Diseases Commons^™

Continuity Of Care And Outpatient Management For Patients With And At High Risk For Cardiovascular Disease During The Covid-19 Pandemic: A Scientific Statement From The American Society For Preventive Cardiology, Amit Khera, Seth J. Baum, Ty J. Gluckman, Martha Gulati, Seth S. Martin, Erin D. Michos, Ann Marie Navar, Pam R. Taub, Peter P. Toth, Salim S. Virani

Office of the Provost

The coronavirus disease 2019 (COVID-19) pandemic has consumed our healthcare system, with immediate resource focus on the management of high numbers of critically ill patients. Those that fare poorly with COVID-19 infection more commonly have cardiovascular disease (CVD), hypertension and diabetes. There are also several other conditions that raise concern for the welfare of patients with and at high risk for CVD during this pandemic. Traditional ambulatory care is disrupted and many patients are delaying or deferring necessary care, including preventive care. New impediments to medication access and adherence have arisen. Social distancing measures can increase social isolation and alter …

Screening For Hepatitis C Virus Infection In Adolescents And Adults: Updated Evidence Report And Systematic Review For The Us Preventive Services Task Force, Roger Chou, Tracy Dana, Rongwei Fu, Bernadette Zahker, Jesse Wagner, Shaun Ramirez, Sara Grusing, Janice H. Jou

OHSU-PSU School of Public Health Faculty Publications and Presentations

IMPORTANCE: A 2013 review for the US Preventive Services Task Force (USPSTF) of hepatitis C virus (HCV) screening found interferon-based antiviral therapy associated with increased likelihood of sustained virologic response (SVR) and an association between achieving an SVR and improved clinical outcomes. New direct-acting antiviral (DAA) regimens are available.

OBJECTIVE: To update the 2013 review on HCV screening to inform the USPSTF.

DATA SOURCES: Ovid MEDLINE, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews through February 2019, with surveillance through September 2019.

STUDY SELECTION: Randomized clinical trials (RCTs) and nonrandomized treatment studies of HCV …

Non-Tuberculous Mycobacterial Infections-A Neglected And Emerging Problem, Imran Ahmed, Simon Tiberi, Joveria Farooqi, Kauser Jabeen, Dorothy Yeboah-Manu, Giovanni Battista Migliori, Rumina Hasan

Department of Pathology and Laboratory Medicine

Non-tuberculous mycobacteria (NTM) are ubiquitous dwellers of environmental niches and are an established cause of natural and nosocomial infections. The incidence of NTM infections is rising owing to a growing population of immunocompromised and vulnerable individuals, complex medical and surgical procedures, as well as increased awareness and diagnostic capabilities. The prevalence of different NTM varies between continents, regions, and countries. The true global burden of pulmonary and extrapulmonary disease is unknown and estimates are subject to under and/or over-estimation. Diagnosis requires confirmation by isolation of NTM along with clinical and radiological criteria, which may be suboptimal at all levels. Susceptibility …

Probable African Tick Bite Fever In The United States, Kami Lowery, Theodore Rosen

Faculty, Staff and Students Publications

African tick bite fever (ATBF) is a tick-borne rickettsial disease most often observed in North American and European tourists returning home from the southern portion of Africa. Ticks infected with Rickettsia africae transmit this parasitic bacterium to humans, who subsequently develop an influenza-like illness, one or more inoculation eschars, and in some cases, a cutaneous rash. Because ATBF often presents with non-specific symptoms that suggest other infectious diseases, establishing the diagnosis may be difficult. Confirmatory assays, including serology and nucleic acid amplification, may take weeks to return and cannot help with acute treatment decisions. We present a case of a …

The Impact Of Diabetic Foot Ulcers And Unilateral Offloading Footwear On Gait In People With Diabetes, Erica Ling, Brian Lepow, He Zhou, Ana Enriquez, Ashley Mullen, Bijan Najafi

Faculty, Staff and Students Publications

BACKGROUND: Unilateral offloading footwear prescribed to patients with diabetic foot ulcers elevates one limb relative to the other, which may lead to limp and abnormal gait. This study investigated whether the unilateral foot ulcer and offloading combination negatively impacts gait function beyond diabetic peripheral neuropathy.

