Internal Medicine Commons^™

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 …

Empiric Treatment For Suspected Malaria In The United States: A Case Report., Jonathan C. Li, Emma Lundsmith

Division of Internal Medicine Faculty Papers & Presentations

Malaria in the United States is rare and most commonly presents among returning travelers from endemic areas. Diagnosis is classically dependent on a positive blood smear or polymerase chain reaction (PCR) test. The objective of this case report is to highlight a case of suspected malaria in a high-risk individual with negative diagnostic testing where a trial of empiric treatment was initiated based on clinical presentation after a thorough discussion of risks and benefits. However, empiric treatment based on a single case is limiting. We present a case of a 56-year-old man with extensive travel history throughout Asia, who presented …

Accidental Botulism Poisoning: A Case Of Pickled Herring, Garrett Spencer, Greg Flick

Providence St. Vincent Internal Medicine 2020

INTRODUCTION: Botulism is a rare cause of neuromuscular weakness that presents a diagnostic challenge in the face of respiratory collapse. Pupil and bulbar paralysis aid prompt recognition and treatment, as clinical confirmation can be time intensive and limited by sample integrity. Early treatment can halt paralysis and prevent ICU and ventilator days.

CASE DESCRIPTION: A 74-year-old male with hypertension and DVT presented with acute weakness and respiratory failure after three days of cough and diarrhea. Upon ICU admission for mechanical ventilation, we discovered sluggish pupils, mild ptosis, and proximal muscle weakness. Symptoms then progressed to unresponsive pupils, complete ptosis, and …

Chronic Hepatitis B Reactivation: Deadly, But Preventable, Sarah Xie, Jesse Powell, Andrea Roast

Providence Portland Medical Center Internal Medicine 2020

Chronic Hepatitis B Reactivation:

Deadly, But Preventable

Sarah Xie, DO

Providence Portland Medical Center – Portland, OR

Additional Authors: Andrea Roast, MD, FACP; Jesse Powell, MD

A 51-year-old Vietnamese male with chronic hepatitis B presents with symptoms of acute hepatitis. 2 months prior, his PCP had discontinued Tenofovir, for which he had been taking for the past decade, based on an undetectable viral load and a negative HBeAg. 1 month later, his viral load soared to 796 million so Tenofovir was restarted. On admission a few days later, the patient had scleral icterus and jaundiced skin. He had severe transaminitis, …

A Rare Case Of Metastatic Insulinoma In A Patient With Huntington’S Disease, Olesya Petrenko, Brinton C. Clark

Providence Portland Medical Center Internal Medicine 2020

A Rare Case Of Metastatic Insulinoma

In A Patient With Huntington’s Disease

Olesya Petrenko, DO

Providence Portland Medical Center – Portland, OR

Additional Authors: Brinton Clark, MD, FACP

A 49-year-old female with past medical history of Huntington’s disease presents to the ED after being found unresponsive at her assisted-living facility. She was noted to be hypoglycemic with a glucose of 21 and responded to dextrose. For the past several months, patient had symptoms of dizziness, tremors. She has no history of diabetes, and only home medication is Zyprexa. Patient required D10 drip to maintain glucose levels. Given patient’s psychiatric history, …

A Case Of Gluten-Induced Delirium: Using Capsule Endoscopy To Diagnose Occult Gi Bleeding, Rachael Starcher, Lisa Sanders

Providence Portland Medical Center Internal Medicine 2020

A Case Of Gluten-Induced Delirium:

Using Capsule Endoscopy To Diagnose Occult GI Bleeding

Rachael Starcher, MD

Providence Portland Medical Center – Portland, OR

Additional Authors: Lisa Sanders, MD

Introduction: Despite an increasing prevalence of celiac disease worldwide, many patients remain undiagnosed, putting them at risk for late stage complications of unidentified and untreated celiac disease. Ulcerative jejunoileitis is a rare cause of occult GI bleeding seen only in refractory celiac disease or in atypical celiac disease at the time of diagnosis. When left untreated, ulcerative jejunoileitis can lead to bowel perforation, blood loss anemia, and T-cell lymphoma.

