The efficiency of several one-step testing strategies for the diagnosis of hepatitis C.

BACKGROUND: implementing one-step strategies for hepatitis C diagnosis would help shorten the time to treatment access. Thus avoiding disease progression and complications, while facilitating hepatitis C virus (HCV) elimination. OBJECTIVE: to assess the validity and certainty of potential one-step strategies for the diagnosis of HCV infection and their associated cost and efficiency. METHODS: the study design is an economic appraisal of efficiency (cost/efficacy) using decision trees and deterministic sensitivity analysis. The analysis was performed from the payer perspective (Spanish National Health System), which exclusively considers the direct costs. Only the differential costs (diagnostic testing costs) were taken into account and the study was set in Spain. The efficacy of a diagnostic strategy was defined as the percentage of patients with an active HCV infection who received a positive diagnosis and the efficiency was defined as the cost per patient with a correctly diagnosed and active infection. RESULTS: the one-step strategies evaluated for the diagnosis of HCV had an acceptable validity and certainty due to the high sensitivity and specificity of the considered tests. The Ab-Ag strategy was the most efficient, followed by Ab-Ag-VL and Ab-VL. Ab-Ag was the most efficient due to the lower cost per patient tested, although the efficacy was lower than the Ab-VL efficacy. CONCLUSION: the study findings may help to establish more appropriate one-step diagnostic approaches whilst considering the efficacy and efficiency.

Impact of age on the transmission of SARS-CoV-2 in healthcare workers : Influence of nonoccupational risk factors.

BACKGROUND: The incidence of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV­2) infection was highest among older adults early in the COVID-19 pandemic; however, this pattern was later reversed with young adults showing the highest incidence. The aim of this study was to identify risk factors in healthcare workers (HCWs) associated with this evolution. METHODS: We conducted a survey nested within a prospective cohort study of 680 HCWs from a tertiary referral public hospital who received 2 doses of SARS-CoV­2 vaccine in January and February 2021 (VACCICO-VAO cohort). In October 2022 all participants were invited to participate in a survey. Risk factors were tested for association with COVID-19 ever, the number of COVID-19 episodes, and the time to the first episode. RESULTS: Among 350 respondents (51% response rate, 90% female, mean age 48.1 years), 323 COVID-19 episodes were diagnosed during the study period. Multivariable analysis revealed that age < 35 years vs. > 50 years (odds ratio, OR 2.12, 95% confidence interval, CI 1.27-3.51; P = 0.004) and not maintaining social distance at social events (OR: 1.82, 95% CI: 1.16-3.19; P = 0.011) were associated with a higher risk of COVID-19. Age < 35 years (hazard ratio, HR 1.70, 95% CI 1.14-2.54; P = 0.010), and not maintaining social distance (HR 1.34, 95% CI 1.05-1.72; P = 0.020) were also associated with the time to the first episode. CONCLUSIONS: The youngest HCWs had the highest incidence rate of COVID-19, which was not explained by occupational risk factors or health conditions. The increase in nonoccupational exposure since the end of the lockdowns in summer 2020 could by a key factor.

[Co-infection with Neisseria gonorrhoeae and Actinomyces naeslundii]. / Coinfección por Neisseria gonorrhoeae y Actinomyces naeslundii.

OBJECTIVE: To report a case of co-infection with Neisseria gonorrhoeae and Actinomyces naeslundii in a woman with an intrauterine device. CASE REPORT: A 36-year-old woman with IUD, who entered to the hospital because of suprapubic abdominal pain, fever and foul-smelling vaginal discharge. RESULTS: We identified Neisseria gonorrhoeae and Actinomyces naeslundii and despite antibiotic treatment, ultrasound allowed objectify pelvic inflammatory disease and appendiceal involvement, which led to its surgical removal and bilateral salpingectomy. CONCLUSIONS: The surgical approach allowed to solve the box co.

Geometric Deep Learning for Unsupervised Registration of Diffusion Magnetic Resonance Images.

Deep learning based models for registration predict a transformation directly from moving and fixed image appearances. These models have revolutionized the field of medical image registration, achieving accuracy on-par with classical registration methods at a fraction of the computation time. Unfortunately, most deep learning based registration methods have focused on scalar imaging modalities such as T1/T2 MRI and CT, with less attention given to more complex modalities such as diffusion MRI. In this paper, to the best of our knowledge, we present the first end-to-end geometric deep learning based model for the non-rigid registration of fiber orientation distribution fields (fODF) derived from diffusion MRI (dMRI). Our method can be trained in a fully-unsupervised fashion using only input fODF image pairs, i.e. without ground truth deformation fields. Our model introduces several novel differentiable layers for local Jacobian estimation and reorientation that can be seamlessly integrated into the recently introduced manifold-valued convolutional network in literature. The results of this work are accurate deformable registration algorithms for dMRI data that can execute in the order of seconds, as opposed to dozens of minutes to hours consumed by their classical counterparts.

