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Introduction: The increasing cancer incidence and mortality rates in Costa Rica have become a public health concern, with prostate, breast, and colorectal cancers being the most prevalent. This study aimed to analyze the trends in cancer incidence and mortality rates by tumor type, sex, age group, and geographic region using data from the Costa Rican National Cancer Registry. Methods: In this retrospective study, we analyzed cancer incidence and mortality anonymized data from the Costa Rican National Cancer Registry between 2010 and 2020. The study included data on cancer cases diagnosed and deaths attributable to cancer within the population. Results: Our findings revealed variations in cancer incidence and mortality rates based on geographic region, age group, and tumor type. Cancer was most predominant in the province of San Jose, followed by Alajuela, Heredia, Cartago, Guanacaste, and Puntarenas. Breast cancer, colorectal cancer, and prostate cancer were the leading causes of cancer in both sexes. Mortality rates due to gastric cancer and prostate cancer were highest among men, while breast cancer was the leading cause of cancer mortality among women. Conclusion: The results of this study underscore the need for targeted prevention and screening programs, improved access to treatment for patients living in rural areas, and a comprehensive cancer control program in Costa Rica. By implementing evidence-based interventions, such as tobacco control programs, cancer screening initiatives, and equitable access to cancer treatment, the cancer burden in Costa Rica can be mitigated, ultimately improving the overall health of the population.

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Coralsnakes of the genus Micrurus are a diverse group of venomous snakes ranging from the southern United States to southern South America. Much uncertainty remains over the genus diversity, and understanding Micrurus systematics is of medical importance. In particular, the widespread Micrurus nigrocinctus spans from Mexico throughout Central America and into Colombia, with a number of described subspecies. This study provides new insights into the phylogenetic relationships within M. nigrocinctus by examining sequence data from a broad sampling of specimens from Mexico, Guatemala, Honduras, Nicaragua, Costa Rica, and Panama. The recovered phylogenetic relationships suggest that M. nigrocinctus is a species complex originating in the Pliocene and composed of at least three distinct species-level lineages. In addition, recovery of highly divergent clades supports the elevation of some currently recognized subspecies to the full species rank while others may require synonymization.

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We examine, for the first time, biogeographic patterns in a series of tropical montane coastal systems in northern South America. We use amphibians and reptiles, which constitute the most critical communities based upon the prevalence of endemic taxa, to assess the region's biodiversity. The montane coastal system spans an east-west distance of 925 km. It includes peaks ranging from 549 m to 2765 m above sea level and encompasses the montane complexes of northern Venezuela (including Isla de Margarita), an outlier at Santa Marta (Colombia), and ranges on the islands Trinidad and Tobago. The area supports 14 family level amphibian clades and 23 family level reptile clades. Fieldwork, museum specimen surveys, and a literature review suggest that biodiversity decreases at higher elevations. Here we examine the biogeographic patterns in the region to assess the role of the montane systems as possible refugia. We also look at the possible island and sky island effects using data from altitudes >200 m. At lower elevations, we tabulated 294 species, comprising 112 amphibians and 182 reptiles. About 45% of these taxa are endemic or exclusive to different sub-regions. At mid-elevation montane cloud forests, we find a much-reduced biodiversity with a total of 125 species (66 amphibians and 59 reptiles) exclusive or restricted to the region, and few species shared between systems. We find that biogeographical patterns follow a natural topographic disposition above 200 m in elevations. At the lower elevation cut off, there are 118 species (26 amphibians and 92 reptiles) shared among two or more of the studied mountain systems, suggesting a common origin and dispersal events, despite what seem to be topographic barriers. Biogeographical relationships support a topographic disposition of the region with close associations between the islands of Trinidad and Tobago, the Paria Range and the Turimiquire Massif, and close associations between the Sierra Nevada de Santa Marta and the Sierra de San Luis. Overall, the biogeographic relationships between amphibians and reptiles are similar. Species diversity in the eastern Caribbean region is less rich than in the west. This study includes the first herpetological surveys at the two easternmost mountains (Cerro La Cerbatana and Campeare) belonging to the Paria Range biogeographic unit, and aims to contribute to a better understanding of the rich biodiversity of the region.