Case Presentation …

Beck’S Tetrad? Adding Pocus To The Clinical Exam For Pericardial Tamponade Improves Diagnostic Accuracy In Obstructive Shock, Cody Wiench, Benjamin Pedroja

Providence Portland Medical Center Internal Medicine 2020

Beck’s Tetrad?

Adding POCUS To The Clinical Exam For Pericardial Tamponade Improves Diagnostic Accuracy In Obstructive Shock

Cody Wiench, MD

Providence Portland Medical Center – Portland, OR

Additional Authors: Benjamin Pedroja, MD

Introduction: Obstructive shock due to tamponade is an important, but rare, cause for sudden cardiovascular collapse. Accurate treatment requires prompt (and correct) diagnosis. Bedside echocardiogram can provide rapid and accurate diagnosis, however the physical exam can provide important clues to consider tamponade. In patients with conditions that predispose them to pericardial disease, such as SLE, one must have a high index of suspicion for tamponade when …

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 …

Vocal Cord Dysfunction Masquerading As Exercise-Induced Bronchoconstriction, Brandon Tempte, Meera Jain, Jason Wells

Providence Portland Medical Center Internal Medicine 2020

Vocal Cord Dysfunction Masquerading As

Exercise-Induced Bronchoconstriction

Brandon Temte, DO

Providence Portland Medical Center – Portland, OR

Additional Authors: Meera Jain, MD, FACP; Jason Wells, MD

Intro: Exercise-induced bronchoconstriction (EIB), previously exercise-induced asthma, has a high prevalence in the community. Patients with these symptoms are typically diagnosed clinically and treated empirically with pre-exercise albuterol. Eucapnic voluntary hyperventilation (EVH) has been used to objectively test for EIB and can help to confirm the diagnosis, as well as rule out other causes such as exercise-induced vocal cord dysfunction (EIVCD), which may mimic EIB.

Case Description: A 42-year old female with …

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 …

Implementing Inter-Professional Patient-Family Centered Plan Of Care Meetings On An Inpatient Hospital Unit, Nicolas Hernandez, Alice Fornari, Sage Rose, Leanne Tortez

Patient Experience Journal

Inpatient plan of care meetings support efforts to encourage collaborative practice and patient-family centered care and result in an effective strategy to enhance communication and patient satisfaction. Clinical team members participated in patient/family centered plan of care meetings at a community hospital in a selected inpatient unit with full time hospitalist physicians. Quantitative data were gathered pre/post implementation from the external Hospital Consumer Assessment of Health Care Providers (HCAHPS) survey. HCAHPS data were collected independently, specifically for questions related to communication between patients, family members/guardians and the medical team and also the effects of care transition. There was a slow …

Living Sweet: A Multi-Functional Mobile-Phone Application Strategy For Adults With Uncontrolled Type 2 Diabetes Mellitus, Chantel K. Anderson

Evidence-Based Practice Project Reports

Type 2 Diabetes Mellitus (T2DM), one of the most common chronic diseases, is increasing worldwide, and once diagnosed, lifetime self-management is critical to maintain glycemic control (Vermeire et al., 2005; American Diabetes Association (ADA), 2018). Management of T2DM has been acknowledged as challenging due to the need for strict lifestyle adaptations. From a public health perspective, uncontrolled diabetes leads to increased healthcare costs, secondary complications, and ultimately severe disabilities (ADA, 2018). The purpose of this evidencebased practice (EBP) project was to evaluate the effectiveness of a diabetes-specific mobile health application (MHA) on glycated-hemoglobin (HbA1C), self-care perception (SCP), and self-care behaviors …

How Immune T-Cell Augmentation Can Help Prevent Covid-19: A Possible Nutritional Solution Using Ketogenic Lifestyle, Ravi K. Kamepalli Md,Fidsa,Cwsp

The University of Louisville Journal of Respiratory Infections

No abstract provided.

