Patient Navigation to Enhance Access to Care for Underserved Patients with a Suspicion or Diagnosis of Cancer.

BACKGROUND: Interventions aimed at improving access to timely cancer care for patients in low- and middle-income countries (LMIC) are urgently needed. We aimed to evaluate a patient navigation (PN) program to reduce referral time to cancer centers for underserved patients with a suspicion or diagnosis of cancer at a public general hospital in Mexico City. MATERIALS AND METHODS: From January 2016 to March 2017, consecutive patients aged >18 years with a suspicion or diagnosis of cancer seen at Ajusco Medio General Hospital in Mexico City who required referral to a specialized center for diagnosis or treatment were enrolled. A patient navigator assisted patients with scheduling, completing paperwork, obtaining results in a timely manner, transportation, and addressing other barriers to care. The primary outcome was the proportion of patients who obtained a specialized consultation at a cancer center within the first 3 months after enrollment. RESULTS: Seventy patients (median age 54, range 19-85) participated in this study. Ninety-six percent (n = 67) identified >1 barrier to cancer care access. The most commonly reported barriers to health care access were financial burden (n = 50) and fear (n = 37). Median time to referral was 7 days (range 0-49), and time to specialist appointment was 27 days (range 1-97). Ninety-one percent of patients successfully obtained appointments at cancer centers in <3 months. CONCLUSION: Implementing PN in LMIC is feasible, and may lead to shortened referral times for specialized cancer care by helping overcome barriers to health care access among underserved patients. IMPLICATIONS FOR PRACTICE: A patient navigation program for patients with suspicion or diagnosis of cancer in a second-level hospital was feasible and acceptable. It reduced patient-reported barriers, and referral time to specialized appointments and treatment initiation were within international recommended limits. Patient navigation may improve access to care for underserved patients in developing countries.

Gluten-Free Snacks Based on Brown Rice and Amaranth Flour with Incorporation of Cactus Pear Peel Powder: Physical, Nutritional, and Sensorial Properties.

An agroindustrial by-product (cactus pear peel) and whole grains flour (brown rice and amaranth) were used to present a gluten-free snack proposal. The effect of 5% (F1), 7% (F2), and 10% (F3) substitution of brown-rice flour for yellow cactus pear peel powder (Opuntia ficus-indica) on the snack physical, sensorial, and nutritional properties was evaluated. In addition, 20% of amaranth flour (Amaranthus caudatus) was used for all formulations. As the percentage of substitution increased, the a⁎ value increased, while the L⁎ decreased. The control snacks presented higher hardness, while the snacks with 10% substitution presented a greater crispness. The sensorial properties (overall liking, colour, crispness, and oiliness) reported that the samples containing cactus pear peel powder were the most accepted. The fat content decreased as the substitution percentage increased. The F3 formulation presented the best physical and sensorial properties and when compared with other commercial snack brands, it presented low fat and an adequate protein and fibre content. Therefore, snacks based on brown rice, amaranth, and cactus pear by-product could be considered as a good option of gluten-free product, contributing to reducing the lack of gluten-free products on the markets.

[Spontaneous liver rupture in a patient with choledocholithiasis resolved by ERCP]. / Ruptura hepática espontánea en paciente con antecedente de coledocolitiasis resuelta por colangiopancreatografia retrograda endoscópica.

We present the case of a 34 years old female patient who presents with abdominal pain and elevated total and direct bilirrubins, so she underwent ERCP Reporting: a) successful sphincterotomy without complications, b) choledocholithias is endoscopically resolved, c) secondary cholangitis. She developed significant abdominal pain at 72 h, with hypovolemic shock and peritoneal irritation. She was taken to the surgery, finding a grade III liver laceration. This one was resolved with liver raffia and packing, during the same operative time cholecystectomy was performed. A second look was performed at 24 h, achieving adequate control of bleeding after placing hemostatic (Nexstat®). The patient developed a subdiaphragmatic abscess which needed drainage by another laparotomy. After which the patient had a satisfactory evolution, so she was discharged.

Ruptura hepática espontánea en paciente con antecedente de coledocolitiasis resuelta por colangiopancreatografia retrograda endoscópica

Presentamos el caso de un paciente femenino de 34 años que inicia con cuadro de dolor abdominal, así como elevación de bilirrubinas a expensas de la directa, por lo que se le realiza una colangiopancreatografía retrograda endoscópica (CPRE), reportando: a) esfinterotomía exitosa sin complicaciones, b) coledocolitiasis resuelta endoscópicamente, c) colangitis secundaria. Presentó dolor abdominal importante a las 72 h, con cuadro clínico de choque hipovolémico e irritación peritoneal. Se realizó una laparotomía exploradora observando una laceración hepática grado III. Se realizó rafia hepática y colecistectomía y se deja empaquetada a la paciente, para ser reintervenida quirúrgicamente a las 24 h, logrando un adecuado control del sangrado posterior a la colocación de hemostático (Nexstat®). Se realizó una nueva laparotomía debido a la formación absceso subdiafragmático residual; posterior a la cual, la paciente presentó una evolución satisfactoria, por lo que fue dada de alta

We present the case of a 34 years old female patient who presents with abdominal pain and elevated total and direct bilirrubins, so she underwent ERCP Reporting: a) successful sphincterotomy without complications, b) choledocholithias is endoscopically resolved, c) secondary cholangitis. She developed significant abdominal pain at 72 h, with hypovolemic shock and peritoneal irritation. She was taken to the surgery, finding a grade III liver laceration. This one was resolved with liver raffia and packing, during the same operative time cholecystectomy was performed. A second look was performed at 24 h, achieving adequate control of bleeding after placing hemostatic (Nexstat®). The patient developed a subdiaphragmatic abscess which needed drainage by another laparotomy. After which the patient had a satisfactory evolution, so she was discharged

Primary pulmonary biphasic synovial sarcoma: a case report and literature review.

BACKGROUND: Primary synovial sarcomas of the lung are extremely rare, constituting 0.1% to 0.5% of lung cancers. The first case was reported by Gaertner in 1996. CLINICAL CASE: We present the case of a 15-year-old female who presented with cough, white-colored secretions, right-sided chest pain and progressive dyspnea. Physical examination revealed increased exertion during breathing with no cyanosis. The presence of right scapular pulmonary condensation syndrome was observed. Chest x-ray demonstrated homogeneous opacity occupying the lower two thirds of the right hemithorax. Posterolateral thoracotomy with right lower and medium lobectomy was performed. Because there was evidence of upper lobe tumor, it was decided to carry out a right pneumonectomy. Histopathological diagnosis was biphasic synovial sarcoma. CONCLUSIONS: The presentation of pulmonary synovial sarcoma generally shows a peripheral location with a nonencapsulated and well-circumscribed tumor. Size ranges from 0.6 to 17 cm (mean: 5 cm). Histology is often characterized by a monophasic pattern. Diagnosis is difficult except for a uniform spindle cell pattern. Most synovial sarcomas show immunoreactivity for cytokeratin and/or epithelial membrane antigen. Cytogenetic characteristic of synovial sarcoma are t(X; 18)(p11, q11). Patient prognosis for pulmonary synovial sarcoma is poor with an overall 5-year survival rate of 50%.