Changes in In-Person, Audio-Only, and Video Visits in California's Federally Qualified Health Centers, 2019-2022.

This study assesses telehealth visit trends among California federally qualified health centers from 2019 to 2022.

Postirradiation pseudosclerodermatous panniculitis: three new cases with additional histopathologic features supporting the radiotherapy etiology.

Postirradiation pseudosclerodermatous panniculitis is a rare panniculitic disorder induced by radiotherapy. Clinically, it consists of an indurate plaque localized on the irradiated area that may appear months or even years after radiotherapy was administered. Histopathologically, postirradiation pseudosclerodermatous panniculitis is characterized by a mostly lobular panniculitis without vasculitis, with lipophagic granuloma involving the fat lobules, a variable inflammatory infiltrate of lymphocytes and plasma cells and sclerotic thickening of the connective tissue septa of the subcutis. We report 3 additional cases of this rare variant of panniculitis, in which besides the panniculitis findings, dermal vessels showed sclerotic vessel walls and atypical bizarre fibroblasts with large pleomorphic and hyperchromatic nuclei were interstitially arranged between collagen bundles of the dermis. These dermal findings represent additional histopathologic features supporting the pathogenic role of the radiotherapy in the development of this rare variant of panniculitis.

Generalized livedo reticularis induced by silicone implants for soft tissue augmentation.

Silicone is one of the most widely used filler for facial cosmetic correction and soft tissue augmentation. Although initially it was considered to be a biologically inert material, many local and generalized adverse effects have been reported after silicone usage for cosmetic purposes. We present a previously healthy woman who developed progressive and persistent generalized livedo reticularis after cosmetic surgery for volume augmentation of buttocks. Histopathologic study demonstrated dermal presence of interstitial vacuoles and cystic spaces of different sizes between the collagen bundles, which corresponded to the silicone particles implanted years ago. These vacuoles were clustered around vascular spaces and surrounded by a few foamy macrophages. General examination and laboratory investigations failed to show any evidence of connective tissue disease or other systemic disorder. Therefore, we believe that the silicone implanted may have induced some kind of blood dermal perturbation resulting in the characteristic violet reticular discoloration of livedo reticularis.

Familial acral localized late-onset focal dermal elastosis.

Late-onset focal dermal elastosis is a rare disorder of elastic tissue, characterized by a local accumulation of elastic fibers in the mid and deep reticular dermis. This disorder occurs mainly in elderly people and consists of multiple yellow papules that are typically distributed on the sides of the neck and flexural areas, closely resembling pseudoxanthoma elasticum from the clinical point of view. We report 2 sisters who have presented with a 20-year history of multiple yellow papules, mainly located on the dorsum of their hands. They also had few lesions of similar morphology scattered on the anterior aspects of their wrists, thighs, and lower abdomen. Histopathologic study demonstrated a focal increase in thick, interlacing elastic fibers in the mid and deep reticular dermis. The most striking features of our cases were the early age of clinical presentation, the familial involvement, and the predominantly acral distribution of the lesions.

Pseudoxanthoma elasticum-like papillary dermal elastolysis: immunohistochemical study using elastic fiber cross-reactivity with an antibody against amyloid P component.

Pseudoxanthoma elasticum (PXE)-like papillary dermal elastolysis is a rare disorder clinically characterized by multiple, asymptomatic nonfollicular papules, yellow or flesh colored, grouped to form plaques with cobblestone appearance. These plaques are arranged symmetrically on the neck and supraclavicular areas of adult or elderly women, closely resembling the lesions of PXE. Histopathologically, the lesions are characterized by a band-like area of elastolysis along the papillary dermis. We report 2 cases of PXE-like papillary dermal elastolysis, in which the anomalies of the elastic tissue were immunohistochemically investigated with an antibody to the amyloid P component. This immunostaining demonstrated a band-like loss of elastic tissue along the papillary dermis. No clumping, fragmentation, or calcification of the elastic tissue was seen. We also review the literature about this rare process and discuss the differential diagnosis with other elastic tissue disorders that may show similar clinical and/or histopathologic findings.