Relationship of fat distribution with adipokines in patients with acquired immunodeficiency virus infection.

BACKGROUND: The aim was to examine the relationship of fat distributions with adipokines concentrations in HIV-infected patients. METHODS: This was a cross-sectional analysis of 36 HIV (free of lipodystrophy) infected patients. Dual-energy X-ray absorptiometry was used. RESULTS: In the multivariate analysis, basal adiponectin concentration was a dependent variable, whereas waist to hip ratio and abdominal fat mass were independent predictors in the model (F = 5.1; P < 0.05). Adiponectin concentration decreases by 5.541.2 µg/ml (CI 95%: 8,071.9-3,029.1) for each unit of waist to hip ratio and 561.9 ng/ml (CI 95%: 918.2-213.4) for each kilogram of fat mass of abdominal area. In the multivariate analysis, basal leptin concentration was a dependent variable, whereas waist circumference remained an independent predictor in the model (F = 6.3; P < 0.05), with a direct correlation. Leptin concentration increases by 0.067 ng/ml (CI 95%: 0.001-0.12) for each centimeter of waist circumference. CONCLUSIONS: Leptin and adiponectin are related with adiposity in HIV-infected patients.

VolterraNet: A Higher Order Convolutional Network With Group Equivariance for Homogeneous Manifolds.

Convolutional neural networks have been highly successful in image-based learning tasks due to their translation equivariance property. Recent work has generalized the traditional convolutional layer of a convolutional neural network to non-euclidean spaces and shown group equivariance of the generalized convolution operation. In this paper, we present a novel higher order Volterra convolutional neural network (VolterraNet) for data defined as samples of functions on Riemannian homogeneous spaces. Analagous to the result for traditional convolutions, we prove that the Volterra functional convolutions are equivariant to the action of the isometry group admitted by the Riemannian homogeneous spaces, and under some restrictions, any non-linear equivariant function can be expressed as our homogeneous space Volterra convolution, generalizing the non-linear shift equivariant characterization of Volterra expansions in euclidean space. We also prove that second order functional convolution operations can be represented as cascaded convolutions which leads to an efficient implementation. Beyond this, we also propose a dilated VolterraNet model. These advances lead to large parameter reductions relative to baseline non-euclidean CNNs. To demonstrate the efficacy of the VolterraNet performance, we present several real data experiments involving classification tasks on spherical-MNIST, atomic energy, Shrec17 data sets, and group testing on diffusion MRI data. Performance comparisons to the state-of-the-art are also presented.

ManifoldNet: A Deep Neural Network for Manifold-Valued Data With Applications.

Geometric deep learning is a relatively nascent field that has attracted significant attention in the past few years. This is partly due to the availability of data acquired from non-euclidean domains or features extracted from euclidean-space data that reside on smooth manifolds. For instance, pose data commonly encountered in computer vision reside in Lie groups, while covariance matrices that are ubiquitous in many fields and diffusion tensors encountered in medical imaging domain reside on the manifold of symmetric positive definite matrices. Much of this data is naturally represented as a grid of manifold-valued data. In this paper we present a novel theoretical framework for developing deep neural networks to cope with these grids of manifold-valued data inputs. We also present a novel architecture to realize this theory and call it the ManifoldNet. Analogous to vector spaces where convolutions are equivalent to computing weighted sums, manifold-valued data 'convolutions' can be defined using the weighted Fréchet Mean ([Formula: see text]). (This requires endowing the manifold with a Riemannian structure if it did not already come with one.) The hidden layers of ManifoldNet compute [Formula: see text]s of their inputs, where the weights are to be learnt. This means the data remain manifold-valued as they propagate through the hidden layers. To reduce computational complexity, we present a provably convergent recursive algorithm for computing the [Formula: see text]. Further, we prove that on non-constant sectional curvature manifolds, each [Formula: see text] layer is a contraction mapping and provide constructive evidence for its non-collapsibility when stacked in layers. This captures the two fundamental properties of deep network layers. Analogous to the equivariance of convolution in euclidean space to translations, we prove that the [Formula: see text] is equivariant to the action of the group of isometries admitted by the Riemannian manifold on which the data reside. To showcase the performance of ManifoldNet, we present several experiments using both computer vision and medical imaging data sets.

