Immunotherapy Plus Chemotherapy Versus Chemotherapy Alone as First-Line Treatment for Advanced Urothelial Cancer: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials.

INTRODUCTION: Platinum-based chemotherapy (CTX) has historically been the primary treatment for advanced urothelial cancer (aUC), with limited alternative options. The therapeutic landscape experienced a paradigm shift following the results of the EV-302 and Checkmate-901 trials, which led to the approval of Enfortumab vedotin plus pembrolizumab (EV-P) as the preferred first-line treatment, and nivolumab plus CTX for those unable to receive the preferred regimen. Currently, further investigations are underway to explore PD-1 and PD-L1 inhibitors in the initial treatment of aUC. PATIENTS AND METHODS: We conducted a systematic search across PubMed, Embase, and the Cochrane Library for randomized controlled trials (RCTs) comparing immune checkpoint inhibitors (ICI)-CTX combinations versus CTX alone as first-line treatment for advanced UC. Employing a random-effects model, we pooled hazard ratios (HR) with 95% confidence intervals (CI). RESULTS: Our analysis encompassed 3 RCTs, involving 2162 participants, with 51.16% randomized to combination therapy with platinum-based CTX. Compared to CTX alone, immune-chemotherapy significantly improved overall survival (HR 0.84; 95% CI 0.75-0.93; P < .01), progression-free survival (HR 0.78; 95% CI 0.70-0.86; P < .01), and objective response rate (RR 1.20; 95% CI 1.06-1.36; P < .01), while elevating the risk of immune-related adverse events (P-value = .02). CONCLUSION: In this meta-analysis of RCTs, ICI plus CTX demonstrated a significant association with improved survival at the expense of an increased risk of immune-related adverse events. Therefore, our findings suggest that this combination should be considered as an initial treatment for aUC in platinum-eligible patients who cannot receive EV-P.

Survival and pulmonary function in stage IA non-small cell lung cancer after sublobar resection versus lobectomy: An updated meta-analysis.

Traditionally, lobectomy was standard for stage IA non-small-cell lung cancer (NSCLC). Recent RCTs suggest sublobar resection's comparable outcomes. Our meta-analysis, incorporating 30 studies (including four RCTs), assessed sublobar resection's efficacy. Employing a random-effects model and I2 statistics for heterogeneity, we found sublobar resection reduced DFS (HR 1.31, p < 0.01) and OS (HR 1.27, p < 0.01) overall. However, RCT subgroup analysis showed no significant differences in DFS (p = 0.28) or OS (p = 0.62). Sublobar resection is a viable option for well-selected patients.

[Child and adolescent abuse recorded at a national referral hospital, 2006 - 2011]. / Maltrato infantil y del adolescente registrado en un hospital de referencia nacional, 2006 - 2011.

OBJECTIVES: To describe the records of child and adolescent abuse of the Instituto Nacional de Salud del Niño (INSN) from January 2006 to September 2011, characterizing the victim and perpetrator. MATERIALS AND METHODS: A secondary sources analysis was performed, based on the domestic violence and child abuse records, from froms administered by Child Abuse and Adolescent Health Unit (MAMIS) at the INSN. The records include data of the victim, offender and characteristics of the aggression. Types of aggression were categorized as: sexual, physical, psychological or neglection. Frequencies and percentages are presented. RESULTS: A total of 1798 records were included. From them 63.9% were girls, and 39.9% were adolescents. Males accounted for 60.6% of the offenders, and 65.8% of assaults occurred at home. Sexual assault was recorded in 48.6%, with more frequency among girls (73.2%) and adolescents (44.4%); and intercourse occurred in 9.6% of the cases. CONCLUSIONS: From the INSN MAMIS records, aggressions to girls was the most frequent type of report, the aggressor was often a male and most of the attacks occurred in the child's home. Sexual assault accounted for almost half of the series.

