On-site extraction using a 3D printed device coated with Zn/Co-ZIF-derived carbon followed by an on-line SIA-HPLC-FL system for fluoroquinolones determination in wastewater.

A 3D printed device covered with Zn/Co-ZIF-derived carbon allows the on-site extraction of fluoroquinolones (FQs) from wastewater, avoiding the sample transportation to the laboratory, and the subsequent elution, separation and determination using an on-line flow system based on sequential injection analysis (SIA) coupled to HPLC-FL. Several parameters that affect the extraction efficiency and desorption were optimized including the sorption phase immobilization technique on the 3D device, extraction time, pH effect, sample volume as well as the type of eluent, eluent volume, and flow rate. Under optimum conditions, detection limits of 3-9 ng L-1 were achieved for norfloxacin, ciprofloxacin, danofloxacin, enrofloxacin and difloxacin. The precision expressed as relative standard deviation (%RSD, n = 3), showed intraday and interday ranges of 1.5-5.3% and 2.8-5.7%, respectively, demonstrating a good precision of the proposed methodology. To assess matrix effects and accuracy of the proposed method in real samples, recovery studies were performed without and with FQs spiked at different concentrations (0.5-10 µg L-1) to wastewater samples, showing good recoveries in the range of 91-104%. The results allow to confirm the applicability of MOF-derived carbons as adsorbents for on-site extraction, and the satisfactory separation and quantification of FQs by a SIA-HPLC-FL on-line system after their desorption with small eluent volumes.

Interaction among health workers and trans men: Findings from a qualitative study in Chile.

PURPOSE: To explore trans men's access and use of healthcare services in Chile, based on the experiences of the trans men themselves, as well as of healthcare professionals. METHODS: A qualitative study with an ethnographic approach was carried out with 30 participants: 14 trans men and 16 healthcare professionals. Semi-structured one-on-one interviews with open-ended questions were used to collect the data. A thematic analysis was carried out with the NVivo Software. RESULTS: Three main themes were identified: (1) failures in the recognition of trans identity, (2) challenges with patient-centered care, and (3) use of other ("non-trans") health services. CONCLUSIONS: The results suggest that not all transition processes are the same, individuals seek different ways; therefore, it is necessary to consider different body types and identities when planning programs and care for men in transition. Moreover, the accompaniment provided during the gender transition process should contemplate emotional and mental support. CLINICAL RELEVANCE: The study outlines the need for all healthcare professionals to have training and knowledge about the transgender population, regardless of whether they are part of the teams supporting gender transition processes. The role of nurses and the contributions that can be made from nursing discipline in this research field are fundamental.

Expert Review and Consensus on the Treat-to-Target Management of Hereditary Angioedema: From Scientific Evidence to Clinical Practice.

BACKGROUND: Hereditary angioedema with C1 inhibitor deficiency (HAE-C1INH) is a rare disease characterized by swelling episodes. It affects quality of life (QOL) and can be fatal when the upper airways are involved. Treatment is individualized, with therapeutic options including on-demand treatment (ODT) and short- and long-term prophylaxis (STP, LTP). However, available guidelines are not always clear about the selection of treatment, the goals of treatment, or how achievement of these goals is assessed. OBJECTIVE: To review available evidence for the management of HAE-C1INH and build a Spanish expert consensus to steer management towards a treat-to-target approach, while addressing some of the less clear aspects of the Spanish guidelines. METHODS: We reviewed the literature on the treat-to-target management of HAE-C1INH, focusing on treatment selection and goals and the tools available to assess whether the goals have been achieved. We discussed the literature based on clinical experience and drew up 45 statements on undefined management aspects. A panel of 53 HAE experts validated the statements through a 2-round Delphi process. RESULTS: The goals for ODT and STP are to minimize the morbidity and mortality of attacks and to prevent attacks caused by known triggers, respectively, while the main goal of LTP is to decrease the rate, severity, and duration of attacks. Furthermore, when prescribing, clinicians should consider the reduction in adverse effects, while increasing patient QOL and satisfaction. Appropriate instruments for assessing achievement of treatment goals are also indicated. CONCLUSIONS: We provide recommendations on previously unclear aspects of HAE-C1INH management with ODT, STP, and LTP, focusing on clinical and patient-oriented goals.

