Cervical cancer disparities in stage at presentation for disaggregated Asian Americans, Native Hawaiians, and Pacific Islanders.

BACKGROUND: Over 20 million people in the United States identified as Asian American, Native Hawaiian, or Pacific Islander in 2022. Despite the diversity of immigration histories, lived experiences, and health needs within the Asian American, Native Hawaiian, or Pacific Islander community, prior studies in cervical cancer have considered this group in aggregate. OBJECTIVE: We sought to analyze disparities in cervical cancer stage at presentation in the United States, focusing on disaggregated Asian American, Native Hawaiian, or Pacific Islander groups. STUDY DESIGN: Data from the United States National Cancer Database from 2004 to 2020 of 122,926 patients newly diagnosed with cervical cancer were retrospectively analyzed. Asian American, Native Hawaiian, or Pacific Islander patients were disaggregated by country of origin. Logistic regression, adjusted for clinical and sociodemographic factors, was used to calculate adjusted odds ratios. Higher adjusted odds ratios indicate an increased likelihood of metastatic versus nonmetastatic disease at diagnosis. RESULTS: Out of 122,926 patients with cervical cancer, 5142 (4.2%) identified as Asian American, Native Hawaiian, or Pacific Islander. Compared to non-Hispanic White patients, pooled Asian American, Native Hawaiian, or Pacific Islander patients presented at lower stages of cancer (non-Hispanic White: 58.7% diagnosed local/regional, Asian American, Native Hawaiian, or Pacific Islander : 85.6% at local/regional, χ2 P<.001). The largest Asian American, Native Hawaiian, or Pacific Islander subgroups included Filipino Americans (n=1051, 20.4% of Asian American, Native Hawaiian, or Pacific Islander), Chinese Americans (n=995, 19.4%), Asian Indian/Pakistani Americans (n=711, 13.8%), Vietnamese Americans (n=627, 12.2%), and Korean Americans (n=550, 10.7%) respectively. Asian American, Native Hawaiian, or Pacific Islander disaggregation revealed that Pacific Islander American patients had higher odds of presenting with metastatic disease (adjusted odds ratio 1.58, 95% confidence interval 1.21-2.06, P=.001) relative to non-Hispanic White patients. Conversely, Chinese American (adjusted odds ratio 0.47, 95% confidence interval 0.37-0.59, P<.001), Vietnamese American (adjusted odds ratio 0.54, 95% confidence interval 0.41-0.70, P<.001), Hmong American (adjusted odds ratio 0.46, 95% confidence interval 0.22-0.97, P=.040), and Indian/Pakistani American (adjusted odds ratio 0.76, 95% confidence interval 0.61-0.94, P=.013) patients were less likely to present with metastatic disease. Compared to the largest Asian American, Native Hawaiian, or Pacific Islander group (Chinese American), 9 other subgroups were more likely to present with metastatic disease. The largest differences were observed in Pacific Islander American (adjusted odds ratio 3.44, 95% confidence interval 2.41-4.91, P<.001), Thai American (adjusted odds ratio 2.79, 95% confidence interval 1.41-5.53, P=.003), Kampuchean American (adjusted odds ratio 2.39, 95% confidence interval 1.29-4.42, P=.006), Native Hawaiian American (adjusted odds ratio 2.23, 95% confidence interval 1.37-3.63, P=.001), and Laotian American (adjusted odds ratio 2.02, 95% confidence interval 1.13-3.61, P=.017). In contrast, Vietnamese American (adjusted odds ratio 1.20, 95% confidence interval 0.85-1.71, P=.303), and Hmong American (adjusted odds ratio 1.09, 95% confidence interval 0.50-2.37, P=.828) patients did not show a statistically significant difference in presenting with metastatic disease compared to Chinese American patients. CONCLUSION: Aggregated evaluation of the Asian American, Native Hawaiian, or Pacific Islander monolith masks disparities in outcomes for distinct populations at risk for equity gaps. This disaggregation study shows that marginalized groups within the larger Asian American, Native Hawaiian, or Pacific Islander population-including Pacific Islander American and Thai American patients-may face different exposures and larger structural barriers to cancer screening and early-stage diagnosis. A future focus on community-based disaggregated research and tailored interventions is necessary to close these gaps.

