Evaluating the Hounsfield unit assignment and dose differences between CT-based standard and deep learning-based synthetic CT images for MRI-only radiation therapy of the head and neck.

BACKGROUND: Magnetic resonance image only (MRI-only) simulation for head and neck (H&N) radiotherapy (RT) could allow for single-image modality planning with excellent soft tissue contrast. In the MRI-only simulation workflow, synthetic computed tomography (sCT) is generated from MRI to provide electron density information for dose calculation. Bone/air regions produce little MRI signal which could lead to electron density misclassification in sCT. Establishing the dosimetric impact of this error could inform quality assurance (QA) procedures using MRI-only RT planning or compensatory methods for accurate dosimetric calculation. PURPOSE: The aim of this study was to investigate if Hounsfield unit (HU) voxel misassignments from sCT images result in dosimetric errors in clinical treatment plans. METHODS: Fourteen H&N cancer patients undergoing same-day CT and 3T MRI simulation were retrospectively identified. MRI was deformed to the CT using multimodal deformable image registration. sCTs were generated from T1w DIXON MRIs using a commercially available deep learning-based generator (MRIplanner, Spectronic Medical AB, Helsingborg, Sweden). Tissue voxel assignment was quantified by creating a CT-derived HU threshold contour. CT/sCT HU differences for anatomical/target contours and tissue classification regions including air (<250 HU), adipose tissue (-250 HU to -51 HU), soft tissue (-50 HU to 199 HU), spongy (200 HU to 499 HU) and cortical bone (>500 HU) were quantified. t-test was used to determine if sCT/CT HU differences were significant. The frequency of structures that had a HU difference > 80 HU (the CT window-width setting for intra-cranial structures) was computed to establish structure classification accuracy. Clinical intensity modulated radiation therapy (IMRT) treatment plans created on CT were retrospectively recalculated on sCT images and compared using the gamma metric. RESULTS: The mean ratio of sCT HUs relative to CT for air, adipose tissue, soft tissue, spongy and cortical bone were 1.7 ± 0.3, 1.1 ± 0.1, 1.0 ± 0.1, 0.9 ± 0.1 and 0.8 ± 0.1 (value of 1 indicates perfect agreement). T-tests (significance set at t = 0.05) identified differences in HU values for air, spongy and cortical bone in sCT images compared to CT. The structures with sCT/CT HU differences > 80 HU of note were the left and right (L/R) cochlea and mandible (>79% of the tested cohort), the oral cavity (for 57% of the tested cohort), the epiglottis (for 43% of the tested cohort) and the L/R TM joints (occurring > 29% of the cohort). In the case of the cochlea and TM joints, these structures contain dense bone/air interfaces. In the case of the oral cavity and mandible, these structures suffer the additional challenge of being positionally altered in CT versus MRI simulation (due to a non-MR safe immobilizing bite block requiring absence of bite block in MR). Finally, the epiglottis HU assignment suffers from its small size and unstable positionality. Plans recalculated on sCT yielded global/local gamma pass rates of 95.5% ± 2% (3 mm, 3%) and 92.7% ± 2.1% (2 mm, 2%). The largest mean differences in D95, Dmean , D50 dose volume histogram (DVH) metrics for organ-at-risk (OAR) and planning tumor volumes (PTVs) were 2.3% ± 3.0% and 0.7% ± 1.9% respectively. CONCLUSIONS: In this cohort, HU differences of CT and sCT were observed but did not translate into a reduction in gamma pass rates or differences in average PTV/OAR dose metrics greater than 3%. For sites such as the H&N where there are many tissue interfaces we did not observe large scale dose deviations but further studies using larger retrospective cohorts are merited to establish the variation in sCT dosimetric accuracy which could help to inform QA limits on clinical sCT usage.

Prevalence of hypertension in adults living at altitude in Latin America and the Caribbean: A systematic review and meta-analysis.

