TitleNativity and neighborhood characteristics and cervical cancer stage at diagnosis and survival outcomes among hispanic women in California Despite advances in early detection, cervical cancer remains the second most-common cancer worldwide and the third most-common gynecologic malignancy in the United States, 1,2 with an age-adjusted incidence rate of 7.8 per 100 000 and mortality rate of 2.3 per 100 000 from 2007 to 2011. 3 Notably, although the incidence of cervical cancer is higher among Hispanic women (10.2 per 100 000) than among Asian/Pacific Islander (6.4), African American (9.4), and nonHispanic White (7.8) women, mortality rates among Hispanic women are comparable with those of other groups (2.8 per 100 000). 3---5Compared with women of other racial/ethnic groups, studies consistently show a survival advantage for Hispanic women after control for stage at diagnosis and other clinical and sociodemographic characteristics 2,6---13 ; this observation of lower mortality among Hispanics compared with non-Hispanic Whites is consistent with the "Hispanic paradox." 14,15 Previous studies further suggest that the paradox applies in particular to Hispanic immigrants, particularly immigrants born in Mexico. 15 A recent analysis of national data from the Surveillance, Epidemiology, and End Results (SEER) program found that foreignborn Hispanic women had lower survival than US-born Hispanic women for early-stage disease, but better survival for late-stage disease. 16,17 However, this analysis was based on imputed data for women missing place of birth, which is problematic when one considers that SEER birthplace data are not missing at random. 18---20 The observed survival advantage may also reflect higher rates of losses to follow-up among foreign-born Hispanics, causing underreporting of cervical cancer mortality in this group if significant numbers of women return to their native country once diagnosed with later-stage disease. Thus, to date, reasons for the apparent immigrant survival advantage among women with cervical cancer are poorly understood.The "healthy immigrant effect" suggests that the Hispanic mortality advantage is greater among the foreign-born than US-born because immigrants are selected for better health 21 ; this hypothesis may explain the patterns seen for cervical cancer survival. Therefore, neighborhood characteristics including socioeconomic status (SES) and ethnic enclave (geographical areas that are culturally and ethnically concentrated and distinct from the surrounding area) may be important contributors to survival after cervical cancer diagnosis. Low-income residential ethnic enclaves may protect health by increasing residents' ability to maintain positive health behaviors such as a healthy native diet or abstention from smoking, and provide increased social support. Residents of ethnic enclave communities may also receive targeted public health services or perceive fewer barriers to care. However, ethnic enclaves tend to be of low SES and frequently have higher crime rates a...

Objective A recent randomized controlled trial (RCT) demonstrated no difference in 6 month survival in expectantly managed stage I twin‐twin transfusion syndrome (TTTS) patients and those undergoing immediate laser surgery. We aimed to describe outcomes following immediate laser surgery at a single fetal surgery center. Methods A retrospective study of monochorionic diamniotic twins diagnosed with stage I TTTS who underwent laser surgery between 16 and 26 gestational weeks from 2006 to 2019. The primary outcome was 6 month survivorship. Intact survival was also assessed. Secondarily, outcomes were compared to the RCT expectant management group. Results Of 126 consecutive stage I TTTS patients, 114 (90.5%) met inclusion criteria. Median (range) gestational age at delivery was 34.1 (20.6–39.4) weeks. At 6 months, the proportion of patients with at‐least‐one survivor in the single‐center‐laser cohort was 97.4%, with 88.6% dual survivorship. Neurological morbidity outcomes were available in 110 pregnancies (220 fetuses). Severe neurological morbidity occurred in 2.7% (6/220), and 6 month survival without severe neurological morbidity was 90.0%. Outcomes compared favorably with the RCT expectant management group. Conclusions Given favorable survival and neurological outcomes, laser surgery is a reasonable treatment option for stage I TTTS at experienced fetal surgery centers. Further study is warranted to optimize treatment strategies.

Introduction: Bacteria are the most common pathogens implicated in ascending infections in patients with cervical insufficiency. However, Candida albicans is a rare and serious cause of intraamniotic infection that should be considered on the differential. Upon diagnosis following cerclage placement, patients are generally advised to undergo immediate cerclage removal and discontinuation of the pregnancy due to the high risk of maternal and fetal morbidity. However, some patients decline and instead elect to continue the pregnancy with or without treatment. Limited data exists to guide management of these high-risk patients. Case Presentation: We describe a case of previable intraamniotic C. albicans infection diagnosed following physical examination-indicated cerclage placement. The patient declined pregnancy termination, and subsequently underwent systemic antifungal therapy as well as serial intraamniotic fluconazole instillations. Fetal blood sampling confirmed transplacental transfer of maternal systemic antifungal therapy. The fetus delivered preterm and without evidence of fungemia, despite persistently positive amniotic fluid cultures. Conclusion: In a well-counseled patient with culture proven intraamniotic Candida albicans infection declining termination of pregnancy, multi-modal antifungal therapy in the form of systemic and intraamniotic fluconazole administration may prevent subsequent fetal or neonatal fungemia and improve postnatal outcomes.

