Diagnosis Commons^™

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 …

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 …

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.

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: 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 …

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 …

Portable Head Computed Tomography Protocol For Trauma, Christian Quinones, Alexander Bolufer, Cory Hewitt, Sagun Tuli

HCA Healthcare Journal of Medicine

The use of portable computed tomography (CT) scanners has been shown to reduce risks associated with intrahospital transport and to expedite imaging in critically ill patients. While their use is established in intensive care units, their utility on intraoperative trauma patients remains underexplored. This paper reviews existing literature on portable CT use, defines appropriate clinical indications, outlines contraindications, and identifies quality metrics and implementation challenges. It also presents a proposed protocol for integrating portable head CT imaging into trauma workflows, focusing on early identification of intracranial or spinal injuries in the operating room. The development and analysis of standardized protocols …

Comparison Of Outcomes Among Neurovascular Patients Managed In Dedicated Neurological Intensive Care Units Vs. General Intensive Care Units, Joanna Roy, Basel Musmar, Nassos Tziviskos, Saarang Patel, Roberto Deleon, Ashley Thommana, Shady Mina, Stavropoula Tjoumakaris, Michael Gooch, Robert Rosenwasswer, Pascal Jabbour

Department of Neurosurgery Faculty Papers

Background/Objectives: Patients with neurovascular conditions often require multidisciplinary management to optimize recovery. Our systematic review identifies literature comparing outcomes among neurovascular patients managed at dedicated neurological intensive care units (ICUs) compared to general ICUs. Methods: PubMed was searched to identify articles that reported outcomes among patients managed at dedicated neurological ICUs versus general ICUs. Articles that reported outcomes among patients with neurovascular conditions were included. Articles that reported outcomes among patients managed at stroke units were excluded. The Newcastle Ottawa Scale (NOS) was used to assess for risk of bias across individual studies. Results: After a title and abstract screen …

A Hybrid Deep Learning-Based Approach For Visual Field Test Forecasting, Ashkan Abbasi, Sowjanya Gowrisankaran, Wei-Chun Lin, Xubo Song, Bhavna Josephine Antony, Gadi Wollstein, Joel Schuman, Hiroshi Ishikawa

Wills Eye Hospital Papers

OBJECTIVE: Longitudinal assessment of visual field (VF) testing is essential in glaucoma management. Conventional VF forecasting methods require numerous prior tests, while deep learning techniques have shown promising results with fewer tests. This study introduces a hybrid deep learning framework to enhance flexibility and accuracy in VF test forecasting.

DESIGN: A retrospective longitudinal study using deep learning-based VF forecasting models.

SUBJECTS AND CONTROLS: A total of 1750 subjects (healthy and glaucoma patients) with 19 437 Humphrey VF (24-2 Swedish Interactive Threshold Algorithm) tests collected from longitudinal glaucoma cohorts at the University of Pittsburgh and New York University.

METHODS: Three deep …

Use Of Procalcitonin In Therapeutic Decisions In The Pediatric Intensive Care Unit, Pierre Tissières, Elisabeth Esteban Torné, Johannes Hübner, Adrienne Randolph, Corsino Rey Galán, Scott Weiss

Department of Medicine Faculty Papers

Procalcitonin (PCT) is frequently used by clinicians in children with suspected bacterial infections and sepsis. However interpretation in the critically ill child may be challenging due to the complexity of underlying conditions and its impact on PCT values. Herein, we propose a guidance for the use of procalcitonin in critically ill children, supported by a comprehensive analysis of the literature, to help the clinician for interpreting PCT in the various clinical conditions encountered in pediatric intensive care units. We describe the importance of the clinical context, timing of measurement and evidence on PCT values in diagnosing sepsis and to guide …

Characterizing Radiation-Related Laryngotracheal Stenosis, Natalia Queenan, Jay Trivedi, Dylan Bertoni, Sana Siddiqui, Austin Yap, Kathleen Tibbetts

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

BACKGROUND: Radiation-related laryngotracheal stenosis (RLTS) develops due to fibrosis of the airway after radiotherapy. We aim to characterize the presentation, management, and outcomes of patients with RLTS and compare these to patients with iatrogenic laryngotracheal stenosis (ILTS).

METHODS: In a single-center retrospective cohort study, patients diagnosed with RLTS between 2017 and 2022 were identified. Demographic data, risk factors, cancer history and treatment, presentation of stenosis, primary stenosis intervention, and outcomes were extracted. Patients were compared to a cohort of patients with ILTS and no history of radiation therapy. Data were analyzed using Fisher's Exact Tests and paired t-tests.

RESULTS: Seven …

Desmoplastic Small Round Cell Tumor: An Update Of Current Management Practices, Ahmed Gawash, Alexa Simonetti, Brandon J Goodwin, Alissa Brotman O'Neill

Rowan-Virtua School of Osteopathic Medicine Departmental Research

BACKGROUND: Desmoplastic small round cell tumor (DSRCT) poses a diagnostic challenge, initiating with imaging techniques like ultrasound, CT, MRI, and PET scans, with CT being the primary choice for abdominal tumor visualization. Despite advances, the absence of a standardized staging system complicates the diagnostic process.

METHODS: A comprehensive literature review and search strategy, encompassing databases like PubMed and Cochrane was performed.

