LILLINGTON — Medical school is rigorous. Along with the demands of didactics and patient care during his third and fourth years of medical school in community hospitals of North Carolina, Daren Fomin took the opportunity to develop and submit not one, but three case reports for publication and presentation.
“I am very curious about the human body – so much to learn all the time!” said Fomin. “And, I am very privileged to be in a place where I can study it further – particularly my interest in the role of the ketogenic diet in health and disease. I want to learn as much as I can about the science and art of medicine in order to be as capable as possible in caring for my future patients.”
Neurology
While on rotation in Fayetteville with Dr. Richard Serano, Diplomate to the American Board of Psychiatry and Neurology and Fellow of the American Academy of Medical Acupuncture, Fomin observed Dr. Serano’s treatment of an unusual case of acute neck pain. The case report entitled “Unusual case of acute neck pain: acute calcific longus colli tendinitis” was published in BMJ of Case Reports on June 2, 2016.
“This is an uncommon condition that is often misdiagnosed and can lead to unnecessary surgical intervention that puts patients at risk,” said Fomin. “The condition is often misdiagnosed as a retro-pharyngeal abscess which is then incised by an ENT surgeon, but that treatment is not successful because the condition is an inflammatory process of the muscle. The hope was to get this case study out so physicians would have another diagnosis on their differential of acute neck/throat pain and hopefully avoid unnecessary surgeries on these patients.”
Fomin’s classmate, Gunjan Joshi (CUSOM 2017), authored the paper with him.
“Neck pain is one of the most common reasons for a doctor’s visit and familiarity with an uncommon cause of neck pain such as acute calcific longus colli tendinitis (ACLCT) is important to prevent unnecessary medical and surgical intervention,” said Joshi. “Our case report highlighted a novel approach in the management of ACLCT with oral steroid, benzodiazepine, and aural acupuncture. I strongly believe that sharing this kind of work within the medical community leads to overall improvement in patient-care through prompt recognition and treatment of diseases. I hope to continue doing clinical research throughout my medical career for the betterment of patient-care and the profession.”
Dermatology
In October 2016, Fomin had another paper accepted for publication: “The Promising Potential Role of Ketones in Inflammatory Dermatologic Disease” was accepted by the Journal of Dermatological Treatment. He wrote this paper with the guidance of Dr. Jonathan Crane, associate professor of Dermatology and Director of the Dermatology Residency at Sampson Regional Medical Center, along with resident physician, Dr. Brianna McDaniel.
“Much is known about the health benefits of the ketogenic diet, particularly for weight loss, athletic performance, cancer, brain and nerve health, cardiovascular health, etc. but there is no research to date looking at the benefits of a ketogenic diet for skin health,” said Fomin.
“With new evidence showing that the ketogenic diet promotes an anti-inflammatory state in the body, I wanted to see if there was any evidence that these known mechanisms of anti-inflammatory activity could be used to fight inflammatory dermatologic disease and provide a basis and an impetus for further research in this area.”
After looking through available literature, Fomin, Crane and McDaniel believe the ketogenic diet has a promising future role in treating inflammatory dermatoses.
“A ketogenic diet inhibits the NLRP3 inflammasome, upregulate the body’s innate antioxidant activity, and augment the mTOR pathway,” said Fomin.
In addition to these two publications, Fomin assisted Lieutenant John Roman, MD, at Walter Reed National Military Medical Center, compose a poster that will be presented at the annual American Academy of Dermatology conference in Orlando, Florida in March 2017.
“While on my audition rotation in Walter Reed’s Dermatology program, I worked closely with Dr. Roman who was the primary dermatologist for a patient who presented with paraneoplastic IgA Vasculitis – a large rash on the body caused by IgA deposition in small blood vessels of the skin that can be associated with cancer in adults.”
“This was one of only a few known cases in all of medical literature in which this specific vasculitis (IgA vasculitis) was caused by undetected breast cancer; a mammogram was ordered to screen for a cancerous cause of her vasculitis and confirmed it as the cause.”
Dr. Roman and student doctor Fomin worked together to write the poster entitled “Paraneoplastic IgA Vasculitis Prompting a Diagnosis of Breast Cancer” that includes a review of the literature available for adult IgA Vasculitis and the association with occult malignancy.
“IgA vasculitis is most commonly associated with prostate and lung cancer; there is not much literature pertaining to IgA vasculitis and breast cancer, so we wanted to use this as an opportunity to educate physicians on the importance of age-appropriate cancer screening in adult patients who present with IgA vasculitis.”
“I want to be a part of where medicine goes in the future,” concluded Fomin. “I want it to emphasize things like diet, movement, and sleep – lifestyle – as much if not more so than disease-managing medications and procedures, thereby putting a lot of power and knowledge of health in the hands of patients”