Increasing and sustaining blood-borne virus screening in Spain and Portugal throughout the COVID-19 pandemic: a multi-center quality improvement intervention.

Background: Around 57,000 people in Spain and Portugal currently living with HIV or chronic hepatitis C are unaware of their infection. The COVID-19 pandemic severely disrupted screening efforts for these infections. We designed an intervention to increase and sustain opportunistic blood-borne virus (BBV) screening and linkage to care (SLTC) by implementing the TEST model. Methods: The Plan Do Study Act (PDSA) method of quality improvement (QI) was implemented in 8 healthcare organizations (HCOs), including four hospitals, two clusters of community health centers, and two community-based organizations (CBOs). Baseline assessment included a review of BBV SLTC practices, testing volume, and results 12 months before the intervention. Changes in BBV testing rates over time were measured before, during, and after the COVID-19 lockdowns in 2020. A mixed ANOVA model was used to analyze the possible effect on testing volumes among HCOs over the three study periods. Intervention: BBV testing was integrated into normal clinical flow in all HCOs using existing clinical infrastructure and staff. Electronic health record (EHR) systems were modified whenever possible to streamline screening processes, implement systemic institutional policy changes, and promote QI. Results: Two years after the launch of the intervention in screening practices, testing volumes increased by 116%, with formal healthcare settings recording larger increases than CBOs. The start of the COVID-19 lockdowns was accompanied by a global 60% decrease in testing in all HCOs. Screening emergency department patients or using EHR systems to automate screening showed the highest resilience and lowest reduction in testing. HCOs recovered 77% of their testing volume once the lockdowns were lifted, with CBOs making the fullest recovery. Globally, enhanced screening techniques enabled HCOs to diagnose a total of 1,860 individuals over the research period. Conclusions: Implementation of the TEST model enabled HCOs to increase and sustain BBV screening, even during COVID-19 lockdowns. Although improvement in screening was noted in all HCOs, additional work is needed to develop strong patient linkage to care models in challenging times, such as global pandemics.

A dimensão da diástase abdominal tem influência sobre a dor lombar durante a gestação? / Does abdominal diastasis influence lumbar pain during gestation?

RESUMO JUSTIFICATIVA E OBJETIVOS: Avaliar e comparar a ocorrência e dimensão da diástase dos músculos retos abdominais nos segundo e terceiro trimestres gestacionais e correlacioná-las com presença e intensidade da dor lombar. MÉTODOS: Estudo observacional do tipo transversal com 128 gestantes, divididas em dois grupos: 53 gestantes no segundo trimestre gestacional e 75 gestantes no terceiro trimestre gestacional. Utilizou-se para avaliar a dor lombar o questionário Roland Morris e a escala analógica visual da dor. A mensuração da diástase dos músculos retos abdominais foi realizada com auxílio de um paquímetro. Os dados foram analisados segundo a correlação de Spearman e teste U de Mann-Whitney. RESULTADOS: A comparação dos grupos demonstrou que as gestantes do terceiro trimestre apresentavam maior diástase abdominal, mais relatos de dor lombar intensa por meio da escala analógica visual p=0,0017 e maior impacto nas atividades da vida diária (p=0,0012). A correlação foi positiva entre a dimensão da diástase dos músculos retos abdominais e os escores obtidos no questionário Roland Morris e na escala analógica visual. CONCLUSÃO: A dimensão da diástase dos músculos retos abdominais, a intensidade da dor e a incapacidade determinadas pela lombalgia foram maiores nas gestantes do terceiro trimestre gestacional.

