Medical Specialties Commons^™

Characterization Of Patients With Both Alcoholic And Nonalcoholic Fatty Liver Disease In A Large United States Cohort., George Khoudari, Amandeep Singh, Mazen Noureddin, Danielle Fritze, Rocio Lopez, Imad Asaad, Eric Lawitz, Fred Poordad, Kris V Kowdley, Naim Alkhouri

Articles, Abstracts, and Reports

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is the hepatic manifestation of the metabolic syndrome (MetS) and is characterized by steatosis in the absence of significant alcohol consumption. However, MetS and significant alcohol intake coexist in certain individuals which may lead to the development of BAFLD.

AIM: To assess the clinical characteristics of patients with both alcoholic and NAFLD (BAFLD) in a large cohort in the United States.

METHODS: Adults from the National Health and Nutrition Examination Survey between 2003-2014 were included. NAFLD was diagnosed based on elevated alanine aminotransferase (ALT) and being overweight or obese in the absence of other …

Endoscopic Management Of A Surgical Clip Found Within The Common Bile Duct Following Remotely Performed Laparoscopic Cholecystectomy, Sheila Rastegari Do, Curtis Brewer Do, Long T. Hoang

Gastroenterology

Minimally invasive surgery with surgical clip placement has become the gold standard for management of cholecystitis and biliary colic due to its favorable safety profile and low rate of complications. Though generally safe, surgical clips may cause complications days to years after the cholecystectomy by migrating into the common bile duct and serving as a nidus for stone formation. To date, very few cases of this have been reported. While uncommon, this possibility should be considered in the differential diagnosis for choledocholithiasis with or without cholangitis post laparoscopic cholecystectomy.

Female Predominance In Metronidazole-Induced Acute Pancreatitis: A Case Report And Review Of Literature, Eileen Chang Do, Marvin Vaishnani Md, Ian Chang Do, Whitney Jennings Md

Internal Medicine

Acute pancreatitis is a relatively common condition in the hospital. About 75% of cases are associated with excessive alcohol use or gallstones, and only 0.1 to 2% are drug-induced. The clinical and pathologic findings are similar regardless of the inciting cause. We have suspicion that metronidazole-induced pancreatitis occurs at a significantly higher incidence, or maybe exclusively, in females.

Listen To Your Heart, Or At Least Theirs: Maintaining A High Index Of Suspicion For Infective Endocarditis, Mollie Powell Do, Mahesh Setty Md

Emergency Medicine

After an endothelial injury, a fibrin and platelet cap forms. This cap is typically sterile but in times of infection can become colonized by microbes leading to a vegetation. When this occurs on the endothelium of the heart, it is termed infective endocarditis (IE). IE is a difficult diagnosis to make in the ED. The symptoms are vague. Classic exam findings are often absent, murmur auscultation can be challenging and there is not a single diagnostic test. A delayed or missed diagnosis can be fatal; therefore, it is essential that ED physicians maintain a high index of suspicion in high …

Spontaneous Fungal Peritonitis: A Rare Complication Of Ascites Secondary To Right Heart Failure: A Case Report, Saaah Siddiqui Md, Dharti R. Patel Md, Arshad M. Iqbal Md, Ateeq Mubarik Md, Salman Muddassir Md, Fahad Zafar Md

Internal Medicine

•Spontaneous fungal peritonitis (SFP) is an infection defined as a neutrophil count (> 250 cells/mL) in the ascitic fluid with the evidence of positive fungal culture (1) while excluding other intra-abdominal infections. SFP is not as common as spontaneous bacterial peritonitis and has higher mortality rates due to late recognition and difficulty in differentiation between SFP and SBP. (1,2). The common risk factors that have shown to increase the mortality for SFP include hepatorenal syndrome, patient on SBP prophylaxis, elevated APACHE II scores on admission, and elevated lactate levels (2,3). Candida albicans and Candida glabrata are the two …

Rare Malignant Peritoneum Mesothelioma Masquerading With Respiratory Manifestation, Ravish Patel, Pratikkumar Vekaria, Devin Vaishnani, Johnnie Mao, Chandrika Raiyani, Marvin Vaishnani, Tejas Raiyani

Internal Medicine

Mesothelioma is a rare and aggressive cancer that affects the linings of the pleura, peritoneum and pericardium. Pleural involvement is however most common. Malignant Peritoneal mesothelioma (MPM) is a cancer developing in the lining of the peritoneum, which is extremely rare. Most MPM cases are caused by asbestos exposure. Common symptoms of MPM include abdominal distension, abdominal pain, swelling or tenderness and constipation or diarrhea, with most common being abdominal swelling. MPM is difficult to diagnose due to its vague, nonspecific symptoms.