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Severe congenital neutropenia type 4 (SCN-4) is an autosomal recessive condition in which mutations in the G6PC3 gene encoding for the catalytic 3 subunit of glucose-6-phosphatase-ß result in neutropenia, neutrophil dysfunction, and other syndromic features. We report a child with SCN-4 caused by compound heterozygous mutations in G6PC3, a previously identified missense mutation in exon 6 (c.758G>A[p.R235H]), and a novel missense mutation in exon 2 (c.325G>A[p.G109S]). The patient had recurrent bacterial infections, inflammatory bowel disease, neutropenia, and intermittent thrombocytopenia. Administration of granulocyte colony-stimulating factor (G-CSF) resolved the neutropenia and allowed for detailed evaluation of human neutrophil function. Random and directed migration by the patient's neutrophils was severely diminished. Associated with this were defects in CD11b expression and F-actin assembly. Bactericidal activity at bacteria/neutrophil ratios >1:1 was also diminished and was associated with attenuated ingestion. Superoxide anion generation was <25% of control values, but phox proteins appeared quantitatively normal. Extensive metabolomics analysis at steady state and upon incubation with stable isotope-labeled tracers (U-13C-glucose, 13C,15N-glutamine, and U-13C-fructose) demonstrated dramatic impairments in early glycolysis (hexose phosphate levels), hexosemonophosphate shunt (required for the generation of the NADPH), and the total adenylate pool, which could explain the dramatic cell dysfunction displayed by the patient's neutrophils. Preliminary experiments with fructose supplementation to bypass the enzyme block demonstrated that the metabolic profile could be reversed, but was not sustained long enough for functional improvement. In human deficiency of G6PC3, metabolic defects resulting from the enzyme deficiency account for diverse neutrophil functional defects and present a major risk of infection.

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CONTEXT: Partner services are a broad array of services that should be offered to persons with human immunodeficiency virus (HIV) and that are based on a process through which HIV-infected persons are interviewed to elicit information about their sex and needle-sharing partners. Human immunodeficiency virus testing of partners can result in a high yield of newly diagnosed HIV positivity, but despite this yield and the benefits of partners knowing their exposures and HIV status, partner services are often not conducted. OBJECTIVE: We sought to determine the newly diagnosed HIV positivity and benefits to 2 health departments that conducted demonstration projects that focused on statewide HIV partner services. DESIGN: The main sources of information used for this case study analysis included the health department funding applications, progress reports and final reports submitted to the Centers for Disease Control and Prevention, and records of communications between Centers for Disease Control and Prevention and the health departments. Required quantitative reporting included the number of partners tested and the number of partners with newly diagnosed confirmed HIV infection. Required qualitative reporting included how health departments benefited from their demonstration project activities. SETTING: Hawaii and New Mexico. PARTICIPANTS: Sex and needle-sharing partners of persons who were newly diagnosed with HIV infection. INTERVENTION: The use of HIV surveillance data to initiate statewide HIV partner services. MAIN OUTCOME MEASURE: Newly diagnosed HIV positivity. RESULTS: During 2012-2015, the newly diagnosed HIV positivity among partners was 18% (78/427): 16% (17/108) in Hawaii and 19% (61/319) in New Mexico. The health departments benefited from improved collaborations among HIV prevention program and surveillance staff and among the health departments, providers, and AIDS service organizations. CONCLUSIONS: Hawaii and New Mexico each achieved a high newly diagnosed HIV positivity and benefited from improved local collaborations. As a result of the success of these projects, both health departments have continued the activities since the end of category C funding by securing alternative funding sources.