Expert Review and Consensus on the Treat-to-Target Management of Hereditary Angioedema: From Scientific Evidence to Clinical Practice

Background: Hereditary angioedema with C1 inhibitor deficiency (HAE-C1INH) is a rare disease characterized by swelling episodes. It affects quality of life (QOL) and can be fatal when the upper airways are involved. Treatment is individualized, with therapeutic options including on-demand treatment (ODT) and short- and long-term prophylaxis (STP, LTP). However, available guidelines are not always clear about the selection of treatment, the goals of treatment, or how achievement of these goals is assessed. Objective: To review available evidence for the management of HAE-C1INH and build a Spanish expert consensus to steer management towards a treat-to-target approach, while addressing some of the less clear aspects of the Spanish guidelines. Methods: We reviewed the literature on the treat-to-target management of HAE-C1INH, focusing on treatment selection and goals and the tools available to assess whether the goals have been achieved. We discussed the literature based on clinical experience and drew up 45 statements on undefined management aspects. A panel of 53 HAE experts validated the statements through a 2-round Delphi process. Results: The goals for ODT and STP are to minimize the morbidity and mortality of attacks and to prevent attacks caused by known triggers, respectively, while the main goal of LTP is to decrease the rate, severity, and duration of attacks. Furthermore, when prescribing, clinicians should consider the reduction in adverse effects, while increasing patient QOL and satisfaction. Appropriate instruments for assessing achievement of treatment goals are also indicated.Conclusions: We provide recommendations on previously unclear aspects of HAE-C1INH management with ODT, STP, and LTP, focusing on clinical and patient-oriented goals (AU)

Efecto del ungüento oftálmico de carbómero al 02% sobre molestias oculares en pacientes sometidos a anestesia general: Estudio de cohorte no aleatorizado / Effect of 0.2% carbomer ophthalmic ointment on eye discomfort after general anesthesia: A non-randomized cohort study

Introducción y objetivo: Las lesiones oculares durante cirugía son raras. Las causas comunes incluyen trauma directo, lesión química y exposición corneal. Las molestias oculares se pueden presentar después de la cirugía en ausencia de daño estructural del ojo. En nuestro hospital todos los pacientes sometidos a anestesia general reciben protección con oclusión ocular asociado en la mayoría de los casos con la aplicación de gel oftálmico. En este estudio buscamos analizar la incidencia de molestias oculares con la aplicación de gel oftálmico de carbómero 0,2%. Métodos: Se llevó a cabo un estudio tipo cohorte. Se incluyeron los pacientes sometidos a cirugía bajo anestesia general con duración menor a cuatro horas entre febrero y noviembre de 2017. Se excluyeron a los pacientes con patologías oculares previas, los llevados a cirugía oftálmica, facial o de cabeza, y aquellos en los que la oclusión ocular no fue posible. Para el análisis, los pacientes se dividieron en dos grupos: oclusión ocular simple (Grupo 1) y oclusión ocular más gel oftálmico de carbómero al 0,2% (Grupo 2). Nuestro desenlace primario fue la incidencia de molestias oculares y el desenlace secundario fue determinar los factores de riesgo. Resultados: Se analizaron 400 pacientes, de los cuales la mitad (50%) recibieron el gel oftálmico de carbómero 0,2%. No se encontraron diferencias en las características demográficas entre grupos. Durante las primeras 24 horas postoperatorias, el 7,25% de los pacientes presentaron síntomas visuales, y a los siete días postoperatorios ningún paciente refirió síntomas. Los síntomas más frecuentes fueron visión borrosa, prurito, epífora y ojo rojo. En el análisis multivariado el principal factor de riesgo asociado con la aparición de molestias oculares fue la aplicación de gel oftálmico de carbómero 0,2% (RR 13,5; IC 95% 3,27–56,2). Otros factores asociados a molestias oculares fueron cirugía de urgencia y la edad.(AU)

