Identifying research priorities for infection prevention and control. A mixed methods study with a convergent design.

Background: Meaningful research creates evidence for Infection Prevention and Control (IPC) practice. Aim: To establish Infection Prevention Society (IPS) members' research priorities to support future research projects. Methods: A mixed methods convergent parallel design incorporating a cross-sectional survey of IPS members (2022-2023), and focus group findings from the IPS Consultative Committee, (October 2022). Quantitative data were analysed using descriptive statistics. Qualitative data were transcribed verbatim, entered into NVivo 12, and analysed using a thematic analysis approach. Findings/Results: 132 IPS members responded to the survey, including 120 (90.9%) nurses. The three most prevalent priorities were: Quality Improvement and Patient Safety (n = 84, 16.1%); IPC Training and Education (n = 77, 14.8%); and IPC Evidence-based Guidelines (n = 76, 14.6%). Analysis of the focus group transcripts identified six emergent themes 'Patient Centred Care', 'Training and Education', 'IPC Role and Identity', 'IPC Leadership', 'IPC is Everyone's Responsibility', and 'Research Activity'. Triangulation of findings demonstrated concordance between quantitative and qualitative findings with Quality Improvement and Patient Safety (QIPS) and Training and Education identified as priority research areas. Discussion: This study highlights the necessity of developing support systems and incorporating research priorities in QIPS, as well as Training and Education. The findings of this study align with the recommended core competencies and components for effective infection prevention and control programs, making them relevant to QIPS initiatives. The outcomes of the study will serve as a valuable resource to guide the IPS Research and Development Committee in delivering practical support to IPS members.

Comparison of Blue and Infrared Light Transmission Through Dental Tissues and Restorative Materials.

OBJECTIVES: The depth of cure using blue-light photocuring units (BL) is limited by tooth structure and qualities of the restorative material through which the activating wavelength must pass. Recent developments incorporate an infrared (IR) activated upconversion (UC) fluorescence of a lining agent filled with nanocrystals of NaYF4 and doped with YB+3 and Tm+3 that emit both blue and violet light locally at the interface of the liner and restorative resin. The purpose of this study was to evaluate the BL and 975 nm infrared (IR) light power transmission through dental tissues and restorative materials. METHODS AND MATERIALS: Power transmissions of the IR laser (975 nm) and a monowave blue-only light-curing unit (Bluephase 16i) through dental tissues (enamel, dentin, and enamel/dentin junction, or DEJ), eight (8) various dental resin composites, and eight (8) dental ceramics, each at four thicknesses (1, 2, 3 and 4 mm) were evaluated (n=5) using a thermopile sensor (PM10, Coherent Inc) connected to a laser power meter (Fieldmate, Coherent Inc). Power transmission values of each light source and restorative material were subjected to analysis of variance and Tukey test at a pre-set alpha of 0.05. RESULTS: A linear correlation (r=0.9884) between the supplied current and emitted IR power of the laser diode was found, showing no statistical power reduction with increased distances (collimated beam). For tooth tissues, the highest power transmissions for both light sources were observed using 1.0 mm enamel while the lowest values were found for 2.0 mm dentin and an association of 2.0 mm DEJ and 1.0 mm dentin. The only group where IR demonstrated significantly higher transmission when compared to BL was 1.0 mm enamel. For all resin composites and dental ceramics, increased thickness resulted in a reduction of IR power transmission (except for EverX Posterior fiber-reinforced composite and e.max HT ceramic). IR resulted in higher transmission through all resin composites, except for Tetric EvoCeram White. The highest BL transmission was observed for SDR Flow, at all thicknesses. Higher IR/BL ratios were observed for EverX Posterior, Herculite Ultra, and Lava Ultimate, while the lowest ratio was observed for Tetric EvoCeram White. Reduced translucency shades within the same material resulted in lower power ratio values, especially for BL transmission. Higher IR/BL ratios were observed for e.Max LT, VitaVM7 Base Dentin, and e.max CAD HT, while the lowest values were found for VitaVM7 Enamel and Paradigm C. CONCLUSION: IR power transmission through enamel was higher when compared to blue light, while no difference was observed for dentin. The power transmission of IR was higher than BL for resin composites, except for a high value and low chroma shade. Fiber-reinforced resin composite demonstrated the highest IR/BL power transmission ratio. A greater IR/BL ratio was observed for lower translucency ceramics when compared to high translucency.

