Social Determinants and COVID-19 in a Community Health Center Cohort

Associations between social determinants of health (SDOH), demographic factors including preferred language, and SARS-CoV-2 detection are not clear. We conducted a retrospective cohort study among those seeking testing for SARS-CoV-2 at a multi-site, urban community health center. Logistic regression and exact matching methods were used to identify independent predictors of SARS-CoV-2 detection among demographic, SDOH, and neighborhood-level variables. Of 1,361 included individuals, SARS-CoV-2 was detected among 266 (19.5%). Logistic regression demonstrated that SARS-CoV-2 detection was less likely in White participants relative to Hispanic participants (adjusted odds ratio [aOR] 0.18, 95% confidence interval [CI] 0.05–0.46). and more likely in patients who prefer Spanish relative to those that prefer English (aOR 2.04, 95% CI 1.43–2.96). No observed SDOH predicted SARS-CoV-2 detection in adjusted models. A robustness analysis using a matched subset of the study sample produced findings similar to those in the main analysis. Preferring to receive care in Spanish is an independent predictor of SARS-CoV-2 detection in a community health center cohort.

     

Granulosa cell tumor and mucinous cystadenoma arising in a mature cystic teratoma of the ovary: A unique case report and review of literature

Mature cystic teratoma of the ovary, though it contains derivatives of all three embryonic germ cell layers, rarely presents together with ovarian epithelial or sex cord-stromal tumors. Only a few cases of ovarian cystic teratoma in association with granulosa cell tumor have been reported in the literature, and simultaneous occurrence of mucinous cystadenoma and granulosa cell tumor is even rarer. To our knowledge, there has never been a report of mature cystic teratoma of ovary coexisting with granulosa cell tumor and mucinous cystadenoma. We report a case of mature cystic teratoma, mucinous cystadenoma, and granulosa cell tumor in the ovary of a 40-year-old woman. The involved ovary, massively enlarged by a multiloculated cyst, showed a hair-sprouting mass with a yellow-tan nodule embedded in the cyst wall. Microscopically, three tumor types were revealed: mature cystic teratoma, mucinous cystadenoma, and granulosa cell tumor.     

An indolent case of T-prolymphocytic leukemia with t(3;22)(q21;q11.2) and elevated serum beta2-microglobulin

We report a novel case of T-prolymphocytic leukemia, small cell variant, associated with complex cytogenetic findings including t(3;22)(q21;11.2) and elevated serum beta2-microglobulin. The diagnosis is based on morphologic, immunophenotypic, cytogenetic, and molecular analysis of peripheral blood and bone marrow. In contrast to most reported cases of T-prolymphocytic leukemia, this patient did not present with lymphadenopathy or organomegaly. Moreover, only a moderate leukocytosis (25.3 x 10(3)/microL) was evident at presentation. In the absence of any specific treatment, the patient is doing well, with a stable white blood cell count 12 months following presentation. Further investigation may be warranted to determine whether the unusual cytogenetic findings and elevated serum beta2-microglobulin are associated with the indolent clinical course in this patient.     

Pulmonary vascular calcification in a nocturnal hemodialysis patient

Although vascular calcification in end-stage renal disease (ESRD) is common, metastatic pulmonary calcification (MPC) is an under-recognized complication of ESRD with the majority of individuals being asymptomatic. Similar to calcification in other arterial vascular beds, elevated serum calcium and phosphate appear to be potent risk factors although the exact pathogenesis of MPC remains largely unclear. Nocturnal hemodialysis (NHD) is a form of renal replacement therapy that offers superior control of serum phosphate and uremia compared to conventional (3 times weekly) intermittent hemodialysis and shows promise in delaying the progression of vascular calcification. Here, we report the first case of MPC involving the pulmonary vasculature in a patient treated with nocturnal hemodialysis and discuss the epidemiology, pathogenesis, histology and natural history of MPC.     

Attitudes of Asian medical students towards smoking.

BACKGROUND--There have been numerous studies on smoking habits among young adults in developed countries. Similar data from developing countries are scanty. METHODS--A survey of medical students from one of the medical colleges in Pakistan assessed their smoking habits and attitudes towards smoking. In June 1993 a coded survey questionnaire was sent to each medical student at The Aga Khan Medical University in Karachi requesting data on their smoking habits, their attitudes towards smoking in various areas of the hospital, and their views about passive smoking and tobacco publicity. RESULTS--Of 324 medical students, 89% responded of whom 11% were current smokers. The incidence of smoking was greater among male students than females (17% versus 4%). The average age of initiation of smoking was 17 years and the major influence was friends. There was an increased awareness of harmful effects of smoking among medical students. Almost all felt that passive smoking was injurious to health. CONCLUSION--The prevalence of current smokers among Asian medical students was found to be 11%. Females smoked less than their male counterparts. There has been an increased awareness of the hazards of passive smoking among the medical students and most were in favour of legislative actions to discourage tobacco advertising.     

