Medical Specialties Commons^™

An Atypical Presentation Of Metastatic Gastric Adenocarcinoma Due To Pulmonary Lymphangitic Carcinomatosis, Matthew Moritz, Omar Pandhair

Books, Presentations, Posters, Etc.

Pulmonary lymphangitic carcinomatosis (PLC) accounts for approximately 8% of pulmonary metastases and is primarily associated with breast, lung, and gastric cancers. Chest radiographs are often nonspecific and normal in approximately 50% of cases. We present a case of PLC as an initial presentation of metastatic gastric adenocarcinoma. A 57-year-old White woman with prior tobacco use, asthma, and multiple sclerosis on Natalizumab presented with three months of progressive dyspnea and cough. She was evaluated multiple times and treated with various antibiotics and inhalers for presumed bronchitis. Despite this, her symptoms worsened, prompting hospital evaluation. She was tachycardic and markedly hypoxemic on …

Pulmonary Pseudomyxoma Peritonei, Hannah Kirk, Do, Omar Pandhair

Books, Presentations, Posters, Etc.

Introduction: Pseudomyxoma peritonei (PMP) is an intra -abdominal cancer occurring in one to four out of one million patients. It begins as a mucinous adenocarcinoma of the appendix that implants on other peritoneal surfaces, spreading into gelatinous ascites. Treatment consists of hyperthermic intraperitoneal chemotherapy (HIPEC) and cytoreductive surgery (CRS). Extra -abdominal metastases are rare. We present the case of a patient who underwent treatment for PMP and was found to have lung nodules over a decade later. Case Presentation: A 73 -year -old woman with pseudomyxoma peritonei presented to the emergency department with progressive dyspnea and unintentional weight loss. Twenty …

The Rash After The Remedy, Elaine Chen, Md

Books, Presentations, Posters, Etc.

Introduction: Trimethoprim/sulfamethoxazole (TMP/SMX) is a widely prescribed and generally well-tolerated antibiotic. Cutaneous reactions occur in up to 4% of patients, including morbilliform rash, urticaria, DRESS, Stevens-Johnson syndrome, and toxic epidermal necrolysis. More rarely, TMP/SMX can trigger leukocytoclastic vasculitis (LCV), a small-vessel vasculitis characterized by neutrophilic infiltration, fibrinoid necrosis, and leukocytoclasia. LCV typically manifests as palpable purpura on dependent areas. While often skin-limited, systemic involvement may occur. We present a case of TMP/SMX-induced LCV with multi-organ features. Case description: A 53-year-old healthy male presented to urgent care with dysuria. Urine culture grew pan-sensitive E. coli, and he completed a 7-day course …

When Jaundice Isn’T Just The Liver’S Fault: A Chilly Case Of Cold Autoimmune Hemolytic Anemia, Jennifer Wong, Do, Shahana Baig-Lewis, Md, Mph

Books, Presentations, Posters, Etc.

Introduction: Cold agglutinin disease (CAD), a subtype of autoimmune hemolytic anemia (AIHA), is characterized by IgM autoantibodies that target red blood cell antigens at low temperatures, leading to agglutination in cooler peripheral tissues and hemolysis. Predominately directed against the “I” or “i” antigens, cold agglutinins are commonly associated with Mycoplasma pneumoniae and infectious mononucleosis. Distinguishing warm AIHA from CAD can be challenging. Definitive diagnosis relies on antibody testing, with warm AIHA primarily involving IgG and CAD involving IgM. We report a case of CAD initially misattributed to drug-induced liver injury in the setting of a viral upper respiratory infection. Case …

Eosinophilic Fasciitis Masquerading As Myositis: A Diagnostic Challenge, Jennifer L. Wong, Do, Elizabeth S. Ballner, Do, Mary Elizabeth Swift-Taylor

Books, Presentations, Posters, Etc.

