Reverse shoulder replacement versus hemiarthroplasty for proximal humeral fracture in elderly patients: a systematic review.

This systematic review of the literature aims to analyse current knowledge to inform choice between hemiarthroplasty (HA) and reverse total shoulder arthroplasty (rTSA) for managing proximal humerus fractures (PHF) in elderly patients; the aim is to understand if rTSA can be considered the gold standard for treating PHF in the elderly when surgical fixation or conservative treatment is not viable options. Studies reporting outcomes and complications of PHF treated with shoulder arthroplasty in the elderly were included. Studies were in English and published after 2008. Evidence levels I, II, III and IV were included. According to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a comprehensive literature search was conducted using Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature) and PubMed search engines, as well as the Cochrane Central Register of Controlled Trials. General data collected were study design, number of patients treated with HA and rTSA, age of patients (mean, mean and SD, mean and range), length of follow-up, type of implant, and clinical outcomes. rTSA can be regarded as the gold standard for surgical management of displaced 3 and 4-part fractures in the elderly. However, the literature offers mostly low-quality studies, thereby requiring further work to achieve a full understanding of this important topic.

The OPTIMIZE patient- and family-centered, primary care-based deprescribing intervention for older adults with dementia or mild cognitive impairment and multiple chronic conditions: study protocol for a pragmatic cluster randomized controlled trial.

BACKGROUND: Most individuals with dementia or mild cognitive impairment (MCI) have multiple chronic conditions (MCC). The combination leads to multiple medications and complex medication regimens and is associated with increased risk for significant treatment burden, adverse drug events, cognitive changes, hospitalization, and mortality. Optimizing medications through deprescribing (the process of reducing or stopping the use of inappropriate medications or medications unlikely to be beneficial) may improve outcomes for MCC patients with dementia or MCI. METHODS: With input from patients, family members, and clinicians, we developed and piloted a patient-centered, pragmatic intervention (OPTIMIZE) to educate and activate patients, family members, and primary care clinicians about deprescribing as part of optimal medication management for older adults with dementia or MCI and MCC. The clinic-based intervention targets patients on 5 or more medications, their family members, and their primary care clinicians using a pragmatic, cluster-randomized design at Kaiser Permanente Colorado. The intervention has two components: a patient/ family component focused on education and activation about the potential value of deprescribing, and a clinician component focused on increasing clinician awareness about options and processes for deprescribing. Primary outcomes are total number of chronic medications and total number of potentially inappropriate medications (PIMs). We estimate that approximately 2400 patients across 9 clinics will receive the intervention. A comparable number of patients from 9 other clinics will serve as wait-list controls. We have > 80% power to detect an average decrease of - 0.70 (< 1 medication). Secondary outcomes include the number of PIM starts, dose reductions for selected PIMs (benzodiazepines, opiates, and antipsychotics), rates of adverse drug events (falls, hemorrhagic events, and hypoglycemic events), ability to perform activities of daily living, and skilled nursing facility, hospital, and emergency department admissions. DISCUSSION: The OPTIMIZE trial will examine whether a primary care-based, patient- and family-centered intervention educating patients, family members, and clinicians about deprescribing reduces numbers of chronic medications and PIMs for older adults with dementia or MCI and MCC. TRIAL REGISTRATION: NCT03984396. Registered on 13 June 2019.

Local analgesia in paediatric dentistry: a systematic review of techniques and pharmacologic agents.

PURPOSE: To evaluate the evidence supporting effects and adverse effects of local analgesia using different pharmacological agents and injection techniques during dental treatment in children and adolescents aged 3-19 years. METHODS: A systematic literature search of databases including PubMed, Cochrane, and Scopus was conducted in November 2016. The PRISMA-statement was followed. Two review authors independently assessed the selected randomised control trials for risk of bias and quality. RESULTS: 725 scientific papers were identified. 89 papers were identified to be read in full text of which 80 were excluded. Finally, 9 papers were evaluated for quality and risk of bias. Many of the included papers had methodological shortcomings affecting the possibility to draw conclusions. Information about ethical clearance and consent were missing in some of the included papers. No alarming adverse effects were identified. One study was assessed as having low risk of bias. This reported inferior alveolar nerve block to be more effective than buccal infiltration for dental treatment of mandibular molars, while no differences were found regarding pharmacological agents. CONCLUSIONS: At present, there is insufficient evidence in support of any pharmacologic agent or injection technique as being superior compared to others. There is a need for more rigorous studies which also handle the ethical issues of including children in potentially painful studies.