Chronic Lymphocytic Leukemia Of The Liver: A Rare Cause Of Elevated Liver Function Tests, Ricky Buckshaw Do, Anam Malik Md, Michal Kloska Md, Reema M. Vaze Md, She-Yan Wong Md

Department of Medicine

No abstract provided.

An Unusual Case Of Broken Heart, Ammar Hasan, Enrique Rincon

Cardiology

No abstract provided.

Non-Incarcerated Inguinal Hernia With Sigmoidal Diverticulitis, Umair J. Khan, Ali Hassan, Kingsley Dah, M Lambing, P Mathew

Internal Medicine

Introduction: Abdominal wall hernia is defined as a protrusion of a part or whole organ through the wall of a cavity. Inguinal hernias account for 75% of abdominal wall hernias, with a lifetime risk of 27% in men and 3% in women. Indirect inguinal hernia account for 80% of total inguinal hernias. A wide variety of pathological processes can present as inguinal hernias however, large reducible inguinal hernias are quite rare. Recent studies have associated abdominal wall hernia with colonic diverticulosis, a term referred to as herniosis. This association suggests that an underlying connective tissue disorder could be a common …

Post-Stroke Recrudescence In The Setting Of Tramadol Overuse: A Case Report, Richard S. Zhang, Bs, Benjamin Larson, Md

Student Papers, Posters & Projects

This report promotes greater awareness of opioid-induced PSR, especially considering the tragic opioid crisis that has afflicted the US since the 1990s, and the contribution of synthetic prescription opioids to the crisis. This report also supports the establishment of care guidelines to limit PSR risk in people with major risk factors, such as MCA infarcts.

Cavitary Lesion In An Immunocompromised Adult, Syed Talha Qasmi, Turuvekere Jayaram, Enrique Rincon

Internal Medicine

No abstract provided.

Perceptions Of Health Professionals Regarding Minimally Invasive Tissue Sampling (Mits) To Identify The Cause Of Death In Stillbirths And Neonates: Results From A Qualitative Study, Anam Shahil Feroz, Anum Shiraz Ali, Mohsina Noor Ibrahim, Elizabeth M. Mcclure, Shiyam Sunder Tikmani, Sayyeda Reza, Zahid Abbasi, Afia Zafar, Sameen Siddiqi, Sarah Saleem

Community Health Sciences

Background: Pakistan is considered to be one of the riskiest places in the world for childbirth as measured by its high stillbirth and neonatal mortality rates. Complete diagnostic autopsy remains the gold standard to determine the cause of death (CoD); however, it is not routinely implemented due to religious objections, sociocultural beliefs, limited resources and low demand from physicians and families. Recently, minimally invasive tissue sampling (MITS) using needle biopsies of multiple tissues to obtain tissue for histological examination and organism identification with PCR has been developed and promoted to determine CoD in low-resource areas. To ensure successful implementation of …

Amoxicillin-Clavulanate Related Liver Injury, Devin Vaishnani Md, Pratikkumar Vekaria Md, Ravish Patel Md, Megan White Md, Marvin Vaishnani Md

Gastroenterology

Introduction: Recognition of Drug-induced Liver Injury (DILI) may be challenging as it is often diagnosis of exclusion, unavailability of diagnostic test and variability in presentation. Many antibiotics can cause DILI but Amoxicillin-Clavulanate has rare adverse reaction causing mixed cholestatic-hepatocellular injury. Since amoxicillin alone does not induce liver injury, combination of amoxicillin and clavulanic acid could be responsible for this adverse reaction. It can be due to metabolic idiosyncrasy or hypersensitivity mechanism. Case Report: 64-year-old female with no pertinent PMH presented to ER with abdominal pain and jaundice. She had abdominal pain for 4-5 days. Abdominal pain was constant and located …

The Palpitations That Thumped Us All:, Carolyn Falk Tran Do, Gurmanpal Sandhu Md, Daniel Robitshek Md, Tejas Raiyani Md

Internal Medicine

No abstract provided.

