Internal Medicine Commons^™

Aplastic Anemia Secondary To Sars-Co-V-2, Maya Wernick, Stacy Lewis, Christie Moore

Providence St. Vincent Internal Medicine 2021

No abstract provided.

Overloadipine–Emerging Therapies To Treat Refractory Shock, Stephanie Barayuga, Irene Hendrickson

Providence St. Vincent Internal Medicine 2021

Introduction

Refractory vasodilatory shock develops from uncontrolled vasodilation and hyporesponsivenessto vasopressors. •Management of calcium channel blockers (CCB) toxicity can be difficult because it can result in refractory vasodilatory

Case Presentation

•21-year-old male with history of depression and prior suicide attempts presented after intentional ingestion of amlodipine (300 mg) and metformin (150 tablets of 1000 mg). •Presented with slightly altered mentation and hypotension, then quickly deteriorated and required intubation and high vasopressor requirements. •Transferred to PSVMC for consideration of venoarterialextracorporeal membrane oxygenation (VA-ECMO). Since he was hyperdynamic on echocardiogram, our team did not feel he would benefit from VA-ECMO. •His vasopressor …

The Deadly Hoover: A Curiouser And Curiouser Case Of Disappearing Platelets, Rachael Starcher

Providence Portland Medical Center Internal Medicine 2021

No abstract provided.

Double The Battle: Two Cases Of Irreversible Endocrinopathies In Patients Already Fighting Metastatic Cancer., Olesya Petrenko, Nicholas L Stucky

Providence Portland Medical Center Internal Medicine 2021

INTRODUCTION: Emergence of cancer immunotherapy has instigated a new era in field of oncology and revolutionized treatment of cancer. In 2011, Immune Checkpoint Inhibitors (ICI) gained approval for treatment of advanced solid and hematological malignancies and have had remarkable results. Since being released, new cases of irreversible endocrine adverse events are increasingly becoming reported and leave patients with a new life-long diagnosis after battling metastatic cancer.

Discussion • 6 Immune Checkpoint Inhibitors (ICIs) approved: •CTLA-4 (cytotoxic T-lymphocyte-associated protein 4) inhibitor Ipilimumab •PD-1 (programmed cell death protein 1) inhibitors nivolumab, pembrolizumab •PD-L1 (programmed cell death ligand 1) inhibitors atezolizumab, avelumab, durvalumab …

Esophageal Necrosis As An Unexpected Complication Of Diabetic Ketoacidosis, Hayden Smith, Tricia James

Providence Portland Medical Center Internal Medicine 2021

No abstract provided.

Optimizing Critical Illness Recovery: Perspectives And Solutions From The Caregivers Of Icu Survivors, Carla M. Sevin, Leanne M. Boehm, Elizabeth Hibbert, Anthony J. Bastin, James C. Jackson, Joel Meyer, Tara Quasim, Rita N. Bakhru, Ashley A. Montgomery-Yates, Andrew Slack, Mary Still, Giora Netzer, Mark E. Mikkelsen, Theodore J. Iwashyna, Kimberly J. Haines, Joanne Mcpeake

Internal Medicine Faculty Publications

Objectives:
To understand the unmet needs of caregivers of ICU survivors, how they accessed support post ICU, and the key components of beneficial ICU recovery support systems as identified from a caregiver perspective.

Design:
International, qualitative study.

Subjects:
We conducted 20 semistructured interviews with a diverse group of caregivers in the United States, the United Kingdom, and Australia, 11 of whom had interacted with an ICU recovery program.

Setting:
Seven hospitals in the United States, United Kingdom, and Australia.

Interventions:
None.

Measurements and Main Results:
Content analysis was used to explore prevalent themes related to unmet needs, as well as …

Performance In Mortality Prediction Of Saps 3 And Mpm0-Iii Scores Among Adult Patients Admitted To The Icu Of A Private Tertiary Referral Hospital In Tanzania, Nadeem Kassam

Master of Medicine in Internal Medicine

Background Illness predictive scoring systems are significant and meaningful adjuncts of patient management in the intensive care unit. They assist in predicting patient outcomes, improve clinical decision making and provide insight into the effectiveness of care and management while optimizing the use of hospital resources. We evaluated mortality predictive performance of Simplified acute physiology score (SAPS 3) and Mortality probability models (MPM0-III) in predicting ICU outcome as well as identified disease pattern and clinical factors associated with increased mortality. Methods This was a retrospective cohort study of adult patients admitted to the Intensive Care Unit (ICU) of the Aga Khan …

