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Case Report: Haemophilus Influenzae Meningitis in a 65 year old Female
Get PDFWe report a case of a 65-year-old female who presented with fever, altered mental status, and neck stiffness. Cerebrospinal fluid (CSF) analysis confirmed Haemophilus influenzae meningitis. The differential diagnosis of bacterial meningitis in older adults is broad and includes Streptococcus pneumoniae, Neisseria meningitidis, Listeria monocytogenes, and Haemophilus influenzae. However, in the post-Hib vaccine era, non-typeable H. influenzae has emerged as a significant cause of invasive disease in older adults, particularly in those with underlying comorbidities.
Older patients often present with atypical symptoms, which may delay diagnosis and treatment. In this case, early recognition and prompt administration of empiric antibiotic therapy was crucial for optimal patient outcomes. As the aging population grows and the prevalence of chronic diseases increases, H. influenzae meningitis will likely remain an important cause of bacterial meningitis in older adults, requiring continued awareness for timely diagnosis and management
Understanding Obesity Risk in Intellectual and Developmental Disabilities: Key Diagnoses and Factors
Get PDFBackground:
Individuals with intellectual and developmental disabilities (IDD) have obesity rates nearly twice those of the general population, leading to higher rates of diabetes, hypertension, sleep apnea, and reduced quality of life.1 Genetic syndromes such as Prader-Willi syndrome (PWS) and conditions like autism spectrum disorder (ASD) and Down syndrome (DS) feature distinct mechanisms driving weight gain.2 The burden of obesity in IDD exacerbates health disparities and strains caregivers and healthcare systems.3 Yet, comparative obesity prevalence and its drivers across specific IDD diagnoses remain poorly characterized.4
Hypothesis:
Obesity prevalence and underlying risk factors differ among IDD diagnoses such as ASD, DS, and PWS.5 Individuals with IDD are at high risk of comorbidities such as cardiovascular disease due to the increased prevalence of obesity.
Methods:
Narrative review of RCTs, clinical trials, systematic reviews, and meta-analyses on obesity in IDD (2010–2025, English, U.S. studies only).
Results:
• ASD: Elevated obesity driven by low activity, selective eating, and medication side effects.6
• Down syndrome: High obesity linked to hypotonia, hypothyroidism, and reduced metabolism.7
• Prader-Willi syndrome: Near-universal obesity due to hyperphagia and hypothalamic dysfunction.8
• Broader IDD: Obesity correlates with increased rates of diabetes, hypertension, sleep apnea, and metabolic syndrome.9
Conclusions:
Obesity risk varies markedly by IDD diagnosis. Syndrome-specific biological and behavioral mechanisms warrant tailored prevention and intervention strategies to reduce health disparities and improve long-term outcomes.1
Assessing the Efficacy of Using the PTSD Coach Mobile Application for Managing PTSD Symptoms: Results Using the Hopkins Symptom Checklist-21
Get PDFBackground: Primary care settings often become the first place where patients with mental health concerns go, especially with shortages of mental health providers. During Covid-19 mental health concerns increased, increasing the demand of primary care providers to help assist patients navigate their concerns. Hypothesis: Participants that use the PTSD Coach App for 30 days will have reduced HSCL-21 follow-up scores compared to their intake. Methods: Patients were recruited from the Rowan-Virtua family medicine office in Sewell. The PCL-5 with the HSCL-21 was administered, with patients then using the PTSD Coach app for 30 days. Researchers followed up with patients after this period, where the PCL-5 was administered again. Results: 4 out of 21 HSCL-21 questions showed a reduction in scores. Conclusions: The PTSD Coach app may be an effective tool, but needs to be studied further. Future directions include determining loss of follow-up in patients and continuing to analyze collected data to see the effectiveness of the PTSD Coach ap
The Gut Microbiome and Knee Osteoarthritis: A Review of Emerging Pathophysiologic Links
Get PDFBackground
Knee osteoarthritis (OA), a multifactorial degenerative joint disease with growing prevalence in aging and obese populations, leads to disabling pain. Traditionally viewed as mechanically driven, increasing research implicates systemic inflammation and metabolic and neuroimmune modulation. The gut microbiome—an ecosystem of commensal organisms regulating host immune, metabolic, and inflammatory regulation—has emerged as a potential contributor to OA pathogenesis and symptom severity. This review aims to synthesize literature evaluating associations between gut microbiota composition and knee OA, focusing on inflammatory pathways, pain modulation, and emerging therapies.