Background and objective: Eye lesions during surgery are rare. Its common causes include direct trauma, chemical damage, and corneal exposure. Eye discomfort may present after surgery in the absence of structural damage. In our hospital, every patient under general anesthesia receives eye protection with eye occlusion associated in most cases with ophthalmic ointment application. We aim to analyze the incidence of eye discomfort with 0.2% carbomer application. Methods: A cohort study was conducted. Patients who underwent surgery under general anesthesia lasting less than 4hours between February and November 2017 were enrolled. We excluded patients with previous ophthalmologic pathology, those undergoing eye, otolaryngology, face or head surgery, and patients in which eye occlusion was not possible. For analysis, patients were divided into two groups: simple eyelid occlusion (Group 1) and eyelid occlusion plus ophthalmic ointment (Group 2). Primary outcome was the incidence of eye discomfort and secondary outcomes were to stablish associated risk factors. Results: 400 patients were analyzed, 50% were exposed to 0.2% carbomer. There was no difference in patients’ demographics. During the first 24hours post-surgery 7.25% of patients showed visual symptoms, and at one-week postoperative no patient referred symptoms. Most frequent symptoms were blurry vision, pruritus, epiphora and red-eye. On multivariate analysis, the main risk factor associated with eye discomfort was 0.2% carbomer application (RR 13.5 CI 3.27 – 56.2). Emergent surgery and age were also found to be risk factors. Conclusion: 0.2% carbomer does not prevent ophthalmologic symptoms after surgery and it may even increase them in short procedures.(AU)

Effect of 0.2% carbomer ophthalmic ointment on eye discomfort after general anesthesia: A non-randomized cohort study.

BACKGROUND AND OBJECTIVE: Eye lesions during surgery are rare. Its common causes include direct trauma, chemical damage, and corneal exposure. Eye discomfort may present after surgery in the absence of structural damage. In our hospital, every patient under general anesthesia receives eye protection with eye occlusion associated in most cases with ophthalmic ointment application. We aim to analyze the incidence of eye discomfort with 0.2% carbomer application. METHODS: A cohort study was conducted. Patients who underwent surgery under general anesthesia lasting less than 4h between February and November 2017 were enrolled. We excluded patients with previous ophthalmologic pathology, those undergoing eye, otolaryngology, face or head surgery, and patients in which eye occlusion was not possible. For analysis, patients were divided into two groups: simple eyelid occlusion (Group 1) and eyelid occlusion plus ophthalmic ointment (Group 2). Primary outcome was the incidence of eye discomfort and secondary outcomes were to stablish associated risk factors. RESULTS: 400 patients were analyzed, 50% were exposed to 0.2% carbomer. There was no difference in patients' demographics. During the first 24h post-surgery 7.25% of patients showed visual symptoms, and at one-week postoperative no patient referred symptoms. Most frequent symptoms were blurry vision, pruritus, epiphora and red-eye. On multivariate analysis, the main risk factor associated with eye discomfort was 0.2% carbomer application (RR 13.5 CI 3.27-56.2). Emergent surgery and age were also found to be risk factors. CONCLUSION: 0.2% carbomer does not prevent ophthalmologic symptoms after surgery and it may even increase them in short procedures.

[Rapidly progressive dementia as the initial presentation of human immunodeficiency virus infection].

