Effectiveness and Adherence to Closed Face Shields in the Prevention of COVID-19 Transmission: A Non-inferiority Randomized Controlled Trial in a Middle-Income Setting (COVPROSHIELD)

BACKGROUND: The use of respiratory devices can mitigate the spread of diseases such as COVID-19 in community settings. We aimed to determine the effectiveness of closed face shields with surgical face masks to prevent SARS-CoV-2 transmission in working adults during the COVID-19 pandemic in Bogotá, Colombia. METHODS: An open-label non-inferiority randomized controlled trial that randomly assigned participants to one of two groups: the intervention group was instructed to wear closed face shields with surgical face masks, and the active control group was instructed to wear only surgical face masks. The primary outcome was a positive reverse transcription polymerase chain reaction test, IgG/IgM antibody test for SARS-CoV-2 detection, or both during and at the end of the follow-up period of 21 days. The non-inferiority limit was established at - 5%. RESULTS: A total of 316 participants were randomized, 160 participants were assigned to the intervention group and 156 to the active control group. In total, 141 (88.1%) participants in the intervention group and 142 (91.0%) in the active control group completed the follow-up. PRIMARY OUTCOME: a positive SARS-CoV-2 test result was identified in one (0.71%) participant in the intervention group and three (2.1%) in the active control group. In the intention-to-treat analysis, the absolute risk difference was - 1.40% (95% CI [- 4.14%, 1.33%]), and in the per-protocol analysis, the risk difference was - 1.40% (95% CI [- 4.20, 1.40]), indicating non-inferiority of the closed face shield plus face mask (did not cross the non-inferiority limit). CONCLUSIONS: The use of closed face shields and surgical face masks was non-inferior to the surgical face mask alone in the prevention of SARS-CoV-2 infection in highly exposed groups. Settings with highly active viral transmission and conditions such as poor ventilation, crowding, and high mobility due to occupation may benefit from the combined use of masks and closed face shields to mitigate SARS-CoV-2 transmission. TRIAL REGISTRATION: ClinicalTrials.gov NCT04647305 . Registered on November 30, 2020

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Prevalence of dental fluorosis and associated factors in schoolchildren in Cartagena, Colombia

Objectives: To describe the prevalence of dental fluorosis and associated factors related to fluoride ingestion in schoolchildren between 6 to 12 years of age in the city of Cartagena, Colombia, in 2018. Methods: A cross sectional study was performed in a sample of 142 schoolchildren in Cartagena. Sampling was a stratified random probabilistic type, selecting a proportion of schoolchildren in each locality of Cartagena. Clinical examination using Thylstrup and Fejerskov index was done to detect dental fluorosis. A structured survey was used to evaluate the associated factors (frequency of drinking water consumption, fluoridated salt, foods and beverages with high content of fluoride, and accidental ingestion of dental hygiene products). A descriptive analysis was performed for each variable calculating frequencies and proportions. Then, a bivariate analysis with Pearson's Chi-squared test and a multivariate analysis from a logistic regression with robust errors, with models adjusted by potential confounders. The significance level was fixed at 0.05. Results: Prevalence of dental fluorosis was 69.72%. Mild and moderate type of dental fluorosis were found with higher frequency, showing proportions of 62.68% and 7.04% respectively. Schoolchildren of ages 9-12-year-old were found to had 2.24 times the chance of having dental fluorosis than 6-8-year-old children (OR=2.24, 95% CI=1.02-5.03, p value=0.0472). Children who started self-brushing before the age of 3 years had 2.54 times the chance of having dental fluorosis than those who started after that age (OR= 2.54, 95% CI=1.07-6.47, p value= 0.0400). Also, those who started using mouthwashes at the age of 3 years had 77% less chance of presenting dental fluorosis than children who started before that age (OR=0.23, 95% CI= 0.05 -0.80, p value= 0.0371). Conclusions: The high prevalence of dental fluorosis in schoolchildren in Cartagena, Colombia reflects the need to design and implement effective public health programs.Objetivos: Describir la prevalencia de fluorosis dental y factores asociados relacionados con la ingesta de flúor en escolares de 6 a 12 años de la ciudad de Cartagena, Colombia, en 2018. Métodos: se realizó un estudio transversal en una muestra de 142 escolares de Cartagena. El muestreo fue de tipo probabilístico aleatorio estratificado, seleccionando una proporción de escolares en cada localidad de Cartagena. Se realizó un examen clínico mediante el índice de Thylstrup y Fejerskov para detectar la fluorosis dental. Se utilizó una encuesta estructurada para evaluar los factores asociados (frecuencia de consumo de agua potable, sal fluorada, alimentos y bebidas con alto contenido de flúor e ingestión accidental de productos de higiene dental). Se realizó un análisis descriptivo de cada variable calculando frecuencias y proporciones. Luego, un análisis bivariado con la prueba de Chi-cuadrado de Pearson y un análisis multivariante de una regresión logística con errores robustos, con modelos ajustados por posibles factores de confusión. El nivel de significancia se fijó en 0,05. Resultados: La prevalencia de fluorosis dental fue del 69,72%. Los tipos de fluorosis dental leve y moderada se encontraron con mayor frecuencia, mostrando proporciones de 62,68% y 7,04% respectivamente. Se encontró que los escolares de 9 a 12 años tenían 2,24 veces más probabilidades de tener fluorosis dental que los niños de 6 a 8 años (OR = 2,24, IC del 95% = 1,02 a 5,03, valor de p = 0,0472). Los niños que empezaron a cepillarse ellos mismos antes de los 3 años tenían 2,54 veces más probabilidades de tener fluorosis dental que los que empezaron después de esa edad (OR = 2,54, IC del 95% = 1,07-6,47, valor de p = 0,0400). Además, los que empezaron a utilizar enjuagues bucales a los 3 años tenían un 77% menos de posibilidades de presentar fluorosis dental que los niños que empezaron antes de esa edad (OR = 0,23, IC 95% = 0,05 -0,80, valor de p = 0,0371).Magíster en EpidemiologíaMaestrí

