Sociodemographic disparities in oral health-related quality of life of schoolchildren in rural and urban areas.

OBJECTIVE: To assess the association between residence place, socioeconomic conditions and oral health-related quality of life (OHRQoL) among schoolchildren from southern Brazil. METHODS: Participants were 9-14-year-old schoolchildren from rural and urban municipal schools from Rosário do Sul, Brazil. The Child Perceptions Questionnaire (CPQ11-14) was used to assess OHRQoL. A structured questionnaire collected data on sociodemographic condition (family income), residence place (urban or rural), use of dental services, and behavioral variables. Clinical oral examination recorded the presence of missing teeth and the gingival bleeding index. Multilevel Poisson regression analysis with a hierarchical approach assessed the association between predictors and CPQ11-14 scores. Rate ratios (RR) and 95% confidence intervals (CI) were estimated. RESULTS: A total of 373 schoolchildren were included (rural area=122; urban area=251), with a mean CPQ11-14 score of 11.83, ranging from 0 to 42. Low-income schoolchildren living in rural areas had 15% higher CPQ11-14 scores than high-income schoolchildren living in urban areas. In urban areas, family income predicted OHRQoL, with low-income schoolchildren having 9% higher CPQ11-14 scores than high-income children. In rural areas, schoolchildren with low household income had 19% higher CPQ11-14 scores than high-income children. CONCLUSION: Schoolchildren from low-income families had a poorer OHRQoL irrespective of their area of residence (rural or urban). The association between family income and OHRQoL was more pronounced among children living in rural areas.

Does neoadjuvant treatment in resectable pancreatic cancer improve overall survival? A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Neoadjuvant chemotherapy may improve overall survival (OS) in 'borderline' resectable pancreatic cancer (RPC). Whether the results are the same in upfront RPC is unknown. MATERIALS AND METHODS: To evaluate the association of neoadjuvant treatment and survival outcomes in RPC, a systematic literature review was carried out including prospective randomized trials of neoadjuvant treatment versus upfront surgery. Articles indexed in PubMed, Embase and Scopus were evaluated. Data regarding systemic treatment regimens, R0 resection rates, disease-free survival (DFS) and OS were extracted. The outcomes were compared using a random-effects model. The index I2 and the graphs of funnel plot were used for the interpretation of the data. RESULTS: Of 3229 abstracts, 6 randomized controlled trials were considered eligible with a combined sample size of 805 RPC patients. Among the trials, PACT-15, PREP-02/JSAP-05 and updated long-term results from PREOPANC and NEONAX trials were included. Combining the studies with meta-analysis, we could see that neoadjuvant treatment in RPC does not improve DFS [hazard ratio (HR) 0.71 (0.46-1.09)] or OS [HR 0.76 (0.52-1.11)], without significant heterogeneity. Interestingly, R0 rates improved ∼20% with the neoadjuvant approach [HR 1.2 (1.04-1.37)]. It is important to note that most studies evaluated gemcitabine-based regimens in the neoadjuvant setting. CONCLUSIONS: Neoadjuvant chemotherapy or chemoradiation does not improve DFS or OS in RPC compared to upfront surgery followed by adjuvant treatment. Neoadjuvant treatment improves R0 rates by ∼20%. Randomized ongoing trials are eagerly awaited with more active combined regimens including modified FOLFIRINOX.

Treatment With a Three-Drug Regimen for Pulmonary Tuberculosis Based on Rapid Molecular Detection of Isoniazid Resistance: A Noninferiority Randomized Trial (FAST-TB).