Correlation Between Disease Severity And Health-Related Quality Of Life Among Patients With Fibromyalgia Syndrome, Janet Chebet Koros

Master of Medicine in Internal Medicine

Background: Fibromyalgia Syndrome is a rheumatic disorder characterized by chronic widespread musculoskeletal pain accompanied by fatigue, sleep, memory problems, and mood disturbances. Little is known about the characteristics of fibromyalgia patients in Kenya. Studies done elsewhere have shown that patients with fibromyalgia syndrome incur more healthcare costs, have a higher prevalence of comorbidities, have more workdays missed, have poor productivity, retire early, have impaired function, and lead a poorer quality of life. Methods: This study was a prospective cross-sectional study that enrolled patients diagnosed with fibromyalgia syndrome attending the rheumatology clinic at the Aga Khan University Hospital Nairobi, Kenya. Those …

Triggers And Outcomes Of Takotsubo Cardiomyopathy In Cancer Patients, Antoine Addoumieh, Dinu Balanescu, Teodora Donisan, Juan Lopez-Mattei, Peter Kim

Conference Presentation Abstracts

Background: Takotsubo cardiomyopathy (TC) is a well described entity characterized by transient and reversible left ventricular (LV) systolic dysfunction. Primary TC is triggered by psychological or emotional stress, whereas secondary TC could be due to trauma, surgery or medications. We aimed to compare outcomes in primary TC and secondary TC in cancer patients. Methods: We retrospectively identified 80 patients who presented with TC to MD Anderson between December 2008 and January 2019. Baseline characteristics were obtained. We identified the triggers leading to TC. Univariate analysis was done using Cox regression. Kaplan Meier method (KM) was used to compare survival based …

Covid-19 Vaccine Hesitancy Among Medical And Dental Students, Arati Kelekar, Neila Afonso, Victoria Lucia, Ana Karina Mascarenhas

Conference Presentation Abstracts

No abstract provided.

Pharmacist Pilot Project To Reduce Hypoglycemic Events On Internal Medicine Unit, Carly Barnes, Pamela Levine

Providence Pharmacy PGY1 Program at Providence Portland and Providence St. Vincent Medical Centers 2021

No abstract provided.

Hyperlipasemia Does Not Confer Worse Clinical Outcomes In A Retrospective Cohort Of Novel Coronavirus (Covid-19) Patients, Zaid Imam, Inayat Gill, Bana Antonios, Andrew Aneese, Gaurav Kakked, Faisal Kamal, Bara Al Kurdi, Alexandra Halalau

Conference Presentation Abstracts

Abstract Background Gastrointestinal manifestations and hyperlipasemia commonly occur as part of novel coronavirus infection (COVID-19), while data on acute pancreatitis is limited to case reports. We aimed to study the prevalence of hyperlipasemia and acute pancreatitis in a large inpatient cohort of COVID-19 patients and their impact on clinical outcomes. Methods Retrospective chart review of all hospitalized patients with confirmed COVID-19 at an 8-hospital health system in Michigan, USA was performed between February 1,2020 through April 1,2020 with inclusion of patients with obtained lipase levels. Univariate analyses were performed to evaluate associations between hyperlipasemia and degree of hyperlipasemia and clinical …

A Look Into Medical Students' Knowledge On Adverse Childhood Experiences, Lara Fawaz, Neila Afonso

Conference Presentation Abstracts

No abstract provided.

Adding Incapacity To Injury: A Case Of Trauma And Central Cord Syndrome, Christopher Bender, Jesse Powell

Providence Portland Medical Center Internal Medicine 2021

Introduction Central cord syndrome occurs with a lesion or soft tissue injury affecting the central anatomy of the spinal cord, causing weakness more prominent in the arms than legs, and sensory abnormalities at the level of the lesion. Here I present a case of central cord syndrome caused by a traumatic fall.

Case Patient A 71 year oldman with history of ESRD, CAD, CHF, and atrial fibrillation HPI Admitted to the hospital after a syncopalevent at home with traumatic falland subsequent development of weakness Exam Weakness was greater in the upper extremities than lower extremitiesand had a left sided predominance. …

Predictive Factors For Success Of Awake Proning In Hypoxemic Respiratory Failure Secondary To Covid-19: A Retrospective Cohort Study, Sujith V Cherian, Chang Li, Brad Roche, Stephan A Reyes, Siddharth Karanth, Aditya P Lal, Gabriel M Aisenberg, Rosa M Estrada-Y-Martin

Faculty, Staff and Student Publications

BACKGROUND: Awake prone positioning has been recommended as an adjunctive measure in spontaneously breathing patients with hypoxemic respiratory failure during the COVID-19 pandemic. It remains uncertain as to how long this should be implemented, what variables to follow and who would be the ideal candidates for this adjunctive therapy.