Effect Of Lifestyle Modifications On Blood Pressure And Bmi In Overweight Or Obese Adults With Primary Hypertension, Mariska Vandenbergh

Evidence-Based Practice Project Reports

Hypertension (HTN) and obesity contribute to poor cardiovascular outcomes which can be managed with diet and exercise lifestyle changes. In addition, self-awareness (SA) of eating patterns can be a useful tool to promote adherence to lifestyle changes. The purpose of this project was to determine the effect of lifestyle education, the DASH diet, and tools to increase SA for adult clinic patients who were overweight with hypertension. The REAP and PIH tools were utilized to increase patients’ SA of their diagnosis and current dietary habits. A literature search over five databases was conducted and analyzed thoroughly. National guidelines strongly recommend …

Awareness Regarding Causes Of Infertility Among Out-Patients At A Tertiary Care Hospital In Karachi, Pakistan, Hamza M. Ahmed, Mohammad Khan, Farah Yasmin, Haris Jawaid, Hiba Khalid, Anum Shigri, Faryal Nawaz, Choudhary A. Hasan

Section of Internal Medicine

Introduction: Infertility is the inability of a couple to achieve pregnancy within 12 months of sexual intercourse without the use of contraceptives. The Pakistani population, belonging to a low-middle income country, has a high prevalence of infertility due to a low knowledge and awareness regarding its causes, and lack of healthcare-seeking behavior for this medical issue. The prevalence of infertility in Pakistan is reported as 22%, with primary infertility accounting for 4% of the total cases. This leads to psychological trauma among women as societal norms equate infertility with failure on a personal, emotional, and social level. In this study, …

The Implementation Of Exercise For Chronic Kidney Disease And Dialysis Patients, Syed Ahmad Rizvi

Honors College Theses

While commonly known to be the organ that helps with urine production within the human body, the kidney plays one of the most crucial roles in maintaining homeostasis. When establishing all of the roles the kidney has on keeping humans healthy, there is the question of how does the body cope when a patient is diagnosed with kidney failure. One of the more common treatment options that allows the body to continue to function without a kidney is by beginning a patient on a form of dialysis. However, as with any treatment, there will always be a list of side …

How Rare Is Isolated Rheumatic Tricuspid Valve Disease?, Edme R. Mustafa, Octavian Istrătoaie, Roxana Mandia, Georgică C. Târtea, Cristina Florescu

Journal of Mind and Medical Sciences

The incidence of rheumatic fever (RF) has markedly decreased in Europe since the beginning of the 20th century due to improved living conditions, early antibiotic therapy in streptococcal pharyngitis, and changes in serotypes of circulating streptococci. Isolated outbreaks of RF are still found in various parts of the world and the disease has changed its presentation with milder joint symptoms and subclinical carditis that make the correct diagnosis more difficult. Patients can present many years later with severe valve disease and significant disability. This article presents a case of isolated rheumatic tricuspid valve disease that presented with signs and symptoms …

Novel Coronavirus (2019-Ncov) In Disguise, Qian Zhang, Annyella Douglas, Zain U. Abideen, Shristi Khanal, Stephanie Tzarnas

Abington Jefferson Health Papers

Novel coronavirus (2019-nCoV) pandemic is currently one of the most influential topics as it not only impacts the field of medicine but most importantly, it affects the lives of many individuals throughout the world. We report an interesting 2019-nCoV case in a tertiary community hospital with the initial concern of acute pyelonephritis without respiratory symptoms that ultimately led to the quarantine of a number of healthcare providers. This case emphasizes the importance of radiological evidence in diagnosing 2019-nCoV in the setting of an initial atypical presentation. It also serves as an example of how healthcare providers may need to increase …

Drug Deprescription-Withdrawal Risk, Prevention, And Treatment, Madison K Bangert, Gabriel M Aisenberg

Faculty, Staff and Student Publications

In most cases, a sudden interruption of most medications has no major consequences. There are well-recognized therapies that, when withheld, can either lead to the reappearance of the symptoms they were controlling or to signs or symptoms of withdrawal. In this article, we present a table including medications that when interrupted can produce withdrawal syndromes, the signs and symptoms of the withdrawal syndrome, the time to onset and resolution of the syndrome, information regarding alternative delivery options for the drug/s when the oral route is not possible, as well as prevention and therapy.