Background: The rationale behind the use of ethambutol in the standard tuberculosis treatment is to prevent the emergence of resistance to rifampicin in case of primary resistance to isoniazid. We evaluated whether early detection of isoniazid resistance using molecular testing allows the use an ethambutol-free regimen. Methods: FAST-TB, a phase 4, French, multicenter, open-label, non-inferiority trial, compared 2 strategies: (1) polymerase chain reaction (PCR)-based detection of isoniazid and rifampicin resistance at baseline using Genotype MTBDRplus version 2.0 followed by ethambutol discontinuation if no resistance was detected (PCR arm) and (2) a standard 4-drug combination, pending phenotypic drug-susceptibility results (C arm). Adult patients with smear-positive pulmonary tuberculosis were enrolled. The primary endpoint was the proportion of patients with treatment success defined as bacteriological or clinical cure at the end of treatment. A non-inferiority margin of 10% was used. Results: Two hundred three patients were randomized, 104 in the PCR arm and 99 in the C arm: 26.6% were female, median age was 37 (interquartile range, 28-51) years, 72.4% were born in Africa, and 5.4% were infected with human immunodeficiency virus. Chest x-ray showed cavities in 64.5% of the cases. Overall, 169 patients met criteria of treatment success: 87 of 104 (83.7%) in the PCR arm and 82 of 99 (82.8%) in the C arm with a difference of +0.8% (90% confidence interval, -7.9 to 9.6), meeting the noninferiority criteria in the intention-to-treat population (P = .02). Conclusions: In a setting with low prevalence of primary isoniazid resistance, a 3-drug combination with isoniazid, rifampicin, and pyrazinamide, based on rapid detection of isoniazid resistance using molecular testing, was noninferior to starting the recommended 4-drug regimen.

Co-infections and superinfections complicating COVID-19 in cancer patients: A multicentre, international study.

BACKGROUND: We aimed to describe the epidemiology, risk factors, and clinical outcomes of co-infections and superinfections in onco-hematological patients with COVID-19. METHODS: International, multicentre cohort study of cancer patients with COVID-19. All patients were included in the analysis of co-infections at diagnosis, while only patients admitted at least 48 h were included in the analysis of superinfections. RESULTS: 684 patients were included (384 with solid tumors and 300 with hematological malignancies). Co-infections and superinfections were documented in 7.8% (54/684) and 19.1% (113/590) of patients, respectively. Lower respiratory tract infections were the most frequent infectious complications, most often caused by Streptococcus pneumoniae and Pseudomonas aeruginosa. Only seven patients developed opportunistic infections. Compared to patients without infectious complications, those with infections had worse outcomes, with high rates of acute respiratory distress syndrome, intensive care unit (ICU) admission, and case-fatality rates. Neutropenia, ICU admission and high levels of C-reactive protein (CRP) were independent risk factors for infections. CONCLUSIONS: Infectious complications in cancer patients with COVID-19 were lower than expected, affecting mainly neutropenic patients with high levels of CRP and/or ICU admission. The rate of opportunistic infections was unexpectedly low. The use of empiric antimicrobials in cancer patients with COVID-19 needs to be optimized.

[Pneumocystis jirovecii and quantitative PCR: Pneumonia or colonization?] / Pneumocytis jirovecii et PCR quantitative : pneumonie ou colonisation à Pneumocystis jirovecii ?

BACKGROUND: Quantitative PCR to detect Pneumocystis jirovecii (Pj) is a new tool for the diagnosis of Pneumocystis jirovecii pneumonia (PJP). The yield of this technique, in cases of low fungal burden, when the standard technique using immunofluorescence (IF) is negative, needs to be evaluated. METHODS: We retrospectively reviewed the charts of all patients with a positive PCR but negative IF test (PCR+/IF-) in bronchoalveolar lavage (BAL) fluid performed over one year. We used an algorithm based on underlying immunosuppression, clinical picture, thoracic CT scan appearances, existence of an alternative diagnosis and the patient's outcome on treatment. Using this, each case was classified as probable PJP, possible PJP or colonization. RESULTS: Among the 416 BAL performed, 48 (12%) were PCR+/IF- and 43 patients were analyzed. Patients were mostly male (56%) with a median age of 60 years. Thirty-five (84%) were immunocompromised: 4 (9%) HIV-infected patients, 26 (60%) with hematologic or solid organ cancer, 3 (7%) were renal transplant recipients. Seven (16%) were classified as probable PPJ and 9 (21%) as possible PJP. Patients with a probable or possible PJP were more frequently admitted to the ICU (P<0.02) and had higher risk of death (P<0.01) when compared to those with colonization. Median PCR levels were very low and were not different between PJP or colonized patients (P=0.23). CONCLUSIONS: Among patients with a positive Pj PCR in BAL but with negative IF, only 37% had probable or possible PJP and PCR could not discriminate PJP from colonization.