Methods
A literature search was conducted using PubMed, Embase, Scopus, and Web of Science. Inclusion criteria of the English language and examining knee OA pain associations with microbiota composition yielded 16 articles. Outcomes included microbial diversity, endotoxin levels, inflammatory pathways, and microbiome-targeted interventions (prebiotics/probiotics).
Results
Individuals with knee OA exhibited altered gut microbiota composition compared to controls, with reduced diversity and shifts towards pro-inflammatory taxa. These changes correlate with elevated inflammatory markers and may influence joint pain and cartilage integrity. Mendelian randomization studies suggest causal links between specific microbial taxa and chronic regional pain, including knee OA. In preclinical murine models, particular species mitigated OA-related pain, cartilage degradation, and gut dysbiosis, with associated reductions in pro-inflammatory mediators and restoration of beneficial bacteria. Some clinical trials demonstrated that prebiotics and probiotics improved function, reduced inflammatory markers, and modulated gut flora.
Conclusions
The gut microbiome may influence the development and progression of knee OA via systemic inflammatory and metabolic pathways. Microbiome-directed therapies may serve positive clinical implications for OA management, though further research is needed to establish causal relationships
Assessing the Impact of the COVID-19 Pandemic on Health Literacy in Patients Presenting to a Student-Run Free Clinic
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Health literacy as defined by the Center for Disease Control and Prevention (CDC), refers to an individual’s ability to find, understand, and use health information and services1. This definition has evolved with the onset of the COVID-19 pandemic and increasing emphasis on preventative healthcare. We aimed to observe the impact of the pandemic on the health literacy of patients in a free community clinic run by medical students.
Hypothesis
This study aims to assess the effect of various demographic and socioeconomic factors and the COVID-19 pandemic on health literacy levels estimated by the NVS assessment in the patient population served by RVCHC.
Methods
A total of 57 patients were enrolled: 33 during the pandemic and 24 post-pandemic. Basic demographic information was collected and health literacy was assessed using the Newest Vital Sign (NVS) Assessment--a 6 question screening test for literacy in a primary care setting2 .Data was analyzed for differences in health literacy based on pandemic status, gender, and college education.
Results
Preliminary data showed no significant differences were found between patients with limited literacy and adequate literacy based on presence of the COVID-19 pandemic, gender, or college education.
Conclusions
Data analysis showed no statistical significance or observable trends between pandemic and post-pandemic health literacy at the community clinic level. The pandemic introduced many hardships and challenges that we wanted to analyze to gain a greater understanding of its effects in our community. Some limitations to this study that can be addressed include the small sample size and incomplete patient-reported demographics
Case Report: Dysphagia in Inclusion Body Myositis Leading to Respiratory and Gastrointestinal Complications
Get PDFInclusion 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 for respiratory distress, was found to have severe dysphagia, and subsequently required intubation and percutaneous endoscopic gastrostomy (PEG) tube placement
Cobenfy(Xanomeline/Trospium) vs. Clozapine for Treatment-Resistant Schizophrenia
Get PDFBackground: Treatment-resistant schizophrenia (TRS) poses significant therapeutic challenges. Although clozapine remains the gold-standard pharmacologic treatment for TRS, its clinical utility is hampered by severe side effects and intensive monitoring requirements. KarXT (Cobenfy), a combination of xanomeline and trospium chloride, represents a novel antipsychotic approach by targeting muscarinic M1/M4 receptors instead of dopamine D2 pathways.