OBJECTIVE: The objective of this systematic review and meta-analysis was to assess the prevalence of hypertension in populations living at altitude in Latin America and the Caribbean. METHODS: We conducted a systematic search from January 1, 2000 to January 10, 2023 in Web of Science (WoS)/Core Collection, WoS/Medline, WoS/Scielo, Scopus, PubMed and Embase databases. We included studies that assessed the prevalence of hypertension in altitude populations (>1500 m.a.s.l.) and these were meta-analyzed using a random-effects model. To assess the sources of heterogeneity, we performed subgroup and meta-regression analyses. RESULTS: Thirty cross-sectional studies (117 406 participants) met the inclusion criteria. Studies used different cut-off points. The prevalence of hypertension in the studies that considered the cut-off point of ≥ 140/90 mmHg in the general population was 19.1%, ≥ 130/85 mmHg was 13.1%, and ≥ 130/80 mmHg was 43.4%. There was a tendency for the prevalence of hypertension to be higher in men. In meta-regression analyses, no association was found between altitude, mean age, year of publication, risk of bias and prevalence of hypertension. CONCLUSION: The prevalence of hypertension in the altitude population of Latin America and the Caribbean is lower than that reported in populations living at sea level and lower than other altitude populations such as Tibetans. PROSPERO: CRD42021275229.

Prevalence and incidence of chronic obstructive pulmonary disease in Latin America and the Caribbean: a systematic review and meta-analysis.

BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) remains one of the leading causes of morbidity and mortality worldwide, and its epidemiology in Latin America and the Caribbean is not well described. The aim of this study was to evaluate the prevalence and incidence of COPD in Latin America and the Caribbean. METHODS: We searched systematically in Web of Science (WoS)/Core Collection, WoS/MEDLINE, WoS/Scielo, Scopus, PubMed, and Embase from 2010 to 2021. Studies assessing the prevalence and incidence of COPD according to the GOLD classification were included. The overall prevalence of COPD was calculated as a function of the general population using a random-effects model. RESULTS: 20 studies (19 cross-sectional and 1 cohort) met the inclusion criteria. The prevalence of COPD in the general population older than 35 years was 8.9%. The prevalence in men was 13.7% and in women 6.7%. The prevalence in smokers and ex-smokers was 24.3%. The incidence in the general population of COPD according to one study was 3.4% at 9 years of follow-up. CONCLUSIONS: COPD is prevalent in Latin America, especially in men and in smokers and ex-smokers. Further prevalence and incidence studies in the general population are needed, as well as health policies and strategies to address the disease.

Fecal Microbiota Transplantation for People Living with Human Immunodeficiency Virus: A Scoping Review.

The aim of this scoping review was to determine the characteristics of studies evaluating fecal microbiota transplantation (FMT), as well as its effects and safety as a therapeutic intervention for people living with human immunodeficiency virus (HIV). We conducted a scoping review following the methodology of the Joanna Briggs Institute. We searched the following databases: PubMed, Web of Science, Scopus, Embase, Cochrane Library, and Medline until September 19, 2021. Studies that used FMT in people living with HIV and explored its effects on the health of these people were included. Two randomized and 2 uncontrolled clinical trials with a total of 55 participants were included. Participants were well-controlled HIV-infected people. Regarding microbiota changes, three studies found significant post-FMT increases in Fusobacterium, Prevotella, α-diversity, Chao index, and/or Shannon index, and/or decreases in Bacteroides. Regarding markers of intestinal damage, one study found a decrease in intestinal fatty acid binding protein post-FMT, and another study found an increase in zonulin. Other outcomes evaluated by the studies were as follows: markers of immune and inflammatory activation, markers of immunocompetence (CD4+, and CD8+ T lymphocytes), and HIV viral load; however, none showed significant changes. Clinical outcomes were not evaluated by these studies. Regarding the safety of FMT, only mild adverse events were appreciated. No serious adverse event was reported. The clinical evidence for FMT in people living with HIV is sparse. FMT appears to have good tolerability and, no serious adverse event has been reported so far. Further clinical trials and evaluation of clinically important biomedical outcomes for FMT in people living with HIV are needed.

[Validation of a questionnaire that measures perceptions of the role of community nursing professionals in Peru]. / Validación de un cuestionario que mide las percepciones del rol del profesional de enfermería comunitaria en Perú.