Airplane cabin waste characterization: Knowing the waste for sustainable management and future recommendations.

The aviation industry generates a significant amount of comingle waste. Nowadays, companies are making efforts to enhance waste management and reduce waste generation. In order to improve present practices and implement a proper waste management system, the quantities, materials, and typology of waste generated need to be studied. A total of 145 airplanes were analysed. We differentiated 5 strips of duration and identified 4 different generation sources within the cabin associated to the business and tourist passenger classes. We classified and characterized the waste into 20 different materials. Results provide a detailed, representative and adapted study of the catering waste generated in the aviation industry. The characterization, which allows distinguishing between manipulated and unmanipulated materials, aims at providing useful information to reduce the generation of waste. The analysis performed in the present study shows that the flying distance increases the waste generation, as more food is served. It also shows that organic matter, paper/cardboard and packaging are the dominant materials in the waste generated in flights. The results of the characterizations obtained allow making some recommendations. The use of bi-compartmentalized waste trolleys to separate on-board recyclable materials from the rest is desirable to obtain a clean recoverable waste stream. Supressing unpopular food from menus, identified analysing the leftovers, could also reduce the amount of waste generated. (This characterization study is part of the European project LIFE + Zero Cabin Waste.). Changes in the CE 1069/2009 regulation would allow more waste to be recycled instead of landfilled. Ultimately, the information obtained from this study will be used to design a more sustainable waste management system.

Bacillus Calmette-Guerin infection following intravesical instillation: Does the strain matter?

PURPOSE: Intravesical BCG is the standard treatment of non-muscle invasive bladder cancer. No difference has yet been reported in the safety profiles of the various BCG strains. METHODS: A nationwide multidisciplinary retrospective survey was conducted between January 2013 and December 2016 to identify cases of BCG infection and differentiate them based on the type of BCG strain used. RESULTS: Forty patients were identified (BCG RIVM 28; other strains 8; unknown 4). Patients treated with BCG RIVM were less severely ill, with fewer occurrences of septic shock (3.6% vs. 50%, P=0.003) and ICU admission (7.1% vs. 62.5%, P=0.003). A higher frequency of pulmonary miliaries (71.4% vs. 12.5%, P=0.005) but lower transaminase levels (mean AST 65 vs. 264 U/L, P=0.001) were observed in these patients. No difference in terms of recovery was reported. CONCLUSION: The type of BCG strain could correlate with the frequency and severity of subsequent BCG infections.

[BCG infection following intravesicular immunotherapy for bladder cancer]. / BCGites après immunothérapie pour cancer de vessie, une pathologie hétérogène: physiopathologie, description clinique, prise en charge diagnostique et thérapeutique.

BACKGROUND: Bacille of Calmette et Guérin (BCG) immunotherapy is the most effective treatment for non-muscle-invasive bladder cancer. Yet, potentially severe localized or systemic mycobacterial infections can happen. STATE OF KNOWLEDGE: In a patient who underwent BCG instillation for bladder cancer, the diagnosis of BCG infection is usually suggested by more than 3 days of high-grade fever and systemic and/or local symptoms with no other plausible alternative diagnosis. BCG infection can be localized (usually to the genitourinary tract, the bones or blood vessels) or systemic (mainly with pulmonary and hepatic involvements). The presence of granuloma in tissue biopsies (other than from the genitourinary tract) supports the diagnosis. The advent of polymerase chain reaction has recently improved the sensitivity of microbiological investigations. The management of BCG infection is not well established but relies on broad-spectrum antimycobacterial therapy (with the exclusion of pyrazinamide), glucocorticoids (in the context of general symptoms refractory to antimicrobial therapy alone) and occasionally surgery. CONCLUSION: BCG infection is a rare but not exceptional complication of BCG immunotherapy with heterogeneous clinical presentation. Prospective studies are warranted in order to improve treatment outcomes.

