Changes in the “minor surgery” program at a health center after 10 years. Differences in techniques, diagnoses, coverage and efficiency

Objetivos. Se desean conocer los cambios en el programa de cirugía menor de un centro de salud urbano tras una década desde su implantación, valorando la cobertura, las características de los pacientes y los profesionales implicados, los procedimientos realizados, la concordancia diagnóstica y la eficiencia del mismo. Material y métodos. Se diseña un estudio descriptivo transversal, mediante auditoría de historias y registros clínicos escritos entre los años 2007 y 2017. Se recoge el tipo de procedimiento realizado, la edad del paciente, el profesional que interviene, el envío de muestras a anatomía patológica, así como los diagnósticos clínicos y anatomopatológicos. Se estimará la diferencia del gasto realizado con el ocasionado en caso de derivación al hospital. Se realizará un análisis descriptivo y bivariante según el año de estudio. Resultados. Se valoran 477 actos quirúrgicos (53% en 2017), con edad media del paciente de 49,9 años (±17,9) (superior en 9 años en 2017, p<0,001 t Student). Se incrementa el porcentaje de MIR y enfermeros participantes al doble (p<0,05 Χ2) aunque el principal actor es el médico de familia. Mejora el envío correcto de muestras a anatomía patológica un 16% (p<0,001 Χ2) con una moderada- alta concordancia entre diagnóstico clínico y anatomopatológico (kappa 0,746 en 2007, 0,554 en 2017; p<0,001 Χ2). Incrementan las escisiones de piel e infiltraciones, disminuye el uso de la criocirugía y algunos procedimientos (matricectomía, drenaje) siguen sin realizarse. Se estima un coste inferior al hospitalario en un 320%. Conclusiones. La cirugía menor realizada en el centro de salud se muestra capaz tanto en patologías tratadas como en cuanto ahorro respecto a otros ámbitos. La diversidad de intervenciones y de personal sanitario hace necesario una mayor incorporación de plantilla y de formación.Our objective is to assess the changes occurred in the minor surgery program of an urban health centre. We designed a cross-sectional descriptive study to perform audits of patients history and clinical records of 2007 and 2017.477 surgical acts were evaluated. Patient mean age is 49,9 years. Percentage of resident doctors and participating nurses is double on 2017, although the main actor is the general practitioner. The right consignment of tissue samples to pathological anatomy is improved in a 16% with a high diagnostic concordance (kappa 0,703). Skin excisions and infiltrations are increased, cryosurgery is decreased. Costs are estimated to be 320% lower to hospital ones. The results of minor surgery carried out in primary-care are comparable to hospitals; however, costs are lower in primary setting. The diversity of interventions and health staff involved, makes necessary a greater incorporation of staff and training hours

Persistence, clearance and reinfection regarding six high risk human papillomavirus types in Colombian women : A follow-up study

Background: The design of new healthcare schemes which involve using molecular HPV screening means that both persistence and clearance data regarding the most prevalent types of HR-HPV occurring in cities in Colombia must be ascertained.Methods: This study involved 219 HPV positive women in all of whom 6 types of HR-HPV had been molecularly identified and quantified; they were followed-up for 2 years. The Kaplan-Meier survival function was used for calculating the time taken for the clearance of each type of HPV. The role of a group of independent variables concerning the time taken until clearance was evaluated using a Cox proportional-hazards regression model or parametric (log-logistic) methods when necessary. Regarding viral load, the Wilcoxon rank-sum test was used for measuring the difference of medians for viral load for each type, according to the state of infection (cleared or persistent). The Kruskal-Wallis test was used for evaluating the change in the women's colposcopy findings at the start of follow-up and at the end of it (whether due to clearance or the end of the follow-up period).Results: It was found that HPV-18 and HPV-31 types had the lowest probability of becoming cleared (1.76 and 2.75 per 100 patients/month rate, respectively). Women from Colombian cities other than Bogotá had a greater probability of being cleared if they had HPV-16 (HR 2.58: 1.51-4.4 95% CI) or HPV-58 (1.79 time ratio: 1.33-2.39 95% CI) infection. Regarding viral load, HPV-45-infected women having 1 × 106 to 9.99 × 109 viral copies had better clearance compared to those having greater viral loads (1.61 time ratio: 1.01-2.57 95% CI). Lower HPV-31 viral load values were associated with this type's persistence and changes in colposcopy findings for HPV-16 gave the worst prognosis in women having low absolute load values.Conclusions: HPV infection clearance in this study was related to factors such as infection type, viral load and the characteristics of the cities from which the women came. Low viral load values would indicate viral persistence and a worse prognosis regarding a change in colposcopy findings. © 2014 Soto-De León et al.; licensee BioMed Central Ltd

