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Colorectal cancer is the second most common cause of cancer death in both men and women. Although the overall incidence and mortality rates of colorectal cancer are declining, African Americans have significantly higher rates of colorectal cancer than Caucasians, and they have worse 5-year survival rates. This article reviews some of the contributing factors that lead to this racial disparity in colorectal cancer between these groups. The increase in poor health outcomes among African Americans is due to low socioeconomic standing, poor compliance, psychosocial barriers, and patient mistrust of healthcare providers and the healthcare system. Research on interventions to improve health outcomes is important to reduce the causes of these disparities. Keywords: colorectal cancer; screening; African Americans; Blacks; health disparities; interventions; public health

Background: Since the Severe Acute Respiratory Syndrome Coronavirus-2 was discovered in December 2019, there have been tireless efforts by the medical and scientific community to understand its pathophysiology, treatment, and prevention. Discussion: In the last several months, several therapeutic treatments, including a corticosteroid, antiviral drugs, convalescent plasma, and several others, have been tried in the treatment of SARS-CoV-2 with varying results. Pfizer and Moderna COVID-19 vaccines recently received approval for Emergency Use Authorization. Although COVID-19 vaccine is the first hurdle in an attempt to control the pandemic, the following challenges still remain: adequate vaccine doses, issues with mass distribution, global access, proper storage, and sufficient vaccine compliance. Summary: Vaccination, in addition to social distancing and wearing facemasks, will likely provide the best way to control the COVID pandemic. Healthcare professionals and government officials will need to address any concern or hesitancy the community has with the COVID vaccine to promote compliance. Keywords: coronavirus therapeutics, herd immunity, coronavirus vaccine, vaccine targets, clinical trials

Due to its rapid spread, the World Health Organization characterized coronavirus disease 2019 (COVID-19) as a pandemic on March 11, 2020. Coronaviruses cause a variety of respiratory diseases, ranging from the mild common cold to the lethal Middle East Respiratory Syndrome. At the end of 2019, COVID-19 made its way onto the global stage due to its rapid human-to-human transmission and its ability to cause death secondary to respiratory failure. Symptoms of lower respiratory illness, including cough and shortness of breath, along with fever, should raise suspicion of COVID-19 infection in those who have recently traveled to high-risk areas or have had close contact with a confirmed or suspected case of COVID-19. Other symptoms include gastrointestinal distress and cardiac involvement. Polymerase chain reaction testing of respiratory specimens and computed tomographic scans of the chest can be used to confirm the disease. Preventing exposure to the disease through handwashing, surface disinfection, and avoiding contact with those who are sick is the best way to prevent transmission of the disease. Many countries and local governments have implemented stayat-home orders to decrease the rapid spread of COVID-19. Management of the disease involves symptom control, as there is currently no available treatment, but many clinical trials are underway. Global health efforts have concentrated on quick and aggressive actions to slow the transmission of the disease and identify cases as quickly as possible but with varying degrees of success.

Multiple pulmonary pathologies have been associated with elevated levels of Immunoglobulin E (IgE). Since its discovery in 1966, its role in multiple diseases has become clearer. This has allowed for the emergence of new medications that target IgE. In this review, we will summarize some of the most common pulmonary pathologies in which IgE has a role in their etiology.

Heparin, one of the world’s oldest anticoagulation medications, accelerates the rate ofinhibition of previously activated clotting factors. It is most often used in the prophylaxis andtreatment of thromboembolic disorders and complications associated with atrial fibrillation.The two most common ways to monitor plasma heparin levels and anticoagulation therapyare the activated partial thromboplastin time (aPTT) and anti-factor Xa assay (anti-Xa). Thisarticle assesses the performance of aPTT and anti-Xa monitoring protocols and analyzes thediscordance between aPTT and anti-Xa levels and its clinical implications in patients receivingintravenous heparin therapy.

Immunoglobulin E (IgE) was the last immunoglobulin to be discovered, possibly secondaryto its low levels in plasma. Following extensive investigation, its role in the pathogenesis ofseveral diseases, most notably atopic conditions, has become evident. The immunologicpathways related to its synthesis and relation to effector cells is becoming more lucid. This hasallowed for the emergence of new medications that target different steps in its activity. In thisreview, we will summarize some of the most common systemic pathologies in which IgE hasa role in their etiology.

