Medicine and Health Sciences Commons^™

Hiv-Associated Burkitt Lymphoma: More Than A Starry Sky Appearance, Rahwa Ghebremichael, Amy Dechet

Providence Portland Medical Center Internal Medicine 2020

Introduction: •People with HIV infection are at least 50 times more likely to get lymphoma as compared to the general population. •25-40% of these lymphomas will be Burkitt Lymphoma (BL) – an aggressive B cell malignancy with a high proliferative rate and potentially fatal within months if not diagnosed and treated in a timely manner. •This translates to a 10-20% individual life-time risk of BL for an HIV infected person. •The incidence of BL declined after the introduction of highly active antiretroviral therapy (HAART), but to a lesser extent than other HIV-associated malignancies. •Epidemiologic studies suggest the incidence of BL …

Autoimmune Hemolytic Anemia In Chronic Lymphocytic Leukemia, Kelley Newton, Janan Markee

Providence Portland Medical Center Internal Medicine 2020

Autoimmune Hemolytic Anemia In Chronic Lymphocytic Leukemia

Kelley Newton, MD

Providence Portland Medical Center – Portland, OR

Additional Authors: Janan Markee, MD

Patients with chronic lymphocytic leukemia have a 5-10% risk of developing autoimmune complications, the most common of which is autoimmune hemolytic anemia. Here we present a case of AIHA in a patient with suspected CLL that underscores several of the diagnostic and treatment challenges unique to this process. A 79-year old man with a history of hypertension, atrial fibrillation, type 2 diabetes and hypothyroidism was undergoing workup for suspected CLL due to a persistent leukocytosis. He then presented …

Soft Rock – When Blasting It Doesn’T Work, Mark Schneider, Jesse Powell

Providence Portland Medical Center Internal Medicine 2020

Soft Rock – When Blasting It Doesn’t Work

Mark Schneider, MD

Providence Portland Medical Center – Portland, OR

Additional Authors: Jesse Powell, MD

Case-History of Present Illness: 68-year-old female presents with several days of malodorous urine and fevers. Brought to the ED by her daughter who diagnosed urinary tract infection (UTI) due to the distinct urine odor. No hematuria, dysuria, retention, or incontinence.

Past Medical History: Recent hospitalization for UTI with culture that grew P.mirabilis, completed course of cefdinir, with follow-up culture ordered by PCP that grew extended-spectrum beta lactamase (ESBL) E.coli.

Physical Exam and Vital Signs: Vitals: 115/48, 101, …

Comparative Detection Of Airway Mrsa In Patients With Community-Acquired Pneumonia (Cap), Hiromichi Park, Shirin Ferdosian Najafabadi, Lian Wang, David Gilbert

Providence Portland Medical Center Internal Medicine 2020

Comparative Detection Of Airway MRSA In Patients With Community-Acquired Pneumonia (CAP)

Hiromichi Park, DO

Providence Portland Medical Center

Portland, OR

Additional Authors: Shirin Ferdosian Najafabadi; Lian Wang, PhD; David Gilbert, MD, MACP

Introduction: Vancomycin is often included in the empiric therapy of CAP to ensure activity against MRSA. The current gold standard for detection of MRSA in the airway is a nasal swab PCR. The FilmArray sputum pneumonia panel includes PCR probes for MRSA. This study compares the detection performance of the nasal swab versus the sputum PCR detection of MRSA. Clinically, the absence of airway-detectable MRSA allows cessation …

The Dangers Of Gardening – Nocardia Infection In An Immunocompromised Patient, Gerald Hutfles, Justin Jin

Providence Portland Medical Center Internal Medicine 2020

The Dangers Of Gardening –

Nocardia Infection In An Immunocompromised Patient

Gerald Hutfles, DO

Providence Portland Medical Center – Portland, OR

Additional Authors: Justin Jin, MD

Introduction: Nocardia is a gram-positive, partially-acid fast, aerobic, branching bacillus that can be found in soil and water. It is typically an opportunistic pathogen, with most infections occurring in the immunocompromised. Disease can be localized or disseminated, preferring pulmonary, nervous, and cutaneous tissues. Optimal antimicrobial therapy depends on speciation of the isolate, as Nocardia may exhibit variable antimicrobial susceptibility. A high clinical suspicion and appropriate empiric antimicrobial therapy is necessary. This clinical case …

A Perplexing Case Of Episodic Abdominal Pain And The Role Of Mast Cells Gastroenteritis, Hayden Smith, Mari Kai

Providence Portland Medical Center Internal Medicine 2020

Here we present a case of chronic intractable vomiting and diarrhea of unknown cause, and introduce the relatively new entity of mast cell gastroenteritis.