MARGINAL DISCREPANCY OF ZIRCONIUM OXIDE COPINGS MADE WITH TWO CAD/CAM SYSTEMS

Purpose: To compare the marginal discrepancy of copings made in zirconium oxide with two systems CAD/CAM.Methods: In vitro marginal discrepancies of two systems CAD/CAM (Procera® and Everest®) for ceramic copings and a control group of gold copings were evaluated and compared. A first one human premolar superior was prepared, duplicate 30 times and divided in three groups. Ten copings by group were made. The measurements of marginal discrepancy were made on the natural tooth, on 20 points distributed randomly around the margin preparation. A 3D microscope video was used with magnification of 200X. Values of average and standard deviation were calculated for the marginal openings. The data were analyzed with analysis of variance of a route ANOVA.Results: mean of the marginal discrepancies and standard deviations of the copings were 29±8.6 um for the control group, 22,31±14.6um for Everest® and 21.55±6.9um for Procera®. Significant differences were not found between the copings of the three groups (P&gt; 0.05).Conclusions: The marginal discrepancies were all within the clinically acceptable standard set at 50-100mm, However, Procera® and Everest® systems showed the smallest marginal discrepancies compared with the copings made in an alloy of medium gold content.Objetivo: Comparar la discrepancia marginal de cofias elaboradas en óxido de zirconio con dos sistemas CAD/CAM. Materiales y métodos: Discrepancias marginales in vitro de dos sistemas CAD/CAM (Procera® y Everest®) para cofias cerámicas y un grupo control de cofias en oro fueron evaluadas y comparadas. Un primer premolar superior humano fue preparado, duplicado 30 veces y dividido en 3 grupos. Diez cofias por grupo fueron fabricadas. Las mediciones de discrepancia marginal fueron realizadas sobre el diente natural, sobre 20 puntos distribuidos aleatoriamente alrededor del margen preparado. Se utilizó un video microscopio 3D con magnificación de 200X. Valores de media y desviación estándar fueron calculados para las aperturas marginales. Los datos fueron analizados con análisis de varianza de una vía ANOVA. Resultados: Los promedios de las discrepancias marginales y desviaciones estándar de las cofias fueron 29 ±8.6 micras para el grupo control, 22.31 ±14.6 micras para el Everest® y 21.55 ±6.9 micras para Procera®. No fueron encontradas diferencias significativas entre las cofias de los tres grupos (P &gt;0.05). Conclusiones: Las discrepancias marginales obtenidas se encuentran dentro de los rangos clínicamente aceptables entre 50-100 micras; sin embargo, Procera® y Everest® presentaron menores discrepancias marginales comparadas con las cofias elaboradas en una aleación de mediano contenido de oro.[Pinilla SM, Barrera GC, Palomino EE, Quijano MA, Henao D. Discrepancia marginal de cofias en zirconio elaboradas con dos sistemas CAD/CAM. Ustasalud 2009; 8: 9 - 18

High expression of antiviral proteins in mucosa from individuals exhibiting resistance to human immunodeficiency virus

ABSTARCT: Several soluble factors have been reported to have the capacity of inhibiting HIV replication at different steps of the virus life cycle, without eliminating infected cells and through enhancement of specific cellular mechanisms. Yet, it is unclear if these antiviral factors play a role in the protection from HIV infection or in the control of viral replication. Here we evaluated two cohorts: i) one of 58 HIV-exposed seronegative individuals (HESNs) who were compared with 59 healthy controls (HCs), and ii) another of 13 HIV-controllers who were compared with 20 HIV-progressors. Peripheral blood, oral and genital mucosa and gut-associated lymphoid tissue (GALT) samples were obtained to analyze the mRNA expression of ELAFIN, APOBEC3G, SAMHD1, TRIM5α, RNase 7 and SerpinA1 using real-time PCR. RESULTS: HESNs exhibited higher expression of all antiviral factors in peripheral blood mononuclear cells (PBMCs), oral or genital mucosa when compared with HCs. Furthermore, HIV-controllers exhibited higher levels of SerpinA1 in GALT. CONCLUSIONS: These findings suggest that the activity of these factors is compartmentalized and that these proteins have a predominant role depending on the tissue to avoid the infection, reduce the viral load and modulate the susceptibility to HIV infection