METHODS: Eighty-six participants were recruited in 3 groups: 12 with diabetic peripheral neuropathy and unilateral foot ulcers wearing offloading footwear (offloading group, age = 55.6 ± 9.5 years, BMI = 30.9 ± 4.5 kg/m

FINDINGS: The offloading group exhibited deteriorated gait function compared to the non-diabetic group (p < 0.005, Cohen's effect size d = 0.90-2.61). They also had decreased gait speed (p < 0.001, d = 1.79) and stride length (p < 0.001, d = 1.76), as well as increased gait cycle time (p < 0.001, d = 1.67) and limp (p < 0.050, d = 0.72-1.49) compared to the neuropathy group. The offloading group showed increased gait unsteadiness compared to the neuropathy group, but the difference did not reach statistical significance in our samples.

INTERPRETATION: This study demonstrated that while diabetic …

Safety And Efficacy Profile Of Ozenoxacin 1% Cream In Pediatric Patients With Impetigo, Adelaide A Hebert, Theodore Rosen, Núria Albareda López, Ilonka Zsolt, Xavier Masramon

Faculty, Staff and Students Publications

BACKGROUND: Ozenoxacin is a topical antibiotic approved in the United States for treatment of impetigo in adults and children age ≥2 months. This analysis evaluated the efficacy and safety of ozenoxacin in specific pediatric age groups.

METHODS: Data for children aged 2 months to <18 years recruited from eight countries who had participated in phase 1 and 3 trials of ozenoxacin were extracted and analyzed by age range.

RESULTS: Across studies, 644 pediatric patients with impetigo received ozenoxacin 1% cream (n = 287) or vehicle (n = 247). One study included retapamulin 1% ointment as the internal validity control (n = 110). The clinical success rate at the end of treatment and bacterial eradication rates after 3 to 4 days of treatment and at …

Methyl-Sensing Nuclear Receptor Liver Receptor Homolog-1 Regulates Mitochondrial Function In Mouse Hepatocytes, Sungwoo Choi, Bingning Dong, Chih-Chun Janet Lin, Mi Jeong Heo, Kang Ho Kim, Zhen Sun, Martin Wagner, Nagireddy Putluri, Jae Myoung Suh, Meng C Wang, David D Moore

Faculty, Staff and Students Publications

Liver receptor homologue-1 (LRH-1; NR5A2) is a nuclear receptor that regulates metabolic homeostasis in the liver. Previous studies identified phosphatidylcholines as potential endogenous agonist ligands for LRH-1. In the liver, distinct subsets of phosphatidylcholine species are generated by two different pathways: choline addition to phosphatidic acid via the Kennedy pathway, or trimethylation of phosphatidylethanolamine via Phosphatidylethanolamine N-methyl Transferase (PEMT). Here we report that a PEMT - LRH-1 pathway specifically couples methyl metabolism and mitochondrial activities in hepatocytes. We show that the loss of Lrh-1 reduces mitochondrial number, basal respiration, beta-oxidation and ATP production in hepatocytes, and decreases expression of mitochondrial …

Orthostatic Hypotension, Cardiovascular Outcomes, And Adverse Events: Results From Sprint, Stephen P Juraschek, Addison A Taylor, Jackson T Wright, Gregory W Evans, Edgar R Miller, Timothy B Plante, William C Cushman, Tanya R Gure, William E Haley, Imran Moinuddin, John Nord, Suzanne Oparil, Carolyn Pedley, Christianne L Roumie, Jeff Whittle, Alan Wiggers, Ciarán Finucane, Rose Anne Kenny, Lawrence J Appel, Raymond R Townsend