[Analysis of the efficiency of hospitals in Castilla y León (Spain)]. / Análisis de la eficiencia de los hospitales de Castilla y León.

OBJECTIVE: The analysis of efficiency represents an area of growing interest in the field of public management. Hospital efficiency depends mainly on the use that the institution makes of its resources and their cost. The importance of hospital efficiency studies is justified by the fact that health spending is the second most important item of public spending. The objective of the present study focused on the analysis of the degree of efficiency with which the public hospitals of Castilla y León were managed. METHODS: The scope of the research was limited to the 14 hospitals of the Public Health Service of Castilla y León (Sacyl), taking the five-year period 2014-2018 as the study period. For the analysis, the non-parametric technique of Data Envelopment Analysis (DEA) was used. Both constant returns to scale (CRS) and variable returns to scale (VRS) have been used, calculating the global technical efficiency, pure technical efficiency and scale efficiency for each health institution. RESULTS: The grouped results showed that the global technical efficiency (GTE) had reached an average of 92.02%, the pure technical efficiency (PTE) 94.10% and the scale efficiency (EE) 97.74%. CONCLUSIONS: The DEA is presented as a valid technique for analyzing the efficiency of hospitals, with the efficiency of all groups of hospitals (groups I, III and IV) being very similar in terms of PTE, around 97%, with the exception of group II hospitals that are the least efficient.

OBJETIVO: El análisis de la eficiencia representa un área de creciente interés en el ámbito de la gestión pública, siendo además el gasto sanitario la segunda partida más importante del gasto público. La eficiencia hospitalaria depende principalmente del uso que la institución haga de sus recursos y del coste de los mismos. El objetivo del presente trabajo se centró en el análisis del grado de eficiencia con el que se gestionaban los hospitales públicos de Castilla y León. METODOS: El ámbito de la investigación se circunscribió a los catorce hospitales del Servicio Público de Salud de Castilla y León (Sacyl) durante el quinquenio 2014-2018. Se empleó la técnica no paramétrica del Análisis Envolvente de Datos (DEA), utilizándose tanto rendimientos constantes a escala (CRS) como rendimientos variables a escala (VRS), calculando la eficiencia técnica global, la eficiencia técnica pura y la eficiencia de escala para cada institución sanitaria. RESULTADOS: Los resultados agrupados mostraron que la eficiencia técnica global (ETG) alcanzó un promedio de un 92,02%, la eficiencia técnica pura (ETP) un 94,10% y la eficiencia de escala (EE) un 97,74%. CONCLUSIONES: El DEA se presenta como una técnica válida para el análisis de la eficiencia de los hospitales siendo, en términos de ETP, muy semejante la eficiencia de todos los grupos de hospitales (grupos I, III y IV), en torno al 97%, a excepción de los hospitales del grupo II que resultan los menos eficientes.

Relative Effectiveness of Cell-Cultured versus Egg-Based Seasonal Influenza Vaccines in Preventing Influenza-Related Outcomes in Subjects 18 Years Old or Older: A Systematic Review and Meta-Analysis.

Avian mutations in vaccine strains obtained from embryonated eggs could impair vaccine effectiveness. We performed a systematic review and meta-analysis of the adjusted relative vaccine effectiveness (arVE) of seed cell-cultured influenza vaccines (ccIV) compared to egg-based influenza vaccines (eIV) in preventing laboratory-confirmed influenza related outcomes (IRO) or IRO by clinical codes, in subjects 18 and over. We completed the literature search in January 2021; applied exclusion criteria, evaluated risk of bias of the evidence, and performed heterogeneity, publication bias, qualitative, quantitative and sensitivity analyses. All estimates were computed using a random approach. International Prospective Register of Systematic Reviews, CRD42021228290. We identified 12 publications that reported 26 adjusted arVE results. Five publications reported 13 laboratory confirmed arVE and seven reported 13 code-ascertained arVE. Nine publications with 22 results were at low risk of bias. Heterogeneity was explained by season. We found a significant 11% (8 to 14%) adjusted arVE favoring ccIV in preventing any IRO in the 2017-2018 influenza season. The arVE was 3% (-2% to 7%) in the 2018-2019 influenza season. We found moderate evidence of a significant advantage of the ccIV in preventing IRO, compared to eIV, in a well-matched A(H3N2) predominant season.

Direct Medical Costs of Four Vaccine-Preventable Infectious Diseases in Older Adults in Spain.