Our patient is a 38-year old female with PMH of seronegative rheumatoid arthritis, mixed connective tissue disorder, and several recent hospitalizations over the past 4 months at outside hospitals for suspected colitis with associated vomiting and diarrhea. Current symptoms include 4 days of nausea with intractable vomiting, and 2 days of rectal fullness with mucoid rectal discharge. Previous workup at outside hospitals included multiple abdominal CT scans, flexible sigmoidoscopy, colonoscopy, and exploratory laparotomy. Prior to admission …

When Less-Virulent Becomes Virulent!! An Atypical Presentation Of Streptococcus Viridians., Samreen Khan, Stavan Patel, Mary Anne Nidiry

Providence Portland Medical Center Internal Medicine 2020

When Less Virulent Becomes Virulent!!

An Atypical Presentation Of Streptococcus Viridians

Samreen Kahn, MBBS

Providence Portland Medical Center – Portland, OR

Additional Authors: Stavan Patel MS, MD

Introduction: There are several cardiac and non-cardiac causes and risk factors for the development of infective endocarditis (IE) in young healthy adults. Some risk factors include prior IE, history of valvular or congenital heart disease, IV drug use, indwelling intravenous lines, immunosuppression, or a recent dental or surgical procedure. Most two common sites of IE are mitral and aortic valve. We present a case of a 45-year-old man with no-known risk factors, …

Drugging Chemokine Receptors: Biased Cxcr3 Agonists Differentially Regulate Chemotaxis And Inflammation, Jeffrey Smith, Dylan Eiger, Chia-Feng Tsai, Lowell Nicholson, Rachel Glenn, Priya Alagesan, Amanda Macleod, John Jacobs, Tujin Shi, Sudarshan Rajagopal

Providence Portland Medical Center Internal Medicine 2020

Drugging Chemokine Receptors: Biased CXCR3 Agonists Differentially Regulate Chemotaxis And Inflammation

Jeffrey Smith, MD, PhD

Providence Portland Medical Center – Portland, OR

Additional Authors: Dylan Eiger, BS; Chia-Feng Tsai, PhD; Lowell Nicholson,MD; Rachel Glenn, BS; Priya Alagesan, BS; Amanda MacLeod, MD; John Jacobs, PhD; Tujin Shi, PhD; Sudarshan Rajagopal, MD,PhD

Introduction: G protein-coupled receptors (GPCRs) are the largest class of transmembrane receptors and the target of ~30% of FDA approved drugs. It is now well established that GPCRs can signal through multiple transducers, including classical heterotrimeric G proteins but also GPCR kinases and β-arrestins (1). While these signaling pathways can …

Wrap It Up – Sexually Transmitted Primary Cytologmegalovirus Proctitis In Immunocompetent Host: A Case Report, Vanessa Nwaokocha, Brinton Clark, Ronald Dworkin

Providence Portland Medical Center Internal Medicine 2020

Background: In persons who presents with fever, rectal pain and bleeding, CMV proctitis should be considered if other workup is negative, especially if recent unprotected anal receptive intercourse.

Case Presentation: A 26-year-old bisexual man presented with chief complaints of fever, malaise, rectal pain, and rectal bleeding after anal insertion of foreign body. He initially denied any unprotected sexual intercourse. CBC, CMP, stool pathogen, rectal gonorrhea, and rectal chlamydia were unremarkable. He returned after 1 week with the similar complaints, however admitted to unprotected anal receptive intercourse a month prior. His vitals were notable for temperature of 102 with …

A Case Of Multifactorial Orthostatic Hypotension Complicated By Chemotherapy Associated Autonomic Toxicity, Christopher Bender, Amy Dechet

Providence Portland Medical Center Internal Medicine 2020

A Case Of Multifactorial Orthostatic Hypotension Complicated By Chemotherapy Associated Autonomic Toxicity

Christopher Bender, MD

Providence Portland Medical Center – Portland, OR

Additional Authors: Amy Dechet, MD

Introduction: Autonomic neuropathy is known to occur as a side effect of some chemotherapy drugs, including cisplatin. This reports presents a patient with new onset of autonomic instability and orthostatic hypotension after receiving multiple rounds of cisplatin and gemcitabine chemotherapy.