Faculty, Staff and Students Publications

Orthostatic hypotension (OH) is frequently observed with hypertension treatment, but its contribution to adverse outcomes is unknown. The Systolic Blood Pressure Intervention Trial (SPRINT) was a randomized trial of adults, age ≥50years at high risk for cardiovascular disease (CVD) with a seated systolic BP (SBP) of 130–180 mmHg and a standing SBP ≥110 mmHg. Participants were randomized to a SBP treatment goal of either <120 mmHg or <140 mmHg. OH was defined as a drop in SBP≥20 or diastolic BP ≥10 mmHg one minute after standing from a seated position. We used Cox models to examine the association of OH with CVD or adverse study events by randomized BP goal. During the follow-up period (median 3years), there were 1,170 (5.7%) instances of OH among those assigned a standard BP goal, and 1,057 (5.0%) among those assigned the intensive BP goal. OH was not associated with higher risk of CVD events (primary outcome: HR 1.06; 95%CI: 0.78,1.44). Moreover, OH was not associated with syncope, electrolyte abnormalities, injurious falls, or acute renal failure. OH was associated with hypotension-related hospitalizations or emergency department visits (HR 1.77; 1.11,2.82) and bradycardia (HR 1.94; 1.19,3.15), but these associations did not differ by BP treatment goal. OH was not associated with a higher risk of CVD events and BP treatment goal had no effect on OH’s association with hypotension and bradycardia. Symptomless OH during hypertension treatment should not be viewed as a reason to down-titrate therapy even in the setting of a lower BP goal.

The Role Of Alternative Mrna Splicing In Heart Development, Douglas Bittel, Nataliya Kibiryeva, Naoya Kenmochi, Prakash Patil, Tamayo Uechi, Brenda Rongish, Mike Filla, Jennifer A. Marshall, Michael Artman, Rajasingh Johnson, James E. O'Brien

Manuscripts, Articles, Book Chapters and Other Papers

Research in the last 10 years has led to improved understanding of the genetic regulation of vertebrate heart development, but despite this effort, approximately 70% of all congenital heart defects (CHDs) still have an unknown etiology. Alternative splicing of mRNA has been documented to play roles in normal and abnormal development. Dysregulated splicing of mRNA has been shown to cause heart defects in mice, however a link between mRNA splicing and CHDs has not yet been shown in humans. We reported that more than 50% of genes associated with heart development were alternatively spliced in the right ventricle (RV) of …

The Great Imitator Strikes Again: A Case Of A Lupus Flare-Up Presenting Like An Acute Abdomen, Emmanouil Kiriakopoulos, Vanessa Perez, Robyn Hoelle

HCA Healthcare Journal of Medicine

Systemic lupus erythematosus (SLE) is an autoimmune disease affecting all age groups and can manifest in various forms, often making the initial or successive presentations difficult to diagnose. Peritonitis secondary to lupus is a rare manifestation of this disease and the prevalence is said to be much lower in children. We present a case report of an adolescent male with a known history of lupus who presented to the emergency department with a clinical picture consistent with an acute surgical abdomen and underwent an appendectomy. Subsequent workup identified the culprit as a lupus-related peritonitis requiring corticosteroids for resolution.

A Novel Case Of Bacterial Meningitis In A Patient With Loeys-Dietz, Lacey D. Colvin Do, Christy Fagg

Infectious Disease

No abstract provided.

Diagonal 1 And Mid-Lad Myocardial Bridge With Elevated Troponin Enzymes, Ronak Patel Do

Cardiology

No abstract provided.

Bullet Hole Sinus Tarsi: Functional And Radiographic Outcomes Following A Self-Inflicted Gunshot Wound To The Talus With Vascular Injury, Eric P. Krznaric Dpm, John R. Greaves Dpm, Jason C. Spector Dpm, Alan A. Macgill Dpm, Christopher Ochner

Podiatry

No abstract provided.

Adjuvant Therapy In Adrenocortical Carcinoma: Reflections And Future Directions, Sara Bedrose, Marilyne Daher, Lina Altameemi, Mouhammed Amir Habra

Faculty, Staff and Students Publications

Adrenocortical carcinoma (ACC) is a rare and aggressive malignancy with high risk of recurrence despite macroscopically complete surgical resection. The main predictors of ACC recurrence include advanced disease stage, incomplete surgical resection, cortisol production, certain genetic alterations, and high proliferation rate (Ki-67 proliferation index). Mitotane has been the mainstay adjuvant therapy of ACC. However, the use of mitotane is based on retrospective and occasionally conflicting evidence. As mitotane levels can take a few months before reaching therapeutic levels, there is an emerging practice of combining platinum-based chemotherapy with mitotane in the adjuvant setting. Retrospective data indicate that radiotherapy is an …

A Unique Schwannoma Of The Distal Hallux: A Case Study, Rebecca D. Stack Dpm, Brett Sachs Dpm Facfas, Dustin Kruse Dpm, Paul A. Stone Dpm, Facfas

Podiatry

No abstract provided.

