Colorectal Cancer Screening Knowledge and Practices Among Practicing Obstetrician-Gynecologists and Residents.

Background: Colorectal cancer (CRC) is the second leading cause of cancer death in the US, the third most diagnosed cancer in women, and the second leading cause of cancer death in women. The aims of our study are to (1) investigate knowledge of and adherence to CRC screening guidelines by obstetrician-gynecologists (Ob/Gyns) and (2) assess whether this knowledge/adherence vary by demographic and practice characteristics. Methods: An anonymous cross-sectional survey was distributed to a convenience sample of 142 practicing Obs/Gyns drawn from National Medical Association section members/conference attendees and hospital Ob/Gyn department members. Results: Most respondents (80.3%) viewed colorectal screening within the scope of Ob/Gyn practice, and 71.8% used the American College of Obstetricians and Gynecologists guidelines for screening. Most respondents were knowledgeable regarding CRC screening but not in all areas. On average they only identified half of the 10 risk factors listed and only one-quarter correctly identified the age when screening can stop. Residents were somewhat more knowledgeable about screening guidelines and risk factors than attendings. More than half of respondents (57.8%) reported always initiating CRC screening for the appropriate age and risk factors. Respondents identified education and awareness (56.3%) and patients' unwillingness to undergo an invasive procedure (75.4%) as barriers to screening. Conclusions: Knowledge regarding CRC screening was less than optimal and differed by attending/resident status. Greater emphasis should be placed on CRC screening and guidelines training for primary care providers like Ob/Gyns. Some of this could be accomplished through maintenance of certification and continued integration into residency education.

Young-Onset Colon Cancer: A Case Report.

Colorectal cancer (CRC) which is diagnosed in patients under the age of 50 years is defined as young-onset CRC. There has been a substantial increase in the incidence and mortality of young-onset CRC in the past four decades and the patients have delayed diagnoses leading to the advanced stages of CRC at the time of diagnosis. Here we present a case of a 34-year-old male patient with colon cancer and a literature review on young-onset colon cancer to highlight the age-related disparities in CRC incidence and try to explore the possible causative factors for the rise in incidence and mortality in young patients due to CRC.

A Rare Case of Esophageal Leukoplakia in Achalasia.

Esophageal leukoplakia refers to a clinical finding of a white patch on the mucous membrane surface that cannot be scraped off. It has been associated with alcohol and tobacco use and chronic acid reflux. An association with squamous cell dysplasia and carcinoma has been reported with potential for malignant transformation warranting endoscopic intervention or surveillance, but no guidelines exist. We present a case of a 77-year-old female with a history of longstanding achalasia requiring multiple Botox injections. After presenting with weight loss, esophageal dysphagia, and acid reflux the patient underwent an esophagogastroduodenoscopy (EGD) showing a 20 mm white plaque in the middle third of the esophagus and histopathology consistent with esophageal leukoplakia. After repeated Botox injection and treatment with PPI and H2 blocker, no findings of esophageal leukoplakia were noted on repeat EGD. With this case, we aim to increase awareness of this rare disease pathology, especially in the setting of underlying achalasia. This case also raises the question if maximum anti-reflux therapy could have a potential benefit in avoiding the recurrence of esophageal leukoplakia.

A Case of Megaesophagus Secondary to a Massive Phytobezoar in a Patient With Achalasia.

Bezoar is a rare entity that is composed of indigested foreign material and is most commonly seen in the stomach. Phytobezoars are the most common type of bezoars and are composed of indigestible cellulose and lignin from fruits and vegetables. We present a unique case of esophageal phytobezoar, which was seen in a patient with long-standing achalasia. The patient presented to the gastroenterology clinic complaining of decreased appetite as she had worsening dysphagia, weight loss, vomiting on eating food. An endoscopy revealed a large phytobezoar that was extending along the whole length of the esophagus. There was stenosis at the gastroesophageal (GE) junction. The phytobezoar was dissolved with carbonated soda lavage and the remainder of the phytobezoar was fragmented with water irrigation and rescue net via the endoscope and fragments were retrieved. Botulinum was injected at the GE junction in all four quadrants which resulted in a relaxation of the stenosis. Untreated long-standing esophageal phytobezoars can lead to life-threatening complications like perforation. Endoscopic modalities with carbonated soda lavage is an efficacious mode of treatment. Surgical interventions are recommended in case of endoscopic modality failure.

Non-Bleeding Colonic Ulcer as Initial Manifestation of Disseminated Cryptococcosis in a Patient With Human Immunodeficiency Virus.

