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Despite the disproportionate impact of COVID-19 on Latinos, there were disparities in vaccination, especially during the early phase of COVID-19 immunization rollout.Leveraging a community-academic partnership established to expand access to SARS-CoV2 testing, we implemented community vaccination clinics with multifaceted outreach strategies and flexible appointments for limited English proficiency Latinos.Between February 26 and May 7 2021, 2250 individuals received the first dose of COVID-19 vaccination during 18 free community events. Among them, 92.4% (95% confidence interval [CI], 91.2%-93.4%) self-identified as Hispanic, 88.7% (95% CI, 87.2%-89.9%) were limited English proficiency Spanish speakers, 23.1% (95% CI, 20.9%-25.2%) reported prior COVID-19 infection, 19.4% (95% CI, 16.9%-22.25%) had a body mass index of more than 35, 35.0% (95% CI, 32.2%-37.8%) had cardiovascular disease, and 21.6% (95% CI, 19.2%-24.0%) had diabetes. The timely second-dose completion rate was high (98.7%; 95% CI, 97.6%-99.2%) and did not vary by outreach method.A free community-based vaccination initiative expanded access for Latinos with limited English proficiency at high risk for COVID-19 during the early phase of the immunization program in the US.

Latinx immigrants have been profoundly impacted by COVID-19. As the Johns Hopkins Health System faced a surge in admissions of limited English proficiency patients with COVID-19, it became evident that an institutional strategy to address the needs of this patient population was needed. The Johns Hopkins Medicine (JHM) Latinx Anchor Strategy was established in April 2020 with diverse stakeholder engagement to identify the most urgent community needs and develop timely solutions. The JHM Latinx Anchor Strategy provided a platform for information sharing to promote equitable access to resources for Latinxs with limited English proficiency who were impacted by COVID-19. Leveraging institutional, community, and government resources and expertise, the JHM Latinx Anchor Strategy helped establish interventions to improve access to COVID-19 testing and care for low-income immigrants without a primary care doctor and helped mitigate economic vulnerability through the distribution of food for 2,677 individuals and cash to 446 families and 95 individuals (May to August 2020). Expanded linguistic and culturally competent communication through webinars and livestream events reached more than 10,000 community members and partners. Over 7,500 limited English proficiency patients received linguistically congruent direct patient services through the Esperanza Center bilingual hotline, community testing resulting efforts, and inpatient consultations. The first stage of the JHM Latinx Anchor Strategy relied heavily on volunteer efforts. Funding for a sustainable response will be required to address ongoing COVID-19 needs, including expansion of the bilingual/bicultural healthcare workforce, expanded access to primary care, and investments in population health strategies addressing social determinants of health.

To characterise the key epidemiological, clinical, immunological, imaging, and pathological features of the coexistence between sarcoidosis and Sjögren's syndrome (SS).All centres included in two large multicentre registries (the Sjögren Syndrome Big Data Consortium and the Sarco-GEAS-SEMI Registry) were contacted searching for potential cases of coexistence between SS and sarcoidosis seen in daily practice. Inclusion criteria were the fulfilment of the current classification criteria both for SS (2016 ACR/EULAR) and sarcoidosis (WASOG). The following features were considered for evaluating a coexisting immunopathological scenario between the two diseases: non-caseating granulomas (NCG), focal lymphocytic sialadenitis (FLS) and positive anti-Ro antibodies.We identified 43 patients who fulfilled the inclusion criteria (38 women, with a mean age of 53 years at diagnosis of SS and of 52 years at diagnosis of sarcoidosis). In 28 (65%) cases, sarcoidosis was diagnosed concomitantly with SS, or during the follow-up of patients with an already diagnosed SS, while in the remaining 15 (35%), SS was diagnosed during the follow-up of an already diagnosed sarcoidosis. Patients in whom sarcoidosis was diagnosed first showed a lower mean age (43.88 vs. 55.67 years, p=0.005) and were less frequently women (73% vs. 96%, p=0.04) in comparison with those in whom sarcoidosis was diagnosed concomitantly with SS, or during the follow-up of an already diagnosed SS. We identified the following immunopathological scenarios: a combination of NCG involving extrasalivary tissues and anti-Ro antibodies in 55% of patients, a coexistence of both pathological scenarios (extrasalivary NCG and FLS in MSGB) in 42% (with positive anti-Ro antibodies in two thirds of cases), and NCG involving salivary glands and anti-Ro antibodies in 3% of cases.We have characterised the largest reported series of patients who fulfilled the current classification criteria for both SS and sarcoidosis. This implies that sarcoidosis (and not just the presence of isolated NCG on salivary gland biopsy) may, like other systemic autoimmune diseases, coexist with SS, and that a sarcoidosis diagnosis does not preclude the development of SS in the future.

Latinxs in the U.S. are disproportionately affected by HIV and more likely to have delayed diagnosis than their non-Latinx peers. We developed and implemented Sólo Se Vive Una Vez (You Only Live Once), the first Spanish-language campaign aimed at improving HIV testing and prevention among Latinx immigrants in Baltimore, Maryland. Sólo Se Vive Una Vez featured a website ( www.solovive.org ) and social marketing campaign promoting free HIV testing through the Baltimore City Health Department (BCHD) clinic and Latinx outreach team. The campaign was not associated with a change in the overall number of Latinxs obtaining HIV testing. However, Latinx HIV testers who reported being exposed to the campaign had significantly higher rates of high-risk sexual behaviors, mean number of sexual partners, and substance use. The campaign was also associated with increased PrEP referrals through the BCHD Latinx outreach team.Los latinos en los Estados Unidos están desproporcionadamente afectados por el VIH y es más probable que sean diagnosticados más tarde que pacientes no latinos. Desarrollamos e implementamos Sólo Se Vive Una Vez, la primera campaña en español dirigida a mejorar la detección y prevención del VIH entre los inmigrantes latinos en Baltimore, Maryland. Sólo Se Vive Una Vez consiste en un sitio web (www.solovive.org) y una campaña en las redes sociales que promueve la prueba gratuita de VIH a través de la clínica del Departamento de Salud de la Ciudad de Baltimore así como la unidad móvil operada por nuestro equipo latino de promotores de salud. La campaña no se asoció con un cambio en el número absoluto de latinos que hicieron la prueba del VIH. Sin embargo, los latinos expuestos a la campaña que se hicieron la prueba del VIH tenían tasas más altas de conductas sexuales de alto riesgo, de parejas sexuales, y de uso de sustancias. La campaña también se asoció con un aumento de referidos a PrEP a través del equipo de promotores de salud latinos.

