Atypical Presentation of Interval Colorectal Cancer/Post-Colonoscopy Colorectal Cancer in a Nursing Home Patient

The Centers for Disease Control and Prevention estimates that there are around 1.7 million beds in certified nursing homes across the United States and approximately 1.3 million residents in long-term and end-of-life care. There could be several factors causing a delayed recovery in such patients, such as decreased ambulation, multiple comorbidities, and polypharmacy.

An 83-year-old Caucasian woman sustained a fall resulting in compression fractures of the thoracic and lumbar spine. She had multiple comorbidities, including anemia of chronic disease, malnutrition, and a significant weight loss of 30 lbs over the four months prior to hospitalization. She was on antihypertensives, antidepressants, vitamin D, and calcium supplementation. Her medical history was significant for constipation with the passage of stools once in three days. Her family history was significant for colorectal cancer (CRC) and her screening colonoscopy three years ago was normal. Physical examination revealed no abdominal tenderness or distention. Subsequently, she developed edema in the left lower extremity. She underwent a venous Doppler/ultrasound study, which showed an occlusive thrombus from the common femoral vein to the popliteal vein. She was started on anticoagulants and supportive therapy. Four months later, while at the nursing home, she developed bloating and flatulence, in addition to pre-existing constipation. Examination revealed a 6 x 7 cm mass in the right lower quadrant without peritoneal signs. Bowel sounds were significantly decreased. CT imaging showed a 6-cm diameter cecal mass. The tumor was a low-grade 4 x 9 cm T4N0M0 cecal cancer, and she underwent placement of a Greenfield filter and subsequent hemicolectomy. She had methicillin-resistant Staphylococcus aureus infection and right upper extremity deep vein thrombosis (DVT), urinary tract infection, Clostridium difficile colitis, and depression, all managed successfully and without sequelae in the post-operative period. Treatment on discharge comprised Coumadin maintenance for nine months with an international normalized ratio goal of 2-3, a back brace, antidepressants, and antihypertensive medications. She received follow-up care at home.

Maintaining a high degree of suspicion for new and persistent symptoms in the elderly is essential to identify the underlying cause. One of the leading causes of post-colonoscopy CRC is a missed lesion. Careful attention to all cases of anemia as well as DVT in the elderly is also imperative to diagnose such missed cases. Future research should focus on the methods of CRC diagnosis in elderly patients with comorbidities apart from using colonoscopy alone.

Opportunistic Infections in COVID-19: A Systematic Review and Meta-Analysis

The prevalence, incidence, and characteristics of bacterial infections in patients infected with severe acute respiratory syndrome coronavirus 2 are not well understood and have been raised as an important knowledge gap. Therefore, our study focused on the most common opportunistic infections/secondary infections/superinfections in coronavirus disease 2019 (COVID-19) patients.

This systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Eligible studies were identified using PubMed/Medline since inception to June 25, 2021. Studies meeting the inclusion criteria were selected. Statistical analysis was conducted in Review Manager 5.4.1. A random-effect model was used when heterogeneity was seen to pool the studies, and the result was reported as inverse variance and the corresponding 95% confidence interval.

We screened 701 articles comprising 22 cohort studies which were included for analysis. The pooled prevalence of opportunistic infections/secondary infections/superinfections was 16% in COVID-19 patients. The highest prevalence of secondary infections was observed among viruses at 33%, followed by bacteria at 16%, fungi at 6%, and 25% among the miscellaneous group/wrong outcome.

Opportunistic infections are more prevalent in critically ill patients. The isolated pathogens included Epstein-Barr virus, Pseudomonas aeruginosa, Escherichia coli, Acinetobacter baumannii, Hemophilus influenza, and invasive pulmonary aspergillosis. Large-scale studies are required to better identify opportunistic/secondary/superinfections in COVID-19 patients.

A culturally adapted, social support-based, diabetes group visit model for Bangladeshi adults in the USA: a feasibility study

Background

Interventions focused on weight loss can prevent, delay, and improve management of type 2 diabetes (T2D). However, implementation of these programs is challenging in diverse populations. South Asians have higher risk for T2D, yet to date, there have been limited programs for this community in the USA. The aim of this project was to develop and test the feasibility of a tailored group visit model for Bangladeshis with type 2 diabetes (T2D) or prediabetes based in primary care.

Design

Mixed-methods single-arm feasibility study.

Setting

An academic health center-based primary care clinic in Atlanta, Georgia.

Participants

Bangladeshi adults > 18 years old with T2D or prediabetes

Methods

In conjunction with a community-academic board, we conducted focus groups to tailor an existing evidence-based curriculum to a culturally acceptable intervention. Fourteen participants enrolled in the 16-week program focusing on healthy diet, exercise, and weight loss. The primary feasibility outcomes were number of sessions attended and participant satisfaction with the intervention. Weight, blood pressure, cholesterol, and HbA1C were measured at beginning and end of study. Participants were asked to evaluate each session on level of satisfaction. One tailed paired t tests were used to test significance of pre-post changes in outcomes.

Results

Key themes from the formative focus groups (n = 50) were closely tied to sociocultural beliefs and included: dietary patterns, physical activity perceptions, and healthcare access concerns. In the intervention, 10 of 14 participants had baseline and follow-up data. Participant attendance averaged 50%. Statistically significant reductions in mean weight (− 2%, 95%CI: − 3.1, 0.2 kg), systolic/diastolic blood pressure (− 12.7 mmHg [95%CI: − 23.2, − 2.2]/− 3.7 mmHg [95%CI: − 7.6, − 0.1], respectively), and triglycerides (− 62.6 mg/dl, 95%CI: − 123.1, − 2.0) were noted. Overall, participants reported high levels of satisfaction with the program.

Conclusion

A lifestyle program based in primary care is feasible and acceptable for Bangladeshi immigrants. Larger studies testing the effectiveness of group programs, in primary care, to improve cardiometabolic factors are important.

Trials registration

ClinicalTrials.gov; NCT03861546. Registered 28 February 2019.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40814-022-00974-9.