OBJECTIVE: To develop a valid and reliable scale to measure the role of the nursing professional in the community (REFCO). DESIGN: Observational with cross-sectional and instrumental design. SITE: Populated centers and communities of the coast, highlands and jungle from Peru. PARTICIPANTS: The validation phase of the questionnaire had the voluntary participation of 402 Peruvian adults (50.7% from the coast, 40.5% from the highlands and 8.8% from the jungle). INTERVENTIONS: The elaborated questionnaire that measures perceptions about the role of the nursing professional in the community was applied. MAIN MEASUREMENTS: The psychometric properties of the REFCO scale were analyzed, such as content validation and internal consistency through the calculation of Aiken's V, exploratory factor analysis (EFA) and later confirmatory factor analysis (CFA), respectively. Finally, the reliability of the scale was calculated. RESULTS: Overall, all values were statistically significant when evaluated with the V-Aiken coefficient. Likewise, the skewness and kurtosis values of all the items of the instrument did not exceed the range >±1.5. The correlations between factors 1 and 2 were significant (p < .05). The reliability of the scale presents a Cronbach's α coefficient = 0.865. CONCLUSIONS: The REFCO scale has 9 items and 2 dimensions; outreach and education; with content and construct validity that provide evidence for community nursing categories, which is useful for measuring nursing work in the community field.

Dual endovascular repair (coils and stent) of a true aneurysm of the gastroduodenal artery.

We report a case of an asymptomatic gastroduodenal artery aneurysm diagnosed in a 39 year-old woman. An abdominal ultrasound study showed an aneurysmal dilatation of the gastroduodenal artery with 2 x 2 cm diameter. To confirm this finding, she then underwent a computed tomography scan of the abdomen and pelvis that showed a saccular aneurysm of the gastroduodenal artery. A dual endovascular approach was used to exclude the aneurysm by stent-assisted coil embolization. Complete exclusion of the aneurysm sac was confirmed on final angiography. She was discharged from the hospital on postoperative day 1.

Relatamos um caso de aneurisma de artéria gastroduodenal assintomático diagnosticado em uma mulher de 39 anos. Uma ultrassonografia abdominal mostrou uma dilatação aneurismática associada à artéria gastroduodenal com 2 x 2 cm de diâmetro. Para confirmar esse achado, foi realizada uma tomografia computadorizada do abdome e da pelve, que revelou um aneurisma sacular da artéria gastroduodenal. Uma abordagem endovascular dupla foi utilizada para exclusão do aneurisma mediante embolização com molas assistida por stent. A exclusão completa do saco aneurismático foi confirmada na angiografia final. A paciente recebeu alta hospitalar no primeiro dia de pós-operatório.

Executive Summary of the Consensus Statement of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), the Spanish Society of Tropical Medicine and International Health (SEMTSI), the Spanish Association of Surgeons (AEC), the Spanish Society of Pneumology and Thoracic Surgery (SEPAR), the Spanish Society of Thoracic Surgery (SECT), the Spanish Society of Vascular and Interventional Radiology (SERVEI), and the Spanish Society of Paediatric Infectious Diseases (SEIP), on the Management of Cystic Echinococcosis.

The Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), the Spanish Society of Tropical Medicine and International Health (SEMTSI), the Spanish Association of Surgeons (AEC), the Spanish Society of Pneumology and Thoracic Surgery (SEPAR), the Spanish Society of Thoracic Surgery (SECT), the Spanish Society of Vascular and Interventional Radiology (SERVEI), and the Spanish Society of Paediatric Infectious Diseases (SEIP) considered it pertinent to issue a consensus statement on the management of cystic echinococcosis (CE) to guide healthcare professionals in the care of patients with CE. Specialists from several fields (clinicians, surgeons, radiologists, microbiologists, and parasitologists) identified the most clinically relevant questions and developed this Consensus Statement, evaluating the available evidence-based data to propose a series of recommendations on the management of this disease. This Consensus Statement is accompanied by the corresponding references on which these recommendations are based. Prior to publication, the manuscript was open for comments and suggestions from the members of the SEIMC and the scientific committees and boards of the various societies involved.

Dual endovascular repair (coils and stent) of a true aneurysm of the gastroduodenal artery / Reparo endovascular duplo (molas e stent) de aneurisma verdadeiro da artéria gastroduodenal

Abstract We report a case of an asymptomatic gastroduodenal artery aneurysm diagnosed in a 39 year-old woman. An abdominal ultrasound study showed an aneurysmal dilatation of the gastroduodenal artery with 2 x 2 cm diameter. To confirm this finding, she then underwent a computed tomography scan of the abdomen and pelvis that showed a saccular aneurysm of the gastroduodenal artery. A dual endovascular approach was used to exclude the aneurysm by stent-assisted coil embolization. Complete exclusion of the aneurysm sac was confirmed on final angiography. She was discharged from the hospital on postoperative day 1.