Maltrato infantil y del adolescente registrado en un hospital de referencia nacional, 2006 - 2011 / Child and adolescent abuse recorded at a national referral hospital, 2006 - 2011

Objetivos. Realizar una descripción de los registros del Instituto Nacional de Salud del Niño (INSN), desde enero de 2006 hasta septiembre de 2011, sobre maltrato infantil y del adolescente, lo cual permite la caracterización del agredido y del agresor. Materiales y métodos. Se realizó un análisis de fuentes secundarias, basado en registros de la "Ficha de evaluación de violencia familiar y maltrato infantil", aplicada por el Módulo de Atención al Maltrato Infantil y del Adolescente en Salud (MAMIS) del INSN. La ficha incluye datos del agredido, del agresor y las características de la agresión. Se diferenció el tipo de agresión como: sexual, física, psicológica o por abandono. Se muestran los resultados en frecuencias y porcentajes. Resultados. Se incluyeron 1798 registros. El 63,9% eran niñas y el 39,9% fueron adolescentes. El 60,6% de los agresores fueron varones y el 65,8% de las agresiones ocurrieron en casa. El 48,6% fueron registros de agresión sexual, que fue más frecuente en niñas (73,2%) y adolescentes (44,4%); en el 9,6% de los casos existió coito. Conclusiones. En los registros del MAMIS del INSN, la agresión en niñas fue la más frecuente; el agresor con frecuencia era un varón y la mayoría de las agresiones ocurrieron en el domicilio del menor. La agresión sexual fue casi la mitad de la serie.

Objectives. To describe the records of child and adolescent abuse of the Instituto Nacional de Salud del Niño (INSN) from January 2006 to September 2011, characterizing the victim and perpetrator. Materials and methods. A secondary sources analysis was performed, based on the domestic violence and child abuse records, from froms administered by Child Abuse and Adolescent Health Unit (MAMIS) at the INSN. The records include data of the victim, offender and characteristics of the aggression. Types of aggression were categorized as: sexual, physical, psychological or neglection. Frequencies and percentages are presented. Results. A total of 1798 records were included. From them 63.9% were girls, and 39.9% were adolescents. Males accounted for 60.6% of the offenders, and 65.8% of assaults occurred at home. Sexual assault was recorded in 48.6%, with more frequency among girls (73.2%) and adolescents (44.4%); and intercourse occurred in 9.6% of the cases. Conclusions. From the INSN MAMIS records, aggressions to girls was the most frequent type of report, the aggressor was often a male and most of the attacks occurred in the child’s home. Sexual assault accounted for almost half of the series.

Caracterización de la violencia en niños y adolescentes en el Instituto Nacional de Salud del Niño 2000-2010 / Characterization of the violence in children and teenagers in the National Institute of Health of the Child 2000-2010

Objetivos: describir las características del agresor, de la víctima y según tipo de violencia en niños y basado en la ficha multisectorial de violencia familiar que es conducida por el MAMIS (Módulo de Atención al Maltrato Infantil en Salud) del Instituto Nacional de Salud del Niño (INSN) en el periodo 2006-2011. Metodología: estudio descriptivo observacional retrospectivo análitico retrsopectivo basado en la ficha multisectorial de violencia familiar que es conducida por la MAMIS (Módulo de Atención al Maltrato Infantil en Salud)del Instituto Nacional de Salud del Niño (INSN) en el periodo 2006-2011. La ficha recolecta datos de filiación del agredido, del agresor, del lugar de la agresión las medidas que se tomarán y el seguimiento y es aplicada a niñas y niños de 0 a 18 años atendidos o referidos al INSN por sospecha del maltrato infantil. Análisis de datos usando el programa estadístico SPSS V.18 se aplica Chi cuadrado para las variables cualitativas...

Descripción de la conducta sexual en adultos jóvenes limeños / Description of sexual behaviors in Peruvian younger adults

Objetivo: Describir las conductas sexuales en una muestra de adultos jóvenes limeños de nivel socioeconómico C y D. Diseño: Estudio descriptivo transversal. Lugar: EIGER. Participantes: 156 adultos jóvenes. Intervenciones: Se usó un cuestionario semi-estructurado auto-administrado y se realizó el análisis con el Software STATA 9.0. Principales medidas de resultados: Para comparar las variables cuantitativas de acuerdo a variables cualitativas dicotómicas se usó el test T de Student, previo examen de los supuestos de normalidad por el test de Shapiro Wilk y de homogeneidad de varianzas por el test de Levene, de no cumplirse los supuestos se usó el test de suma de Rangos de Wilxocon. Para evaluar la asociación entre dos variables cualitativas se usó el Test exacto de Fisher. Resultados: La edad promedio de inicio sexual fue de 17.23 ±3.51 años. La primera relación sexual se da con la pareja sentimental, el número promedio de parejas sexuales 1.88 ±1.01 en mujeres y 4.35 ±3.57 en hombres. Tener más de una pareja sexual durante la misma época, usar el Internet para buscar parejas sexuales, acudir a los servicios de prostitución y tener RS con parejas ocasionales conocidas o desconocidas son conductas mayoritariamente practicadas por hombres en nuestro estudio. Conclusiones: La población masculina se encuentra en mayor riesgo por presentar conductas y actitudes más riesgosas que la población femenina.

