ABSTRACT
Sarcoidosis is a systemic granulomatous disease of unknown etiology with the potential to involve many organs of the body. Less than 1% of patients with sarcoidosis have GI manifestations. Here, we report a case of GI tract sarcoidosis that presented with severe symptomatic anemia. A 51-year-old female with a history of pulmonary and liver sarcoidosis presented to the emergency room with a one-week history of chest pain and shortness of breath. A physical exam was significant for conjunctival pallor. On admission, her hemoglobin was 6.9 g/dL. Her iron studies showed anemia of chronic disease. There was no evidence of recurrent pulmonary sarcoidosis on the CT scan of the chest. Transthoracic echo showed no abnormal wall motion movements. A nuclear stress test was negative for perfusion defects. She underwent esophagogastroduodenoscopy (EGD) and colonoscopy to further evaluate potential sources of active GI tract blood loss. Biopsies of gastric mucosa and small bowel revealed non-caseating granulomas. Immunohistochemical stains for acid-fast bacilli and fungus were negative. Random biopsies of erythematous mucosa from the colonoscopy were unremarkable. The patient's history of pulmonary and liver sarcoidosis along with non-caseating granulomas found in the gastric mucosa and small bowel suggest GI tract sarcoidosis manifestations. She was started on corticosteroids with complete resolution of symptoms in five months. Clinical presentation varies widely based on the specific organ involvement, as well as the underlying pathophysiology of the organ damage. The pathogenesis of sarcoidosis is poorly understood and attributable to both genetic and environmental factors. Overall, the treatment of sarcoidosis is not standardized. It is primarily driven by the effect of sarcoidosis on the patient's symptoms and quality of life. However, symptomatic sarcoidosis usually responds well to corticosteroids. We believe that clinicians should maintain a high level of vigilance for patients with a known history of sarcoidosis and new symptoms, as these might signal sarcoid involvement of a new organ and help guide the diagnostic and treatment process.
ABSTRACT
OBJECTIVE: To gather preliminary insights through formative research on social media usage, and experiences, attitudes and perceptions around COVID-19 and COVID-19 vaccination in three high-risk, underserved districts in Karachi, Pakistan. DESIGN: Cross-sectional mixed-method design. PARTICIPANTS: 392 adults (361 surveys and 30 in-depth interviews (IDI)) from districts South, East and Korangi in Karachi, Pakistan. MAIN OUTCOME MEASURES: Social media usage and knowledge, perception and behaviour towards COVID-19 infection and vaccination. RESULTS: Using social media was associated with an increased probability of getting vaccinated by 1.61 units. Most of the respondents (65%) reported using social media, mainly to watch videos and/or keep in touch with family/friends. 84.76% knew of COVID-19 while 88.37% knew about the COVID-19 vaccination, with 71.19% reported vaccine receipt; reasons to vaccinate included belief that vaccines protect from the virus, and vaccination being mandatory for work. However, only 56.7% of respondents believed they were at risk of disease. Of the 54 unvaccinated individuals, 27.78% did not vaccinate as they did not believe in COVID-19. Despite this, 78.38% of respondents scored high on vaccine confidence. In IDIs, most respondents knew about COVID-19 vaccines: 'This vaccine will create immunity in your body. Therefore, I think we should get vaccinated', and over half knew how COVID-19 spreads. Most considered COVID-19 a serious public health problem and thought it important that people get vaccinated. However, there was a low-risk perception of self as only a little over half felt that they were at risk of contracting COVID-19. CONCLUSION: With our conflicting results regarding COVID-19 vaccine confidence, that is, high vaccine coverage but low perception of risk to self, it is likely that vaccine coverage is more a result of mandates and coercion than true vaccine confidence. Our findings imply that interactive social media could be valuable in fostering provaccine sentiment.
