ABSTRACT
Background Breast cancer remains a pressing public health challenge in the United States, ranking as one of the most prevalent cancers and the second leading cause of cancer-related deaths among women. This study investigates the effectiveness of early mammogram screening in underserved populations. Methods Data from female patients receiving primary care at a tertiary hospital in Nashville between January 2022 and January 2023 were retrospectively analyzed. Inclusion criteria encompassed females aged 40 or older with initial mammogram screenings before turning 50. Exclusions included genetically or environmentally related risk factors, cosmetic motivations, age above 50 at first screening, and screenings prompted by physical exams. Results Of 150 eligible women aged 40-49, the majority (n=121, 80.7%) had normal findings, 18.0% (n=27) had benign lesions, and 1.3% (n=2) had suspicious/malignant lesions. About 30.7% (n=46) underwent additional testing due to suspicious masses, with ultrasounds and diagnostic mammograms being common. The breast malignancy positivity rate was 1.33% (n=2) for the study population and 4.3% among those requiring additional testing. The positivity rate for the population of Black American descent is 1% (n=2), and for the Hispanic population, it is 6.25% (n=1). Discussion Breast cancer remains a significant concern, with disparities in screening guidelines and varying age of diagnosis. Overdiagnosis and false positives are challenges, with our study highlighting potential benefits in early screening, particularly for populations with unique risk factors, such as smokers. However, the study's limitations, including a small sample size and demographic bias, necessitate larger, more diverse studies to establish stronger correlations. Shared decision-making in early mammogram screening is emphasized. Conclusion Early mammogram screening in the 40-49 age group may detect breast cancer cases, but guidelines remain inconsistent. The study recommends early screening at age 40, with awareness of potential advantages and disadvantages. Larger, more comprehensive studies are needed to inform breast cancer screening practices better.
ABSTRACT
Tinospora cordifolia (Guduchi/Giloy) is a relatively common herbal supplement whose use has recently become prominent in Southeast Asia. It was promoted to the public in India as an immunity booster, especially against the novel COVID-19. There have been reports, mostly from India, of an association between Guduchi/Giloy and liver injury. We present a 50-year-old female with a history of Hashimoto thyroiditis, who presented with abdominal discomfort and nausea of two weeks duration, which coincided with starting HistaEzeTM supplement containing Tinospora cordifolia. The vital signs upon presentation showed no significant abnormalities. Labs were significant for severely elevated transaminases; however, viral panels, autoimmune serologies, and imaging studies were unremarkable. Roussel Uclaf causality assessment method (RUCAM) score was at 6, which was indicative of probable drug/herb-induced liver injury. HistaEzeTM was discontinued, and the patient took a three-day course of oral steroids with significant interval improvement in clinical status, as evidenced by progressive normalization of the transaminases level. The transaminases decreased by greater than 50% within two weeks of discontinuation and trended back to baseline within three months. This case highlights the worldwide availability and use of Tinospora cordifolia, which can cause liver injury that appears to be idiosyncratic and possibly immune-mediated. Further research on the precise mechanism of its hepatotoxicity is warranted.
ABSTRACT
Tachycardia-induced cardiomyopathy (TIC) is gradually gaining the attention it deserves as one of the most common causes of reversible cardiomyopathy. Although TIC appears common, there has been limited data, especially among young adults. Patients with tachycardia and left ventricular dysfunction should be suspected of having TIC, with or without established etiology of heart failure, because TIC can develop by itself or contribute to cardiac dysfunction. We present a case of a previously healthy 31-year-old woman with persistent nausea and vomiting, poor oral intake, fatigue, and persistent palpitations. Vital signs at presentation were significant for tachycardia of 124 beats per minute, which she reported was similar to her baseline heart rate of 120s per minute. There were no apparent signs of volume overload at the presentation. Labs were significant for microcytic anemia with hemoglobin/hematocrit of 10.1/34.4 g/dL, and mean corpuscular volume was low at 69.4 fL; other labs were unremarkable. Transthoracic echocardiography obtained at admission was significant for mild global left ventricular hypokinesis, systolic dysfunction with an estimated left ventricular ejection fraction of 45-50%, and mild tricuspid regurgitation. Persistent tachycardia was suggested as the primary cause of cardiac dysfunction. The patient was subsequently started on guideline-directed medical therapy, including beta blockers, angiotensin-converting enzyme inhibitors, and spironolactone, with eventual normalization of the heart rate. Anemia too was also treated. Follow-up transthoracic echocardiography done four weeks after was notable for significant interval improvement in left ventricular ejection fraction of 55-60%, with a heart rate of 82 beats per minute. The case illustrates the need for early identification of TIC regardless of the patient's age. It is essential that physicians consider it in the differential diagnosis of new-onset heart failure because prompt treatment leads to the resolution of symptoms and improvement of ventricular function.
ABSTRACT
BACKGROUND: Epidemiological information paucity exists on musculoskeletal disorders (MSD) among secondary school students in Nigeria. We aimed to determine the prevalence, pattern, and treatment seeking behaviors (TSB) of MSD in Southwest, Nigeria. MATERIALS AND METHODS: A school-based cross-sectional study was conducted in four randomly selected secondary schools in Ile-Ife in 2007. All the students were screened for MSD using an interviewer-administered questionnaire and physical examination, which involved the use of a scoliometer and a goniometer. Affected children were recommended for follow-up treatment and a plain radiography taken. RESULTS: A total of 133 students had 204 MSD representing a 3.0% prevalence among the 4,441students screened. Eighty-one (60.9%) students had congenital disorders and 52 (39.1%) were acquired. The lower limbs (93.1%) were most commonly affected and 87 (65.4%) students presented with a knee deformity. Other abnormalities were limb length discrepancy 6.8%, scoliosis 4.4%, Pes planus 3.9%, and poliomyelitis 2.9%. A total of 100 students (75.2%) had no form of treatment, 18.8% receive treatment in the hospital, 3.7% received treatment in a traditional healing home and 2.3% received treatment in a church. Age, family, and school type were significant factors (P<0.05) in health-seeking behavior. The factors affecting treatment outcome were the place of treatment, hospital specific treatment, and reasons for stopping treatment. CONCLUSION: Treatable cases constitute a large proportion of MSD among secondary school students, but TSB was generally poor. Parental socio-economic and health services factors were related to the health-seeking behavior. Strengthening of school health services and improved linkage with orthopedic services, community education on MSD, and education of all cadres of health professionals are recommended.
