A Rare Case Of Acute Appendicitis In A 21-Year-Old Male With Midsternal Chest Pain, 2022 Rowan University
A Rare Case Of Acute Appendicitis In A 21-Year-Old Male With Midsternal Chest Pain, Muhammad Noman, James Espinosa, Alan Lucerna, Andrew Caravello
Rowan-Virtua Research Day
Acute appendicitis is inflammation of the vestigial vermiform appendix. It is one of the leading causes of emergency department visits due to abdominal pain. The vermiform appendix is located at the base of cecum. The attachment does not change; however the tip may migrate to the retrocecal, subcecal, preileal, postileal and pelvic positions. Considering these normal anatomical positions, the pain presentation may vary in patients.
Even though this patient presented with midsternal chest pain, which was suspicious for GERD, it was crucial to perform a thorough head-to-toe exam to discover incidental findings that the patient did not report. In this …
A Case Of Akinetic Mutism In Patient With Unilateral Anterior Communicating Artery Stroke, 2022 Rowan University
A Case Of Akinetic Mutism In Patient With Unilateral Anterior Communicating Artery Stroke, David Ho, Or Shachar, James Espinosa, Alan Lucerna, James Lee
Rowan-Virtua Research Day
Akinetic mutism, a rare neurological condition involving sensory, motor, language, behavior, and emotional changes, mimicking locked-in syndrome, should be considered in acute stroke patients presenting with speech deficits. This condition, although debilitating initially, does have prospects for recovery. In this case report, we present the case of a patient presenting to the ER for altered mental status, found to be in DKA, NSTEMI, suspected narcotic overdose, and unilateral acute ischemic stroke of the left anterior communicating artery (ACA), who was found to have Akinetic Mutism. In stroke patients presenting with aphasia and dysarthria, it is worth considering akinetic mutism in …
Case Report: Glioblastoma Tumor Presenting With Mild Changes In Memory, 2022 Rowan University
Case Report: Glioblastoma Tumor Presenting With Mild Changes In Memory, Samuel Thalathoti, Nicholas Palladino, James Espinosa, Alan Lucerna
Rowan-Virtua Research Day
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: A Patient With Gait Dysfunction With Acute Inflammatory Demyelinating Polyneuropathy Masquerading As Diabetic Polyneuropathy, 2022 Rowan University
Case Report: A Patient With Gait Dysfunction With Acute Inflammatory Demyelinating Polyneuropathy Masquerading As Diabetic Polyneuropathy, David Parkes, Russell Mordecai
Rowan-Virtua Research Day
New onset gait dysfunction often prompts admission to the hospital for further evaluation. The typical patient is an elderly person who normally is self-sufficient but had recently experienced a decline in their ability to care for themselves. Sometimes, however, those who present with gait dysfunction do not fit the expected demographic. These individuals raise concern for less common “zebra” presentations of neurological dysfunction. We describe one such rare case of a 39-year-old female with a new onset of type 2 diabetes mellitus and recent COVID-19 infection that presented to the emergency department with a sensation of bilateral lower extremity burning …
Case Report: Thyrotoxic Hypokalemic Periodic Paralysis, 2022 Rowan University
Case Report: Thyrotoxic Hypokalemic Periodic Paralysis, Kelly Schuitema, Wayne Tamaska, Robin Lahr
Rowan-Virtua Research Day
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: How A Vallecular Cyst Could Have Become An Airway Emergency, 2022 Rowan University
Case Report: How A Vallecular Cyst Could Have Become An Airway Emergency, Adam Kandil, Robin Lahr, Andrew Caravello
Rowan-Virtua Research Day
Vallecular cysts, also known as epiglottic mucous retention cysts are known to be generally self-limiting laryngeal lesion. They can however also be associated with airway obstruction, and dysphagia in infants. In adults, they are usually asymptomatic, and usually incidentally diagnosed. At times they are diagnosed during rapid sequence intubation, as they may contribute to endotracheal intubation difficulty. Moreover, there is question as to the correlation between vallecular cysts and the incidence of acute epiglottitis, as a vallecular cyst may become infected and cause a localized expansion of inflammation and infection. This expansion from the vallecula progresses to epiglottis.