Primary and secondary haemophagocytic lymphohistiocytosis (HLH) are hyperferritinaemic hyperinflammatory syndromes with a common terminal pathway triggered by different etiopathogenetic factors. HLH is characterised by a decreased capacity of interferon gamma production with an activated NK phenotype profile similar to other hyperinflammatory syndromes. Viruses are closely linked to the development of HLH as infectious triggers, and the break of tolerance to self-antigens is considered a critical mechanism involved in the development of immune-mediated conditions triggered by viral infections. Emerging studies in patients with COVID-19 are suggesting a key role of monocytes/macrophages in the pathogenesis of this viral infection, and there is a significant overlap between several features reported in severe COVID-19 and the features included in the HLH-2004 diagnostic criteria. Therefore, SARS-Cov-2, as other respiratory viruses, may also be considered a potential etiological trigger of HLH. The frequency of HLH in adult patients with severe COVID-19 is lower than 5%, although this figure could be underestimated considering that most reported cases lacked information about some specific criteria (mainly the histopathological criteria and the measurement of NK cell function and sCD25 levels). Because HLH is a multi-organ syndrome, the diagnostic approach in a patient with severe COVID-19 in whom HLH is suspected must be carried out in a syndromic and holistic way, and not in the light of isolated clinical or laboratory features. In COVID-19 patients presenting with persistent high fever, progressive pancytopenia, and hepatosplenic involvement, together with the characteristic triad of laboratory abnormalities (hyperferritinaemia, hypertriglyceridaemia, and hypofibrinogenaemia), the suspicion of HLH is high, and the diagnostic workup must be completed with specific immunological and histopathological studies. Supplementary Information The online version contains supplementary material available at 10.1007/s10067-020-05569-4.

OBJECTIVE: To evaluate the survival impact of adding definitive pelvic radiation therapy (RT) to chemotherapy among patients with stage IVB neuroendocrine cervical carcinoma (NECC). METHODS: We retrospectively studied patients with FIGO 2018 stage IVB NECC diagnosed during 1998-2020 who received chemotherapy with or without definitive whole pelvic RT (concurrent or sequential). Demographic, oncologic, and treatment characteristics were summarized. Progression-free (PFS) and overall survival (OS) were plotted using the Kaplan-Meier method, and hazard ratios (HRs) were calculated using Cox regression. RESULTS: The study included 71 patients. Median age was 43 years (range, 24-75). Fifty-nine patients (83%) had pure neuroendocrine histology, and 57 (80%) had pretreatment tumor size >4 cm. Fifty-six patients (79%) received chemotherapy alone with (n=15) or without (n=41) palliative pelvic RT, and 15 (21%) received chemotherapy and definitive pelvic RT (chemo+RT). Median follow-up time was 20.1 months (range, 11.3-170.3) for the chemo+RT group and 13.5 months (range, 0.9-73.6) for the chemotherapy-alone group. Median PFS was 10.3 months (95% CI, 7.5-∞) for the chemo+RT group vs 6.6 months (95% CI, 6.1-8.7) for the chemotherapy-alone group (p=0.0097). At 24 months, the PFS rate was 24% for chemo+RT vs 7.8% for chemotherapy alone. Median OS was 20.3 months (95% CI, 18.5-∞) for the chemo+RT group vs 13.6 months (95% CI, 11.3-19.2) for the chemotherapy-alone group (p=0.0013). At 24 months, the OS rate was 49.2% for chemo+RT vs 21.5% for chemotherapy alone. In a Cox regression model, definitive RT was associated with improved PFS (HR, 0.44; 95% CI, 0.23-0.83; p=0.0119) and OS (HR, 0.31; 95% CI, 0.14-0.65; p=0.0022). CONCLUSIONS: Addition of definitive pelvic RT to chemotherapy may improve survival in patients with stage IVB NECC.

Immunotherapies are designed to target a specific molecule of the immune system and emerged at the end of the last century as effective therapies the treatment of a widening spectrum of inflammatory diseases. Paradoxically, their use was quickly linked to the development of autoimmune disorders, whose treatment indications often include the very biological agent producing the adverse event. The scenario has changed dramatically in recent years due to the increasing use of immunotherapies in patients with solid cancers (mainly checkpoint inhibitors, but also tyrosine-kinase inhibitors and others). Cancer immunotherapies are broadly defined as therapies directly or indirectly targeting any component of the immune system involved in the immune response against cancer. These therapies include different molecules (monoclonal antibodies, small proteins, fusion proteins) that target specific proteins of cancer or immune cells. A key challenge that has emerged with the progressive broad implementation of these treatments in daily practice has been the collateral side effects on the immune system of treatment, which may lead to immune-related adverse events (irAEs). The cumulated number of cases of irAEs related to cancer immunotherapies has increased exponentially during this century. As the objective of cancer immunotherapy is to stimulate the immune system, these autoimmune and inflammatory irAEs were expected. The pharmacological targeting of kinases has led to a significant change in the therapeutic management of cancer. About one-third of all protein targets under research in the pharmaceutical industry are kinase inhibitors, overwhelmingly used in the treatment of malignancies. Very few studies have reviewed the broad scenario of irAEs related to kinase inhibitors, in contrast with the large number of studies published on irAEs caused by checkpoint inhibitors, with an often-fragmented view according to the specialty. The purpose of this review is to update current knowledge on the wide pharmacological and phenotypic scenario of irAEs associated with kinase inhibitors from a multidisciplinary perspective.

