The NYC Department of Health implemented a patient navigation program, Check Hep C, to address patient and provider barriers to HCV care and potentially lifesaving treatment. Services were delivered at two clinical care sites and two sites that linked patients to off-site care. Working with a multidisciplinary care team, patient navigators provided risk assessment, health education, treatment readiness and medication adherence counseling, and medication coordination. Between March 2014 and January 2015, 388 participants enrolled in Check Hep C, 129 (33%) initiated treatment, and 119 (91% of initiators) had sustained virologic response (SVR). Participants receiving on-site clinical care had higher odds of initiating treatment than those linked to off-site care. Check Hep C successfully supported high-need participants through HCV care and treatment, and SVR rates demonstrate the real-world ability of achieving high cure rates using patient navigation care models.
Deaths attributable to hepatitis C (HCV) infection are increasing in the USA even as highly effective treatments become available. Neighborhood-level inequalities create barriers to care and treatment for many vulnerable populations. We seek to characterize citywide trends in HCV mortality rates over time and identify and describe neighborhoods in New York City (NYC) with disproportionately high rates and associated factors. We used a multiple cause of death (MCOD) definition for HCV mortality. Cases identified between January 1, 2006, and December 31, 2014, were geocoded to NYC census tracts (CT). We calculated age-adjusted HCV mortality rates and identified spatial clustering using a local Moran's I test. Temporal trends were analyzed using joinpoint regression. A multistep global and local Poisson modeling approach was used to test for neighborhood associations with sociodemographic indicators. During the study period, 3697 HCV-related deaths occurred in NYC, with an average annual percent increase of 2.6% (p = 0.02). The HCV mortality rates ranged from 0 to 373.6 per 100,000 by CT, and cluster analysis identified significant clustering of HCV mortality (I = 0.23). Regression identified positive associations between HCV mortality and the proportion of non-Hispanic black or Hispanic residents, neighborhood poverty, education, and non-English-speaking households. Local regression estimates identified spatially varying patterns in these associations. The rates of HCV mortality in NYC are increasing and vary by neighborhood. HCV mortality is associated with many indicators of geographic inequality. Results identified neighborhoods in greatest need for place-based interventions to address social determinants that may perpetuate inequalities in HCV mortality.
The geographic variation in HCC highlights the need for neighborhood-targeted interventions to address risk factors and barriers to care. The clusters of HCC by viral hepatitis status may serve as a basis for healthcare policymakers and practitioners to prioritize neighborhoods for cancer screening and control efforts.
Subcutaneous metastasis from a visceral malignancy is rare with an incidence of 5.3%. Skin involvement as the presenting sign of a silent internal malignancy is an even rarer event occurring in approximately 0.8%. We report a case of a patient who presented to her dermatologist complaining of rapidly developing subcutaneous nodules which subsequently proved to be metastatic colon cancer, and we provide a review of the literature.
A 65-year-old male with complaints of lump in left breast since 2 years. CT scan findings were non-homogeneous mass in left breast along with bilateral axillary lymphadenopathy. Lumpectomy was performed and diagnosed as infiltrating duct carcinoma breast. After that, we received modified radical mastectomy specimen in our lab. On gross examination, subareolar cavity was surrounded by whitish solid area of 2 cm without involvement of skin. Total 26 lymph nodes were retrieved. Lymph nodes were whitish and fleshy {Fig. 1}. The resection specimen was fixed in formalin, routinely processed and multiple representatives of 3-micron sections were stained with haematoxylin and eosin stain and Immunohistochemistry (IHC) was also performed. Microscopic examination showed the features of infiltrating duct carcinoma NOS: Modified Nottingham Bloom Richardson's Grade II in breast specimen. All the lymph nodes were submitted for processing and H and E stained sections taken from all the submitted lymph nodes showed the complete effacement of lymph node by small lymphocytes having slightly irregular round nuclei. The chromatin was condensed, and cytoplasm was scanty [Fig. 3]. None of the lymph nodes showed any metastatic deposits. Peripheral smear of patient showed features of chronic lymphocytic leukaemia (absolute lymphocyte count was 16400 cells/mm 3) [Fig. 5]. IHC of breast tumour showed ER/ PR positivity with H score of 350 and 240 respectively and HER-2/ Neu protein expression was negative with score of 1+ [Fig. 2]. Lymph nodes were immunoreactive for CD 19, CD 23 and for CD 5. Cells were non-reactive for Cyclin D1 a and CD3 [Fig. 4]. FINAL DIAGNOSIS IDC breast Stage II B with Small lymphocytic lymphoma and chronic lymphocytic leukaemia.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.