Resumo Relatamos um caso de aneurisma de artéria gastroduodenal assintomático diagnosticado em uma mulher de 39 anos. Uma ultrassonografia abdominal mostrou uma dilatação aneurismática associada à artéria gastroduodenal com 2 x 2 cm de diâmetro. Para confirmar esse achado, foi realizada uma tomografia computadorizada do abdome e da pelve, que revelou um aneurisma sacular da artéria gastroduodenal. Uma abordagem endovascular dupla foi utilizada para exclusão do aneurisma mediante embolização com molas assistida por stent. A exclusão completa do saco aneurismático foi confirmada na angiografia final. A paciente recebeu alta hospitalar no primeiro dia de pós-operatório.

Análisis de los accidentes de trabajo y de trayecto de los trabajadores de un hospital de especialidades, en Jalisco México / Analysis of work-related accidents and commuting accidents among workers of a speciality hospital in Jalisco, México

Se presenta un análisis sobre accidentes de trabajo y de trayecto, de los años 2006 al 2010 de un hospital de especialidades, en el estado de Jalisco, México. En los años antes mencionados se dieron 102, 117, 122, 106 y 135 accidentes, respectivamente. Con el objetivo de evaluar el comportamiento en los años mencionados sobre accidentabilidad y establecer comparaciones entre ellos, se revisaron los formatos existentes en lo referente accidentes de trabajo y de trayecto, dándose una accidentabilidad de 582 riesgos de trabajo de los cuales 345 fueron accidentes de trabajo y 237 accidentes de trayecto, en los periodos antes mencionados. En el año 2010 se dio el mayor número de riesgos de trabajo (accidentes de trabajo y de trayecto), con el 23,197 por ciento. En la categoría de enfermera general, los accidentados de trabajo como de trayecto, en los cinco años de la investigación, fue la de mayor accidentabilidad. En lo referente al turno de trabajo, el matutino fue el de mayor accidentabilidad, tanto para accidentes de trabajo como de trayecto, en cada uno de los años. En el año 2008, el mes de noviembre fue donde ocurrió el mayor número de accidentes, con el 13,90 por ciento del total de los años estudiados. En la actividad que realizaban al accidentarse, los trabajadores con mayor siniestralidad fue caminando en los años estudiados. En el tipo de accidente con mayor accidentabilidad fue movimientos bruscos. En la región anatómica afectada, en el año 2006 fue manos y sus partes de la misma; en el 2007, el cuello fue el de mayor accidentabilidad; en el año 2008 fueron las manos y sus partes de la mismas como también el cuello; en el 2009, cuello y tobillos; y, en el 2010 fue el cuello. Las causas de los accidentes para los años 2006, 2007 y 2009 fue falta de atención; para el 2008 y 2010 fue acto inseguro de terceros. El agente de la lesión fue la reacción corporal en los cinco años estudiados.

This paper presents an analysis of commuting accidents and work related accidents occurred between 2006 and 2010 to workers of a specialty hospital in the state of Jalisco, México. The total number of both types of accidents in these years were 102, 117, 122, 106 and 135 respectively. The purpose of this analysis is to evaluate and compare occurrence patterns. Commuting and work related accident reports from these years were reviewed resulting in a total of 582 events (345 industrial accidents and 237 commuting accidents). 2010 presented the highest rate of work-related events (work-related and commuting accidents) with 23.197percent. “Registered Nurse” was the category with the highest accident rate (work-related as well as commuting accidents) during the five-year period reviewed. As to the working shift with the highest rate, the morning shift showed the most accidents (work-related and commuting) in every year reviewed. November 2008 was the month with the highest accident rate (13.9percent). The activity performed by workers with the highest accident rate was walking. Sudden movements was the type of accident with the highest rate. In 2006 the hands were the most affected body part; in 2007 the neck; in 2008 hands and neck; in 2009 neck and ankles, and in 2010 the neck. The main causes of accidents were: in 2006, 2007, and 2009 lack of attention; in 2008, and 2010 unsafe actions by third parties. The agent of injury in the reviewed five-year period was body reaction.