Idiopathic granulomatous mastitis (IGM) is an infrequently reported benign breast disease of unknown etiology. Surgical treatment has been widely advocated but can be disfiguring. We describe demographic and clinico-pathologic features of women with IGM in a safety net hospital, and evaluate steroid therapy as a breast-conserving modality of treatment. We also examine a possible ethnic predominance in Hispanic women. We conducted an observational prospective cohort study of all women with biopsy-proven granulomatous mastitis in the breast clinics of an urban safety net public hospital from 2006 to 2010. Demographic, ethnic and clinical data, treatment history, and response to treatment were collected. Patients were followed up prospectively to determine the type of treatment prescribed, complete resolution of disease, and median time to resolution. A nested case-control study was conducted to examine Hispanic prevalence using chi-square statistic. The mean age was 35 years. 80% were Hispanic. 80% presented with a painful breast mass. 59% initially received antibiotics with incomplete resolution. 90% women were prescribed oral steroids, 3% underwent surgical treatment, and 6% remained under observation with spontaneous resolution. Of those who received steroid, 80% had complete resolution of disease with a median time to complete resolution of 159 days (IQR 120-241 days). Ethnicity data in a nested case-control study revealed that women in the IGM group were more likely to be Hispanic than in the control group with an odds ratio of 3 (95% CI 1.42-6.24, p-value 0.0032). IGM is a benign but locally aggressive breast disease. Treatment with steroids is an effective breast-conserving option. Predominance in Hispanic women of childbearing age suggests a common genetic, environmental, immunologic, or infectious etiology and warrants further study with a multi-disciplinary approach.
Background: Despite increasing numbers of MDR TB cases seen in Nepal, a lot remains to be understood about the disease in the local context. We evaluated possible risk factors for MDR TB among patients enrolled for treatment at a district hospital in western Nepal. Methods:A descriptive case-series study using structured interviews and abstraction of treatment records of all patients registered at the DOTS Plus clinic at Bhim Hospital, Bhairahawa from April 2008 to Dec 2008 was done. Descriptive analysis was done to find out frequencies and relations.Results: Of the total 31 patients, 22 were males (age range 18-68, median 36.7) and the remaining 9 females (age range 23-56, median 33.7). 27(87%) of the patients had monthly income below Rs 3000 and 24 (77%) of them were illiterate. 21(67%) had missed at least a few weeks of drugs during their previous treatment and 4 (13%) had been marked as defaulters. 6 (20%) had treatment failure. 74% of the patients were smokers, 2 were HIV positive. 20 (58%) had lived in India for at least 6 months where they had incomplete treatment of TB. 30 (97%) patients had disclosed their MDR status to their families; however 70% said they did not do so immediately. Conclusions:Previous TB treatment, male sex, poverty, migration to India, illiteracy and smoking have been observed in a majority of the cases in this study. These findings need to be corroborated with multi-centre casecontrol studies to bring out nationally relevant risk factors for MDR TB.
Background: The uterus is the vital organ of female reproductive system which holds the fetus during pregnancy. Diseases of uterus has been broadly grouped into inflammatory, benign and malignant lesions. In our study hysterectomy specimens were studied and results were compared with their clinical diagnosis. Primary aim of our study was to correlate the histopathological features of the disease with its clinical diagnosis. Material & Methods: This was a retrospective study and included 277 hysterectomy specimens received over 2 year periods. Patient data was retrieved from the medical records and histopathology requisition form which included age, clinical findings, histopathological diagnosis, indication of hysterectomy and type of hysterectomy done. Histopathological findings from the cervix, endometrium, myometrium, ovaries and fallopian tubes of each and every hysterectomy specimen were noted. Result: A total of 277 cases were analyzed. Patient's age ranged from 16 to 85 years thus included reproductive age group, perimenopausal and post-menopausal women. In our study most common indication for hysterectomy was abnormal uterine bleeding in 33.9 % cases followed by fibroid in 22% cases. The commonest chief complaint was heavy menstrual bleeding in 35.0% cases followed by abdominal pain in 32.5% cases. Majority of the patients were in 36-45year age group. Conclusion: Majority of the hysterectomy cases post-operatively were consistent with the clinical diagnosis, histopathological examination is still the gold standard test to diagnose and rule out malignancy and compulsory for all the surgical specimens.
Cardiovascular disease (CVD) is the leading cause of death and remains a major cause of health disparities. The underuse of prevention strategies and suboptimal control of risk factors could partially explain the increased CVD burden. We conducted a study to assess the prevalence of major cardiovascular risk factors and cardiovascular disease among vulnerable population in a general medical clinic (GMC) of a safety net hospital. A retrospective chart review of patients was conducted in GMC at John Stroger Hospital. Patients were selected using a random sampling method over two weeks and demographic, clinical and laboratory data was collected. Major CVD risk factors were defined based on current national guidelines. Hypercholesterolemia and dyslipidemia were defined as total cholesterol ≥240mg/dl, or LDL ≥160mg/dl, or HDL <40mg/dl (for persons with and without diabetes) or receiving cholesterol-lowering medication. Hypertension was a blood pressure (BP) ≥140/90 mmHg, or receiving antihypertensive medication. Obesity was defined as a BMI of 30 or greater. Diabetes mellitus was a fasting plasma glucose ≥126mg/dl, 2-hour-postload plasma glucose ≥200mg/dl, an HgbA1c ≥6.5%, or use of antihyperglycemic medications. Smoking was defined as currently smoking cigarettes. Prevalence of CHD and stroke was ascertained based upon the physician’s problem list. Of 255 charts, 5 were excluded from analysis because of missing data. The mean age was 61; 57% were women, 59% were African American. The overall prevalence of hypercholesterolemia was 57 % among men (62 of 108) and 56% (80 of 142) among women; with the highest among African American. Overall, 92 out of 108 (85%) of men and 116 out of 142 (82%) of women had hypertension; prevalence was respectively 60% (55 of 92) and 68% (79 of 116) for African American men and women. About 48 out of 108 (44%) of men were obese and among women overall prevalence of obesity was 52% (74 of 142). Overall, 50 out of 108 (49%) of men and 73 out of 142 (51%) of women had diabetes. The overall prevalence of smoking was 11% (27 of 250) and ranged from 10% (14 of 142) among women to 12% (13 of 108) among men. Overall, 10% (11 of 108) of men had an adverse level of any 1 major risk factor only; 26% (28 of 108) and 59% (64 of 108) had any 2 only or 3 or more risk factors. Among women, 16% (23 of 142) had 1 risk factor only; 25% (36 of 142) and 54% (76 of 142) had 2 or 3 or more risk factors. The overall prevalence of CHD and stroke was, respectively, 18% (19 of 108) and 1% (1 of 108) for men and 9% (13 of 142) and 10% (14 of 142) for women. In conclusion, findings from the study demonstrate the pervasive burden of CVD risk factors in vulnerable groups compared with the national trends. These data may enhance the impetus to implement interventions to lower burden of CVD risk factors among overall and targeted at-risk groups, as well as develop strategies to prevent future development of adverse CVD risk factors starting at the youngest age.
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