Postmenopausal onset of androgen excess: a diagnostic and therapeutic algorithm based on extensive clinical experience.

PURPOSE: Postmenopausal hyperandrogenism is a rare condition that requires identifying those women bearing a life-threatening tumor. We aimed to study diagnostic work-up and management of postmenopausal androgen excess, proposing an algorithm for clinical decision supporting. METHODS: We conducted an observational cross-sectional study and longitudinal follow-up including 51 consecutive menopausal patients reported for hyperandrogenism between 2003 and 2023 to our clinics. We assessed diagnostic testing accuracy and performance by receiver operating characteristic curves, their respective areas under the curve (AUCROC), and 95% confidence intervals (95%CI), for distinguishing between benign and malignant conditions, and androgen excess source. RESULTS: Most commonly, postmenopausal hyperandrogenism derived from benign conditions such as ovarian hyperthecosis (n = 9). However, four (8%) patients had borderline/malignant tumors arising at the ovaries (n = 3) or adrenals (n = 1). These latter were more likely to develop virilization than those with benign disorders [specificity(95%CI)]: 0.87 (0.69; 0.92)]. Circulating total testosterone [AUCROC(95%CI): 0.899 (0.795; 1.000)] and estradiol [AUCROC(95%CI): 0.912 (0.812; 1.000)] concentrations showed good performances for discriminating between both conditions. Transvaginal-ultrasonography found two out of three potentially malignant ovarian neoplasms, and another was apparent on a pelvic computed tomography scan. An adrenal computed tomography scan also located an androgen-secreting carcinoma. CONCLUSIONS: Clinical or biochemical features of an aggressive androgen-secreting tumor should lead to urgently obtaining a targeted imaging. At first, an abdominal-pelvic CT scan represents the best choice to perceive adrenal malignancy, and may identify aggressive ovarian tumors. When warning signs are lacking, a calm and orderly work-up allows properly addressing the diagnostic challenge of postmenopausal hyperandrogenism.

Safety and usability of the MAK exoskeleton in patients with stroke.

BACKGROUND AND PURPOSE: Stroke is one of the leading causes of disability in adults worldwide, and one of the main objectives in the rehabilitation of these patients is to recover the gait. New technologies have emerged to cope with this issue, complementing conventional therapy with the use of devices such as exoskeletons. The Marsi Active Knee (MAK) exoskeleton (Marsi Bionics SL, Madrid, Spain) has already been tested, but an updated version was improved to allow the patients to perform functional exercises. The aim of this study was to assess the safety and usability of the MAK in the stroke population as well as its potential clinical effects. METHODS: A single-group open label intervention trial was conducted. The device was used twice a week for 5 weeks during 1 h per visit. During the visits, sit-to-stand transitions, walking, stair climbing, trunk rotations, and weight-transfer exercises were performed using the device. Adverse events were collected from participants and therapists to assess safety. The Quebec User Evaluation of the Satisfaction with assistive Technology (QUEST 2.0) was used by both therapists and participants to assess usability. To evaluate its clinical effects, active range of motion (ROM) and muscle strength were assessed in the lower limb. RESULTS: Six participants with stroke were recruited. The device was shown to be safe since no serious adverse events were reported neither by patients nor by therapists. Every proposed exercise was performed. Regarding clinical effects, overall muscle strength showed an increase after the treatment, although ROM measurements did not show any difference. DISCUSSION: Our results suggest that the MAK device is safe for stroke patients. Nevertheless, further changes to enhance usability are recommended, such as an improvement of the attachment system and an adaptation for the drop foot. Beneficial effects regarding increases in muscle strength were obtained. Further trials with a larger sample size, longer intervention periods, and a control group are needed to verify these results. Also, future research should focus on the usability of the MAK as an assistive technology.