Evaluation of fluoride and calcium concentrations in drinking water from public water fountains on a university campus

Optimal exposure to fluoride and calcium from tap water is beneficial for dental caries prevention. Water fountains may be an important source of drinking water in work and educational settings. The aims of this study were to quantify the fluoride and calcium concentrations of drinking water samples collected from public water fountains on the Indiana University-Purdue University Indianapolis campus; compare the fluoride and calcium concentrations in water collected at 2 different times; and determine whether the presence or absence of a visible external filter affects fluoride and calcium concentrations. Ninety samples were collected from 45 water fountains accessible to the public, and 90 duplicate samples were collected 1 month later. A fluoride ion-selective electrode was used in conjunction with an ion-specific meter to determine fluoride concentration, while atomic absorption spectrometry in an air-acetylene flame was implemented to quantify the calcium concentration. The fluoride and calcium concentration of drinking water samples displayed ranges of 0.62 mg/L to 0.97 mg/L and 56.61 mg/L to 89.11 mg/L, respectively. The concentrations of fluoride and calcium in drinking water were slightly lower at the second collection period (P < 0.001; Wilcoxon signed rank test). No statistically significant differences were observed in the fluoride or calcium concentration of drinking water collected from water fountains with an external filter cartridge in comparison with fountains that did not have a filter. Fluoride concentrations were within the optimal range recommended by the US Public Health Service for fluoridated drinking water, and calcium concentrations were consistent with those reported in previous surveillance studies

El cáncer bucal y su relación con la proteína translocadora mitocondrial de 18kda

Oral cancer has a high incidence and mortality rate globally. Despite theadvances in the diagnosis and prognosis of this disease, a 5 years survivalrate still remains, which makes it necessary to study diagnostic methodscapable to detect the disease in early stages. That is why advances in proteomicsand immunohistochemistry had allowed the identification of variousbiomarkers, including the 18 kDa mitochondrial translocator protein(TSPO), which is involved in some cellular processes, such as cholesteroltransport, cellular proliferation and apoptosis. It has been reported the altered TSPO values in various types of cancer, as well as the presence of TSPO insaliva of subjects with oral cancer, which represents an opportunity to understandthe oral carcinogenic process and identify new alternatives for the diagnosis of thisdisease. The objective of this review is to present theoretical aspects related to TSPOas a biomarker to study in subjects with oral cancer, considering its implication inthe apoptosis mechanism and participation in oxidative stress.El cáncer bucal posee una alta incidencia y mortalidad a nivel global. A pesar de los avances en el diagnóstico y el pronóstico de esta enfermedad, aún se mantiene una baja tasa de supervivencia de 5 años, lo cual hace necesario el estudio de métodos diagnósticos que sean capaces de detectar la enfermedad en estadios tempranos. Es por esto que avances en proteómica e inmunohistoquímica, han permitido identificar diversos biomarcadores, entre ellos la proteína translocadora (TSPO) mitocondrial de 18kDa, la cual está involucrada en diversos procesos celulares, como el transporte de colesterol, la proliferación celular y la apoptosis. Se ha reportado la presencia de valores alterados de la TSPO en diversos tipos de cáncer, así como la presencia de la TSPO en saliva y tejido de sujetos con cáncer bucal, lo cual representa una oportunidad para entender el proceso de la carcinogénesis bucal e identificar nuevas alternativas para el diagnóstico de esta enfermedad. La presente revisión de tema tiene como objetivo presentar aspectos teóricos en relación con la TSPO como un biomarcador a estudiar en sujetos con cáncer bucal, considerando su implicación en los procesos de apoptosis celular y participación en el estrés oxidativo

