Durable response after tisagenlecleucel in adults with relapsed/refractory follicular lymphoma: ELARA trial update.

ABSTRACT: Tisagenlecleucel is approved for adults with relapsed/refractory (r/r) follicular lymphoma (FL) in the third- or later-line setting. The primary analysis (median follow-up, 17 months) of the phase 2 ELARA trial reported high response rates and excellent safety profile in patients with extensively pretreated r/r FL. Here, we report longer-term efficacy, safety, pharmacokinetic, and exploratory biomarker analyses after median follow-up of 29 months (interquartile range, 22.2-37.7). As of 29 March 2022, 97 patients with r/r FL (grades 1-3A) received tisagenlecleucel infusion (0.6 × 108-6 × 108 chimeric antigen receptor-positive viable T cells). Bridging chemotherapy was allowed. Baseline clinical factors, tumor microenvironment, blood soluble factors, and circulating blood cells were correlated with clinical response. Cellular kinetics were assessed by quantitative polymerase chain reaction. Median progression-free survival (PFS), duration of response (DOR), and overall survival (OS) were not reached. Estimated 24-month PFS, DOR, and OS rates in all patients were 57.4% (95% confidence interval [CI], 46.2-67), 66.4% (95% CI, 54.3-76), and 87.7% (95% CI, 78.3-93.2), respectively. Complete response rate and overall response rate were 68.1% (95% CI, 57.7-77.3) and 86.2% (95% CI, 77.5-92.4), respectively. No new safety signals or treatment-related deaths were reported. Low levels of tumor-infiltrating LAG3+CD3+ exhausted T cells and higher baseline levels of naïve CD8+ T cells were associated with improved outcomes. Tisagenlecleucel continued to demonstrate highly durable efficacy and a favorable safety profile in this extended follow-up of 29 months in patients with r/r FL enrolled in ELARA. This trial was registered at www.clinicaltrials.gov as #NCT03568461.

Comparative efficacy and safety of tisagenlecleucel and axicabtagene ciloleucel among adults with r/r follicular lymphoma.

Regulatory approvals of tisagenlecleucel (tisa-cel) and axicabtagene ciloleucel (axi-cel) have established the feasibility of chimeric antigen receptor T-cell therapies for the treatment of adults with relapsed or refractory follicular lymphoma (r/r FL). This study used individual patient data from ELARA (tisa-cel) and aggregate published patient data from ZUMA-5 (axi-cel) to compare efficacy and safety outcomes in r/r FL using matching-adjusted indirect comparison methods. After adjustment for baseline differences in the trial populations, the results suggested that tisa-cel (n = 52), compared with axi-cel (n = 86), had similar effects on overall response rate (91.2% vs. 94.2%; p = .58), complete response rate (74.0% vs. 79.1%; p = .60), progression-free survival (HR [95% CI]: 0.8 [0.4, 1.9]; p = .67), and overall survival (HR [95% CI]: 0.5 [0.2, 1.5]; p = .21). Tisa-cel (n = 53) was associated with better safety outcomes than axi-cel (n = 124), reflected by lower rates of any grade and grade ≥3 cytokine release syndrome and neurological events.

Assessment of Healthcare Resource Utilization and Hospitalization Costs in Patients With Relapsed or Refractory Follicular Lymphoma Undergoing CAR-T Cell Therapy With Tisagenlecleucel: Results From the ELARA Study.