Ocular involvement secondary to Monkeypox virus infection.

We present the case of a 37-year-old male patient with symptoms compatible with adenoviral conjunctivitis of 5 days' evolution. Topical corticosteroids, lubricants and removal of pseudomembranes were prescribed. PCR analysis of conjunctival exudate was positive for Monkeypox virus. During follow-up, the patient developed corneal ulcers with a torpid course, requiring admission for treatment with Tecovirimat. Ocular involvement by Monkeypox virus is usually mild and self-limiting. Cases with severe visual involvement have been described when there is corneal damage, as exemplified in this case. After admission to hospital for systemic treatment, the patient progressed favourably.

External urology consultation quality at a third-level public hospital in Mexico.

INTRODUCTION: Patient satisfaction is the degree of conformity with the healthcare they receive. It is real evidence and one of the most important factors in determining the effectiveness and quality of healthcare systems. OBJECTIVE: To identify the quality of care in the Urology outpatient department of a third-level hospital. MATERIALS AND METHODS: The NHS (National Health Service) 2018 quality of care questionnaire with 11 sections, 133 items, and duration of approximately 25min was randomly administered to 250 patients attending Urology outpatients at a third-level public hospital in Mexico. RESULTS: According to responses, 92% (n=230) knew the reason for the consultation. 64.8% (n=162) had a consultation with the same physician by whom they were initially seen. The longest reported hospital wait time before being seen was more than 2h in 29.6% (n=74). As for consultation time, 212 patients responded and the duration was 11-20min in 52.8% (n=112). Finally, 33.2% (n=83) considered the quality of service to be good. CONCLUSIONS: The use of the NHS 2018 survey in the Urology service at a third-level public hospital in Mexico is feasible, since we managed to obtain a significant and continuous improvement in all its indicators which is satisfactory for all.

Frecuencia y tipología del segundo conducto mesiovestibular en primeros molares superiores / Frequency and typology of the second mesiobuccal canal in maxillary first molars

Objetivos: Evaluar mediante microscopia quirúrgica la presencia del segundo conducto mesiovestibular (MV2) en el piso de la cámara pulpar de los primeros molares superiores, determinar su abordabilidad, establecer el calibre de lima que llegó al tercio apical y tipificar radiovisiográficamente su morfología se-gún la clasificación de Weine. Materiales y métodos: Se utilizaron 48 primeros molares superiores huma-nos extraídos. Sé tomaron radiovisografías preope-ratorias (Carestream 5200) en sentido orto radial y mesio-distal. Se realizó apertura y se localizó entra-da del MV2 con microscopio quirúrgico (Newton MEC XXI, Argentina) a 16 x. Se cateterizó MV1 y MV2 con limas tipo K #10 y #15 (Dentsply Maillefer). Se cortó raíz distovestibular para mejorar visualización ra-diovisográfica. Se tomó conductometria en sentido mesio-distal para establecer la tipología. Se compa-raron frecuencias y porcentajes mediante test de Chi-cuadrado con corrección de Yates, prueba exac-ta de Fisher y test z para diferencia de proporcio-nes. Se calcularon intervalos de confianza 95% para porcentajes mediante método score de Wilson. Re-sultados: El 54% (26 casos) presentó MV2. De los 26 MV2, el 77% (20 casos) fueron abordables, porcen-taje significativamente mayor al 23% no abordable (z=3,62; P<0,05). Al hacer cateterismo, hubo asocia-ción significativa entre tipo de conducto (MV1 y MV2) y calibre de lima que llegó al tercio apical (Chi-cua-drado=29,12; gl=1; P<0,05). La tipología I (58%) fue significativamente mayor que las tipologías II (21%) y III (21%) (P<0,05 para ambas comparaciones). Con-clusión: El alto porcentaje de piezas que presentó MV2 evidencia la importancia clínica de detectarlo y tratarlo correctamente. Dado el alto porcentaje de piezas donde fue abordable, se concluye que el clíni-co debe tener conocimiento, destreza y la tecnología necesaria para poder abordarlo. Si bien la tipología I (58%) fue la más encontrada, cuando el MV2 termina en foramen independiente (tipo III), su omisión puede conducir al fracaso del tratamiento (AU))