Hypothesis: KarXT offers comparable efficacy to clozapine with a more favorable safety and tolerability profile, making it a viable alternative for patients with TRS.
Methods: A systematic review was conducted to identify studies from 2015–2025 evaluating KarXT in schizophrenia. Sources included PubMed, ClinicalTrials.gov, FDA databases, ICER reports, and peer-reviewed journals. Inclusion criteria included randomized controlled trials (RCTs), long-term extension studies, or economic evaluations that reported on clinical efficacy (e.g., PANSS scores), safety, relapse prevention, or cost utility.
Results: Eight studies met inclusion criteria. KarXT demonstrated consistent reductions in PANSS scores, improved both positive and negative symptom domains, and exhibited a low incidence of extrapyramidal symptoms, weight gain, or sedation. Long-term data showed durable responses over 52 weeks. Although no direct comparison with clozapine exists, KarXT’s safety and minimal monitoring requirements offer distinct advantages.
Conclusions: KarXT offers a promising antipsychotic alternative for TRS, particularly in patients unable or unwilling to use clozapine. Its unique mechanism and improved tolerability may support its integration earlier in clinical practice, though further comparative trials will be critical to define its optimal placement in the treatment sequence
The Use of Intramedullary Screw for Fixation of Distal Ulnar Fractures
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Distal ulna fractures frequently accompany distal radius fractures but are often underappreciated in both clinical and research contexts. While conservative management is frequently employed, particularly following volar locking plate (VLP) fixation of the radius, certain indications, such as distal radioulnar joint (DRUJ) instability, comminution, or high-energy trauma, may necessitate surgical fixation. This study evaluates patient-reported outcomes among patients with distal radius fractures treated operatively, comparing those with and without concomitant distal ulna fractures, and further stratifying based on the method of ulna fixation.
Methods
This retrospective review included 477 patients treated operatively for distal radius fractures by a single Rothman hand surgeon from 2014 to 2024. Patients were grouped based on the presence and management of a concomitant distal ulna fracture: no ulna fracture, ulna fracture without fixation, or ulna fracture with fixation (plating or intramedullary screw). Visual Analogue Scale (VAS) and Disabilities of the Arm, Shoulder, and Hand (DASH) scores were collected and compared across groups.
Results
A total of 477 patients were analyzed in this study. 214 patients sustained a distal radius fracture without an associated distal ulna fracture. Among these, 140 patients had a mean VAS score of 2, and 118 patients had a mean DASH score of 34. In contrast, 248 patients sustained a distal radius fracture with a concomitant distal ulna fracture that was not surgically treated. Of these, 139 patients had a mean VAS score of 5, while 133 patients had a mean DASH score of 48. 15 patients underwent surgical fixation of a concomitant distal ulna fracture. Among the 11 patients treated with a distal ulnar intramedullary screw, eight had a mean VAS score of 1, and five had a mean DASH score of 46. Two patients underwent plating of the distal ulna; one had a VAS score of 0, and one had a DASH score of 59. Overall, for patients who received any form of ulnar fixation, the mean VAS score was 1, and the mean DASH score was 50.
Conclusions
Distal radius fractures without an associated distal ulna fracture are linked to lower pain and better function. Conversely, untreated distal ulna fractures in the setting of distal radius fixation are associated with worse patient-reported outcomes. Surgical fixation of the distal ulna may improve outcomes, with intramedullary screw fixation associated with the lowest VAS scores. Therefore, intramedullary screw fixation may be a viable technique for pain reduction in patients with concomitant distal ulna fractures
Adherence to Follow-Up Among High-Risk NICU Patients
Get PDFBackground:
Preterm infants, especially those ≤32 weeks\u27 gestational age (GA) are at increased risk of vision and hearing loss. Risks of both vision and hearing loss can be ameliorated and in some cases prevented by conscientious screening, follow up and treatment. Universally, infants ≤32 weeks are cared for in neonatal intensive care units and there is considerable confidence that screenings and treatment occur according to established guidelines. At hospital discharge, follow up responsibility shifts to infant caretakers likely resulting in reduced compliance.