Introduction: Primary Sjogren syndrome (pSS) is a systemic autoimmune disease that may affect 3 in 1,000 people within the general population. The therapeutic scenario is complex, and no therapy has proved to be able to modify the natural course of the disease, nor to prevent the most severe systemic complications.Areas covered: Recently, the EULAR 2020 Recommendations for pSS have underlined the low level of evidence supporting efficacious therapeutic approaches, lacking a definition of specific treatment targets and being far from the 'disease modification' concept that is frequently used in other diseases. Herein, the authors review the status of current targeted therapies and provide the reader with their expert opinion.Expert opinion: The progress in discovering novel treatments for pSS seem to be focused on searching new biological therapies as highly-selective drugs that can be effective without the adverse effects related to the wide, nonspecific immunosuppression induced by the drugs currently used. Most likely, the more disruptive therapeutic approach in pSS that could be seen in a few years is the use of combination strategies targeting different etiopathogenic pathways.

Primary care physicians can play a crucial role by recognising Sjögren's syndrome (SS) in the early stages identifying those patients with the greatest probability of being diagnosed with SS. SS has a very specific epidemiological profile at presentation (female aged 30-50 years), which may aid an early diagnosis. Although the disease may be expressed in many guises, there are three predominant clinical presentations that should be considered as key clues to increased clinical suspicion (multiple symptoms of dryness, asthenia-polyalgia syndrome and systemic organ-specific manifestations). The physical examination may provide important clues to systemic involvement (parotid gland enlargement, skin lesions suggestive of purpura or annular erythema, respiratory crackles, arthritis, neurological sensory or motor deficits). Simple laboratory studies may be very useful in reinforcing the clinical suspicion of SS, and the triad of cytopenia, raised erythrocyte sedimentation rate and high serum gamma globulin levels is a very specific "biological" pattern suggesting SS. A solid clinical suspicion of SS requires both the patient reporting sicca symptoms and objective evidence that these symptoms are associated with dysfunction of the lachrymal and salivary glands. Ultrasonography of the parotid glands, a non-invasive method, may be a major advance in the diagnostic approach to SS in primary care. Primary care physicians must be considered essential members of the multidisciplinary team in charge of the follow-up of SS patients, due to their key role in the continuum of patient care and their cross-sectional knowledge of common diseases that frequently coexist in patients with SS.

HIV-related stigma exacerbates Latino immigrants’ risk of HIV infection and delayed care. Following the implementation of the social marketing campaign Sólo Se Vive Una Vez (You Only Live Once) to increase HIV testing that addressed stigmatizing beliefs, we conducted a survey among Latinos in Baltimore, Maryland (N = 357). The aims of this paper are to 1) characterize the sociodemographic characteristics, HIV-related stigma beliefs, and testing behaviors of the survey respondents by campaign exposure, and 2) model the effects of Vive exposure on stigma beliefs and testing behaviors. Comparing post-campaign survey respondents exposed and unexposed to the campaign to survey findings previously obtained and reported before the campaign implementation, respondents to the post-Vive survey continued to hold high levels of stigma beliefs, and compared to the pre-Vive survey sample, were more likely to hold four or more stigmatizing beliefs (from the six survey items). Among the post-Vive survey respondents, those for whom religion was important or very important had an increased odds of 1.6 of holding four or more stigmatizing beliefs. Survey respondents who were exposed to the campaign, however, had an increased odds of 2.25 of reporting ever having been tested for HIV. Our findings demonstrate the importance of the changing social context in addressing stigma within emerging immigrant communities and highlight the critical role of religious leaders in efforts to address HIV-related stigma.

Lessons We’ve Learned In Baltimore, Covid-19 spread rapidly in the immigrant Latinx community. Transmission was fueled by poverty and economic necessity, and precarious housing arrangements and fea...

Objective To analyse the clinical patterns of sarcoidosis triggered by immune checkpoint inhibitors (ICIs) in patients with cancer. Patients and methods The ImmunoCancer International Registry is a big data–sharing multidisciplinary network from 18 countries dedicated to evaluating the clinical research of immune-related adverse events related to cancer immunotherapies. Results We identified 32 patients with biopsy-proven sarcoidosis. Underlying cancer included mainly melanoma (n = 24). Cancer immunotherapy consisted of monotherapy in 19 cases (anti-PD-1 in 18 and ipilimumab in 1) or combined ipilimumab + nivolumab in 13. The time median interval between initiation of ICI and sarcoidosis diagnosis was 3 months (range, 2–29 months). The use of combined ICI was associated with a shorter delay in developing sarcoidosis symptoms. The disease was symptomatic in 19 (59%) cases with mostly cutaneous, respiratory and general symptoms. The organs involved included mainly the mediastinal lymph nodes (n = 32), the lungs (n = 11), the skin (n = 10) and the eyes (n = 5). Pulmonary computed tomography studies showed bilateral hilar lymphadenopathy in all cases. There was no severe manifestation. Specific systemic therapy was required in only 12 patients (37%): oral glucocorticoids in 9, and hydroxychloroquine in 3. ICIs were held in 25 patients (78%) and definitively discontinued in 18 (56%) patients. Seven patients continued ICI treatment with a second flare in one case. In six additional patients, an ICI was reintroduced with no harm, and sarcoidosis relapsed in one of them. Conclusion Our study shows that ICI-related sarcoidosis seems to have a specific profile, possibly more benign than that of idiopathic sarcoidosis, and does not necessarily imply ICI discontinuation.

