Study protocol of a telephone problem-solving intervention for Spanish-speaking caregivers of veterans post-stroke: an 8-session investigator-blinded, two-arm parallel (intervention vs usual care), randomized clinical trial.

BACKGROUND: Stroke is one of the leading causes of death and the main cause of long-term disability in the United States. The significant risk factors of stroke among Hispanics are well-documented. The majority of stroke survivors return home following a stroke and are cared for by family caregivers. Due to the abrupt nature of strokes, caregivers experience unexpected changes and demands that oftentimes lead to caregiver burden and depression. Given the significant risk factors for stroke in Hispanics and the influence of culture in family norms and family management, we developed a telephone and online problem-solving intervention for Spanish-speaking stroke caregivers. This study tests the impact of a telephone and online problem-solving intervention for Spanish-speaking stroke caregivers on caregiver outcomes. METHODS: The design is a two-arm parallel randomized clinical trial with repeated measures. We will enroll 290 caregivers from 3 Veterans Affairs (VA) medical centers. Participants randomized into the intervention arm receive a problem-solving intervention that uses telephone and online education and care management tools on the previously developed and nationally available RESCUE en Español Caregiver website. In the usual care group, participants receive the information and/or support caregivers of veterans with stroke normally receive through existing VA resources (e.g., stroke-related information and support). The primary outcome is change in caregiver's depressive symptoms at 1- and 12-weeks post-intervention. Secondary outcomes include changes in stroke caregivers' burden, self-efficacy, problem-solving, and health-related quality of life (HRQOL) and veterans' functional abilities. We will also determine the budgetary impact, the acceptability of the intervention and participation barriers and facilitators for Spanish-speaking stroke caregivers. DISCUSSION: This is an ongoing study. It is the first known randomized controlled trial testing the effect of a telephone and online problem-solving intervention in Spanish for caregivers of veterans post-stroke. If successful, findings will support an evidence-based model that can be transported into clinical practice to improve the quality of caregiving post-stroke. TRIAL REGISTRATION: ClinicalTrials.gov: NCT03142841- Spanish Intervention for Caregivers of Veterans with Stroke (RESCUE Español). Registered on February 23, 2018. Protocol version 8. 08.11.2022.

Interventions for Informal Caregivers of Stroke Survivors: Is There Racial and Ethnic Representation in Stroke Caregiver Studies?

PURPOSE: The specific aims of this scoping review of the literature are to (1) map the current scope of literature regarding nonpharmacological interventions for informal stroke caregivers and (2) explore the degree to which racial/ethnic minority groups were represented in nonpharmacological interventions for stroke caregivers in the United States. DESIGN AND METHODS: Arksey and O'Malley's methodological framework was used to conduct this scoping review. The framework entails formulating research questions, developing criteria for selecting relevant studies, charting the data, and synthesizing results. FINDINGS: The scoping review yielded 11 studies that varied in intervention design, methods of implementation, and outcome measurements. The review indicated that racial and ethnic minorities were less likely to be represented in nonpharmacological intervention studies for stroke caregivers. CONCLUSION: Currently, there is sparse research that focuses on interventions with family caregivers of varying racial/ethnic groups in the United States.

Interobserver Variability in Assessing Pathologic Response to Preoperative Treatment in Rectal Cancer: Standardization of an Evaluation Method and Comparisons Between Published Scales.

BACKGROUND: Evaluating tumor response of rectal cancer to preoperative chemoradiotherapy (NCRT) has a prognostic value on overall survival; however, grading tumor response is a controversial issue due to lack of reproducibility and the lack of information about the standardization of the evaluation. METHODS: We performed this study to examine the variability between observers' assessment of the pathological responses to NCRT using a systematic quantitative grading system based on a percentage of tumor response against the proportion of residual tumor burden. As a secondary aim, we classified the tumor response according to six published systems to determine the correlation between the observers into each grading system. RESULTS: From 70 cases, the mean age was 60.6 ± 11.78 years, 36 (51.47%) patients were female, the pathological T stage was pT3 in 48.6% of cases, pT2 in 32.9%, pT1 in 11.4% and 7.1% in pT4, whereas 40% had lymph node metastasis. The median lymph node count was ten lymph nodes (range 6-43). Our method of tumor regression evaluation has a good intraclass correlation (ICC) value. From the scales compared regarding interobserver agreement, the Ryan's and Royal College of Pathologists showed fair agreement (but good ICC); the scales from Dworak, Becker, and Rizk showed substantial agreement (and good to excellent ICC values); and the scale from Rödel showed almost-perfect agreement. RESULTS: All the evaluated systems showed good interobserver agreement, but the best interobserver agreement was reached with the Rödel's scale.

Report of three cases of gastric choriocarcinomas-an emphasis on morphologic changes in the non-affected gastric mucosa.

Primary gastric choriocarcinomas (PGC) are very rare and aggressive neoplasms with a worrisome prognosis. Most cases are reported in Asia and presented in middle-aged adults with male predominance. Most cases are associated with an intestinal adenocarcinoma; however, the pathogenesis of this tumor is uncertain. No previous reports exist of the characteristics of the non-tumoral stomach in these patients, and this data that could help to clarify their pathogenesis. We presented a series of three cases of PGC in Latin American patients, emphasizing the characteristics of non-neoplastic mucosa.