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Tegus of the genera Tupinambis and Salvator are the largest Neotropical lizards and the most exploited clade of Neotropical reptiles. For three decades more than 34 million tegu skins were in trade, about 1.02 million per year. The genus Tupinambis is distributed in South America east of the Andes, and currently contains four recognized species, three of which are found only in Brazil. However, the type species of the genus, T. teguixin, is known from Bolivia, Brazil, Colombia, Ecuador, French Guyana, Guyana, Peru, Suriname, Trinidad and Tobago, and Venezuela (including the Isla de Margarita). Here we present molecular and morphological evidence that this species is genetically divergent across its range and identify four distinct clades some of which are sympatric. The occurrence of cryptic sympatric species undoubtedly exacerbated the nomenclatural problems of the past. We discuss the species supported by molecular and morphological evidence and increase the number of species in the genus Tupinambis to seven. The four members of the T. teguixin group continue to be confused with Salvator merianae, despite having a distinctly different morphology and reproductive mode. All members of the genus Tupinambis are CITES Appendix II. Yet, they continue to be heavily exploited, under studied, and confused in the minds of the public, conservationists, and scientists.

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Community-based projects have become popular as a method to address various community problems. Specifically important is that community members take an active role in these interventions resulting in sustainable social change. Although considerable literature exists on the dynamics of small group interaction, this article addresses how group processes differ in community-based projects. Instead of constructing a static model for group interaction, this discussion focuses on experiences from a recent community-based health project on the island of Grenada. Because community-based projects are directed by a diverse group of community members, maturity is described as a process of negotiation rather than consensus.

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OBJECTIVE: To assess the association between serum 25-hydroxyvitamin D (25OHD) levels and outcomes in preterm infants (<32 weeks gestation). STUDY DESIGN: Serum 25OHD was measured in mothers and their infants within 24 hours of birth, before the start of enteral vitamin D supplementation, and at discharge from the neonatal intensive care unit. We evaluated the associations between vitamin D status and various early preterm outcomes. RESULTS: Ninety-four preterm infants and their mothers were included; 92% of the infants had a 25OHD level≤50 nmol/L (20 ng/mL), and 64% had a 25OHD level<30 nmol/L (12 ng/mL). A low 25OHD level (<30 nmol/L) in preterm infants at birth was associated with increased oxygen requirement (P=.008), increased duration of intermittent positive-pressure ventilation during resuscitation at delivery (P=.032), and greater need for assisted ventilation (P=.013). CONCLUSION: We observed a high prevalence of low 25OHD (<30 nmol/L), and found an association between vitamin D status and acute respiratory morbidity in preterm infants after birth.

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The presence of Hyalinobatrachium orientale in Tobago and in northeastern Venezuela is puzzling as this species is unknown from the island of Trinidad, an island often hypothesized to be a stepping-stone for the mainland fauna to colonize Tobago. A period of extended isolation on Tobago could result in the Hyalinobatrachium population becoming distinct from the mainland H. orientale. Here, we use 12S and 16S rDNA gene fragments from nine H. orientale specimens from Tobago and the mainland to assess their relationship and taxonomy, as well as the tempo and mode of speciation. The results suggest H. orientale from Venezuela and Tobago are monophyletic and the two populations diverged about 3 million years ago. This estimate corresponds with the drier climate and lower sea levels of the Pliocene glaciation periods. We hypothesize that lower sea levels resulted in land-bridge formations connecting the mainland and Tobago, with a corridor of habitat allowing H. orientale to colonize Tobago to the west of Trinidad.

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Currently, two snake species of the genus Leptophis occur in Trinidad and Tobago. One, L. stimsoni, is endemic to Trinidad's Northern Range and known from relatively few specimens. The second is the diurnal, arboreal, brightly colored parrot snake Leptophis coeruleodorsus Oliver. It was originally described based on 23 specimens from Trinidad, Tobago, and four locations in northern Venezuela but remains poorly known. It was later assigned as a subspecies of Leptophis ahaetulla; a widespread, polytypic species. Here we compare 11 specimens of the L. ahaetulla Group using DNA sequences from two mitochondrial genes (cytochrome b and 16S, 1,383 bp total) from island and mainland populations, report on the variation in the morphology of 54 museum specimens of Leptophis a. coeruleodorsus; describe the previously undescribed holotype of L. coeruleodorsus Oliver, and restrict its type locality. Additionally, we describe a new species of Leptophis from the island of Tobago that can be distinguished from L. coeruleodorsus on the basis of snout shape, upper labial architecture, elongated prefrontal scales, and ventral scale counts. The new Leptophis raises the number of endemic Tobago amphibians and reptiles to 11 taxa.

