American University of the Caribbean School of Medicine

Diabetes mellitus is a chronic metabolic disorder that affects millions of people globally. Among three types of diabetes, Type 2 diabetes mellitus (T2DM) is a rapidly growing global health challenge. Despite available modern antidiabetic drugs, patients still struggle with side effects and treatment failure, as an alternative to this, there is a crucial requirement to develop a potential and traditional plant-based medicine which could be a safer sources and multi-target therapies to treat chronic disease like diabetes. Solanum lasiocarpum (S. lasiocarpum) is a sour fruit-vegetable being widely used in Southeast Asia as both food and traditional medicine, including for the management of diabetes. However, its active components and antidiabetic mechanisms have not been systematically explored. In this study, we combined metabolomics, proteomics, and transcriptomics to investigate the bioactive pathways and potential molecular targets of S. lasiocarpum. Untargeted UHPLC–QTOF–MS profiling identified 45 candidate bioactive compounds with good predicted gastrointestinal absorption, and the network pharmacology analysis linked these compounds to 43 diabetes-related human targets. Protein–protein interaction analysis highlighted several core nodes, including TNF, PPARG, IL6, AKT1, and STAT3, and functional enrichment suggested roles in hormone regulation, inflammation, glucose and lipid metabolism, and vascular function. De novo transcriptome assembly and data-independent acquisition-based proteomics of mature S. lasiocarpum fruit showed that central carbon metabolism is highly active and that the shikimate, phenylpropanoid, and flavonoid pathways are strongly expressed at both gene and protein levels. Key enzymes such as EPSPS, PAL, C4H, 4CL, CHS, CHI, F3H, and FLS formed a coherent biosynthetic network supporting sustained production of phenolic and flavonoid metabolites. Integrating these omics layers with target prediction suggests that S. lasiocarpum may exert antidiabetic effects by modulating a TNF–PPARG axis, reducing pro-inflammatory signaling while supporting insulin-sensitizing pathways. Overall, these results support the traditional use of S. lasiocarpum and provide a multi-omics resource to prioritise candidate metabolites, enzymes and targets for follow-up studies. As the pathway links were inferred computationally, the proposed TNF–PPARG-centred mechanism should be regarded as hypothesis-generating and will require validation in experimental models and, ultimately, well-designed human intervention trials.

Cancer is a major health threat in sub-Saharan Africa (SSA). Patient navigation has emerged as a strategy to address this, but the scope and impact of patient navigation for cancer care in SSA remains unclear. We aimed to comprehensively map the existing literature on patient navigation interventions for cancer care in SSA. A scoping review was conducted using a standardized 3-step search strategy. Eligible studies involved a patient navigation intervention for cancer care in SSA. Data were extracted on study, participant and navigator characteristics, intervention outcomes and implementation barriers and facilitators. Twenty-two studies describing 20 distinct interventions across 10 countries were included. Most studies were descriptive, focused on breast and cervical cancers and targeted the treatment stage of care. Navigator roles included patient education, psychosocial support, care coordination, and attenuation of patient barriers to care. Patient navigation appeared feasible, acceptable, and beneficial across a variety of study populations in this setting, but limited funding was a commonly reported barrier to maintenance. Cancer patient navigation is a promising strategy to improve cancer outcomes in SSA. Strategic investment is needed to support sustainable scale-up and maximize the impact of cancer patient navigation in the region.

