Risk of thyroid cancer among Caribbean Hispanic patients with familial adenomatous polyposis

Familial adenomatous polyposis (FAP) is an inherited form of colorectal cancer characterized by hundreds of adenomatous polyps in the colon and rectum. FAP is also associated with thyroid cancer (TC), but the lifetime risk is still unclear. This study reports the standardized incidence ratio (SIR) of TC in Hispanic FAP patients. TC incidence rates in patients with FAP between the periods of January 1, 2006 to December 31, 2013 were compared with the general population through direct database linkage from the Puerto Rico Central Cancer Registry (PRCCR) and the Puerto Rico Familial Colorectal Cancer Registry (PURIFICAR). The study population consisted of 51 Hispanic patients with FAP and 3239 with TC from the general population. The SIR was calculated using the Indirect Method, defined as observed TC incidence among patients with FAP in PURIFICAR’s cohort (2006–2013) divided by the expected TC incidence based on the PR population rates (2006–2010). SIR values were estimated by sex (male, female, and overall). This study received IRB approval (protocol #A2210207). In Hispanic patients with FAP, the SIR (95 % CI) for TC was 251.73 (51.91–735.65), with higher risk for females 461.18 (55.85–1665.94) than males 131.91 (3.34–734.95). Hispanic FAP patients are at a high risk for TC compared to the general population. Our incidence rates are higher than previous studies, suggesting that this community may be at a higher risk for TC than previously assumed. Implementation of clinical surveillance guidelines and regular ultrasound neck screening in Hispanic FAP patients is recommended.     

Clinical characterization and mutation spectrum in Hispanic families with adenomatous polyposis syndromes

Several genetically defined hereditary colorectal cancer (CRC) syndromes are associated with colonic polyposis including familial adenomatous polyposis (FAP) and MUTYH adenomatous polyposis (MAP). Limited data exists on the clinical characterization and genotypic spectrum of polyposis syndromes among Hispanics. To describe the phenotype and genotype of Puerto Rican Hispanic patients with FAP and MUTYH and compare with other ethnic and racial groups. Probands were identified from the Puerto Rico Familial Colorectal Cancer Registry (PURIFICAR). Recruited individuals completed risk factors, medical, and family history questionnaires and underwent genetic testing for genotype analysis. Frequency analysis, Chi square, Fisher’s exact and Wilcoxon rank-sum tests were used for statistical analysis methods. A total of 31 FAP (from 19 families) and 13 MAP (from 13 families) Hispanic patients recruited from the PURIFICAR were evaluated. Among the FAP cases, mean age at diagnosis was 27.6 (range 9–71 years); 67.7 % cases had more than 100 polyps and 41.9 % had upper gastrointestinal polyps. Among the 19 FAP families, there were 77 affected FAP individuals and 26 colorectal cancer cases. Genetic mutations were available for 42.2 % of FAP families; all mutations identified were unique. Surgeries were reported in 31 cases; 14 (45.2 %) prophylactic surgeries and 6 (19.4 %) therapeutic surgeries for management of CRC. Among MAP cases, mean age at diagnosis was 53 (range 34–76 years). Genetic analysis revealed homozygous biallelic mutations (G382D) in 53.8 %, compound heterozygous mutations (G382/Y165C) in 23 %, and non-G382/Y165C monoallelic mutations in 23 %. Familial cancer registries should be promoted as vehicles for detection, education and follow up of families at-risk of acquiring familial cancers. PURIFICAR is the first and only familial cancer registry in Puerto Rico providing these services to families affected with familial cancer syndromes promoting education, testing and surveillance of at-risk family members, and focusing on cancer prevention efforts. The fact that only 40 % of FAP patients had access to genetic testing stresses the need to promote the establishment of policies supporting genetic testing coverage by medical insurance companies in order to provide patients with the highest standard of care to prevent cancer. Furthermore, our results suggest that Hispanics may have uncommon mutations in adenomatous polyposis related genes, which emphasize the need for full gene sequencing to establish genetic diagnosis.     

A Retrospective Cohort Study on the Increasing Trend of Suicide Ideations and Risks in an Opioid-Dependent Population of Puerto Rico 2015–2018

Journal of Immigrant and Minority Health - The rate of suicide attempts among people with substance abuse disorders in the U.S. is six times higher than in the general population. The prevalence of...     

Assessing Biopharmaceutical Company Experience with Patient-centric Initiatives

PurposeA growing number of biopharmaceutical companies have been implementing patient-centric initiatives (PCIs). The Drug Information Association (DIA) and the Tufts Center for the Study of Drug Development (CSDD) collaborated on a study to gather data on the usage and impact of these PCIs to characterize company experience and impact.MethodsDIA and Tufts CSDD collaborated with 17 organizations to define PCIs used in clinical research and development and to quantify their use, and to define metrics in use to document impact and return on engagement (ROE) for these PCIs. The study used a mixed methods approach that consisted of an online survey, in-depth interviews, and literature review.FindingsTwenty-two unique companies responded to an on-line survey on the use of 23 PCIs identified by the study working group. PCIs most frequently implemented included patient organization landscape analysis, support of patient advocacy groups, use of patient advisory boards, and use of home nursing networks. Seven additional PCIs were found through a literature search and included in the group of PCIs for which impact measures were assessed. A total of 121 cases of use of the 30 PCIs and associated impact measures and impact data were gathered through literature review, in-depth interviews with the study companies, and in-depth interviews with organizations identified in the literature as having experience with patient engagement in clinical research as well as with patients who had participated in clinical trials. Analysis of the 121 case studies resulted in a list of 666 measures of impact (metrics) in use for 13 of the PCIs. Assessment of overall ROE for these PCIs found that PCIs such as support of patient advocacy groups and use of patient advisory boards indicated the greatest ROE, whereas costlier, more complex PCIs such as digital medicine and gaming indicated relatively low ROE.ImplicationsActivity around PCIs among the companies studied was widespread, with initiatives more frequently planned and piloted than implemented at the time of this study. Measures of impact have been identified and can be used to assess ROE, providing insights to facilitate the adoption of PCIs of highest impact for patients and biopharmaceutical research organizations.     