First next-generation sequencing full-genome characterization of a hepatitis C virus genotype 7 divergent subtype.

We report the near-full-length genome sequence of a hepatitis C virus (HCV) isolate from a man originating from Democratic Republic of Congo, the genotype of which could not be determined by the routinely used sequencing technique. The near-complete genome sequence of this variant BAK1 was obtained by the association of two next-generation sequencing technologies. Evolutionary analysis indicates that this isolate, BAK1, could be the first reported strain belonging to a new HCV-7b subtype. This new subtype has been incorrectly identified as genotype 2 by the Versant HCV Genotype 2.0 assay (LiPA). The requirement of three independent isolates has been filled, and a new subtype can be assigned. More examples of HCV-7 are required to better understand its origin, its pathogenicity and its relationship with genotype 2.

Archived HIV-1 DNA resistance mutations to rilpivirine and etravirine in successfully treated HIV-1-infected individuals pre-exposed to efavirenz or nevirapine.

OBJECTIVES: Efavirenz and nevirapine failure is associated with a rapid selection of resistance-associated mutations (RAMs), which may impact on etravirine or rilpivirine susceptibility. However, RAMs for rilpivirine and etravirine cannot be reported on previous resistance genotypes because these specific RAMs were not analyzed at that time. Therefore, our objective was to determine, in virologically suppressed HIV-1-infected individuals, the presence of RAMs to rilpivirine, etravirine and the combination of tenofovir/emtricitabine/rilpivirine in HIV-1 DNA from individuals previously exposed to efavirenz and/or nevirapine. METHODS: The studied population included 169 treatment-experienced individuals enrolled in the ANRS 138-EASIER trial who previously failed on and/or were intolerant to efavirenz and/or nevirapine and who had plasma HIV-1 RNA<400 copies/mL. Resistance to rilpivirine, etravirine, tenofovir and emtricitabine by bulk sequencing was performed on extracted HIV-1 DNA from whole blood collected at the time of trial inclusion. RESULTS: Reverse transcriptase gene amplification was successful in 128/169 (76%) individuals and 95% of HIV-1 were infected with subtype B. Rilpivirine RAMs were detected in 41 (32%) individuals, with highest frequency for the mutations Y181C/I/V (18%), K101E/P (7%) and E138A/G/K/Q/R/S (6%) and the association L100I+K103N/S (5%). Etravirine RAMs were detected in five (4%) individuals. Resistance to emtricitabine, tenofovir and at least one drug included in the combination of tenofovir/emtricitabine/rilpivirine were detected in 72 (56%), 12 (9%) and 88 (69%), respectively. CONCLUSIONS: In individuals with suppressed viraemia under antiretroviral therapy (ART), but who had been previously exposed to an efavirenz and/or nevirapine-based regimen, rilpivirine RAMs are frequent and etravirine RAMs are rare. This finding suggests that the switch to a rilpivirine-based regimen should not be recommended.

Impaired responses to gliadin and gut microbes of immune cells from mice with altered stress-related behavior and premature immune senescence.

Stress is associated with impaired communication between the nervous and immune systems leading to immunosenescence and increased disease risk. We investigated whether leukocytes from mice with altered stress-related behavior and premature immunosenescence, as well as from chronologically aged mice differently responded ex vivo to celiac disease (CD) triggers (gliadin) and intestinal bacteria by ELISA and flow cytometry and differed in microbiota composition. We found that altered stress-related behavior and premature immunosenescence led to alterations in T lymphocytes and cytokine release of immune cells basally and in response to peptic fragments of gliadin and commensal and pathogenic bacteria, possibly increasing susceptibility to CD in adulthood.

Medication non-adherence as a cause of hospital admissions.