Follicular lymphoma (FL) is generally considered an indolent disease, although patients with relapsing FL experience progressively shorter durations of response to second or later lines of therapy. The ongoing ELARA trial in adult patients with relapsed/refractory (r/r) FL treated with tisagenlecleucel demonstrated an overall response rate of 86.2% and a complete response rate of 69.1%, with no treatment-related deaths. Tisagenlecleucel was administered in the outpatient setting in 18% of patients in ELARA; however, there is limited knowledge concerning the impact of inpatient versus outpatient tisagenlecleucel administration on healthcare resource utilization (HCRU) among patients with r/r FL. Here, we present the first HCRU analysis among patients with r/r FL who received tisagenlecleucel in the Phase II, single-arm, multicenter ELARA trial. HCRU was characterized using hospitalization data from day 1 to month 2 after tisagenlecleucel infusion. Information on length of stay, facility use, and discharge was assessed in patients who received tisagenlecleucel in the outpatient or inpatient setting. All costs were inflated to 2020 US dollars. As of August 3, 2021 (20-month median follow-up), 17/97 (18%) r/r FL patients were infused in an outpatient setting. Patients infused in the outpatient setting generally had favorable Eastern Cooperative Oncology Group performance status and Follicular Lymphoma International Prognostic Index scores, and less bulky disease at baseline. However, the outpatients had higher proportions of patients with grade 3A FL, primary refractory disease, and >5 lines of prior therapy compared with inpatients. Forty-one percent of patients treated in the outpatient setting did not require hospitalization within 30 days after infusion, and outpatients who did require hospitalization had a shorter average length of stay compared with inpatients (5 versus 13 days). No outpatients required intensive care unit (ICU) admission, whereas 9% of inpatients were admitted to the ICU. The mean postinfusion hospitalization costs were $7477 and $40,054 in the outpatient and inpatient settings, respectively. Efficacy between both groups was similar. Tisagenlecleucel can be safely administered to some patients in the outpatient setting, which may reduce HCRU for patients with r/r FL.

Morphological, clinical, and functional efficacy in the short and medium-term after radiofrequency treatment of predominantly solid, large, and clinically relevant thyroid nodules in patients who are not candidates for surgery: The experience after 100 procedures.

INTRODUCTION: Thyroid nodules (TN) are a prevalent pathology that can generate morbidity, in which case the traditional treatment is usually surgery. OBJECTIVE: To analyse the efficacy of radiofrequency ablation (RFA) treatment as a therapeutic alternative in the combined clinical, morphological, and functional control of predominantly solid, benign and clinically relevant TNs in patients not subsidiary to surgery. MATERIALS AND METHODS: A descriptive, retrospective, case series study was carried out to assess the efficacy and safety of the use of RFA. According to medical criteria, the selected patients underwent a clinical, ultrasound, and biochemical assessment prior to the procedure and then after the procedure at 1, 3, 6, and 12 months and then every 6-12 months according to medical criteria. RESULTS: A total of 100 RFA were performed on 83 patients with 85 TNs of ≥2.5 cm with an initial volume (IV) of 21.48 ±â€¯15.89 ml. After a mean of 1.17 RFA sessions per TN, the volume decreased progressively and significantly (p < 0.01 for all times compared to the initial value), with a mean volume reduction rate (VRR) in relation to the IV of 54.43 ±â€¯19.56% at 1-month follow-up; 67.69 ±â€¯17% at 3 months; 70.38 ±â€¯15.46% at 6 months; 70.67 ±â€¯17.27% at 12 months and 70.24 ±â€¯17.7% at the last follow-up. 88% of the patients followed up >6 months achieved the combined objective of a volume reduction rate of more than 50% of the VI, thyroid normal function and absence of clinic; and in all of these, it was maintained until the final follow-up date. Acute complications (mostly mild and all transient) were reported in 9 of the 100 RFA performed. CONCLUSION: Our findings validate in our setting the efficacy and safety of RFA in predominantly large and solid TNs, and add undescribed information to position the technique more favourably as a therapeutic alternative.

