Knowledge, Attitudes, and Perceptions of Skin Cancer Clinical Trials in the Hispanic Population.

OBJECTIVE: To determine the factors that might limit Hispanic patients from participating in dermatological clinical trials. METHODS: From January 2022 to July 2022, we administered a 31-item, in-person questionnaire to patients recruited in the waiting area of the Caridad Center, one of the largest free clinics in the United States with a predominately Hispanic population, and a nearby private primary care clinic. RESULTS: Overall, Hispanic patients agreed significantly more with statements in the domain of attitude and behavioral beliefs compared to non-Hispanic survey respondents. The Hispanic ethnicity was associated with increased odds of agreeing with the following statements: "My community would really benefit from skin cancer clinical trials" (OR=0.52; 95% CI 0.30, 0.92), "My participation in a skin cancer study would be very good" (OR=0.59; 95% CI 0.35, 0.99), and "I like to do good for others" (OR=0.41; 95% CI 0.22, 0.77). CONCLUSION: While the United States population is composed of 18.5% Hispanics, they only account for 1% of patients enrolled in clinical trials. This study helps identify potential motivational factors for Hispanic patients to participate in skin cancer clinical trials.

Comparing outcomes of cholecystectomies in white vs. minority patients.

BACKGROUND: This study aimed to investigate the disparity between white and minority patients undergoing cholecystectomies, including presentation, outcomes, and financial burden. METHODS: This was an IRB approved retrospective review of all cholecystectomies at an academic medical center from 2013 to 2018. Data collected include demographics, insurance type, charge of admission, and clinical outcomes. RESULTS: 1539 patients underwent cholecystectomies. Of those, 36.9% were white and 63.1% were minority. Minority patients presented at a younger age than white patients (45.5 vs 53.9, p < 0.01) and required emergent admission (76.2% vs 68.4%, p < 0.01). No significant difference was found for clinical outcomes between white and minority. Minority patients were more commonly uninsured (32.1%). Among the uninsured, self-pay had a higher charge than emergency MediCal (by 5.46 per 1000 dollars). CONCLUSION: Minority patients are more commonly disadvantaged at presentation and charged more due to insurance status despite similar outcomes after cholecystectomies.

COVID19 in hematological patients and telemedicine: lessons learned across Europe and the US.

PURPOSE OF REVIEW: To describe the state-of-the-art of telemedicine in hematology through the description of most relevant studies published in the pre-COVID19 and during the COVID19 era. RECENT FINDINGS: Telemedicine has recently gained momentum in hematology due to the COVID19 pandemic. Due to a necessary improvement of domiciliary follow-up of patients during the pandemic and an increase in technologies able to offer telemedicine, the number of studies has increased in the last 2 years. Telemedicine showed the potential to improve the monitoring of both benign and malignant hematological diseases. Patients affected by thalassemias, hemophilias and/or myeloproliferative diseases were monitored successfully with telemedicine platform. For higher-risk patients such as high-dose chemotherapy or stem cell transplantation, better platforms are needed (e.g. use of wearable devices systems). Also, telemedicine showed to be useful for the follow-up of hematological patients with COVID19. SUMMARY: Despite the clear potential advantages of telemedicine for the follow-up of hematological patients, more evidence is required before adopting this approach in larger cohorts of patients. Larger- and higher-quality studies are highly needed in this setting.

Role of gamma radiation on functional expression of the voltage-gated potassium channel Kv10.1 and its importance in the radiobiological response.

Exposure of biological systems to a radiation absorbed dose produces early and late radiogenic responses, such as ion channel modulation, oxidative stress, cell migration enhancement, and metabolic changes that could impact the efficiency of radiotherapy. To understand how radiation modulates ion channels, we irradiated HEK cells stably expressing the human ether à-go-go potassium channel-1 with gamma photons in the dose range of 2-10 Gy (60Co, 0.2 Gy/min) and measured ionic currents generated by the channel. The importance of the Kv10.1 modulation by gamma radiation was studied using cell proliferation. Results showed that a radiation-absorbed dose of 4 Gy significantly reduced the Kv10.1-evoked currents by depolarizing pulses between -100 mV and +50 mV. Additionally, the expression of Kv10.1 positively modulates HEK293 proliferation and, certainly, prevents the effect of gamma radiation on this phenomenon. Results allow concluding that the modulation of the functional expression of the Kv10.1 channel, induced by gamma radiation, leads to the expression of a radioresistant phenotype in Kv10.1 expressing cells.

