Hepatoblastoma in a patient with Goldenhar Syndrome

Goldenhar Syndrome (GS), also known as oculo-auricular vertebral syndrome, is a congenital defect that occurs in 1 of 5,000 births characterized by the underdevelopment of the ears, soft palate, lip, and mandible due to an anomaly of the first and second branchial arches. Hepatoblastoma is the most common primary liver tumor in the pediatric population. However, it is still considered a rare malignancy because liver cancers only account for 1% of childhood cancers. Most children with hepatoblastoma are asymptomatic, however we describe a 2-year-old girl with Goldenhar Syndrome diagnosed with hepatoblastoma after experiencing abdominal pain and constipation. Findings from the case can further support the argument for an association between Goldenhar Syndrome and hepatoblastoma

Quality Improvement Project to Increase Hepatitis C Virus Screening for Ambulatory GME Internal Medicine Clinic Patients

Background: In 2020, CDC established new guideline expanding Hepatitis C virus (HCV) screening to all adults aged 18 to 79 years. Our QI project objective is to enhance HCV screening amongst the UTRGV-DHR IM department by establishing suitable reminders and educational sessions. Methods: We reviewed HCV screening status of all adult patients 18 to 79 years old from June 1st 2020 to December 1st 2020. We then provided one lecture on the new screening recommendation from CDC 2020 guideline. We also encouraged residents to educate patients on the importance of HCV screening, and to identify and overcome barriers against screening. We then measured HCV screening performed from March 1st 2021 to May 1st 2021. The primary objective is to increase HCV screening in the ambulatory setting by 50%. Results: Among 843 patients from June 1st 2020 to December 1st 2020, 219 patients were screened for HCV (26%). The results from March 1st 2021 to May 1st 2021 was 190 out 548 patients (35%). The difference was significant with p-value of 0.0005 using Chi-square statistical analysis. Conclusions: Even though we did not achieve our primary objective, HCV screening performance in our clinic had increased significantly from 26% to 35%. With this positive result, we will continue to enhance awareness among the residents by implementing didactic lectures to support evidence –based medicine practice about HCV screening. It is also important to identify the drawbacks of HCV screening including stress on patients and their family, future costs and side-effects of further testing and treatments