Introduction: Eosinophilic fasciitis (EF), or Shulman’s disease, is a rare disorder of unknown etiology and poorly understood pathogenesis. It is characterized by fibroblast activation and interleukin-driven eosinophilia. Early clinical features include limb or trunk erythema, non-pitting edema, and progressive fascial thickening, often producing an “orange peel” appearance. Eosinophilia is a prominent laboratory finding in the early phase, but diagnosis often requires a full-thickness skin-to-muscle biopsy. Systemic corticosteroids are first-line therapy, with methotrexate as the steroid -sparing agent for refractory disease. We present a unique and diagnostically challenging case of EF confirmed by histopathology. Case Presentation: A 56-year-old man presented with …

Closing The Gap: Standardizing Sepsis Management To Address Racial Disparities Across Oregon Providence Hospitals, Jennifer Wong, Do, Shelley Schoepflin Sanders, Md, Facp

Books, Presentations, Posters, Etc.

Introduction: Sepsis is a time-sensitive, life-threatening medical emergency affecting approximately 1.7 million adults annually in the United States, contributing to nearly 270,000 deaths and over $24 billion in healthcare expenditures. Delays in recognition and initiation of treatment can significantly increase mortality. Previous studies have identified persistent racial disparities in sepsis care, including lower rates of recognition as the principal diagnosis and delayed antibiotic initiation for Black patients compared with White patients. In alignment with Providence’s mission to provide compassionate, equitable care, Oregon Providence hospitals implemented a standardized “Sepsis Order Set” in all Emergency Departments (ED) to reduce treatment delays and …

Idiopathic Systemic Capillary Leak Syndrome With Shock And Compartment Syndrome Due To Influenza A, Jobe Ashby, Md, Katelyn Bobrowski, Do, Ryan Best, Md

Books, Presentations, Posters, Etc.

INTRODUCTION: Idiopathic systemic capillary leak syndrome (ISCLS) is a rare, poorly understood condition that leads to extreme pathology with severe but predictable complications. First described in 1960, ISCLS has been identified in about 260 case reports and is marked by a triad of hypotension, hypoalbuminemia, and hemoconcentration often preceded by upper respiratory tract infection. It is divided into distinct phases of prodrome, extravasation, and recovery. We present a case of a middle-aged woman who presented with influenza A infection and developed ISCLS needing ICU level care for shock and bilateral upper extremity compartment syndrome. DESCRIPTION: Our patient is a 49-year-old …

Sepsis Transitional Care Management: A Phone Call To Reduce Readmission Health Inequity, Linh Tang Taylor, Md, Erica Leser, Ms, Alyssa Nelson, Michelle Schoepflin Sanders, Md

Books, Presentations, Posters, Etc.

Introduction: Sepsis accounts for 52% of hospital admissions in the United States and is the leading cause of death among hospitalized patients1 . However, disparity exists among sepsis survivors with race being reported as a determinant of recovery2 . Such disparity exists in Providence Oregon 8 hospitals: Providence Black patients have higher sepsis readmission rates than White (12.93% vs 11.65%). Using modified community-based participatory research, data analysis, and stakeholder interviews, we identified one potential root cause of the disparity: Black patients being readmitted are not receiving our system's Transitional Care Management (TCM) services. We aim to eliminate the Black/White sepsis …

Ofatumumab Associated Legionella Pneumonia In A Young Multiple Sclerosis Patient, Jobe Ashby, Omar Panhair

Books, Presentations, Posters, Etc.

Ofatumumab is the only anti-CD20 IgG1κ human monoclonal antibody therapy for relapsing forms of multiple sclerosis (MS) that patients can self-administer subcutaneously. Anti-CD20 agents are biologic therapies that carry an increased risk of serious infections, but rarely Legionellosis. We present the case of a young man taking ofatumumab for his MS who developed Legionella pneumoniae pneumonia. A 30-year-old man with MS diagnosed two years prior, stable on ofatumumab, presented with fevers, cough, and hemoptysis. A week earlier, he developed fevers and myalgias after administering ofatumumab, but these symptoms persisted longer than usual. Though initial vital signs were normal, he appeared …

Spur Cell Anemia: A Crucial Unanticipated Anemia In Critical Care, Jobe Ashby

Books, Presentations, Posters, Etc.

