Pathological Conditions, Signs and Symptoms Commons^™

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: Herba Epimedium (Horny Goat Weed) Toxicity With Severe Muscle Spasms And Elevated Creatine Kinase And Creatinine, Tucker A. Ledo, Dhara Patel, Wayne Tamaska, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Here we present the case of a 33-year-old male who presented to the emergency department (ED) with a complaint of severe muscle spasms of a ten-hour duration. He noted that he took a supplement which he purchased over the internet called Epimedium, also known as Horny Goat Weed, for the purpose of improving his mood and sense of energy and reducing his sense of anxiety. He noted that he started this supplement one month prior to ED presentation, coincident with the first episodes of muscle cramps. In the ED, he had elevations of his CK and creatinine and required hospital …

Case Report: Dysphagia In Inclusion Body Myositis Leading To Respiratory And Gastrointestinal Complications, Veroneka Mikhail, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Inclusion body Myositis (IBM) stands as a rare and complex neuromuscular disorder (NMD) characterized by progressive muscle weakness and atrophy. Among its cardinal symptoms are dysphagia and respiratory distress, which are the most common cause of death in this disease. While the differential diagnosis of respiratory distress is vast and includes aspiration, pneumonia, acute coronary syndrome, emphysema, and congestive heart failure, a clinician should recognize that respiratory distress can also be secondary to dysphagia in NMDs like IBM and can quickly become life threating. Here we present the case of a 68-year-old female with a history of IBM who presented …

A Rare Case Of Diffuse Alveolar Hemorrhage In The Setting Of Iga Nephropathy, Vasculitis And Atypical Hemolytic Uremic Syndrome In A Previously Healthy Young Adult, Karl Schlicht, Nancy Kaura

Rowan-Virtua Research Day

IgA Nephropathy, also known as Berger disease, can precipitate acute renal failure in patients. IgA Nephropathy (IgAN) is deposition of protein from IgA into the renal tissue with subsequent renal dysfunction. IgA vasculitis (IgAV) is another condition where similarly the protein of IgA is deposited into the vessels. There are some cases of co-existing atypical hemolytic uremic syndrome (aHUS) with IgAN. However, rare combinations seen with all three IgAN, IgAV, and aHUS without any pre-existing conditions nor medical history. Patients that develop any one of these conditions are looking at life long changes with hemodialysis (HD) and organ transplants being …

Tricyclic Antidepressant (Tca) Overdose Causing Diffuse Alveolar Hemorrhage: A Case Report, Md Fateha, Jose Aragon, Joan Wiley

Rowan-Virtua Research Day

Tricyclic antidepressant (TCA) overdose is an uncommon complication that results from excessive administration of TCAs. Signs and symptoms include bradycardia, fever, dry mouth, and altered mental status. Patients can develop cardiac arrhythmia and diffuse alveolar hemorrhage, which can be fatal. This case report details a 65-year-old female who experienced a suspected TCA overdose as a suicide attempt. She had a history of depression and a previous suicide attempt. The patient was unresponsive with declining oxygen saturation, necessitating emergent intubation. Important lab findings included a decreased partial pressure of oxygen to fraction of inspired oxygen ratio (P/F ratio) and prolonged QRS …

Case Report: Dissecting Retroperitoneal Abscess With Gas Formation, David F. Koziel Jr.

Rowan-Virtua Research Day

Presenting as a case to the emergency department was a 53-year-old male with a complaint of diffuse abdominal pain and focal right flank pain at site of recent percutaneous abscess drain site performed exactly one month prior. This followed hospitalization in the preceding year for complicated multifocal intra-abdominal infections requiring surgical interventions including exploratory laparotomy and surgical debridement for intra-abdominal abscess and scrotal abscess formation. Despite prior aggressive management and extensive coverage with broad-spectrum antibiotics, this patient was found to have fulminant recurrance of infection in the right retroperitoneal space with an expanding abscess dissecting through the retroperitoneal structures into …

Synchronous Clear Cell Renal Cell Carcinoma And Classic Hodgkin Lymphoma, Phuoc Christie-Nguyen, Ahmed A Ahmed, Nourhan Ibrahim, Jacob Armstrong, Brenda Mai

Faculty, Staff and Student Publications

Introduction: The coexistence of renal cell carcinoma and classic Hodgkin lymphoma is exceedingly rare, with only two documented cases. Here, we present the third case diagnosed in our institution.