INTRODUCTION: Latinxs have been disproportionately impacted by COVID-19. Latinx immigrants, in particular, face significant barriers to SARS-CoV-2 testing, including lack of insurance, language barriers, stigma, work conflicts, and limited transportation. METHODS: In response to a disproportionately high SARS-CoV-2 positivity rate among Latinxs at the Johns Hopkins Health System, investigators implemented free community-based testing by partnering with religious leaders and leveraging the skill of trusted community health workers. Data were extracted from the electronic health record and a Research Electronic Data Capture database. SARS-CoV-2 positivity was evaluated per event stratified by race/ethnicity. Total rates of SARS-CoV-2 positivity and categorical patient characteristics were compared between groups using chi-square tests. RESULTS: Between June 25, 2020 and October 15, 2020, a total of 1,786 patients (57.5% Latinx, 31.2% non-Hispanic White, 5.9% non-Hispanic Black, and 5.3% non-Hispanic other) were tested for SARS-CoV-2 in 18 testing events. Among them, 355 (19.9%) tested positive. The positivity rate was 31.5% for Latinxs, 7.6% for non-Hispanic Blacks, 3.4% for non-Hispanic Whites, and 5.3% for patients of other races/ethnicities. Compared with Latinxs who tested negative, Latinxs who tested positive were more likely to report Spanish as their preferred language (91.6% vs 81.7%, p

Cancer immunotherapies have changed the landscape of cancer treatment during the past few decades. Among them, immune checkpoint inhibitors (ICIs), which target PD-1, PD-L1 and CTLA-4, are increasingly used for certain cancers; however, this increased use has resulted in an increased reports of immune-related adverse events (irAEs). These irAEs are unique and are different to those of traditional cancer therapies, and typically have a delayed onset and prolonged duration. IrAEs can involve any organ or system. These effects are frequently low-grade and are treatable and reversible; however, some adverse effects can be severe and lead to permanent disorders. Management is based primarily on corticosteroids and other immunomodulatory agents, which should be prescribed carefully to reduce the potential for short-term and long-term complications. Thoughtful management of irAEs is important in optimizing quality of life and long-term outcomes.

BACKGROUND: Female sex workers (FSW) constitute a highly vulnerable population challenged by numerous co-existing, or syndemic, risk factors. FSW also display resilience to these, and some evidence suggests that resilience may be associated with protective factors that improve health outcomes. METHODS: We conducted in-depth interviews with indirect sex workers (n = 11) and their clients (n = 18). Interviews were coded utilizing an iterative, modified constant comparison method to identify emergent themes. RESULTS: We identified five syndemic risk factors (difficulty finding work due to undocumented status, shame and mental health hardship, lack of social support, alcohol use, and violence) and five resilient factors (rationalizing sex work, identifying as a “decent” woman, fulfilling immigrant goals, reducing alcohol consumption, and creating rules to reduce risk of violence and HIV/STIs). DISCUSSION: Understanding the syndemic risk factors and resiliency developed by FSW is important to develop tailored, strength-based interventions for HIV/STIs and other risks.

Introduction: Biological drugs are therapies designed to target a specific molecule of the immune system that have been linked with the development of autoimmune diseases. Areas covered: The BIOGEAS Registry currently collects information about nearly 13,000 reported cases of autoimmune diseases developed in patients exposed to biologics, including more than 50 different systemic and organ-specific autoimmune disorders, of which psoriasis (n=6375), inflammatory bowel disease (n=845), demyelinating CNS disease (n=803), interstitial lung disease (n=519) and lupus (n=369) were the most frequently reported. The main biologics involved were anti-TNF agents in 9133 cases (adalimumab in 4154, infliximab in 3078 and etanercept in 1681), immune checkpoint inhibitors in 913 (ipilimumab in 524 and nivolumab in 225), B-cell targeted therapies in 741 (rituximab in 678), and growth factor inhibitors in 549 cases (bevacizumab in 544). Even though targeting a particular immune molecule may be associated with an excellent clinical response in most patients, an unexpected autoimmune disease may arise in around 8 out of 10,000 exposed patients. Expert opinion: Following the increased use of biologics, the number and diversity of induced autoimmune diseases is increasing exponentially. Management of these disorders will be an increasing clinical challenge in the daily practice in the next years. Fil: Pérez De Lis, Marta. Hospitalario Universitario de la Coruña; España Fil: Retamozo, Maria Soledad. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba; Argentina. Hospital Clínic; España. Hospital Privado Universitario de Córdoba; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigaciones en Ciencias de la Salud. Universidad Nacional de Córdoba. Instituto de Investigaciones en Ciencias de la Salud; Argentina Fil: Flores Chávez, Alejandra. Hospital Clínic; España. Hospital de Especialidades; México. Universidad de Colima; México Fil: Kostov, Belchin. Primary Care Research Group; España Fil: Perez Alvarez, Roberto. Hospital Alvaro Cunqueiro; España Fil: Brito Zerón, Pilar. Hospital Clínic; España. Hospital CIMA; España Fil: Ramos Casals, Manuel. Hospital Clínic; España. Universidad de Barcelona; España

The objective of this study was to compare the nutritional statuses and masticatory function of the non-indigenous and indigenous adult people of the state of Nayarit, Mexico.Forty-two indigenous (Cora or Huichol ethnic group) and 100 non-indigenous people, all adults with natural dentition, participated in this cross-sectional study. They performed a free-style masticatory test consisting five trials of chewing silicon pieces for 20 cycles. Masticatory performance was determined by sieving the silicon particles, masticatory laterality was determined by calculating the asymmetry index, and the cycle duration was also recorded. Weight and body fat mass were measured using a portable digital weighing machine and height and body circumferences were recorded to calculate the body mass index (BMI), body fat percentage, and the waist-hip ratio. Each aspect of masticatory function and each nutritional variable were compared using T-test, analysis of variance, and Kruskal-Wallis or Mann-Whitney tests, as appropriate.Body fat percentage, BMI, and waist-hip ratio were higher (P 0.0005) in the indigenous group compared to the non-indigenous. The indigenous group had a significantly shorter stature than the non-indigenous group. Cora group had a higher BMI and higher percentage of body fat than the Huichol group (P 0.05). No significant differences were detected between the groups for any aspect of masticatory function.Indigenous people from the Nayarit, especially the Cora ethnic group, are more obese, have more total body fat, and more abdominal fat than non-indigenous people. Indigenous people show similar masticatory function.

