Association between gender and receipt of magnetic resonance imaging (MRI) in stroke patients from Puerto Rico

Introduction: Stroke is the fifth principal cause of death in the United States and Puerto Rico and a prime cause of adult disability. Women tend to have worse outcomes post-stroke. Initial diagnoses and management of stroke include the use of computed tomography (CT) and magnetic resonance image (MRI) scans. MRI scans are more sensitive and more specific than CT scans. Still, CT scans are used more commonly. Whether differences in the choice of imaging techniques exists for gender and whether that can be a potential reason for gender differences in post-stroke outcomes it is yet unknown. The study is directed to evaluate the association between gender and receipt of a MRI in stroke patients in the Puerto Rico population. Methods: We did a secondary analysis of data collected from patients who suffered from a stroke and who participated in the Puerto Rican Cardiovascular Surveillance System (PRCSS) in 2007, 2009 and 2011. The main independent variable was gender (male and female). The dependent variable will be receipt of a MRI (alone or in combination with any other imaging modality as recorded in the medical charts). Multivariate logistic regression was used to assess for the independent associations. P-value < 0.05 for a two tailed test was considered to be statistically significant. SPSS software was used for analysis. Results: A total of 1,950 patients suffered from an ischemic stroke and participated at the PRCSS. We excluded 595 patients due to BMI ≥35 (n=135) or no recorded BMI (n=460). MRI was used for 50% of participants. Women were 85% less likely to receive a MRI compared to men in both the unadjusted (OR-0.85, 95% CI=0.11-0.20, p-value <0.001) and after adjusting for BMI, age, marital status, hypertension, and transient ischemic attacks (TIA) (OR=0.15; 95%CI: 0.11-0.20). No other variables assessed had significant independent association with the receipt of a MRI. Conclusions: We found evidence of gender disparities in the receipt of MRI during hospitalization for stroke in patients in the Puerto Rico. Women were less likely to receive MRI compared to men. Further research on potential reasons for such dispairites, increasing awareness, and testing intervention as to decrease these potential disparities are needed

Diabetes and atypical presentations of patients hospitalized for an acute myocardial infarction in Puerto Rico

Introduction: Diabetes mellitus is one of the fastest growing health issues concerning the world today with an estimated 382 million individuals affected as of 2013 and a projected increase in number to 592 million by 2035. Diabetes mellitus is a condition affecting 12-15% of the population or around 400,000 people in Puerto Rico. The most common presenting complaint of diabetics who are hospitalized for an acute myocardial infarction (AMI) is chest pain. However, the pervasiveness of atypical symptoms in diabetic patients is yet unclear. The aim of this study is to determine if there is an association between diabetes and the presentation of atypical symptoms in the emergency room in those suffering from an AMI in Puerto Rico. Methods: We conducted a secondary data analysis of data from participants from the 2007, 2009 and 2011 Puerto Rico Cardiovascular Disease Surveillance system (PRCDS), an observational, non-concurrent, cross-sectional study. The main independent variable was presence of diabetes mellitus (Type I and Type II). The outcome was the presence of atypical symptoms at the time of presentation, defined as the absence of chest pain on admission. The prevalence of atypical symptoms in diabetic patients and non-diabetic patients was compared. Binary logistic regression was used to test for independent association. Statistical significance was considered for p-values ≤0.05 for a two-tailed test. Analysis was conducted using SPSS software. Results: We found no association between atypical presentation of an AMI and diabetes, before or after adjustment for age, gender, congestive heart failure, stroke history and BMI. (unadjusted OR= 1.0, 95%CI=0.7-1.4 and adjusted OR=1.0, 95% CI=0.6-1.5). Other independent associations identified were that patients older than 75 were 3.5 times more likely to present atypically than people younger than 55 (OR= 3.5, 95% CI=1.6-7.6), and those with CHF and stroke were more likely to present with atypical symptoms (OR=3.2, 95% CI=1.7-6.1 and OR=4.2 95% CI=2.1-8.4, respectively). Lastly, overweight patients were 3.3 times more likely to present atypically than healthy weight patients (OR=2.0, 95% CI=0.6-7.0). Conclusion: We found no evidence of an association between diabetes and the presentation of atypical symptoms in patients hospitalized for AMI in Puerto Rico

Hispanic ethnicity and survival in pediatric acute lymphocytic leukemia (all) patients in Florida

