Moving Forward on Tumor Pathology Research Reporting: A Guide for Pathologists From the World Health Organization Classification of Tumors Living Evidence Gap Map by Tumour Type Group.

Evidence-based medicine (EBM) can be an unfamiliar territory for those working in tumor pathology research, and there is a great deal of uncertainty about how to undertake an EBM approach to planning and reporting histopathology-based studies. In this article, reviewed and endorsed by the Word Health Organization International Agency for Research on Cancer's International Collaboration for Cancer Classification and Research, we aim to help pathologists and researchers understand the basics of planning an evidence-based tumor pathology research study, as well as our recommendations on how to report the findings from these. We introduce some basic EBM concepts, a framework for research questions, and thoughts on study design and emphasize the concept of reporting standards. There are many study-specific reporting guidelines available, and we provide an overview of these. However, existing reporting guidelines perhaps do not always fit tumor pathology research papers, and hence, here, we collate the key reporting data set together into one generic checklist that we think will simplify the task for pathologists. The article aims to complement our recent hierarchy of evidence for tumor pathology and glossary of evidence (study) types in tumor pathology. Together, these articles should help any researcher get to grips with the basics of EBM for planning and publishing research in tumor pathology, as well as encourage an improved standard of the reports available to us all in the literature.

The Role of Environmental Factors in Lyme Disease Transmission in the European Union: A Systematic Review.

BACKGROUND: Lyme disease (LD) is an emergent vector-borne disease caused by Borrelia spp. and transmitted through infected ticks, mainly Ixodes spp. Our objective was to determine meteorological and environmental factors associated with LD transmission in Europe and the effect of climate change on LD. MATERIALS AND METHODS: A systematic review following the PRISMA guidelines was performed. We selected studies on LD transmission in the European Union (EU) and the European Economic Area (EEA) published between 2000 and 2022. The protocol was registered in the PROSPERO database. RESULTS: We included 81 studies. The impact of environmental, meteorological or climate change factors on tick vectors was studied in 65 papers (80%), and the impact on human LD cases was studied in 16 papers (19%), whereas animal hosts were only addressed in one study (1%). A significant positive relationship was observed between temperature and precipitation and the epidemiology of LD, although contrasting results were found among studies. Other positive factors were humidity and the expansion of anthropized habitats. CONCLUSIONS: The epidemiology of LD seems to be related to climatic factors that are changing globally due to ongoing climate change. Unfortunately, the complete zoonotic cycle was not systematically analyzed. It is important to adopt a One Health approach to understand LD epidemiology.

A systematic review of environmental factors related to WNV circulation in European and Mediterranean countries.

Introduction/objective: West Nile virus (WNV) is one of the most widely distributed flaviviruses worldwide. It is considered an endemic and emerging pathogen in different areas of the Europe and Mediterranean countries (MR). Mosquitoes of the genus Culex spp. are the main vectors, and birds its main vertebrate hosts. It can occasionally infect mammals, including humans. Different environmental factors can influence its distribution and transmission through its effects on vector or host populations. Our objective was to determine environmental factors associated with changes in vector distribution and WNV transmission in Europe and MR. Material & methods: Systematic peer review of articles published between 2000 and 2020. We selected studies on WNV, and its vectors carried out in Europe and MR. The search included terms referring to climatic and environmental factors. Results: We included 65 studies, of which 21 (32%) were conducted in Italy. Culex spp. was studied in 26 papers (40%), humans in 19 papers (29%) and host animals (mainly horses) in 16 papers (25%), whereas bird reservoirs were addressed in 5 studies (8%). A significant positive relationship was observed between changes in temperature and precipitation patterns and the epidemiology of WNV, although contrasting results were found among studies. Other factors positively related to WNV dynamics were the normalized difference vegetation index (NDVI] and expansion of anthropized habitats. Conclusion: The epidemiology of WNV seems to be related to climatic factors that are changing globally due to ongoing climate change. Unfortunately, the complete zoonotic cycle was not analyzed in most papers, making it difficult to determine the independent impact of environment on the different components of the transmission cycle. Given the current expansion and endemicity of WNV in the area, it is important to adopt holistic approaches to understand WNV epidemiology and to improve WNV surveillance and control.

International travels and transmission of multidrug resistant Neisseria gonorrhoeae in Europe: A systematic review.