Objectives To describe the prevalence of previously diagnosed diabetes among Mexican adults, to characterize the associated risk factors, and to describe which glycemic control strategies are the most used. Methods We analyzed data from 8,631 adults aged ≥20 years who participated in the ENSANUT-2016 and from whom we gathered data about previously diagnosed diabetes, risk factors, glycemic control strategies, and measures to prevent complications. Results The prevalence of previously diagnosed diabetes in Mexican adults was 9.4% (10.3% in women and 8.4% in men). The adjusted OR for having diabetes was higher in adults aged ≥60 years (OR = 11.0 in women and OR = 30.7 in men) than in adults aged 20–39 years (OR = 1.0). The adjusted OR for having diabetes was higher in overweight men (OR = 1.7) than in men with normal BMI (OR = 1.0). A total of 30.5% of adults with diabetes did not report any control strategies, 44.9% measured their venous blood glucose, and 15.2% used the HbA1C as an indicator of glycemic control. Only 46.4% of them reported preventive measures. Discussion Diabetes is a common disease among Mexican adults. Being older or overweight are risk factors for an adult to be diagnosed with diabetes. Most adults with diabetes evaluate their glycemic control but only half practice preventive measures.

To describe the prevalence of hypertension (HBP) in adults with vulnerability, the percentage of them with previous diagnosis and the proportion that had adequate control.Blood pressure was measured in 7 838 adults who participated in the Ensanut 100k. Those who self-reported the diagnosis of HBP or had systolic blood pressure (SBP) ≥130mmHg or diastolic blood pressure (DBP) ≥80mmHg were classified as hypertensive. Controlled blood pressure was considered when SBP was130mmHg and TAD80mmHg.The prevalence of hypertension in adults with a vulnerability condition was 49.2%, of which 54.7% did not know had hypertension. Of the hypertensive patients who received pharmacological treatment (69.0%), 66.8% of them had blood pressure under control.Almost half of Mexican adults in vulnerable condition have HBP and of these more than half do not know that they have this disease. One third of hypertensive adults have inadequate control.Describir la prevalencia de hipertensión arterial (HTA) en adultos en condición de vulnerabilidad, el porcentaje de ellos con diagnóstico previo y la proporción con control adecuado.Se midió la tensión arterial a 7 838 adultos participantes en la Ensanut 100k. Se clasificó como hipertensos a quienes autorreportaron el diagnóstico de HTA o presentaban tensión arterial sistólica (TAS) ≥130mmHg o tensión arterial diastólica (TAD) ≥80mmHg. Se consideró tensión arterial controlada cuando la TAS fue130mmHg y la TAD80mmHg.La prevalencia de HTA en adultos en condición de vulnerabilidad fue de 49.2%, de los cuales 54.7% desconocía tener HTA. De los hipertensos que recibían tratamiento farmacológico (69.0%), el 66.8% tuvo tensión arterial controlada.Casi la mitad de los adultos mexicanos en condición de vulnerabilidad tiene HTA y de ellos, más de la mitad desconoce que tiene esta enfermedad. Asimismo, un tercio de los adultos hipertensos tiene un inadecuado control de su enfermedad.

BACKGROUND Although Latinos living in the United States are disproportionately affected by HIV, the development, implementation, and evaluation of HIV prevention, testing, and linkage to care interventions lag behind efforts occurring in other communities. To address sociocultural barriers to testing, we developed a multilevel intervention. This study is a pilot evaluation of the individual-level component of the intervention-animated video modules that address specific barriers to HIV testing common among foreign-born Latino men. METHODS We conducted a survey assessing HIV risk and barriers to testing with a convenience sample of 104 foreign-born Latino men in Baltimore, MD, who had not tested for HIV within the past year. Intention to test in the next 3 months was measured before and after viewing an intervention module selected based on survey responses. RESULTS Fifty-two (50.0%) participants had never tested for HIV. Of the participants who had previously tested for HIV, the mean time since their last test was 3.48 years (SD = 3.55). Participants' intention to test for HIV significantly increased after watching the module (t = -8.28, P < 0.001). Increased intention to test was not associated with any socio-demographic characteristics (ie, age, country of origin) or reported sexual behaviors (ie, number of sex partners in the past year). DISCUSSION These results suggest that our culturally sensitive, individually tailored intervention can be an additional tool to encourage HIV testing among previously untested foreign-born Latino men, one of the demographic groups at highest risk for delayed HIV diagnosis in the United States.

Various cell types participate in the tumor process, in which the mast cells have been described; however, the role they play in colorectal adenocarcinoma has not yet been fully understood. Therefore, the present work aimed to compare employing histochemistry and immunohistochemistry, the number of mast cells and the content of some cytoplasmic granules in moderately differentiated non-metastatic and metastatic colorectal adenocarcinoma, analyzing tissue samples from patients. Histochemical techniques with Toluidine Blue (TBO), Periodic Schiff Acid (PAS), Alcian Blue/Periodic Acid-Schiff (PAB) and Alcian Blue/Safranin (ABS); as well as immunohistochemical reactions with anti-antibodies anti-Tryptase and anti-Chymase were applied to quantify total mast cells and content of some cytoplasmic granules. Statistical analysis was performed using SPSS V22.0 software (p ≤ 0.05). The degree of positivity of the reaction and degranulation of mast cells was reported in percentages. In our results, we observed that there are differences in the quantity and histochemical composition of the granules of mast cells (metastatic group PAS and ABS comparing the TBO reaction), as well as in the immunohistochemical composition between Tryptase and Chymase and the number of degranulated cells in both study groups (74 % degranulated mast cells in the metastatic group, 66 % integrate mast cells in the non-metastatic group). Therefore, we consider that the differences may be some of the probable factors that lead to metastasis of colorectal adenocarcinoma.