OBJECTIVE: Protection against vaccine-preventable diseases is especially relevant in older adults due to age-related decline in immunity (immunosenescence). However, adult vaccination remains a challenge with overall low coverage rates, which has an impact on both the patients who have these diseases and the health care system in terms of resource use and costs derived. This study aimed to estimate the direct economic impact of herpes zoster, pneumococcal disease, influenza and pertussis in Spanish adults 45 years and older. METHODS: Data from 2015 were extracted from two Spanish public databases: the Minimum Basic Data Set for Hospitalisations and the Clinical Database of Primary Care. Codes from the International Classification of Diseases and the International Classification of Primary Care were used to identify and classify the diseases analysed. The variables extracted and calculated were hospitalisation (cases, percentage, length of stay, costs, mortality), primary care (cases, percentage, costs) and referrals (cases, percentage, costs). Results were presented for the age groups 45-64 years, 65-74 years, > 74 years and all ages. RESULTS: In adults 45 years and older, total costs amounted to €134.1 million in 2015 (i.e. 63.9% of the total direct costs for all age groups): 44.4% due to pneumococcal disease, 39.5% due to influenza, 16.0% due to herpes zoster and 0.1% due to pertussis. Hospitalisations represented 58.1% (€77.9 million) of the total costs, with 15,910 admissions, 144,752 days of hospitalisation and 1170 deaths. Primary care registered 566,556 visits with a cost of €35.0 million, and 269,186 referrals with a cost of €21.1 million. CONCLUSION: The direct economic burden of herpes zoster, pneumococcal disease, influenza and pertussis in adults 45 years and older was high in Spain, and may be underestimated as it only considered medical assistance and not other applicable direct or indirect costs. Increasing vaccination rates in adults may potentially reduce the economic burden derived from these diseases, although future cost-effectiveness analysis including other disease-related costs, vaccination costs and vaccination effectiveness would be needed.

[Zoonotic infectious diseases]. / Enfermedades infecciosas zoonóticas.

To effect a structured review about what emerging zoonoses represent, we present the following aspects in a deliberately biased way: firstly, by way of introduction, we discuss certain concepts and characteristics common to the profile of an emergent agent; secondly, we comment on the factors that facilitate the emergence of zoonotic infections at present; and finally, we describe the surveillance, medical practice and laboratory work in this area.

[Factors associated with antiretroviral treatment and their influence on health related quality of life in HIV infected patients]. / Factores relacionados con el tratamiento antirretroviral y su influencia en la calidad de vida relacionada con la salud en personas infectadas por VIH.

OBJECTIVES: Access to antiretroviral treatment (ART) has become essential to delay HIV clinical progression and increase survival, so improving Health Related Quality of Life (HRQL). The aim of this investigation was to describe factors associated with ART and their impact on HRQL in HIV infected patients. METHODS: A cross-sectional study on 150 HIV-outpatients in a tertiary hospital was designed, and ART-related data collected. Adherence was assessed by the SMAQ questionnaire. HRQL data were collected by disease-specific questionnaire MOS-HIV (Medical Outcomes Study HIV Health Survey). RESULTS: A total of 84% of patients were on ART. Half of the treatment regimens were Protease inhibitor (PI) based, LPV/r being the most commonly used drug. The large majority of treatments used (89.7%) were second line or successive, and NNRTI-based combinations were the most used in first line. Lipodystrophy was the most frequently referred side-effect (61.1%). Almost all (94.5%) of our patients declared they were adapting well to treatment in their daily-life-activities, with 64.3% adhering to treatment according to the SMAQ (Simplified Medication Adherence Questionnaire) questionnaire. In the HRQL, patients with PI-based treatment got lower scores in 4 of 11 domains with the MOS-HIV questionnaire; while patients that adapted well to their ART had better scores in 4 of 11 domains and overall HRQL assessment in MOS-HIV. CONCLUSIONS: Most of our patients were on ART during our investigation. We have documented a negative association between PI-based treatment and HRQL domains, and a positive association between subjective ART adaptation and HRQL. The assessment of HRQL in this population has increasing interest as it is influenced by ART related factors as treatment improves life conditions of HIV infected people.

The impact of influenza vaccination on cardiovascular disease. / Impacto de la vacunación antigripal sobre la enfermedad cardiovascular.

Influenza infection has been identified as a triggering or exacerbating factor for cardiovascular events. To analyse the effect of influenza vaccination on cardiovascular disease, a systematic search of studies published between 2009-2019 was conducted. All the studies that evaluated the effect of vaccination against influenza on cardiovascular events and their outcome were considered. Finally, 30 of the 1147 identified studies were included. These studies show a protective effect of the influenza vaccine on the development of cardiovascular events (myocardial infarction, cerebrovascular accidents, atrial fibrillation, and heart failure) and on the worsening of these conditions. Furthermore, the data showed that vaccinated patients have a lower risk of death from cardiovascular pathologies. Influenza vaccination is therefore an effective measure in the prevention of cardiovascular diseases both in patients with established cardiovascular disease and in the population without previous coronary pathology.