Dementia associated with human immunodeficiency virus (HIV) is currently a rare cause of rapidly progressive dementia. Its appearance is not only limited to the late phases of the disease, but can sometimes be the presenting symptom. We present the case of a patient who debuted with anxious-depressive symptoms and rapid cognitive deteri-oration with early repercussions on his daily functionality. HIV was detected in the study, with a higher viral load in cerebrospinal fluid than in plasma. Despite a torpid course at the beginning, antiretroviral therapy brought about a progressive improvement in the cognitive sphere, consistent with the decrease in the viral load. Although rare, HIV continues to be a cause of dementia that primary care and hospital care professionals should not forget. The relevance of its early diagnosis lies in its potentially reversible nature.

Demencia rápidamente progresiva como forma de presentación de infección por el virus de la inmunodeficiencia humana / Rapidly progressive dementia as the initial presentation of human immunodeficiency virus infection

La demencia asociada a virus de la inmunodeficiencia humana (VIH) es una causa de demencia rápidamente progresiva poco frecuente en la actualidad. Su aparición no se limita a las fases tardías de la enfermedad, sino que en ocasiones puede ser el síntoma de presentación. Presentamos el caso de un paciente que debutó con síntomas ansioso-depresivos y un rápido deterioro cognitivo con repercusión precoz en su funcionalidad diaria. En el estudio se detectó VIH con mayor carga viral en líquido cefalorraquídeo que en plasma. La terapia antirretroviral logró, a pesar de la tórpida evolución inicial, una mejora progresiva en la esfera cognitiva, congruente con la disminución de la carga viral. Aunque poco frecuente, el VIH sigue siendo una causa de demencia que los profesionales de atención primaria y hospitalaria no debemos olvidar. La importancia de su diagnóstico precoz radica en su carácter potencialmente reversible.(AU)

Dementia associated with human immunodeficiency virus (HIV) is currently a rare cause of rapidly progressive dementia. Its appearance is not only limited to the late phases of the disease, but can sometimes be the presenting symptom. We present the case of a patient who debuted with anxious-depressive symptoms and rapid cognitive deterioration with early repercussions on his daily functionality. HIV was detected in the study, with a higher viral load in cerebrospinal fluid than in plasma. Despite a torpid course at the beginning, antiretroviral therapy brought about a progressive improvement in the cognitive sphere, consistent with the decrease in the viral load. Although rare, HIV continues to be a cause of dementia that primary care and hospital care professionals should not forget. The relevance of its early diagnosis lies in its potentially reversible nature.(AU)

Whole-Genome Sequencing and De Novo Assembly of 61 Staphylococcus pseudintermedius Isolates from Healthy Dogs and Dogs with Pyoderma.

We have de novo assembled and polished 61 Staphylococcus pseudintermedius genome sequences with Nanopore-only long reads. Completeness was 99.25%. The average genome size was 2.70 Mbp, comprising 2,506 coding sequences, 19 complete rRNAs, 56 to 59 tRNAs, and 4 noncoding RNAs (ncRNAs), as well as CRISPR arrays.

Major differences in the larval anatomy of the digestive and excretory systems of three Oestridae species revealed by micro-CT.

Oestrid flies (Diptera: Oestridae) do not feed during the adult stage, so they depend on an efficient assimilation and storage of nutrients during their parasitic larval stage. We describe the general morphology and provide volumetric data for the digestive and excretory organs of the three larval instars of the nasal bot fly Oestrus ovis L., using micro-computed tomography. The size of the digestive and excretory organs greatly increased across larval instars. In all instars, the two salivary glands were remarkably large and formed a 'glandular band' by coming together, but without lumina uniting, at their posterior ends. The distal region of the anterior Malpighian tubules was greatly enlarged and full of highly radio-opaque concretions. Moreover, the anatomy of O. ovis third-instar larva was compared to that of two species of, respectively, similar and different feeding habits: Cephenemyia stimulator (Clark) and Hypoderma actaeon Brauer. Whereas the general morphology and arrangement of the digestive and excretory systems of C. stimulator was similar to that of O. ovis, some differences were observed in H. actaeon: a swollen anterior region of the midgut, salivary glands shorter and not forming a 'band' and anterior Malpighian tubules narrowly uniform throughout their entire length.