Background: There have been varying reports on the prevalence of antineutrophil cytoplasmic antibodies with bactericidal/permeability-increasing protein (BPI-ANCA) specificity in cystic fibrosis (CF) patients. These autoantibodies are believed to develop in response to infection and colonization, especially with Pseudomonas aeruginosa. The aim of this review was to estimate the overall prevalence of BPI-ANCA in CF patients. Methods: We searched PubMed, Scopus, and Embase databases for studies reporting the prevalence of BPI-ANCA in CF patients. We also searched the Journal of Cystic Fibrosis and our institution's library for relevant studies on BPI-ANCA. We calculated the proportion with a 95% confidence interval (CI) to assess the prevalence of BPI-ANCA in the individual studies and then pooled the results using a random effects model. Publication bias was assessed using graphical and statistical methods. Finally, we assessed statistical heterogeneity using the I(2) test. Results: Our search yielded 12 eligible studies published between 1996 and 2015. The prevalence of BPI-ANCA in patients with CF varied from 17.9% to 83% with a pooled prevalence of 49.45% (95% CI 35.53–63.42). No evidence of bias was found. However, there was evidence of statistically significant variation in the prevalence estimate due to heterogeneity (I(2) = 93.4%, P

COVID-19 vaccination related adverse events is an evolving field. Here we present a case of acute myocardial injury that developed as a result of an acute immune response following the second dose of COVID-19 vaccination (Moderna) in a 67-year-old man who presented in acute congestive heart failure. His clinical course improved over 3 days. Review of the Vaccine Adverse Events Reporting System (VAERS) in the Centers for Disease Control and Prevention websites identified 37 vaccine recipients who developed myocarditis as an adverse event following COVID-19 vaccination. With the mass expansion of COVID-19 vaccine administration, physicians need to be vigilant about the possibility of new adverse events.

Background: The ongoing coronavirus disease (COVID-19) pandemic has a major impact on first responders. Scarce personal protective equipment (PPE) has forced them to conserve and reuse some of their PPE. The efficacy of these practices in preventing transmission of COVID-19 from patients to first responders is unclear. There are limited data on the prevalence of antibodies specific for COVID-19 exposure in these front-line workers. Aim: Our objective was to determine the prevalence of positive immunoglobulin G antibody specific to COVID-19 among first responders in Lubbock, Texas. Methods: Blood samples were collected on 683 asymptomatic first responders who work in Lubbock, Texas and the surrounding area, after informed consents were signed. IgG antibody to SARS-CoV-2 was measured using Abbott’s SARS-CoV-2 IgG Reagent Kit in combination with the SARS-CoV-2 IgG Calibrator Kit on the Abbott’s ARCHITECT i1000SR analyzer. Results: The prevalence of IgG specific antibodies to COVID-19 was 0.73%, five of the 683 participants tested positive. Four of those who tested positive had no known prior SARS-CoV-2 infection or exposure without adequate PPE. Conclusions: The prevalence of IgG specific antibodies to COVID-19 was much lower than expected in our study population despite high sensitivity and specificity of the test reagent. The most likely explanations for this finding include limited exposure, inadequate time for a IgG response, possible clearance of COVID-19 infection locally by the respiratory tract IgA defense system without eliciting a systemic IgG response, and short persistence of IgG antibodies in mild or asymptomatic cases.

Patients in acute care hospitals are often transferred to long-term care (LTC) when there is an expectation for a lengthy recovery. Prolonged non-thyroidal illness syndrome (NTIS) creates a state of hypothyroidism. We aimed to investigate the prevalence of NTIS in patients at LTC facilities. A cross-sectional study at University Hospitals and Rehabilitation and Skilled Nursing facility was performed. Four groups: control (n:33), intensive care unit (ICU) (n:34), long-term care hospital (LTCH) (n:50), and long-term care on chronic ventilatory support (LTCVS) (n:30). Serum levels of TSH, free T4 (FT4), free T3 (FT3), and interleukin 6 (IL6) measured at admission day in controls, within 48 h of admission in the intensive care group, between days 31 and 120 in the LTC hospital group and days 31 and 6 years in the LTC on chronic ventilatory support group. Serum FT3 levels were lower in groups intensive care unit ICU, LTCH, and LTCVS than control. Low serum FT3 levels were observed in 80% ICU, 54% LTCH, 37% LTCVS, and 6% control patients. Low serum FT4 levels were observed in 32% ICU, 16% LTCH, and 20% LTCVS patients. Both low serum FT4 and FT3 levels were observed in 32% ICU, 16% LTCH, and 13% LTCVS patients. Serum IL6 and FT3 levels showed a negative correlation. NTIS is highly prevalent in patients in LTC, creating a state of persistent hypothyroidism. The effects of thyroid hormone replacement in patients at LTC with non-thyroidal illness deserve further investigation.

