Faculty Bibliography

BACKGROUND:Food insecurity related to immigration status remains largely underexplored. This study examined trends and disparities in household food insecurity by immigration status in the United States (US). METHODS:We analyzed data from 427,942 households from the US Current Population Survey Food Security Supplement from 2011 to 2021. Immigration status categories included recent immigrants (< 5 years), long-term immigrants (≥ 5 years), naturalized citizens, and US-born citizens. Food insecurity was assessed using validated questions on consistent access to enough food for an active and healthy life. RESULTS:From 2011 to 2021, food insecurity prevalence declined from 14.9 % (95 % CI, 14.5 %-15.3 %) to 10.2 % (95 % CI, 9.8 %-10.6 %). Among recent immigrants, prevalence decreased from 25.2 % (95 % CI, 23.1-27.4) in 2011 to 15.0 % (95 % CI, 12.8 %-17.2 %) in 2019, then increased to 17.7 % (95 % CI, 14.7 %-20.2 %) in 2020 and 17.4 % (95 % CI, 14.7 %-20.2 %) in 2021. Long-term immigrants' prevalence dropped from 20.4 % (95 % CI, 16.9 %-24.0 %) in 2011 to 10.2 % (95 % CI, 7.2 %-13.1 %) in 2018, then increased to 17.7 % (95 % CI, 13.7 %-21.7 %) in 2021. Naturalized citizens' prevalence decreased from 14.4 % (95 % CI, 12.9 %-15.9 %) to 9.5 % (95 % CI, 8.2 %-10.9 %). US-born citizens' prevalence decreased from 14.2 % (95 % CI, 13.8 %-14.6 %) to 9.7 % (95 % CI, 9.3 %-10.2 %). Compared to the US-born citizens, the adjusted prevalence ratio was 1.63 (95 % CI,1.57-1.69) for recent immigrants, 1.22 (95 % CI, 1.13-1.31) for long-term immigrants, and 0.94 (95 % CI, 0.90-0.98) for naturalized citizens. Significant disparities exist in subgroups. CONCLUSIONS:The findings provide insights for stakeholders to address food insecurity among vulnerable immigrant groups in the US.

INTRODUCTION/BACKGROUND:Discrimination in medical settings (DMS) contributes to health care disparities in the United States, but few studies have determined the extent of DMS in a large national sample and across different populations. This study estimated the national prevalence of DMS and described demographic and health-related characteristics associated with experiencing DMS in seven different situations. METHODS:Survey data from 41,875 adults participating in the All of Us Research Program collected in 2021-2022 and logistic regression were used to examine the association between sociodemographic and health-related characteristics and self-reported DMS among adults engaged with a health care provider within the past 12 months. Statistical analysis was performed in 2023-2024. RESULTS:About 36.89% of adults reported having experienced at least one DMS situation. Adults with relative social and medical disadvantages had higher prevalence of experiencing DMS. Compared to their counterparts, respondents with higher odds of experiencing DMS in at least one situation identified as female, non-Hispanic Black, having at least some college, living in the South, renter, having other living arrangement, being publicly insured, not having a usual source of care, having multiple chronic conditions, having any disability, and reporting fair or poor health, p<0.05. CONCLUSIONS:The findings indicate a high prevalence of DMS, particularly among some population groups. Characterizing DMS may be a valuable tool for identifying populations at risk within the health care system and optimizing the overall patient care experience. Implementing relevant policies remains an essential strategy for mitigating the prevalence of DMS and reducing health care disparities.

Traumatic abdominal wall hernia (TAWH) is a protrusion of contents through a defect in the abdominal wall as a consequence of a blunt injury. The objective of this review was to describe demographic and clinical aspects of this rare pathology, identifying the optimal moment for surgical intervention, evaluating the need to use mesh, and analyzing the effectiveness of surgical treatment. Thus, a systematic review using PubMed, Embase, and Scopus databases was carried out between January 2004 and March 2024. Computed tomography is the gold-standard imaging test for diagnosis. Open surgery is generally the preferred approach, particularly in emergencies. Acute TAWH can be treated by primary suture or mesh repair, depending on local conditions, while late cases usually require mesh.