Objectives: To evaluate by surgical microscopy the presence of second mesiobuccal canal (MB2) in the pulp chamber floor of the maxillary first molars, determine its approachability, establish the caliber of the file that reached the apical third, and radiographically typify its morphology according to Weine ́s classification. Materials and methods: 48 extracted human maxillary first molars were used. Preoperative radiovisographies (Carestream 5200) were taken in ortho-radial and mesio-distal direction. Coronal access was made and the entrance of MB2 was located with a surgical microscope (Newton MEC XXI, Argentina) at 16x. MB1 and MB2 were catheterized with K files #10 and #15 (Dentsply Maillefer). Distobuccal root was cut to improve radiovisographic visualization. Conductometry was taken in mesio-distal direction to establish the typology. Frequencies and percentages were compared using Chi-square test with Yates correction, Fisher's exact test and z test for difference in proportions. 95% confidence intervals were calculated for percentages using Wilson score method. Results: 54% (26 cases) presented MB2. Of the 26 MB2, 77% (20 cases) were approachable, a significantly higher percentage than those not approachable (z=3.62; P<0.05). When performing catheterization, there was a significant association between type of canal (MB1 and MB2) and file caliber that reached the apical third (Chi-square=29.12; df=1; P<0.05). Typology I (58%) was significantly higher than typologies II (21%) and III (21%) (P<0.05 for both comparisons). Conclusion: The high percentage of specimens that showed MB2 evidence the clinical importance of detecting and treating it correctly. Given the percentage of pieces where it was approachable (77%), it is concluded that the clinician must have the knowledge, skill and necessary technology to be able to approach it. Although typology I (58%) was the most found, when MB2 ends an independent foramen (type III), its omission can lead to treatment failure (AU)

Defining metabolic flexibility in hair follicle stem cell induced squamous cell carcinoma.

Among the numerous changes associated with the transformation to cancer, cellular metabolism is one of the first discovered and most prominent[1, 2]. However, despite the knowledge that nearly every cancer is associated with the strong upregulation of various metabolic pathways, there has yet to be much clinical progress on the treatment of cancer by targeting a single metabolic enzyme directly[3-6]. We previously showed that inhibition of glycolysis through lactate dehydrogenase (LDHA) deletion in cancer cells of origin had no effect on the initiation or progression of cutaneous squamous cell carcinoma[7], suggesting that these cancers are metabolically flexible enough to produce the necessary metabolites required for sustained growth in the absence of glycolysis. Here we focused on glutaminolysis, another metabolic pathway frequently implicated as important for tumorigenesis in correlative studies. We genetically blocked glutaminolysis through glutaminase (GLS) deletion in cancer cells of origin, and found that this had little effect on tumorigenesis, similar to what we previously showed for blocking glycolysis. Tumors with genetic deletion of glutaminolysis instead upregulated lactate consumption and utilization for the TCA cycle, providing further evidence of metabolic flexibility. We also found that the metabolic flexibility observed upon inhibition of glycolysis or glutaminolysis is due to post-transcriptional changes in the levels of plasma membrane lactate and glutamine transporters. To define the limits of metabolic flexibility in cancer initiating hair follicle stem cells, we genetically blocked both glycolysis and glutaminolysis simultaneously and found that frank carcinoma was not compatible with abrogation of both of these carbon utilization pathways. These data point towards metabolic flexibility mediated by regulation of nutrient consumption, and suggest that treatment of cancer through metabolic manipulation will require multiple interventions on distinct pathways.

[Translated article] Histopathologic and Trichoscopic Correlations in Nonscarring Alopecias.

