Medical Specialties Commons^™

Case Report And Review: Hawthorne Root Toxicity, James Espinosa, Darren Finn, Alan Lucerna

Rowan-Virtua Research Day

Here we present the case of a patient who purchased a hawthorn root product, Raiz de Tejocote, for weight loss purposes. The side effect profile seen, including a positive digoxin level, are consistent with hawthorn root. This case reinforces the importance of asking a patient about all medications, including over the internet medications.

Case Report: Ocular Capsaicin Toxicity With Chemosis From Jalapeño Peppers, Duwayne Campbell, James Espinosa, Eric Maddock, Alan Lucerna, Henry Schuitema

Rowan-Virtua Research Day

A 42 year old female presented to an Emergency Department (ED) with the abrupt onset of left eye pain, tearing and eye redness of a one hour duration. Her symptoms were due to ocular toxicity from contact exposure to capsicum, through preparation of Jalapeño peppers.

Addressing The Access And Barriers To Mental Health Resources In High School Students, Tainiz Polanco, Ocean Alam, Diana Lopez, Vanessa Pizutelli

Rowan-Virtua Research Day

Minority populations throughout the world are hit with obstacles that interfere with their mental health, especially high school students. The recent COVID-19 pandemic has had drastic effects on the performance of these individuals and their social engagement. As observed, there is a divide amongst different races of students that highlights the lack of mental health resources provided to them and how they are utilized. After conducting further research on such issues, we were able to determine the major barriers existing today that tend to push students away from utilizing existing resources. Some of these barriers could vary from external stress …

Challenges To Implementing Screening, Brief Intervention, And Referral To Treatment (Sbirt) For Substance Use In Primary Care Settings At Rowan-Virtua, Alissa Hochman, Kristy Straub, Nancy Chase, Samuel Damiri, Jenna Destefano, Allyson Distel, Sana Farhat

Rowan-Virtua Research Day

Background and Purpose: Implementing the SBIRT model for substance use in a primary care setting has many benefits including normalizing conversations about alcohol and other substance use into patients’ visits, thereby reducing harm, reducing consumption and its negative impact, and promoting system changes to overcome barriers to treatment access. The full scope of the current SBIRT project involves the recruitment, hiring, training, and integration of health educators in 9 primary care sites throughout South Jersey, as well as a project supervisor serving as implementation lead and liaison to medical and administrative staff at all 9 primary care sites. Initial barriers …

Patient Satisfaction With Sutures Used In Knee Arthroscopy Portal Closure: Randomized Control Trial, Adeeb Hanna, John Sonnier, Carlo Coladonato, Henson Destine, Sean Wilson, Michael Ciccotti, Fotios Tjoumakaris, Kevin Freedman

Rowan-Virtua Research Day

Abstract: Introduction Both absorbable and non-absorbable sutures are routinely used for closure of arthroscopic portal incisions. However, current literature assessing patient satisfaction using either suture type in knee arthroscopic portal closure is limited.

Purpose/Hypothesis The purpose of this study is to evaluate patient outcomes and satisfaction following wound closure with absorbable (Monocryl) versus non-absorbable (Nylon) sutures during knee arthroscopy.

Study Design Randomized Controlled Trial (Level I) Methods Patients over 18 years undergoing primary knee arthroscopy were identified during procedure scheduling. Exclusion criteria included revision procedures, concomitant ligament reconstruction or meniscal repair surgery. Before surgery, enrolled patients were randomly assigned to …

Abnormal Placentation With Placenta Accreta In A Post Ablation Pregnancy, Amanda Mirmanesh, Raechel Fockler, Woojin Chong

Rowan-Virtua Research Day

Placenta accreta spectrum (PAS) is a rare complication of pregnancy in which the placenta abnormally implants into, and in rarer cases, through the uterine wall which leads to increased maternal morbidity with risk of maternal mortality. PAS diagnosed at the time of delivery is associated with severe maternal morbidity largely due to elevated blood loss which can result in complications such as DIC and even maternal death. We present a case of a woman with PAS to reiterate the importance of close antepartum monitoring along with having a high suspicion for placenta accreta in a patient with risk factors, specifically …

Infective Endocarditis Secondary To Needle Embolization To The Heart, Tony Elias, David Barsoum, Robert Malak, Veyola Rezkalla, Maziyar Daneshvar, Howard Weinberg, Rafail Beshai

Rowan-Virtua Research Day

Needle embolisms in the heart are very rare, even though the number of intravenous drug users (IVDUs) has increased over the past 10 years.Due to varied symptomology-chest pain, dyspnoea, fever, or asymptomatic, this remains a complex and likely underdiagnosed condition. We describe a 31-year-old female with past medical history of IV drug use who presented to the emergency room with heart palpitations and described it as her “heart feels funny” and shortness of breath. She acknowledged intravenous (IV) heroin use and stated that the last time to use IV drugs was 2 days before coming to the hospital.