METHODS: A retrospective chart review of patients admitted from April to August 2020 within our institution with multifocal pneumonia and hypoxemic respiratory failure secondary to COVID-19 who underwent awake-proning for at least 3 hours was conducted.

RESULTS: Improvement in respiratory parameters including ROX (SpO2/Fio2/ Respiratory Rate) indices and inflammatory markers within …

Potassium For Two: Management Of Refractory Electrolyte Disturbances In Gitelman Syndrome During Pregnancy, Eric Torkildsen Md, Yesha K. Shah Do, Sharon E. Maynard Md

Department of Medicine

No abstract provided.

Exercise-Induced Alterations In Phospholipid Hydrolysis, Airway Surfactant, And Eicosanoids And Their Role In Airway Hyperresponsiveness In Asthma, Ryan C Murphy, Ying Lai, James D Nolin, Robier A Aguillon Prada, Arindam Chakrabarti, Michael V Novotny, Michael C Seeds, William A Altemeier, Michael H Gelb, Robert Duncan Hite, Teal S Hallstrand

Faculty, Staff and Student Publications

The mechanisms responsible for driving endogenous airway hyperresponsiveness (AHR) in the form of exercise-induced bronchoconstriction (EIB) are not fully understood. We examined alterations in airway phospholipid hydrolysis, surfactant degradation, and lipid mediator release in relation to AHR severity and changes induced by exercise challenge. Paired induced sputum (

Navigating Uncertainty In A Critically Ill Patient, Brandon Tempte, Amy Dechet

Providence Portland Medical Center Internal Medicine 2021

Introduction Aspergillus spores are routinely inhaled.Innate immune defenses prevent fungal growth and disease in immunocompetent individuals.However, immunocompromised patients are at risk of developing invasive aspergillosis. Diagnosis of invasive aspergillus is often difficult as biopsy is not always feasible and relies on the interpretation of non-invasive testing. Early recognition and initiation of therapy is paramount as the mortality rate is high.

Case Presentation Patient is a 59 year oldfemale with a history of alcohol abuse admitted with acute encephalopathy and new onset seizure. History: -Initially presented 3 weeks earlier for jaundice, found to have acute alcoholic hepatitis, started and discharged on …

Hormone Wars: The Thyroid Strikes Back! A Case Of Hashimoto Encephalopathy Manifesting As Diffuse Extremity Weakness And Confusion, Cody Paiva, Brinton Clark

Providence Portland Medical Center Internal Medicine 2021

Case Presentation

A 42-year-old female with a past medical history of schizoaffective disorder recently discontinued on multiple psychiatric medications, stable HIV, and hypothyroidism presented with a chief complaint of diffuse extremity weakness and Parkinsonism-like symptoms. History of Present Illness •4-month history of jerking leg movements bilaterally •2-week history of ”feeling paralyzed” with difficulty ambulating •Recent long-term hospitalization at a psychiatric facility as a ward of the state •Multiple changes to psychiatric medication regimen, including abrupt discontinuation of clozapine and risperidone •Abrupt onset confusion at facility and decreased level of interaction at facility prior to admission Exam •T 98.8F, BP 114/66, …

A Case Of Vaccine-Preventable Back Pain, Gerald Hutfles, Tricia James

Providence Portland Medical Center Internal Medicine 2021

The Case 55-year-old male with minimal medical history who presented multiple times over 9 months with progressive and severe gluteal & back pain, ultimately found to be from anal cancer.

