Molecular and Sociodemographic Colorectal Cancer Disparities in Latinos Living in Puerto Rico.

BACKGROUND: The incidence of sporadic colorectal cancer (CRC) among individuals <50 years (early-onset CRC) has been increasing in the United States (U.S.) and Puerto Rico. CRC is currently the leading cause of cancer death among Hispanic men and women living in Puerto Rico (PRH). The objective of this study was to characterize the molecular markers and clinicopathologic features of colorectal tumors from PRH to better understand the molecular pathways leading to CRC in this Hispanic subpopulation. METHODS: Microsatellite instability (MSI), CpG island methylator phenotype (CIMP), and KRAS and BRAF mutation status were analyzed. Sociodemographic and clinicopathological characteristics were evaluated using Chi-squared and Fisher's exact tests. RESULTS: Of the 718 tumors analyzed, 34.2% (n = 245) were early-onset CRC, and 51.7% were males. Among the tumors with molecular data available (n = 192), 3.2% had MSI, 9.7% had BRAF, and 31.9% had KRAS mutations. The most common KRAS mutations observed were G12D (26.6%) and G13D (20.0%); G12C was present in 4.4% of tumors. A higher percentage of Amerindian admixture was significantly associated with early-onset CRC. CONCLUSIONS: The differences observed in the prevalence of the molecular markers among PRH tumors compared to other racial/ethnic groups suggest a distinct molecular carcinogenic pathway among Hispanics. Additional studies are warranted.

The interplay between infection risk factors of SARS-CoV-2 and mortality: a cross-sectional study from a cohort of long-term care nursing home residents.

BACKGROUND: Covid-19 pandemic has particularly affected older people living in Long-term Care settings in terms of infection and mortality. METHODS: We carried out a cross-sectional analysis within a cohort of Long-term care nursing home residents between March first and June thirty, 2020, who were ≥ 65 years old and on whom at least one PCR test was performed. Socio-demographic, comorbidities, and clinical data were recorded. Facility size and community incidence of SARS-CoV-2 were also considered. The outcomes of interest were infection (PCR positive) and death. RESULTS: A total of 8021 residents were included from 168 facilities. Mean age was 86.4 years (SD = 7.4). Women represented 74.1%. SARS-CoV-2 infection was detected in 27.7% of participants, and the overall case fatality rate was 11.3% (24.9% among those with a positive PCR test). Epidemiological factors related to risk of infection were larger facility size (pooled aOR 1.73; P < .001), higher community incidence (pooled aOR 1.67, P = .04), leading to a higher risk than the clinical factor of low level of functional dependence (aOR 1.22, P = .03). Epidemiological risk factors associated with mortality were male gender (aOR 1.75; P < .001), age (pooled aOR 1.16; P < .001), and higher community incidence (pooled aOR 1.19, P = < 0.001) whereas clinical factors were low level of functional dependence (aOR 2.42, P < .001), Complex Chronic Condition (aOR 1.29, P < .001) and dementia (aOR 1.33, P <0.001). There was evidence of clustering for facility and health area when considering the risk of infection and mortality (P < .001). CONCLUSIONS: Our results suggest a complex interplay between structural and individual factors regarding Covid-19 infection and its impact on mortality in nursing-home residents.

Cluster-Based Relocation of Stations for Efficient Forest Fire Management in the Province of Valencia (Spain).

Forest fires are undesirable situations with tremendous impacts on wildlife and people's lives. Reaching them quickly is essential to slowing down their expansion and putting them out in an effective manner. This work proposes an optimized distribution of fire stations in the province of Valencia (Spain) to minimize the impacts of forest fires. Using historical data about fires in the Valencia province, together with the location information about existing fire stations and municipalities, two different clustering techniques have been applied. Floyd-Warshall dynamic programming algorithm has been used to estimate the average times to reach fires among municipalities and fire stations in order to quantify the impacts of station relocation. The minimization was done approximately through k-means clustering. The outcomes with different numbers of clusters determined a predicted tradeoff between reducing the time and the cost of more stations. The results show that the proposed relocation of fire stations generally ensures faster arrival to the municipalities compared to the current disposition of fire stations. In addition, deployment costs associated with station relocation are also of paramount importance, so this factor was also taken into account in the proposed approach.

