Evaluating SARS-CoV-2 Saliva and Dried Blood Spot Surveillance Strategies in a Congregate Population.

The optimal approach to COVID-19 surveillance in congregate populations remains unclear. Our study at the US Naval Academy in Annapolis, Maryland, USA, assessed the concordance of antibody prevalence in longitudinally collected dried blood spots and saliva in a setting of frequent PCR-based testing. Our findings highlight the utility of salivary-based surveillance.

Disease staging according to international scoring system in newly diagnosed patients with multiple myeloma.

OBJECTIVE: To determine the frequency of disease staging according to international scoring system in patients who are newly diagnosed with Multiple Myeloma (MM) at a tertiary care hospital at Karachi. METHODS: This single center, non probability consecutive, cross sectional study was conducted from Nov 11, 2015 to May 11, 2016. After taking informed written consent, detailed history was taken and serum ß2 microglobulin and albumin levels were checked to assess the study outcome variable i.e. stage of MM. All the collected information was entered in the prescribed performa. RESULTS: Eighty newly diagnosed patients with multiple myeloma as per inclusion criteria were included. Sixty seven (83.75%) were male and 13(16.25) were females, with mean age of 58.35+10.077 years. Twenty seven patients (33.75%) were found to have stage-I disease, in 23 (28.75%) stage-II and stage-III in 30 (37.5%). CONCLUSION: Multiple myeloma is relatively common in 5th decade, with male predominance. International Staging System have great potential for characterizing and stratifying multiple myeloma and revealed a predominance of advanced stage III disease in our setting.

An Investigation of Mucosal Leishmaniasis in the Military Health System.

Leishmaniasis is a protozoal infection with an increased risk of transmission to those serving in the U.S. Military due to theaters of operation in endemic regions. There has, in recent decades, been robust experience with old-world leishmaniasis in the Military Health System (MHS); however, new-world leishmaniasis, which may result in mucosal leishmaniasis, has been less studied. A total of 88 patients from 2012 to 2022 with diagnosis codes for "mucocutaneous leishmaniasis" or "leishmaniasis, unspecified" were identified in the Military Data Repository and reviewed. Within this cohort, upon medical records review, there were 2 cases of leishmaniasis that met inclusion criteria. Case 1 was a 28-year-old active duty male with recent travel to Belize who presented with a mucosal lip lesion that was biopsied and had inconclusive species confirmation but was thought to be either L. braziliensis or L. mexicana. The second case involved a 30-year-old active duty male with a history of travel to French Guiana who had a cutaneous lesion on his left hand that was identified as L. guyanensis, a causative species for mucosal leishmaniasis. Neither had evidence of any further mucosal involvement on otolaryngologic evaluation, and both subsequently received systemic therapy with a good clinical response. Although only 2 cases were identified over an 11-year period, this disease remains an important medical consideration when conducting military operations within Central and South America, as both cases had recent military-specific travel to areas endemic for leishmaniasis.

Pre-operative peritoneal drainage as a part of resuscitation in severe peritonitis.

The objective of this prospective observational study was to evaluate the benefits of peritoneal drainage under ultrasonic guidance in cases of severe peritonitis. Fifty cases with peritonitis were included in this study, who were unfit for general anaesthesia, i.e. American Society for Anesthesiologists (ASA) IV plus. The results showed improvement in general condition of the patients in the terms of improved respiration, decreased abdominal distension and circulation. Thus, it was concluded that peritoneal intubation dramatically decreases abdominal distension. Drainage of septic fluid decreases the sepsis, resulting in improvement of organ functions. This procedure has been found to be beneficial and helpful as a supportive procedure in cases where immediate major surgical procedures like laparotomy are not possible due to comorbidities and unstable general condition.

Concordance Between Clinical and Pathological Response Assessment After Neo-Adjuvant Chemotherapy in Patients With Invasive Lobular Carcinoma.

Background Neo-adjuvant chemotherapy (NAC) is frequently administered in breast carcinoma patients. The clinical response to NAC guides further treatment. The pathological response is not only an independent prognostic factor, but it also guides further treatment and prognosis. Objectives The aim of our study was to find the degree of concordance between clinical and pathological response assessments after NAC in Invasive lobular Carcinoma (ILC) cases by using World Health Organization (WHO) criteria and different pathological systems, respectively. We also tried to identify any useful parameter of clinical assessment that could better correlate with pathologic assessment and provide a better estimation of residual tumor. Methods This retrospective study was conducted on 26 ILC tumors diagnosed in 24 patients who were treated with NAC followed by surgical resection between January 2009 and December 2020. Medical records and microscopy glass slides were reviewed for clinical and pathological response assessments, respectively. Results The pre-treatment tumor area ranged from 1.8-255 cm2 and the mean±SD was 52.2±66.8 cm2. After NAC, complete clinical response was observed in four (15.3%) cases. The clinically assessed mean tumor area significantly reduced from 52.2±66.8 cm2 to 17.2±22.6 cm2 (p-value<0.001). The pathologically assessed mean tumor area (27.4±24.1 cm2) didn't differ significantly from the clinically assessed mean tumor area (17.2±22.6 cm2) (p-value=0.114). Pathologically, the majority of the cases showed partial response, and a complete pathological response was achieved in only two (7.7%) cases. The concordance rates between clinical assessment by the WHO method and pathological assessment of the breast using the Sataloff method, Miller-Payne (MP) system, Residual Cancer Burden system, and Chevallier method were 26.7%, 15.8%, 9%, and 3.5%, respectively, with insignificant p-values. Percentage reduction in clinical size and percentage reduction in tumor cellularity differed significantly (p-value=0.038). Conclusion Clinical response assessment provides a less accurate estimation of residual disease, as it shows poor concordance with pathological assessment using different assessment systems/methods.