Frecuencia de dirofilariosis en caninos de la localidad 3 de Cartagena, Bolívar (Colombia) / Frequency of dirofilariosis in canines of the locality 3 of Cartagena, Bolívar (Colombia)

RESUMEN Objetivo: determinar la frecuencia de dirofilariosis en caninos de la localidad 3 de la ciudad de Cartagena. Materiales y métodos: estudio correlacional de corte transversal. Se tomaron muestras de sangre de 128 perros con el consentimiento previo e informado de sus dueños. Se registró la información sociodemográfica y los síntomas. A las muestras se les realizo observación directa, extendido de sangre periferia coloreado con Wright y la técnica de Knott. Resultados: se estableció que 19,5% de los perros se encontraban parasitados con Dirofilaria sp. Los signos sugestivos de dirofilariosis más frecuentes fueron pérdida de peso y disminución del apetito (10,9% cada uno). El 76% de los caninos eran mestizos. Conclusiones: la frecuencia de dirofilariosis se concentra principalmente en barrios de escasos recursos, los síntomas identificados son sugestivos de una dirofilariosis canina.

ABSTRACT Objective: to determine the frequency of dirofilariosis in canines from locality 3 of Cartagena city. Materials and methods: cross-sectional correlational study. Blood samples were taken for 128 dogs prior informed consent by their owners. Sociodemographic information and symptoms were registered. The samples have been analyzed using direct examination, Wright stained blood smear and Knott technique. Results: it was established that 19.5% of dogs were parasitized by Dirofilaria sp. Most common signs suggestive of Dirofilariosis were weight loss, and decreased appetite (10.9% each). 76% were mixed race dogs. Conclusions: the frequency of dirofilariosis focused on lower income neighborhoods. The identified symptoms are suggestive of canine dirofilariasis.

Internal morphological changes during metamorphosis in the sheep nasal bot fly, Oestrus ovis.

During the larval stage, oestrid flies (Diptera: Oestridae) are obligate parasites, whereas during the adult stage they are free-living and do not feed. Like other cyclorrhaphous flies, oestrids undergo metamorphosis inside an opaque puparium, formed by the contracted and hardened cuticle of the third-instar larva. The present study documents the internal morphological changes taking place during metamorphosis of the sheep nasal bot fly, Oestrus ovis L., using non-invasive, micro-CT-based virtual histology and provides quantitative data of volumetric changes in specific organs. Virtual histological sections allowed visualisation of the progression and completion of the apolyses, which delimit the different intra-puparial stages, and the connection to the tracheal system of a large gas bubble, which plays an essential role during early metamorphosis. Overall, our results show that the sequence of morphological and volumetric changes in tissues and organs is similar to those found in other cyclorrhaphous flies, but they also reveal developmental differences that result in an adult vestigial digestive tract. Future studies could develop non-invasive, reliable methods for aging the intra-puparial forms of different oestrid species of veterinary importance, based on both qualitative and quantitative markers, thus improving our knowledge of their development and the efficiency of control strategies.

Prevalence of dental and mandibular disorders in culled sheep in Spain.

At the slaughterhouse, 1465 culled sheep heads were studied in order to identify disorders of the mandibular cheek teeth. Of these, 227 (15.5%) had evidence of osteomyelitis. The lesional profile showed that the mandible was affected in a similar proportion on both sides (46.7% on the right side vs 50.7% on the left side), mainly in the middle region (55.3%) and with most of the lesions closed without fistulisation (89.4%). In addition, swelling was palpable, with an increase in thickness in the area of the affected body (2.65 ± 0.065 cm vs 1.74 ± 0.030 cm). In 78.6% of the animals, the regional lymph nodes were enlarged. Concerning the mandibular cheek teeth, more than half of the animals lacked at least one tooth (57.0%), with the first premolar being the most frequently missing tooth (34.8%) and the third molar the least (8.2%). The impaction of food around the teeth was very common with the posterior molars being more frequently affected. In the knowledge of the authors, this is the first study that analyses the prevalence of mandibular molar and premolar disorders in sheep, and these are revealed as an important condition affecting culled sheep.