El material restaurador ideal en la era de la odontología de invasión mínima. Rescatando al oro directo / The ideal restorative material at the minimal invasive dentistry era. Rescuing direct gold

Los logros de los avances obtenidos en el manejo actual de la caries han dado la oportunidad a los odontólogos de detectar lesiones de caries en sus estadios incipientes. A pesar de la existencia de una gran variedad de materiales restauradores directos disponibles en el mercado actual y que pueden utilizarse para restaurar lesiones pequeñas de caries, el material que tiene más posibilidades de éxito para este tipo de lesiones es sin duda alguna el oro cohesivo, también conocido como oro directo (AU)

The goals obtained with the current management of dental caries has given the dentists the opportunity to detect incipient caries lesions in early stages. Although, the current existence of a great variety of direct restorative materials available in the market to restore small caries lesions, the material that may show better success for these type of lesions, is without any doubt: the gold foil or direct gold (AU)

A Retrospective Cohort Study of Treatment Outcomes of Adult Patients With Relapsed or Refractory Follicular Lymphoma (ReCORD-FL).

This study (ReCORD-FL) sought to construct a historical control cohort to augment single-arm trials in relapsed/refractory follicular lymphoma (r/r FL). A retrospective study in 10 centers across North America and Europe was conducted. Adults with grade 1-3A FL were required to be r/r after ≥2 therapy lines including an anti-CD20 and an alkylator. After first becoming r/r, patients were required to initiate ≥1 additional therapy line, which defined the study index date. Endpoints were observed from start of each therapy line (including index line) until death, last follow-up, or December 31, 2020. Endpoints were complete response (CR) rate, overall response rate (ORR), time to next treatment or death (TNT-D), event-free survival (EFS), and overall survival (OS). One hundred eighty-seven patients were identified. Most patients' (80.2%) index therapy occurred in third line (3L) (range, 3L-6L). Median follow-up from FL diagnosis was 9 years (range, 1-21 years). CR and ORR to the index therapy were 39.0% and 70.6%, respectively. Median (95% confidence interval) EFS from index was 14.6 (11.0-18.0) months; median OS from index was 10.6 years. Outcomes worsened across successive treatment lines and for patients who were double refractory (r/r to both an anti-CD20 monoclonal antibody and an alkylator) or POD24 (progressed ≤24 months after front-line anti-CD20) at index. Findings demonstrate the unmet need of FL patients with multiply relapsed, double refractory, or POD24 disease. Based on robustness of the historical data collected and comparability with a previous study (SCHOLAR-5), ReCORD-FL presents a valuable source of control data for comparative studies in r/r FL.

Lifetime Costs for Treated Follicular Lymphoma Patients in the US.

BACKGROUND AND OBJECTIVE: The objective of this study was to estimate the lifetime costs of patients receiving treatment for follicular lymphoma (FL) in the United States. METHODS: A Markov model was programmed in heRo3 with a 6-month cycle length, 35-year time horizon (lifetime projection), and health states for line of treatment, response, receipt of maintenance therapy among responders, transformation to diffuse large B-cell lymphoma (DLBCL), development of second primary malignancy (SPM), and death. The model was used to estimate the expected lifetime costs of FL (in 2019 USD), including costs of drug acquisition and administration, transplant procedures, radiotherapy, adverse events, follow-up, DLBCL, SPM, end-of-life care, and indirect costs. Model inputs were based on published sources. RESULTS: In the US, patients with FL receiving treatment have a life expectancy of approximately 14.5 years from initiation of treatment and expected lifetime direct and indirect costs of US$515,884. Costs of drugs for induction therapy represent the largest expenditure (US$233,174), followed by maintenance therapy costs (US$88,971) and terminal care costs (US$57,065). Despite the relatively advanced age of these patients, indirect costs (due to patient morbidity and mortality and caregiver lost work time) represent a substantial share of total costs (US$40,280). Treated FL patients spend approximately 6.9 years in the health states associated with first-line therapy. Approximately 66 and 46% continue to second- and third-line therapies, respectively. The mean (95% credible interval) of expected lifetime costs based on the probabilistic sensitivity analyses was US$559,202 (421,997-762,553). CONCLUSIONS: In the US, the expected lifetime costs of care for FL patients who receive treatment is high. The results highlight the potential economic benefits that might be achieved by treatments for FL that prevent or delay disease progression.