ABSTRACT BACKGROUND AND OBJECTIVES: To evaluate and compare the presence and size of recti abdominis diastasis in the second and third gestational trimester and to correlate them to lumbar pain incidence and intensity. METHODS: This is a cross-sectional observational study with 128 pregnant women divided in two groups: 53 pregnant women in the second gestational trimester and 75 pregnant women in the third gestational trimester. Lumbar pain was evaluated with Roland Morris questionnaire and Pain Visual Analog Scale. Recti abdominis diastasis was measured with a caliper rule. Data were analyzed according to Spearman correlation and Mann-Whitney U test. RESULTS: Comparison between groups has shown that pregnant women in the third gestational trimester had more recti abdominis diastasis, more reports of severe lumbar pain by the visual analog scale (p=0.0017) and further impact on daily life activities (p=0.0012). There has been positive correlation between recti abdominis diastasis size and scores obtained by Roland Morris questionnaire and visual analog scale. CONCLUSION: Recti abdominis diastasis size, pain intensity and incapacity determined by low back pain were more severe in pregnant women in the third gestational trimester.

Deciphering the link between salicylic acid signaling and sphingolipid metabolism.

The field of plant sphingolipid biology has evolved in recent years. Sphingolipids are abundant in cell membranes, and genetic analyses revealed essential roles for these lipids in plant growth, development, and responses to abiotic and biotic stress. Salicylic acid (SA) is a key signaling molecule that is required for induction of defense-related genes and rapid and localized cell death at the site of pathogen infection (hypersensitive response) during incompatible host-pathogen interactions. Conceivably, while levels of SA rapidly increase upon pathogen infection for defense activation, they must be tightly regulated during plant growth and development in the absence of pathogens. Genetic and biochemical evidence suggest that the sphingolipid intermediates, long-chain sphingoid bases, and ceramides, play a role in regulating SA accumulation in plant cells. However, how signals generated from the perturbation of these key sphingolipid intermediates are transduced into the activation of the SA pathway has long remained to be an interesting open question. At least four types of molecules - MAP kinase 6, reactive oxygen species, free calcium, and nitric oxide - could constitute a mechanistic link between sphingolipid metabolism and SA accumulation and signaling.

The influence of nutritional status and disease on adiponectin and TNF-α; levels in colorectal cancer patients.

BACKGROUND: The aim of this study was to evaluate the association between adiponectin and tumor necrosis factor-α;(TNF-α;) serum levels in colorectal cancer (CRC) patients and compare these levels to clinical stage and nutritional status. METHODS: A total of 79 patients were enrolled in the study (39 with CRC and 40 in the control). Nutritional status was assessed by Patient-Generated Subjective Global Assessment (PG-SGA), body mass index (BMI), and phase angle (PhA). Adiponectin and TNF-α;serum concentrations were determined using an enzyme-linked immunosorbent assay. RESULTS: Serum adiponectin levels were higher among CRC patients (p = 0.001). TNF-α;serum levels were not significantly different between the groups, but patients with stage III or IV CRC had higher levels of TNF-α;than those with lower stage disease (p = 0.037). The three tools used for the assessment of nutritional status (BMI, PhA, and PG-SGA) demonstrated that patients with a more severe nutritional deficit had higher adipocytokine levels, although these differences were significant only to TNF- , when distributed PhA in tertiles. CONCLUSIONS: Adiponectin levels were higher among CRC patients. Although TNF-α;serum levels from CRC patients did not differ significantly to the control group, CRC patients with stage III or IV had higher levels compared to those with stage I and II tumors. Nutritional status, as determined by BMI, PhA, and PG-SGA, demonstrated that patients with a greatest nutritional deficit, had higher levels of adipocytokines; however, these differences were significant only for TNF-, when distributed PhA in tertiles.