El papel de las intervenciones biomédicas en la prevención del VIH: la profilaxis preexposición (PrEP) / The role of biomedical interventions in HIV prevention: pre-exposure Prophylaxis (PrEP)

La transmisión del VIH sigue siendo un importante problema de salud pública en todo el mundo. Estrategias tradicionales de prevención como la educación sexual, el cribado y el inicio precoz de tratamiento antirretroviral, a pesar de ser efectivas, resultan insuficientes para el control de las nuevas infecciones. En este contexto, se ha propuesto la profilaxis preexposición (PrEP) como estrategia preventiva. Actualmente, se ha demostrado ampliamente que la administración de fármacos antirretrovirales en personas expuestas y no infectadas por VIH puede reducir el riesgo de transmisión sin asociarse a inconvenientes significativos. A pesar de haber demostrado su eficacia para la prevención de nuevas infecciones, la PrEP sigue siendo un tema controvertido, especialmente su coste-efectividad, y no se ha conseguido acceso unánime a los grupos de mayor riesgo de infección. Por ello, y basándonos en la evidencia actual, planteamos que el debate no debería ser si la PrEP es coste-eficaz, sino las posibles repercusiones de implementarla

HIV infection remains an important public health problem worldwide. The traditional preventive measures, such as sexual education, screening, and early antiretroviral treatment initiation, despite having shown their effectiveness, are not enough to control new infections. In this context, Pre-Exposure Prophylaxis (PrEP) has been investigated as a preventive measure. Currently, it has been extensively documented that the administration of antiretroviral treatment in an HIV exposed, but not infected population, could reduce the risk of transmission without significant drawbacks. Despite its high efficacy for HIV prevention, the use of PrEP remains a controversial measure, particularly its cost-effectiveness. For this reason, the access to PrEP is not available for all the HIV risk groups. Therefore, and based on the evidence found, the current approach must be the repercussions of not to implement PrEP, more than its cost or its effectiveness

Impact of systematic advanced care planning in lung cancer patients: A prospective study.

BACKGROUND: End-of-life (EOL) communication is crucial, particularly for cancer patients. While advanced care planning is still uncommon, we sought to investigate its impact on care intensity in case of organ failure in lung cancer patients. METHODS: We prospectively included consecutive lung cancer patients hospitalised at the Grenoble University Hospital, France, between January 1, 2014 and March 31, 2016. Patients could be admitted several times and benefited from advanced care planning based on three care intensities: intensive care, maximal medical care, and exclusive palliative care. Patients' wishes were addressed. RESULTS: Data of 739 hospitalisations concerning 482 patients were studied. During the three first admissions, 173 (25%) patients developed organ failure, with intensive care proposed to 56 (32%), maximal medical care to 104 (60%), and exclusive palliative care to 13 (8%). Median time to organ failure was 9 days [IQR 25%-75%: 3-13]. All patients benefited from care intensity that was either equal to or lower than the care proposed. Specific wishes were recorded for 158 (91%) patients, with a discussion about EOL conditions held in 116 (73%). CONCLUSIONS: In case of organ failure, advanced care planning helps provide reasonable care intensity. The role of the patient's wishes as to the proposed care must be further investigated. CLINICAL TRIAL REGISTRATION: The study was registered at www.ClinicalTrials.gov with the identifier NCT02852629.

[The role of biomedical interventions in HIV prevention: Pre-exposure Prophylaxis (PrEP)]. / El papel de las intervenciones biomédicas en la prevención del VIH: la profilaxis preexposición (PrEP).