Reducing Cardiovascular Risk for Patients With Diabetes: An Evidence-Based, Population Health Management Program.

ABSTRACT: Those with diabetes are at an increased risk of cardiovascular disease (CVD). Safety net clinics serve populations that bear a significant burden of disease and disparities and are a key setting in which to focus on reducing CVD. An integrated health system provided funding and technical assistance (TA) to safety net organizations (community health centers and public hospitals) in Northern California to decrease the risk of cardiovascular events for patients with diabetes. This was a program called Preventing Heart Attacks and Strokes Everyday (PHASE), which combined an evidence-based medication protocol with population health management and team-based care strategies. The TA supported organizations by sharing best practices, providing quality improvement coaching, and facilitating peer learning. A mixed-methods evaluation found that organizations involved in PHASE improved rates of blood pressure control and cardioprotective medication prescriptions for patients with diabetes. They made progress on these measures through strategies such as leveraging team-based care, providing education on evidence-based protocols, and using data to drive improvements. The evaluation concluded that financially supporting and providing focused TA to safety net organizations can help them build capacity and leverage their strengths to improve outcomes and potentially decrease the risk of heart attacks and strokes in communities.

Phytochemical Characterization of a Tree Tomato (Solanum betaceum Cav.) Breeding Population Grown in the Inter-Andean Valley of Ecuador.

Tree tomato (Solanum betaceum Cav.) is an Andean fruit crop that is grown in Ecuador. It is an exceptional source of minerals and vitamins, thus has nutraceutical properties. The objective of this research was to carry out a phytochemical characterization of a breeding population composed of 90 segregants. Pulp (including mesocarp, mucilage, seeds and placenta) was ground and sieved in order to obtain the liquid pulp to be lyophilized for the chemical analyzes. Antioxidants compounds were determined by spectrophotometry and vitamin C by reflectometry. Data were analyzed by principal components, grouping, and variance analyses; in addition, Z Score estimation was carried out to select elite individuals. There was a broad variability in the data obtained for the breeding population, polyphenol content varied from 5.11 to 16.59 mg GAE g-1, flavonoids from 1.24 to 6.70 mg cat g-1, carotenoids from 50.39 to 460.72 µg ß-carotene g-1, anthocyanins from 1.06 to 240.49 mg cy-3-glu 100 g-1, antioxidant capacity from 49.51 to 312.30 µm Trolox g-1, and vitamin C from 78.29 to 420.16 mg 100 g-1. It can be concluded that tree tomato is a good source of beneficial biocompounds and has a high antioxidant capacity.

Diffuse lower limb lipoatrophy.

Lipoatrophic panniculitis is the term used to describe those panniculitides in which atrophy of the subcutaneous fat is the main residual lesion. They can be classified as primary or secondary. Primary lipoatrophic panniculitis is idiopathic, whereas secondary lipoatrophic panniculitides include those because of infection, malignancy, pancreatic disorders or connective tissue diseases. Usually, these entities are characterized by the appearance of tender, erythematous nodules or plaques that resolve leaving one or several localized areas with loss of subcutaneous fat. We report a 76-year-old female who developed diffuse and symmetric lipoatrophy of lower limbs after an extensive inflammatory process affecting both extremities from thighs to ankles. Histopathologic assessment revealed a lobular panniculitis with a lymphohistiocytic infiltrate, foamy macrophages and lipophagic granuloma formation. The most striking feature in our patient was the clinical presentation as a symmetrical diffuse inflammatory process resulting in lipoatrophy of the lower limbs.

Lichen scrofulosorum mimicking lichen planus.