Introduction: Pediatric cancer mortality rates have drastically declined according to analyzed population-based surveillance data; however, incidences of most childhood cancers continue to rise. Recent studies have indicated an association between ethnicity/race and cancer survival. Florida's ethnically/racially diverse population and surging pediatric cancer incidence characterize the state as an ideal setting to study the association between ethnicity/race and pediatric cancer survival. Objective: To determine whether or not an association exists between Hispanic ethnicity and cancer survival in a Floridian population of pediatric patients with Acute Lymphocytic Leukemia (ALL). Methods: We will use data from participants 18 years or younger of Florida Cancer Data System (FCDS). Cox-proportional hazard regression was used to assess independent association between Hispanic ethnicity and time to death (time interval from diagnose of ALL to the last patient contact, as recorded in the database). Survival status (death or alive) was assessed at the date of last contact. Those who are alive at last contact were then censored. Results: In the unadjusted model, ethnicity was not associated with risk of death (HR= 0.87, 95% CI=0.73 - 1.04). After adjustment for sex, race, age at diagnosis, insurance status, geographic area, and immunophenotype) the results showed again no association between Hispanic ethnicity and survival (HR = 1.19, 95% CI=0.82 - 1.72). Conclusions: We found no evidence for differences in survival based on ethnic status. Potential difference in racial-survival disparities in pediatric ALL within various geographic regions might depend on Hispanic ancestries or cancer type. Further research on the topic is still deemed necessary as to clarify the nature of the association between ethnicity and cancer survival

In-hospital mortality of non-st segment elevation myocardial infarction in a Puerto Rican population

Introduction: Currently, there is limited published information on in-hospital mortality regarding ST segment elevation and non-ST segment elevation myocardial infarction. This information is even scarcer on the Hispanic population. We aim to study if there is a difference on in-hospital mortality between ST elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI) in a mostly Hispanic population. Methods: A secondary data analysis of a non-concurrent prospective study was performed using the Puerto Rican Heart Attack study database. Dependent variable was in-hospital mortality and independent variable was type of myocardial infarction (STEMI or NSTEMI). We conducted, sequentially, a descriptive, bivariate and multivariate analysis. The chi-squared test was used to compare categorical variables and t-test for continuous variables. Finally, a logistic regression model was used to perform the multivariate analysis. Results: From the 838 Puerto Rican patients hospitalized with ST classification, 310 (37%) were diagnosed with STEMI. Patients with STEMI were younger (65 years vs 68 years; p=0.008), more likely to receive invasive treatment (47.9% vs 27.5%, p<0.001), and less likely to have a history of hypertension (72.5% vs 79.0%, p=0.033) compared to NSTEMI patients. For every 1- year increase in age, there is a 4% increase in in-hospital mortality. Patients with hyperlipidemia were approximately two times more likely to die in the hospital compared to patients without hyperlipidemia. In the unadjusted analysis, there was no significant association between STEMI and NSTEMI patients and in-hospital mortality. After adjusting for confounders, patients with STEMI had twice the risk of dying than those with NSTEMI. Conclusions: Findings from this study suggest that Puerto Ricans with STEMI have double the risk of in-hospital mortality than NSTEMI patients. Our findings were similar to those reported in the literature. A timely recognition of at-risk patients, especially among STEMI patients, may help reduce short-term morality among patients hospitalized with acute myocardial infarction in Puerto Rico

Endomicroscopic and transcriptomic analysis of impaired barrier function and malabsorption in environmental enteropathy

Introduction: Environmental enteropathy (EE) is associated with growth failure, micronutrient malabsorption and impaired responses to oral vaccines. We set out to define cellular mechanisms of impaired barrier function in EE and explore protective mechanisms. Methods: We studied 49 adults with environmental enteropathy in Lusaka, Zambia using confocal laser endomicroscopy (CLE); histology, immunohistochemistry and mRNA sequencing of small intestinal biopsies; and correlated these with plasma lipopolysaccharide (LPS) and a zinc uptake test. Results: CLE images (median 134 for each study) showed virtually ubiquitous small intestinal damage. Epithelial defects, imaged by histology and claudin 4 immunostaining, were predominantly seen at the tips of villi and corresponded with leakage imaged in vivo by CLE. In multivariate analysis, circulating log-transformed LPS was correlated with cell shedding events (β = 0.83; P = 0.035) and with serum glucagon-like peptide-2 (β = -0.13; P = 0.007). Zinc uptake from a test dose of 25mg was attenuated in 30/47 (64%) individuals and in multivariate analysis was reduced by HIV, but positively correlated with GLP-2 (β = 2.72; P = 0.03). There was a U-shaped relationship between circulating LPS and villus surface area. Transcriptomic analysis identified 23 differentially expressed genes in severe enteropathy, including protective peptides and proteins. Conclusions: Confocal endomicroscopy, claudin 4 immunostaining and histology identify epithelial defects which are probably sites of bacterial translocation, in the presence of which increased epithelial surface area increases the burden of translocation. GLP 2 and other protective peptides may play an important role in mucosal protection in EE

