BackgroundRacial‐ethnic disparities in acute stroke care can contribute to inequality in stroke outcomes. We examined race‐ethnic disparities in acute stroke performance metrics in a voluntary stroke registry among Florida and Puerto Rico Get With the Guidelines‐Stroke hospitals.Methods and ResultsSeventy‐five sites in the Florida Puerto Rico Stroke Registry (66 Florida and 9 Puerto Rico) recorded 58 864 ischemic stroke cases (2010–2014). Logistic regression models examined racial‐ethnic differences in acute stroke performance measures and defect‐free care (intravenous tissue plasminogen activator treatment, in‐hospital antithrombotic therapy, deep vein thrombosis prophylaxis, discharge antithrombotic therapy, appropriate anticoagulation therapy, statin use, smoking cessation counseling) and temporal trends. Among ischemic stroke cases, 63% were non‐Hispanic white (NHW), 18% were non‐Hispanic black (NHB), 14% were Hispanic living in Florida, and 6% were Hispanic living in Puerto Rico. NHW patients were the oldest, followed by Hispanics, and NHBs. Defect‐free care was greatest among NHBs (81%), followed by NHWs (79%) and Florida Hispanics (79%), then Puerto Rico Hispanics (57%) (P<0.0001). Puerto Rico Hispanics were less likely than Florida whites to meet any stroke care performance metric other than anticoagulation. Defect‐free care improved for all groups during 2010–2014, but the disparity in Puerto Rico persisted (2010: NHWs=63%, NHBs=65%, Florida Hispanics=59%, Puerto Rico Hispanics=31%; 2014: NHWs=93%, NHBs=94%, Florida Hispanics=94%, Puerto Rico Hispanics=63%).ConclusionsRacial‐ethnic/geographic disparities were observed for acute stroke care performance metrics. Adoption of a quality improvement program improved stroke care from 2010 to 2014 in Puerto Rico and all Florida racial‐ethnic groups. However, stroke care quality delivered in Puerto Rico is lower than in Florida. Sustained support of evidence‐based acute stroke quality improvement programs is required to improve stroke care and minimize racial‐ethnic disparities, particularly in resource‐strained Puerto Rico.

Squamous cell carcinoma (SCC) of the stomach is a rare entity. There are several theories regarding the development of this tumor, but its pathogenesis remains obscure. Fewer than 100 cases of primary SCC of the stomach have been published in the literature. Due to advanced stage at the time of diagnosis in most of these cases, the prognosis is generally poor. In the case presented here, endoscopy revealed a vegetative tumor in the stomach described as SCC by biopsy. Following curative surgery, adjuvant chemotherapy was administered; however, the patient died 3 years and 4 months after surgery after recurrence was diagnosed.

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Gastric necrosis is a rare condition because of the rich blood supply and the extensive submucosal vascular network of the stomach. "Gas-bloat" syndrome is a well known Nissen fundoplication postoperative complication. It may cause severe gastric dilatation, but very rarely an ischemic compromise of the organ. Other factors, such as gastric outlet obstruction, may concur to cause an intraluminal pressure enough to blockade venous return and ultimately arterial blood supply and oxygen deliver, leading to ischaemia. We report a case of a 63-year-old women, who presented a total gastric necrosis following laparoscopic Nissen fundoplication and a pyloric phytobezoar which was the trigger event.No preexisting gastric motility disorders were present by the time of surgery, as demonstrated in the preoperative barium swallow, thus a poor mastication (patient needed no dentures) of a high fiber meal (cabbage) may have been predisposing factors for the development of a bezoar in an otherwise healthy women at the onset of old age. A total gastrectomy with esophagojejunostomy was performed and patient was discharged home after a 7-d hospital stay with no immediate complications. We also discuss some technical aspects of the procedure that might be important to reduce the incidence of this complication.© 2014 Baishideng Publishing Group Inc. All rights reserved.Key words: Gastric dilatation; Gastric outlet obstruction; Necrosis; Fundoplication; Nissen operation Core tip: Gastric necrosis is a rare condition because of the rich blood supply and the extensive submucosal vascular network of the stomach. "Gas-bloat" syndrome is a Nissen fundoplication postoperative complication that causes gastric dilatation, but very rarely an ischemic compromise of the organ. We report a case of a 63-year-old women, who presented a total gastric necrosis following laparoscopic Nissen fundoplication and we discuss technical aspects of the procedure that are important to prevent this complication.Salinas J, Georgiev T, González-Sánchez JA, López-Ruiz E, Rodríguez-Montes JA. Gastric necrosis: A late complication of nissen fundoplication.

Background: Hospitals must be prepared to deal efficiently and effectively with different emergencies. To accomplish this, several countries have standardized their hospital emergency codes to improve their response capability. This is particularly important in Puerto Rico given that many health professionals, particularly physicians and nurses, provide services in more than one hospital. This study examined the emergency codes and alerts utilized in Puerto Rican hospitals. Objective: To assess hospitals' level of emergency preparedness and response capability related to the variability of emergency codes and alerts utilized to respond to a situation in Puerto Rico. Method: A survey was conducted to characterize hospital emergency department level of preparedness and response to a mass fatality incident. A total of 39 out of a sample of 44 hospitals participated in the study. Semi-structured questionnaires were administered by the research team to members of each hospital's administrative staff to explore the following: general hospital characteristics, emergency plans, emergency department capacity, collaborative agreements, personnel training, emergency communications, laboratory facilities, treatment protocols, security, epidemiologic surveillance, equipment and infrastructure. Results: Some hospitals in Puerto Rico use color coded emergency alerts, while others use key words or codes. Single color emergency codes can have different meanings in different hospitals. Conclusions: The findings clearly show that there is a lack of uniformity and clarity in the emergency codes utilized by hospitals in Puerto Rico. Single color codes have diverse meanings in different hospitals. This could adversely affect hospitals' efficient and effective emergency response.