally discovered in most cases. Most NF-PNETs are found at an advanced stage because patients are mostly asymptomatic. We present a case of 32-yr-old female who initially presented with increasing abdominal girth, decreased mobility, and lower extremity swelling up to the hip and was found to have an advanced NF-PNET with metastatic disease to the pelvis and liver. There have been few studies directed toward early detection and management; Computed tomography (CT) is the imaging modality of choice as well as …

Panniculectomy Performed In Conjunction With Gynecologic Surgery In The Morbidly Obese Patient - A Nsqip Analysis And Meta-Analysis Of The Literature, Shayoni Nag, Tirth Patel, Steven C. Bonawitz

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Purpose: Panniculectomy is a common procedure in plastic surgery, often performed following massive weight loss and in morbidly obese patients. It can be performed in combination with various gynecologic procedures based on the rational that it will reduce complication rates.^{1, 2, 3} These studies fail to provide proof of these claims for reasons including study design and the lack of inclusion of both morbidly obese and non-morbidly obese patients. Recent medical practice has focused increasingly on minimizing patient morbidity and trends in reimbursement are moving towards penalizing practices which increase complications.

Methods/Results:We reviewed the NSQIP database to assess …

Maternal Morbidity Outcomes In Idiopathic Moyamoya Syndrome In New York State, Hajere J. Gatollari, Amelia K. Boehme, E. Sander Connolly, Alexander M. Friedman, Mitchell S.V. Elkind, Joshua Z. Willey, Eliza C. Miller

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Background: Pregnancy is associated with an increased risk of stroke in young women. Idiopathic moyamoya syndrome (IMMS) is a rare condition characterized by progressive narrowing of large cerebral arteries resulting in flimsy collaterals prone to rupture or thrombosis. Data are limited on pregnancy outcomes in women with IMMS. We hypothesized that IMMS would be associated with increased pregnancy morbidity, including stroke.

Conclusion: Pregnancies within 1 year prior or any time after IMMS diagnosis did not have increased maternal morbidity compared to unexposed pregnancies after adjusting for age and clustering of women with multiple pregnancies. Prospective studies are needed to better …