Collaborative Integration of Community Health Workers in Hospitals and Health Centers to Reduce Pediatric Asthma Disparities: A Quality Improvement Program Evaluation.

To address pediatric asthma disparities on the South Side of Chicago, a community health worker (CHW) home visiting intervention was implemented collaboratively by academic institutions and community based health centers. This evaluation assessed the effectiveness of this longitudinal quality improvement CHW intervention in reducing asthma morbidity and healthcare utilization. All patients aged 2-18 who met the high-risk clinical criteria in outpatient settings or those who visited the ED due to asthma were offered the program. A within-subject study design analyzed asthma morbidity and healthcare utilization at baseline and follow-up. Multivariable mixed-effects regression models, adjusted for baseline demographic and asthma characteristics, were used to assess changes over time. Among 123 patients, the average age was 8.8 (4.4) years, and 89.3% were non-Hispanic black. Significant reductions were observed in the average daytime symptoms days (baseline 4.1 days and follow-up 1.6 days), night-time symptoms days (3.0 days and 1.2 days), and days requiring rescue medication (4.1 days and 1.6 days) in the past two weeks (all p < 0.001). The average number of emergency department visits decreased from 0.92 one year before to 0.44 one year after program participation, a 52% reduction (p < 0.001). No significant difference was found in hospital admissions. These results support the use of a collaborative approach to implement the CHW home visiting program as part of standard care for pediatric asthma patients in urban settings. This approach has the potential to reduce asthma disparities and underscores the valuable role of CHWs within the clinical care team.

Adequacy of Surgical Pathology Reports of Colorectal Carcinoma and Its Significance.

Introduction Colorectal cancer is the fifth most common cancer in the world. For loco-regionally confined disease surgery is the definitive treatment. An adequate surgical pathology report is mandatory for the selection of adjuvant therapy. The objective of this study is to analyze whether adequate information is provided or not in the surgical pathology reports of colorectal carcinoma as according to College of American Pathologists (CAP) guidelines. Method This is a cross-sectional study carried out in the Department of Clinical Oncology, Jinnah Postgraduate Medical Center (JPMC) Karachi, tertiary care hospital in Pakistan. The duration of the study was from February 2020 to January 2021. A total of 153 surgical pathology reports issued by 11 different hospital-based laboratories after definitive surgery was assessed to look at its concordance rate with the checklist adapted from the CAP guidelines. Results Out of 153 surgical pathology reports, clinical information was provided in 72.5% of reports. Details of tumor extension were present in 88.2%, tumor margin in 75%, surgical procedure in 79%, and tumor deposits in 39.2% of reports. Macroscopic details including tumor perforation and evaluation of mesorectum were documented in 51.6% and 53.5% of the reports respectively. Details regarding perineural invasion along with lymphovascular invasion were present in 81.6% and 93% of the reports, respectively. The treatment effect was documented in only 25% of reports and regional lymph node status has been described in 85% of reports. Parameters described in all surgical pathology reports were: tumor site, tumor type, histologic type, and histologic grade. The pathological stage of the disease was documented in 91.5% of the reports. Conclusion This study concluded that surgical pathology reports of the majority of pathology laboratories were not fully adhered to the checklist provided by the CAP guidelines. This will affect post-operative management along with the prediction of disease prognosis.

Incidence of Ewing's Sarcoma in Different Age Groups, Their Associated Features, and Its Correlation With Primary Care Interval.

Introduction Primary care interval is the time duration from a patient's first presentation to the final diagnosis. Ewing's sarcoma is a rare small round blue cell bone tumor originating from neuroectoderm and undifferentiated neuroepithelial cells, having an annual incidence of approximately one case per million in the United States. In this study, we analyzed the age pattern among patients diagnosed with Ewing's sarcoma undergoing management, along with associated features including involved site, regional lymphadenopathy, and distant metastasis at the time of presentation and their correlation with the primary care interval. Methods This is a cross-sectional study carried out at the Oncology department of a Tertiary Care Government Hospital in Karachi, Pakistan. The duration of our study was from January 2020 to December 2020. During this period, all patients with proven diagnosis of Ewing's sarcoma between ages 10 years and 65 years were included in the study. All the participants of the study were divided into groups, based on the age and site of the tumor. Results A total of 895 cases of bone cancer were reported. Among these, 147 cases (16.4%) had Ewing's sarcoma. Of these patients, 88 were male (60%) while 59 (40%) were female. The mean age of patients was 18.9 ± 3.2 years. Ewing's sarcoma most commonly occurred during 15 to 20 years of age. The most common region involved was lower limb (n=76, 52%) followed by upper limb (n=63, 43%) followed by pelvis (n=8, 5.4%). Conclusion The peak time for the occurrence of Ewing's sarcoma is from 15 years to 20 years of age. Regional painful swelling is the most common presenting feature in our study population. Factors causing a prolonged primary care interval include early age of onset, non-specific clinical presentation, and insufficient knowledge of the primary care physician, which results in poor prognosis. Hence, it is important to consider Ewing's sarcoma as a differential on the first presentation especially in the high-risk age group.

A Case of Polyautoimmunity: Celiac Hepatitis, Grave's Disease and Autoimmune Hemolytic Anemia.