CRISPR/CasRx Proof-of-Concept for RNA Degradation: A Future Tool against RNA Viruses?

Influenza viruses provide a great threat for the human population, causing highly contagious respiratory infections that can lead to serious clinical complications. There are a limited variety of influenza antivirals, and these antivirals are subjected to the constant emergence of resistances. Therefore, the development of new antiviral strategies to combat influenza viruses and other RNA viruses must be promoted. In this work, we design a proof-of-concept of a recently described CRISPR/Cas tool that has been proposed as a possible future RNA virus antiviral, named CRISPR/CasRx. For this, we verified the efficiency of the CasRx endonuclease in the degradation of the eGFP mRNA reporter gene and we established the best conditions for, and the efficient performance of, the CRISPR/CasRx system. The results were measured by fluorescence microscopy, flow cytometry, and qRT-PCR. The analyses demonstrated a reduction in fluorescence, regardless of the amount of eGFP reporter plasmid transfected. The analyses showed an 86-90% reduction in fluorescence by flow cytometry and a 51-80% reduction in mRNA expression by qRT-PCR. Our results demonstrate that the CasRx endonuclease is an efficient tool for eGFP mRNA knockdown. Therefore, subsequent experiments could be useful for the development of a new antiviral tool.

Social Distancing, Lockdown and the Wide Use of Mask; A Magic Solution or a Double-Edged Sword for Respiratory Viruses Epidemiology?

The use of non-pharmaceutical interventions (NPIs), such as social distancing, lockdowns and the massive use of masks, have not only largely prevented the spread of SARS-CoV-2, but also of other respiratory viruses such as influenza or respiratory syncytial virus (RSV). This decrease has been so high that, in most countries, the influenza and RSV epidemic has not occurred. Far from being a beneficial fact, this can be problematic, since the absence of circulation of certain pathogens can lead to a decrease in herd immunity against them. This can promote the rise of more serious, longer-lasting epidemics that start sooner. To alleviate the collateral effects that may occur due to the decrease in circulation of viruses such as influenza, it is necessary to increase the production of influenza vaccines, carry out mass vaccination campaigns and focus on vaccinating the main drivers of this virus, children.

Do Vaccines Need a Gender Perspective? Influenza Says Yes!

Background: Sex differences in immune responses are well known. However, the humoral response in males and females in the case of influenza vaccination is yet to be characterized since studies have shown uneven results. Methods: A retrospective study was conducted in 2,243 individuals (46.9% males) divided by age (15-64 and ≥65 years old). A serological analysis was performed by hemagglutination inhibition assay (HI) just before and 28 days after annual vaccination against seasonal influenza viruses in people vaccinated during the 2006-2018 seasons. A comparison of the humoral responses against influenza A and B viruses contained in the vaccine, between male and female individuals in young adults and elderly was conducted. Results: Significative higher humoral response against classical influenza A (H1N1), A(H1N1)pdm09 subtype and B/Victoria lineage in terms of seroconversion rate were found in elderly women. No significant differences were found in the case of A(H3N2) subtype. Conclusions: Elderly women seem to display a greater humoral response against classical A(H1N1), pandemic A(H1N1)pmd09 and B/Victoria lineage than elderly men. Sex dimorphism does not affect young adults.

[Evaluation of the influenza a H1N1 vaccination in Castilla and Leon regions, Spain]. / Evaluación de la vacunación frente al virus de la gripe A H1N1 en Castilla y León.

BACKGROUND AND OBJECTIVES: The recent approval of influenza A H1N1 monovalent vaccine has attracted considerable public health interest. The aim of this paper is to assess the development of vaccination campaign in Castilla y Leon. MATERIAL AND METHOD: We have performed a descriptive analysis of the number of vaccines given in Castilla y Leon from November 16, 2009 to January 17, 2010, inside the designed campaign for that purpose. RESULTS: The total number of vaccines administered has been 116,243, 86,810 of which were from Focetria(®) which were administered to 3286 children under 18 years; 28,439 were from Pandemrix(®) and 994 from Panenza(®). The estimated vaccination coverage for all of the target groups has reached a percentage of 26.3% while the coverage achieved in pregnant women has been 4.7%. Of all the vaccines administered during this period, 82.2% were applied in the first month of the vaccination campaign. CONCLUSION: The introduction of pandemic vaccine in target groups of Castilla y Leon has been lower than expected, with a mismatch between the different health areas.