To our …

Case Study: Posterior Reversible Encephalopathy Syndrome (Pres) In A Stroke Patient With Seizures, Akhmad Ernazarov, Shikhar Manchanda, Yvette Wang

Rowan-Virtua Research Day

Posterior Reversible Encephalopathy Syndrome (PRES) is a condition in which patients present with visual disturbances, headaches, seizures, and impaired consciousness. It can affect a wide variety of patients ranging from infants to elderly, but young and middle aged adults are most commonly affected; females are more likely to be affected by PRES than males. Risk factors such as hypertension, pre-eclampsia/eclampsia, renal failure, cytotoxic conditions and autoimmune conditions predispose patients to PRES. In this unique case, a 63 female patient was admitted to Jefferson Washington Hospital exhibiting classic stroke like symptoms. Patient also began seizing in the ED which was unusual …

Immigration Status And Household Income As Predictors Of Childhood Obesity, Bhaumik Patel, Jeffery Powers

Rowan-Virtua Research Day

Childhood obesity rates have been on a remarkably steep rise in recent years. According to recent literature, the rate in the United States alone has more than doubled compared to other regions in the world such as Australia, Canada and Europe1,2 . Especially in the African immigrant community, there has been speculation of a higher prevalence of childhood obesity in the United States3 . This warranted further investigation into demographic factors impacting childhood obesity rates and their subsequent consequences with other clinical diseases such as diabetes and heart disease. The CDC reports that in 2011-2014, among individuals ages 2 to …

Comparison Of Patient Outcomes In Female Patients Undergoing Slap Repair Or Biceps Tenodesis For The Treatment Of Slap Lesions, Adeeb Hanna, Matthew Wallingford, William Johns, John Sonner, Emma Johnson, Sommer Hammoud, Brandon Erickson, Steven Cohen, Michael G. Ciccotti, Meghan Bishop, Meghan Bishop

Rowan-Virtua Research Day

Background: There is no consensus on whether SLAP repair (SR) or biceps tenodesis (BT) yields superior long-term outcomes in managing superior labrum anterior to posterior (SLAP) tears. No previous study has examined outcomes of these procedures in female patients.

Hypothesis/Purpose: The purpose of this study was to compare outcomes following SR and BT for SLAP tears in females. The authors hypothesized there would be no difference in outcomes between patients who underwent SR or BT.

Study Design: Retrospective Cohort (level III)

Methods: Female patients who underwent SR or BT for treatment of SLAP tears between 1/1/2014 and 9/1/2019 were retrospectively …

Determining Accuracy Of Chondral Lesion Sizing Methods Prior To Surgery, Adeeb Hanna, Henson Destine, Emma Johnson, Michael Campbell, Austin Looney, Dominic Farronato, Joshua Pezzulo, Bradford S. Tucker, Kevin Freedman

Rowan-Virtua Research Day

Background: Osteochondral lesions of the knee may require cartilage restoration such as osteochondral allograft (OCA) transplantation or autologous chondrocyte implantation (ACI). Although MRI and arthroscopy can offer valuable information regarding lesion characteristics prior to these procedures, no study has compared the use of each in estimating the sizes of grafts used at the time of surgical correction.

Hypothesis/Purpose: To compare osteochondral defect size measurements and characteristics across MRI, arthroscopy, and at the time of implantation with OCA or ACI. Study Design: Retrospective Cohort Study (Level III)

Methods: Patients who underwent ACI and OCA transplantation at a single institution between 2015 …

Mcl-1 Inhibition Modulates Erk-Mediated Resistance In Multiple Myeloma, Omar Al-Odat, Krishne Gowda, Shantu Amin, Tulin Budak-Alpdogan, Subash Jonnalagadda, Manoj Pandey

Rowan-Virtua Research Day

Novel multiple myeloma (MM) treatments have significantly improved over the previous several decades, primarily on account of targeting bone marrow microenvironment (BMM) pathways. However, drug resistance and patient relapse remain major clinical problems. The role of BMM in the upregulation of anti-apoptotic protein Mcl-1 is well documented. The Mcl-1 protein plays a critical role in the progression and acquired drug resistance in MM. The regulation of Mcl-1, a protein characterized by a short half-life, from transcription to degradation is crucial for understanding its role in cell survival. The GSK3β and Erk play important role in the stability of Mcl-1. Also, …