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Using the Las Mercedes Project as an example, the aim of this article is to discuss the philosophy and practice of community-based projects. At the core of such projects is a shift in understanding the nature of community. A community, in this case, represents a reality that persons construct that determines the character of rules, norms, and the focus and style of interventions. Additionally, community-based organizations, such as the Las Mercedes Project, are fully participatory, decentered, and carry the imprint of a community's members. Community-based projects, in this regard, improve the likelihood of creating successful interventions.

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In a qualitative study of urban Trinidadians who work in the medical industry, the concept of medical globalization was provisionally analysed. Two research questions were addressed: what is globalization, in the context of mainstream medicine, and how is this process manifested in everyday practices? Four fundamental principles of medical globalization emerged from in-depth interviews and analysis of observational materials: (1) the notion of history as an autonomous force with globalization as the latest stage, (2) the expansion of 'Total Market' philosophy as a driving social force, (3) the fragmentation of society into atomistic, self-interested, and competitive individuals, and (4) the adoption of a 'centralised' set of ideals as the normative core necessary for social order. In this paper, findings from this investigation and their implications are discussed. In particular, medical globalization is linked with major themes in medical sociological theory including dualism and medicalization.

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OBJECTIVES: To evaluate the research-related coursework and research experiences in doctor of pharmacy programs and compare the findings to those of 2 previous studies. METHODS: A questionnaire was mailed to 88 colleges and schools of pharmacy in the United States and Puerto Rico. The survey instrument sought information on formal research-related coursework; required and elective research experiences; and perceptions of student-conducted research. RESULTS: Seventy-nine colleges and schools completed the questionnaire for a response rate of 88%. Most colleges (>90%) required students to study/complete courses in biostatistics and drug information/literature evaluation; approximately half required research methods coursework. Twenty-five percent required some form of project and requirements were not influenced by class size. Students could often work in teams to complete projects. Respondents generally thought participation in research had some value for motivated students. CONCLUSIONS: This study demonstrates the variability in extent of research-related coursework and research experiences in PharmD programs across the country.

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Introducción: La incidencia de taquicardias auriculares (TA) luego de la operación de Fontan es alta. El acceso a la aurícula pulmonar (AuP) requiere de una punción transeptal o acceso aórtico retrógrado. Se presentan resultados iniciales con una técnica percutánea que permite el acceso a la AuP para mapeo y ablación por radiofrecuencia (ARF). Métodos: Seis EEF con mapeo 3D electroanatómico (CARTO) y ARF se efectuaron en 5 pacientes (1.2 a 17 años). Todos tenían un Fontan (túnel lateral) y TA. Vía transtoráxica se posicionó en la AuP un catéter Navistar para mapeo, estimulación y ARF. Se indujo TA con estimulación programada e isoproterenol. La secuencia de activación, áreas de bloqueo eléctrico y anatómico, y la ubicación del electrograma de His fueron definidas con mapeo 3D electroanatómico. Las zonas de interés fueron estudiadas con técnicas de “entrainment”. Luego de la ARF, el éxito se definió como la imposibilidad de reinducir TA. Resultados: Se encontró taquicardia por reentrada auricular en 5 casos y taquicardia ectópica en uno. La ARF fue exitosa en todos ellos. Hubo 1 pneumotórax y hemotórax en dos casos. En un paciente se observó recurrencia de la TA a los 3 meses, que requirió una segunda ARF, sin nueva recidiva. Ningún paciente esta recibiendo tratamiento antiarrítmico. Resumen: El acceso transtorácico percutáneo a la AuP parece apropiado para mapear y tratar las taquicardias auriculares en pacientes con cirugía de Fontan.

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