Systematic Review of Laser and Other Light Therapy for the Management of Oral Mucositis in Cancer Patients

Background The aim of this study was to review the available literature and define clinical practice guidelines for the use of laser and other light therapies for the prevention and treatment of oral mucositis. Methods A systematic review was conducted by the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology. The body of evidence for each intervention, in each cancer treatment setting, was assigned an evidence level. Based onthe evidence level, one of the following three guideline determinations was possible: recommendation, suggestion, and no guideline possible. Results A new recommendation was made for low-level laser (wavelength at 650 nm, power of 40 mW, and each square centimeter treated with the required time to a tissue energy dose of 2 J/cm2 (2 s/point)) for the prevention of oral mucositis in adult patients receiving hematopoietic stem cell transplantation conditioned with high-dose chemotherapy, with or without total body irradiation. A new suggestion was made for low-level laser (wavelength around 632.8 nm) for the prevention of oral mucositis in patients undergoing radiotherapy, without concomitant chemotherapy, for head and neck cancer. No guideline was possible in other populations and for other light sources due to insufficient evidence. Conclusions The increasing evidence in favor of low-level laser therapy allowed for the development of two new guidelines supporting this modality in the populations listed above. Evidence for other populations was also generally encouraging over a range of wavelengths and intensities. However, additional well-designed research is needed to evaluate the efficacy of laser and other light therapies in various cancer treatment settings

Clinical performance of an infliximab rapid quantification assay

Background: Therapeutic drug monitoring (TDM)-based algorithms can be used to guide infliximab (IFX) adjustments in inflammatory bowel disease (IBD) patients. This study aimed to explore a rapid IFX-quantification test from a clinical perspective. Methods: This manuscript describes a prospective cohort study involving 110 ulcerative colitis (UC) patients on the maintenance phase of IFX. IFX trough levels were quantified using a rapid quantification assay and a commonly-used reference kit. Results: Irrespective of the assay used to measure IFX, its through levels were statistically different between patients with and without endoscopic remission (Mayo endoscopic score = 0), as well as between patients stratified by their faecal calprotectin (FC) levels. Despite the fact that the two methods correlated well with each other [Spearman's rank correlation coefficient = 0.843, p < 0.001; intraclass correlation coefficients = 0.857, 95% confidence interval (CI): 0.791-0.903], there was a discernible systematic variation; values obtained with the reference kit were on average 2.62 units higher than those obtained with the rapid assay. Notwithstanding, 3 mu g/ml was shown to be an acceptable cut-off to assess endoscopic status and inflammatory burden levels using both assays. The percentage of patients that had a positive outcome when the IFX concentration measured by the rapid assay ranked above 3 mu g/ml was 88% both for a Mayo endoscopic score <= 1 and for an FC concentration <250 mu g/g. Conclusions: Based on this study, we concluded that using the rapid IFX assessment system with a 3 mu g/ml threshold is a reliable alternative to the time-consuming enzyme-linked immunosorbent assays in patients on the maintenance phase of IFX.Portuguese IBD Group (GEDII, Grupo de Estudo da Doenca Inflamatoria Intestinal)info:eu-repo/semantics/publishedVersio

Soluble human Suppression of Tumorigenicity 2 is associated with endoscopic activity in patients with moderate-to-severe ulcerative colitis treated with golimumab

Suppressor of Tumorigenicity 2 (ST2) is an IL33 receptor detected in the mucosa and serum of ulcerative colitis (UC) patients. We evaluated soluble ST2 (sST2) as a surrogate biomarker of disease outcome and therapeutic response, in moderate-to-severe UC patients treated with golimumab.Agência financiadora Merck Sharp and Dohme, Lda, Portugal MK8259-22info:eu-repo/semantics/publishedVersio

Responding to health needs of women, children and adolescents within Syria during conflict: intervention coverage, challenges and adaptations.