Celiac disease (CD) is an autoimmune disorder with high incidence of multi organ involvement; especially, gastrointestinal manifestations and an increased risk of malignancies. Here we report a case of CD with celiac hepatitis, autoimmune hemolytic anemia (AIHA) and Grave's disease (GD) with their complications. Polyautoimmunity requires comprehensive analysis. While CD and GD were previously diagnosed, AIHA and cirrhosis were diagnosed during admission upon extensive work-up. Similarly, other autoimmune etiologies, such as autoimmune hepatitis (AIH), and/or primary biliary cholangitis were ruled out. All three diseases were treated afresh with strict adherence to a gluten-free diet (GFD) and carbimazole along with addition of medications for cirrhosis complicated by ascites. This was a rare case where non-adherence to a GFD led to such severe adverse events. A case of celiac hepatitis presenting with such a wide array of signs and symptoms has rarely been reported in the literature and the management of this patient was unique and challenging.

Primary Squamous Cell Carcinoma of the Ovary.

Primary squamous cell carcinoma (SCC) is a rare entity that usually arises from the malignant transformation of a mature cystic teratoma, an endometrioma, or a Brenner tumor. The de novo occurrence of the pure variety in the absence of a prior lesion is the rarest type, and it arises from the metaplasia of the surface epithelium of the ovary. Because of its rarity, a definitive treatment protocol for treatment is not yet available. We present a case of pure primary SCC of the ovary that was managed by surgery followed by chemotherapy.

Case Report: Sarcoidosis in the lymph nodes of a breast cancer patient.

Background: Sarcoidosis is an inflammatory disease that affects multiple organs in the body, especially the lungs and lymph nodes. The coexistence of sarcoidosis and breast cancer has been reported, but the coexistence of both diseases in the same patient often leads to misdiagnosis. Case: We report a case of a 36-year-old woman who presented with concerns of a lump in her left breast along with pain and discharge from the nipple. On examination a 3-cm hard and tender mass was noted in the upper medial quadrant of the left breast with no palpable axillary lymph nodes. The patient was diagnosed with an infiltrating ductal cell carcinoma of the left breast with T2N0M1 Stage IV disease, due to positive mediastinal lymphadenopathy on positron emission tomography scan. The biopsy of mediastinal lymph nodes allowed us to diagnose sarcoidosis and correctly stage her disease as T2N0M0 Stage IIA breast cancer. The patient underwent lumpectomy followed by adjuvant chemo radiotherapy and hormonal therapy - corticosteroids given for sarcoidosis up to 1 year. The patient is doing well 18 months later without recurrence of disease. Conclusion: The simultaneous occurrence of both diseases in the same patient is the risk for misdiagnosis and mismanagement, therefore it is of utmost importance to correctly stage the disease with appropriate investigations and histologic confirmation prior to initiate the treatment for breast cancer.

Knowledge of Chikungunya Fever Among Medical Students of Jinnah Sindh Medical University, Karachi, Pakistan.

Objective Chikungunya is a viral disease characterized by severe arthralgia, fever, rash, muscle pain, and neurological symptoms. Warm and humid weather, poor sanitary conditions, and improper water storage and disposal can lead to an uncontrolled outbreak of the Chikungunya virus in South Asia. Because a vaccine against the Chikungunya virus has not yet been developed, we must rely on appropriate awareness and suitable preventive measures to prevent its spread. A review of the literature shows that knowledge of the Chikungunya virus among medical students in Karachi is scarce. Because medical students are future medical practitioners, they should be adequately aware of this growing issue. Materials and methods We performed a single-center, cross-sectional study at the Jinnah Sindh Medical University in Karachi, Pakistan, in which 200 students were assessed on their knowledge of the Chikungunya virus and fever via a structured questionnaire. Results A total of 200 students participated in the study. The mean age of the study participants was 20 ± 1 years. Only 50% of the study participants had an adequate knowledge score related to the Chikungunya virus and fever. We found that 43% had an average knowledge, and 7% had poor knowledge. The study also revealed a strong association between year of study and knowledge score (p=0.003); those in the higher age group had more knowledge (p=0.014). Conclusion A low percentage of medical students have sufficient knowledge about Chikungunya virus and fever, which is alarming because Pakistan has recently faced a severe epidemic of Chikungunya virus fever and is a country prone to further outbreaks. Multiple training programs and lectures are necessary to prepare and educate medical students about both basic and clinical knowledge of Chikungunya.

Bilateral Posterior Vitreous Detachment in a Young Patient with Systemic Lupus Erythematosus.

Vitreous detachment is a rarely reported manifestation of systemic lupus erythematosus (SLE). We present here the case of a 20-year-old woman with a history of SLE who presented with a decrease in vision in both eyes, massive hepatosplenomegaly, and multiple joint pain. B-scan ultrasonography revealed bilateral vitreous detachment. Ocular involvement in SLE is associated with high disease activity and morbidity. Therefore, ophthalmological screening for ocular involvement is important for SLE patients at any age.

Acute Myeloid Leukemia with Occult Systemic Mastocytosis or Atypical Mast Cells Post-induction.

Systemic mastocytosis (SM) is a state of disease that is related to the clonal, neoplastic proliferation of mast cells. Patients who present with SM-Acute Myeloid Leukemia (AML) often have the worst outcome. We present a case of an 18-year-old female who was diagnosed with AML (FLT3 (Fms like tyrosine kinase 3) and PML-RARA (promyelocytic leukemia-retinoic acid receptor alpha) translocation-negative) and after initial treatment with a standard induction regimen of cytarabine and daunorubicin (3+7 regimen), her bone marrow showed blast cells less than 5% and dense aggregates/sheets of atypical/immature mast cells with immunohistochemical stain CD117+ve and toluidine blue positive in mast cell aggregates. Mastocytosis is a clonal neoplastic proliferation of mast cells that accumulate in one or more organ system. Therefore, it is essential to diagnose systemic mastocytosis, particularly in patients of hematological neoplasms.