CD38: From Positive to Negative Expression after Daratumumab Treatment.

CD38 is a glycoprotein expressed at a low level in myeloid and lymphoid tissues. However, it is highly and homogeneously expressed in plasma cells (PC) in multiple myeloma. Daratumumab is a human CD38-specific IgG1 antibody available for the treatment of multiple myeloma in Colombia. It has been authorized in relapsed/refractory disease as front-line treatment for non-eligible stem cell transplantation patients by INVIMA (Instituto Nacional de Vigilancia de Medicamentos y Alimentos) that is the regulatory agency. Daratumumab treatment has been associated with the negativization of the expression of CD38 in PC, demonstrating a resistance mechanism under the clonal evolution theory. We report the case of a 63-year-old male, diagnosed with a relapsed/refractory multiple myeloma, heavily treated, who expressed strong CD38 marker at the beginning of the treatment, with a posterior negativization of CD38 after four cycles of treatment with daratumumab.

Use of bone char prepared from an invasive species, pleco fish (Pterygoplichthys spp.), to remove fluoride and Cadmium(II) in water.

In this study, bone char (BC) from pleco fish (Pterygoplichthys spp.) was synthesized, and their textural and physicochemical properties, as well as its adsorption capacity towards fluoride and Cd(II) from single and binary aqueous solutions, were determined. The results showed that the properties of the BCs were independent of the type of bone used and the surface areas were close to 110 m2 g-1. The effect of solution pH revealed that the adsorption capacity of BC towards fluoride from water raised by decreasing the solution pH. This trend was attributed to the electrostatic interaction between the positively charged surface and the fluoride in aqueous solution. On the contrary, the capacity of BC for adsorbing Cd(II) was enhanced by increasing the solution pH, indicating that electrostatic interactions were also essential but with a contrary effect in comparison with fluoride adsorption due to the negatively charged surface at pH above the point zero charge (pHPZC = 8.16). The experimental data for binary adsorption of fluoride and Cd(II) were interpreted satisfactorily using the modified Freundlich multicomponent isotherm (EFMI), and the experimental data revealed that Cd(II) have an antagonistic effect on the adsorption of fluoride, whereas the presence of fluoride does not affect the capacity of BC for adsorbing Cd(II). Thermogravimetric, XRD diffraction and IR spectroscopy analysis corroborated that the adsorption of fluoride in BC is due to electrostatic attractions, ion exchange or chemisorption and physisorption. Besides, the removal of Cd(II) occurs by physical adsorption and ion exchange. It was concluded that BC is an alternative material for the removal of fluoride and Cd(II) from aqueous solutions, and it is a possible application for using the bones of this invasive fish species.

Satisfacción de usuarios externos de los servicios brindados por Fondo Solidario para la Salud (FOSALUD). San Salvador, El Salvador años 2013, 2016 y 2018 / Satisfaction of external users of the services provided by the Solidarity Fund for Health (FOSALUD). San Salvador, El Salvador years 2013, 2016 and 2018

OBJETIVO: Determinar la satisfacción de los usuarios externos de los servicios brindados por Fondo Solidario para la Salud (FOSALUD). San Salvador, El Salvador en los años 2013, 2016 y 2018. METODOLOGÍA: Estudio descriptivo de corte transversal, el área de estudio fueron las Regiones Metropolitana, Occidental, Oriental, Central y Paracentral de Unidades Comunitarias de Salud Familiar, fue un universo de 6, 111,403 y una muestra de 3199 pacientes. RESULTADOS: La satisfacción de los usuarios de los servicios de Salud del FOSALUD, en cuanto a desempeño se percibe como muy bueno en un 39.14% para personal de Odontólogia y 39.46% Personal Médico, en cuanto al Nivel de Organización: Rapidez en la atención del Médico 36% y Odontólogo 34.8% fue percibido como Muy Bueno y en cuanto a la Calidez: Trato del personal Odontólogo 38% y Médico 36.8%, ambas áreas fueron percibidas como Muy Bueno. El 98% de los usuarios manifiesta que se dió solución al problema de salud por el cual consultó y el 96% de los usuarios tiene confianza en el personal FOSALUD CONCLUSIONES: Los encuestados percibieron una atención con mayor Calidad en los servicios del FOSALUD del Odontólogo/a y Medico/a, ya que fueron considerados de Muy Bueno, teniendo una mejor organización, prestando mayor calidez y un mejor desempeño en su trabajo. Además los usuarios de los servicios de Salud manifiestan en su mayoría que se le dio solución a su problema de salud por el cual consultaron y muestran un alto grado de confianza en la atención recibida