Proteína translocadora mitocondrial 18kDa en saliva como un biomarcador asociado a cáncer bucal

Tesis (Odontólogo). -- Universidad de Cartagena. Facultad de odontología. Departamento de Investigación, 2016Esta trabajo busca cuantificar en saliva la expresión de la proteína translocadora mitocondrial 18kDa (TSPO) en individuos con cáncer bucal o lesiones potencialmente malignas y en individuos sin cáncer en Cartagena, Colombia

Exploratory Analysis of Objective Outcome Measures for the Clinical Assessment of Erosive Tooth Wear.

This study proposed using enamel surface texture and thickness for the objective detection and monitoring of erosive tooth wear (ETW), comparing them to the standard subjective Basic Erosive Wear Evaluation (BEWE). Thirty-two subjects (n = 597 teeth) were enrolled in this longitudinal observational clinical study. Enamel thickness (by cross-polarization optical coherence tomography, CP-OCT) and 3D dental microwear parameters, i.e., area-scale fractal complexity (Asfc), anisotropy (Str), and roughness (Sa) (by white-light scanning confocal profilometry), were obtained from buccal surfaces. Buccal, occlusal, and lingual surfaces were scored for BEWE and the maximum score per tooth (BEWEMax) was determined at baseline and 12 months (M12). Data outcome relationships were evaluated (alpha = 0.05). Enamel thickness decreased (p &lt; 0.001), BEWE scores, Sa, and Str increased (p &lt; 0.001), while Asfc did not change at M12. Baseline BEWEBuccal correlated strongly with BEWEMax (r = 0.86, p &lt; 0.001) and moderately with BEWELingual (r = 0.42, p &lt; 0.001), but not with enamel thickness (r = 0.03, p = 0.43). Change (Δ) in surface texture outcomes correlated poorly but significantly with ΔBEWEBuccal (r = -0.15-0.16, p &lt; 0.001) and did not correlate with Δenamel thickness (r = 0.02-0.09, p &gt; 0.06). Teeth with BEWE progression revealed a greater increase in ΔSa and ΔStr. These findings suggest that enamel surface roughness can potentially determine ETW severity, and CP-OCT may be relevant for clinically monitoring enamel thickness

Risk factors for SARS-CoV-2 transmission in close contacts of adults at high risk of infection due to occupation: results from the contact tracing strategy of the CoVIDA epidemiological surveillance study in Bogotá, Colombia, in 2020–2021

Objectives To estimate the risk factors for SARS-CoV-2 transmission in close contacts of adults at high risk of infection due to occupation, participants of the CoVIDA study, in Bogotá D.C., Colombia.Setting The CoVIDA study was the largest COVID-19 intensified sentinel epidemiological surveillance study in Colombia thus far, performing over 60 000 RT-PCR tests for SARS-CoV-2 infection. The study implemented a contact tracing strategy (via telephone call) to support traditional surveillance actions performed by the local health authority.Participants Close contacts of participants from the CoVIDA study.Primary and secondary outcome measures SARS-CoV-2 testing results were obtained (RT-PCR with CoVIDA or self-reported results). The secondary attack rate (SAR) was calculated using contacts and primary cases features.Results The CoVIDA study performed 1257 contact tracing procedures on primary cases. A total of 5551 close contacts were identified and 1050 secondary cases (21.1%) were found. The highest SAR was found in close contacts: (1) who were spouses (SAR=32.7%; 95% CI 29.1% to 36.4%), (2) of informally employed or unemployed primary cases (SAR=29.1%; 95% CI 25.5% to 32.8%), (3) of symptomatic primary cases (SAR of 25.9%; 95% CI 24.0% to 27.9%) and (4) living in households with more than three people (SAR=22.2%; 95% CI 20.7% to 23.8%). The spouses (OR 3.85; 95% CI 2.60 to 5.70), relatives (OR 1.89; 95% CI 1.33 to 2.70) and close contacts of a symptomatic primary case (OR 1.48; 95% CI 1.24 to 1.77) had an increased risk of being secondary cases compared with non-relatives and close contacts of an asymptomatic index case, respectively.Conclusions Contact tracing strategies must focus on households with socioeconomic vulnerabilities to guarantee isolation and testing to stop the spread of the disease