Case presentation: A 46-year-old man presented with right flank pain, fever, mild pancytopenia, and renal mass on computed tomography scan, suggesting renal malignancy. Despite intravenous antibiotics and extensive workup for recurrent fever, his condition did not improve. A bone marrow biopsy revealed rare large EBV-positive B cells. Surprisingly, imaging only showed minimal intraabdominal lymphadenopathy in the perinephric region. Subsequent surgery confirmed clear cell renal cell carcinoma in the kidney and scattered …

Pathobiology Of Aortic Aneurysms And Dissections: Synthesis Of Recent Investigations And Evolving Insights, L Maximilian Buja, Bihong Zhao, Deborah Vela, Ana Segura, Navneet Narula

Faculty, Staff and Student Publications

The pathobiology of aortic disease is linked to aortic region: atherosclerosis for abdominal aorta, primary medial degeneration or aortitis for ascending thoracic aorta, and all causes for descending thoracic aorta and thoracoabdominal lesions. The pathogenesis of aortic dissection involves damage of the outer media from impaired perfusion from dysfunctional vasa vasorum, formation of discrete foci of disrupted vascular smooth muscle cell-elastic fiber extension-contractile units, and imbalance of radial sheer stress across the aortic wall, thereby creating an intimal tear and linear dissection. Thoracic aortic aneurysms develop from the chronic progression of medial degeneration coupled with the weakening of the remodeled …

Synchronous Clear Cell Renal Cell Carcinoma And Classic Hodgkin Lymphoma, Phuoc Christie-Nguyen, Ahmed A Ahmed, Nourhan Ibrahim, Jacob Armstrong, Brenda Mai

Faculty, Staff and Student Publications

Introduction: The coexistence of renal cell carcinoma and classic Hodgkin lymphoma is exceedingly rare, with only two documented cases. Here, we present the third case diagnosed in our institution.

Case presentation: A 46-year-old man presented with right flank pain, fever, mild pancytopenia, and renal mass on computed tomography scan, suggesting renal malignancy. Despite intravenous antibiotics and extensive workup for recurrent fever, his condition did not improve. A bone marrow biopsy revealed rare large EBV-positive B cells. Surprisingly, imaging only showed minimal intraabdominal lymphadenopathy in the perinephric region. Subsequent surgery confirmed clear cell renal cell carcinoma in the kidney and scattered …

The Impact Of Biomaterial Characteristics On Macrophage Phenotypes In Tissue Engineering: A Review, Julian Jackson, Hani Samarah, William Palmer, Zachary Kaplan, Marianna Nicodem, Parvesh Kumar, Spenser Short, Kelly Bridgham, Larry Harshyne, Joseph Curry

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

Macrophages are highly plastic cells central to pathogen removal, tissue regeneration, and inflammation, making them key targets in biomaterial design for improved clinical outcomes. Foreign body responses (FBRs) to implanted biomaterials often involve excessive macrophage-mediated inflammation, leading to fibrotic encapsulation, infection, and implant failure. Advances in tissue engineering demonstrate that macrophage polarization - the transition from pro-inflammatory M1 to anti-inflammatory M2 phenotypes - can be influenced by biomaterial properties to mitigate these responses and enhance regeneration. This review synthesizes the relationship between biomaterial properties, such as surface chemistry, structure, and stiffness, and their ability to modulate macrophage behavior. Key innovations, …

Fatigue Level Associated With Quality Of Life For Prostate Cancer Patients: Results From The All Of Us Research Program, Hui-Yi Lin, Masuma Mannan, Yu-Wen Chiu, Ya-Hsin Li, Rajasree P. Chowdry, Tung-Sung Tseng

School of Public Health Faculty Publications

BACKGROUND/OBJECTIVES: Prostate cancer (PCa) patients frequently experience extended survivorship, highlighting the importance of quality of life (QoL) in cancer care. QoL has been shown to influence survival and PCa progression. For PCa patients, fatigue is a common issue due to cancer itself or its treatments. However, many QoL studies on PCa patients are limited by small sample sizes in clinic settings and often overlook the impact of fatigue and health-related behaviors. To fill this gap, this study aims to evaluate fatigue associated with QoL and related health measures among PCa patients. METHODS: This study used the All of Us cohort …

Leveraging Lower Body Negative Pressure For Enhanced Outcomes In Orthopedic Arthroplasty—Insights From Nasa’S Bone Health Research, Phani Paladugu, Rahul Kumar, Tamer Hage, Swapna Vaja, Tejas Sekhar, Samuel Weisberg, Kyle Sporn, Ethan Waisberg, Joshua Ong, Amar S. Vadhera, Mouayad Masalkhi, Ryung Lee, Chirag Gowda, Ram Jagadeesan, Nasif Zaman, Alireza Tavakkoli

SKMC Student Presentations and Publications

Exposure to microgravity causes rapid bone loss and muscle atrophy, posing serious challenges for long-duration spaceflight. In response, NASA developed countermeasures such as Lower Body Negative Pressure (LBNP) to simulate gravitational loading on astronauts’ lower extremities. LBNP, often combined with exercise, has proven effective in mitigating musculoskeletal degradation during bed rest analogs. This opinion paper argues that LBNP’s success in preserving bone mass and muscle function in microgravity can be translated to improve re- covery after orthopedic arthroplasty on Earth. We draw physiological parallels between microgravity-induced musculoskeletal disuse and the postoperative period following total joint replacement, during which reduced weight-bearing …