Case Report: Epigastric Abdominal Pain From Beverage Ingestion Of Freshly Squeezed Juice Of The Hardy Orange Flying Dragon Plant (Poncirus Trifoliata), 2022 Rowan University
Case Report: Epigastric Abdominal Pain From Beverage Ingestion Of Freshly Squeezed Juice Of The Hardy Orange Flying Dragon Plant (Poncirus Trifoliata), James Espinosa, Alan Lucerna, David Ho
Rowan-Virtua Research Day
We report the case of a 25 year old male who presented to the ED with epigastric abdominal pain after ingesting a freshly squeezed beverage form of Flying Dragon Hardy Orange plant (Poncirus trifoliata). Poison control was contacted and recommended symptomatic treatment only. The patient’s pain resolved while in the emergency department. Seed and rind preparations have been used as an herbal remedy in East Asia. Freshly squeezed Poncirus trifoliata can cause significant abdominal pain.
Case Report: Covid Arm (Covid Vaccine Arm), 2022 Jefferson Health - NJ
Case Report: Covid Arm (Covid Vaccine Arm), Joseph Pagano, James Espinosa, Alan Lucerna, Henry Schuitema
Rowan-Virtua Research Day
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: The Heart Breaking Tale Of Takotsubo In The Ed, 2022 Rowan University
Case Report: The Heart Breaking Tale Of Takotsubo In The Ed, Richard Baluyot, James Espinosa, Alan Lucerna, Sergey Medlenov, Joseph Pagano, Bhumi Shah
Rowan-Virtua Research Day
Chest pain is one of the most common chief complaints that emergency room physicians deal with on a daily basis. Here we present a rare cause of chest pain on a patient diagnosed with takotsubo cardiomyopathy. This is a condition that has been on the rise since its initial discovery and therefore clinicians should consider this on their differential when assessing patients with chest pain, especially postmenopausal women.
Case Report: Segmental Testicular Infarction, 2022 Rowan University
Case Report: Segmental Testicular Infarction, Nicholas Coan, Ronald Clearie, Amanda Maciag, Joseph Pagano, James Espinosa, Alan Lucerna, Neelesh Parikh
Rowan-Virtua Research Day
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 …
Syncope Masquerading As Pulmonary Embolism, 2022 Rowan University
Syncope Masquerading As Pulmonary Embolism, Melissa Itidiare Locke, Andrew Caravello, Melanie Angelo, Andrew Vasta
Rowan-Virtua Research Day
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.
Case Report: Octreotide Associated Hyperkalemia, 2022 Rowan University
Case Report: Octreotide Associated Hyperkalemia, Darren Finn, Eric Maddock, James Espinosa, Andrew Caravello, Alan Lucerna, Henry Schuitema
Rowan-Virtua Research Day
78-year-old female with past medical history of acromegaly status post pituitary adenoma status post resection presents to the emergency department with abdominal pain. ED workup was not significant for any acute intra-abdominal abnormalities; however, incidental finding of hyperkalemia was pertinent to the visit. Patient was treated in the ED for her condition but her potassium levels remained elevated despite repeated saline infusions. Patient was ultimately admitted to the hospital where it was discovered that she had recently been switched from octreotide injections to an oral somatostatin analogue Mycapssa. We believe that this patient’s hyperkalemia was caused by octreotide-induced insulin suppression …
Case Study Of Metformin-Induced Lactic Acidosis, 2022 Rowan University
Case Study Of Metformin-Induced Lactic Acidosis, Kajel Patel, Kishan Patel
Rowan-Virtua Research Day
Metformin induced lactic acidosis is when high levels of metformin cause dangerously high levels of lactic acid. Here is a case report of a 72-year-old female who came in for nausea, vomiting, and diarrhea found to have a high suspicion for metformin induced lactic acidosis. She stabilized in the emergency department, nephrology and ICU was contacted, and she went for emergent dialysis. For many patients the prognosis of metformin induced lactic acidosis is poor. This patient was made comfort care by her family.