HPV - The Bad, Insidious Bug

What is it? •Human Papillomavirus (HPV) is a double-stranded DNA virus of the Papillomaviridaefamily. Its lifecycle is tied to epithelial tissue. Why do we care? •HPV is associated with warts (including condyloma acuminatum) and cancer •Approximately 45,000 HPV-associated cancers occur in the US each year •7,083 -anal cancer •12,143 -cervical cancer •19,975 -oropharyngeal cancer What About Anal Cancer? •Affects ~1.6/100,000 women, and 1.0/100,000 men …

Cryptococcoma From Disseminated Cryptococcus Neoformans Infection In An Immunocompetent Patient, Megan Block, David Hotchkin, Amy Dechet

Providence Portland Medical Center Internal Medicine 2021

Background Cryptococcal infection is an infection caused by encapsulated yeasts of the Cryptococcusfungi that primarily manifests in the CNS or lungs in immunocompromised hosts. Our case describes disseminated Cryptococcus neoformansinfection and cerebral cryptococcomain an immunocompetent individual.

Case History •A 64 year-oldmale with no pertinent medical history presented to his PCP for worsening headaches for the past 2 months. •MRI: new ring enhancing lesion of the left thalamus •CT chest: bilateral upper lobe tree-in-bud nodules and a right upper lobe nodule with stippled calcification. •Lung biopsy, complicated by pneumothorax, was unremarkable. •2 days later developed headaches and nausea, became non-verbal, and …

The Peculiar Case Of Purulent Pericarditis, Laura Bennetts, Meera Jain

Providence Portland Medical Center Internal Medicine 2021

Introduction

Purulent pericarditis is a localized purulent infection in the pericardial space •Before the era of antibiotics, purulent pericarditis was related to complications of pneumococcal pneumonia. Now more frequently associated with thoracic surgeries, immunocompromised hosts and nosocomial blood infections.1 •This case is an unusual presentation of acute methicillin-resistant staphylococcus aureus (MRSA) purulent pericarditis with a course complicated by cardiac tamponade, opiate withdrawal, and a right ventricle (RV) laceration.

Case Presentation

History of Present Illness •Patient is a 30-year-old M active intravenous drug use (IDU) with a recent history of MRSA bacteremia, endocarditis, parasternal abscess s/p I&D, and sternal osteomyelitis with …

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

HCA Healthcare Journal of Medicine

A 24-year-old African American male with a history of sickle cell anemia (Hb S/S) presented to an outside hospital with acute colitis, acute renal failure and sickle cell crisis and was treated with supportive measures. On day 3 of hospitalization, he developed bilateral ascending paralysis with sacral numbness. Magnetic resonance imaging (MRI) demonstrated epidural lipomatosis, which was attributed as the cause of his paralysis. He was transferred to our facility for neurosurgery evaluation. Based on the physical examination, Guillain-Barré Syndrome (GBS) was suspected. This conclusion lead to a lumbar puncture with cerebrospinal fluid (CSF) analysis that confirmed the diagnosis. He …

Clinical Characteristics And Outcomes Of Covid-19: Experience At A Major Tertiary Care Center In Pakistan, Nosheen Nasir, Kiren Habib, Iffat Khanum, Naveera Khan, Zehra Abdul Muhammad, Syed Faisal Mahmood

Section of Internal Medicine

Introduction: Limited data exist on clinical characteristics and outcomes of hospitalized COVID-19 patients in low-middle income countries. We aimed to describe the clinical spectrum and outcomes of hospitalized COVID-19 patients at a tertiary-care center in Karachi, Pakistan.
Methodology: We conducted an observational study of adult COVID-19 patients hospitalized between February-June 2020. Patients with a discharge diagnosis of COVID-19 and PCR positivity were included. We created logistic regression models to understand association of clinical characteristics with illness severity and in-hospital mortality.
Results: The study population comprised 445 patients [67% males, median age 53 (IQR 40-64) years]. Majority of patients (N = …

Hemodynamic Management Of Patients With Ejection Fraction < 50% Undergoing Pulmonary Vein Ablation, Aaron B. Hesselson, Heather Hesselson

Internal Medicine Faculty Publications

There is no consensus regarding optimal methodology forblood pressure monitoring inpatients with a depressed ejection fraction undergoingcatheter ablationfor atrial fibrillation. Our goalswere to determine ifhemodynamicmanagementdifferences exist during radiofrequency ablation for atrial fibrillation in patients with and without an ejection fraction< 50%, and whether management was influenced by the utilization of invasive arterial blood pressure monitoring. This single-center trial retrospectively compared blood pressure management during catheterablation of atrial fibrillationin all patients with an ejection fraction< 50% over a 2-year span (n=44), and compared to an age-matched cohort with preserved ejection fraction ablated over the same span in time (n=44). Blood pressure was not significantly managed differently between the groups, and did not appear to be influenced by the use of invasive arterial blood pressure monitoring. Hemodynamic management is similar across the spectrum of ejection fraction, regardless of invasive arterial blood pressure monitoring, which challenges the need for invasive arterial blood pressure monitoringduringcatheter ablation ofatrial fibrillationin left ventricular systolic dysfunction.