Case Presentation: An 81-year-old man with history of stage III lung cancer presented after a fall at home that occurred while getting out of bed in the middle of the night …

Sweets Syndrome: A Case Report, Michael Waddick, Elizabeth Deyo

Milwaukie Family Medicine 2020

Title: Add Sweet’s Syndrome to your dermatologic differential

Authors: Dr. Elizabeth Deyo, Dr. Mike Waddick

Context: Sweet’s Syndrome, an uncommon acute painful inflammatory rash, can be easily misdiagnosed. Early recognition and treatment can speed clinical recovery for patients with this difficult condition.

Objective: Here we describe an interesting case report of Sweet’s Syndrome in one of our patients in order to help providers remember this diagnosis on their dermatologic differential diagnosis.

Case report synopsis: Our 44 year old male HIV positive patient with type 2 diabetes mellitus presents with athralgias, chills, malaise and a plaque-like rash on the …

Acute Pancreatitis: Case Report And The Importance Of Early Prediction Of Severity, Christelle Serra-Van Brunt

Milwaukie Family Medicine 2020

INTRODUCTION: Acute Pancreatitis (AP) was the third most common GI diagnosis in 2012, resulting in approximately 275,000 admissions and costing about $2.6 billion. It remains a disease characterized by significant morbidity and mortality, and to this day, there is not a medication to treat it. Most care is supportive. Establishing the severity of the disease accurately is important in order to triage patients to the correct level of care to decrease rate of complications, mortality, and potentially shorten duration of stay.

CASE REVIEW: 30yo male with history of alcohol use/abuse, with prior episode of pancreatitis 5mo earlier, presented …

Increasing Vaccination Rates Of Children Up To 24 Months Old At Pmg Milwaukie Family Medicine, Justin Ferley, Rachel Jackson, Aubrey Miller, Sebastian Reeve, Christelle Serra-Van Brunt, Jamie Skreen, Jeffrey Sun, John Yates, Daniel Ruegg

Milwaukie Family Medicine 2020

Increasing Vaccination Rates of children up to 24 months old at PMG Milwaukie Family Medicine

Authors: Justin Ferley DO; Rachel Jackson MD; Aubrey Miller MD; Sebastian Reeve MD; Christelle Serra Van-Brunt DO; Jamie Skreen DO; Jeffrey Sun DO; John Yates MD; Daniel Ruegg MD

Introduction: Each year in the US, 42000 adults and 300 children die of vaccine preventable diseases. Yet across the country, clinics – including ours – fall short of the CDC Healthy People 2020 goals of pediatric vaccination rates. This resident-led quality improvement (QI) project aimed to improve our clinic vaccination rates in the under …

Miliary Tb Disease With Tb Meningitis, Jamie Skreen

Milwaukie Family Medicine 2020

Context/background: Miliary tuberculosis is a condition that is fatal if not diagnosed and can present in the outpatient setting with vague symptoms that resemble a viral illness, therefore, can be easily missed. Recognition of this disease as a differential is important in the primary care setting, especially when caring for immigrant and International patient populations.

Case Description: A previously healthy 35 yo female from Vietnam whom presented initially to the ER for headache and fever for the past 2 weeks. She was diagnosed with acute viral syndrome given her symptoms, normal labs, and head CT, and discharged home. A few …

Education Of Heparin Per Pharmacy Guidelines To Increase Compliance, Safety, And Pharmacists’ Management Of Heparin Infusions, Christopher Truong, Braxton Mehl

Providence Pharmacy PGY1 Program at Providence Medford 2020

Presentation Title: Education of heparin per pharmacy guidelines to increase compliance, safety, and pharmacists’ management of heparin infusions

Authors: Christopher Truong, PharmD and Braxton Mehl, PharmD, BCCCP

Facility: Providence Medford Medical Center

Background: Element of Performance 4 of The Joint Commission’s National Patient Safety Goal 03.05.01 requires that hospitals have a written policy that addresses the need for baseline and ongoing laboratory tests to monitor and adjust anticoagulant therapy. Our hospital has a written Anticoagulation Management General Operating Policy for heparin orders managed through nursing or pharmacy. Currently, most heparin orders are nurse-managed and have resulted in lab and dosing …

Sola Dosis Facit Venenum: Understanding Severity Of Tca Intoxication, Sean Brachvogel, Justin Osborn, Tanya Page

Milwaukie Family Medicine 2020

The Dose Makes the Poison, or does it? Judicious Management of TCA Intoxication.