BACKGROUND: The increase of gonococcal infection cases in Europe and rises in Neisseria gonorrhoeae antibiotic resistance (AMR) have become an urgent concern globally. In the last few years international tourism has increased, which might contribute to the spread of different strains of multiresistant gonococcal infections. This study aimed at assessing the effect of international travel on the transmission of multidrug resistant N. gonorrhoeae in the European Union and associated European countries. METHOD: We conducted a systematic review and searched PubMed, Scopus, Embase and CENTRAL between January 1, 2010 and June 30, 2021 for gonococcal infection, antibiotic resistance and international travel. Articles were screened in title, abstract and keywords. The quality of the articles was assessed using a pre-designed tool. Individual, travel related and susceptibility to antimicrobials data were collected. RESULTS: A total of 18 studies met our criteria, of which 88.9% concluded that international travel directly influences the transmission of multidrug resistant N. gonorrhoeae from the country of travel to the country of return. Travelers mainly visited South East Asian countries (66.7%) and returned to the UK (38.9%). Half of the included studies reported ciprofloxacin resistant strains and the most frequently prescribed drug used for treatment was ceftriaxone. CONCLUSIONS: International travels might be an important factor in the spread of multi-resistant sexually transmitted infections (STIs). There is a need to strengthen AMR surveillance in international travelers for prompt investigation and notification of drug resistance in STIs.

Risks of adverse outcomes in COVID-19 patients and vaccination status in a secondary hospital in Spain.

Introduction: In December 2020, vaccination against SARS-CoV-2 started in Spain. Until March 2022, 91.1% of the target population was vaccinated. The objective of the study is to describe the characteristics of patients with SARS-CoV-2 infection, the risk of serious outcomes and their vaccination status. Material and methods: Retrospective longitudinal analytical observational study. Demographic characteristics and outcomes of COVID-19 infections and vaccination history from 01/01/2021-08/10/2021 were collected from electronic medical records and the Unified Vaccination Registry. Data analysis was performed with Excel and Stata 16. Results: 4161 COVID-19 cases were detected; of which 185 (4.5%) had received a complete vaccination schedule. The most affected age group was 80-89 years (34.1%). 1697 patients were hospitalized, of whom 78 (4.6%) had been vaccinated against SARS-CoV-2. No patient admitted to the ICU had a history of vaccination. The mean hospitalization time in unvaccinated patients was 11 days (95% CI -41.54-63.54) compared to 8.5 days (95% CI 7.04-9.96) in vaccinated patients. The relative risk of hospitalization in vaccinated patients compared to unvaccinated patients for the age group 40 to 59 years was 0.29 (95% CI 0.11-0.72) and 0.77 (95% CI 0.67-0). 0.90) for people over 60 years of age. Conclusions: The risk of hospitalization and death was lower in vaccinated patients compared to unvaccinated patients in the age groups 40-59 and older than 60 years. This finding supports current clinical evidence.

Introducción: En diciembre 2020 inició la vacunación frente al SARS-CoV-2 en España. Hasta principios de marzo 2022 el 91,1% de la población diana ha sido vacunada. El objetivo del estudio es describir las características de los pacientes con infección por SARS-CoV-2, el riesgo de desenlaces graves y el estado de vacunación. Material y métodos: Estudio observacional analítico longitudinal retrospectivo. Se recogieron características demográficas y desenlace de infecciones COVID-19 de casos confirmados y sus antecedentes de vacunación desde 01/01/2021­10/08/2021 de las historias clínicas electrónicas y del Registro Unificado de Vacunación. El análisis de datos se realizó con Excel y Stata 16. Resultados: Se detectaron 4161 casos COVID-19; 185 (4,5%) recibieron pauta de vacunación completa. El grupo de edad más afectado fue 80­89 años (34,1%). 1697 pacientes hospitalizaron, de los cuales 78 (4,6%) recibieron pauta de vacunación completa. Ningún paciente ingresado en UCI tenía antecedentes de vacunación. El tiempo medio de hospitalización en no vacunados fue de 11 días (IC95% -41,54-63,54) frente a 8,5 días (IC95% 7,04-9,96) en vacunados. El riesgo relativo de hospitalización en vacunados respecto a no vacunados para el grupo de edad de 40 a 59 años fue de 0,29 (IC95% 0,11-0,72) y de 0,77 (IC95% 0,67-0,90) para las personas de más de 60 años. Conclusiones: El riesgo de hospitalización y muerte fue menor en los pacientes vacunados en comparación con los no vacunados en los grupos de edad 40­59 y mayores de 60 años. Este hallazgo está de acuerdo con los datos de la evidencia clínica actual.