BACKGROUND: Women and children suffer disproportionately in armed-conflicts. Since 2011, the protracted Syrian crisis has fragmented the pre-existing healthcare system. Despite the massive health needs of women and children, the delivery of key reproductive, maternal, newborn, child and adolescent health and nutrition (RMNCAH&N) interventions, and its underlying factors are not well-understood in Syria. Our objective was to document intervention coverage indicators and their implementation challenges inside Syria during conflict. METHODS: We conducted 1) a desk review to extract RMNCAH&N intervention coverage indicators inside Syria during the conflict; and 2) qualitative interviews with decision makers and health program implementers to explore reasons behind provision/non-provision of RMNCAH&N interventions, and the rationale informing decisions, priorities, collaborations and implementation. We attempt to validate findings by triangulating data from both sources. RESULTS: Key findings showed that humanitarian organisations operating in Syria adopted a complex multi-hub structure, and some resorted to remote management to improve accessibility to certain geographic areas. The emergency response prioritised trauma care and infectious disease control. Yet, with time, humanitarian organisations successfully advocated for prioritising maternal and child health and nutrition interventions given evident needs. The volatile security context had implications on populations' healthcare seeking behaviors, such as women reportedly preferring home births, or requesting Caesarean-sections to reduce insecurity risks. Additional findings were glaring data gaps and geographic variations in the availability of data on RMNCAH&N indicators. Adaptations of the humanitarian response included task-shifting to overcome shortage in skilled healthcare workers following their exodus, outreach activities to enhance access to RMNCAH&N services, and operating in 'underground' facilities to avoid risk of attacks. CONCLUSION: The case of Syria provides a unique perspective on creative ways of managing the humanitarian response and delivering RMNCAH&N interventions, mainly in the multi-hub structure and use of remote management, despite encountered challenges. The scarcity of RMNCAH&N data is a tremendous challenge for both researchers and implementing agencies, as it limits accountability and monitoring, thus hindering the evaluation of delivered interventions

Neoplasia Gástrica: Peculiaridades do Adenocarcinoma Mucinoso

Gastric mucinous adenocarcinoma, a rare histological subtype of gastric cancer, is characterized by the presence of calcifications which, together with other peculiarities, allows its suspicion by currently available imaging techniques. The authors describe the case of a patient with this subtype of gastric neoplasia and revise its imaging and pathophysiological characteristics

Care after premenopausal risk-reducing salpingo-oophorectomy in high-risk women: Scoping review and international consensus recommendations

Women at high inherited risk of ovarian cancer are offered risk-reducing salpingo-oophorectomy (RRSO) from age 35 to 45 years. Although potentially life-saving, RRSO may induce symptoms that negatively affect quality of life and impair long-term health. Clinical care following RRSO is often suboptimal. This scoping review describes how RRSO affects short- and long-term health and provides evidence-based international consensus recommendations for care from preoperative counselling to long-term disease prevention. This includes the efficacy and safety of hormonal and non-hormonal treatments for vasomotor symptoms, sleep disturbance and sexual dysfunction and effective approaches to prevent bone and cardiovascular disease

Accuracy of faecal calprotectin and neutrophil Gelatinase B-associated Lipocalin in evaluating subclinical inflammation in UlceRaTIVE colitis-the ACERTIVE study

Background and Aims: Mucosal healing and histological remission are different targets for patients with ulcerative colitis, but both rely on an invasive endoscopic procedure. This study aimed to assess faecal calprotectin and neutrophil gelatinase B-associated lipocalin as biomarkers for disease activity in asymptomatic ulcerative colitis patients. Methods: This was a multicentric cross-sectional study including 371 patients, who were classified according to their endoscopic and histological scores. These results were evaluated alongside the faecal levels of both biomarkers. Results: Macroscopic lesions [i.e. endoscopic Mayo score >= 1] were present in 28% of the patients, and 9% had active disease according to fht Ulcerative Colitis Endoscopic Index of Severity. Moreover, 21% presented with histological inflammation according to the Geboes index, whereas 15% and 5% presented with focal and diffuse basal plasmacytosis, respectively. The faecal levels of calprotectin and neutrophil gelatinase B-associated lipocalin were statistically higher for patients with endoscopic lesions and histological activity. A receiver operating characteristic-based analysis revealed that both biomarkers were able to indicate mucosal healing and histological remission with an acceptable probability, and cut-off levels of 150-250 mu g/g for faecal calprotectin and 12 mu g/g for neutrophil gelatinase B-associated lipocalin were proposed. Conclusions: Faecal calprotectin and neutrophil gelatinase B-associated lipocalin levels are a valuable addition for assessment of disease activity in asymptomatic ulcerative colitis patients. Biological levels of the analysed biomarkers below the proposed thresholds can rule out the presence of macroscopic and microscopic lesions with a probability of 75-93%. However, caution should be applied whenever interpreting positive results, as these biomarkers present consistently low positive predictive values.Portuguese IBD Group [GEDII - Grupo de Estudo da Doenca Inflamatcria Intestinal]info:eu-repo/semantics/publishedVersio