Isolated Forefoot Juvenile Xanthogranuloma: Unique Case Study And Treatment In A Pediatric Patient, Brian Derner Dpm, Kristine Hoffman, Amy Storfa Md, Dustin Kruse Dpm, Paul A. Stone Dpm, Facfas

Podiatry

Juvenile xanthogranulomas (JXG) are a benign histiocytic cell proliferative disorder in early childhood. They most commonly present within the first two years of life with papular or nodular changes to the skin on the head, neck or upper trunk. Xanthogranulomas are mostly self-limiting, can be singular or multiple, and rarely can infer a systemic disease process1. The purpose of this study was to publish a unique finding of an extra-tendinous solitary mass in an otherwise healthy 17-year old, with surgical and medical treatment after diagnosis.

Effect Of Venous Thromboembolic Prophylaxis On Surgical Incision Healing, Rebecca Stack Dpm, Brett Sachs Dpm Facfas, Dustin Kruse Dpm, Paul A. Stone Dpm, Facfas

Podiatry

No abstract provided.

Atypical Spindle Cell Lipomatous Tumor Under The Sesamoids In The Foot: A Case Report, Nilin M. Rao Dpm, Hani H. Saeed Dpm, Md, Facfas, Dustin Kruse Dpm, Bryan Raymond Dpm, Paul A. Stone Dpm, Facfas

Podiatry

Atypical spindle cell lipomatous (ASCL) tumors have a distinct histological and clinical presentation, rarely presenting in the foot. With the sub-sesamoidal location of this neoplasm found in our case report being an unusual location for atypical spindle cell lipomatous tumors to present, the purpose of our case report was to present the clinical presentation, histology/pathology, method of resection and outcome of our patient on follow-up to provide a framework for other surgeons on how to approach these neoplasms in the future.

Hispanics Have Higher Grade Intracerebral Hemorrhage Compared To Non-Hispanics, Jessica Houck Do, Tej Stead, Paul Banerjee, Latha Ganti Md

Emergency Medicine

No abstract provided.

Comparison Of Microneutralization And Histo-Blood Group Antigen-Blocking Assays For Functional Norovirus Antibody Detection, Robert L Atmar, Khalil Ettayebi, B Vijayalakshmi Ayyar, Frederick H Neill, Ralph P Braun, Sasirekha Ramani, Mary K Estes

Faculty, Staff and Students Publications

BACKGROUND: The development of an in vitro cultivation system for human noroviruses allows the measurement of neutralizing antibody levels.

METHODS: Serum neutralizing antibody levels were determined using a GII.4/Sydney/2012-like virus in human intestinal enteroids in samples collected before and 4 weeks after administration of an investigational norovirus vaccine and were compared with those measured in histo-blood group antigen (HBGA)-blocking assays.

RESULTS: Neutralizing antibody seroresponses were observed in 71% of 24 vaccinated adults, and antibody levels were highly correlated (r = 0.82, P < .001) with those measured by HBGA blocking.

CONCLUSIONS: HBGA-blocking antibodies are a surrogate for neutralization in human noroviruses.

A Decerebrating Female: A Rare Presentation Of Acute Disseminated Encephalomyelitis Due To Measles, Natasha Del Rio, Yordan Orive, Andres Sobrado, Ruben Cabrera, Ilde Manuel Lee, Troy Hoang, Sherard Lacaille, Ricardo Garcia-Rivera, Robert Hernandez

Internal Medicine

No abstract provided.

Hemodynamic And Clinical Effects Of Selexipag In Children With Pulmonary Hypertension, Abraham Rothman, Gabriel Cruz, William N. Evans, Humberto Restrepo

School of Medicine Faculty Research

Selexipag is an oral prostacyclin receptor agonist; it was recently approved for use in adults with pulmonary arterial hypertension. The safety and efficacy of selexipag has not yet been determined in the pediatric population. We describe short-term hemodynamic and clinical data with selexipag therapy in four pediatric patients with pulmonary hypertension. We reviewed clinical, echocardiographic, and hemodynamic data. One patient was transitioned from subcutaneous treprostinil to selexipag, and in three patients, selexipag was added as a third agent. Drug dosing was attained empirically based on patient body size. A follow-up catheterization was performed 12–18 months after initiation of selexipag therapy. …

Hyperammonemic Encephalopathy With Triphasic Waves: A Case, Brian Birdsong, Brielle Marks, Rishim Jayswal, Adeel Rahman

Psychiatry

No abstract provided.