Small Bowel Variceal Bleeding Successfully Treated With Percutaneous Coil Embolization, Anam Malik Md, Reema M. Vaze Md, Ricky Buckshaw Do, Michal Kloska Md, Eric Nellis Md, She-Yan Wong Md

Department of Medicine

No abstract provided.

Contraceptive Use Following Unintended Pregnancy Among Ugandan Women Living With Hiv, Jana Jarolimova, Jerome Kabakyenga, Kara Bennett, Winnie R. Muyindike, Annet Kembabazi, Jeffrey N. Martin, Peter W. Hunt, Yap Boum, Jessica E. Haberer, David Bangsberg, Angela Kaida, Lynn T. Matthews

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Preventing unintended pregnancy is critical for women living with HIV (WLWH) to safely achieve their reproductive goals. Family planning services should support WLWH at risk of repeat unintended pregnancies. We examined the relationship between unintended pregnancy and subsequent contraception use among WLWH in Uganda.

Study design: This was a retrospective analysis of data from a longitudinal cohort of individuals initiating antiretroviral therapy (ART), restricted to women with pregnancy (confirmed via urine β-hcg testing) between 2011–2013. The exposure of interest was intended vs unintended pregnancy, and the outcome was self-report of modern contraceptive use (hormonal methods, intrauterine device, sterilization, and/or …

Spitting Blood And Casts With Mud: A Rare And Unusual Presentation Of C3 Glomerulonephritis, Gerardo Mederos, Harsh Patel, Menalee Hapuarachchi, Som Aftabizadeh, Prashanth Reddy, Ranjit Nair, Dana Ciobanu, Machaiah Madhrira

Internal Medicine

C3 glomerulonephritis (C3GN) is a rare disease that falls under the umbrella of C3 glomerulopathy. It is manifested by abnormal activation of the alternate pathway resulting in complement deposition in the glomeruli. Kidney biopsy with characteristic findings of electron-dense deposits in the mesangial and capillary wall confirms the diagnosis. Until recently, C3GN presenting with primarily lung involvement had not been reported. We present a unique case of initial pulmonary manifestation C3GN.

Metastatic Renal Cell Carcinoma To The Small Bowel: A Rare Cause Of Gastrointestinal Hemorrhage, Ricky Buckshaw Do, Anam Malik Md, Reema M. Vaze Md, Michal Kloska Md, Robert Andrews Md, Hiral N. Shah Md

Department of Medicine

No abstract provided.

Can We Predict Low Quality Colonoscopy? Establishing Open Access Colonoscopy At A Fellow-Run Gastroenterology Clinic, Matthew Sullivan Do, Abdul Aleem Md, Rajesh Essrani Md, Patrick Hickey Do, Robert Andrews Md, Anam Malik Md, Hiral N. Shah Md, Shashin Shah Md

Department of Medicine

No abstract provided.

Intestinal Tuberculosis In An Immunocompetent Patient, Reema M. Vaze Md, Anam Malik Md, Ricky Buckshaw Do, Michal Kloska Md, Abdul Aleem Md, Frederic Stelzer Md

Department of Medicine

No abstract provided.

A Case Of Cmv Colitis Seen In Dress, Anam Malik Md, Reema M. Vaze Md, Ricky Buckshaw Do, Eric Nellis Md, Hiral N. Shah Md

Department of Medicine

No abstract provided.

Rare Infective Endocarditis Caused By Dental Source Due To Streptococcus Bovis Masquerading As Cardiac Failure, Ravish Patel, Pratikkumar Vekaria, Devin Vaishnani, Johnnie Mao, Asif Shah

Internal Medicine

No abstract provided.

Guillain Barre Syndrome In A Patient With Sickle Cell Anemia, Kunjan Udani Md, Pooja Patel, Dveet Patel, Hajra Awwab, Nino Balanchivadze

Internal Medicine

No abstract provided.