EL IMPACTO Y LAS CONSECUENCIAS DE LA HIPERTENSIÓN ARTERIAL EN EL ACV

O acidente vascular cerebral (AVC) é uma das complicações de maior impacto no mundo, devido a sua prevalência, morbidade e mortalidade, e na maioria dos casos há presença de fatores cardiovasculares, como a hipertensão arterial, que é o seu principal fator de risco modificável, podendo causar diferentes tipos de AVC, como infarto, hemorragia, AVCs grandes ou lacunares e as demências vasculares. O objetivo deste estudo foi analisar e discutir os impactos da hipertensão arterial e os seus fatores de risco que possam levar a um quadro de acidente vascular cerebral. Metodologia: Realizou-se uma revisão de literatura com busca sistemática, com objetivo de coletar e analisar informações atuais sobre esta temática, de forma que contribuiu para um direcionamento clínico, no qual foi utilizada a estratégia do acrônimo PICO. Resultados e discussão: Foram levantadas evidências que contribuíram no direcionamento clínico referente à influência da hipertensão arterial sistêmica no quadro de AVC em indivíduos acima de 50 anos.El accidente cerebrovascular (ACV) es una de las complicaciones más impactantes del mundo, debido a su prevalencia, morbilidad y mortalidad, y en la mayoría de los casos existe la presencia de factores cardiovasculares, como la hipertensión arterial, que es su principal factor de riesgo modificable, que puede causar diferentes tipos de ictus, como infarto, hemorragia, accidentes cerebrovasculares grandes o lacunares y demencias vasculares. El objetivo de este artículo fue analizar y discutir los impactos de la hipertensión y sus factores de riesgo que pueden conducir al accidente cerebrovascular. Metodología: Se realizó una revisión de la literatura con una búsqueda sistemática, con el objetivo de recolectar y analizar información actual sobre este tema, de manera que contribuyera a una dirección clínica, en la que se utilizó la estrategia del acrónimo PICO. Resultados y discusión: Se recogieron evidencias que contribuyeron a la dirección clínica con respecto a la influencia de la hipertensión arterial sistémica en el accidente cerebrovascular en individuos mayores de 50 años.Cerebrovascular accident (CVA) is one of the most impactful complications in the world, due to its prevalence, morbidity and mortality, and in most cases there is the presence of cardiovascular factors, such as arterial hypertension, which is its main modifiable risk factor, which can cause different types of stroke, such as infarction, hemorrhage, large or lacunar strokes and vascular dementias. The objective of this article was to analyze and discuss the impacts of hypertension and its risk factors that may lead to stroke. Methodology: A literature review was carried out with a systematic search, with the objective of collecting and analyzing current information on this theme, in a way that contributed to a clinical direction, in which the strategy of the acronym PICO was used. Results and discussion: Evidence was collected that contributed to the clinical direction regarding the influence of systemic arterial hypertension on stroke in individuals over 50 years of age.O acidente vascular cerebral (AVC) é uma das complicações de maior impacto no mundo, devido a sua prevalência, morbidade e mortalidade, e na maioria dos casos há presença de fatores cardiovasculares, como a hipertensão arterial, que é o seu principal fator de risco modificável, podendo causar diferentes tipos de AVC, como infarto, hemorragia, AVCs grandes ou lacunares e as demências vasculares. O objetivo deste estudo foi analisar e discutir os impactos da hipertensão arterial e os seus fatores de risco que possam levar a um quadro de acidente vascular cerebral. Metodologia: Realizou-se uma revisão de literatura com busca sistemática, com objetivo de coletar e analisar informações atuais sobre esta temática, de forma que contribuiu para um direcionamento clínico, no qual foi utilizada a estratégia do acrônimo PICO. Resultados e discussão: Foram levantadas evidências que contribuíram no direcionamento clínico referente à influência da hipertensão arterial sistêmica no quadro de AVC em indivíduos acima de 50 anos

The COVID-19 pandemic: local to global implications as perceived by urban ecologists

From Springer Nature via Jisc Publications RouterHistory: received 2020-07-27, registration 2020-08-27, accepted 2020-08-27, pub-print 2020-09, pub-electronic 2020-09-11, online 2020-09-11Publication status: PublishedAbstract: The global COVID-19 pandemic is affecting everyone, but in many different ways, stimulating contrasting reactions and responses: opportunities for some, difficulties for many. A simple survey of how individual workers in urban ecology have been coping with COVID-19 constraints found divergent responses to COVID-19 on people’s activities, both within countries and between continents. Many academics felt frustrated at being unable to do fieldwork, but several saw opportunities to change ways of working and review their engagement with the natural world. Some engaging with social groups found new ways of sharing ideas and developing aspirations without face-to-face contact. Practitioners creating and managing urban greenspaces had to devise ways to work and travel while maintaining social distancing. Many feared severe funding impacts from changed local government priorities. Around the world, the COVID-19 pandemic has amplified issues, such as environmental injustice, disaster preparation and food security, that have been endemic in most countries across the global south in modern times. However, developing and sustaining the strong community spirit shown in many places will speed economic recovery and make cities more resilient against future geophysical and people-made disasters. Significantly, top-down responses and one-size-fits-all solutions, however good the modelling on which they are based, are unlikely to succeed without the insights that local knowledge and community understanding can bring. We all will have to look at disaster preparation in a more comprehensive, caring and consistent way in future