Rheumatoid arthritis (RA) has been associated with a higher risk of developing cardiovascular (CV) diseases. It has been proposed that systemic inflammation plays a key role in premature atherosclerosis development, and is therefore crucial to determine whether systemic components from RA patients promotes endothelial cell-oxidative stress by affecting reactive oxygen species (ROS) and nitric-oxide (NO) production. The aim of this study was to evaluate whether plasma from RA patients impair NO synthesis and ROS production by using the cell-line ECV-304 as a biosensor. NO synthesis and ROS production were measured in cells incubated with plasma from 73 RA patients and 52 healthy volunteers by fluorimetry. In addition, traditional CV risk factors, inflammatory molecules and disease activity parameters were measured. Cells incubated with plasma from RA patients exhibited reduced NO synthesis and increased ROS production compared to healthy volunteers. Furthermore, the imbalance between NO synthesis and ROS generation in RA patients was not associated with traditional CV risk factors. Our data suggest that ECV-304 cells can be used as a biosensor of systemic inflammation-induced endothelial cell-oxidative stress. We propose that both NO and ROS production are potential biomarkers aimed at improving the current assessment of CV risk in RA.

International audience; To analyse the worldwide occurrence of sicca/Sjögren's (SS) syndrome associated with the use of immune checkpoint inhibitors (ICI) in patients with cancer.METHODS:The ImmunoCancer International Registry (ICIR) is a Big Data-Sharing multidisciplinary network composed by 40 specialists in Rheumatology, Internal Medicine, Immunology and Oncology from 18 countries focused on the clinical and basic research of the immune-related adverse events (irAEs) related to cancer immunotherapies. For this study, patients who were investigated for a clinical suspicion of SS after being exposed to ICI were included.RESULTS:We identified 26 patients (11 women and 15 men, with a mean age at diagnosis of 63.57 years). Underlying cancer included lung (n=12), renal (n=7), melanoma (n=4), and other (n=3) neoplasia. Cancer immunotherapies consisted of monotherapy (77%) and combined regimens (23%). In those patients receiving monotherapy, all patients were treated with PD-1/PD-L1 inhibitors (nivolumab in 9, pembrolizumab in 7 and durvalumab in 4); no cases associated with CTLA-4 inhibitors were identified. The main SS-related features consisted of dry mouth in 25 (96%) patients, dry eye in 17 (65%), abnormal ocular tests in 10/16 (62%) and abnormal oral diagnostic tests in 12/14 (86%) patients. Minor salivary gland biopsy was carried out in 15 patients: histopathological findings consisted of mild chronic sialadenitis in 8 (53%) patients and focal lymphocytic sialadenitis in the remaining 7 (47%); a focus score was measured in 5 of the 6 patients (mean of 1.8, range 1-4). Immunological markers included positive ANA in 13/25 (52%), anti-Ro/ SS-A in 5/25 (20%), RF in 2/22 (9%), anti-La/SS-B in 2/25 (8%), low C3/C4 levels in 1/17 (6%) and positive cryoglobulins in 1/10 (10%). Classification criteria for SS were fulfilled by 10 (62%) out of 16 patients in whom the two key classificatory features were carried out. Among the 26 patients, there were only 3 (11%) who presented exclusively with sicca syndrome without organ-specific autoimmune manifestations. Therapeutic management included measures directed to treat sicca symptoms and therapies against autoimmune-mediated manifestations (glucocorticoids in 42%, second/third-line therapies in 31%); therapeutic response for systemic features was observed in 8/11 (73%). No patient died due to autoimmune involvement.CONCLUSIONS:Patients with Sjögren's syndrome triggered by ICI display a very specific profile different from that reported in idiopathic primary SS, including more frequent occurrence in men, a higher mean age, a predominant immunonegative serological profile, and a notable development of organ-specific autoimmune involvement in spite of the poor immunological profile. The close association found between sicca/Sjögren's syndrome and primarily PD-1 blockade requires further specific investigation.

Although Hispanics of Mexican origin in the United States have been identified as a population with a particularly higher rate of Down syndrome (DS), there is a paucity of studies concerning this topic in Mexico. The aim of this study was to determine the prevalence and risk factors for DS in a population from Western Mexico. For prevalence, 230 liveborn infants with DS were included from a total of 89,332 births occurring during the period 2009-2017 at the Dr. Juan I. Menchaca Civil Hospital of Guadalajara (Mexico). In order to evaluate potential DS risks, a case-control study was conducted among 633 newborns, including those 211 DS patients with full trisomy 21 (cases) and 422 infants without birth defects (controls). Data were analyzed using multivariable logistic regression analysis. The overall prevalence for DS was 25.7 per 10,000 (95% confidence interval [95% CI]: 22.4-29.1). Patients with DS had a significantly higher risk for family history of DS in distant relatives (adjusted odds ratio [aOR] = 4.4, 95% CI: 2.5-7.7), relatives with thyroid disease (aOR = 2.3, 95% CI: 1.2-4.0), maternal age ≤ 19 years (aOR = 5.1, 95% CI: 2.7-9.6) or ≥ 35 years (aOR = 3.3, 95% CI: 1.5-6.9), paternal age ≤ 19 years (aOR = 3.5, 95% CI: 1.7-7.4), pre-pregnancy BMI ≥ 25 kg/m2 (aOR = 1.6, 95% CI: 1.0-2.4), and pre-pregnancy alcohol consumption (aOR = 1.8, 95% CI: 1.1-2.9). The identified risks in family history, and previously mentioned nutritional disadvantages were associated with DS in our sample and probably also to its increased prevalence in our population.

