Trends in Pediatric Primary Care Visits During the COVID-19 Pandemic: Opportunity to Address Adolescent Behavioral Health Through Telemedicine.

BACKGROUND AND OBJECTIVES: The COVID-19 pandemic impacted the volume and nature of pediatric primary care visits nationwide. This study aimed to identify trends in pediatric visits at our institution during the pandemic to reveal opportunities to improve care of children and adolescents. METHODS: We performed a retrospective chart review of all pediatric visits conducted at a single family medicine clinic within a large academic medical center in Northern California from January 1, 2019, through September 30, 2021. Data collected for each visit included age, sex, type of visit (preventive or problem-focused), reason for visit (if problem-focused), and mode of visit (in-person or telehealth). We analyzed data using descriptive statistics and χ2 tests. RESULTS: A total of 4,844 pediatric visits occurred during the study period. Visit volume dropped 9% from 2019 to 2020 and recovered to prepandemic levels in 2021. During the study period from 2019 to 2021, the percentage of problem-focused visits increased from 30% to 37% (P=.008) among adolescents, driven largely by an increase in the percentage of behavioral health visits from 14% to 29% (P<.001). We found no significant changes in the age or sex of patients seen. Telemedicine visit volume decreased from 2020 to 2021 in all age categories except for adolescents, which remained stable at 43% of all visits. CONCLUSIONS: A sharp increase in behavioral health concerns among adolescents stands out as the most notable impact of COVID-19 on pediatric care at our institution. Our findings raise questions about how behavioral health care can be optimized for adolescents in the postpandemic era.

AIDS-related malignancies: revisited.

Since the first reports between the association of Human Immunodeficiency Virus (HIV) infection and neoplasia, there has been a dramatic change in the incidence and epidemiology of AIDS-related malignancies. Kaposi sarcoma (KS), non-Hodgkin's lymphomas (NHL), and cervical cancer are classified by the Centers for Disease Control and Prevention (CDC) as AIDS-defining malignancies. However, since the availability of highly active combination antiretroviral therapy (cART), especially protease inhibitors, there has been a steady increase in non- AIDS defining malignancies, such as Hodgkin's lymphoma (HL), lung cancer, hepatocellular cancer, anal cancer and others and a decline in AIDS-defining neoplasias. Although the emergence of non-AIDS defining cancers could be a result of longer life expectancy and due to a better control of HIV, toxic habits and co-infection with other viruses such as hepatitis B, hepatitis C and human papilloma virus (HPV) could play an important role. The interactions of cART and incomplete immune reconstitution could be other factors explaining the increase in non-AIDS defining cancers. These emerging non-AIDS defining malignancies present a new challenge in the care of patients with HIV infection, and require optimal treatment protocols that take into consideration the interaction between cART and systemic chemotherapy. We review the current status of AIDS-related malignancies, its pathophysiology, epidemiology and management with emphasis in the changing patterns of presentation.

Changes in profile and colorectal cancer stage over 15 years in Puerto Rico.

INTRODUCTION: The stage of a malignant tumor defines how advanced the malignant process is at the time of diagnosis. In many clinical scenarios it is an indirect measurement of the efficacy of screening interventions used for early detection. We have evaluated changes in the tumor-node-metastasis (TNM) stage of colorectal cancer across a 15-year period. METHODS: This was a retrospective study in which all patients who underwent colorectal cancer surgery at the HIMA San Pablo Medical Center in 1988-1990 (period 1) and 2002-2004 (period 2) had their pathological report examined. The TNM stage for all patients was examined by using standard criteria. RESULTS: A total of 285 patients were evaluated: 108 in period 1 and 177 in period 2. The number of patients > 71 years of age who underwent colon surgery increased (33% vs 46%). An increase in patients with stage one colon cancer was observed in period 2 (30% vs 10%) with a corresponding decrease in stage 2 and 3 (59% vs 83%). CONCLUSION: The pathologic and demographic profile of patients with colorectal cancer has changed over 15 years. Patients with colon cancer are younger and have an earlier stage of disease with a decrease in lymph node involvement. Patients with rectal cancer were older and more likely to be men.

Factor V Leiden thrombophilia: presentation of three patients and a literature review.

Hypercoagulable states represent a condition with multiple etiologies in which an interplay of acquired and congenital coagulation defects contribute to abnormal clotting. Several of the thrombophilic disorders are relatively prevalent; one person may have multiple defects, leading to thrombosis without obvious external stimuli. Factor V Leiden thrombophilia is the most common inherited form of thrombophilia and it is occasionally associated with the anomalous prothrombin G20210A mutations. We presents three puertorrican middle-aged females diagnosed with Factor V Leiden after debuting with abnormal clotting events. They shared the common traits of being female, having been born in Puerto Rico, and having parents of European descent. The first two cases presented with deep venous thrombosis of lower and upper extremities, and both had the association of Factor V Leiden and prothrombin G20210A mutation. The third case presented with a cerebrovascular accident, evidencing arterial thrombosis, after receiving estrogen replacement therapy. This report adds Factor V Leiden as a cause of hypercoagulable states in puertorrican patients.