Lichen scrofulosorum is the most uncommon clinicopathologic variant of the tuberculids. Usually, the eruption appears in children and adolescents with strong immune sensitivity to Mycobacterium tuberculosis and consists of tiny follicular papules, closely resembling lichen nitidus. We report a case of lichen scrofulosorum in an adult male with active cervical scrofuloderma who developed lesions of lichen scrofulosorum mimicking clinically lichen planus. Histopathologic study demonstrated granulomas around the hair follicles, although acid-fast bacilli stains, immunohistochemical stain for mycobacteria, polymerase chain reaction investigations and cultures failed to demonstrate Mycobacterium tuberculosis in the cutaneous lesions. The most striking features of the reported case were the onset of the eruption in an adult patient and the clinical appearance of the lesions, resembling lichen planus.

Superficial thrombophlebitis: A new clinical manifestation of the immune reconstitution inflammatory syndrome in a patient with HIV infection.

Skin manifestations of immune reconstitution inflammatory syndrome in response to highly active antiretroviral therapy may account for up to 50% of the clinical presentations in this syndrome. Viable or dying infective antigens, host antigens, tumoral antigens, and others may target immune reconstitution inflammatory syndrome, resulting in a wide spectrum of clinical manifestations. We describe a 26-year-old HIV-infected man who had started highly active antiretroviral therapy a few months earlier. He developed multiple linear nodules following the superficial veins in both legs. Histopathologic examination demonstrated a mostly septal panniculitis with features of superficial thrombophlebitis. We propose that superficial thrombophlebitis should be added to the list of clinical manifestations of this newly observed immune restoration disease.

The leucokinin-like peptide receptor from the cattle fever tick, Rhipicephalus microplus, is localized in the midgut periphery and receptor silencing with validated double-stranded RNAs causes a reproductive fitness cost.

The cattle fever tick, Rhipicephalus microplus (Canestrini) (Acari: Ixodidae), is a one-host tick that infests primarily cattle in tropical and sub-tropical regions of the world. This species transmits deadly cattle pathogens, especially Babesia spp., for which a recombinant vaccine is not available. Therefore, disease control depends on tick vector control. Although R. microplus was eradicated in the USA, tick populations in Mexico and South America have acquired resistance to many of the applied acaricides. Recent acaricide-resistant tick reintroductions detected in the U.S. underscore the need for novel tick control methods. The octopamine and tyramine/octopamine receptors, both G protein-coupled receptors (GPCR), are believed to be the main molecular targets of the acaricide amitraz. This provides the proof of principle that investigating tick GPCRs, especially those that are invertebrate-specific, may be a feasible strategy for discovering novel targets and subsequently new anti-tick compounds. The R. microplus leucokinin-like peptide receptor (LKR), also known as the myokinin- or kinin receptor, is such a GPCR. While the receptor was previously characterized in vitro, the function of the leucokinin signaling system in ticks remains unknown. In this work, the LKR was immunolocalized to the periphery of the female midgut and silenced through RNA interference (RNAi) in females. To optimize RNAi experiments, a dual-luciferase system was developed to determine the silencing efficiency of LKR-double stranded RNA (dsRNA) constructs prior to testing those in ticks placed on cattle. This assay identified two effective dsRNAs. Silencing of the LKR with these two validated dsRNA constructs was verified by quantitative real time PCR (qRT-PCR) of female tick dissected tissues. Silencing was significant in midguts and carcasses. Silencing caused decreases in weights of egg masses and in the percentages of eggs hatched per egg mass, as well as delays in time to oviposition and egg hatching. A role of the kinin receptor in tick reproduction is apparent.

