Professional Liability in Plastic Surgery: A Change of Scenario in Medical Professional Liability in Spain

Background:The epidemic of complaints and/or litigation, both in and out of court, for cases of alleged malpractice has increased dramatically. In Spain, claims related to plastic surgery are gaining more and more interest. Methods:The Council of Medical Associations of Catalonia database was used to analyze claims related to plastic surgery from 1986 to 2021. Results:1039 claims (9.8% over 10,567 total claims) were studied. Both the total number of claims (P = 0.016; R-2=0.16) and the number of claims for plastic surgery (P < 0.0005; R-2=0.732) showed an upward trend during the period of study. In the period from 2000 to 2021, the behavior was different; while the number of total claims stabilized (P = 0.352; R-2 = 0.043), plastic surgery claims continued to show a time-related tendency to increase (P < 0.0005; R-2=0.484). The distribution was 50.12% out of court. Ten unique procedures accounted for 84.5% of the total number of claims. Liability was observed in 21.46% of the closed claims, with differences between civil (20.34%), criminal (6.89%), and out-of-court (25.53%) procedures. Regarding compensation amounts, out-of-court cases had an average of 33,169.44 euros paid; civil cases, 29,153.37 euros; and criminal cases, 37,186.88 euros. Conclusions:The increase in the number of cases can only be related to an increase in the activity carried out by plastic surgeons. There has been a change in Spain in terms of the most sought-after medical specialty, with plastic surgery having displaced the perennially most sought-after specialty, orthopedic surgery and traumatology

Epidemiology of human papillomavirus-related oropharyngeal cancer in a classically low-burden region of southern Europe

The incidence of human papillomavirus (HPV)-related oropharyngeal cancer is increasing in some regions. Nevertheless, the epidemiology of this disease has not been extensively investigated in southern Europe. We conducted a retrospective cohort study of patients diagnosed with primary oropharyngeal cancer from 1991 to 2016. Cancer tissues underwent histopathological evaluation, DNA quality control, HPV-DNA detection and p16 immunohistochemistry. Data were collected from medical records. Factors associated with HPV positivity and time trends were evaluated with multivariable Bayesian models. The adjusted prevalence of HPV-related cases in 864 patients with a valid HPV-DNA result was 9.7%, with HPV-DNA/p16 double positivity being considered. HPV-related oropharyngeal cancer was likely to occur in non-smokers and non-drinkers, to be located in the tonsil or diagnosed at advanced stages. Time-trend analysis showed an increasing risk of HPV-related oropharyngeal cancer in the most recent periods (5-year period increase of 30%). This increase was highest and with a clear increasing trend only in the most recent years (2012-2016). The prevalence of HPV-related oropharyngeal cancer started to sharply increase in the most recent years in our setting, as occurred two decades ago in areas where most oropharyngeal cancer cases are currently HPV-related. Our results provide a comprehensive assessment of the epidemiological landscape of HPV-related oropharyngeal cancer in a region of southern Europe

Small Towns, una realidad urbana en la Hispania romana (II)

