JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY
WHATCAMEFIRST:THEOVARYORTHELYMPHOCYTE?
HOMELESS HEALTH IN NEW ORLEANS: DO STUDENT CLINICS CONNECT PATIENTS TO LONG-TERM CARE? A. Brug; M. Gregersen; G. Green; S. Mayer; J. Kanter, MD, MPH; C. Jones, MD Department of Internal Medicine, Tulane Health Sciences Center, New Orleans Background: Tulane University School of Medicine operates Student Run Free Clinics (SRFCs) serving underserved populations throughout greater New Orleans. Patients are regularly referred to Health Care for the Homeless (HCH), a Federally Qualified Health Center (FQHC). The factors associated with referral and establishment of sustained care at HCH are unknown. This study aims to characterize Tulane SRFCs' role in linking New Orleans underserved to HCH. Method: Using a secure online database, students at SRFCs collect demographics, health risk factors, key objective findings, and treatment plans following each patient visit. This study included all individuals in the database from homeless shelter clinics between 10/2016 to 9/2017. In collaboration with HCH, patients referred to HCH were tracked for appointment attendance, both prior to referral and within 90 days of being referred. Study population was characterized; referral rates were assessed relative to a variety of disease and demographic variables. Results: 146 patients met study criteria. The population was 93.9% homeless, 90.3% male, with an average age of 51.2 years (±11.6). Patients were 60.0% African American and 37.9% Caucasian. Of the 30.8% (n=45) of patients referred to HCH, 22% (n=10) had been to HCH prior and 31.1% (n=14) followed up within 90 days. No patients who followed up within 90 days had been to HCH before. Successfully referred patients attended between 1 and 5 appointments within 90 days, an average of 1.76 appointments (±1.01) with 57.1% attending multiple appointments. Using a significance threshold of 0.1 and controlling for all other disease and demographic factors, patient with younger age (p=0.041) and/or history of illicit drug use (p=0.067) were less likely to receive a referral. Patients given Acetaminophen (p=0.065) were more likely to receive a referral. Patients with a high-school diploma (p=0.019), psychiatric diagnosis (p=0.010) or prescribed Inhaled Bronchodilator/ Corticosteroids (0.047) were more likely to attend follow-up appointments at HCH. Conclusion: Despite barriers to care, some (31.1%) referred patients do attend appointments at HCH within 90s days. Although this proportion could be improved, the majority (57.1%) who successfully follow up achieved some degree of longitudinal care. This suggests that SRFCs can act as a bridge connecting underserved patient populations with long-term medical care. Predictive factors provide the opportunity to understand and improve patient SRFC patient care.
H. Oddo Moise; A. Coulon, MD; J. Doan, MD; S. Sanne, DO Department of Medicine, LSU Health Sciences Center, New Orleans, LA Case: A 31-year-old woman with history of daily IVDU and untreated Hepatitis C presented to the emergency department with three months of non-specific progressive ailments including left knee pain, shortness of breath with exertion and three-pillow orthopnea, twelve pound weight loss, abdominal “tightness” greatest in the left lower quadrant, early satiety, dysphagia to liquids and solids, left axillary node swelling and bilateral supraclavicular lymph node swelling. She denied fever, chills, night sweats, recent travel, sick contacts or family history of cancer. Chest CT showed a substantial left pleural effusion with lobulated pleural thickening and mediastinal and hilar lymphadenopathy consistent with sarcoma versus metastatic disease. Subsequent abdominal and pelvic CT showed enlarged retroperitoneal lymph nodes of the left pelvis and groin with a solid mass in the left deep pelvis concerning for ovarian malignancy, metastatic disease, lymphoma or sarcoma. Transvaginal ultrasound revealed a solid left adnexal mass measuring 5.6x3.4x5.2 cm. Workup was begun to ascertain the primary site of malignancy suspicious for lymphocyte versus ovarian source. A right supraclavicular lymph node biopsy was performed during which she was intubated for increasing left pleural effusion with compression of mediastinal structures. Thoracentesis was performed with removal of 1.5 L of blood- tinged pleural fluid and a chest tube was placed. Flow cytometry of the lymph node biopsy showed 95.6%T lymphoblasts positive for CD2, CD3, CD7, TdT and CD99 consistent with the diagnosis of Non-Hodgkin T-cell lymphoblastic lymphoma. CA125 was mildly elevated at 47, not suggestive of ovarian malignancy. Despite numerous attempts at discussing the importance of a bone marrow biopsy and cancer treatment options, the patient declined all medical intervention or palliative resources. Discussion: Malignant lymphoma involvement of the female genitourinary tract, including the ovary, is not commonly seen. While ovarian involvement is relatively rare, non-Hodgkin Lymphomas such as T cell lymphoblastic lymphoma (T-LBL) represent a frequency of approximately 7 to 26% of those diagnoses and shouldbe considered in the differential diagnoses of young females with ovarian masses.
60 J La State Med Soc VOL 170 MARCH/APRIL 2018
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