Trichoscopy is an essential tool in the evaluation of alopecia. The current compilation of trichoscopic signs in this setting helps distinguish between different forms of hair loss and has improved our understanding of the pathogenic mechanisms involved. The trichoscopic signs are always linked to the pathogenic mechanisms of the alopecia being examined. We examine correlations between the main trichoscopic and histopathologic findings in nonscarring alopecias.

Satisfaction analysis of overground gait exoskeletons in people with neurological pathology. a systematic review.

BACKGROUND: People diagnosed with neurological pathology may experience gait disorders that affect their quality of life. In recent years, research has been carried out on a variety of exoskeletons in this population. However, the satisfaction perceived by the users of these devices is not known. Therefore, the objective of the present study is to evaluate the satisfaction perceived by users with neurological pathology (patients and professionals) after the use of overground exoskeletons. METHODS: A systematic search of five electronic databases was conducted. In order to be included in this review for further analysis, the studies had to meet the following criteria: [1] the study population was people diagnosed with neurological pathology; [2] the exoskeletons had to be overground and attachable to the lower limbs; and [3]: the studies were to include measures assessing either patient or therapist satisfaction with the exoskeletons. RESULTS: Twenty-three articles were selected, of which nineteen were considered clinical trials. Participants diagnosed with stroke (n = 165), spinal cord injury (SCI) (n = 102) and multiple sclerosis (MS) (n = 68). Fourteen different overground exoskeleton models were analysed. Fourteen different methods of assessing patient satisfaction with the devices were found, and three ways to evaluate it in therapists. CONCLUSION: Users' satisfaction with gait overground exoskeletons in stroke, SCI and MS seems to show positive results in safety, efficacy and comfort of the devices. However, the worst rated aspects and therefore those that should be optimized from the users' point of view are ease of adjustment, size and weight, and ease of use.

Virulence Factors of the Gut Microbiome Are Associated with BMI and Metabolic Blood Parameters in Children with Obesity.

The development of metabolic diseases is linked to the gut microbiota. A cross-sectional study involving 45 children (6 to 12 years old) was conducted to investigate the relationship between gut microbiota and childhood obesity. Anthropometric and metabolic measurements, food-frequency questionnaires (FFQs), and feces samples were obtained. Using the body mass index (BMI) z-score, we categorized each participant as normal weight (NW), or overweight and obese (OWOB). We determined 2 dietary profiles: one with complex carbohydrates and proteins (pattern 1), and the other with saturated fat and simple carbohydrates (pattern 2). The microbial taxonomic diversity and metabolic capacity were determined using shotgun metagenomics. We found differences between both BMI groups diversity. Taxa contributing to this difference, included Eubacterium sp., Faecalibacterium prausnitzii, Dialister, Monoglobus pectinilyticus, Bifidobacterium pseudocatenulatum, Intestinibacter bartlettii, Bacteroides intestinalis, Bacteroides uniformis, and Methanobrevibacter smithii. Metabolic capacity differences found between NW and OWOB, included the amino acid biosynthesis pathway, the cofactor, carrier, and vitamin biosynthesis pathway, the nucleoside and nucleotide biosynthesis and degradation pathways, the carbohydrate-sugar degradation pathway, and the amine and polyamine biosynthesis pathway. We found significant associations between taxa such as Ruminococcus, Mitsuokella multacida, Klebsiella variicola, and Citrobacter spp., metabolic pathways with the anthropometric, metabolic, and dietary data. We also found the microbiome's lipooligosaccharide (LOS) category as differentially abundant between BMI groups. Metabolic variations emerge during childhood as a result of complex nutritional and microbial interactions, which should be explained in order to prevent metabolic illnesses in adolescence and maturity. IMPORTANCE The alteration of gut microbiome composition has been commonly observed in diseases involving inflammation, such as obesity and metabolic impairment. Inflammatory host response in the gut can be a consequence of dietary driven dysbiosis. This response is conducive to blooms of particular bacterial species, adequate to survive in an inflammatory environment by means of genetical capability of utilizing alternative nutrients. Understanding the genomic and metabolic contribution of microbiota to inflammation, including virulence factor prevalence and functional potential, will contribute to identifying modifiable early life exposures and preventive strategies associated with obesity risk in childhood.