Author(s): Sean Brachvogel, MD, MPH; Justin Osborn, MD; Tanya Page, MD

Context/background: Tricyclic antidepressants (TCAs) have been mostly supplanted by SSRIs in the treatment of depression, however they remain a mainstay of chronic pain management.¹ Untreated suicide attempts with a TCAs carry a 70% fatality rate, which drops dramatically to 3% with hospitalization.² As such, maintaining healthcare provider recognition and management of TCA toxicity is of lifesaving importance.

Objective: Here we describe a case report in which alcohol ingestion masked the severity of an accidental …

Pd-1 And Pd-L1 Inhibitors: A Single Center Medication Assistance Program (Map) Experience, Sarah Tu, Shuntao Cai

Earle A. Chiles Research Institute Fellowship Program 2020

PD-1 and PD-L1 Inhibitors: A Single Center Medication Assistance Program (MAP) Experience

Sarah Tu, PharmD and Shuntao Cai, PharmD, BCOP

Robert W. Franz Cancer Center, Providence Cancer Institute, Portland, OR, USA

Background: PD-1 and PD-LI inhibitors are a large component of the growing immuno-oncology field and every year there are increasing studies investigating potential indications for these agents. This IRB approved retrospective chart review examines patients in the Medication Assistance Program (MAP) within a large tertiary medical center who are on PD-1 and PD-L1 medications due to financial barriers and/or non-FDA approved regimens (unlabeled indications). This study seeks to evaluate …

Clinical Decision-Making Support For Covid-19 Based On Data Driven Artificial Intelligence For Clinical Severity And Treatment Response (Issue 2, 28 April 2020), Hiba Alblooshi, Ahmed Al Suwaidi, Fatma Aljasmi, Taleb M. Almansoori

Covid19 Newsletters

No abstract provided.

Week Of April 27, 2020, New York Medical College

InTouch

• NYMC Observes Yom Hashoah Virtually
• NYMC Experts Leading the Way in Coronavirus Updates

Inclusion In Religion And Spirituality For Children With Special Needs, Mackinzie C. Weiss, Kayla Collins, Mary P. Shotwell

Spring 2020 Virtual OTD Capstone Symposium

The purpose of this capstone project will focus on using occupational therapy interventions to help a local church be more inclusive to children and families with special needs. This project partners with a pre-existing special needs program to develop evidence-based volunteer training, implement a parent respite program, and introduce a movement-based program for children with special needs.

Animal-Assisted Therapy And Quality Of Life Of Patients With Dementia, Karissa D. Thomson, Kayla Collins, Mary P. Shotwell

Spring 2020 Virtual OTD Capstone Symposium

The aim of this quantitative study was to examine the effects animal-assisted therapy (AAT) had on people diagnosed with dementia living in a nursing home. The study examined the effects AAT had on depression, blood pressure, social interaction and how these factors impact quality of life (QOL). The study was conducted once a week for one hour on Thursdays for 6 weeks. 7 participants were included in the study and further broken down into two groups based upon their level of cognition as measured by the Mini Mental State Examination. The Beck’s depression inventory (BDI) and the World Health Organization …

Perceived Impact Of Non-Contact Boxing On Daily Life And Occupational Participation At Home Among Individuals With Parkinson’S Disease, Kristen E. Bignal, Susan Macdermott, Becki Cohill

Spring 2020 Virtual OTD Capstone Symposium

The aim of this project was to determine whether individuals with Parkinson's disease perceive an impact on their daily life and occupational participation at home secondary to participation in non-contact boxing.

Semi-structured open-ended interview questions were conducted with 17 participants (3 female) who have been diagnosed with Parkinson's disease for(i.e., self-care, home and health maintenance, sleep, intimacy, social and leisure interests, etc.) in the home environment. Interviews were transcribed and analyzed utilizing thematic analysis.

Data analysis derived three overarching themes including psychological benefits, sense of community, and framework to develop routines. Subsequent research exploring how non-contact boxing directly impacts specific …

Introduction To Adaptive Surfing: A Pool Program To Promote Engagement, Safety, And Confidence, Madison Mcbride, Susan Macdermott, Becki Cohill

Spring 2020 Virtual OTD Capstone Symposium

This poster delves into a needs assessment done on the international community of adaptive surfers with spinal cord injuries to determine the interest in creating a pool-based program as a prerequisite for adaptive surfing. This was done through a survey which inquired about their experiences with learning how to adaptive surf, as well as important skills necessary for adaptive surfing. Results of the survey were used to inform curriculum design for an introduction to adaptive surfing pool program.