Cystic echinococcosis: late rupture and complication of a stable pulmonary cyst

Cystic echinococcosis is observed worldwide. Traditional management includes an invasive surgical approach with adjunctive chemotherapy. It has been suggested that observation alone may be appropriate in asymptomatic individuals with stable cysts. A case involving a 38-year-old Peruvian man with an asymptomatic bronchogenic cyst (suspected to be due to echinococcus, but never definitely diagnosed) is presented. The cyst was first noted in 1998, and was followed for 10 years during which time he remained asymptomatic with minimal radiographic change. One year later, in 2009, he presented with acute rupture of the cyst causing empyema. The patient required thoracotomy, decortication and resection of the ruptured cyst. Final pathology showed Echinococcus organisms. The patient responded well to treatment with albendazole and praziquantel, and became completely asymptomatic within six months. The present case demonstrates that echinococcal cysts may be at risk of spontaneous rupture, even after many years of clinical stability, thus supporting the case for resection of asymptomatic cysts suspected of being echinococcal at the time of diagnosis. In addition, the case illustrates that medical therapy with albendazole and praziquantel, in conjunction with surgical drainage, can be successful in the treatment of echinococcal empyema.     

Role of curcumin on chloroquine phosphate-induced reproductive toxicity

The present study was conducted to screen the efficacy of curcumin against chloroquine phosphate (CQ)-induced reproductive toxicity in adult male Swiss albino mice. Animals were given oral doses of 100, 200, 300?mg/kg body weight (b.w.), and high dose of CQ (300?mg/kg b.w.) + curcumin (80?mg/kg b.w.) for 45 days. Animals of the withdrawal group were given high dose of CQ (300?mg/kg b.w.) for 45 days and, at day 46, were kept for another 45 days. Effects were observed on some key enzymes, such as alkaline phosphatase, which was found to be decreased, whereas acid phosphatase was increased and succinate dehydrogenase and adenosine triphosphatase were decreased. Oxidative parameters, such as superoxide dismutase declined, whereas thiobarbituric acid-reactive substances were found to be elevated. Protein level was also decreased. Gravimetric indices were also recorded. Results obtained indicated adverse effects of CQ in a dose-dependent manner. The presence of curcumin with CQ alleviated its toxic effects. Hence, it can be concluded that curcumin has beneficial influences and appears able to ameliorate CQ toxicity.     

Prospective randomized comparison of tropisetron with and without dexamethasone against high-dose metoclopramide in prophylaxis of acute and delayed cisplatin-induced nausea and vomiting

Several studies have confirmed the efficacy of high-dose metoclopramide and, more recently, serotonin antagonists, with and without dexamethasone, in the prophylaxis of cisplatin-induced nausea and vomiting. Most of these trials have been reported from Western countries. There is little or no information about the efficacy and tolerability of these agents in ethnic groups in other countries. Furthermore, many patients in the developing countries cannot afford serotonin antagonists. The result is a critical need to evaluate these agents and justify their increasingly common use. The authors performed a prospective randomized trial to compare the efficacy and tolerability of tropisetron with and without dexamethasone against high-dose metoclopramide cocktail in patients receiving a uniform dose of cisplatin (100 mg/m2). Metoclopramide 2 mg/kg was combined with clemastine, dexamethasone, and lorazepam. These drugs were initially repeated at short intervals and subsequently given in the oral form for the next 5 days. Tropisetron 5 mg was administered intravenously 15 minutes immediately before cisplatin therapy and followed up with oral therapy for 5 days. The third group received the same doses of tropisetron along with dexamethasone before cisplatin and twice daily thereafter. The authors randomized 301 episodes. The patient characteristics were well balanced between the three groups. Acute nausea and vomiting were completely prevented in almost two thirds of patients receiving metoclopramide and tropisetron plus dexamethasone. These results are significantly superior to those of tropisetron alone (p < 0.01). Similarly, delayed nausea and vomiting were significantly better controlled with metoclopramdie cocktail and tropisetron plus dexamethasone than with tropisetron alone. Side effects were generally mild; however, they were more frequent with metoclopramide. The authors conclude that metoclopramide-based combination antiemetic therapy continues to be a cheaper alternative to serotonin antagonists and equally effective. Metoclopramide-based therapy, however, is more labor intensive, and issues related to administrative errors, side effects, and compliance gain increasing importance. The identification of persons at a higher risk for metoclopramide-induced side effects may help minimize the unacceptable consequences of therapy.     

Paradoxical inflammatory reaction to Seprafilm: case report and review of the literature

This report describes a paradoxical inflammatory reaction to Seprafilm caused by extensive adhesion formation early in the postoperative period. A female patient had development of small bowel obstruction immediately after an uneventful low anterior resection for rectal carcinoma with placement of Seprafilm. The obstruction did not improve with nonoperative therapy. At laparotomy, extensive adhesions necessitating bowel resection and ileostomy were noted. Pathology results showed a giant cell foreign body reaction to Seprafilm. A literature search yielded only two other instances of adverse reactions to Seprafilm. The information provided by this and other atypical reports suggests that further studies aimed at identifying the incidence and pathophysiological mechanisms for such paradoxical reactions are needed.