Survival times of patients with glioblastoma in low- and middle-income countries: a systematic review and meta-analysis.

Little is known about the survivorship of glioblastoma (GBM) patients in low- and middle-income countries (LMICs). We hypothesize that this would be lower than published figures for high-income countries due to cancer health disparities. We performed a systematic review and meta-analysis to estimate the median overall survival (OS) of GBM in LMICs and determine factors affecting OS. A systematic review of 12 electronic databases was conducted according to PRISMA guidelines to identify studies of newly diagnosed adult GBM patients done in countries classified as LMIC by the World Bank (WB) from inception to December 2020. Random effects meta-analysis of collected median overall survival data was done. Subgroup analysis and meta-regression were done to determine if WB income classification (WBIC), start year of recruitment (pre- or post-popularization of the standard Stupp protocol), and treatment modality affected OS. The 24 articles (n = 2,552) that met the inclusion criteria were from 8 low-middle income and upper-middle income countries, with 0 articles from low-income countries. Random effects analysis of 24 studies showed a pooled median OS of 14.17 months (95% CI 12.90-15.43, I2 = 79). Subgroup analysis showed a significant difference (p < 0.05) in the pooled median OS of studies predating Stupp protocol (12.54 mo, 95% CI 11.13-13.96, I2 = 80%; n = 1027) and studies postdating Stupp protocol (15.64 mo, 95% CI 13.58-17.69, I2 = 77; n = 1412). Subgroup analysis of WBIC and treatment modalities did not show significant differences. Published data on the survivorship of GBM patients in LMICs is sparse, highlighting the need for good quality pragmatic studies from LMICs. The limited evidence suggests improving survivorship after introduction of the Stupp protocol.

Outcomes for Australian children with relapsed/refractory acute lymphoblastic leukaemia treated with blinatumomab.

We report on the Australian experience of blinatumomab for treatment of 24 children with relapsed/refractory precursor B-cell acute lymphoblastic leukaemia (B-ALL) and high-risk genetics, resulting in a minimal residual disease (MRD) response rate of 58%, 2-year progression-free survival (PFS) of 39% and 2-year overall survival of 63%. In total, 83% (n = 20/24) proceeded to haematopoietic stem cell transplant, directly after blinatumomab (n = 12) or following additional salvage therapy (n = 8). Four patients successfully received CD19-directed chimeric antigen receptor T-cell therapy despite prior blinatumomab exposure. Inferior 2-year PFS was associated with MRD positivity (20%, n = 15) and in KMT2A-rearranged infants (15%, n = 9). Our findings highlight that not all children with relapsed/refractory B-ALL respond to blinatumomab and factors such as blast genotype may affect prognosis.

Palliative and Supportive Care in the Philippines: Systems, Barriers, and Steps Forward.

Although integral to alleviating serious health-related suffering, global palliative care remains systemically and culturally inaccessible to many patients living in low- and middle-income countries. In the Philippines, a lower-middle income country in Southeast Asia of over 110 million people, up to 75% of patients with cancer suffer from inadequate pain relief. We reviewed factors that preclude access to basic palliative care services in the Philippines. PubMed and Google Scholar were searched thoroughly; search terms included but were not limited to "palliative care," "supportive care," "end-of-life care," and "Philippines." We found that a limited palliative care workforce, high out-of-pocket healthcare costs, and low opioid availability all hinder access to palliative care in the archipelago. Religious fatalism, strong family-orientedness, and physician reluctance to refer to palliative care providers represent contributory sociocultural factors. Efforts to improve palliative care accessibility in the country must address health systems barriers while encouraging clinicians to discuss end-of-life options in a timely manner that integrates patients' unique individual, familial, and spiritual values. Research is needed to elucidate how Filipinos-and other global populations-view end-of-life, and how palliative care strategies can be individualised accordingly.

Sex differences in transcatheter aortic valve replacement outcomes among patients with bicuspid aortic stenosis.

