Esophageal cancer is a disease with high mortality. This is mainly due to late presentations with nonspecific symptoms. Despite advances in surgery and chemoradiotherapy, it is the eighth most common cancer but the sixth deadliest. It is reportedly common in older patients but rare in young ones. In this case report, we present a 29-year-old male patient with no prior medical condition who presented with hematemesis to the emergency unit and was found to have esophageal cancer with the biopsy. Not only is esophageal cancer rare in young adults, but hematemesis is a rare symptom in esophageal cancer patients.
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 HistaEze TM 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. HistaEze TM 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.
Background: Disparities are well-documented in the time spent seeking medical care in the US. Studies have found that minority populations are likely to have longer wait times securing healthcare access and higher total time spent at clinic visits. However, this relationship has not been previously examined among the cancer survivor population, which constitutes about 17 million people in the US. Methods: Study data were derived from the 2018 National Health Interview Survey, a nationally representative survey of US adults. Study sample was restricted to cancer survivors (n=2,940; N=23,310,174). The primary outcome of this study was reports of prolonged wait times during doctor office visits. Weighted multivariable logistic regression were used to estimate adjusted associations between prolonged wait times during doctor office visits and sociodemographic and behavioral characteristics of cancer survivors. All analyses were conducted using STATA version 14.2. Results: Respondents who identified as Black/African American were almost 3 times more likely than their White counterparts to report prolonged wait times during doctor office visits (aOR 2.65, 95% CI; 1.296, 5.419). Similarly, respondents who identified as Hispanic were almost 3 times more likely than non-Hispanic respondents to report prolonged wait times during doctor office visits (aOR 2.604, 95% CI; 1.347, 5.035). Respondents in the $50,000 - $74,999 income bracket were less likely to report prolonged wait times during doctor office visits than respondents who earned less than $35,000 (aOR: 0.50, 95% CI, 0.276, 0.916). Conclusion: Black/African American and Hispanic cancer survivors had increased odds of reporting prolonged wait times during doctor office visits. Disparities in cancer health and survivorship are well documented among racial minorities. Addressing disparities in healthcare experiences and access will be crucial in dispelling existing cancer health disparities. Citation Format: Onyema Chido-Amajuoyi, Ikenna Nnamani, Owhofasa Agbedia. Disparities in physician office visit wait time among US cancer survivors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 751.
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