Antagonistic, synergistic and non-interactive competitive sorption of sulfamethoxazole-trimethoprim and sulfamethoxazole­cadmium (ii) on a hybrid clay nanosorbent.

The competitive sorption of the antibiotics sulfamethoxazole (SMX) and trimethoprim (TMP) and SMX-Cd(II) on a hybrid clay nanosorbent (NanoSorb) was investigated in detail in this work. NanoSorb was synthesized by sorbing a surfactant on bentonite. Besides, the sorption of SMX on the NanoSorb was confirmed by FTIR analysis, and SMX was mainly sorbed on NanoSorb by a partition mechanism due to hydrophobic interactions. Otherwise, the single adsorption of Cd(II) and TMP onto NanoSorb were due to electrostatic interaction and hydrophobic partition, respectively. The capacity of NanoSorb for sorbing single SMX was very similar to that for single Cd(II), but more than 10 times higher than that for single TMP. The competitive sorption of SMX-TMP was antagonistic because the sorption of one antibiotic on NanoSorb was decreased by the presence of the other antibiotic. The uptake of SMX was reduced up to 43.4% by the presence of TMP, whereas the presence of SMX decreased the uptake of TMP up to 29.6%. The non-modified Langmuir multicomponent isotherm (NLMI) interpreted quite well the experimental competitive sorption data of SMX-TMP. On the other hand, the competitive sorption of SMX-Cd(II) on NanoSorb revealed that the sorption of SMX was non-interactive because it was not influenced by the presence of Cd(II). Whereas, the sorption of Cd(II) was synergistic or cooperative since the uptake of Cd(II) sorbed increased considerably with the uptake of SMX sorbed on NanoSorb. The two-site Langmuir model fitted the experimental competitive sorption data of Cd(II) on NanoSorb saturated with SMX. The application of this isotherm was based on the fact that Cd(II) sorbed on two types of sites: a) cationic sites of the NanoSorb and b) Pi-cation interactions between the aromatic ring of the SMX sorbed on NanoSorb and Cd2+.

Sub fascial flap based on the supraclavicular artery in reconstruction of neck burn contractures.

This study presents 3 cases of women ages ranged from 25 to 52 years with anterior cervical contractures caused by burns that resulted in functional and aesthetic deficit. Contracture release in 3 patients and reconstruction was done using a sub-fascial flap whose main pedicle was the supraclavicular artery and the occipito-postero-cervical vessels that were preserved. The flap was designed differently from the classically described that uses the skin of the shoulder but which presents differences of color and texture with relation to the skin of the neck. The results were satisfactory and no complications such as infections or necrosis.

Zetaplastia na retração axilar: técnica e tática para facilitar o aprendizado dos residentes / Z-plasty in axillary retraction: techniques and strategies to facilitate learning by medical residents