Adrenal Insufficiency Following Intraarticular Steroid Injections, Julia Hitchcock, Ankur Gupta

Medical Student Research Symposium Abstracts and Posters

A 59-year-old woman presented with fatigue and 50 pounds weight gain in the last two years.She has been receiving triamcinolone steroid injections in both knees every three months for the last two years.She has also been receiving triamcinolone injections in ankles sporadically during this time period. Laboratory evaluation showed undetectable serum cortisol and inappropriately normal serum adrenocorticotropic hormone (ACTH). The patient underwent cosyntropinstimulation test confirming secondary adrenal insufficiency (Table 1).Magnetic resonance imaging (MRI) showed a normal pituitary gland with no tumors.She was started on hydrocortisone 10mg twice daily with improvement in fatigue.The patient was recommended to minimize steroid injections. The …

Evaluation Of Glutaminase Expression In Prostate Adenocarcinoma And Correlation With Clinicopathologic Parameters, Zin W. Myint, Ramon C. Sun, Patrick J. Hensley, Andrew C. James, Peng Wang, Stephen E. Strup, Robert J. Mcdonald, Donglin Yan, William H. St. Clair, Derek B. Allison

Internal Medicine Faculty Publications

High Glutaminase (GLS1) expression may have prognostic implications in colorectal and breast cancers; however, high quality data for expression in prostate cancer (PCa) are lacking. The purpose of this study is to investigate the status of GLS1 expression in PCa and correlated expression levels with clinicopathologic parameters. This study was conducted in two phases: an exploratory cohort analyzing RNA-Seq data for GLS1 from The Cancer Genome Atlas (TCGA) data portal (246 PCa samples) and a GLS1 immunohistochemical protein expression cohort utilizing a tissue microarray (TMA) (154 PCa samples; 41 benign samples) for correlation with clinicopathologic parameters. In the TCGA cohort, …

Efficacy Of Diabetes Self-Management Education Administered Via Telehealth For Adults With Uncontrolled Diabetes, Tanner Free

Evidence-Based Practice Project Reports

Patient’s with a diagnosis of diabetes require significant lifestyle modification and education. The need for patient education has led to the development of diabetes self-management education (DSME) classes. Unfortunately, utilization of DSME classes is only 5% among Medicare beneficiaries and 6.8% among privately insured patients (Centers for Disease Control [CDC], 2018). The purpose of this evidence-based practice (EBP) project was to implement DSME via telehealth and assist with goal formation to help patients with uncontrolled diabetes achieve glycemic control by increasing access to crucial education. The intervention consisted of bi-weekly calls for a period of 3 months. Participant data were …

The Use Of Automated Text Messaging As An Intervention For Smoking Cessation, Oluwasayo Sinkaiye

Evidence-Based Practice Project Reports

Tobacco smoking is a widespread problem that affects the adult population in the United States (U.S.). In 2018, about 14 of every 100 adults in the USA aged 18 years or older were cigarette smokers (Centers for Disease Control and Prevention [CDC], 2020). Tobacco smoking is associated with chronic disease conditions that have serious health implications including cancer, heart disease, diabetes, and chronic obstructive pulmonary disease (COPD) (CDC, 2020). The purpose of this evidence-based practice project (EBP) was to determine the effectiveness of an automated text messaging application (SmokefreeTXT) for smoking cessation in a primary care setting for adult cigarette …

Streptococcus Anginosus Lung Infection And Empyema: A Case Report And Review Of The Literature, Nishita Tripathi, Kuldeep Ghosh, Anupama Raghuram

The University of Louisville Journal of Respiratory Infections

Streptococcus milleri group (SMG) also referred to as the Streptococcus anginosus group. These are Gram-positive, variable hemolysis, catalase negative, microaerophilic, non-motile facultative anaerobes which have been known to cause abscesses in humans. We report a case of empyema caused by Streptococcus anginosus in a patient with an unresolved pneumonia for over a month. In early October 2018, the patient presented to an emergency room with the complaints of shortness of air, productive cough, chills, subjective fever and weight loss for 4 weeks. A chest X-ray revealed a left lower lobe pneumonia. He was treated with 250 mg of azithromycin for …