Seroprevalence of Helicobacter pylori in Hispanics living in Puerto Rico: A population-based study.

BACKGROUND: Helicobacter pylori is an important etiologic factor for peptic ulcers and gastric cancer, one of the top ten leading causes of cancer death in Puerto Rico. However, the prevalence of H. pylori infections in this population was previously unknown. The aim of this study was to examine the seroprevalence of H. pylori and its associated risk factors in Puerto Rico. MATERIALS AND METHODS: A cross-sectional study was designed using an existing population-based biorepository. Seropositivity was determined using the Premier™ H. pylori immunoassay. Helicobacter pylori seroprevalence was estimated with 95% confidence using marginal standardization following logistic regression. To assess the risk factors associated with H. pylori seropositivity, a multivariable log-binomial model was fitted to estimate the prevalence ratio (PR) and its 95% confidence interval (95% CI). RESULTS: A total of 528 population-based serum samples were analyzed. The mean age of the study population was 41 ± 12 years, of whom 55.3% were females. The overall seroprevalence of H. pylori was 33.0% (95% CI = 28.3%-38.1%). Increasing age and having <12 years of education were significantly (P < .05) associated with H. pylori seropositivity in the multivariable model; however, residing in counties with low population density reached marginal significance (P = .085). CONCLUSIONS: We report that H. pylori infection is common among Hispanics living in Puerto Rico. The H. pylori seroprevalence observed in Puerto Rico is similar to the seroprevalence reported in the overall population of the United States. The association between H. pylori seroprevalence and the risk factors analyzed offers insight into the epidemiology of gastric cancer in Puerto Rico and warrants further investigation.

Assessment of Hypertension Management and Outcomes at an Indianapolis Student-Run Free Clinic.

PURPOSE: To characterize the quality of health care at student-run free clinics (SRFCs) by analyzing hypertension management and outcomes at the Indiana University Student Outreach Clinic (IUSOC). METHODS: A retrospective review of medical records was conducted for hypertensive patients managed at IUSOC over 15 months (N = 64). Indiana University Student Outreach Clinic's hypertension control rate was compared with National Health and Nutrition Examination Survey (NHANES) data. RESULTS: Blood pressure control rates increased significantly over the study period. Indiana University Student Outreach Clinic's control rate did not differ significantly with the NHANES national average, but was significantly greater than the NHANES group with no usual source of care. Similarly, IUSOC patients without insurance or with unknown insurance status had greater control rates than an uninsured NHANES group, but did not differ significantly from an insured NHANES group. CONCLUSIONS: Despite unfavorable demographic characteristics, records for patients with hypertension who used IUSOC as a regular provider of primary care compared favorably with national data.

Interprofessional education through service-learning: lessons from a student-led free clinic.

The academic community must replicate and strengthen existing models for interprofessional education (IPE) to meet widespread calls for team-based patient-centered care. One effective but under-explored possibility for IPE is through student-led clinics, which now exist in the majority of medical schools. This short report presents the Indiana University Student Outreach Clinic (IU-SOC), which involves seven different professional programs across three institutions, as a model for how IPE can be delivered formally through service learning. Lessons learned, such as nurturing an intentional interprofessional program, structured orientation and reflection, and resource and knowledge sharing between the clinic and academic institutions, can be applied to all student-led clinics, but also can inform other IPE initiatives in health professional curricula.

Using Tic-Tac software to reduce anxiety-related behaviour in adults with autism and learning difficulties during waiting periods: a pilot study.