INTRODUCTION: Spur Cell Anemia (SCA) is a rare underrecognized non-autoimmune hemolytic anemia occurring in severe liver disease with prognostic implications. Since the 1980s there have been only a few dozen case reports and clinical images concerning SCA. We present a case of a young man managed in the ICU with multiorgan failure and a masked diagnosis of SCA. DESCRIPTION: A 33-year-old man was found down and presented to the ICU with hematemesis and hemorrhagic shock. He required massive transfusion for bleeding esophageal varices that were later banded and an expanding thigh hematoma. He was diagnosed with alcohol induced liver cirrhosis …

Enhancing Gestational Diabetes Screening, Sataj Johnson, Daniel Ruegg

Books, Presentations, Posters, Etc.

Background: Gestational diabetes mellitus (GDM) screening is recommended between 24–28 weeks of gestation to allow timely diagnosis and treatment and reduce adverse maternal and neonatal outcomes. The two-step glucose tolerance testing method is supported by ACOG, though completion can be delayed due to the need for multiple tests. In 2024 at Providence Milwaukie Family Medicine Clinic, incomplete GDM screening occurred in 23.1% of patients, and incomplete two-step screening occurred in 33.3%, with an average completion time of 12 days. Objective: To increase completion rates of two-step GDM screening and reduce time between abnormal 1-hour and diagnostic 3-hour glucose tolerance tests …

Improving Cervical Cancer Screening At Pmg Southeast Family Medicine Through Implementing A New Screening Tool: Patient-Collected High-Risk Hpv Screening, Brianna Pickering, August Stuppy, Eric Waelbroeck, Ben Pederson, Daniel Ruegg

Books, Presentations, Posters, Etc.

No abstract provided.

Veratridine Suppresses Rictor-Mtorc2 Signaling Pathway In Colon Cancer Patient-Derived Xenograft Cells, Morgan Daniel Montgomery

Honors Thesis

Colorectal cancer (CRC) remains the second deadliest and fourth most common cancer in the world. The metastatic form of CRC is especially devastating due to a lack of effective and safer therapeutic options. Another challenge includes an increasing number of younger patients. Among critical signaling pathways overactivated in CRC, mTORC2 plays a key role in the progression of metastatic CRC, yet there is no selective mTORC2 inhibitor in the clinic. Interestingly, a natural plant alkaloid from the Veratrum genus, Veratridine (VTD), shows promise as VTD can upregulate UBXN2A, a colon-specific tumor suppressor protein. UBXN2A works with E3 ligases to ubiquitinate …

Intraoperative Liposomal Bupivacaine Is Associated With Reduced Opioid Use And Enhanced Recovery After Total Knee Arthroplasty: A Multicenter Registry Study, Mitchell Ng, Jennifer Lin, Andrew Spitzer, Vinod Dasa, Adam Rivadeneyra, David Rogenmoser, Andrew Concoff, Mary Digiorgi, Joshua Urban, William Mihalko, Michael Mont

Rothman Institute Papers

BACKGROUND: With an annual volume of total knee arthroplasties (TKAs) in the United States projected to exceed 1.5 million by 2050, optimizing perioperative pain control and facilitating early discharge remain clinical priorities. This study evaluated the effectiveness of liposomal bupivacaine (LB) vs conventional bupivacaine/ropivacaine in opioid-naïve patients undergoing primary TKA, comparing/contrasting: (1) pain score improvements, (2) opioid usages, (3) functional recoveries, and (4) hospital lengths of stay.

METHODS:  Data from the Innovations in Genicular Outcomes Research (iGOR) registry were used to identify patients undergoing unilateral primary TKA between September 2021 and December 2024. Two hundred twenty-five patients were analyzed, 42 …

Powering Up Clinical Scholarship In Santa Fe Family Medicine, Evelyn Wang

HSLIC Faculty and Staff Instructional Resources

This presentation introduces family medicine residents and faculty in Santa Fe to clinical scholarship pathways, highlighting research question formulation, literature search strategies, full-text access tools, and HSLIC services that support evidence-based practice, quality improvement, and publication.