Background: Congenital circulatory anomalies remain a significant cause of mortality in the United States, especially among infants and young children. Understanding long-term mortality trends and disparities across demographics and geography is crucial for targeted public health interventions. Methods: Mortality data for congenital circulatory anomalies were extracted from CDC WONDER for the years 1999 to 2020. Annualized Percentage Change (APC) in absolute death counts was calculated using log-linear regression models, stratified by state, census region, urbanization, sex, age group, race, and Hispanic origin. Results: Nationally, deaths declined from 4,436 in 1999 to 3,011 in 2020, reflecting an APC of –2.14%. Among census regions, the Northeast experienced the steepest decline (APC: –2.37%), followed by the Midwest (–2.25%), South (–2.05%), and West (–2.02%). Urbanization-wise, the greatest reduction was noted in NonCore (–2.53%) and Large Fringe Metro areas (–2.01%), while Small Metro areas had a milder decline (–1.44%). State-level analysis showed that Alaska had an increasing trend (APC: +4.66%), while several states showed moderate-to-high declines, with California (–3.12%) and Texas (–2.84%) among the top. Age-specific trends revealed significant reductions in the 1–4 year age group (APC: –1.70%) and 75–84 year group (–1.56%), with relatively stable trends among those aged 55–64 (–0.04%). Sex-stratified analysis showed a sharper decline in females (–2.33%) compared to males (–1.97%). Racial disparities were evident: White individuals experienced the highest decline (–2.36%), followed by Black or African American (–1.82%), American Indian or Alaska Native (–0.60%), while Asian or Pacific Islanders showed a slight increase (APC: +1.02%). By Hispanic origin, deaths among Hispanic or Latino populations declined with an APC of –1.20%, while those not of Hispanic origin declined more steeply (–2.29%). The "Not Stated" category also declined (–2.13%). Conclusion: Despite overall declining mortality from congenital circulatory anomalies in the U.S. from 1999 to 2020, marked disparities persist across race, state, age, and urbanization level. Targeted efforts are needed to reduce the widening gaps and address the concerning upward trends observed in specific states and ethnic groups.

324 Background: Given the increasing complexity of end-of-life care and the expanding role of palliative medicine in modern healthcare, exposure to this specialty through medical student rotations is more important than ever. However, such exposure remains limited. Caribbean medical schools, which educate a large number of international graduates who pursue residencies in the United States, are strategically positioned to shape early exposure to this field. Despite this, little is known about why few students opt for palliative care rotations during their final year. Clarifying these influences is key to promoting student engagement and addressing workforce shortages in this specialty. Methods: A voluntary, anonymous survey was distributed electronically to fourth-year students across four Caribbean medical schools. The 20-item instrument used branching logic and included Likert-scale, multiple-choice, and open-ended items. The survey assessed interest in palliative care electives, perceived preparedness, views on end-of-life communication, emotional readiness, career alignment, and potential incentives for participation. Chi-square testing was used to examine differences in elective interest across intended specialties. Mann-Whitney U tests compared median scores for emotional preparedness and confidence in end-of-life care between students with high and low interest. Results: A total of 102 students completed the survey. Only 5% rated their interest in a palliative care elective as high, and just 6% had actively scheduled or completed such a rotation. Interest varied by specialty intention, with those pursuing internal medicine more likely to express interest compared to students aiming for surgical specialties (27% vs. 10%; p = 0.039). Reported obstacles included a lack of formal exposure to palliative care during training (61%), discomfort managing end-of-life issues (67%), and unclear expectations of a student’s role within palliative teams (43%). Qualitative comments revealed recurring concerns about insufficient training in death-related communication (n = 46), a desire for more structured learning opportunities (n = 54), and uncertainty about how palliative care fits into their long-term career plans (n = 31). Students who reported lower emotional readiness also tended to rate their interest in the elective lower ( p = 0.032). Conclusions: Uptake of palliative care rotations among Caribbean medical students is limited by emotional discomfort, lack of exposure, and unclear student roles. Strengthening mentorship, introducing earlier communication training, and clarifying student responsibilities may boost engagement. Future work should integrate structured palliative experiences into core curricula and assess their impact on student interest and career decisions.