MOLNUPIRAVIR COMPARED TO NIRMATRELVIR/RITONAVIR FOR COVID-19 IN HIGH-RISK PATIENTS WITH HAEMATOLOGICAL MALIGNANCY IN EUROPE. A MATCHED-PAIRED ANALYSIS FROM THE EPICOVIDEHA REGISTRY

Introduction: Molnupiravir and nirmatrelvir/ritonavir are antivirals used to prevent progression to severe SARS-CoV-2 infections, which reduce both hospitalization and mortality rates. Nirmatrelvir/ritonavir was authorised in Europe in December 2021, while molnupiravir is not yet licensed in Europe as of February 2022. Molnupiravir may be an alternative to nirmatrelvir/ritonavir, because it displays less frequent drug-drug interactions and contraindications. A caveat connected to molnupiravir derives from the mode of action inducing viral mutations. In clinical trials on patients without haematological malignancy, mortality rate reduction of molnupiravir appeared less pronounced than that of nirmatrelvir/ritonavir. Little is known about the comparative efficacy of the two drugs in patients with haematological malignancy at high-risk of severe COVID-19. Thus, we here assess the effectiveness of molnupiravir compared to nirmatrelvir/ritonavir in our cohort of patients with haematological malignancies. Methods: Clinical data of patients treated either with molnupiravir or nirmatrelvir/ritonavir monotherapy for COVID-19 were retrieved from the EPICOVIDEHA registry. Patients treated with molnupiravir were matched by sex, age (±10 years), and baseline haematological malignancy severity to controls treated with nirmatrelvir/ritonavir. Results: A total of 116 patients receiving molnupiravir for the clinical management of COVID-19 were matched to an equal number of controls receiving nirmatrelvir/ritonavir. In each of the groups, 68 (59%) patients were male; with a median age of 64 years (IQR 53-74) for molnupiravir recipients and 64 years (IQR 54-73) for nirmatrelvir/ritonavir recipients; 57% (n=66) of the patients had controlled baseline haematological malignancy, 13% (n=15) stable, and 30% (n=35) had active disease at COVID-19 onset in each of the groups. During COVID-19 infection, one third of patients from each group were admitted to hospital. Although a similar proportion of vaccinated patients was observed in both groups (molnupiravir n=77, 66% vs nirmatrelvir/ritonavir n=87, 75%), those treated with nirmatrelvir/ritonavir had more often received four doses (n=27, 23%) as compared to patients treated with molnupiravir (n=5, 4%, p&lt;0.001). No differences were detected in COVID-19 severity (p=0.39) or hospitalization (p=1.0). No statistically significant differences were identified in overall mortality rate (p=0.78) or in survival probability (d30 p=0.19, d60 p=0.67, d90 p=0.68, last day of follow up p=0.68). In all patients, deaths were either attributed to COVID-19 or the infection contributed to death as per treating physician's judgement. Conclusions: In high-risk patients with haematological malignancies and COVID-19, molnupiravir showed rates of hospitalization and mortality comparable to those of nirmatrelvir/ritonavir in this matched-pair analysis. Molnupiravir appears to be a plausible alternative to nirmatrelvir/ritonavir for COVID-19 treatment in patients with haematological malignancy

Worldwide comparison of survival from childhood leukaemia for 1995–2009, by subtype, age, and sex (CONCORD-2): a population-based study of individual data for 89 828 children from 198 registries in 53 countries