Determinants of COVID-19 disease severity in patients with cancer.

As of 10 April 2020, New York State had 180,458 cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and 9,385 reported deaths. Patients with cancer comprised 8.4% of deceased individuals1. Population-based studies from China and Italy suggested a higher coronavirus disease 2019 (COVID-19) death rate in patients with cancer2,3, although there is a knowledge gap as to which aspects of cancer and its treatment confer risk of severe COVID-194. This information is critical to balance the competing safety considerations of reducing SARS-CoV-2 exposure and cancer treatment continuation. From 10 March to 7 April 2020, 423 cases of symptomatic COVID-19 were diagnosed at Memorial Sloan Kettering Cancer Center (from a total of 2,035 patients with cancer tested). Of these, 40% were hospitalized for COVID-19, 20% developed severe respiratory illness (including 9% who required mechanical ventilation) and 12% died within 30 d. Age older than 65 years and treatment with immune checkpoint inhibitors (ICIs) were predictors for hospitalization and severe disease, whereas receipt of chemotherapy and major surgery were not. Overall, COVID-19 in patients with cancer is marked by substantial rates of hospitalization and severe outcomes. The association observed between ICI and COVID-19 outcomes in our study will need further interrogation in tumor-specific cohorts.

Determining the incidence of distraction among trauma patients in all modes of transportation.

BACKGROUND: The use of distracting technology is an increasing source of risk for injury among trauma patients. Both drivers and pedestrians show increased unsafe behavior. The data for prevalence and risk for distraction in trauma has varied widely. Our hypothesis is that distraction is more highly prevalent and widely distributed among all mechanisms of injury and variety of trauma patients. METHODS: A 10-question survey of adult trauma victims at a Level I trauma center regarding distraction at time of event was performed, examining age, sex, ethnicity, education level, mode of injury and role in the accident (driver, passenger, pedestrian, bicyclist, motorcyclist). Multiple-variable logistic regression was performed to identify risk factors for distraction. RESULTS: From June 2016 to October 2018, 1,316 patients were surveyed, and 1,011 (76.8%) patients reported their role in the traffic accident. The prevalence of distraction was 21.73% among drivers, 9.01% among passengers, 16.50% among pedestrians, 20.00% among bicyclists, and 8.09% among motorcyclists. Males (odds ratio [OR], 1.84; 95% confidence interval [CI], 1.26-2.67) as well as all Others (OR, 2.09; 95% CI, 1.10-3.98) showed statistically significant increased risk for distraction. Motorcyclist (OR, 0.25; 95% CI, 0.13-0.50) and passenger (OR, 0.37; 95% CI, 0.18-0.77) roles during collision were a lowered risk of distraction. Furthermore, Asian/Pacific Islanders (OR, 1.62; 95% CI, 0.94-2.79) trended toward being at greater risk for distraction. CONCLUSION: Distraction is prevalent among a wide range of traffic accident victims, not just drivers. Males as well as all Others are more likely to be distracted. In contrast, motorcyclists and passengers are less likely to be distracted. Further studies to assist in determining effective interventions and public safety efforts aimed at specific at-risk groups beyond motor vehicle drivers are warranted. LEVEL OF EVIDENCE: Epidemiological, level V.

Reconstitution of the gut microbiota of antibiotic-treated patients by autologous fecal microbiota transplant.