Objective:
We aimed to determine if preterm infants at risk for vision and hearing loss, attended follow up appointments with ophthalmology and audiology as prescribed by the medical team at hospital discharge and whether the families preferred language preference contributed to compliance.
Design Method:
As part of a QI project, charts for preterm infants ≤32 weeks’ GA cared for in the NICU of Hackensack University Medical Center between 1/1/22-12/31/22 were reviewed. The discharge summary of patients were reviewed, instructions for ophthalmology and audiology follow-up extracted and completed appointments for ophthalmology and audiology were compared to discharge instructions. The birthing parent’s preferred language was also noted. Patients whose discharge summary did not have ophthalmology and audiology follow-up appointment instructions were excluded from analysis. Chi-square (��2 ) test was used to compare follow-up data with a statistical significance level set at p\u3c .05.
Results: In 2022, 138 infants ≤32 weeks’GA were cared for in the NICU with 79 instructed to follow up with ophthalmology and 127 to follow up with audiology. Spanish was the preferred language of 18% of families included in the analysis. Only 54% of patients (n=43) completed ophthalmology follow-up, while 66% of patients (n=84) followed up with audiology. Of patients completing ophthalmology follow up, 40% followed up within a week of the recommended time (-352 to 325 days). Patients whose family had Spanish as a preferred language were more likely to complete follow up than those having English language preference (��2 p=.03). For audiology 31% (n=39) of appointments were completed within the recommended time (range). Although families with Spanish as preferred language compared to those with English language preference were more likely to follow up as recommended (53% vs 30%), this difference was not statistically significant (��2 p=.07).
Conclusion: These results suggest limited compliance of families with prescribed outpatient ophthalmology and audiology follow-up that seems unrelated to language barriers. Future research should focus on potential for targeted education to impact follow-up compliance and understanding the challenges to outpatient follow-up experienced by parents of infants at risk for vision and hearing loss
Pathways Beyond Performance: How Curriculum Style Impacts Emotional Intelligence and Interpersonal Communication in Medical Students
Get PDFBackground: Medical schools employ various curricula to foster medical knowledge and professional competencies. Emotional intelligence (EQ)—the capacity to manage emotions and interpersonal relationships—is essential in clinical care. While research links EQ to academic and communication skills in nursing and international medical students, limited data exist for U.S. medical students, particularly regarding curriculum type.
Objective: This study evaluates whether different curricula—Problem-Based Learning (PBL) and Synergistic-Guided Learning (SGL)—are associated with differences in EQ and interpersonal communication skills (ICS) at Rowan-Virtua SOM.
Methods: EQ was measured using the MySkills Profile (EIQ16). ICS scores were derived from standardized patient encounters in the pre-clinical years. Comparative analyses assessed differences between PBL and SGL students and examined the relationship between EQ and ICS.
Results: Two-tailed t-test showed SGL students demonstrated significantly higher EQ scores than PBL students (p \u3c 0.05). PBL students scored significantly higher on first-year exams, while second-year exam differences were not significant. SGL students outperformed PBL students in ICS during Events 5 and 7 (p \u3c 0.05). However, contrary to our hypothesis, the correlation between EQ and ICS was weak and did not significantly differ between curricula.
Conclusion: Curriculum structure may influence specific educational outcomes, including EQ and communication skills. Nonetheless, EQ’s relationship with ICS appears consistent across learning models.
Limitations & Future Directions: Findings are based on a single cohort and assessment tool. Future work should include longitudinal, multi-cohort studies with varied EQ measures to better understand curriculum impact and guide interventions to enhance EQ throughout training