OBJECTIVES: 1. To determine the profile of patients who are admitted to hospital as a result of non-adherence. 2. To obtain an estimate of the economic impact for the hospital. METHODS: Observational and retrospective study that included patients who were admitted to hospital with a secondary diagnosis of «Personal history of non-compliance with chronic medication¼ according to International Classification of Diseases, during 2012. DATA COLLECTED: demographics; socioeconomic and clinical data; data related to the treatment; readmissions; hospital days; degree of adherence: ≤ 75% or severe non-adherence and > 75% or moderate non-adherence; type of non-adherence: non-persistence and noncompliance; hospitalization costs. Statistical analysis was performed. RESULTS: Eighty-seven patients were admitted. These patients caused 104 episodes (16.3% were readmissions). 71.2% were men, and 51.5 (SD 17.8) years old. All patients had a chronic disease, adherence ≤ 75% (76%) and non-persistence (63.5%). Polypharmacy (47.1%) was not associated with non-adherence. Total stay was 1,527 days (mean stay was 14.7 (SD 14.0) days/episode): psychiatry 827 days (54.2%); cardiology 174 days (11.4%); critical unit 48 days (3.1%). Patients with a degree of adherence ≤ 75% had a mean stay/episode higher than those with a degree of adherence > 75%, without significant differences (p > 0.05, t-Student). Overall cost of hospitalization was Euros 594,230.8, with a mean cost/episode: Euros 5,713.6 (SD 5,039.5). Mean cost/episode for adherence ≤ 75% was higher than > 75%, Euros 6,275.8 (SD 5,526.2) vs Euros 3,895.6 (SD 2,371.3), (p < 0.05, t-Student). CONCLUSIONS: The profile of this patient is fundamentally, a male psychiatric or chronic cardiac patient with a degree of adherence ≤ 75% due to abandoning domiciliary treatment. Admissions due to medication non-adherence are associated with an important depletion of economic resources in the hospital.

OBJETIVO: 1. Determinar el perfil del paciente hospitalizado por falta adherencia. 2. Estimar el impacto económico generado al hospital. MÉTODO: Estudio retrospectivo observacional, en pacientes hospitalizados con diagnóstico secundario de «historia personal de no cumplimiento del tratamiento crónico¼ según la Clasificación Internacional de Enfermedades, durante 2012. Variables recogidas: demográficas; datos socio-económicos y clínicos; datos relacionados con el tratamiento; reingresos; estancia (días); grado de adherencia: ≤75% o no adherencia severa y > 75% o no adherencia moderada; tipo no adherencia: no persistencia e incumplimiento; costes de hospitalización. Se realizó análisis estadístico. RESULTADOS: Ingresaron 87 pacientes generando 104 episodios (16,3% reingresos). El 71,2% fueron hombres con una edad media de 51,5 (DE 17,8) años. Todos los pacientes tenían una patología crónica, el 76% una adherencia ≤75% y el 63,5% falta de persistencia. La polifarmacia (47,1%) fue independiente del grado de adherencia. La estancia total fue 1.527 días (estancia media de 14,7 (DE 14,0) días/episodio): psiquiatría 827 días (54,2%); cardiología 174 días (11,4%); unidad de críticos 48 días (3,1%). Los pacientes con un grado de adherencia ≤75% tuvieron una estancia media mayor que los pacientes con un grado de adherencia > 75%, aunque no alcanzó significación estadística (p > 0,05, t-Student).El coste total fue de 594.230,8 con un coste medio de 5.713,6 (DE 5.039,5) /episodio. El coste medio de hospitalización en pacientes con adherencia ≤75% fue mayor que en el caso de adherencia > 75%, 6.275,8 (DE 5.526,2) vs 3.895,6 (DE 2.371,3) , (p < 0,05, t-Student). CONCLUSIONES: El perfil de este tipo de paciente es fundamentalmente, varón psiquiátrico o cardiológico crónico, con adherencia ≤75% por abandono del tratamiento. Las hospitalizaciones por falta de adherencia al tratamiento generan un importante consumo de recursos económicos en el hospital.

Autochthonous falciparum malaria possibly transmitted by luggage-carried vector in Paris, France, February 2013.

We report a case of autochthonous falciparum malaria in a patient in Paris, France, in February 2013 who reported no recent travel to malaria-endemic countries. The parasite, Plasmodium falciparum, was possibly transmitted by an infective Anopheles mosquito carried in baggage from a malaria-endemic area.

Birth weight, rapid weight gain in infancy and markers of overweight and obesity in childhood.