The numeric pain rating scale (NPRS) and shoulder pain and disability index (SPADI) are commonly used patient-reported outcome measures (PROMs) in patients with rotator cuff tendinopathy. To date, there are gaps in the evidence supporting the clinimetric properties of these PROMs for patients treated with subacromial pain syndrome (SAPS). A clinimetric analysis (n=145) was performed to examine the reliability, construct validity, responsiveness, interpretability, minimal detectable change (MDC95) and minimum clinically important difference (MCID) of the NPRS and SPADI for "improved" (global rating of change from +3 to +7) and "much-improved" (global rating of change from +5 to +7) patients at 3-months follow-up. The NPRS (ICC: 0.86; 95 %CI, 0.33-0.96) and SPADI (ICC: 0.79; 95 %CI 0.12-0.94) exhibited good reliability and excellent responsiveness (NPRS: area under the curve (AUC)=0.96, 95 %CI 0.92-0.99; SPADI: AUC=0.90, 95 %CI 0.84-0.95) in this patient population. Both outcomes demonstrated strong construct validity (Pearson's r; p<0.001). The MDC95 was a 1.7- and 20.5-point change for the NPRS and SPADI, respectively. For the NPRS, the MCID was a 1.5-point change in the "improved" group and a 2.5-point change in the "much improved" group. For the SPADI, the MCID was an 18-point or 50% change for the "improved" group, and a 25-point or 70% change in the "much improved" group. The NPRS and SPADI demonstrated sound clinimetric properties in patients with SAPS. The MCID exceeded measurement error in the "much improved" group. Diagnosis, type of intervention, level of improvement, and measurement error should be considered when applying the MCID.

Acute coronary syndrome (ACS) is a major cause of morbidity and mortality in the United States (US). However, the trends and disparities in ACS mortality are not well understood. This study aimed to analyze the ACS mortality in the US from 1999 to 2020 using the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database. The age-adjusted mortality rates (AAMR) due to ACS were calculated for each year from 1999 to 2020, stratified by sex, race, urbanization, and state. The trends and disparities in AAMR were examined using descriptive statistics and graphical methods. The AAMR due to ACS decreased from 1999 to 2010 and for some variables till 2018, but then increased from 2018 to 2020. The AAMR due to ACS was higher in men than in women, non-Hispanic black adults than in non-Hispanic white adults and rural than in urban populations. The AAMR due to ACS varied widely among different states, with New York having the highest AAMR and Minnesota having the lowest AAMR. This study revealed the trends and disparities in ACS mortality in the US from 1999 to 2020. The study showed an increase in AAMR due to ACS in the recent years. The study also found significant disparities in AAMR due to ACS by sex, race, urbanization, and state. Further research is needed to explore the factors that contribute to the variation and inequality in ACS mortality.

Idiopathic intracranial hypertension (IIH) is a clinical diagnosis made from the exclusion of other possible causes of increased intracranial pressure (ICP): cerebrospinal fluid (CSF) overflow obstruction, mass lesion, infection, or malignancies. IIH is a phenomenon with a rapid onset that most notably presents in obese women of childbearing age. We present the case of a 30-year-old African American woman with a past medical history of bipolar disorder who arrived at the emergency department (ED) with acute bilateral vision loss, two weeks of bilateral retro-orbital headache, painful eye movements, and progressive vision loss with a decrease in appetite. Management involved plasma exchange, high-dose steroids, consistent neurological and ophthalmic tests, and close observation and follow-up. One week after the most recent ED visit, the patient confirmed a significant improvement in vision. When diagnosing our patient with IIH, it was imperative to rule out myelinating oligodendrocyte glycoprotein antibody-associated disease (MOGAD), multiple sclerosis (MS), and other demyelinating diseases such as optic neuritis.Initial brain imaging using computed tomography (CT) without contrast showed no evidence of intracranial hemorrhagebut demonstrated the presence of prominent sheath complexes, suggestive of optic neuritis, and a slightly small pituitary gland height for a patient who is 30 years of age. Further testing with a CT venogram (CTV) and a magneticresonance imaging (MRI) of the head and neck confirmed demyelination. The patient's lumbar puncture continuously revealed a normal opening pressure during her hospital stay. This case presentation will highlight and compare the current literature regarding the clinical presentation and management of idiopathic intracranial hypertension.