Determination of losartan,telmisartan, and valsartan by direct injection of human urine into a column-switching liquid chromatographic system with fluorescence detection

Column-switching high-performance liquid chromatographic (HPLC) method has been developed and validated for quantification of losartan, telmisartan, and valsartan in human urine. Urine samples were diluted on the extraction mobile phase (1:4, v/v) and a volume of 20 μL of this mixture were directly injected onto the HPLC system. The analytes were extracted from the matrix using an on-line solid-phase extraction procedure involving a precolumn packed with 25 μm C₁₈ alkyl-diol support (ADS), and a solution 2% methanol in 5 mM phosphate buffer (pH 3.8) at a flow-rate of 0.8 mL/min for isolation and preconcentration of losartan, telmisartan, and valsartan. The enriched analytes were back-flushed after, onto the analytical column with a mixture of 5 mM phosphate buffer (pH 3.8)–acetonitrile–methanol (65:20:15, v/v/v) at a flow-rate of 3.0 mL/min and detected by fluorescence at 259 and 399 nm as excitation and emission wavelength respectively. The separation of losartan, telmisartan, and valsartan was achieved on a Chromolith RP-18e monolithic column. The method provides extraction recoveries from spiked urine samples greater than 93%. Intra-day and inter-day precision were generally acceptable; the intra-day-assay C.V. was <3.5 for all compounds and the inter-day-assay C.V. was <3.7%. The estimated calibration range was 0.001–2.5 μg mL⁻¹ with excellent coefficient of determination (>0.9981). The detection limits for losartan, telmisartan, and valsartan at a signal-to-noise ratio of 5:1 were 0.002, 0.0002 and 0.001 μg mL⁻¹ when a sample volume of 20 μL was injected. The proposed method permitted the simultaneous determination of losartan, telmisartan, and valsartan in 8 min, with an adequate precision and sensitivity. However, the overlap of the sample cleanup step with the analysis increases the sampling frequency to 12 samples/h. The developed column-switching method was successfully applied for the determination of these analytes in human urine samples of patients submitted at ARA-IIs therapy.     

Childbearing Age Women Characteristics in Latin America. Building Evidence Bases for Early Prevention. Results from the ELANS Study

Latin American (LA) women have been exposed to demographic and epidemiologic changes that have transformed their lifestyle, with increasing sedentary and unhealthy eating behaviors. We aimed to identify characteristics of LA women to inform public policies that would benefit these women and their future children. The Latin American Study of Nutrition and Health (ELANS) is a multicenter cross-sectional study of representative samples in eight Latin American countries (n = 9218) with a standardized protocol to investigate dietary intake, anthropometric variables, physical activity, and socioeconomic characteristics. Here we included the subsample of all 3254 women of childbearing age (15 to <45 years). The majority of ELANS women had a low socioeconomic status (53.5%), had a basic education level (56.4%), had a mostly sedentary lifestyle (61.1%), and were overweight or obese (58.7%). According to the logistic multiple regression model, living in Peru and Ecuador predicts twice the risk of being obese, and an increased neck circumference is associated with a 12-fold increased obesity risk. An increased obesity risk was also predicted by age <19 years (Relative Risk (RR) 19.8) and adequate consumption of vitamin D (RR 2.12) and iron (RR 1.3). In conclusion, the identification of these risk predictors of obesity among Latin American women may facilitate targeted prevention strategies focusing on high-risk groups to promote the long-term health of women and their children.     

Application of the SSA Calorimetric Technique to Characterise an XLPE Insulator Aged under Multiple Stresses

In this work the thermal behaviour of crosslinked low density polyethylene (XLPE) used as an insulator for commercial underground high tension (15 kV) cables was studied. Three types of materials were selected: an uncrosslinked low density polyethylene (NXLPE) used as a control sample, an XLPE and an aged XLPE sample. The ageing conditions involved the application of multiple stresses: temperature, voltage and voltage impulses during 60 d under time and temperature cycles that are the most representative load of daily operation in Caracas, Venezuela. The effect of morphology segregation or thermal fractionation under multiple stresses conditions was analysed by measuring the percentage of crosslinking before and after the ageing tests were performed, and by investigating the thermal response of the material by conventional DSC and by the application of the successive self‐nucleation and annealing (SSA) thermal fractionation technique. The degree of crosslinking was found to vary in the material depending on the distance from the conductor because a thermal gradient is generated radially during the curing reaction. Such differences did not significantly affect the usual DSC heating scans of the samples. However, when SSA was applied, a difference in the distribution of thermal fractions was detected as a function of the distance towards the conductor that could be correlated to the variations in the crosslinking degree. After the accelerated ageing the thermal response of XLPE changes as evidenced by the presence of multiple melting peaks in subsequent DSC heating scans. This multiple melting was interpreted, as a first approximation, as arising from thermal fractionation during ageing (ignoring the possible effects of the other stresses applied) and SSA was able to simulate a similar fractionation that was very accurate in the prediction of the exact temperatures of the melting peaks produced.