Introdução: São apresentados dois casos de retração em região axilar após queimadura em que a correção cirúrgica foi realizada empregando-se zetaplastias múltiplas. Apresentamos uma tática de marcação que visa facilitar o aprendizado desse procedimento pelos residentes de Cirurgia Plástica. Métodos: Dois pacientes com retrações axilares e de membros superiores após queimadura com líquido aquecido foram submetidos à correção cirúrgica empregando-se a zetaplastia múltipla. A tática de planejamento proposta nesse estudo preconiza primeiro a marcação do retalho triangular localizado no ponto médio da retração axilar, o qual irá avançar e cruzar o eixo da cicatriz, e a partir daí o desenho dos retalhos subsequentes com ângulo de 60° entre si. Acreditamos que essa sistematização da marcação facilita o planejamento e aprendizado da plástica em Z. Resultados: Os pacientes apresentaram adequadas amplitude de movimento e recuperação funcional do membro acometido no pós-operatório. Não houve necrose das extremidades dos retalhos, que preconizamos serem cuidadosamente trabalhadas e um pouco arredondadas; e a execução do procedimento foi simples devido à tática de marcação que aplicamos. Conclusão: A tática de marcação que apresentamos é reprodutível e de fácil aprendizado. A zetaplastia múltipla foi eficaz em restabelecer a amplitude de movimento das áreas com sequela de queimadura tratadas com esse método.

Introduction: Herein, we present two cases of post-burn retraction of the axillary region, which were subsequently surgically corrected using multiple Z-plasties. We present a marking strategy to facilitate the learning of this procedure by plastic surgery residents. Methods: Two patients with axillary and upper limb retractions due to burns with hot liquids were surgically treated using multiple Z-plasties. The strategy proposed in this study recommends the marking of the triangular flap located at the midpoint of the axillary retraction, which then advances and crosses the axis of the scar. Then, subsequent flaps are made at an angle of 60° to each other. We believe that this systematization of marking facilitates the planning and learning of Z-plasty. Results: The study patients achieved an adequate range of motion and functional recovery of the affected limb postoperatively. We observed no cases of necrosis of the flap ends, which should be carefully worked and slightly rounded. The execution of the procedure was simple using the suggested marking strategy. Conclusion: The presented marking strategy was reproducible and easy to learn. Multiple Z-plasties were effective in restoring the range of motion of the areas affected by burns that were treated using this method.

Nivel de actividad física en adolescentes de un distrito de la región Callao / Level of physical activity among adolescents in a district of the Callao region

RESUMEN Objetivos. Determinar el nivel de actividad física (AF) y la asociación con el uso excesivo de Internet entre los adolescentes del distrito de "Mi Perú", en la región Callao. Materiales y métodos. Estudio descriptivo transversal. Los sujetos participantes fueron estudiantes de 15 a 19 años de edad de los colegios estatales del distrito de "Mi Perú". Se empleó la versión larga del IPAQ (Physical Activity Questionnaire), fue aplicado en las aulas de clases entre octubre y diciembre del 2013. La AF se ha expresado en equivalente metabólico (MET) y se clasifico en nivel bajo, moderado y alto. El uso de Internet de más de 20 h semanales fue considerado excesivo. Resultados. Del total de participantes, el 59% (272) obtuvieron nivel alto de AF, el 25,8% (119) nivel moderado de AF, y 15,2% (70) nivel bajo de AF. En el 50% de los adolescentes el nivel de AF fue menor o igual a 4212 MET/min/sem. Según las áreas del IPAQ, se obtuvieron mayores niveles de AF en las áreas "labores de hogar" y "recreación". La AF en las labores del hogar fue mayor en el sexo femenino respecto a los varones (p=0,010), mientras que en las actividades de recreación la AF fue mayor en los varones (p=0,009). Solo el 2,6% (12) de los adolescentes usaron Internet más de 20 h semanales. Conclusiones. El estudio muestra un nivel alto de actividad física, no se encontró asociación entre el nivel de actividad física y el uso excesivo de Internet en la población estudiada.