HIV infection remains an important public health problem worldwide. The traditional preventive measures, such as sexual education, screening, and early antiretroviral treatment initiation, despite having shown their effectiveness, are not enough to control new infections. In this context, Pre-Exposure Prophylaxis (PrEP) has been investigated as a preventive measure. Currently, it has been extensively documented that the administration of antiretroviral treatment in an HIV exposed, but not infected population, could reduce the risk of transmission without significant drawbacks. Despite its high efficacy for HIV prevention, the use of PrEP remains a controversial measure, particularly its cost-effectiveness. For this reason, the access to PrEP is not available for all the HIV risk groups. Therefore, and based on the evidence found, the current approach must be the repercussions of not to implement PrEP, more than its cost or its effectiveness.

[Concomitant use of nivolumab and immunosuppressants in a renal transplant patient]. / Utilisation concomitante du nivolumab et d'immunosuppresseurs chez un patient greffé rénal.

INTRODUCTION: Immune-checkpoint inhibitors have been approved for first and second line treatments of metastatic non-small cell lung cancer based on the results of several phase III trials. Patients with organ transplantation were excluded from these studies because checkpoint inhibitors could activate allo-reactive T cells leading to acute graft rejection. CASE REPORT: A 71-year-old Caucasian-male was diagnosed with stage IV pulmonary adenocarcinoma with multiple metastases, without molecular alteration and negative PD-L1 status. He had a left kidney transplant, and his immunosuppressive regimen consisted of sirolimus and mycophenolate mofetil. After failure of two therapeutic lines (carboplatin-paclitaxel and erlotinib) a multidisciplinary oncology meeting with the nephrologist started third line treatment with nivolumab 3mg/kg every 15 days, with no modification of the immunosuppressive treatment. The patient received a total of 14 injections of nivolumab with stable disease but treatment was discontinued due to acute rejection of the transplanted kidney 6 months later, without need for dialysis. The patient died of a chylothorax related to progression of the tumour 12 months after initiation of nivolumab. CONCLUSION: Immune checkpoint inhibitors are a potential treatment for solid organ transplant patients despite the risk of graft rejection.

[Hybrid radiotherapy machines: Evolution or revolution?] / Machines de radiothérapie hybrides : évolution ou révolution ?

The arrival of new hybrid radiotherapy machines with MRI or PET is announced as a milestone in radiotherapy management. Based on recent literature, we will describe the contribution of each of these modalities and the technological challenges that have already been or are still to be addressed.

Pancreatic Cancer Incidence, Mortality, and Survival in Puerto Rico, 2001-2015.

OBJECTIVE: To perform an epidemiologic profile of pancreatic cancer (PC) in Puerto Rico (PR) with data gathered from 2001 to 2015. METHODS: Using data from the PR Central Cancer Registry we estimated incidence and mortality rates and trends of PC in PR, and performed survival analyses. We also compared the age-standardized incidence and mortality rates of PC in people in PR with those of Hispanics, non-Hispanic whites, and non Hispanic blacks in the United States (US). RESULTS: From 2011 to 2015, 7.8 per 100,000 persons were diagnosed with PC in PR; higher rates were observed in men than in women (9.2 vs. 6.7 per 100,000, respectively) and in persons 65 years old and older (42.7 per 100,000 persons). For the same period, 6.7 per 100,000 persons died from PC; men and persons 65 years and older had higher mortality rates. Incidence and mortality trends of PC in PR increased from 2001-2015 (annual percent change [APC] = 3.8% and 1.9%, respectively (p<0.05). Lower risk of being diagnosed with and dying from PC was seen in PR than in members of several racial/ethnic groups in the US. The median survival time for PC cases diagnosed in PR during the period of 2008 to 2012 was 5.3 months. CONCLUSION: We observed increasing mortality rates and low survival in PC patients in PR. Research on access and response to treatment is needed to elucidate the reasons for the observed results and have a positive impact on PC burden and survival.