We present a rare case of a healthy, non-pregnant, middle-aged and immunocompetent woman who underwent laparoscopic cholecystectomy for acute cholecystitis with a post-operative course complicated by herpes simplex virus type 1 (HSV-1) hepatitis secondary to post-surgical inflammation. Her initial post-operative course was complicated by intermittent fevers, leukocytosis, jaundice, elevated transaminases, and right upper quadrant abdominal pain, and she was subsequently placed on broad-spectrum antibiotics with no improvement. During her hospital course, the patient developed herpes labialis, and HSV-1 hepatitis was confirmed by serology and HSV-1 polymerase chain reaction (PCR), in lieu of a liver biopsy. After this was discovered, the patient was placed on valacyclovir and had a successful response. The importance of this case is to emphasize the possibility of herpes simplex virus (HSV) hepatitis as a post-operative complication and the benefit of early empiric antiviral treatment.
Cancer, in general, and breast cancer in particular, is one of the noncommunicable diseases (NCDs) that is increasing rapidly in the world, especially in developing countries like Vietnam. Along with other etiological factors (e.g., genetics, family history, age, etc.), there is growing scientific evidence that exposure to environmental carcinogens, especially endocrine disrupting chemicals-EDCs (e.g., organochlorine pesticides (OCPs) and some other organic compounds), is potentially associated with increased incidence of several NCDs including breast cancer in animal and human studies. People are frequently exposed to various carcinogens, such as pesticides, in their lifetime. Organochlorine pesticides (OCPs) are frequently used worldwide as insecticides, fungicides, herbicides and termiticides, and people may be exposed to these substances at different levels due to direct and/or indirect ways. Therefore, the aim of this paper is to study the accumulation level of serum organochlorines in breast cancer in a case-control study in Vietnam. A random collection of blood samples was carried out from the cases (breast cancer patients, n=146) and controls (healthy women, n=146) with informed consent in a hospital-based case and control study. Serum was separated within 2h of blood collection and then subjected to further purification before analysis by Gas chromatography–mass spectrometry (GC-MS) method. The determination of 18 organochlorines (Aldrin, α-BHC, β-BHC, δ-BHC, γ-BHC, Heptaclor, Heptaclor epoxide, Diendrin, Endosulfan I, Endosulfan II, Endosulfan sulfat, Endrin, Endrin aldehyde, Endrin ketone, p,p’ DDD, p,p’ DDT, p,p’DDE, Methoxyclor) showed that only p,p′-DDE (as a main metabolite of p,p′-DDT) was detected in the blood samples of the cases (26.0%) and controls (10.3%). In addition, p,p′-DDT was the only pesticide detected in the disease group with low concentration (3.4%). The average concentration of p,p'-DDE in the case (3.51 ± 0.99 ppb) was higher than that in the control (1.89 ± 0.43 ppb) with a significant statistical difference (p < 0.05).
Lung cancer in women and minorities often occur at a younger age and with minimal (or absence of) tobacco use. As a result, a large proportion of these patients do not qualify for lung cancer screening in the United States despite the fact that it has been proven to reduce cancer-related mortality by 20-24%. However, in July 2020, the USPSTF proposed to loosen screening criteria to include patients who are $50 years old and have a $20 pack year history of smoking. Using CISNET modeling of subgroup data from the NLST and NELSON trials, this will potentially increase the screening eligibility from 14.1% to 20.6%-23.6%, as well as increase lung cancer deaths averted from 381 per 100,000 to 469-558 per 100,000. We propose to evaluate the potential impact of this change on our population of lung cancer patients, many of whom are women and minorities. METHODS:In this IRB-approved retrospective cohort study, the charts of 664 lung cancer patients seen at Los Angeles County Hospital and Norris Comprehensive Cancer Center from 2005-2015 were reviewed. Data on demographic information (ie, age, gender, ethnicity), smoking status, and family history of cancer were collected. A two-sample z-test for proportions was used to test for a difference in the proportion of patients eligible for lung cancer screening using the original vs. new USPSTF guidelines in the overall sample. Data was then stratified by sex and ethnicity, and a two-sample z-test for proportions was used to test for a difference in the proportion of patients eligible for screening using original vs. new guidelines for gender and ethnicity, respectively. A p-value <0.05 was considered statistically significant. All analyses were done in R version 4.0.2. RESULTS:Based on original USPSTF guidelines (age $55, $30 pack-years), only 201 patients (30.3%) would have qualified for lung cancer screening. 421 (63.5%) failed to meet eligibility criteria due to insufficient smoking history alone. However, by lowering the age requirement and smoking threshold based on the new USPSTF changes, an additional 13.2% (p=<0.001) of our patients would have qualified for screening. When stratifying by gender, we found that the revised guidelines would increase screening eligibility among men by 16.5% (p=<0.001) and women by 10.2% (p=<0.001). When stratifying by ethnicity, the revised guidelines would increase screening eligibility among Blacks by 30.2% (p=<0.001), Whites by 13.3% (p¼0.010), Hispanics by 12.5% (p¼0.012), and Asians by 8.5% (p¼0.048). CONCLUSIONS:Original USPSTF lung cancer screening criteria benefit only a narrow subset of lung cancer patients. Our study demonstrates that expanding criteria can potentially improve lung cancer survival in vulnerable subgroups, such as African-Americans and other minorities, who may otherwise not be eligible for screening.CLINICAL IMPLICATIONS: Our study shows that lowering age and smoking requirements allowed for a statistically significant increase in the number of patients screened for lung cancer across both genders, and it was espe...
Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose Board of Pharmacy Specialties (BPS) certification is endorsed to distinguish pharmacists for advanced practice areas, yet perceived value to stakeholders remains poorly described. This study characterized how board certification is integrated in hospital pharmacy departments across California. Methods A prospective, cross-sectional study was conducted in which a survey was administered to all hospital pharmacy directors in California between November 2019 and March 2020. Licensed institutions and corresponding pharmacy directors were identified from the California State Board of Pharmacy. The survey queried for institution and pharmacy director characteristics and if/how board certification was integrated. Multivariable logistic models identified predictors of institutions with at least 25% full-time board-certified pharmacists and those that reward board certification. Results Surveys were completed by 29% of institutions. Most of these institutions were urban (81%) and nonteaching (57%), with fewer than 325 hospital beds (71%), and with fewer than 50 full-time pharmacist positions (86%). The majority reported that less than 25% of their pharmacists were board certified. Currently, 47% consider board certification during hiring and 38% reward board-certified employees. Predictors of institutions with 25% or more board-certified pharmacists included being a teaching institution (odds ratio [OR], 2.96; 95% confidence interval [CI], 1.24-7.06), having 325 or more beds (OR, 7.17; 95% CI, 2.86-17.97), and having a pharmacy director who was previously or currently board certified (OR, 3.69; 95% CI, 1.46-9.35). Hospitals with 100 or more pharmacist positions predicted institutions that reward board certification (OR, 16.69; 95% CI, 1.78-156.86). Conclusion Board certification was an employment preference for almost half of the hospital survey respondents in California. Institutions more likely to reward board-certified pharmacists are larger, urban, and teaching hospitals and have pharmacy directors who have been board certified.
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