Deficits in the perception of time and processing of changes across time are commonly observed in individuals with autism. This pilot study evaluated the efficacy of the use of the software tool Tic-Tac, designed to make time visual, in three adults with autism and learning difficulties. This research focused on applying the tool in waiting situations where the participants exhibited anxiety-related behaviour. The intervention followed a baseline and intervention (AB) design, and a partial interval recording procedure was used to code the presence of stereotypes, nervous utterances, wandering or other examples of nervousness during the selected waiting situations. The results showed that the use of Tic-Tac resulted in lower levels of anxiety-related behaviour in all three participants, compared to the baseline, suggesting that this software may be an effective technology for helping people with autism with organisation and predictability during waiting periods. The results are discussed in terms of limitations and implications for further study.

Reemplazo total del arco con injerto vascular trifurcado en disección aórtica de tipo A de Stanford / Total replacement of the arch with trifurcated vascular graft in Stanford's A Type aortic dissection

La cirugía del arco aórtico es particularmente complicada; sin embargo, la gravedad y evolución clínica de las enfermedades que afectan esta estructura vascular, aconsejan la difícil intervención quirúrgica en muchos de los casos. En Cuba, si bien concurren las condiciones técnicas para efectuarlas, no existen informes de pacientes intervenidos por esa causa. En el Cardiocentro de Santiago de Cuba, partiendo de la experiencia acumulada en resecciones de la aorta ascendente, se logró recientemente el primer reemplazo exitoso de todo el arco; razón que justificó describir los resultados de esa compleja operación, explicar concisamente las tendencias actuales en materia de protección cerebral y procedimientos quirúrgicos, así como exponer los criterios escogidos para seleccionar la variante técnica empleada.

Aortic arch surgery is particularly complicated; however, severity and clinical course of the diseases that affect this vascular structure suggest that it is advisable to undergo the difficult intervention in most of the cases. In Cuba, there are many technical conditions to carry it out but no reports of patients operated due to that cause have been registered. The first successful replacement of the whole arch was achieved in Santiago de Cuba's Heart Center, taking into account the accumulated experience in upper aortic resection. That is why the results of this complex surgery are described, and current tendencies according to cerebral protection and surgical procedures are explained, as well as the chosen criteria to select the applied technical variant are set out.

Complicaciones mayores en el período posoperatorio inmediato de la cirugía cardiaca abierta / Major Complications in the Early Postoperative Period of Open Heart Surgery

Se llevó a cabo el estudio de 660 pacientes operados a corazón abierto en el Cardiocentro de Santiago de Cuba durante el quinquenio 2000 - 2004, con la finalidad de identificar las principales complicaciones que ocurren durante el período posoperatorio inmediato. La investigación reveló que las complicaciones no sépticas fueron las más frecuentes, con las arritmias cardíacas y el bajo gasto cardíaco en los primeros lugares

Complicaciones neurológicas posoperatorias de la cirugía cardiaca / Postoperative Neurologic Complications of the Heart Surgery

Se realizó un estudio descriptivo y transversal de 65 pacientes que sufrieron complicaciones neurológicas en el período posoperatorio de la cirugía cardíaca abierta en la Unidad de Cuidados Intensivos del Cardiocenter de Santiago de Cuba, durante el período de enero del 2000 a diciembre del 2004, dirigido a identificarlas y relacionarlas con la mortalidad y otras variables de interés. Del total fallecieron 28, fundamentalmente a causa del edema cerebral y los accidentes vasculares encefálicos, en particular de los hemorrágicos.

Pesquisa masiva de cáncer de mama con un equipo móvil de mamografía

Se presenta un informe preliminar sobre los resultados obtenidos con la aplicación del Programa de Detección Preclínica del Cáncer Mamario en un área de salud del distrito No. 4 del municipio Santiago de Cuba, cubierta con el subsistema del médico y la enfermera de la familia. La exploración de las mamas mediante un equipo móvil de mamografía permitió examinar a la mayor parte de las mujeres con riesgo, de las cuales el 79,4 porciento no presentaban afección alguna en dicha localización. Entre las causas de no realización de la prueba predominaron: negación, invalidez y hallarse fuera del área en el momento del examen, pero se ha seguido insistiendo para lograr el cumplimiento de ese objetivo