SARS-CoV-2 infection during pregnancy has severe consequences on maternal and neonatal health. Presently, vaccination stands as a critical preventive measure for mitigating infection-related risks. Although the initial clinical trials for the COVID-19 vaccines excluded pregnant women, subsequent investigations have indicated mRNA vaccinations' effectiveness and short-term safety during pregnancy. However, there is a lack of information regarding the potential biodistribution of the vaccine mRNA during pregnancy and lactation. Recent findings indicate that COVID-19 vaccine mRNA has been detected in breast milk, suggesting that its presence is not confined to the injection site and raises the possibility of similar distribution to the placenta and the fetus. Furthermore, the potential effects and responses of the placenta and fetus to the vaccine mRNA are still unknown. While potential risks might exist with the exposure of the placenta and fetus to the COVID-19 mRNA vaccine, the application of mRNA therapies for maternal and fetal conditions offers a groundbreaking prospect. Future research should leverage the unique opportunity provided by the first-ever application of mRNA vaccines in humans to understand their biodistribution and impact on the placenta and fetus in pregnant women. Such insights could substantially advance the development of safer and more effective future mRNA-based therapies during pregnancy.

Treatment of anastomotic ulcers, also known as marginal ulcers, is challenging, especially when established techniques have failed. PuraStat is a biocompatible synthetic peptide gel that is indicated for hemostasis of bleeding in the gastrointestinal tract and vascular anastomoses. We aim to evaluate the feasibility of PuraStat in the setting of nonhealing anastomotic ulcers when used alongside standard therapies. This is a multicenter case series of adult patients who had PuraStat applied with a follow-up repeat endoscopy. Nine out of 10 patients showed clinical improvement. We concluded that PuraStat is an effective agent to aid in healing of anastomotic ulcer.

BACKGROUND:Open Hartmann's procedure has traditionally been the procedure of choice to treat complicated diverticulitis. We analyzed the ACS-NSQIP database to compare outcomes in patients who underwent emergent laparoscopic Hartmann's procedure (LHP) to those who had an open Hartmann's procedure (OHP). STUDY DESIGN/METHODS:Data analyzed from 2015 to 2019 using ICD-10 codes. Patients were matched on several important covariates using a propensity score matching method (PSM). Patients were matched in a 4:1 ratio of controls to cases based on the propensity score. RESULTS:We identified 5026, of which 456 had LHP and 4570 had OHP. PSM analysis yielded 369 LHP and 1476 OHP patients. LHP had lower rates of superficial surgical site infection (SSSI) compared to OHP (2.44% vs. 5.89%, p = 0.007). LHP had similar post-operative outcomes compared to OHP, including 30-day mortality (5.15% vs. 2.98%, p = 0.060), organ space surgical site infection (OSSSI) (14.36% vs. 12.60%, p = 0.161), wound disruption (1.36% vs. 2.44%, p = 0.349), median LOS (8 vs. 9 days, p = 0.252), readmission within 30 days (11.92% vs. 8.67%, p = 0.176), rate of reoperation (6.0 vs. 6.5%, p = 0.897), and discharge to home (76% vs. 77%, p = 0.992). LHP had longer operative times compared to OHP (median 129 vs. 118 min, p < 0.0001). CONCLUSION/CONCLUSIONS:The LHP is associated with lower rates of SSSI. However, it is not associated with lower rates of mortality, OSSSI, readmissions and reoperations within 30 days. Surgical times are longer in LHP. More studies are needed to determine whether LHP offers advantages in the long-term, particularly in rates of incisional hernia and colostomy closure.

This study presents two cases of lipid-rich pancreatic neuroendocrine tumors (PanNETs), a rare variant posing significant diagnostic challenges in fine needle aspiration (FNA) cytology and small biopsies. The first case involves an elderly male with a pancreatic tumor, displaying distinct cytoplasmic vacuoles, while the second case is a middle-aged male present with a pancreatic tail mass exhibiting foamy cytoplasm and eccentric nuclei, infiltrating in the stroma. Both cases did not exhibit typical morphologic features of PanNET but demonstrated cytomorphologic features and infiltrative growth patterns that mimicked adenocarcinoma. Further work-up demonstrated that both tumors were immunoreactive for synaptophysin and chromogranin, and were interpreted as well-differentiated, PanNET, lipid-rich variant. The study highlights the overlapping morphological features between lipid-rich PanNETs and other pancreatic neoplasms and underscores the importance of comprehensive cytological and immunohistochemical analysis for accurately diagnosing this variant, particularly due to the risk of misinterpreting it as pancreatic adenocarcinoma. Recognizing lipid-rich PanNETs is crucial for appropriate clinical management, as their identification can significantly impact treatment decisions and patient outcomes.