La prueba de figuras enmascaradas en la versión SaWa sobre figuras Gottschaldt ­presentación e indicadores psicométricos / The Embedded Figures Test in the SaWa Version on Gottschaldt Figures ­Presentation and Psychometric Indicators­ / O teste de figuras mascaradas na versão SaWa em figuras de Gottschaldt ­Apresentação e indicadores psicométricos­

El artículo presenta la versión de la prueba EfT desarrollada por Sawa sobre las figuras Gottschaldt, como indicador de la capacidad de reestructuración perceptual y del estilo cognitivo en la dimensión de independencia- dependencia de campo. Se examina la consistencia interna del instrumento, su validez estructural y de constructo a partir de los datos recogidos en cuatro diferentes estudios en los que ha sido aplicado (n = 6.530). Los resultados indican altos niveles de consistencia interna y adecuados niveles de validez estructural del instrumento. La validez de constructo se determina mediante el examen de los comportamientos de la prueba frente al sexo y el grado/edad. Los resultados demuestran que el instrumento se comporta de acuerdo con lo esperado en el constructo. Por último, se presentan los baremos del instrumento

This paper presents the version of the Embedded Figures Test (EfT) that Sawa developed using Gottschaldt's figures. The test indicates the perceptual restructur- ing ability and the field dependence-independence dimension of cognitive style. The instrument's internal consistency and its structural and construct validity are examined using data collected in four previous studies in which the test was administered (n = 6.530). Results show high levels of internal consistency and adequate levels of structural validity. The construct validity was determined by examining the instrument's behavior regarding sex and grade/age. Results indicate that the test behaves as expected considering the construct. Finally, the instrument's norms are presented

O artigo apresenta a versão do teste EfT, desenvol- vida por Sawa sobre as figuras de Gottchaldt, como indicador da capacidade de reestruturação perceptiva e, do estilo cognitivo na dimensão independência- -dependência do campo. A consistência interna do instrumento, sua validade estrutural e sua validade de construto são examinadas a partir dos dados co- letados em quatro diferentes estudos em que o teste foi aplicado (n = 6.530). Os resultados indicam altos níveis de consistência interna e níveis adequados de validade estrutural do instrumento. A validade de cons- truto é determinada examinando os comportamentos de teste em relação ao gênero e nível de escolaridade/ idade. Os resultados indicam que o instrumento se comporta conforme o esperado no construto. Por fim, são apresentadas as escalas do instrumento.

Primary cutaneous dermal mucinosis on herpes zoster scars.

The term isotopic response refers to the appearance of a new skin disease at the site of another unrelated and already healed skin disorder. Often, the first disease is herpes zoster (HZ). Several cutaneous reactions have been described in a dermatome recently affected by HZ. We present the case of a 33-year-old man who developed whitish papules with a zosteriform distribution on HZ scars. Histopathologic study with hematoxylin and eosin and Alcian blue (pH 2.5) staining demonstrated abundant deposits of mucin interstitially arranged between collagen bundles of the papillary dermis. Cutaneous dermal mucinosis as a postherpetic isotopic response is rare, but it should be added to the list of cutaneous reactions arising in HZ scars.

Neumonía por Bordetella bronchiseptica en paciente con antecedente de linfoma pulmonar / Bordetella bronchiseptica pneumonia in a patient with a history of pulmonary lymphoma

Resumen Bordetella bronchiseptica es un cocobacilo Gram negativo patógeno de animales que, con poca frecuencia causa infecciones en seres humanos. La mayoría de casos registrados en la literatura están asociados con pacientes que presentan algún tipo de inmunosupresión. Este reporte de caso se refiere a una paciente femenina de 67 años con antecedentes de linfoma pulmonar, que recibió quimioterapia y radioterapia 16 años atrás, fue ingresada al Servicio de Medicina Interna del Hospital Tomás Casas Casajús con un diagnóstico de neumonía bacteriana, tras descartarse infección por Covid19. Unos días después, se aisló una B. brochiseptica de una muestra de esputo y con el reporte de la prueba sensibilidad a los antibióticos, se modificó la terapia de antibióticos que originalmente se había indicado, lo que se conlleva a una mejoría en el estado físico de la paciente. Sin embargo, debido a una aparente infección nosocomial la paciente se contagió de SARS- CO2 y falleció debido a las complicaciones causadas por el Covid19.