Exploring The Impact Of Race On Ipv Screening In The Emergency Department Of A Metropolitan Pediatric Hospital, Leena Kasa, Katherine Obenschain, Kristine Alexander, Priyanka Joshi, Ashlee Murray

Rowan-Virtua Research Day

Research highlights racial disparities among those experiencing intimate partner violence (IPV), yet little is known about disparities in screening for IPV in the emergency department(ED). This study was designed to examine variability in pediatric caregiver screening rates within a metropolitan pediatric ED across patient race and to explore potential reasons for such variability. We conducted a mixed-methods study using quantitative data on IPV screening rates over four years (along with patient race and, if applicable, the reason for no screening) and qualitative data from semi-structured interviews with ED providers. Analyses compared rates of IPV screening and rates of screen deferral …

The Effect Of Perceived Weight Status And Bmi On Food Attitudes And Food Relationships, Sahil Patel, Ryan Gericke, Jaime Dougherty, Adarsh Gupta

Rowan-Virtua Research Day

The findings of this study have shed light on the intricate relationship that exists between perceived weight status from a “non-obese/obese” perspective and attitudes towards food and the overconsumption of particular food items. Participants who perceived their weight status as “obese” despite having a calculated BMI below the CDC threshold and classification for “obesity” had poorer relationships with food, consumption behaviors, and on average consumed food items that were detrimental to overall health. Comprehending a patient’s weight status perception and conducting a thorough history of their food intake could play a crucial role in addressing the patient’s overall health and …

Clinical Practice Workflow Implementation For The Improvement Of Diabetic Metric Compliance, Sugosh Anur, Sohil Khanna, Alison Mancuso, Alexander Kowalski

Rowan-Virtua Research Day

Recent guidance suggests the management of screen-detected diabetes can be optimized using multifactorial interventions to improve overall disease burden, patient outcomes, and cost-savings. We explored preventive diabetic care and implemented interventions to increase recommended testing compliance among patients with Type II Diabetes Mellitus. This study employed a multi-faceted approach beginning with the distribution of surveys to patients in the Stratford Family Medicine Office in order to gauge their health literacy level pertaining to Diabetes management. Patient electronic medical records were evaluated to determine baseline levels for all laboratory values. Data analysis was completed using Statistical Package for the Social Sciences …

Factors That Influence The Decision To Get Vaccinated Against Covid-19, Rhea Bhargava, Meghan H. Foos, Brandy M. Gotti, Alexandra L. Mulvenna, Taylor O. Smith, Danielle Cooley, Venkateswar Venkataman

Rowan-Virtua Research Day

Since the start of the COVID-19 pandemic and the launch of the vaccine, healthcare workers have been encouraging people to get vaccinated to prevent the spread of the virus. However, there is a significant number of people who are vaccine hesitant, or uncertain about receiving the COVID-19 vaccine and its booster. Vaccine hesitancy represents a state of opportunity to make positive change; therefore, it is crucial for healthcare workers to identify those who are in this population. When factors contributing to the vaccine hesitancy, including gender, age, ethnicity, education level, and income were studied, it was found that women, those …

Maackia Amurensis Seed Lectin (Masl) Increases Movement Velocity Of Mice With Tnfα Induced Rheumatoid Arthritis, Amanda A. Greenspan, Kelly L. Hamilton, Alan J. Shienbaum, Bradford Fischer, Andrea Bottaro, Gary S. Goldberg

Rowan-Virtua Research Day

Up to 70 million people around the world suffer from rheumatoid arthritis. Current treatment options have varied efficacy and can cause unwanted side effects. New approaches are needed to treat this condition. Sialic acid modifications on chondrocyte receptors have been associated with arthritic inflammation and joint destruction. The transmembrane mucin receptor protein podoplanin (PDPN) has been identified as a functionally relevant receptor that presents extracellular sialic acid motifs. PDPN signaling promotes inflammation and invasion associated with arthritis and, therefore, has emerged as a target that can be used to inhibit arthritic inflammation. Maackia amurensis seed lectin (MASL) can target PDPN …

Comparison Of Clinical And Radiographic Efficacy Of Particles Versus Nbca/Onyx In Middle Meningeal Artery Embolization For Chronic Subdural Hematoma, Jane Khalife, Mohamed Salem, Victoria Wong Murray, Allen Karimov, Brian Jankowitz, Jan Karl Burkhardt, Hamza Shaikh, Daniel Tonetti, Pratit Patel, Tudor Jovin, Ajith Thomas

Rowan-Virtua Research Day

Different embolic materials are utilized in MMA embolization of chronic subdural hematoma per operators’ discretion. We aim to compare the clinical and radiographic efficacy of different embolic materials in a pooled retrospective cohort of two US centers.