Antibiotic treatment can deplete the commensal bacteria of a patient's gut microbiota and, paradoxically, increase their risk of subsequent infections. In allogeneic hematopoietic stem cell transplantation (allo-HSCT), antibiotic administration is essential for optimal clinical outcomes but significantly disrupts intestinal microbiota diversity, leading to loss of many beneficial microbes. Although gut microbiota diversity loss during allo-HSCT is associated with increased mortality, approaches to reestablish depleted commensal bacteria have yet to be developed. We have initiated a randomized, controlled clinical trial of autologous fecal microbiota transplantation (auto-FMT) versus no intervention and have analyzed the intestinal microbiota profiles of 25 allo-HSCT patients (14 who received auto-FMT treatment and 11 control patients who did not). Changes in gut microbiota diversity and composition revealed that the auto-FMT intervention boosted microbial diversity and reestablished the intestinal microbiota composition that the patient had before antibiotic treatment and allo-HSCT. These results demonstrate the potential for fecal sample banking and posttreatment remediation of a patient's gut microbiota after microbiota-depleting antibiotic treatment during allo-HSCT.

Protective Factors in the Intestinal Microbiome Against Clostridium difficile Infection in Recipients of Allogeneic Hematopoietic Stem Cell Transplantation.

Background: Clostridium difficile infection (CDI) is a frequent complication in recipients of allogeneic hematopoietic stem cell transplantation (allo-HSCT), who receive intensive treatments that significantly disrupt the intestinal microbiota. In this study, we examined the microbiota composition of allo-HSCT recipients to identify bacterial colonizers that confer protection against CDI after engraftment. Methods: Feces collected from adult recipients allo-HSCT at engraftment were analyzed; 16S ribosomal RNA genes were sequenced and analyzed from each sample. Bacterial taxa with protective effects against development of CDI were identified by means of linear discriminant analysis effect size analysis and then further assessed with clinical predictors of CDI using survival analysis. Results: A total of 234 allo-HSCT recipients were studied; postengraftment CDI developed in 53 (22.6%). Within the composition of the microbiota, the presence of 3 distinct bacterial taxa was correlated with protection against CDI: Bacteroidetes, Lachnospiraceae, and Ruminococcaceae. Colonization with these groups at engraftment was associated with a 60% lower risk of CDI, independent of clinical factors. Conclusions: Colonization with these 3 bacterial groups is associated with a lower risk of CDI. These groups have been shown to be vital components of the intestinal microbiota. Targeted efforts to maintain them may help minimize the risk of CDI in this at-risk population.

Nontuberculous Mycobacterial Infections After Silicone Breast Implant Reconstruction Emphasize a Diversity of Infecting Mycobacteria.

Postsurgical skin and soft tissue infections (SSTIs) caused by nontuberculous mycobacteria (NTM) are uncommon, indolent, difficult to treat, and often mimic pyogenic bacterial infections. Here we present 3 cases of NTM infections following placement of silicone implants for reconstructive breast surgery. These cases emphasize the importance of a high index of suspicion for NTM in patients with SSI after a prosthetic reconstruction refractory to conventional antibiotic therapy and the importance of early investigation with mycobacterial-specific diagnostics.

DUI histories in intoxicated injured bicyclists.

INTRODUCTION: It has been well documented that the use of alcohol correlates with injury risk, especially in DUI (driving under the influence) and DWI (driving while intoxicated). Consumption of alcohol in patients presenting with bicycle-related injuries is associated with greater injury severity, longer hospitalization, and higher health care costs. We hypothesized that intoxicated patients operating a bicycle with traumatic injuries have previous DUI or DWI convictions and had lost their privilege to drive a motor vehicle, resorted to bicycling, and had continued alcohol consumption despite negative previous consequences. METHODS: We retrospectively collected data on injured bicyclists older than 18 years with positive blood alcohol content levels treated from the period January 2009 to June 2014 at a large Level 1 urban trauma center. We then matched each patient by name and date of birth and were able to obtain public criminal records through the Superior Court of California for the local of county. RESULTS: A total of 149 injured bicyclists with positive blood alcohol levels were identified. Their average blood alcohol content was 236.0 mg/dL, and their average age was 41 years. Sixty-six (44.2%) of these patients had prior DUI/DWI convictions with suspension of driving privileges. Ninety-five patients in this group (63.8%) had no health insurance, and 51 patients (34.2%) tested positive for other drugs. Intoxicated bicyclists trended toward longer hospital length compared with nonintoxicated bicyclists (4.60 vs. 3.44 days; p = 0.07). Three (0.02%) of 149 patients were charged with bicycling while intoxicated. CONCLUSION: Intoxicated bicyclists involved in trauma are more likely to have a previous DUI/DWI, have other drug use, tend to have longer hospital stays, and are less likely to have insurance. Bicycle safety education and behavior modification targeting DUI/DWI offenders are warranted. In order to promote injury prevention, resources to increase awareness of this underestimated public health issue should be promoted. LEVEL OF EVIDENCE: Epidemiologic study, level III.