BACKGROUND: Despite comprising almost half of all patients undergoing valvular repair, data on transcatheter aortic valve replacement (TAVR) in patients with bicuspid aortic stenosis (BAS) are limited. OBJECTIVE: We aimed to evaluate whether there are any sex differences in trends and outcomes of TAVR in this population. METHODS: We utilized the National Inpatient Sample from 2012 to 2020 to identify admissions with BAS who underwent TAVR and analyzed trends and outcomes. Our primary outcome was in-hospital mortality and secondary outcomes were in-hospital complications. We used two models to adjust for demographics (A) and interventions (B). RESULTS: Between 2012 to 2020, there were 76,540 hospitalizations for BAS patients who underwent AVR, among which 6,010 (7.9 %) underwent TAVR. There was an overall increasing trend in number of TAVR cases with a decreasing trend in mortality (2013: 8.7 %, 2020: 1.3 %). TAVR was performed more in males (61.1% vs 38.9 %). Despite the worse baseline characteristics in males, in-hospital mortality (2.4% vs. 1.5 %; OR: 1.584; 95 % CI: 0.621-4.038; p = 0.335) and secondary outcomes were similar across both sexes, even after adjusting for demographics and interventions. CONCLUSION: TAVR in BAS has grown rapidly in the last decade. Males comprised the majority and had more comorbidities, but mortality and complications were similar in both sexes. Despite the increasing number of cases, a decreasing trend in mortality was observed for both sexes ultimately approaching that of SAVR, suggesting that TAVR may be a safe alternative among eligible males and females with bicuspid AS.

Access to surgical treatment for hepatopancreaticobiliary cancer in the Philippines.

Hepatopancreaticobiliary cancers are among the most diagnosed cancers in the world. However, although high-income countries have the highest incidence rates, low- and middle-income countries have the highest mortality rates. In this article, we describe the geographic distribution of board-certified hepatopancreaticobiliary surgeons who provide surgical management for patients with these diseases in the Philippines. We draw attention to the geographic disparities in the distribution of these surgeons and the other factors that contribute to the lack of access. Lastly, we suggest ways forward.

Current status of hypertension care and management in the Philippines.

AIMS: In this paper, we discuss the existing data on the burden of hypertension in the Philippines and present the status of management, prevention, and control of hypertension in the country. METHODS: A literature review was conducted to synthesize the status of hypertension care in the Philippines. RESULTS: Hypertension continues to contribute to the country's leading causes of death. Similar to the global trend, almost half of hypertensive Filipinos are still not aware of their condition, and only 27 % have it under control. The prevalence of hypertension has steadily increased from 22 % in 1993 to 25.15 % in 2013. The 2020 Philippine Society for Hypertension clinical practice guideline defines hypertension as an office BP of 140/90 mm Hg or above following the proper standard BP measurement. During the past decade, monotherapy has been the mode of treatment in more than 80 % of Filipino patients. This could also explain why the BP control rates have been low. The most prevalent complications of hypertension in the Philippines were stroke (11.6 %), ischemic heart disease (7.7 %), chronic kidney disease (6.30 %), and hypertensive retinopathy (2.30 %). Hypertension causes economic tolls on patients, from the cost of drugs to hospitalization and complications. Hospitalization from hypertensive complications can easily wipe out the savings of middle-class families and is catastrophic for lower-income Filipinos. CONCLUSION: In this review, we summarize the existing data on the burden of hypertension among Filipinos and the risk factors associated with the disease. We present the current screening tools, diagnostics, treatment, and prevention strategies for hypertension in the Philippines. Lastly, we propose solutions to meet the global targets of hypertension management and help relieve the growing burden of this disease.

Current status of diabetes mellitus care and management in the Philippines.

AIMS: In this paper, we discuss the existing data on the burden of diabetes in the Philippines and present the status of management, prevention, and control of diabetes in the country. METHODS: A review of literature was conducted to synthesize the status of diabetes mellitus in the Philippines. RESULTS: An estimated 4.3 million Filipinos were diagnosed with diabetes, while 2.8 million remained undiagnosed in 2021. Diabetic retinopathy is a top cause of preventable blindness in Region 3, Philippines. Diabetic nephropathy contributes to 38% of renal disease cases in the Philippines. The 2021 Philippine Guidelines on Periodic Health Examination (PhEX) advocate for the utilization of fasting blood sugar (FBS) as a screening measure for Type 2 Diabetes Mellitus (T2DM) in healthy adults aged 40 years and older or in those with specified risk factors. The alternative option of hemoglobin A1c is (HbA1c) deemed appropriate but comes with a conditional recommendation due to its uneven accessibility across different regions of the country. Treatment guidelines align between the Philippines and the US. Initial medical nutrition therapy involves healthy habits, progressing to pharmacologic treatment if necessary. Financial constraints, seen in limited insurance coverage and high out-of-pocket costs, impede care, amplifying disease impact. The complex diabetes care, encompassing pharmacotherapy, nutrition, exercise, and monitoring, faced challenges during COVID-19 quarantines. CONCLUSION: In conclusion, the paper outlines diabetes care principles-screening, diagnostics, and multidisciplinary care-alongside economic implications. Local and national initiatives are discussed to mitigate diabetes trends and reduce its burden in the Philippines.