Background: With the rising cost of ICU care and concerns about vasopressor associated complications, clinicians need oral medications that can hasten recovery from septic shock in patients requiring low dose IV vasopressors.Methods: We retrieved all the available studies published on PubMed and Embase (until September 2018) that reported the use of midodrine in septic shock.Results: Levine et al reported a decrease in the intravenous vasopressor infusion rate from -0.62 ± 1.40 mcg/min per hour before midodrine to -2.20 ± 2.45 mcg/min per hour after the first four doses of midodrine (P = 0.012). Whitson et al reported a two-day decrease in mean ICU length of stay when midodrine was used with IV vasopressors (P = 0.017).Conclusions: Midodrine may have the potential to hasten vasopressor weaning in patients recovering from septic shock, but there are limited published data available to support its use in these patients.

Takotsubo cardiomyopathy is a transient cardiomyopathy predominantly characterized byleft ventricular hypokinesis and wall motion abnormalities, usually apical ballooning during thesystolic phase of heart contraction. The clinical presentation may closely mimic acute coronarysyndrome. The majority of the cases are diagnosed in post-menopausal Caucasian women.The exact mechanism of takotsubo cardiomyopathy is unknown. To avoid complications andmortality, early diagnosis and treatment are important.

Acute necrotizing esophagitis, also known as “black esophagus,” is typically characterized by a circumferential, friable black mucosal surface and preferentially involves the distal esophagus. It predominantly affects elderly men and presents as an upper gastrointestinal bleed. We describe a 60-year-old man with an acute upper gastrointestinal bleed and sepsis and subsequently acute necrotizing esophagitis.

Super-refractory status epilepticus is a rare medical and neurological emergency due to the high mortality and morbidity associated with this condition. Furthermore, there is very little data regarding its incidence, etiology, and management in the pregnant population with super-refractory status epilepticus. The treatment of super-refractory status epilepticus during pregnancy is specifically a major challenge as there are limited available therapeutic options due to the well-established teratogenicity of most antiepileptic drugs and the unknown safety profile of some of the anesthetics commonly used for seizure control. We report a case of successfully treated super-refractory status epilepticus in a 29-year-old, 26 weeks pregnant female who after an emergent delivery and prolonged exposure to multiple antiepileptic drugs recovered full neurological function.

INTRODUCTION: The ongoing coronavirus disease (COVID-19) pandemic has a major impact on frontline health care workers Scarce personal protective equipment (PPE) has forced hospitals to conserve and reuse some of their PPE The efficacy of these practices in preventing transmission of COVID-19 from patients to health care workers is unclear There are limited data on the prevalence of antibodies specific for COVID-19 exposure among health care workers Our objective was to determine the prevalence of positive immunoglobulin G antibody specific to COVID-19 in frontline healthcare workers at University Medical Center (UMC) and Texas Tech University Health Sciences Center in Lubbock, Texas METHODS: Blood samples were collected on 764 asymptomatic healthcare workers at University Medical Center and Texas Tech University Health Sciences Center, Lubbock, Texas, after informed consents were signed IgG antibody to SARS-CoV-2 was measured using Abbott's SARS-CoV-2 IgG Reagent Kit in combination with the SARSCoV- 2 IgG Calibrator Kit on the ARCHITECT i1000SR analyzer RESULTS: The prevalence of IgG specific antibodies to COVID-19 was 0 8% Six of the 764 participants tested positive Three of the six participants with positive results had prior COVID-19 diagnosis with mild symptoms managed at home The other three had asymptomatic infection CONCLUSIONS: The prevalence of IgG specific antibodies to COVID-19 was much lower than expected in our study population despite high sensitivity and specificity of the test reagent Possible explanations for this include adequate PPE measures, low COVID-19 infection in Lubbock, Texas, inadequate time for IgG response, and possible clearance of COVID-19 infection locally by the respiratory tract defense system without eliciting a systemic immunologic response