Clinical and radiographic differentiation of lung nodules caused by mycobacteria and lung cancer: a case-control study.

BACKGROUND: Lung nodules caused by mycobacteria can resemble lung cancer on chest imaging. The advent of lung cancer screening with low-dose Computed Tomography is accompanied by high false-positive rates, making it necessary to establish criteria to differentiate malignant from benign nodules. METHODS: We conducted a retrospective case-control study of 52 patients with mycobacterial lung nodules and 139 patients with lung cancer, diagnosed between 2010 and 2012. We compared clinical and radiographic characteristics to identify predictors of disease by univariate and multivariate analysis. The discriminatory power of maximum Standardized Uptake Values from Positron-Emission-Tomography was also evaluated. RESULTS: Several variables were correlated with a diagnosis of mycobacterial infection or lung cancer on univariate analysis. Such variable include smoking status and history, lesion size and imaging evidence of tree-in-bud opacities, lymphadenopathy or emphysema on computed tomography. Upon author consensus, the most clinically-relevant variables were selected to undergo multivariate analysis. A history of current or former smoking [OR 4.4 (95 % CI 1.2-15.6) and 2.7 (95 % CI 1.1-6.8), respectively P = 0.04] was correlated with diagnoses of lung cancer. Contrarily, the presence of tree-in-bud opacities was less likely to be correlated with a diagnosis of malignancy [OR 0.04 (95 % CI 0.0-1.0), P = 0.05]. Additionally, higher maximum standardized uptake values from positron emission tomography were associated with malignancy on multivariate analysis [OR 1.1 (95 % CI 1.0-1.2), P = 0.04]; but the accuracy of the values in differentiating between diseases was only 0.67 as measured by the area under the curve. Lesion size was not independently associated with diagnosis [OR 0.5 (95 % CI 0.2-1.2), (P = 0.12)]. CONCLUSIONS: Establishing the likelihood of malignancy for lung nodules based on isolated clinical or radiographic criteria is difficult. Using the variables found in this study may allow clinicians to stratify patients into groups of high and low risk for malignancy, and therefore establish efficient diagnostic strategies.

Cetoacidosis diabética en niños: experiencia hospitalaria. Estudio retrospectivo de 15 años / Diabetic ketoacidosis in children: hospital experience. A 15-year retrospective study

ResumenIntroducción: La cetoacidosis diabética (CAD) es una de las complicaciones más graves de la diabetes mellitus (DM). El objetivo de este trabajo fue destacar la importancia clínica y de laboratorio en el tratamiento de pacientes con CAD, atendidos en el Hospital Infantil del Estado de Sonora (HIES) durante un periodo de 15 años.Métodos: Se revisaron en forma retrospectiva 140 pacientes con episodios de CAD para informar el seguimiento clínico, de laboratorio y mortalidad con el Protocolo HIES.Resultados: La mortalidad fue de 0%, y mediante estadística descriptiva se observaron mínimas complicaciones hidroelectrolíticas sin secuelas neurológicas en tres pacientes con edema cerebral.Conclusiones: El Protocolo HIES es práctico y efectivo para el tratamiento hidroelectrolítico y ácido-base de la CAD con un mínimo de complicaciones.

AbstractBackground: Diabetic ketoacidosis (DKA) is one of the major complications of diabetes mellitus (DM). The objective of this report was to highlight the clinical and laboratory importance in the treatment of patients with DKA during a 15-year period treated at the Hospital Infantil del Estado de Sonora (HIES).Methods: We retrospectively reviewed 140 patients with episodes of DKA to report clinical and laboratory features, mortality, and treatment with HIES protocol.Results: Mortality was 0%. Using descriptive statistics we observed minimal complications without neurologic sequelae in three patients with cerebral edema.Conclusions: The HIES protocol is a practical and effective electrolyte and acid-base treatment for DKA.