Pitfalls In Quantitative Myocardial Pet Perfusion I: Myocardial Partial Volume Correction, K Lance Gould, Linh Bui, Danai Kitkungvan, Tinsu Pan, Amanda E Roby, Tung T Nguyen, Nils P Johnson

Faculty, Staff and Student Publications

BACKGROUND: PET quantitative myocardial perfusion requires correction for partial volume loss due to one-dimensional LV wall thickness smaller than scanner resolution.

METHODS: We aimed to assess accuracy of risk stratification for death, MI, or revascularization after PET using partial volume corrections derived from two-dimensional ACR and three-dimensional NEMA phantoms for 3987 diagnostic rest-stress perfusion PETs and 187 MACE events. NEMA, ACR, and Tree phantoms were imaged with Rb-82 or F-18 for size-dependent partial volume loss. Perfusion and Coronary Flow Capacity were recalculated using different ACR- and NEMA-derived partial volume corrections compared by Kolmogorov-Smirnov statistics to standard perfusion metrics with established …

Protection Against Ionizing Radiation And Chemotherapy Toxicity Via Latexin Regulation, Gary Van Zant, Ying Liang, Yi Liu

Internal Medicine Faculty Patents

The present invention relates to methods for protecting against damage caused by radiation and/or chemotherapy, and methods for treating bone marrow damage by reducing/ inhibiting Latexin expression and/or Latexin activity. The methods comprise administering to a subject in need thereof a pharmaceutical composition comprising an antagonist that reduces expression and/or activity of latexin, wherein latexin is a latexin polynucleotide variant and/or a latexin polypeptide variant that binds to the antagonist.

Case Series Of Anca Vasculitis As Prognostic Marker For Severity Or Relapse Of Glomerulonephritis., Jake N. Cho, Venkat Chitumalla, Izuchukwu Nwakoby

Nephrology

No abstract provided.

A Case Series Of Hyponatremia And Management In Hospitalized Patients, Jake N. Cho, Rebecca Ong, Izuchukwu Nwakoby

Nephrology

No abstract provided.

Dapatkah D-Dimer Digunakan Sebagai Penanda Koagulasi Pada Kanker?, Lugyanti Sukrisman

Jurnal Penyakit Dalam Indonesia

Pasien kanker mempunyai risiko tinggi untuk mengalami trombosis, terutama tromboemboli vena (TEV). Pasien kanker yang mengalami TEV mempunyai risiko mortalitas yang lebih tinggi dibandingkan dengan pasien kanker tanpa TEV.

Arthritis In Chronic Hepatitis C Infection: Is It Rheumatoid Like Arthritis Or True Rheumatoid Arthritis?, Jefri P. Susanto, Syifa Mustika, Bogi Pratomo

Jurnal Penyakit Dalam Indonesia

No abstract provided.

Change Of Coagulation Status In Solid Cancer Patients Undergoing Chemotherapy In Indonesia: A Prospective Cohort Study, Noorwati Sutandyo, Lyana Setyawan

Jurnal Penyakit Dalam Indonesia

No abstract provided.

Level Of Plasma Cortisol In Functional Dyspepsia With Psychosomatic Disorder, Arina Widya Murni

Jurnal Penyakit Dalam Indonesia

No abstract provided.

Relationship Between Quality Of Life And Nutritional Status On Chronic Kidney Disease Patients With Dialysis Type, Ratih Tri Kusuma Dewi, Wachid Putranto, Agung Susanto, Aryo Suseno, Bambang Purwanto, Rini Dwi Mangesti, Maia Thalia Giani, Muhammad Raditia Septian

Jurnal Penyakit Dalam Indonesia

No abstract provided.

The Relationship Between Serum Calcidiol Deficiency And The Degree Of Sarcopenia In Elderly Communities In Surabaya, Hemma Wahyuda Indirayani, Novira Widajanti, Hadiq Firdausi

Jurnal Penyakit Dalam Indonesia

No abstract provided.

Length Of Stay Of Geriatric Patients With Gram-Negative Bacteremia: An Analytical Observation, Czeresna Heriawan Soejono

Jurnal Penyakit Dalam Indonesia

No abstract provided.