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Background:Patients with Systemic Sclerosis (SSc) have increased risk of malignancy compared to general population. The specific risk factors and underlying physiopathological mechanisms are still unknown, although some studies suggest that a relationship between malignancies and certain antibodies can exist. Lung, breast and hematological cancers are the most frequently seen among these patients.Objectives:To describe the prevalence of malignancies in a cohort of SSc patients and analyze the epidemiological, clinical and immunological characteristicsMethods:A retrospective observational study was conducted at a tertiary-level university hospital, including a cohort of patients with SSc (ACR/EURLAR 2013 criteria). The main variable was neoplasia prevalence and also, malignancy type, age, evolution of the SSc at the time of diagnosis and mortality were collected. Regarding SSc, demographic data, clinical and immunological characteristics, organ involvement, capillaroscopy findings and presence of other autoimmune diseases were collected.Results:A 15% of the 98 patients with SSc presented malignancies (80% women). The mean age at the time of diagnosis was 57±15 years old (table 1). The frequency of cancer was: 40% breast, 13% colon, 7% ovary and lung. 2 patients died (1 breast, 1 lung). The limited subtype (lSSc) was the most frequent (80%) and 33% showed overlap syndrome (26% Sjögren syndrome). Regarding clinical manifestations: 67% had telangiectasia, 33% pitting scars, joint and digestive involvement. Most frequently seen antibodies were: 67% anti centromere (ACA) and 20% anti topoisomerase (ATA). None of the patients presented anti-ARN polimerase III (ARN-pol), and 13% had none of them (triple negative). Active and early capillaroscopy patterns were seen in a 46% and 27%. SSc and cancer were diagnosed in less than 5 years difference among a 33% of the cohort. A relationship between age and cancer was detected (p=0,042). Patients with neoplasia were a mean of 10 years older than those without malignancies (IC95%: 1-19 years)Table 1.SSc with neoplasian= 15(%)SSc without neoplasian= 83(%)Female12 (80)76 (92)Mean age*(n; DE)57(15)52(17)Pre-scleroderma1 (7)11 (13)Limited12 (80)54 (65)Diffuse2 (13)12 (15)SINE06 (7)Overlap syndrome5 (33)14 (17) Sjögren4 (27)10 (12) MCTD1 (7)2 (2) Rheumatoid Arthritis1 (7)3 (4) Myositis1 (7)0Clinical manifestations Telangiectasia10 (67)41 (49) Pitting Scars5 (33)11 (13) Joint5 (33)27 (33) Digestive5 (33)33 (40) Digital ulcers4 (27)11 (13) Calcinosis4 (27)12 (14) ILD3 (20)16 (19) PAH3 (20)8 (10) Cardiac3 (20)4 (5) Muscular2 (13)3 (4) Puffy Fingers2 (13)24 (29) Renal02(2)Antibodies ACA10 (67)46 (55) ATA3 (20)12 (14) Anti-ARN04 (5) Triple negative2 (13)23 (28)Capillaroscopy Early4 (27)19 (23) Active7 (46)39 (47) Late03 (4)Treatment Calcium antagonists11 (73)52 (63) PPIs7 (46)33 (40) Corticosteroids8 (53)24 (29) DMARD5 (33)26 (31)*P<0,05 test t-studentMCTD (Mixed Connective Tissue Disease), ILD (Interstitial Lung Disease), PAH (Pulmonary Artery Hypertension), Triple negative (anti ARN, ACA and ATA negative antibodies), PPI (Proton Pump Inhibitor), ACE inhibitors (Angiotensin Converting Enzyme inhibitors), ARBs (Angiotensin II Receptor Blockers), DMARD (Disease-Modifying Anti-Rheumatic Drugs).Conclusion:Our study showed a similar prevalence of the most frequent neoplasia among patients with SSc compared to general population (around 15%). This prevalence is similar to other series. The only epidemiological factor related to neoplasia was the age; a major proportion of lSSc was detected but without statistical significance. In a third of the patients there were less than 5 years of difference between cancer and SSc diagnosis. No association was found between neoplasia and certain antibodies. We recommend further studies to evaluate the relationship between SSc and cancer.Disclosure of Interests:None declared