Myeloid-Derived Suppressor Cells And Pancreatic Cancer: Implications In Novel Therapeutic Approaches, Anita Thyagarajan, Mamdouh Salman A. Alshehri, Kelly L.R. Miller, Catherine M. Sherwin, Jeffery B. Travers, Ravi P. Sahu

Pediatrics Faculty Publications

Pancreatic ductal adenocarcinoma (PDAC) remains a devastating human malignancy with poor prognosis and low survival rates. Several cellular mechanisms have been linked with pancreatic carcinogenesis and also implicated in inducing tumor resistance to known therapeutic regimens. Of various factors, immune evasion mechanisms play critical roles in tumor progression and impeding the efficacy of cancer therapies including PDAC. Among immunosuppressive cell types, myeloid-derived suppressor cells (MDSCs) have been extensively studied and demonstrated to not only support PDAC development but also hamper the anti-tumor immune responses elicited by therapeutic agents. Notably, recent efforts have been directed in devising novel approaches to target …

Picture Perfect: Pediatric Ct Utilization In Trauma, Laura Strickland, Christa Zino Md

Pediatrics

No abstract provided.

Identifying Emergency Department Symptom-Based Diagnoses With The Unified Medical Language System., Benjamin H. Slovis, Danielle M. Mccarthy, Garrison Nord, Amanda Doty, Katherine Piserchia, Kristin L. Rising

Department of Emergency Medicine Faculty Papers

INTRODUCTION: Many patients who are discharged from the emergency department (ED) with a symptom-based discharge diagnosis (SBD) have post-discharge challenges related to lack of a definitive discharge diagnosis and follow-up plan. There is no well-defined method for identifying patients with a SBD without individual chart review. We describe a method for automated identification of SBDs from ICD-10 codes using the Unified Medical Language System (UMLS) Metathesaurus.

METHODS: We mapped discharge diagnosis, with use of ICD-10 codes from a one-month period of ED discharges at an urban, academic ED to UMLS concepts and semantic types. Two physician reviewers independently manually identified …

Contributing Factors To Diabetic Brain Injury And Cognitive Decline, Nirmal Verma, Florin Despa

Pharmacology and Nutritional Sciences Faculty Publications

The link of diabetes with co-occurring disorders in the brain involves complex and multifactorial pathways. Genetically engineered rodents that express familial Alzheimer's disease-associated mutant forms of amyloid precursor protein and presenilin 1 (PSEN1) genes provided invaluable insights into the mechanisms and consequences of amyloid deposition in the brain. Adding diabetes factors (obesity, insulin impairment) to these animal models to predict success in translation to clinic have proven useful at some extent only. Here, we focus on contributing factors to diabetic brain injury with the aim of identifying appropriate animal models that can be used to mechanistically dissect the …

Holep Vs Bipolar Turp As Same Day Surgery: Analysis Of Length Of Stay And Costs, Michael Su Ms4, Sarah Azari Ms4, Jacob Rust Md, Alexis R. Brown Pa-C, Clifford Georges Md, James Johannes Md

Department of Medicine

No abstract provided.

Case 22-2019: A 65-Year-Old Woman With Myopathy., Marinos C. Dalakas

Department of Neurology Faculty Papers

No abstract provided.

Systematic Review Of Doppler For Detecting Intrapartum Fetal Heart Abnormalities And Measuring Perinatal Mortality In Low‐ And Middle‐Income Countries, Marya Plotkin, Benjamin Kamala, Jim Ricca, Linda Fogarty, Sheena Currie, Hussein Kidanto, Stephanie B. Wheeler

Obstetrics and Gynaecology, East Africa

Background: Using Doppler to improve detection of intrapartum fetal heart rate (FHR) abnormalities coupled with appropriate, timely intrapartum care in low-and middle-income countries (LMIC) can save lives.

Objective: To review studies using Doppler to improve detection of intrapartum FHR abnormalities and intrapartum care quality in LMIC health facilities.

Search strategy: PubMed, Web of Science, Embase, Global Health, and Scopus were searched from inception to October 2018 by combining terms for Doppler, perinatal outcomes, and FHR monitoring.

Selection criteria: Selected studies compared Doppler and Pinard stethoscope for detecting/monitoring intrapartum FHR, or described provider and maternal preferences for FHR monitoring in LMIC …