Physical Activity Measurement Reactivity Among Midlife Adults With Elevated Risk For Cardiovascular Disease: Protocol For Coordinated Analyses Across Six Studies., Kiri Baga, Gabrielle M Salvatore, Iris Bercovitz, Amanda L Folk, Ria Singh, Laura M König, Meghan L Butryn, Jacqueline A Mogle, Danielle Arigo

Rowan-Virtua School of Osteopathic Medicine Departmental Research

BACKGROUND: Cardiovascular disease (CVD) remains the leading cause of death in the United States, and adults aged 40-60 years with specific health conditions are at particularly elevated risk for developing CVD. Physical activity (PA) is a key cardioprotective behavior and many interventions exist to promote PA in this group. Effective promotion requires accurate assessment of PA behavior; as PA is often estimated by averaging across multiple days, a threat to accurate assessment is measurement reactivity, or an atypical increase in PA behavior at the start of measurement periods that may bias conclusions. Evidence for PA measurement reactivity is equivocal, though …

Diabetic Retinopathy: A Pathophysiological Discussion, Nathanael C. Nicholls

Senior Honors Theses

Diabetic retinopathy is a severe complication of diabetes that is capable of causing vision loss or blindness. As a result of hyperglycemia, the disease increases oxidative stress and activates biochemical processes such as the Hippo pathway and the complement system to cause significant damage to the retina. Overexpression of BTG1 and microRNA-183 enables activation of biochemical pathways that lead to negative effects on the retinal vascular endothelium including angiogenesis and inflammation. Conventional methods of diagnosis for diabetic retinopathy include fundus examination, nucleoside detection, and optical coherence tomography angiography. Photocoagulation and hormonal intravitreal injection are the most popular current treatments, while …

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. …

Plasma Proteomic Biomarkers Of Physical Frailty In Heart Failure: A Propensity Score Matched Discovery-Based Pilot Study, Quin Denfeld, Noelle Pavlovic, Christopher Lee, Jon Jacobs, Mary Roberts Davis, Samantha Powell, Marina Gritsenko, Susan Joseph, Beth Habecker

Division of Cardiology Faculty Papers

BACKGROUND: Physical frailty is highly prevalent in heart failure (HF), but we lack an understanding of the underlying pathophysiology. Proteomic evaluation of plasma samples may elucidate potential mechanisms and biomarkers of physical frailty in HF.

OBJECTIVES: We aimed to identify plasma proteomic biomarkers that are differentially expressed between physically frail and non-physically frail adults with HF.

METHODS: This was a secondary analysis of a subset of data and plasma samples from a study of frailty among patients with New York Heart Association (NYHA) Functional Classification I-IV HF. Physical frailty was measured using the Frailty Phenotype Criteria. Propensity score matching was …

Daily Acute Intermittent Hypoxia Elicits Age & Sex-Dependent Changes In Molecules Regulating Phrenic Motor Plasticity, Jayakrishnan Nair, Alexandria Marciante, Carter Lurk, Mia Kelly, Maclain Capron, Gordon Mitchell

Department of Physical Therapy Faculty Papers

Acute intermittent hypoxia (AIH) elicits a form of respiratory motor plasticity known as phrenic long-term facilitation (pLTF). Exposure to repetitive daily AIH (dAIH) enhances pLTF, a form of metaplasticity. Little is known concerning cellular mechanisms giving rise to dAIH-induced metaplasticity and the age-dependent sexual dimorphism of AIH associated pro-plasticity mRNA expression. To test if age, sex, and dAIH effects are associated with differential expression of molecules that regulate the Q- and S-pathways and their cross-talk interactions to phrenic motor facilitation, we analyzed key regulatory molecules in ventral spinal (C3-C5) homogenates from young (3-month) and middle-aged (12-month) male and female Sprague-Dawley …

A Hypoxia Research-Driven Path Led To Identifying Neuroprotection Mediators: An Interview With Dr. Nicolas G. Bazan, Nicolas G. Bazan

School of Medicine Faculty Publications

No abstract provided.

Clinical Characteristics And Outcomes Of Pediatric Staphylococcal Scalded Skin Syndrome (Ssss) At An Inner-City Tertiary Care Center, Nina Kb Gust Md, Ashley Frei Bs, Rebecca M. Adams Bs, Elika Ridelman Phd, Christina Shanti Md, Ronald Thomas Phd, Jocelyn Y. Ang Md

Medical Student Research Symposium

Introduction

Staphylococcal Scalded Skin Syndrome (SSSS) is a blistering skin condition caused by a toxin-producing staphylococcus species. Epidemiologic studies on pediatric SSSS in the United States are limited, with a reported incidence of 7.67 cases per million children and 45.1 per million infants. Immature renal function, lack of protective antibodies, and increased exotoxin target desmoglein-1 are hypothesized to increase incidence in younger children. We aimed to determine clinical and microbiological characteristics of pediatric SSSS and factors that could help predict disease severity.

Methods

A retrospective chart review was performed for admitted patients under 18 years old diagnosed with SSSS from …