Abstract Bordetella bronchiseptica is an animal pathogenic Gram negative coccobacillus that infrequently causes human infections. Most of the cases recorded in the literature are associated with patients with some type of immunosuppression. In this case, a 67-year- old female patient with a history of pulmonary lymphoma, who received chemotherapy and radiotherapy 16 years ago, is admitted to the Internal Medicine Service of the Tomás Casas Casajús Hospital, with a diagnosis of bacterial pneumonia, after ruling out Covid19 infection. A few days later, a B. brochiseptica is isolated from a sputum sample and with the report of the antibiotic sensitivity test, the antibiotic therapy that had originally been indicated is modified, which is reflected in an improvement in the physical state of the patient. However, due to an apparent nosocomial infection, the patient becomes infected with SARS-CO2 and dies due to complications caused by Covid19.

Estigma familiar percibido por los cuidadores primarios de personas con enfermedad mental / Family stigma perceived by primary caregivers of people with mental illness

Se planteó como objetivo describir el estigma familiar percibido por los cuidadores primarios de personas con enfermedad mental, para lo que empleamos como metodología un estudio de tipo exploratorio descriptivo, basado en la fenomenología eidética, en donde se describió de forma detallada la experiencia de vida frente al estigma de la enfermedad mental percibida por el cuidador primario, buscamos revelar, describir e interpretar el fenómeno. Fueron entrevistados en profundidad 14 cuidadores primarios de pacientes con la técnica de punto donde se presentó la saturación de datos cualitativos, fueron analizados estableciendo categorías y subcategorías que permitieron identificar claros patrones de estigma el estigma experimentado y el estigma por asociación, el estudio se desarrolló en una Institución Prestadora de Servicios de Salud mental. Podemos concluir que se logran identificar claros patrones de estigma asociados a una condición mental, estos patrones son percibidos por el cuidador principal del paciente con dicha alteración; esto abre la puerta a nuevas preguntas relacionadas con los alcances que tiene el rechazo social que sufren las familias y pacientes que adolecen alteraciones mentales; por lo tanto esta problemática deberá ser objeto para continuar con investigaciones de este fenómeno.

The objective was to describe the family stigma perceived by the primary caregivers of people with mental illness, for which we used as a methodology a descriptive exploratory study, based on the eidetic phenomenology, where the life experience was described in detail. To the stigma of mental illness perceived by the primary caregiver, we seek to reveal, describe and interpret the phenomenon. Fourteen primary caregivers of patients were interviewed in depth with the point technique where the saturation of qualitative data was presented, they were analyzed establishing categories and subcategories that allowed to identify clear patterns of stigma, stigma experienced and stigma by association, the study was developed in a Institution that provides mental health services. We can conclude that it is possible to identify clear stigma patterns associated with a mental condition, these patterns are perceived by the main caregiver of the patient with said alteration; this opens the door to new questions related to the scope of the social rejection suffered by families and patients who suffer from mental disorders; therefore, this problem should be the object to continue with investigations of this phenomenon.

Printed indium gallium zinc oxide transistors. Self-assembled nanodielectric effects on low-temperature combustion growth and carrier mobility.