Indicators Of Fontan Circulatory Failure In Pediatric Patients: A Scoping Review Of Early Clinical And Hemodynamic Factors, Marina Mcmahon

Student Works

Structured Summary

a. Background/Introduction:

For patients with single ventricle congenital heart disease, the Fontan procedure is the definitive palliative procedure. Although advancements have been made in the surgical technique and management, the Fontan circulation is inefficient and prone to progressive dysfunction. Elevated central venous pressure, non-pulsatile pulmonary blood flow, and reduced cardiac output can lead to many complications, and eventual failure. These conditions can lead to protein losing enteropathy, plastic bronchitis, and hepatic fibrosis which often indicate advanced decline. Though a known problem, there is a lack of standardized criteria to guide optimal intervention timing of Fontan revision prior to …

Breakthroughs In Cervical Cancer Screening: Hpv Self-Collection At Pmg Milwaukie Family Medicine Clinic, Brandon Bartlett, Sataj Johnson, Emily Miyasako, Rachel Gallagher, Daniel Ruegg

Books, Presentations, Posters, Etc.

Background: Cervical cancer screening is a cornerstone of preventative healthcare and cancer screening in primary care. Based on data from the CDC, in the US alone, the rate of new cervical cancers each year is ~13,000, accounts for ~4,000 deaths annually, and disproportionally effects people of color and people of low SES (CDC, 2025). In our clinic (PMG Milwaukie), the rate of cervical cancer screening has remained around 70% for years, which is below the national average of ~75% (Healthy People, 2021). Primary HPV screening with self-collected swabs has been used successfully for years outside of the US, improving screening …

Improving Post-Hospital Medication Reconciliation In A Rural Primary Care Clinic Through An Rn-Led Workflow, Jack Kennady

Books, Presentations, Posters, Etc.

Context/background: Adverse events after hospital discharge are common and represent a major patient safety concern. Approximately 1 in 5 patients experience a safety event after discharge, and 39% of these events are adverse drug events (ADEs), with 26% considered preventable. Medication discrepancies during transitions of care contribute significantly to these events, with an estimated 40% of medication errors resulting from inadequate medication reconciliation. Rural primary care clinics face additional challenges, including limited communication between inpatient and outpatient systems and inconsistent reconciliation workflows. Improving medication reconciliation during the transition from hospital discharge to outpatient follow-up represents an important opportunity for family …

Improving Recognition Of Chronic Kidney Disease In A Federally Qualified Health Center Through A Quality Improvement Initiative, Rachel Monroe, Evan Saulino, Kathleen Mckenna

Books, Presentations, Posters, Etc.

Context/background: Chronic kidney disease (CKD) affects approximately 15% of adults in the United States, yet nearly 90% of affected individuals are unaware of their diagnosis. Early identification in primary care enables interventions such as blood pressure optimization, renin –angiotensin system blockade, and kidney -protective medications that can significantly delay disease progression and postpone dialysis. Screening and diagnosis gaps disproportionately affect high -risk populations, including Latinx patients and immigrant agricultural workers commonly served in federally qualified health centers (FQHCs). National CKD screening rates among patients with diabetes or hypertension remain low, leaving many high -risk individuals unscreened for kidney disease. Improving …

All-Inside Endoscopic Zone 1 Flexor Hallucis Longus Transfer: A Cadaveric Feasibility Study., Kevin D Martin, Yi Wei, Adam G F Smith, Franco Piscitani, Luke M Martin, Brian Steginsky, Brian Tscholl, Nathaniel A Bates

Surgery Articles

BACKGROUND: Endoscopic flexor hallucis longus (FHL) tendon transfer addresses chronic Achilles tendon ruptures. Traditional percutaneous plantar incisions gain FHL length but risk neurovascular injury. This study evaluated the feasibility of an all-inside endoscopic FHL zone 1 tenotomy and transfer technique, which avoids plantar incisions by using zone 1 of the FHL tendon. We hypothesized that this technique would (1) provide sufficient tendon length, (2) avoid neurovascular damage, and (3) securely anchor the FHL tendon without tunnel blowout.