Primary Sjögren syndrome (SjS) is a systemic autoimmune disease that may affect 1 in 1000 people (overwhelmingly women) and that can be a serious disease with excess mortality due to severe organ-specific involvements and the development of B cell lymphoma; systemic involvement clearly marks the disease prognosis, and strongly suggests the need for closer follow-up and more robust therapeutic management. Therapy is established according to the organ involved and severity. As a rule, the management of systemic SjS should be organ-specific, with glucocorticoids and immunosuppressive agents limited to potentially-severe involvements; unfortunately, the limited evidence available for these drugs, together with the potential development of serious adverse events, makes solid therapeutic recommendations difficult. The emergence of biological therapies has increased the therapeutic armamentarium available to treat primary SjS. Biologics currently used in SjS patients are used off-label and are overwhelmingly agents targeting B cells, but the most recent studies are moving on into the evaluation of targeting specific cytokines involved in the SjS pathogenesis. The most recent etiopathogenic advances in SjS are shedding some light in the search for new highly-selective biological therapies without the adverse effects of the standard drugs currently used (corticosteroids and immunosuppressant drugs). This review summarizes the potential pharmacotherapeutic options targeting the main cytokine families involved in the etiopathogenesis of primary SjS and analyzes potential insights for developing new therapies. Fil: Retamozo, Maria Soledad. Laboratory of Autoimmune Diseases Josep Font; España. Hospital Privado Universitario de Córdoba; Argentina. Hospital Clínic de Barcelona; España. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigaciones en Ciencias de la Salud. Universidad Nacional de Córdoba. Instituto de Investigaciones en Ciencias de la Salud; Argentina Fil: Flores Chavez, Alejandra. Laboratory of Autoimmune Diseases Josep Font; España. Mexican Institute for Social Security; México. Universidad de la Colima; México. Hospital Clínic de Barcelona; España Fil: Consuegra Fernández, Marta. Institut D'Investigacions Biomèdiques August Pi I Sunyer; España Fil: Lozano, Francisco. Institut D'Investigacions Biomèdiques August Pi I Sunyer; España. Hospital Clínic de Barcelona; España. Universidad de Barcelona; España Fil: Ramos Casals, Manuel. Laboratory of Autoimmune Diseases Josep Font; España. Universidad de Barcelona; España. Hospital Clínic de Barcelona; España Fil: Brito Zerón, Pilar. Laboratory of Autoimmune Diseases Josep Font; España. Hospital CIMA-Sanitas; España. Hospital Clínic de Barcelona; España

To analyse the clinical features and outcomes of patients presenting with life-threatening systemic disease in a large cohort of Spanish patients with primary Sjögren's syndrome (SS).The GEAS-SS multicentre registry was formed in 2005 with the aim of collecting a large series of Spanish patients with primary SS, and included more than 20 Spanish reference centres with substantial experience in the management of SS patients. By January 2018, the database included 1580 consecutive patients fulfilling the 2002 classification criteria for primary SS. Severe, life-threatening systemic disease was defined as an activity level scored as "high" in at least one ESSDAI domain.Among 1580 patients, 208 (13%) were classified as presenting a severe, potentially life-threatening systemic disease: 193 presented one ESSDAI domain classified as high, 14 presented two high scored domains and only one presented three high activity domains. The ESSDAI domains involved consisted of lymphadenopathy in 78 (37%) cases, CNS in 28 (13%), PNS in 25 (12%), pulmonary in 25 (12%), renal in 21 (10%), cutaneous in 19 (9%), articular in 18 (9%), haematological in 7 (3%) and muscular in 4 (2%). Patients with severe systemic disease were more frequently men (p=0.001) and had a higher frequency of anaemia (p0.001), lymphopenia (p0.001), rheumatoid factor (p=0.021), low C3 levels (p=0.015), low C4 levels (p0.001) and cryoglobulins (p0.001). From a therapeutic point of view, systemic patients received more frequently glucocorticoids (p0.001), immunosuppressants (p0.001), intravenous immunoglobulins (p=0.008) and rituximab (p0.001). We found an overall mortality rate of 20% in severe systemic patients, a rate that reached to 33% in patients presenting two or more high systemic involvements; these patients had a higher frequency of low C4 levels (p=0.012) and cryoglobulins (p=0.001) in comparison with those with a single severe organ involved.13% of patients with primary SS develop a potentially life-threatening systemic disease (mainly lymphoma, but also severe internal organ involvements including nervous system, the lungs and the kidneys). This subset of patients requires intensive therapeutic management with a mortality rate of nearly 20% of cases.

HIV-related stigma has been associated with a reluctance to test for HIV among Latinos. This study assessed community HIV-related stigma within an emerging Latino immigrant receiving city. We conducted a brief survey among a convenience sample of 312 Spanish-speaking Latinos in Baltimore, Maryland. HIV-related stigma was assessed through six items. Associations between stigma items, socio-demographic characteristics, and HIV testing history were considered. Gender, education, and religiosity were significantly associated with stigmatizing HIV-related beliefs. For example, men were 3.4 times more likely to hold more than three stigmatizing beliefs than women, and were also twice as likely as women to report feeling hesitant to test for HIV for fear of people's reaction if the test is positive. These findings can help inform future stigma interventions in this community. In particular, we were able to distinguish between drivers of stigma such as fear and moralistic attitudes, highlighting specific actionable items.