Modern Concepts in Melanocytic Tumors. / Conceptos modernos en tumores melanocíticos.

The advent of molecular pathology has fueled unprecedented advances in the diagnosis and understanding of melanocytic tumors. These advances, however, have also generated concepts that may be difficult to grasp for clinical practitioners, who are not always conversant with the array of genetic techniques employed in the laboratory. These same practitioners, however, are being increasingly called on to provide treatments that are often based on the latest molecular findings for melanocytic tumors. We review the most recent concepts in the pathway classification of melanocytic tumors, including intermediate lesions known as melanocytomas. We examine the genetic and molecular techniques used to study these tumors, look at where they overlap, and discuss their limitations and some of the most difficult-to-interpret results.

Vascular Malformations: A Histopathologic and Conceptual Appraisal. / [Artículo traducido] Malformaciones vasculares: un enfoque histopatológico y conceptual.

In the field of vascular anomalies, distinguishing between vascular malformations and tumors has become crucial for a correct therapeutic approach. However, the differential diagnosis between these two groups is not always well explained in classical texts, mainly because many vascular malformations are still known with old names that suggest a tumoral nature. Also, genetic and pathogenic knowledge of these entities has greatly increased in recent decades, so researchers and clinicians now have a better understanding of vascular malformations. In this paper, we present the main histopathological tips to recognize and identify a vascular malformation as such. We also contextualize such information in the clinical and pathogenic knowledge for a better understanding of these entities.

[Microscopy vs. molecular biology in the diagnosis of intestinal protozoal infections, is it time for a change?] / Microscopía vs. biología molecular en el diagnóstico de infecciones protozoarias intestinales, ¿es el momento del cambio?

OBJECTIVE: Microscopic examination of the intestinal parasites, from the patient's concentrated feces, has a lower sensitivity when compared to molecular diagnostic techniques. Therefore, the objective of this study has been to compare both techniques, as well as to evaluate whether there is a correlation between the microscopic examination and the threshold cycles (Ct) obtained for Blastocystis hominis. METHODS: Retrospective study of the samples received in the Microbiology laboratory during September 2021. The MiniParasep SF® concentration test was performed for microscopic visualization and then PCR was performed with the Seegene AllplexTM Parasite Assay panel. RESULTS: A 27% (n=74) of the samples were positive by molecular diagnosis, with a total of 87 parasites detected. 53% (n=39) were women with a mean age of 47 ± 24 years. In 76% (n=56) of the cases the service of origin was Primary Care. The most frequently found parasite was B. hominis, 85% (n=64), followed by Dientamoeba fragilis 20% (n=15) and Giardia lamblia 11% (n=8). Co-infection by two parasites was detected in 13 cases (B. hominis + D. fragilis in 6 cases, and B. hominis + G. lamblia in 7 cases). In the microscopic diagnosis, 9.5% (n=26) positivity was obtained. The most frequently found parasite was B. hominis, 84% (n=23), followed by G. lamblia, which was seen in three cases by microscopy. D. fragilis was not seen in any case. Coinfection of B. hominis + G. lamblia was observed in one sample. CONCLUSIONS: Techniques for molecular diagnosis of intestinal parasites are fast, reliable and more sensitive than microscopic techniques, improving microbiological diagnosis and quality of care.

Vascular Malformations: A Histopathologic and Conceptual Appraisal.

In the field of vascular anomalies, distinguishing between vascular malformations and tumors has become crucial for a correct therapeutic approach. However, the differential diagnosis between these two groups is not always well explained in classical texts, mainly because many vascular malformations are still known with old names that suggest a tumoral nature. Also, genetic and pathogenic knowledge of these entities has greatly increased in recent decades, so researchers and clinicians now have a better understanding of vascular malformations. In this paper, we present the main histopathological tips to recognize and identify a vascular malformation as such. We also contextualize such information in the clinical and pathogenic knowledge for a better understanding of these entities.