Solution-processed amorphous oxide semiconductors (AOSs) are emerging as important electronic materials for displays and transparent electronics. We report here on the fabrication, microstructure, and performance characteristics of inkjet-printed, low-temperature combustion-processed, amorphous indium gallium zinc oxide (a-IGZO) thin-film transistors (TFTs) grown on solution-processed hafnia self-assembled nanodielectrics (Hf-SANDs). TFT performance for devices processed below 300 °C includes >4× enhancement in electron mobility (µFE) on Hf-SAND versus SiO2 or ALD-HfO2 gate dielectrics, while other metrics such as subthreshold swing (SS), current on:off ratio (ION:IOFF), threshold voltage (Vth), and gate leakage current (Ig) are unchanged or enhanced. Thus, low voltage IGZO/SAND TFT operation (<2 V) is possible with ION:IOFF = 10(7), SS = 125 mV/dec, near-zero Vth, and large electron mobility, µFE(avg) = 20.6 ± 4.3 cm(2) V(-1) s(-1), µFE(max) = 50 cm(2) V(-1) s(-1). Furthermore, X-ray diffraction analysis indicates that the 300 °C IGZO combustion processing leaves the underlying Hf-SAND microstructure and capacitance intact. This work establishes the compatibility and advantages of all-solution, low-temperature fabrication of inkjet-printed, combustion-derived high-mobility IGZO TFTs integrated with self-assembled hybrid organic-inorganic nanodielectrics.

Sindrome febril asociado a sifilis y bacteriemia por Clostridium limosum / Fever associated to syphilis and bacteremia by Clostridium limosum

Se informa el caso de un paciente masculino de 41 años con fiebre de origen desconocido (FOD) e insuficiencia aórtica, quien recibió dos ciclos independientes de antibiótico con persistencia de su cuadro febril, y a quien luego de múltiples estudios intrahospitalarios, se le diagnosticó bacteriemia por Clostridium limosum y sífilis latente versus tardía. Los estudios realizados no evidenciaron la presencia de enfermedad del tejido conectivo ni procesos tumorales. Las bacteriemias por gérmenes del género Clostridium no son comunes y cuando se presentan, se asocian con procesos neoplásicos, especialmente de colon. Las infecciones por C. limosum son aún más raras; en la literatura sólo se ha informado en cuatro casos (tres humanos y un animal), y en ninguno se ha relacionado con FOD. Por otra parte, aunque la sífilis era una causa frecuente de FOD, actualmente es poco común por la facilidad en su diagnóstico. En este caso no fue posible determinar cuál de los dos diagnósticos fue el origen de la FOD, ya que se inició tratamiento simultáneamente para ambos con resolución clínica. En conclusión, en este caso se presenta una posible nueva causa de FOD: bacteriemia por C. limosum, y se recuerda a la sífilis como uno de los posibles diagnósticos diferenciales de FOD

Factores de riesgo higienicos y ambientales que influyen en la aparicion de peritonitis en pacientes de C.A.P.D / Sanitary and enviromental risk factors that influence peritonitis incidence in patients with C.A.P.D

El paciente con I.R.C.T. tiene diferentes alteraciuones a nivel sistemico debido a los productos finales del metabolismo que no se pueden eliminar como consecuencia del deterioro de la funcion renal. Por esta razon se idearon alternativas del tratamiento como son: hemodialisis, dialisis peritoneal en sus 3 modalidades (dialisisi peritoneal aguda, intermitente y ambulatoria continua), y el transplante renal. La complicacion mas frecuente de la C.A.P.D. es la peritonitis, a la cual se le pueden atribuir como causa factores ambientales o higienicos. El C.A.P.D. es un sistema de dialisis intracorporea que ha sido objeto del interes medico desde 1900 cuando se inicio, infusionando liquidos en la cavidad peritoneal. Al realizar nuestro estudio nos dimos cuenta que en los factores higienicos mas de la mitad de los pacientes observados no presentan riesgo de contraer peritonitis. Aunque las condiciones higienicas de vivienda son adecuadas se concluyo que el mayor porcentaje de riesgo es debido a la mala higiene de los banos. El sitio de recambio es el factor que mas riesgo ofrece, debido a la higiene deficiente, siendo los puntos mas criticos: la ventilacion, el almacenamiento de jabon, la higiene del lavamanos y la higiene de la superficie de la mesa. Otro factor de riesgo percibido es la presencia de animales domesticos en la casa del paciente ya que son portadores de microorganismos patogenos que pueden ocasionar la peritonitis..