Antibiotics are essential treatments, especially in the developing world like World Health Organization (WHO) Southeast Asian region where infectious diseases are still the most common cause of death. In this part of the world, antibiotics are purchased and used without the prescription of a physician. Self-medication of antibiotics is associated with the risk of inappropriate drug use, which predisposes patients to drug interactions, masking symptoms of an underlying disease, and development of microbial resistance. Antibiotic resistance is shrinking the range of effective antibiotics and is a global health problem. The appearance of multidrug-resistant bacterial strains, which are highly resistant to many antibiotic classes, has raised a major concern regarding antibiotic resistance worldwide. Even after decades of economic growth and development in countries that belong to the WHO Southeast Asian region, most of the countries in this region still have a high burden of infectious diseases. The magnitude and consequence of self-medication with antibiotics is unknown in this region. There is a need for evidence from well-designed studies on community use of antibiotics in these settings to help in planning and implementing specific strategies and interventions to prevent their irrational use and consequently to reduce the spread of antibiotic resistance. To quantify the frequency and effect of self-medication with antibiotics, we did a systematic review of published work from the Southeast Asian region.
Tuberculosis of the colon commonly involves the ascending,transverse, or sigmoid colon while rectal involvement in tuberculosis is uncommon and poorly characterized. We report a six-year-old male from Nepal who presented with abdominal pain and difficulty passing stool for two years. On per rectal examination, palpation revealed a circumferential rectal mass. On further evaluation, CT scan showed mural thickening and luminal narrowing in the ano-rectum. Colonoscopy with biopsy showed caseating granuloma and positive acid fast bacilli culture consistent with tuberculosis. After starting anti-tubercular therapy, the patient's abdominal pain resolved and the patient was able to pass stool normally within two weeks. Colonoscopy three months after starting treatment showed complete resolution of the mass. Gastrointestinal tuberculosis should be considered in cases of children from endemic areas who present with a rectal mass.
6541 Background: Prostate cancer remains the most commonly diagnosed cancer and the second leading cause of cancer-related death in men in the United States. BronxCare Health System (BCHS) serves the Bronx neighborhoods of Morris Heights, Fordham South, and Mount Hope, notable for the highest prostate cancer incidence rate in New York City as per the American Cancer Society Cancer Action Network report 2019, highlighting the need for prostate cancer screening among the patient population we serve. An anonymous voluntary paper survey was performed in 2019 at BCHS to determine primary care physician understanding and implementation of current PSA testing guidelines. The study showed that primary care providers at BCHS approach PSA testing in a wide variety of ways and screen a wide age range of patients suggesting a need for intervention. An electronic medical record (EMR) decision support tool activated during primary care visits for men aged 55-69 years was implemented beginning January 1, 2021 which facilitates the provider and patient engagement in a shared decision-making discussion. This a follow-up study to determine the effect of this EMR application on PSA order rates and prostate cancer diagnosis rates at BCHS. Methods: The total number of patients who had PSA and lipid panel (LP) screening were extracted from the EMR of BCHS for potentially eligible men (aged 55-69) seen during primary care visits during the years 2016-2022. LP is done annually as a part of routine screening for adults aged 55-69 and is taken as an equivalent of primary care visits. PSA screening rates were compared to LP screening rates to control for unforeseen variables. Similarly, the number of newly-diagnosed prostate cancers among the same population of men was extracted for the years 2016-2021. Data for 2022 is still not available. 2016-2020 are pre-EMR and 2021 and 2022 are post-EMR flag years. The pre and post-EMR flag PSA and prostate cancer diagnosis numbers were compared by calculating Z scores and p-values. Results: The year-wise PSA, LP, and newly-diagnosed prostate cancers (PC) are tabulated below. The proportion of men who had PSA testing among all men aged 55-69 who had LP testing in each pre-EMR flag year was compared to each post-EMR flag year. A significant increase (p < 0.00001) was noted in the proportion of men who had PSA screening after implementation of the EMR application. Similarly, the proportion of men with newly-diagnosed prostate cancer among all men aged 55-69 who had PSA screening significantly increased after EMR application (p < 0.00001). Conclusions: A decision support tool embedded in the EMR has been an effective approach in increasing prostate cancer screening rates and may help curb prostate cancer mortality in our patient population as early detection in right men at the right age has the potential to reduce prostate cancer mortality. [Table: see text]
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