Absence of ferromagnetic order in high quality bulk Co-doped ZnO samples

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Bulk Zn(1-x)Co(x)O samples were synthesized via standard solid-state reaction route with different Co molar concentrations up to 21%. A detailed microstructural analysis was carried out to investigate alternative sources of ferromagnetism, such as secondary phases and nanocrystals embedded in the bulk material. Conjugating different techniques we confirmed the Zn replacement by Co ions in the wurtzite ZnO structure, which retains, however, a high crystalline quality. No segregated secondary phases neither Co-rich nanocrystals were detected. Superconducting quantum interference device magnetometry demonstrates a paramagnetic Curie-Weiss behavior with antiferromagnetic interactions. We discuss the observed room temperature paramagnetism of our samples considering the current models for the magnetic properties of diluted magnetic semiconductors. (C) 2010 American Institute of Physics. [doi: 10.1063/1.3459885]1083FAPEMIGConselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)FAPEMIG_BrasilCNPq_BrasilFAPESP_Brasi

Integrative genomic analysis reveals low T-cell infiltration as the primary feature of tobacco use in HPV-positive oropharyngeal cancer

Although tobacco use is an independent adverse prognostic feature in HPV(+) oropharyngeal squamous cell carcinoma (OPSCC), the biologic features associated with tobacco use have not been systematically investigated. We characterized genomic and immunologic features associated with tobacco use through whole exome sequencing, mRNA hybridization, and immunohistochemical staining in 47 HPV(+) OPSCC tumors. Low expression of transcripts in a T cell-inflamed gene expression profile (TGEP) was associated with tobacco use at diagnosis and lower overall and disease-free survival. Tobacco use was associated with an increased proportion of T \u3e C substitutions and a lower proportion of expected mutational signatures, but not with increases in mutational burden or recurrent oncogenic mutations. Our findings suggest that rather than increased mutational burden, tobacco\u27s primary and clinically relevant association in HPV(+) OPSCC is immunosuppression of the tumor immune microenvironment. Quantitative assays of T cell infiltration merit further study as prognostic markers in HPV(+) OPSCC

Elderly Patients With Squamous Cell Carcinoma of the Head and Neck and the Benefit of Multimodality Therapy

Limited data are available regarding outcomes in elderly head and neck cancer patients. This retrospective study was designed to characterize head and neck cancer in geriatric patients

Non-Celiac Gluten Sensitivity: The New Frontier of Gluten Related Disorders

Non Celiac Gluten sensitivity (NCGS) was originally described in the 1980s and recently a “re-discovered” disorder characterized by intestinal and extra-intestinal symptoms related to the ingestion of gluten-containing food, in subjects that are not affected with either celiac disease (CD) or wheat allergy (WA). Although NCGS frequency is still unclear, epidemiological data have been generated that can help establishing the magnitude of the problem. Clinical studies further defined the identity of NCGS and its implications in human disease. An overlap between the irritable bowel syndrome (IBS) and NCGS has been detected, requiring even more stringent diagnostic criteria. Several studies suggested a relationship between NCGS and neuropsychiatric disorders, particularly autism and schizophrenia. The first case reports of NCGS in children have been described. Lack of biomarkers is still a major limitation of clinical studies, making it difficult to differentiate NCGS from other gluten related disorders. Recent studies raised the possibility that, beside gluten, wheat amylase-trypsin inhibitors and low-fermentable, poorly-absorbed, short-chain carbohydrates can contribute to symptoms (at least those related to IBS) experienced by NCGS patients. In this paper we report the major advances and current trends on NCG