ANTECEDENTES: El propósito de este estudio fue evaluar la asociación entre las concentraciones séricas de adiponectina y de factor de necrosis tumoral-(TNF-) en paciente con cáncer colorrectal (CCR) y comparar estas concentraciones con el estadio clínico y el estado nutritivo. MÉTODOS: Se reclutó a un total de 79 pacientes en el estudio (39 con CCR y 40 en el grupo control). Se evaluó el estado nutritivo mediante la Evaluación Global Subjetiva Generada por el Paciente (PG-SGA), el índice de masa corporal (IMC) y el ángulo de fase (AF). Se determinaron las concentraciones séricas de adiponectina y de TNF-mediante un inmunoensayo de absorción ligado a enzima. RESULTADOS: Las concentraciones séricas de adiponectina fueron superiores en los pacientes con CCR (p = 0,001). Las concentraciones séricas de TNF-no fueron significativamente distintas entre los grupos pero los pacientes con CC en estadios III o IV tuvieron mayores concentraciones de TNF-que aquellos con un menor estadio de la enfermedad (p = 0,037). Las tres herramientas empleadas para evaluar el estado nutritivo (IMC, AF y PG­SGA) demostraron que los pacientes con un déficit nutricional más pronunciado presentaban mayores concentraciones de adipocitocina, aunque algunas diferencias sólo fueron significativas para el TNF-cuanto se distribuyó el AF en terciles. CONCLUSIONES: Las concentraciones de adiponectina fueron superiores en pacientes con CCR. Aunque las concentraciones séricas de TNF-de los pacientes con CCR no diferían significativamente de las del grupo control, los pacientes con CCR en estadios III o IV tuvieron concentraciones superiores en comparación con aquellos con tumores en estadios I y II. El estado nutritivo, determinado por IMC, AF y PG-SGA, demostró que los pacientes con un mayor déficit nutricional tenían concentraciones superiores de adipocitocinas; sin embargo, estas diferencias sólo fueron significativas para el TNF-cuando el AF se distribuyó en terciles.

What are the most effective methods for assessment of nutritional status in outpatients with gastric and colorectal cancer?

OBJECTIVE: To evaluate methods for the identification of nutrition risk and nutritional status in outpatients with colorectal (CRC) and gastric cancer (GC), and to compare the results to those obtained for patients already treated for these cancers. METHODS: A cross-sectional study was conducted on 137 patients: group 1 (n = 75) consisting of patients with GC or CRC, and group 2 (n = 62) consisting of patients after treatment of GC or CRC under follow up, who were tumor free for a period longer than 3 months. Nutritional status was assessed in these patients using objective methods [body mass index (BMI), phase angle, serum albumin]; nutritional screening tools [Malnutrition Universal Screening Tool (MUST), Malnutrition Screening Tool (MST), Nutritional Risk Index (NRI)], and subjective assessment [Patient-Generated Subjective Global Assessment (PGSGA)]. The sensitivity and specificity of each method was calculated in relation to the PG-SGA used as gold standard. RESULTS: One hundred thirty seven patients participated in the study. Stage IV cancer patients were more common in group 1. There was no difference in BMI between groups (p = 0.67). Analysis of the association between methods of assessing nutritional status and PG-SGA showed that the nutritional screening tools provided more significant results (p < 0.05) than the objective methods in the two groups. PG-SGA detected the highest proportion of undernourished patients in group 1. The nutritional screening tools MUST, NRI and MST were more sensitive than the objective methods. Phase angle measurement was the most sensitive objective method in group 1. CONCLUSION: The nutritional screening tools showed the best association with PG-SGA and were also more sensitive than the objective methods. The results suggest the combination of MUST and PG-SGA for patients with cancer before and after treatment.