Ribosomal RNA gene sequencing for early diagnosis of Blastomyces dermatitidis infection.

Prompt detection and identification of fungal pathogens at the genus and species level is critical in order to provide timely antifungal therapy. Here, we highlight the vital role of molecular diagnostics in achieving a fast and definitive diagnosis of disseminated blastomycosis in a diabetic patient presenting as a brain mass initially thought to be tumoral in nature. A broad-range PCR amplification and sequencing of the fungal ribosomal RNA genes on brain biopsy tissue obtained during elective craniotomy revealed a final microbial identification of Ajellomyces dermatitidis (telemorph of Blastomyces dermatitidis).

Frecuencia de Helicobacter pylori y características clínicas en niños con endoscopía digestiva alta de un hospital de Lambayeque / Clinical characteristics and frequency of Helicobacter pylori infection in child from and Hospital of Lambayeque: 2007 - 2010

Objetivo: Estimar la frecuencia del Helicobacter pylori y describir las características clínicas en menores de 18 años con endoscopía digestiva alta del Servicio de Gastroenterología del Hospital Nacional Almanzor Aguinaga Asenjo - EsSalud. 2007 - 2010.Material y métodos: estudio descriptivo- retrospectivo en el que se revisaron las historias clínicas y la hoja de endoscopía de 93 pacientes menores de 18 años con endoscopía digestiva alta. Se usó estadística descriptiva; el procesamiento fue mediante Microsoft Excel 2010 y STATA v 10.0. Resultados: Hubieron 93 pacientes de los cuales 60 fueron mujeres (64,52%) y 33 varones (35,48%). La media de edad fue de 12 +/-4 años. La frecuencia de Helicobacter pylori fue de 68,82%. En los pacientes con Helicobacter pylori, la principal indicación para endoscopía fue "gastritis": 50,54% seguido por "dolor abdominal inespecífico":24,73%. En los pacientes HP positivos el diagnóstico endoscópico más frecuente fue: Gastritis nodular: 31 pacientes (33,33%) y el principal hallazgo histopatológico fue Gastritis crónica folicular moderada: 55 pacientes (59,14%); se encontró asociación entre Gastritis nodular (p.0,044) y Gastritis crónica folicular moderada (p<0,001) con la presencia de Helicobacter pylori. Conclusiones:La frecuencia de la infección por Helicobacter pylori en niños fue elevada; la gastritis nodular y la gastritis crónica folicular moderada fueron los hallazgos endoscópico y de biopsia más frecuentes; se halló asociación entre éstos hallazgos y la presencia de Helicobacter pylori.(AU)

Objetive: To determine the frequency of Helicobacter pylori infection and describe the clinical characteristics of children with upper endoscopy from the service of Gastroenterology - Hospital Nacional Almanzor Aguinaga Asenjo - ESSALUD: 2007 - 2010. Materials and Methods: Retrospective, descriptive study in which the medical records and the endoscopy sheet of 93 patients younger than 18 years, were reviewed. Descriptive statistics was used. The processing of data was using Microsoft Excel 2010 and 10.0th STATA version. Results: There were 93 patients of whom 60 were women (64.52%) and 33 males (35.48%). The mean age was 12 +/- 4 years. The frequency of Helicobacter pylori infection was 68.82%. In patients with Helicobacter pylori infection the primary indication for endoscopy was "gastritis" followed by nonspecific abdominal pain. In HP positive patients, the principal indication for endoscopic was "gastritis" 50.54%, follow with Abdominal recurrent pain with 24.73%. The most frequent endoscopic diagnosis in HP patients was nodular gastritis: 31 patients (33.33%), the main histopathological finding was moderate chronic follicular gastritis: 55 patients (59.14%). Association between Nodular gastritis (p.0,044) and Chronic folicular moderate Gastritis (p< 0,001) with the presence of Helicobacter pylori, was found. Conclusions: Helicobacter pylori infection in children under 18 years was very frequent, being Nodular gastritis and Chronic follicular moderate gastritis the endoscopic and biopsy findings, more frequently found. We found an association within Helicobacter pylori infection with Nodular gastritis and Chronic moderate follicular gastritis.(AU)