A Ten-Year Retrospective Evaluation Of Acute Flaccid Myelitis At 5 Pediatric Centers In The United States, 2005-2014., Margaret M. Cortese, Anita K. Kambhampati, Jennifer E. Schuster, Zaid Alhinai, Gary R. Nelson, Gloria J. Guzman Perez-Carrillo, Arastoo Vossough, Michael A. Smit, Robert C. Mckinstry, Timothy Zinkus, Kevin R. Moore, Jeffrey M. Rogg, Meghan S. Candee, James J. Sejvar, Sarah E. Hopkins

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Acute flaccid myelitis (AFM) is a severe illness similar to paralytic poliomyelitis. It is unclear how frequently AFM occurred in U.S. children after poliovirus elimination. In 2014, an AFM cluster was identified in Colorado, prompting passive US surveillance that yielded 120 AFM cases of unconfirmed etiology. Subsequently, increased reports were received in 2016 and 2018. To help inform investigations on causality of the recent AFM outbreaks, our objective was to determine how frequently AFM had occurred before 2014, and if 2014 cases had different characteristics.

METHODS: We conducted a retrospective study covering 2005-2014 at 5 pediatric centers in 3 …

A Rare Case Of Perforated Jejunal Diverticulitis, Mohamed Nagi Md, Stanley Deturris Md, Ang Darwin

General Surgery

Introduction: Jejunal diverticulosis is a rare condition with clinical incidence of 0.5%. It is less common than colonic and duodenum diverticulosis. It is usually asymptomatic and diagnosed incidentally but it may cause chronic symptoms and acute complications. The aim of the case report to increase the awareness about the disease Case Report: This is a 56-year-old Caucasian male who presented with abdominal pain and fever and was diagnosed with transverse colon diverticulitis with microperforation on CT scan. Patient was treated nonoperatively with antibiotics and was discharged home. Two months later, he presented with similar recurrent abdominal pain and was found …

General Surgery Residency And Emergency General Surgery Service Reduces Readmission Rates And Length Of Stay In Non-Operative Small Bowel Obstruction, Sarah Waterman Manning Md, Katherine S. Mastriani

General Surgery

No abstract provided.

The Overall Poor Specificity Of Mrcp In The Preoperative Evaluation Of The Jaundiced Patient Will Increase The Incidence Of Non-Therapeutic Ercp, Andrew M. O'Neill Md, Keith Anderson Md, Lorinda K. Baker, Michaal Schurr Md

General Surgery

See additional files.

Spinal Cord Ischemia Following Endovascular Repair Of Infrarenal Abdominal Aortic Aneurysm: A Rare Complication, Abdelrahman Attili Md, Alberto Gonzalez

General Surgery

Introduction:

Paralysis secondary to spinal cord ischemia following Endovascular repair of infrarenal abdominal aortic aneurysm is extremely rare complication, the reported incidence in the literature is 0.21%.

Case report:

Our patient is an 85-year old female patient who presented to the emergency department with abdominal pain radiating to the back. Abdominal examination showed mild epigastric tenderness. Laboratory work up was within the normal limits, and she had Computed Tomography Angiography of the abdomen and pelvis which showed impending rupture of 5.8 cm abdominal aortic aneurysm. The anatomic configuration of the AAA fulfilled the requirements for EVAR.

The patient underwent endovascular …

Diabetic Cardiomyopathy: Understanding The Independent Relationship Between Diabetes And Heart Failure, W. Tyler Crawley, Rage Geringer Md, Jason Snarr Do, Elizabeth Hicks Md, Oliwier Dziadkowiec

Internal Medicine

No abstract provided.

Reverse Takotsubo-Like Cardiomyopathy And Pheochromocytoma, Patryk Purta, Dmitriy Scherbak Do, Michael Gruber Md, Oliwier Dziadkowiec

Cardiology

No abstract provided.