OBJECTIVE: To evaluate the relationship between birth weight and rapid weight gain in infancy and markers of overweight/obesity in childhood, using different cutoff values for rapid weight gain. SUBJECTS/METHODS: Cross-sectional study involving 98 5-year old pre-school Brazilian children. Rapid weight gain was considered as weight gain in standard deviation score (SDS) above +0.67, +1 and +2 in relation to birth weight, at any time during the first 2 years of life. The nutritional status of the children was determined by anthropometry and electrical bioimpedance. Multiple linear regression analysis was used, considering fat mass percentage, body mass index (BMI), waist and neck circumferences as outcomes. RESULTS: Birth weight, rapid weight gain (assessed by different cutoff values) and maternal obesity were positively associated with increased fat mass percentage, BMI, waist and neck circumferences. Different cutoff values of rapid weight gain did not change the positive associations between rapid weight gain and fat mass percentage (>+0.67 SDS, P=0.007; >+1 SDS, P=0.007; >+2 SDS, P=0.01), BMI (>+0.67 SDS, P=0.002; >+1 SDS, P=0.007; >+2 SDS, P<0.001), waist circumference (>+0.67 SDS, P=0.002; >+1 SDS, P=0.002; >+2 SDS, P<0.001) and neck circumference (>+0.67 SDS, P=0.01; >+1 SDS, P=0.03; >+2 SDS, P<0.001). CONCLUSIONS: The use of different cutoff values for the definition of rapid weight gain did not interfere in the associations between birth weight and rapid weight gain with fat mass percentage, BMI, waist and neck circumferences. Children with the highest birth weight, those who undergo rapid weight gain in infancy and whose mothers were obese, seemed to be more at risk for overweight/obesity.

[Economic impact of the resolution of drug related problems in an Emergency Department]. / Impacto económico de la resolución de problemas relacionados con medicamentos en un servicio de urgencias.

OBJECTIVE: Determine the economic impact of avoided cost in hospital stays by preventing drug-related problems. METHOD: Prospective observational study of six months in the emergency department. We included patients admitted for observation and pre-admission beds. A pharmacist was integrated into the healthcare team to validate / reconcile pharmacotherapy. Severity was associated DRPs detected / resolved with the risk increasing the stay of patients admitted to a clinical unit, estimating the potential cost avoided. RESULTS: El 32,5% of patients required intervention and were intercepted 444 drug-related problems, resolving 85.5%. Serious problems serious / significant unresolved affected 130 patients who were admitted, with an estimated avoided cost about 60,000 €. It was noted that serious problems and oral cytostatics, insulin and diabetes were the groups associated with a higher average cost avoided (p <0.05). CONCLUSION: The integration of the pharmacist in the emergency team to intercept medication problems, reducing the risk of stay and increase healthcare costs.

[Pneumocystis jirovecii pneumonia in HIV-infected patients]. / Pneumonie à Pneumocystis jirovecii chez les patients infectés par le VIH.

INTRODUCTION: Despite the dramatic decrease in opportunistic infections after the introduction of highly active antiretroviral therapy, Pneumocystis jirovecii pneumonia remains the major AIDS related infection in France. BACKGROUND: The clinical, radiological and microbiological diagnosis is usually easily made in HIV-infected patients. The preferred treatment is high dose trimethoprim-sulfamethoxazole, in association with steroids in cases of severe hypoxaemia. This has led to a dramatic reduction in mortality in these patients. Prophylactic treatment is mandatory in highly immunosuppressed patients (CD4 counts<200/µL) whose viraemia is not well controlled by antiretroviral therapy. VIEWPOINT: Whether PCR-based diagnosis would be useful for HIV-infected patients is a matter of debate, as is also the clinical significance of P. jirovecii colonization. The best alternative regimens for treating P. jirovecii pneumonia in cases of treatment failure or severe intolerance to trimethoprim-sulfamethoxazole are not clearly defined. CONCLUSION: In the context of universal HIV testing and recent guideline recommendations to start antiretroviral therapy early in the course of HIV infection, the frequency of P. jirovecii pneumonia should continue to decline in France.