Overall survival of patients with colon cancer and a prolonged time to surgery.

BACKGROUND: Factors associated with the time to surgery (TTS) and survival in colon cancer (CC) have not been well studied. Our aim was to find if the TTS has changed in our institution over time and to determine if it influences the survival. METHODS: Retrospective cross-section study of 266 CC analyzed between two periods, and according to the quartiles of TTS, we performed a survival analysis. RESULTS: The median age was 57 years; there was no predominance of sex, and about half of the patients were in stage III. The median TTS was 38 days, and 75% of the cases were operated before 60 days. The median TTS for 2005 to 2010 was 36 days, while for 2011 to 2015 was 41 days (P = 0.107). The survival was not statistically different between cases (1) operated with a delayed TTS or not, (2) operated in four cut-off points of TTS, (3) two different periods of attention, and (4) according to the clinical stage. CONCLUSION: We did not find an association between the TTS with low survival. TTS has increased in the last period so we must work to make the diagnostic process more efficient in our patients to meet international quality standards.

Rehabilitación vestibular de la Enfermedad de Meniere en el estadio tardío: Reporte de un caso / Vestibular rehabilitation of Meniere's Disease in its chronic stage: A case report

La enfermedad de Meniere (EM), se caracteriza por ataques fluctuantes de vértigos, hipoacusia y acúfenos. Una vez que se controlan los síntomas agudos, la rehabilitación vestibular es una alternativa de tratamiento efectiva. Se presenta el caso de una mujer de 46 años con EM en la fase crónica que presenta persistencia de vértigo postural e inestabilidad de la marcha, quien fue intervenida con maniobras de reposición y rehabilitación vestibular con ejercicios de adaptación y sustitución, ejercicios de habituación del equilibrio vestibular y de control postural. Se obtuvo una respuesta favorable, con desaparición del vértigo posicional, disminución significativa de la inestabilidad y gran mejoría en su calidad de vida. No se puede llegar a conclusiones con un solo caso, sin embargo, es importante el abordaje integral en el tratamiento de pacientes con EM. (AU)

Meniere's disease presents fluctuating attacks of dizziness, hearing loss and tinnitus. Once acute symptoms are controlled, vestibular rehabilitation is an effective treatment alternative. We present the case of a 46-year-old woman with Meniere's disease in the chronic phase, who presented persistent postural vertigo and gait instability and who was treated with repositioning maneuvers, along with vestibular rehabilitation with adaptation, substitution and habituation exercises, vestibular balance and postural control. A favorable response is achieved, with the disappearance of positional vertigo, a significant decrease in instability and a great improvement in her quality of life. No conclusions can be drawn from a single case; however, a comprehensive approach is important in the treatment of patients with MS. (AU)

Amniotic membrane modulates innate immune response inhibiting PRRs expression and NF-κB nuclear translocation on limbal myofibroblasts.

Corneal damage observed in a viral infection such as herpetic stromal keratitis is mainly caused by proinflammatory molecules released by resident cells in the response to viral antigens. There are pattern recognition receptors like MDA5, RIG-1, and TLR3, that recognize viral dsRNA and after activation, the innate immune response is exacerbated inducing the synthesis and secretion of inflammatory cytokines through NF-κB activation. Amniotic membrane (AM) has demonstrated to reduce inflammation by several mechanisms, however the effect of AM on innate immune receptors such as MDA5, RIG-1, and TLR3 has not been reported. In this study, we have determined that the presence of AM significantly inhibited the synthesis and secretion of proinflammatory cytokines on human limbal myofibroblasts (HLM) stimulated with poly I:C. Similarly, the presence of AM reduced the protein expression of MDA5, RIG-1, and TLR3 on poly I:C stimulated HLM. Additionally, the presence of the AM significantly inhibited the NF-κB nuclear translocation when the HLM were poly I:C stimulated, and concomitantly, the AM was able to relocate cadherins affecting the myofibroblastic cellular morphology. These results suggest that AM generates an anti-inflammatory microenvironment, and specific inhibition of NFκB nuclear translocation on infected corneal tissue would reduce the inflammation undesirable effects, explaining in part the beneficial usefulness of transplanting AM on herpetic stromal keratitis.

Dynamic splinting of forearm rotational contracture after distal radius fracture.

The results of dynamic forearm rotational splinting for the treatment of forearm rotational contractures in patients with acceptably aligned, healed distal radius fractures are documented. Fifteen patients with distal radius fractures that healed with < or =+5 mm ulnar variance and < or =20 degrees dorsal tilt had dynamic forearm rotational splinting for contractures that had failed conventional hand therapy. Average pronosupination arc before splinting was 83 degrees. Dynamic forearm rotational splinting increased forearm rotation by 52% to an average of 126 degrees. Only one patient with development of ectopic bone in the interosseous space during splinting failed to obtain at least 30 degrees pronation and supination after splinting. Dynamic forearm rotational splinting effectively treats rotational contractures in patients who have healed distal radius fractures that are in acceptable alignment.