Congreso Internacional MARQ Museo Arqueológico de Alicante: 26-28 de Octubre de 2021.Las ciudades pequeñas/Small Towns de la Península Ibérica son la abrumadora mayoría de las aproximadamente 400 ciudades que en época romana existieron en Hispania, es decir casi una quinta parte de las aprox. 2000 ciudades del Imperio Romano entero. De ahí que resulta de interés como punto de partida y base de estudio para la investigación, a pesar de las dificultades de definición. Mientras que los intentos anteriores buscaban utilizar el término en su calidad de clasificador para poder elaborar una jerarquía de asentamientos, y así asignar a cada uno de ellos su lugar en la clasificación y de esa manera describir sus propiedades correspondientes, aqui se propone la utilización del término Small Towns solo en su calidad de aspecto diferenciador con vistas a las capitales de provincia y de conventus, manteniendo toda su imprecisión para asentamientos con o sin trama urbana extendida, en un sentido amplio y genérico sin condicionantes ni jurídicos ni políticos. Las Small Towns suelen y pueden tener, con alguna variedad, características urbanas como edificios sacros y públicos, una muralla defensiva y casas urbanas. Sin embargo, suele observarse una desproporción entre la edificación pública y sacra por un lado y la privada por el otro en el sentido, de que la primera tenga una clara predominancia sobre la segunda tanto en calidad como en cantidad. Por otro lado les suelen faltar a las Small Towns otros criterios importantes habituales de los centros mayores como son la alta densidad de población, altos estándares de calidad, un cierto grado de diversificación económica, un plan urbanístico de circulación. Esas características ausentes son compensadas, por el otro lado, con un elemento del que se nutre a través de la carga generada por la (excesiva) edificación sacra y pública, y que le proporciona aquel atributo, que resume en sí la esencia de los centros mayores, que es la más típica y la que más los destaca: un exceso de significado.Esta publicación ha sido posible gracias a la financiación de la subvención global de la Junta de Extremadura, a través de la Consejería de Ciencia, Economía y Agenda Digital al Instituto de Arqueología de Mérida (Referencia 20164499).Peer reviewe

Subcutaneous anti-COVID-19 hyperimmune immunoglobulin for prevention of disease in asymptomatic individuals with SARS-CoV-2 infection: a double-blind, placebo-controlled, randomised clinical trialResearch in context

Summary: Background: Anti-COVID-19 hyperimmune immunoglobulin (hIG) can provide standardized and controlled antibody content. Data from controlled clinical trials using hIG for the prevention or treatment of COVID-19 outpatients have not been reported. We assessed the safety and efficacy of subcutaneous anti-COVID-19 hyperimmune immunoglobulin 20% (C19-IG20%) compared to placebo in preventing development of symptomatic COVID-19 in asymptomatic individuals with SARS-CoV-2 infection. Methods: We did a multicentre, randomized, double-blind, placebo-controlled trial, in asymptomatic unvaccinated adults (≥18 years of age) with confirmed SARS-CoV-2 infection within 5 days between April 28 and December 27, 2021. Participants were randomly assigned (1:1:1) to receive a blinded subcutaneous infusion of 10 mL with 1 g or 2 g of C19-IG20%, or an equivalent volume of saline as placebo. The primary endpoint was the proportion of participants who remained asymptomatic through day 14 after infusion. Secondary endpoints included the proportion of individuals who required oxygen supplementation, any medically attended visit, hospitalisation, or ICU, and viral load reduction and viral clearance in nasopharyngeal swabs. Safety was assessed as the proportion of patients with adverse events. The trial was terminated early due to a lack of potential benefit in the target population in a planned interim analysis conducted in December 2021. ClinicalTrials.gov registry: NCT04847141. Findings: 461 individuals (mean age 39.6 years [SD 12.8]) were randomized and received the intervention within a mean of 3.1 (SD 1.27) days from a positive SARS-CoV-2 test. In the prespecified modified intention-to-treat analysis that included only participants who received a subcutaneous infusion, the primary outcome occurred in 59.9% (91/152) of participants receiving 1 g C19-IG20%, 64.7% (99/153) receiving 2 g, and 63.5% (99/156) receiving placebo (difference in proportions 1 g C19-IG20% vs. placebo, −3.6%; 95% CI -14.6% to 7.3%, p = 0.53; 2 g C19-IG20% vs placebo, 1.1%; −9.6% to 11.9%, p = 0.85). None of the secondary clinical efficacy endpoints or virological endpoints were significantly different between study groups. Adverse event rate was similar between groups, and no severe or life-threatening adverse events related to investigational product infusion were reported. Interpretation: Our findings suggested that administration of subcutaneous human hyperimmune immunoglobulin C19-IG20% to asymptomatic individuals with SARS-CoV-2 infection was safe but did not prevent development of symptomatic COVID-19. Funding: Grifols