METHODS: Ten cadaveric all-inside endoscopic zone 1 FHL tendon transfers were performed without fluoroscopic guidance. Specimens were independently assessed post hoc by 2 …

Increasing Structured Inpatient Teaching In A Family Medicine Residency, Eric Waelbroeck, Mh Choe

Books, Presentations, Posters, Etc.

Background: What is not measured cannot be improved. Residents at Providence Milwaukie Family Medicine Residency identified a need to increase structured teaching on inpatient rotations. Other projects aimed at increasing structured teaching during family medicine training have demonstrated improvements in resident confidence in key areas of practice, licensing exam performance, and resident satisfaction with their training. However, without a system of measurement, the number of teaching opportunities cannot be reliably improved. Objectives: Develop a method of documenting structured inpatient teaching that occurs at Providence Milwaukie Hospital. Then, implement interventions using a quality improvement model to increase structured teaching over time. …

Addressing Food Insecurity Through Partnering With The Community Teaching Kitchen On Lifestyle Medicine Hypertension Class, Emily Miyasako, Jill Christensen

Books, Presentations, Posters, Etc.

Background: Food insecurity is defined as limited or unreliable access to adequate and nutritious food. In Oregon, approximately 1 in 8 residents experience food insecurity, with rates disproportionately affecting low-income individuals, racial and ethnic minorities, and households with children or elderly individuals. Food insecurity remains a significant threat to our patients’ health and is associated with obesity, malnutrition, and poor mental health. As a primary care provider, I have seen the effects of food insecurity on my patients, but I am thankful for the presence of our Community Teaching Kitchen. The Community Teaching Kitchen (CTK) at Providence Milwaukie provides nutritional …

Erratum To ``Childhood Obesity: Global Burden, Multifactorial Etiologies, Biological Mechanisms, And Emerging Interventions For Prevention And Management'' [Saudi Medical Journal 2026; 47(2):183–194], Fahad H. Baali

Saudi Medical Journal

In the manuscript entitled: ``Childhood Obesity: Global Burden, Multifactorial Etiologies, Biological Mechanisms, and Emerging Interventions for Prevention and Management'' Published in Saudi Med J 2026; Vol. 47(2): 183–194. doi: 10.15537/1658-3175.1001
The tables included in the published version were incorrect due to a production error.

Erratum To ``The Association Between Inflammatory Bowel Disease And Ischemic Heart Disease: A Retrospective Cohort Study'' [Saudi Medical Journal 2025 Oct; 46(10):1174–1181], Mahmoud H. Mosli, Dima M. Alsulami, Yara K. Alghamdi, Abdullah S. Badahdah, Asmaa H. Alhibshi, Thamer M. Alamri, Maan S. Alkhattabi, Khames T. Alzahrani, Hadeel A. Alsufyani, Omar I. Saadah

Saudi Medical Journal

In the manuscript entitled ``The Association between Inflammatory Bowel Disease and Ischemic Heart Disease: A Retrospective Cohort Study,'' published in Saudi Med J 2025 Oct;46(10):1174–1181. doi: 10.15537/smj.2025.46.10.20250181, the affiliation of Dr. Maan Alkhattabi was omitted from the final published version.
The correct affiliation for Dr. Maan Alkhattabi is as follows:
Department of Medicine, Faculty of Medicine, King Abdulaziz University–Rabigh, Jeddah, Kingdom of Saudi Arabia.

Erratum To ``Unmasking Iron Deficiency And Iron Deficiency Anemia In Saudi Arabia'' [Saudi Medical Journal 2025; 46(9):1000–1007], Osman O. Radhwi, Omar M. Raslan, Eman M. Mansory

Saudi Medical Journal

In the manuscript entitled ``Unmasking Iron Deficiency and Iron Deficiency Anemia in Saudi Arabia,'' published in Saudi Med J 2025; Vol. 46(9):1000–1007. doi: 10.15537/smj.2025.46.9.20240970.
The correct affiliation should read as follows: Department of Basic Science, College of Medicine, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia.