Acerca de la violencia humana masiva / About human massive violence

En el artículo "La maldad: ¿responsabilidad cultural o individual"?, Humberto Maturana realiza una serie de precisiones y comentarios al trabajo "Los orígenes psicológicos de la maldad grupal en las FFAA y de orgen: necesidad de una continua revisión", escrito por Francisco Huneeus y Sandra Isella. En ellos, vuelve a exponer sus puntos de vista respecto de lo que él llama "biología del conocimiento". Lo hace, pues le parece que los autores del trabajo señalado, "emiten un juicio, que en mi opinión revela una lectura que parece haber resultado incompleta para el conocimiento serio de lo que yo sostengo en mis trabajos, o muy superficial para su comprensión". En el presente artículo me refiero a algunos aspectos de estos comentarios y realizo una discusión más amplia respecto de la violencia humana masiva y la competitividad, y su relación con la biología, especialmente con la interpretación que el Dr. Maturana hace de esta última

Francisco Varela y las ciencias cognitivas / Francisco Varela and the cognitive sciences

Francisco Varela fue biólogo y su trabajo se desarrolló en campos como la neurobiología, la biología teórica y la epistemología, y especialmente en el último tiempo, en las neurociencias cognitivas. Fue Director de Investigaciones en el Centro Nacional de Investigaciones Científicas de Francia y Director del Laboratorio de Neurociencias Cognitivas en el Hospital de la Salêtriére, en Paris. El comentario que realizamos en este artículo está basado en tres de sus obras principales: Conocer, De cuerpo presente y Ética y acción (1,2,3). El propósito de este artículo es presentar las ideas más importantes del autor respecto de la cognición como un proceso "enactivo" y realizar algunos comentarios acerca de las implicaciones que conlleva

Ignacio Matte Blanco, Armando Roa Rebolledo y Juan Marconi Tassara: tres creadores en la psiquiatría chilena / Ignacio Matte Blanco, Armando Roa Rebolledo and Juan Marconi Tassara: 3 creators in chilean psychiatry

Este trabajo presenta los principales aspectos de las creaciones teóricas y clínicas de Ignacio Matte, Armando Roa y Juan Marconi, tres de los más relevantes psiquiatras chilenos de la segunda mitad del siglo XX. Ellos desarrollaron importantes contribuciones en los aspectos psicodinámicos, fenomenológicos y sociales de la psiquiatría, respectivamente. El propósito de este artículo es hacer accesible a las últimas generaciones de psiquiatras chilenos, una parte seleccionada de las contribuciones de los autores mencionados

La comunicabilidad en la esquizofrenia / Communicability in schizophrenia

El presente trabajo se refiere a una de las propiedades esenciales de las vivencias o actos, la comunicabilidad, y a su perturbación preferencial en el proceso esquizofrénico. Para ello se recogen los conceptos husserlianos sobre la expresión y sus dos funciones: la función significativa y la función notificaativa, siendo esta última la que ejecuta la comunicabilidad de las vivencias. Se analiza la comunicabilidad de las vivencias en la situación clínica, a través de fenómenos psicopatológicos polares, en este sentido, como son los cuadros neuróticos del tipo de la agorafobias, neurosis de angustia y fobias situacionales, por un lado, y las esquizofrenias no productivas junto a los estados residuales por otro. Se analizan los conceptos de lenguaje notificativo (propio de las neurosis) y lenguaje indicativo y comunicativo (propios del proceso esquizofrénico) propuestos por A. Roa. Se concluye que la pérdida de comunicabilidad de las vivencias, o la ausencia de la función notificativa de la expresión, sería un fenómeno propio y característico del proceso esquizofrénico. Se propone denominar lenguaje signitivo o significativo a la situación descrita, en sustitución de los términos indicativo y comunicativo, en este contexto equívocos