Melatonin in the Prophylaxis of SARS-CoV-2 Infection in Healthcare Workers (MeCOVID): A Randomised Clinical Trial.

We evaluated in this randomised, double-blind clinical trial the efficacy of melatonin as a prophylactic treatment for prevention of SARS-CoV-2 infection among healthcare workers at high risk of SARS-CoV-2 exposure. Healthcare workers fulfilling inclusion criteria were recruited in five hospitals in Spain and were randomised 1:1 to receive melatonin 2 mg administered orally for 12 weeks or placebo. The main outcome was the number of SARS-CoV-2 infections. A total of 344 volunteers were screened, and 314 were randomised: 151 to placebo and 163 to melatonin; 308 received the study treatment (148 placebo; 160 melatonin). We detected 13 SARS-CoV-2 infections, 2.6% in the placebo arm and 5.5% in the melatonin arm (p = 0.200). A total of 294 adverse events were detected in 127 participants (139 in placebo; 155 in melatonin). We found a statistically significant difference in the incidence of adverse events related to treatment: 43 in the placebo arm and 67 in the melatonin arm (p = 0.040), and in the number of participants suffering from somnolence related to treatment: 8.8% (n = 14) in the melatonin versus 1.4% (n = 2) in the placebo arm (p = 0.008). No severe adverse events related to treatment were reported. We cannot confirm our hypothesis that administration of melatonin prevents the development of SARS-CoV-2 infection in healthcare workers.

Epidemiological characteristics of the COVID-19 outbreak in a secondary hospital in Spain.

OBJECTIVES: In 2019 Chinese authorities alerted of the appearance of a cluster of cases of unknown pneumonia related to a new type of coronavirus. Spain is among the most affected countries. Our aim is to describe the cases of COVID-19 at Infanta Sofía University Hospital (Madrid), a public secondary hospital that increased its hospital beds to provide assistance during the outbreak. METHODS: Retrospective descriptive study of cases that met COVID-19 clinical diagnosis criteria or had a positive PCR test from February 27 to June 29, 2020. A description of demographic variables, hospital stay, mortality and the epidemiological curve was performed. RESULTS: Of 1,828 confirmed cases, 64.4% were hospitalised, 5.6% were admitted to the ICU. About 52.2% were male. The median age was 63.2 years. About 13.1% were nursing home residents. Nineteen percent were of Latin American origin of which 6.8% were admitted to the ICU. Overall case fatality was 14.6%. We observed a biphasic epidemiological curve. CONCLUSIONS: Sixty to 79-year-old males were admitted and deceased more often than women. Mortality reached 14.7%. Latin Americans were admitted more often to the ICU. Further studies about epidemiological characteristics of COVID-19 in hospitals are necessary.

The impact of climate change on mosquito-borne diseases in Africa.

Despite being one of the continents with the least greenhouse gas emissions, no continent is being struck as severely by climate change (CC) as Africa. Mosquito-borne diseases (MBD) cause major human diseases in this continent. Current knowledge suggests that MBD range could expand dramatically in response to CC. This study aimed at assessing the relationship between CC and MBD in Africa. Methods For this purpose, a systematic peer review was carried out, considering all articles indexed in PubMed, Scopus, Embase and CENTRAL. Search terms referring to MBD, CC and environmental factors were screened in title, abstract and keywords.Results A total of twenty-nine studies were included, most of them on malaria (61%), being Anopheles spp. (61%) the most commonly analyzed vector, mainly in Eastern Africa (48%). Seventy-nine percent of these studies were based on predictive models. Seventy-two percent of the reviewed studies considered that CC impacts on MBD epidemiology. MBD prevalence will increase according to 69% of the studies while 17% predicted a decrease. MBD expansion throughout the continent was also predicted. Most studies showed a positive relationship between observed or predicted results and CC. However, there was a great heterogeneity in methodologies and a tendency to reductionism, not integrating other variables that interact with both the environment and MBD. In addition, most results have not yet been tested. A global health approach is desirable in this kind of research. Nevertheless, we cannot wait for science to approve something that needs to be addressed now to avoid greater effects in the future.