Ocala Research Institute

669 Background: Pancreatic cancer is among the most lethal gastrointestinal malignancies in the United States. Identifying where and in whom the burden is highest can guide smarter prevention, earlier detection, and more equitable healthcare planning. Geographic and demographic analysis is essential to help reduce disparities in outcomes. Methods: Data were obtained using the Institute for Health Metrics and Evaluation (IHME) Global Burden of Disease (GBD) 2021 Results Tool. Age-standardized death and DALY rates were analyzed by state and sex. Age-stratified crude mortality and DALYs identified high-burden subgroups. Risk attribution was assessed using DALY percentages and temporal risk factor rankings from 1990 to 2021. Descriptive statistics were performed using Microsoft Excel. Results: In 2021, Louisiana and Mississippi consistently ranked among the highest states across incidence, mortality, and DALY rates, while Colorado, Utah, and North Dakota showed the lowest burden. Males demonstrated higher incidence and mortality than females, and rates rose sharply after age 65, peaking in those ≥80 years. State-level variation persisted across three decades, with the South and Midwest showing the greatest burden. Smoking and high body mass index accounted for the largest share of attributable DALYs, with variation across states. DALY rates peaked in men aged 65–69 and women aged ≥80. Prevalence was highest in Hawaii, Louisiana, and Michigan, highlighting a growing survivor population with long-term care needs. Conclusions: Pancreatic cancer burden in the United States shows striking geographic variation, with consistently high rates in southern states such as Louisiana and Mississippi. The greatest burden occurs in older adults, particularly men. These findings underscore the importance of targeted prevention and improved resource allocation to reduce disparities in pancreatic cancer outcomes. Pancreatic cancer burden in the United States, 2021 (age-standardized per 100,000). Metric Highest State (Rate) Lowest State (Rate) Notable Pattern Incidence Louisiana (12.93) North Dakota (8.78) South vs. Midwest contrast Prevalence Hawaii (11.46) Montana (8.83) Coastal variation Mortality Louisiana (12.39) North Dakota (8.08) Mirrors incidence DALY Louisiana (281.6) Colorado (177.4) Southern burden highest Male Incidence Louisiana (14.46) North Dakota (10.04) Higher than female Female Incidence Louisiana (11.53) North Dakota (7.55) Lower overall Age Group Peak M 80+ yrs (6,651 cases) <20 yrs (2.3 cases) Sharp rise >65 yrs Age Group Peak F 80+ yrs (9,332 cases) <20 yrs (2.1 cases) Sharp rise >65 yrs

29 Background: Colorectal cancer (CRC) remains as a leading cause of cancer-related morbidity as well as mortality worldwide. Effective screening strategies are needed for early detection of CRC and also for its precursors in the form of advanced neoplasia (AN). Fecal immunochemical testing (FIT) is widely used for non-invasive screening, but its diagnostic accuracy for CRC and especially advanced neoplasia (AN) remains variable across studies. Methods: We conducted a systematic review and meta-analysis in accordance with PRISMA guidelines. PubMed, Embase, and Cochrane Library were searched from inception to July 2025 for studies comparing FIT against colonoscopy in average-risk, asymptomatic adults aged >50 years. After deduplication, 231 articles were screened, of which 11 met eligibility criteria. Data were extracted into 2×2 tables and pooled using a bivariate random-effects model to estimate sensitivity, specificity, likelihood ratios, and diagnostic odds ratio (DOR) with 95% confidence intervals. Study quality was appraised using the QUADAS-2 tool. Results: Across 11 Studies, FIT detected CRC with a pooled sensitivity of 0.74 (95% CI, 0.63–0.83) and specificity of 0.93 (95% CI, 0.88–0.96), corresponding to a positive likelihood ratio (LR+) of 10.10 and DOR of 36.54. For CRC+AN , sensitivity fell to 0.29 (95% CI, 0.23–0.37) with specificity of 0.94 (95% CI, 0.91–0.97). These findings indicate strong ability to confirm CRC when FIT is positive but limited capacity to exclude advanced neoplasia. Assay threshold reduction improved sensitivity at the expense of specificity, while increasing threshold improved specificity, but more AN cases were missed. Conclusions: FIT demonstrates high specificity but only moderate sensitivity for detecting CRC, which supports its role in population based screening and functioning as an effective triage tool that reduces unnecessary colonoscopies. Nonetheless, because of single-sample FIT’s low sensitivity in detecting AN carries the risk of under-detecting AN. Strategies such as repeated annual testing/ multiple-sample FITs, or integration with validated clinical risk models may enhance diagnostic yield. Overall, FIT remains a cornerstone of CRC screening but its limited sensitivity for precancerous lesions underscores the need for optimization, with screening programs required to balance improved detection yield against increased colonoscopy demand. Outcomes CRC only CRC + AN Sensitivity (95% CI) 0.74 (0.63–0.83) 0.29 (0.23–0.37) Specificity (95% CI) 0.93 (0.88–0.96) 0.94 (0.91–0.97) LR+ (95% CI) 10.10 (6.48–15.72) 5.15 (3.86–6.89) LR– (95% CI) 0.28 (0.19–0.41) 0.75 (0.70–0.81) DOR (95% CI) 36.54 (21.34–62.57) 6.87 (5.27–8.95)

A 50-year-old male with a history of a dull headache and neck pain for a few weeks presented to the ER with complaints of progressive weakness and difficulty walking. Physical examination revealed a lethargic, confused patient with abnormal tremors at rest. Initial lab work was significant for elevated hemoglobin, hematocrit, and hyponatremia. Additionally, CT imaging was significant for prominent ventricles. Several serologies and polymerase chain reaction (PCR) tests were ordered to determine the etiology of the patient’s meningitis. On day 10 of admission, serology results returned positive for Coccidioides antibodies. The patient was started on an IV fluconazole treatment and underwent a ventriculoperitoneal shunt and Ommaya reservoir placement procedure. Cases of coccidioidal meningitis are rarely noted in recent literature. We present this clinical case of coccidioidomycosis dissemination into the central nervous system (CNS) to highlight the rare localization of the fungal infection in a baseline immunocompetent patient.