Evans syndrome is characterized by the reduction of at least two blood cell lineages in the absence of other diagnoses; it was previously described as the simultaneous or sequential development of autoimmune hemolytic anemia and immune thrombocytopenia with unknown etiology. An incidence of 37% and mortality rate of 10% were reported for Evans syndrome.We report the clinical presentation and evolution of Evans syndrome in two infants who were initially diagnosed with immune thrombocytopenia. The clinical diagnosis was supported on complementary studies, where hematological disorders were corroborated. Both cases received treatment with steroids and intravenous immunoglobulin.For the management of children with thrombocytopenia, the pediatrician must analyze for other cell lineage disorders. In the cases that we report here, we found the presence of autoimmune hemolytic anemia and monocytosis. Therefore, infectious and immunological studies must be included. The first-line treatment of choice are steroids, and intravenous immunoglobulin can be considered if severe immune thrombocytopenia is associated, as observed in these cases.

We evaluated the association between anti-cyclic citrullinated peptide antibodies (anti-CCP) and anti-mutated citrullinated vimentin antibodies (anti-MCV) with the presence of extra-articular (ExRA) manifestations in 225 patients with rheumatoid arthritis (RA). Ninety-five patients had ExRA and 130 had no ExRA. There was no association of anti-CCP and anti-MCV levels with the presence of ExRA as total group (P=0.40andP=0.91, resp.). Making an analysis of individual manifestations, rheumatoid nodules were associated with positivity for rheumatoid factor (RF); (P=0.01), anti-CCP (P=0.048), and anti-MCV (P=0.02). Instead, RF, anti-CCP, or anti-MCV were not associated with SS, chronic anemia, or peripheral neuropathy. Levels of anti-CCP correlated with the score of the Health Assessment Questionnaire-Disability Index (HAQ-Di) (r=0.154,P=0.03), erythrocyte sedimentation rate (ESR); (r=0.155,P=0.03), and RF (P=0.254,P<0.001), whereas anti-MCV titres only correlated with RF (r=0.169,P=0.02). On adjusted analysis, ExRA was associated with longer age (P=0.015), longer disease duration (P=0.007), higher DAS-28 score (P=0.002), and higher HAQ-DI score (P=0.007), but serum levels of anti-CCP and anti-MCV were not associated. These findings show the need to strengthen the evaluation of the pathogenic mechanisms implied in each specific ExRA manifestation.

Mitral balloon valvuloplasty (MBV) is the therapy of choice for the treatment of symptomatic mitral stenosis with suitable anatomy. Although its short and mid-term results are favorable, there is a paucity of information about long-term follow-up.To assess the late results of MBV.A cohort of 225 patients aged 8 to 20 years who were subjected to a MBV from 1989 to 2001, was studied. All variables at the time of the procedure, short and long-term results and major events during follow-up (new mitral intervention and mortality) were recorded. Uni and multivariate analysis were used to assess prognosis.The mean follow-up lapse was 13.5 years (range 8 to 20 years). During this period, 88 patients (39.1%) remained event-free and in acceptable functional capacity. Eight percent died, 8% required a second MBV and 43.5% required a surgical mitral valve replacement. A post-procedural area equal or greater to 1.9 cm² was associated with a greater likelihood of free-event survival (log rank test: p = 0.02/Cox proportional regression model: coefficient 0.54, p = 0.04).MBV is effective, although there is a high chance of new interventions in the long-term follow-up. A larger post-procedure mitral area is associated with a better prognosis.

Background The Cobra-P drug-eluting stent (DES) system consists of cobalt chromium alloy with bio-absorbable siloxane sol–gel matrix coating that elutes low dose paclitaxel within 6months. The aim of this first-in-man trial was to evaluate the safety and performance of 2 doses of the Cobra-P DES. Methods A total of 60 lesions (54 patients) were sequentially assigned to 2 different paclitaxel doses: group A (3.7μg/18mm, n=30) or group B (8μg/18mm, n=30). The primary endpoint was MACE at 4months defined as cardiac death, myocardial infarction, and target lesion revascularization. Results Patient and lesion characteristics were matched between the 2 groups except for male sex. MACE at 4months was 3.3% and 0% respectively ( P =1.000) and at 1-year follow-up remained unchanged. In-stent late loss at 4months was similar in both groups (0.36±0.30mm and 0.34±0.20mm P =.773). Conclusions In this FIM study, implantation of the Cobra-P low dose paclitaxel-eluting stent with a bioabsorbable sol–gel coating was proven to be feasible and safe. Moderate neointimal proliferation was observed as well as an acceptable MACE rate up to 1year.

Objective. To evaluate the association of -174G/CIL-6polymorphism with failure in therapeutic response to methotrexate (MTX) or leflunomide (LEF). This prospective, observational cohort included 96 Mexican-Mestizo patients with moderate or severe rheumatoid arthritis (RA), initiating MTX or LEF, genotyped forIL-6-174G/C polymorphism by PCR-RFLP. Therapeutic response was strictly defined: only if patients achieved remission or low disease activity (DAS-28 < 3.2).Results. Patients with MTX or LEF had significant decrement in DAS-28 (p<0.001); nevertheless, only 14% and 12.5% achieved DAS-28 < 3.2 at 3 and 6 months. After 6 months with any of these drugs the -174G/G genotype carriers (56%) had higher risk of therapeutic failure compared with GC (RR: 1.19, 95% CI: 1.07–1.56). By analyzing each drug separately, after 6 months with LEF, GG genotype confers higher risk of therapeutic failure than GC (RR = 1.56; 95% CI = 1.05–2.3;p=0.003), or CC (RR = 1.83; 95% CI = 1.07–3.14;p=0.001). This risk was also observed in the dominant model (RR = 1.33; 95% CI = 1.03–1.72;p=0.02). Instead, in patients receiving MTX no genotype was predictor of therapeutic failure. We concluded thatIL-6-174G/G genotype confers higher risk of failure in therapeutic response to LEF in Mexicans and if confirmed in other populations this can be used as promissory genetic marker to differentiate risk of therapeutic failure to LEF.