Nanomedicine and nanoparticle-based delivery systems in plastic and reconstructive surgery.

BACKGROUND: Nanotechnology and nanomedicine are rising novel fields in plastic and reconstructive surgery (PRS). The use of nanomaterials often goes with regenerative medicine. Due to their nanoscale, these materials stimulate repair at the cellular and molecular levels. Nanomaterials may be placed as components of nanocomposite polymers allowing enhancement of overall biochemical and biomechanical properties with improved scaffold properties, cellular attachment, and tissue regeneration. They may also be formulated as nanoparticle-based delivery systems for controlled release of signal factors or antimicrobials, for example. However, more studies on nanoparticle-based delivery systems still need to be done in this field. Nanomaterials are also used as frameworks for nerves, tendons, and other soft tissues. MAIN BODY: In this mini-review, we focus on nanoparticle-based delivery systems and nanoparticles targeting cells for response and regeneration in PRS. Specifically, we investigate their roles in various tissue regeneration, skin and wound healing, and infection control. Cell surface-targeted, controlled-release, and inorganic nanoparticle formulations with inherent biological properties have enabled enhanced wound healing, tumor visualization/imaging, tissue viability, and decreased infection, and graft/transplantation rejection through immunosuppression. CONCLUSIONS: Nanomedicine is also now being applied with electronics, theranostics, and advanced bioengineering technologies. Overall, it is a promising field that can improve patient clinical outcomes in PRS.

Neurosurgical research in Southeast Asia: A bibliometric analysis.

OBJECTIVES: Bibliometric analysis can provide insight into the growth, development and dissemination of research in neurosurgery. Little work has been done to examine the role of country-specific characteristics affecting research productivity. We aimed to characterize andcompare the research productivity among SEA countries in terms of bibliometric indicesand determine associations with country-specific factors. METHODS: We performed a systematic search of all articles by authors affiliated with a neurosurgical department in any of the Southeast Asian countries, indexed in 3 databases from inception to June 10, 2020. Bibliometric indices - number of publications, number of citations, average citations per publication, h-index, and the i-10-index - were computed for each country. Correlations between the indices and country-specific characteristics (population size, GDP per capita, percentage of GDP allocation to research and development (R&D), number of neurosurgeons, number of neurosurgeons per capita, and number of collaborations with non-SEA authors) were determined. RESULTS: The number of publications showed an increasing trend up to 2019. Most studies were cohort studies (37%) or case reports or series (37%). Of the country-specific factors analyzed, only percentage of the GDP allocated to R&D was positively correlated with number of publications (p = 0.0004), total citations (p < 0.0001), H-index (p < 0.0001), and i(10)-index (p < 0.0001). Number of collaborations also positively correlated with the same indices. CONCLUSION: Our bibliometric analysis showed increasing contribution by neurosurgeons in the SEA region. Correlational analysis support the view that increased R&D budget allocation and international collaboration can improve neurosurgical research capacity and productivity.

Riding the waves of the COVID-19 pandemic in South Korea.

During the first months of the coronavirus disease 2019 (COVID-19) pandemic in early 2020, South Korea stood as one of the most successful in preventing a nationwide outbreak. The country was unique in that it did so without enforcing massive border restrictions and tight social distancing measures, instead focusing on maximal testing, contact tracing, and treatment. But as the year 2020 went on, the country has suffered second and third waves, each one being larger and harder to combat than the last. The Korean government, however, has been unwilling to impose stringent measures due to potential economic consequences and has still relied on its initial strategies in an attempt to prevent further disease transmission. It is therefore crucial to revisit their position beyond their early successes to re-evaluate the effectiveness of their strategy, and to finally decide if it is time to move on to more drastic measures.