Incidental Finding Of Unusually Large Renal Cyst During Point Of Care Ultrasound, 2022 Rowan University
Incidental Finding Of Unusually Large Renal Cyst During Point Of Care Ultrasound, David Ho, Jeffrey Gardecki
Rowan-Virtua Research Day
Renal cysts are common, and their frequency and size increase as patients age. Renal cysts are derived primarily from tubules and can occur anywhere between Bowman’s capsule to the renal papilla. The cysts are composed of abnormally differentiated epithelial cells encapsulating a cavity of fluid. These abnormally differentiated cells are due to defects in the structure and function of cilia, the structures responsible for detecting urine flow as well as the epithelial composition of the epithelial architecture and repair. According to Campbell Urology, there are three processes in which renal cysts increase in their size – proliferation of epithelial cells …
Comparing The Relapse Rate Between Medication Assisted-Only Treatment And Medication-Assisted Treatment With An Osteopathic Manipulative Treatment Regimen In Patients With Musculoskeletal Pain, 2022 Rowan University
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
Rowan-Virtua Research Day
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 …
Exploring The Viability Of A Microglia Attenuating Treatment Model For Fibromyalgia Patients, 2022 Rowan University
Exploring The Viability Of A Microglia Attenuating Treatment Model For Fibromyalgia Patients, Rohan Yarlagadda
Rowan-Virtua Research Day
Fibromyalgia refers to a rheumatic condition experienced as pain all over the body without a specific cause. This is considered a diagnosis of exclusion. This classification seems to suggest that any treatment options for it are purely symptomatic and are not disease targeted. Its complex diagnosis and underlying pathology contribute to the challenge of medically addressing fibromyalgia. Without a strict cause, fibromyalgia is often treated symptomatically with CBT and SNRIs. However, recent research suggests that existing therapeutic approaches are not very effective, especially when considering long term benefits for this chronic condition. This beckons for novel treatment options for these …
Association Between Leg Adiposity & Hypertension Subtypes In Young & Middle-Aged American Adults, 2022 Rowan University
Association Between Leg Adiposity & Hypertension Subtypes In Young & Middle-Aged American Adults, David Lo, Aayush Visaria, Pranay Maniar
Rowan-Virtua Research Day
Our research aim was to determine the association between appendicular adiposity and hypertension to better elucidate the role of body fat distribution on blood pressure (BP).
Many studies have provided evidence for the inverse association between leg adiposity and metabolic syndrome criteria.
Hypertension (HT) subtypes have unique age distributions and associated risk factors. BMI ± triglycerides are major risk factors for isolated diastolic hypertension (IDH).
Improvement Of Memory Loss Through Dietary Intervention In The Assisted Living And Rehabilitative Settings, 2022 Rowan University
Improvement Of Memory Loss Through Dietary Intervention In The Assisted Living And Rehabilitative Settings, Alexander Swartz, Martin Forsberg
Rowan-Virtua Research Day
• 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: …
Obsessions In Ocd Mimicking Capgras: A Case Report, 2022 Rowan University
Obsessions In Ocd Mimicking Capgras: A Case Report, Ricky Chu, Alexander Swartz, Helen Yi
Rowan-Virtua Research Day
Obsessive Compulsive Disorder (OCD) is a mentally debilitating condition that can present in a multitude of ways and its manifestations can vary within the diagnosed patient population. OCD can be diagnosed with the presence of either obsessions or compulsions and does not require both. Sometimes, OCD can affect a patient in a way that mimics delusional misidentification syndromes. In these cases, a patient's ego-dystonia can be a key distinguishing feature in diagnosis. In one specific delusional misidentification syndrome, Capgras, a patient possesses fixed beliefs that a known person (or sometimes object) is an imposter. And even though the textbook OCD …
Long-Term Lithium Use In The Younger Population: Do The Benefits Outweigh The Risks? - A Case Report, 2022 Rowan University
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 …