Gestational Diabetes Among The South Asian Diaspora In The United States Of America: A Scoping Review, Anudeep Deevi, Mariam Sharobeem, Gabrianna Andrews, Rahul Ubrani, Venkateswar Venkataraman

Rowan-Virtua Research Day

Aim: The scoping review was conducted to review the current knowledge base regarding gestational diabetes mellitus (GDM) among South Asians in the United States. In addition, the review was meant to identify any gaps in knowledge, specifically about the current care received by South Asians as well as the associated adverse health outcomes.

Methods: A systematic search of PubMed, Web of Science, Embase, and Scopus was conducted. Key words ""gestational diabetes South Asians in the United States" were used as search terms. Search was restricted to U.S. articles published on or after 01/01/2013 with key words. Articles were screened by …

The Effectiveness Of Examination Table Cleaning Protocols In Osteopathic Family Medicine Offices, Riley Phyu, Harrison A. Patrizio, Thomas Boyle, Todd Schachter

Rowan-Virtua Research Day

Contaminated environmental surfaces are responsible for acquisition of healthcare associated infections. In 2002 there were approximately 1.7 million healthcare associated infections, resulting in about 99,000 annual deaths. Appropriate disinfection of environmentally contaminated surfaces are required to reduce transmission of pathogens. Adenosine triphosphate (ATP) bioluminescence is being used in hospital settings to audit the cleanliness in the hospital settings. However, there is a paucity of literature in different healthcare settings outside of hospital settings. This may unintentionally result in a more relaxed cleaning protocol in outpatient settings.

Objective: To assess the effectiveness of disinfecting protocol in osteopathic family medicine offices using …

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

Rowan-Virtua Research Day

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

Rowan-Virtua Research Day

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 …

Analysis Of Implementing Best Practices For Co-Prescribing Naloxone In Your Agency Online Cme Training Module Via Pre- And Post- Knowledge Assessment., Alicia Podwojniak, Arvind Venkataraman, Richard Jermyn

Rowan-Virtua Research Day

The opioid epidemic poses substantial risk to society. Providers must ensure that their patients understand the uses and risks of both opioids and naloxone. One way to analyze this concept is via metacognition. This refers to a person’s knowledge about cognitive phenomena, and thus it regulates self-awareness abilities in decision making, such as planning and evaluating. It is not only important for providers to have knowledge on best practices, but also to have self-awareness, and confidence in their decision making to ensure optimal patient outcomes. True-false confidence weighted scoring can be utilized, whereby various levels of confidence are assessed from …

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

Rowan-Virtua Research Day

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 …

Focused Pocus: Cardiopulmonary Curriculum For Internal Medicine Residents, Daniel Tran, Krunalkumar Patel, Shivani Dalal, Umang Patel, Troy Randle

Rowan-Virtua Research Day

Problem Statement: Point-of-care ultrasound (POCUS) is currently not a required core competency in internal medicine (IM) residency despite its inherent benefits, and many hospitalists are not equipped to confidently acquire nor interpret basic ultrasound images.

Background: POCUS is used at the bedside by physicians to answer directed clinical questions to help guide patient management. During the COVID-19 pandemic, the use of ultrasound for quick, accurate diagnosis of life-threatening pathology has been instrumental in early detection of acute cardiopulmonary failure, monitoring treatment response, and minimizing nosocomial spread. We aimed to determine interest in learning POCUS, confidence level, self-rated proficiency, and perceived …

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

Rowan-Virtua Research Day

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 …

Barriers To Doula Use In New Jersey After 2021 Medicaid Coverage Expansion, June Solow, Aashna Reddy, Natali Sharma, Jonathan Lewis

Rowan-Virtua Research Day

Background: Doulas are trained non-clinical professionals that provide continuous support to a pregnant mother from the prenatal to postpartum period. Presence of a doula has been shown to benefit both mother and newborn health.

Purpose: To determine what prevents doula utilization in New Jersey.

Methods: A review of the current literature about doulas, mothers, clinicians, and legislation in other states was conducted. This included qualitative and quantitative data gathered in the United States.

Results: The most significant barrier from both the mother’s and doula’s perspectives is cost. Besides cost, diversity and number of doulas is low. A major barrier to …

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

Rowan-Virtua Research Day

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

Rowan-Virtua Research Day

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 …