Background Global inequalities in access to health care are reflected in differences in cancer survival. The CONCORD programme was designed to assess worldwide differences and trends in population-based cancer survival. In this population-based study, we aimed to estimate survival inequalities globally for several subtypes of childhood leukaemia. Methods Cancer registries participating in CONCORD were asked to submit tumour registrations for all children aged 0-14 years who were diagnosed with leukaemia between Jan 1, 1995, and Dec 31, 2009, and followed up until Dec 31, 2009. Haematological malignancies were defined by morphology codes in the International Classification of Diseases for Oncology, third revision. We excluded data from registries from which the data were judged to be less reliable, or included only lymphomas, and data from countries in which data for fewer than ten children were available for analysis. We also excluded records because of a missing date of birth, diagnosis, or last known vital status. We estimated 5-year net survival (ie, the probability of surviving at least 5 years after diagnosis, after controlling for deaths from other causes [background mortality]) for children by calendar period of diagnosis (1995-99, 2000-04, and 2005-09), sex, and age at diagnosis (< 1, 1-4, 5-9, and 10-14 years, inclusive) using appropriate life tables. We estimated age-standardised net survival for international comparison of survival trends for precursor-cell acute lymphoblastic leukaemia (ALL) and acute myeloid leukaemia (AML). Findings We analysed data from 89 828 children from 198 registries in 53 countries. During 1995-99, 5-year agestandardised net survival for all lymphoid leukaemias combined ranged from 10.6% (95% CI 3.1-18.2) in the Chinese registries to 86.8% (81.6-92.0) in Austria. International differences in 5-year survival for childhood leukaemia were still large as recently as 2005-09, when age-standardised survival for lymphoid leukaemias ranged from 52.4% (95% CI 42.8-61.9) in Cali, Colombia, to 91.6% (89.5-93.6) in the German registries, and for AML ranged from 33.3% (18.9-47.7) in Bulgaria to 78.2% (72.0-84.3) in German registries. Survival from precursor-cell ALL was very close to that of all lymphoid leukaemias combined, with similar variation. In most countries, survival from AML improved more than survival from ALL between 2000-04 and 2005-09. Survival for each type of leukaemia varied markedly with age: survival was highest for children aged 1-4 and 5-9 years, and lowest for infants (younger than 1 year). There was no systematic difference in survival between boys and girls. Interpretation Global inequalities in survival from childhood leukaemia have narrowed with time but remain very wide for both ALL and AML. These results provide useful information for health policy makers on the effectiveness of health-care systems and for cancer policy makers to reduce inequalities in childhood survival

Early life child micronutrient status, maternal reasoning, and a nurturing household environment have persistent influences on child cognitive development at age 5 years: Results from MAL-ED

Background: Child cognitive development is influenced by early-life insults and protective factors. To what extent these factors have a long-term legacy on child development and hence fulfillment of cognitive potential is unknown. Objective: The aim of this study was to examine the relation between early-life factors (birth to 2 y) and cognitive development at 5 y. Methods: Observational follow-up visits were made of children at 5 y, previously enrolled in the community-based MAL-ED longitudinal cohort. The burden of enteropathogens, prevalence of illness, complementary diet intake, micronutrient status, and household and maternal factors from birth to 2 y were extensively measured and their relation with the Wechsler Preschool Primary Scales of Intelligence at 5 y was examined through use of linear regression. Results: Cognitive T-scores from 813 of 1198 (68%) children were examined and 5 variables had significant associations in multivariable models: mean child plasma transferrin receptor concentration (β: −1.81, 95% CI: −2.75, −0.86), number of years of maternal education (β: 0.27, 95% CI: 0.08, 0.45), maternal cognitive reasoning score (β: 0.09, 95% CI: 0.03, 0.15), household assets score (β: 0.64, 95% CI: 0.24, 1.04), and HOME child cleanliness factor (β: 0.60, 95% CI: 0.05, 1.15). In multivariable models, the mean rate of enteropathogen detections, burden of illness, and complementary food intakes between birth and 2 y were not significantly related to 5-y cognition. Conclusions: A nurturing home context in terms of a healthy/clean environment and household wealth, provision of adequate micronutrients, maternal education, and cognitive reasoning have a strong and persistent influence on child cognitive development. Efforts addressing aspects of poverty around micronutrient status, nurturing caregiving, and enabling home environments are likely to have lasting positive impacts on child cognitive development.publishedVersio

Copernicus Ocean State Report, issue 6

The 6th issue of the Copernicus OSR incorporates a large range of topics for the blue, white and green ocean for all European regional seas, and the global ocean over 1993–2020 with a special focus on 2020