Mathematical Modeling Of Covid-19 In Abu Dhabi (Issue 1, 23 April 2020), Abdessamad Tridane, Hamad Al Jassmi, Umair Hassan, Mohammad Sherif

Covid19 Newsletters

No abstract provided.

Supporting The Role And Transition To Motherhood Through The Occupation Of Feeding, Bethanne N. Vidmar, Becki Cohill, Susan Macdermott

Spring 2020 Virtual OTD Capstone Symposium

The purpose of this project was to assess and explore the occupational needs of mothers who are feeding their infants in a variety of ways to then identify psychosocial and occupational barriers affecting women's’ choices in feeding options for their infant through survey and interviews and opportunities for occupational therapists to become more involved in the occupation of breastfeeding.

Data analysis for this capstone project consisted of running a needs assessment in Santa Barbara County. The needs assessment consisted of written or online surveys and semi-structured in-depth interviews. Of the 95 women who filled out the hard-copy or online survey, …

Improving Awareness And Access To Adaptive Sports, Alison S. Takagaki, Becki Cohill, Susan Macdermott

Spring 2020 Virtual OTD Capstone Symposium

Adaptive sports can be defined as a recreational activity that allows individuals to improve their overall quality of life through an occupation they enjoy (Aytur et al., 2018). Barriers to participation in adaptive sports programs include a lack of resources, limited programs identified, and difficulty in finding the best program to fit the athletes’ needs (Lape et al., 2018). Adaptive sports have been seen as a holistic rehabilitative care plan that helps to improve self-esteem, build self-identity, increase confidence, and provide higher life satisfaction (DiVincenzo, 2013). Occupational therapists can play a role in helping enhance participation in adaptive sports by …

Occupational Therapy’S Role In Adapting Residential Youth Camps For Increased Inclusion, Brittany Tate, Susan Macdermott, Becki Cohill

Spring 2020 Virtual OTD Capstone Symposium

Each year, summer camps serve more than 11 million youth in the United States (US) (Wilson, Sibthorp, & Brusseau, 2017). Summer camps provide children with new experiences and give them opportunities to build confidence, social skills, and peer relationships (Wilson et al., 2017). Occupational therapy (OT) is an emerging area of practice throughout summer camps in the US (Hanscom & Schoen, 2014). Hanscom and Schoen (2014) recommend strategically combining OT with traditional camp programming to create an emotionally, physically, and spiritually safe environment that promotes optimal attending and task follow through. Summer camp has been shown to enhance positive youth …

Occupational Therapy’S Role In Matching Handlers And Assistance Dogs, Jyoti K. Tatla, Becki Cohill, Susan Macdermott

Spring 2020 Virtual OTD Capstone Symposium

The purpose of this project was to assess and observe the matching process and to identify the role of an occupational therapist in aiding the evaluation process with potential handlers and assistance dogs. Three sites were explored within California: Canine Support Teams, Canine Companions for Independence, and Guide Dogs for the Blind. Interviews were conducted with twenty-five participants about roles, routines, physical environment, need for an assistance dog, and additional support.

Key findings from this project revealed a need for occupational therapy within the evaluation process and two-week team training. Therapists could aid with adapting learning material, addressing performance patterns, …

Occupational Therapy’S Role In Pain Management Using Virtual Reality, Johnathan Quach, Becki Cohill, Susan Macdermott

Spring 2020 Virtual OTD Capstone Symposium

Pain is a complex phenomenon that affects millions every day and is frequently associated with activity restriction and decreases in psycho-social health. Studies have shown that opioids alone cannot eliminate all the difficulties that are associated with chronic pain, demonstrating a dire need to consider safer and more effective alternatives. Furthermore, given the impact of chronic pain on an individual’s ability to perform valued activities, and therefore overall well-being and quality of life, occupational therapy must be considered an essential member of any pain management team. Thus, there may be potential benefits to reviewing the use of virtual reality (VR) …

An Occupational Therapy Approach To Education For Foster Parents, Alexandra E. Judd, Susan Macdermott, Becki Cohill

Spring 2020 Virtual OTD Capstone Symposium

The focus of this project is to enhance current programming for foster parent pre-licensure education courses in San Diego, California. This capstone project focused on the preferred learning styles of foster parents and utilized adult learning theories to create suggestions to enhance the current pre-licensure class curriculum. Data collected during verbal interviews with foster parents helped guide the suggestions to enhance the current curriculum. Utilizing specific occupational therapy group strategies, occupational therapists can help enhance education for foster parents by increasing the saliency of the learning material. The increased saliency facilitates a deeper understanding of the material and increases the …