Cryptococcosis is an invasive mycosis caused by Cryptococcus sp. Its presence is described closely with immunosuppressive states. Once it has reached the body, it has shown a predilection for two sites: the lungs and the central nervous system. Nonetheless, since it has hematogenous dissemination, it can colonize and yield disease at any organ. Hence, a patient will typically present with constitutional symptoms including fever, malaise, and weight loss, associated with cough, shortness of breath, chest pain, or associated headache, drowsiness, and meningeal irritation signs. We illustrate here one of the uncommon non-pulmonary non-cerebral forms of the disease of cryptococcosis, a newly diagnosed HIV/AIDS patient with a non-bleeding colon ulcer, who lacks respiratory or central nervous system (CNS)-related symptoms but endorses non-specific gastrointestinal complaints. The first evidence of the disease was the elevated cryptococcal antigen (CrAg). The direct visualization of the spores in the biopsy confirmed the infection.

Helicobacter pylori Resistance to Triple Therapy in a Multicultural Population in New York City.

INTRODUCTION: Helicobacter pylori infection (HPI) has become a worldwide concern due to its associations with intestinal and extraintestinal disease including cancer, autoimmune phenomena, and vitamin deficiencies. HPI has been found to affect Hispanics at higher rates compared with non-Hispanics in the USA. Hispanics comprise most of the patient population at Metropolitan Hospital in New York City. Growing concerns about antibiotic resistance led to the reconciliation of treatment guidelines with the consensus of bismuth quadruple therapy as the first-line treatment, replacing clarithromycin-based triple therapy. We conducted a retrospective study to explore the resistance rate of Helicobacter pylori to triple therapy in patients at Metropolitan Hospital. OBJECTIVE: To explore the resistance rates of Helicobacter pylori in infected patients treated with clarithromycin-based triple therapy in Metropolitan Hospital over a five-year period. MATERIALS AND METHODS: Charts of all patients who underwent upper endoscopy during a five-year period were retrospectively reviewed. Overall, 2000 patients were screened for presence of HPI. We included 322 patients with a demonstrated HPI obtained from biopsies taken during upper endoscopy within the study period. Inclusion criteria were patients older than 18 years old with positive HPI who were prescribed therapy. Exclusion criteria were patients with positive HPI who did not receive treatment for the infection and patients without a confirmatory diagnosis of infection. We further reported on three groups based on the implemented therapy. Each treated group was divided into three subgroups based on eradication testing. Treatment compliance was documented. The patient population was demographically characterized by ethnicity, age at diagnosis, body mass index (BMI), and sex. RESULTS: Of the 322 patients included in the study, 258 were Hispanics (80%). The eradication rate among patients treated with selected clarithromycin-based therapies was found to be statistically significant when compared with other HPI therapies. There was no statistically significant difference between the studied group with respect to age, sex, ethnicity, and BMI. In the group of patients with suspected clarithromycin resistance, antimicrobial sensitivity testing was ordered in one case. DISCUSSION: HPI varies with race and ethnicity. Within the USA, the prevalence is lowest among non-Hispanics. Ethnicity and age, sex, and BMI were not factors that impacted treatment outcomes. We found that triple therapy with a proton pump inhibitor, amoxicillin, and clarithromycin (PAC) was used as a first-line treatment, consistently showing a low rate of resistance. The eradication rate among patients treated with PAC was found to be statistically significant when compared with all other therapies. It is significant for the hospitals with limited resources, where initial treatment follows the "test-and-treat" strategy. Quadruple therapy as the first-line treatment raises concerns about medication costs, insurance coverage, side effects, and dosing, which may have a significant impact on patient compliance. CONCLUSION: Our study showed that selected clarithromycin-based therapies were superior for HPI eradication when compared with non-clarithromycin-based triple therapy in low-resistance communities. Culture with antimicrobial susceptibility testing was used in a de minimis number of cases, which raises awareness for future study.

Clinical significance of discordant positive hepatitis C virus transcription-mediated amplification following end of treatment response.

BACKGROUND: Polymerase chain reaction (PCR) assays are the standard for detecting hepatitis C virus viremia. The transcription-mediated amplification (TMA)-based assay is more sensitive. METHODS: We retrospectively reviewed the charts of patients with a post-end of treatment (EOT) PCR-/TMA+ result to assess the clinical significance of a positive TMA result after a PCR negative EOT response or sustained viral response (SVR). Patients were divided into Group 1: PCR-/TMA+ after EOT response but during 24 week follow-up (n = 4); and Group 2: PCR-/TMA+ after SVR (n = 11). RESULTS: All Group 1 patients achieved SVR. No Group 2 patients became PCR positive or had a rise in ALT. The TMA subsequently became negative in 6/7 patients with follow-up evaluation. CONCLUSIONS: A discordant positive TMA post-EOT response or SVR did not seem to be clinically significant. This finding supports the possibility that patients with SVR have an acquired immune surveillance that prevents low-level viremia from progressing to clinical relapse.