Objetivo: Evaluar los métodos para la identificación del riesgo nutricional y del estado nutricional en pacientes ambulatorios con cáncer colorrectal (CCR) y cáncer gástrico (CG) y comparar los resultados con los obtenidos por los pacientes ya tratados por estos cánceres. Métodos: Se realizó un estudio transversal en 137 pacientes: el grupo 1 (n = 75) comprendía pacientes con CG o CCR y el grupo 2 (n = 62) comprendía pacientes tras el tratamiento de CG o CCR en seguimiento y que estaban libres de tumor por un periodo mayor de 3 meses. Se evaluó el estado nutricional de estos pacientes usando métodos objetivos [índice de masa corporal (IMC), el ángulo de fase y la albúmina sérica]; herramientas de cribado nutricional [Malnutrition Universal Screening Tool (MUST), Malnutrition Screening Tool (MST), Nutritional Risk Index (NRI)] y una evaluación subjetiva [Evaluación Global Subjetiva Generada por el Paciente (EGS-GP)]. La sensibilidad y especificidad de cada método se calcularon con relación a la EGS-GP, que se empleó como prueba de referencia. Resultados: 137 pacientes participaron en el estudio. Los pacientes con cáncer en estadio IV fueron más frecuentes en el grupo 1. No hubo diferencias en el IMC entre los grupos (p = 0,67). El análisis de la asociación entre los métodos de evaluación nutricional y la EGSGP mostró que las herramientas de cribado nutricional proporcionaban resultados más significativos (p < 0,05) que los métodos objetivos en ambos grupos. La EGS-GP detectó la mayor proporción de pacientes desnutridos en el grupo 1. Las herramientas de cribado nutricional MUST, NRI y MST eran más sensibles que los métodos objetivos. La medición del ángulo de fase fue el método objetivo más sensible en el grupo 1. Conclusión: Las herramientas de cribado nutricional mostraron la mejor asociación con la EGS-GP y también fueron más sensibles que los métodos objetivos. Los resultados sugieren el uso de la combinación de MUST y EGSGP en pacientes con cáncer antes y después del tratamiento.

Disruption of sphingolipid biosynthesis in Nicotiana benthamiana activates salicylic acid-dependent responses and compromises resistance to Alternaria alternata f. sp. lycopersici.

Sphingolipids play an important role in signal transduction pathways that regulate physiological functions and stress responses in eukaryotes. In plants, recent evidence suggests that their metabolic precursors, the long-chain bases (LCBs) act as bioactive molecules in the immune response. Interestingly, the virulence of two unrelated necrotrophic fungi, Fusarium verticillioides and Alternaria alternata, which are pathogens of maize and tomato plants, respectively, depends on the production of sphinganine-analog mycotoxins (SAMs). These metabolites inhibit de novo synthesis of sphingolipids in their hosts causing accumulation of LCBs, which are key regulators of programmed cell death. Therefore, to gain more insight into the role of sphingolipids in plant immunity against SAM-producing necrotrophic fungi, we disrupted sphingolipid metabolism in Nicotiana benthamiana through virus-induced gene silencing (VIGS) of the serine palmitoyltransfersase (SPT). This enzyme catalyzes the first reaction in LCB synthesis. VIGS of SPT profoundly affected N. benthamiana development as well as LCB composition of sphingolipids. While total levels of phytosphingosine decreased, sphinganine and sphingosine levels increased in SPT-silenced plants, compared with control plants. Plant immunity was also affected as silenced plants accumulated salicylic acid (SA), constitutively expressed the SA-inducible NbPR-1 gene and showed increased susceptibility to the necrotroph A. alternata f. sp. lycopersici. In contrast, expression of NbPR-2 and NbPR-3 genes was delayed in silenced plants upon fungal infection. Our results strongly suggest that LCBs modulate the SA-dependent responses and provide a working model of the potential role of SAMs from necrotrophic fungi to disrupt the plant host response to foster colonization.

Salicylic acid beyond defence: its role in plant growth and development.

In recent years salicylic acid (SA) has been the focus of intensive research due to its function as an endogenous signal mediating local and systemic plant defence responses against pathogens. It has also been found that SA plays a role during the plant response to abiotic stresses such as drought, chilling, heavy metal toxicity, heat, and osmotic stress. In this sense, SA appears to be, just like in mammals, an 'effective therapeutic agent' for plants. Besides this function during biotic and abiotic stress, SA plays a crucial role in the regulation of physiological and biochemical processes during the entire lifespan of the plant. The discovery of its targets and the understanding of its molecular modes of action in physiological processes could help in the dissection of the complex SA signalling network, confirming its important role in both plant health and disease. Here, the evidence that supports the role of SA during plant growth and development is reviewed by comparing experiments performed by exogenous application of SA with analysis of genotypes affected by SA levels and/or perception.