Location-dependent ethnic differences in the risk of colorectal adenoma: a retrospective multiethnic study.

BACKGROUND AND AIMS: Epidemiological data have demonstrated that Hispanics have a lower incidence rate of colorectal cancer (CRC) compared with other major race/ethnicity groups in the United States. However, data regarding the relative prevalence of colorectal adenomas (CRAs) in Hispanic versus non-Hispanic populations are currently sparse and inconclusive. METHODS: We conducted a retrospective review of colonoscopy patients (n=1656) at a single tertiary-care community hospital from 2007 to 2011, to evaluate the association of self-reported race/ethnicity status with CRA prevalence and characteristics. Established CRC risk factors were also included in multivariate regression models. RESULTS: Overall, the CRA prevalence was lower in Hispanic subjects than non-Hispanic subjects (14.8% vs. 22.5%) and this difference was statistically significant (adjusted odds ratio, 0.67; 95% confidence interval, 0.47-0.96; P<0.01). Conversely, no difference in CRA prevalence was observed between non-Hispanic white and black subjects. Further analyses by adenoma location revealed more pronounced reduction in proximal CRA prevalence for Hispanics versus non-Hispanics (5.3% vs. 13.1%; adjusted odds ratio, 0.42; 95% confidence interval, 0.26-0.70; P<0.001), whereas CRA prevalence in distal colon, rectum or multiple locations did not differ significantly between race/ethnicity groups. CONCLUSIONS: Our data showed a marked distinction in CRA prevalence, particularly proximal adenomas, between Hispanics and non-Hispanics. Additional multicenter studies are needed to confirm these findings, elucidate the underlying mechanisms, and clarify the implications for CRC screening and other preventive and/or therapeutic interventions.

Spectrum of Cardiac Involvement in COVID-19.

Cardiac involvement in coronavirus disease 2019 (COVID-19) commonly accompanies multi-organ system failure with acute respiratory syndrome; however, infrequently myocarditis and pericardial effusions may be isolated, yet fulminant. In this report, we highlight significant variations in cardiac involvement and presentation among patients with COVID-19. This article reports two cases of fulminant myocarditis in COVID-19 positive patients who presented to our facility with contrasting symptoms, laboratory and imaging findings. A 65-year-old patient A had a more typical presentation including respiratory distress, chest pain, ST-segment elevations on electrocardiogram (EKG), lymphopenia, elevated levels of inflammatory markers and cardiac troponin I. A 34-year-old patient B presented with shortness of breath and chest pain similar to patient A; however, she had isolated cardiac involvement with systolic dysfunction and an acute pericardial effusion causing tamponade physiology. Inflammatory marker and cardiac troponin I levels for patient B were within normal range. Patient A had a rapid progression of multi-organ system failure leading to her death within 24 hours from presentation on maximal inopressor support. Patient B, however, is one of few reported cases of cardiac tamponade and veno-arterial extracorporeal membrane oxygenation (VA-ECMO) use in COVID-19 who underwent pericardiocentesis and was additionally managed with colchicine and steroids, leading to complete recovery in systolic function within three weeks from initial presentation. Isolated myocardial dysfunction and pericardial effusions in COVID-19 may have catastrophic sequalae even in the absence of elevated biomarkers described in literature. Therefore, early detection and management of cardiac involvement is warranted. Additionally, the role of mechanical circulatory support devices and VA-ECMO in COVID-19 needs further investigation.

The relationship of vitamin D status, smoking, and colorectal adenoma: a retrospective study in an ethnically diverse community.

OBJECTIVE: Circulating 25-hydroxyvitamin D (25OHD) level is suggested to be negatively correlated with risk of colorectal cancer (CRC) and colorectal adenoma (CRA), but most of the epidemiological data were originated amongst Caucasians and African Americans. This study aimed to investigate the relationship between vitamin D status, smoking and CRA in an ethnically diverse community with a high Hispanic density. METHODS: In this retrospective study, we included 233 patients who underwent complete colonoscopies from 2009 to 2011, and their serum 25OHD levels in the winter season had been measured. Among them, 65 adenoma cases and 168 adenoma-free controls were identified and evaluated for the association of CRA with smoking, ethnicity and serum 25OHD level using unstratified and stratified multivariate logistic regression analyses. RESULTS: In our study participants, the mean serum 25OHD level and the percentage of Hispanics were lower in the adenoma group versus the control group, while no black-white difference was noted in the CRA prevalence. When adjusted for 25OHD level, the lower rate of adenoma in Hispanics compared to non-Hispanics was attenuated and became statistically insignificant. A mild protective effect of vitamin D (6% reduction) on the CRA risk was found significant for active smokers, but not for non-smokers. A detrimental impact of smoking in the CRA risk was only shown among non-Hispanic patients, but not among Hispanics irrespective of vitamin D status. CONCLUSIONS: Our data suggest a marked distinction between Hispanics and non-Hispanics in the risk of CRA. The reduced adenoma prevalence among Hispanics vs. non-Hispanics could be partially explained by vitamin D status, cigarette smoking and their interactions. Future larger-sized multi-center studies on vitamin D status and ethnicity, as well as dietary, behavioral, genetic factors and their interactions for CRA and CRC are needed. This article is part of a Special Issue entitled 'Vitamin D Workshop'.

Obesity, metabolic factors, and colorectal adenomas: a retrospective study in a racially diverse New York State Hospital.

OBJECTIVE: We studied a racially diverse population and the relationship with colorectal adenomas (CA) further looking for risks related to BMI and metabolic factors. DESIGNS: Seven hundred seventy-nine patients who underwent screening colonoscopies between 2007 and 2009 meeting exclusion criteria were included. To evaluate the association between race, BMI, and other metabolic factors with having one or more CA detected at colonoscopy, adjusted odds ratios and 95 % CI were estimated using unconditional logistic regression models. OUTCOMES: CA were detected in 167 out of 779 (21.4 %) patients. Compared to Whites, Hispanics were less likely to have one or more adenomas detected during a screening colonoscopy (OR = 0.52, 95 % CI, 0.31-0.88; p = 0.01). There was no significant statistical difference between Blacks and Whites, or other races and Whites. There was an association between the presence of CA and smoking (OR = 1.57, 95 % CI, 1.02-2.43; p = 0.04). CONCLUSION: Our results showed that Hispanics were less likely to have an adenoma detected during a screening colonoscopy than Whites. No statistical significant difference was found between patients with metabolic factors and the presence of colorectal adenoma.