Interest in short-term global health experiences to underserviced populations has grown rapidly in the last few decades. However, there remains very little research on what participants can expect to encounter. At the same time, it has been suggested that in order for physicians and workers to provide safe and effective care, volunteers should have a basic understanding of local culture, health systems, epidemiology, and socioeconomic needs of the community before arriving. Our objective was to add to the limited literature on what short-term global health trips can expect to encounter through a cross-sectional study of patient demographics, socioeconomic markers, and the prevalence of diseases encountered on a short-term medical service trip to Lima, Peru. Descriptive analysis was conducted on clinic data collected from patients living in Pamplona Alta and Pamplona Baja, Lima, Peru, in July 2015. We found that volunteers encountered mainly female patients (70.8%), and that there were significant socioeconomic barriers to care including poverty, poor housing, environmental exposures, and lack of continuity of health care. Analysis of the disease prevalence found a high proportion of acute and chronic musculoskeletal pain in the adult populations (18.8% and 11.4%, respectively), and a high presentation of upper respiratory tract infections (25.4%) and parasites (22.0%) in the pediatric group. These findings can be used by future short-term medical service trips to address potential gaps in care including the organization of weekend clinics to allow access to working men, and the use of patient education and nonpharmacological management of acute and chronic disease.

Background: Malignant triton tumours (MTTs) are a rare and aggressive subset of malignant peripheral nerve sheath tumours (MPNSTs). A systematic review was conducted to better understand the prognosis and prognostic factors of this tumour in adult patients, and to provide treatment guidance for clinicians encountering this rare tumour. Methods: A PubMed search was conducted using the keywords “rhabdomyoblastic,” “rhabdomyosarcomatous,” “triton,” “case series” and “case report”. A reference list search was also completed. Two independent investigators completed abstract and full-text reviews. Articles were restricted to peer-reviewed articles in English language only containing adult MTT cases (≥ 18 years), and excluding articles with insufficient treatment/outcome data. Univariable and multivariable Cox proportional hazards regression was performed to identify significant predictors of overall survival (OS) and progression-free survival (PFS). Results: A total of 123 cases from the literature and 1 case from our institution were included in the final analysis. The 2-year and 5-year OS was 46.2% and 32.2%, and the 2-year and 5-year PFS was 27.1% and 21.3%, respectively. On multivariable analysis for OS, prior radiation exposure (hazard ratio [HR]: 3.99, p = 0.027), central nervous system or spine disease site (HR: 5.86, p < 0.001) and positive neurofibromatosis 1 (NF1) status (HR: 3.42, p < 0.001) were associated with worse survival. Adjuvant radiotherapy (HR: 0.58, p = 0.038) was associated with improved survival. Positive NF1 status (HR: 2.34, p < 0.001) and positive margins (HR: 3.28, p < 0.001) were associated with worse PFS. Conclusion: MTTs are rare and have poor long-term survival. Negative surgical margins and adjuvant radiation were found to be associated with improved outcomes.

The median age at diagnosis was 20 years with a slight female predominance in both patients under 30 (51.7%) and over 30 (58.9%) years. The primary site was most commonly located in the lower limbs (46.2%) followed by the abdomen, pelvis or retroperitoneum (19.4%). At diagnosis, 204 patients (48.8%) had metastatic disease, and 15 (3.6%) unknown stage. Two-hundred and eighty-three patients (67.7%) were treated with surgery, either alone (21.3%) or in combination with radiation and/or chemotherapy. Radiation was used in about half the cases (n Z 204, 48.8%). The 5-year overall survival (OS) was 59.9% and among those with non-metastatic disease (n Z 199) and metastatic disease the 5-year OS was 89.5% and 33.9%, respectively (P < 0.001). Independent factors associated with worse OS included older age (HR 1.02 per year; P < 0.001), a tumor greater than 5 cm (HR 2.61; P < 0.001), and a primary site in the abdomen, pelvis, or retroperitoneum (HR 2.15; P Z 0.05). Among patients with primary tumors >5 cm, radiotherapy was associated with an improved OS (HR 0.55; P Z 0.013). Conclusion: To our knowledge, this is the largest retrospective review of ASPS. These results are consistent with previous reports that ASPS has a relatively prolonged survival compared to other sarcomas, albeit with a high rate of metastatic disease. We identified a survival advantage in patients with primary tumors >5 cm selected to undergo radiotherapy, supporting the role of radiotherapy in the ASPS treatment paradigm. Limitations include the innate flaws of retrospective reviews including NCDB's hospital-based reporting system which may introduce geographic as well as sociodemographic biases. These results may help guide clinical decision making and inform the direction of future studies.

1.1 Introduction: Malignant triton tumours (MTTs) are a rare and aggressive subset of malignant peripheral nerve sheath tumours (MPNSTs). A systematic review was conducted to better understand the prognosis and prognostic factors of MTTs in adult patients, and provide treatment guidance for clinicians encountering this rare tumour. 1.2 Methods: A PubMed search was conducted using keywords: “rhabdomyoblastic,” “rhabdomyosarcomatous,” “triton,” “case series” and “case report”. Reference list search was also completed. Two independent investigators completed abstract and full-text reviews. Articles were restricted to peer-reviewed articles in English language only containing adult MTT cases (≥ 18 years), and excluding articles with insufficient treatment/outcome data. Univariable and multivariable Cox proportional hazards regression was performed to identify significant predictors of overall survival (OS) and progression-free survival (PFS). 1.3 Results: A total of 123 cases from the literature and 1 case from our institution were included in the final analysis. The 2-year and 5-year OS was 46.2% and 32.2%, and the 2-year and 5-year PFS was 27.1% and 21.3%, respectively. On multivariable analysis for OS, prior radiation exposure (hazard ratio [HR]: 3.99, p = 0.027), central nervous system or spine disease site (HR: 5.86, p < 0.001) and positive neurofibromatosis 1 (NF1) status (HR: 3.42, p < 0.001) were associated with worse survival. Adjuvant radiotherapy (HR: 0.58, p = 0.038) was associated with improved survival. Positive NF1 status (HR: 2.34, p < 0.001) and positive margins (HR: 3.28, p < 0.001) were associated with worse PFS. 1.4 Conclusions: MTTs are rare and have poor long-term survival. Negative surgical margins and adjuvant radiation were found to be associated with improved outcomes.