ABSTRACT Objectives. To determine the level of physical activity (PA) and the association of this factor with excessive Internet use among adolescents from the "Mi Perú" district in the Callao region. Materials and Methods. This cross-sectional descriptive study included 15-19-year-old students at state schools in the "Mi Perú" district. The long version of the Physical Activity Questionnaire (IPAQ) was applied in the subjects' classrooms between October and December 2013. PA was expressed in metabolic equivalent of task (MET) units and classified as low, moderate, and high. Internet usage of ≥20 hours per week was considered excessive. Results. Of the total participants, 59% (272), 25.8% (119), and 15.2% (70) had high, moderate, and low levels of PA, and 50% of adolescents had a PA level ≤4,212 MET/min/wk. According to the IPAQ, higher levels of PA were achieved in the areas of "house work" and "recreation". The PA for house work was higher in female subjects relative to male subjects (p=0.010), whereas the PA for recreation was higher among male subjects (p=0.009). Only 2.6% (12) of teenagers used the Internet for >20 hours per week. Conclusions. This study reveals a high level of PA and a lack of association between the PA level and excessive Internet use in the studied population.

Factores de riesgo para hipertensión arterial en población adulta de una región urbana de Ecuador / Risk factors for arterial hypertension in the adult population of an urban region of Ecuador

RESUMEN Objetivos Determinar los factores de riesgo para hipertensión arterial (HTA) en población adulta residente en la ciudadde Cuenca, Ecuador Materiales y métodos Estudio transversal analítico realizado en adultos seleccionados mediante muestreo aleatorio multietápico, a quienes se les realizó evaluación clínica, evaluación antropométrica y de laboratorio. El diagnóstico de HTA fue definido según los criterios del JNC-7. Se realizó un modelo de regresión logística múltiple Resultados Se incluyeron 318 personas. La prevalencia de HTA fue de 25,8% (hombres: 27,2% vs mujeres: 24,7%; p=0,617). En el modelo de regresión logística múltiple, los factores de riesgo para HTA fueron la edad > 60 años (OR 8,68; IC 95%: 3,56-21,14; p<0,001), obesidad según índice de masa corporal (OR 2,36; IC 95%: 1,04-5,70; p=0,042), alto consumo calórico (OR 2,06; IC 95%: 1,01-4,53; p=0,044) y el antecedente familiar de HTA (OR 1,58; IC 95%: 1,02-2,90; p=0,040) Conclusiones La presencia de HTA en esta población se asocia a factores intrínsecos como medioambientales, los cuales deben ser considerados en la evaluación rutinaria para la identificación y control temprano de esta enfermedad.

ABSTRACT Objectives . To determine the risk factors for arterial hypertension (HTN) in the adult resident population of the city of Cuenca, Ecuador Materials and methods A cross-sectional analytical study of adults selected via multistage random sampling who underwent clinical, anthropometric, and laboratory evaluations. The diagnosis of HTN was defined according to the JNC-7 criteria. A multiple logistic regression model was performed Results A total of 318 persons were included. The prevalence of HTN was 25.8% (males: 27.2% vs. females: 24.7%; p = 0.617). In the multiple logistic regression model, the risk factors for HTN were age > 60 years (OR, 8.68; 95% CI, 3.56-21.14; p < 0.001), obesity according to body mass index (OR, 2.36; 95% CI, 1.04-5.70; p = 0.042), high caloric intake (OR, 2.06; 95% CI, 1.01- 4.53; p = 0.044), and family history of HTN (OR, 1.58; 95% CI, 1.02-2.90; p = 0.040) Conclusions The presence of HTN in this population is associated with both intrinsic and environmental factors, which should be considered in routine evaluations to ensure its early identification and control.

Community health needs assessment: a pathway to the future and a vision for leaders.

There is a need to implement evidence-based public health practice that integrates targeted and specific strategies and actions with community preferences to improve the health of populations. A community health needs assessment (CHNA) is vital to identifying the health concerns of communities, to learn about the factors that influence their health and the assets, resources, and challenges that impact those factors. It is required for tax-exempt entities to conduct a CHNA and adopt an implementation strategy to meet the identified community health needs. The goal of this article is to chart a pathway for health system leaders utilizing a CHNA process to address disparities in racial/ethnic groups and other medically underserved populations and to meet legal requirements. The efforts of the H. Lee Moffitt Cancer Center and Research Institute in developing its CHNA will be highlighted to provide clear evidence to health system leaders for why and how to conduct a thorough and compelling CHNA to meaningfully address health disparities locally and respond to longstanding historical health inequities at the health system level.