Objective: To describe sexual behavior patterns in a sample of Peruvian young adults of socioeconomic levels C and D. Study Design: Descriptive, cross- sectional study. Participants: 156 young adults Interventions: We used a self-completed questionnaire and analyzed it with the statistical software package STATA. Main outcome measures: The T test of Student was used to compare the quantitative variables according to the dichotomy qualitative variables, with a previous examination of the suppositions of normality by the test of Shapiro Wilk and the homogeneity of variances by the test of Levene. If the suppositions were not completed, we used the test of sum of Ranges of Wilxocon. To evaluate the association between two qualitative variables, the exact Test of Fisher was used. Results: Respondents have on average, started their sexual life by the age of 17.23 ±3.51 years. Mostly, the initial intercourse is with their partner ; the average number of sexual partners is 1.88 ±1.01 in women and 4.35 ±3.57 in men. To have more than one sexual partner at the same time, to use the Internet with a sexual purpose, to attend prostitution services and to have intercourse with occasional well-known or strangers are behavior patterns practiced mainly by men in our study. Conclusions: Male population is more threatened because of high-risk behavior and attitudes than female population.

Acceso a páginas pornográficas en Internet y Comunicación familiar sobre sexualidad en adolescentes del distrito de ôEl Agustinoõ, Lima - Péru 2006- 2007 / Access to pornographic web and familiar communication on sexuality in teenagers of the district of ôEl Agustinoõ, Lima - Peru 2006-2007

Se ha realizado un estudio descriptivo transversal, en 10 colegios del Distrito de El Agustino-Lima; desarrollándose un cuestionario en una población total de 1107 adolescentes, siendo el 50% (n=553) de sexo masculino y 50% (n=554) de sexo femenino, indagando sobre el acceso a las páginas pornográficas en Internet, el lugar donde lo realizan y la comunicación familiar global entre progenitores y los mismos. El 30.4% (n=337) de los adolescentes visitan páginas pornográficas; siendo los lugares predominantes de acceso a éstas páginas pornográficas: en cabinas de Internet 22.3% (n=247), en hogares 2.7% (n=30) y en colegios 2.7% (n=30). La comunicación familiar global entre los progenitores y los adolescentes fue insuficiente en un 95.4% (n=1056). Se demostró que el sexo masculino tiene mayor accesibilidad a páginas pornográficas en Internet (33.1%; n=183) con un Chi Cuadrado de Pearson p=0.000; Los adolescentes de 13 y 14 años de edad (33.8%; n=114) son los que más páginas pornográficas en Internet visitan (p=0.000). Finalmente la comunicación familiar global fue deficiente tanto en el grupo de adolescentes que visitan páginas pornográficas (29%; n=321) como en el grupo de adolescentes que no visitan páginas pornográficas en Internet (66.4; n=735) con un Chi Cuadrado de Pearson p=0.538.

A descriptive transverse study, in 10 high schools of the District of ôEl Agustinoõ- Lima was performed, developing a questionnaire in a total population of 1107 teenagers, 50 % (n=553) male and 50 % (n=554) female. We researched on the access to pornography pages in Internet, the place where they do get access to pornography and the family global communication between teenagers and their parents. Pornography pages were visited by 30.4 % (n=337) of the teenagers. The predominant places of access to these in Internet were: internet public places 22.3 % (n=247), homes 2.7 % (n=30) and in schools 2.7 % (n=30). Family global communication between parents and teenagers was insufficient in 95.4 % (n=1056) of cases. It was shown that males have greater accessibility to pornography pages in Internet (33.1 %; n=183) with a Chi Square of Pearson p=0.000. Thirteen and fourteen year old teenagers (33.8 %; n=114) are the ones with more visits to the Internet pornography pages (p=0.000). Finally, family global communication was poor in the group of teenagers who visit pornography pages (29 %; n=321) as well as in the group of teenagers who did not visit pornography pages in Internet (66.4; n=735) with a Square Chi of Pearson p=0.538.