An Update on Racial Disparities With 30-Day Outcomes After Coronary Artery Bypass Graft Under the Affordable Care Act.

OBJECTIVE: The impact of race on outcomes after coronary artery bypass graft (CABG) has been reported before the enactment of the Patient Protection and Affordable Care Act. However, the impact of race on outcomes post-Affordable Care Act enactment remains unclear. The authors evaluated the association of race with outcomes after enactment of the Affordable Care Act in CABG patients. DESIGN: Retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program database from 2012 to 2016. SETTING: Multi-institutional. PARTICIPANTS: The authors identified 9,698 CABG patients. INTERVENTIONS: CABG. MEASUREMENTS AND MAIN RESULTS: Compared with the white population, the black/African American population had higher rates of congestive heart failure, blood transfusion, bleeding disorder, insulin-dependent diabetes mellitus, active smoking, renal dialysis, and hypertension (all p < 0.05). Compared with whites, Asians tended to have a higher prevalence of blood transfusion, American Society of Anesthesiologists class ≥4, diabetes mellitus, and renal dialysis (all p < 0.05). Postoperative red blood cell transfusion (56.5%) and prolonged hospital length of stay ≥12 days (27.7%) were the most prevalent adverse outcomes. Compared with whites, the adjusted odds of postoperative overall morbidity were higher among blacks/African Americans (odds ratio [OR]: 1.42, 95% confidence interval [CI]: 1.15-1.76, p < 0.001) and Asians (OR: 1.43, 95% CI: 1.06-1.91, p = 0.001). Compared with blacks/African Americans, Asians had higher odds of infection complications (OR: 2.07, 95% CI: 1.10-3.88, p = 0.023). CONCLUSION: Differential outcomes were observed for morbidity and mortality outcome measures. The persistence of racial disparities beyond the Affordable Care Act calls for multidisciplinary action.

[Small bowel tumors: experience at the Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán"]. / Tumores de intestino delgado: experiencia en el Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán"

BACKGROUND: Malignant tumors of the small bowel are uncommon and include multiple histologic strains, which helps explain the existing limited understanding of them. The aim of this study was to evaluate surgically treated small bowel tumors and to determine the clinical and pathological characteristics that can have an impact on patient outcome. METHODS: A retrospective, observational, and descriptive study was carried out. The case records of patients with small bowel tumor that were surgically treated at the Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán" from 1990 to August 2011 were analyzed using the SPSS version 17.0 statistical package. RESULTS: Thirty-eight small bowel tumor patients were found that had been operated on within the time frame studied. Fifteen of them were women (39.50%) and 23 were men (60.50%), and the mean age was 55.6 years. The histologic distribution was 13 adenocarcinomas (34.20%), 10 neuroendocrine tumors (26.30%), 8 sarcomas (21.10%) and 4 lymphomas (10.50%). There was an increase in the incidence of sarcomas and adenocarcinomas, whereas lymphomas and neuroendocrine tumors were evenly distributed. CONCLUSIONS: An increase in small bowel tumor incidence in the last few years was observed and adenocarcinoma was the most frequent tumor in the study population. It is important to have a high degree of suspicion for this disease when patients present with symptoms such as gastrointestinal bleeding, bowel obstruction, anemia, and weight loss, because early diagnosis is essential for guaranteeing favorable outcome.

Response to anti-VEGF therapy in macular oedema secondary to acute retinal necrosis. / Respuesta a antiangiogénicos en el edema macular secundario a necrosis retiniana aguda.

A 55 year-old female patient with unilateral Acute Retinal Necrosis (ARN) developed macular oedema (MO) after the resolution of her necrosis. The macular oedema (MO) was managed and controlled for four years with intravitreal anti-VEGF injections. Anti-VEGF therapy could be useful for the treatment of MO secondary to ARN, the same as for treating MO resulting from panuveitis, where its efficacy has been already demonstrated.