RESULTS: Systemic chemotherapy, notably the P6 regimen, is the cornerstone of DSRCT treatment, while other options, including CDK4/6 inhibitors, antibody-drug conjugates, and anlotinib present varying efficacy. A novel chemotherapeutic agent, ONC-201, exhibits promise, inhibiting tumor growth in preclinical models. …

Simulation-Based Assessment Of Blood Pressure By Certified Athletic Trainers, Michael W. Verde, Lindsey E. Eberman, Dawn M. Emerson, Zoë J. Foster, Zachary K. Winkelmann

Internet Journal of Allied Health Sciences and Practice

Purpose: Blood pressure (BP) assessment is a key component of pre-participation examinations and can aid athletic trainers (ATs) in diagnosing hypertension. However, the current pedagogical technique, which involves practicing BP assessment on healthy individuals, may not adequately prepare healthcare providers to recognize Korotkoff sounds at abnormal pressures during clinical practice. Therefore, the purpose of this study was to examine AT's ability to and confidence in assessing and interpreting BP using a high-fidelity simulator.

Methods: We recruited ATs through conferences, in-services, and postprofessional athletic training programs. In total, 100 ATs from various job settings (age=31±11 years; men=37, women=63, clinical experience=8±10 years; …

3d-Printed Organ-Realistic Phantoms To Verify Quantitative Spect/Ct Accuracy For 177lu-Psma-617 Treatment Planning, Lydia J. Wilson, Sara Belko, Eric L. Gingold, Shuying Wan, Rachel Monane, Robert S. Pugliese, Firas Mourtada

Department of Radiation Oncology Faculty Papers

Background/Objectives: Accurate patient-specific dosimetry is essential for optimizing radiopharmaceutical therapy (RPT), but current tools lack validation in clinically realistic conditions. This work aimed to develop a workflow for designing and fabricating patient-derived, organ-realistic RPT phantoms and evaluate their feasibility for commissioning patient-specific RPT radioactivity quantification. Methods: We used computed tomographic (CT) and magnetic resonance (MR) imaging of representative patients, computer-aided design, and in-house 3D printing technology to design and fabricate anthropomorphic kidney and parotid phantoms with realistic organ spacing, anatomically correct orientation, and surrounding tissue heterogeneities. We evaluated the fabrication process via geometric verification (i.e., volume comparisons) and leak testing …

Targeted Ehr-Based Communication Of Diagnostic Uncertainty (Tecu) In The Emergency Department: Protocol For An Effectiveness Implementation Trial, Danielle M Mccarthy, Sara Malone, Dimitrios Papanagnou, Benjamin E Leiby, Amandy M B Doty, Phillip Watts, Rahul Yadav, Julia K Pugliese, Jonathan Woodworth, Tracy Esteves Camacho, Efrat Kean, Kristin L Rising

Department of Emergency Medicine Faculty Papers

BACKGROUND: At least 37 % emergency department (ED) patients are discharged without a definitive diagnosis, resulting in diagnostic uncertainty. Transitions of care are high-risk periods for patient safety, especially for patients discharged with diagnostic uncertainty. Effective communication between clinicians and patients improves these care transitions. Previous research developed tools to support high quality discharge in the setting of diagnostic uncertainty, including: a communication checklist, a physician training program, and a patient-facing information sheet.

METHODS: This study aims to enhance transitions for patients leaving the ED with diagnostic uncertainty through an electronic health record (EHR)-based strategy. The intervention, the Targeted EHR-based …

Ototoxicity Monitoring: The Evolution Of A Protocol For Head And Neck Cancer Patients, Jena Patel, Jacob Beiriger, Kalena Liu, Zachary Urdang, Julia Croce, Molly Wolfson, Jacob Hulswit, Olivia Giglio, Jacob B. Hunter, Irina L. Middleton

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

OBJECTIVE: We evaluated an ototoxicity monitoring program (OMP) for improving audiologic follow-up in head and neck cancer (HNC) patients.

STUDY DESIGN: Retrospective cohort study.

SETTING: Tertiary academic center.

METHODS: Two hundred and forty patients were recommended for chemotherapy between January 2017 and June 2022. An OMP was implemented in March 2021; every patient received an audiology referral and was contacted to schedule a pretreatment audiogram. Patients were divided into pre-OMP and post-OMP cohorts. Main outcome measures included rates of pretreatment audiograms, posttreatment audiograms, posttreatment otologic symptoms, and hearing aid utilization.

RESULTS: There were 131 patients evaluated pre-OMP and 109 evaluated …

Caveolin-1: An Ambiguous Entity In Breast Cancer, Naveen Chintalaramulu, Dhirendra Pratap Singh, Biplov Sapkota, Dayanidhi Raman, Suresh Alahari, Joseph Francis

School of Medicine Faculty Publications

Breast cancer (BC) is the most frequently diagnosed cancer in women and the second leading cause of death from cancer among women. Metastasis is the major cause of BC-associated mortality. Accumulating evidence implicates Caveolin-1 (Cav-1), a structural protein of plasma membrane caveolae, in BC metastasis. Cav-1 exhibits a dual role, as both a tumor suppressor and promoter depending on the cellular context and BC subtype. This review highlights the role of Cav-1 in modulating glycolytic metabolism, tumor-stromal interactions, apoptosis, and senescence. Additionally, stromal Cav-1's expression is identified as a potential prognostic marker, offering insights into its contrasting roles in tumor …

Patient Care Technician Led Reduction In Blood Culture Contamination Rates, Elena Estrella Pct, Elissa Reyes Msn, Rn, Ccrn, Bethany Zoufaly Msn, Rn, Jennifer O'Neil Bsn, Rn, Anne M. Aquila Dnp, Rn, Cenp

Posters

Purpose:

To decrease blood culture contamination by improving staff competency