The Yo me cuido® Program: Addressing Breast Cancer Screening and Prevention Among Hispanic Women.

Breast cancer is less likely to be diagnosed at the earliest stage in Hispanic/Latino (Hispanic) women compared to non-Hispanic White women, even after accounting for differences in age, socioeconomic status, and method of detection. Moffitt Cancer Center created a comprehensive health education program called Yo me cuido (®) (YMC) to address and reduce breast cancer disparities among Spanish- and English-speaking Hispanic women by providing breast cancer and healthy lifestyles awareness and education, and promoting breast cancer screenings, reminders, and referrals for women 40 years and older. The purpose of this paper is to showcase the innovative approaches and methods to cancer prevention and early detection of the YMC program, and to promote it as an effective tool for improving outcomes in community health education, outreach, and engagement activities with Hispanic populations. Key components of the program include educational workshops, mammogram referrals, and a multimedia campaign. The YMC program is unique because of its approaches in reaching the Hispanic population, such as delivering the program with compassionate services to empower participants to live a healthier lifestyle. Additionally, direct follow-up for mammography screenings is provided by program staff. From 2011 to 2013, YMC has educated 2,226 women and 165 men through 93 workshops. About 684 (52 %) women ages 40 and older have had a screening mammogram within their first year of participating in the program. The YMC program is an innovative cancer education and outreach program that has demonstrated a positive impact on the lives of the Hispanic community in the Tampa Bay region.

Empowering underserved populations through cancer prevention and early detection.

It is well documented that cancer is disproportionately distributed in racial/ethnic minority groups and medically underserved communities. In addition, cancer prevention and early detection represent the key defenses to combat cancer. The purpose of this article is to showcase the comprehensive health education and community outreach activities at the H. Lee Moffitt Cancer Center and Research Institute (Moffitt) designed to promote and increase access to and utilization of prevention and early detection services among underserved populations. One of Moffitt's most important conduits for cancer prevention and early detection among underserved populations is through its community education and outreach initiatives, in particular, the Moffitt Program for Outreach Wellness Education and Resources (M-POWER). M-POWER works to empower underserved populations to make positive health choices and increase screening behaviors through strengthening collaboration and partnerships, providing community-based health education/promotion, and increasing access to care. Effective, empowering, and culturally and linguistically competent health education and community outreach, is key to opening the often impenetrable doors of cancer prevention and early detection to this society's most vulnerable populations.

The prostate cancer screening controversy: addressing bioethical concerns at a community health promotion event for men.

There are bioethical concerns related to prostate cancer screening. A new prostate cancer screening approach at a community health promotion event used vouchers to promote informed decision-making in order to reduce these concerns.

Hepatotoxicity associated with dietary energy supplements: use and abuse by young athletes.

 In recent years there has been a significant increase in the consumption of dietary energy supplements (DES) associated with the parallel advertising against obesity and favoring high physical performance. We present the case and outcome of a young patient who developed acute mixed liver injury (hepatocellular and cholestatic) after ingestion of various "over the counter" products to increase muscle mass and physical performance (NO Xplode®, creatine, L-carnitine, and Growth Factor ATN®). The diagnosis was based on the exclusion of other diseases and liver biopsy findings. The dietary supplement and herbal multivitamins industry is one with the highest growth rates in the market, with annual revenues amounting to billions and constantly lacking scientific or reproducible evidence about the efficacy and/or safety of the offered products. Furthermore, and contrary to popular belief, different forms of injury associated with these natural substances have been documented particularly in the liver, supporting the need of a more strict regulation.