Uterine Serous Carcinoma: a rare presentation of an uncommon type of cancer

Introduction: Endometrial adenocarcinoma is the most common type of uterine cancer and is divided into two types; type 1 includes 80 percent of the cases while type 2 comprises 10 to 20 percent, with latter being more aggressive. Type 2 endometrial cancer is of serous or clear cell histology and abnormal uterine bleeding is the most common clinical presentation. This case portrays an infrequent presentation of uterine cancer. Case Presentation: A 73-year-old woman with past medical history of hypertension and diabetes mellitus type 2 presents to the emergency room with chief complaint of nausea and abdominal bloating for 2 months, associated with early satiety, decreased appetite, and weight loss of 30 pounds in over 6 months. On arrival, vitals showed T 98.2, HR 103, BP 129/72, and RR 17. Further labs demonstrated sodium 115, alkaline phosphatase 165, albumin 2.9, WBC 13.15, hemoglobin 11.7, and hematocrit 34.7. Abdominal CT scan revealed diffuse metastatic mesenteric implants. Pelvic ultrasound demonstrated multiple uterine nodules with calcifications and the presence of complex fluid within uterine cavity. Subsequently CA 125 was measured at 396 and CEA was found to be Conclusion: Physicians rely on clinical presentation and physical exam to formulate a diagnosis. However, not every patient presents with the most common clinical symptoms. It is of utmost importance for clinicians to have a high index of suspicion, particularly in the outpatient setting and when malignancy is a potential diagnosis. The goal is to use a comprehensive clinical judgement to provide competent care to the patients and make an early diagnosis. In this manner, we hope to decrease physical, mental, and emotional burden on the patients while providing a better quality of life

A case of Metastatic Lung Adenocarcinoma: A call for importance of preventive medicine

Introduction: Lung cancer is the second most common cancer and the leading cause of death by cancer in both men and women in United States. There is an estimation of over 200 thousand new cases and over 100 thousand deaths due to lung cancer in 2021. Case Presentation: A 67-year-old male with a history of COPD and smoking presents with complaint of progressive cough and exertional shortness of breath. Chest x-ray demonstrated right sided pleural effusion which was exudative in nature upon pleural fluid analysis. Samples were sent for cytology however patient left against medical advice. Two months later, the patient, now undergoing chemotherapy for metastatic lung adenocarcinoma, was readmitted for management of SOB and right sided pleural effusion. During his extensive hospital course, patient received IV antibiotics for right sided empyema and subsequently underwent VATS of right lung with Talc pleurodesis and chest tube placement in right lung for further drainage. Subsequently patient was discharged home in hemodynamically stable condition. Conclusion: Early diagnosis and treatment of lung cancer can increase the survival rate and provide a better prognosis. USPSTF recommends cancer screening in adults aged 50 to 80 years with a 20-pack year smoking history, current smokers, and those quitted within the 15 years. However, due to lack of access to healthcare, lack of awareness and education, and insufficient practice of preventive medicine many qualified individuals do not get screened for lung cancer. A focus on lung cancer screening can decrease patients’ physical, emotional, and financial burden and lessen the immense cost of lung cancer diagnosis and treatment for the healthcare system

Fecal Microbiota Transplant in a patient with multi-drug resistant clostridium difficile (MDR C.diff)

Introduction: Studies have shown MDR C. diff is the most common bacterial cause of diarrhea in resource rich settings. One of the most feared outcome of MDR C. diff infection is pseudomembranous colitis. Multiple studies indicate FMT is the most effective yet underutilized in treating recurrent C. diff. Case report: A 73 year old man presented with complaints of diarrhea and fever of 3 days duration. The diarrhea was watery, voluminous, and up to 10 times per day with associated abdominal discomfort. Patient was hospitalized twice in the last 2 months for similar complaints which were treated with oral antibiotics. On physical examination: Temperature 99.5 B/P 161/86 HR 114 and RR 20. Abdominal distention, mild tenderness and hyperactive bowel sounds. Cardiac and chest exams were unremarkable. Laboratory were significant for hypokalemia, elevated BUN and creatinine, lactic acidosis and leukocytosis. C. diff enzyme immune assay was positive for C. diff antigen and C. diff toxins A+B. Upon admission to the floor, IV fluid and electrolyte replacement began. A 10 day antibiotics regimen showed no clinical improvement. The patient’s son donated stool, and two rounds of FMT were administered via colonoscopy; improving patient’s clinical condition. Resolving leukocytosis and electrolyte abnormalities. Conclusion: FMT is strongly suggested in patients with MDR C. diff as it decreases fatal complications and hospital readmission

The role of women’s empowerment and male engagement in pregnancy healthcare seeking behaviors in western Kenya

We sought to understand whether women’s empowerment and male partner engagement were associated with use of antenatal care (ANC). Women presenting for ANC in Nyanza province of Kenya between June 2015 and May 2016, were approached for participation. A total of 137 pregnant women and 96 male partners completed baseline assessments. Women’s empowerment was measured using the modified Sexual Relationship Power Scale. ANC use measures included timing of the first ANC visit and number of visits. Male engagement was based on whether a husband reported accompanying his wife to one or more antenatal visits during the pregnancy. Multiple linear and logistic regression analyses were used to identify factors independently related to use and timing of ANC. Women with higher mean empowerment scores were likely to have more than one ANC visit in the index pregnancy [Adjusted Odds Ratio (AOR) = 2.8, 95% Confidence Interval (CI): 1.1–7.3], but empowerment was not associated with early ANC use. Women who were more empowered were less likely to have a husband who reported attending an ANC visit with his wife (AOR = 0.1, 95% CI: 0.03–0.8). Women’s empowerment is important and may be related to ANC use and engagement of male partners in complex ways