Advancing Rheumatology In The Middle East: Mrc 2025 Abstracts, Martin Lee, Ahmed Zayat, Beena Hameed, Elsadeg Sharif, Fahda Al Okaily, Fehaid Alanazi, Francis Kynaston-Pearson, Khalid A. Alnaqbi, Mahmood Hachim, Mayam Al Nesf, Mira Mirashli, Mohammed Tariq, Ravi Gutta, Reem Abdwani, Saadeya Naji, Shamma Lootah, Tareq Al Araimi, Waleed Hafiz, Suad Hannawi

Saudi Medical Journal

No abstract provided.

Middle East Bifurcation Club Consensus Document On Percutaneous Revascularization Of Bifurcation Lesions In Association With The National Heart Center – Saudi Health Council, Khaled Al-Shaibi, Mirvat Alasnag, Haitham Amin, Ali Nazmi Calik, Ali Almasood, Abdullah Alenezi, Nouf Alanazi, Abdulrahman Almoghairi, Hadi Abu-Hantash, Khaled Almerri

Saudi Medical Journal

Bifurcation lesions are among the most challenging in percutaneous coronary intervention (PCI), with outcomes affected by anatomy, side-branch disease, and procedural variability. Existing European definitions and strategies require adaptation for Middle Eastern populations, where diabetes, obesity, and hypertension are highly prevalent and present earlier. The Middle East Bifurcation Club (MEBC), with the National Heart Center, used the Nominal Group Technique to standardize bifurcation PCI terminology, techniques, and treatment pathways tailored to regional demographics. The consensus provides evidence-based recommendations on imaging, provisional and 2-stent strategies, POT, and left main versus non-left main bifurcations, alongside practical algorithms and heart team guidance, highlighting …

Rethinking Health-Care Efficiency: A Call For A Multi-Dimensional Framework For Assessing Healthcare System Efficiency, Yasser K. Alotaibi, Ali N. Alharbi

Saudi Medical Journal

No abstract provided.

Prevalence Of Brca1 And Brca2 Germline Mutations In Western Saudi Patients With Epithelial Tubo-Ovarian Carcinoma, Wala Mehros, Faisal Aldaheri, Anas Alqarni, Saif Aljehani, Abdulrahman Alnamlah, Alaa Althubaiti, Safaa Huneef, Hatim Jifree

Saudi Medical Journal

Objective: Ovarian cancer represents the most lethal gynecologic malignancy, the epithelial type (EOC) being the most common. BRCA gene mutations are associated with ovarian cancer, younger age at presentation, strong family history of EOC, and multiple malignancies in a single patient. This study calculated the rate of BRCA-positive EOC and compared BRCA-mutated vs non-mutated EOC cases. Methods: This retrospective cohort study, conducted at Princess Noura Oncology Center between May 2016 and December 2023, explored outcomes in BRCA-positive EOC patients. The inclusion criteria covered all EOC cases. A total of 70 patients were selected. Results: Of the 70 …

The Nephroprotective Effects Of Dulaglutide In Patients With Type 2 Diabetes And Chronic Kidney Disease: A Multicenter Saudi Arabian Study, Maha H. Jamal, Hassan A. Alzahrani, Duaa M. Bakhshwin, Ranya A. Ghamri, Fatmah S. Binzomah, Wisam H. Jamal, Moaz W. Abulfaraj

Saudi Medical Journal

Objective: This study aimed to evaluate the effectiveness and safety of dulaglutide in individuals with chronic kidney disease (CKD) and type 2 diabetes mellitus (T2DM). Methods: This retrospective cohort study included 212 patients with CKD (stages 1–4) and T2DM treated with once-weekly dulaglutide (1.5 mg) for either 12 or 24 months at three tertiary care centers in Saudi Arabia from January 2021 to December 2023. Safety was assessed based on the presence of adverse events. Efficacy was measured using the changes in estimated glomerular filtration rate (eGFR), glycated hemoglobin (HbA1c), and body mass index (BMI). Changes in efficacy outcomes were …