Dépistage des lésions précancéreuses du col utérin et micro-organismes associés dans trois communes de Nouakchott

Introduction : Le cancer du col de l'utérus emporte plus de 266.000 femmes chaque année dans le monde et 70% des victimes de cette affection vivent dans des pays à revenu faible ou intermédiaire. Cette maladie peut être prévenue grâce à un test de frottis cervico-vaginal. Les objectifs de cette étude était de déterminer la prévalence des lésions précancéreuses du col utérin et des micro-organismes associés dans la population étudiée et d'aider à une meilleure prise en charge de la maladie aussi bien dans la prévention que dans le traitement à l'échelle nationale. Patientes et méthodes : Cet article porte sur un échantillon de 500 femmes venant de 3 communes de Nouakchott (Arafat, Riad et Sebkha). Il ressort de notre étude que les infections spécifiques étaient prédominées par celles au Gardnerella vaginalis (58,44%). Elles étaient suivies respectivement par celles au Candida albicans (16,25%), Trichomonas vaginalis (14,29%) et HPV (12,98%). Les lésions pré-cancéreuses représentaient 14,29% des lésions spécifiques avec une forte association du HPV (95,4%).Conclusion : Il importe de vulgariser le test de FCV, en passant par la formation de cyto-techniciens capables de réaliser des FCV et multiplier les sites de dépistage à l'intérieur du pays

Guillain-Barré por vacuna antigripal / Guillain-Barré and flu vaccine

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Trends in HIV testing, prevalence among first-time testers, and incidence in most-at-risk populations in Spain: the EPI-VIH Study, 2000 to 2009.

During 2000 to 2009, data on people undergoing HIV testing and on those newly diagnosed with HIV were collected in a network of 20 Spanish clinics specialising in sexually transmitted infections and/or HIV testing and counselling. The number of tests performed, overall and disaggregated by different variables, was obtained. HIV prevalence among first-time testers and HIV incidence among repeat testers were calculated. To evaluate trends, joinpoint regression models were fitted. In total, 236,939 HIV tests were performed for 165,745 individuals. Overall HIV prevalence among persons seeking HIV testing was 2.5% (95% CI: 2.4 to 2.6). Prevalence was highest in male sex workers who had sex with other men (19.0% (95% CI: 16.7 to 21.4)) and was lowest in female sex workers (0.8% (95% CI: 0.7 to 0.9)). Significant trends in prevalence were observed in men who have sex with men (MSM) (increasing) and heterosexual individuals (decreasing). The incidence analysis included 30,679 persons, 64,104 person-years (py) of follow-up and 642 seroconversions. The overall incidence rate (IR) was 1.0/100 py (95% CI: 0.9/100 to 1.1/100). Incidence was significantly higher in men and transgender females than in women (1.8/100 py (95% CI: 1.6 to 1.9), 1.2/100 py (95% CI: 0.5 to 2.8) and 0.1/100 py (95% CI: 0.09 to 0.2) respectively) and increased with age until 35­39 years. IRs in MSM and people who inject drugs were significantly greater than in heterosexual individuals (2.5/100 py (95% CI: 2.3 to 2.7), 1.6/100 py (95% CI: 1.1 to 2.2) and 0.1/100 py (95% CI: 0.09 to 0.2) respectively), and an upward trend was observed in MSM. Our results call for HIV prevention to be reinforced in MSM and transgender women in Spain.

Increase in gonorrhoea among very young adolescents, Catalonia, Spain, January 2012 to June 2013.

Between January 2012 and June 2013, 27 sexually transmitted infections were reported in adolescents aged 13-15 years in Catalonia, Spain. In the first half of 2013, there were nine cases of gonorrhoea, while in the same period of 2012, there was one. In June 2013, two gonorrhoea cases aged 13-14 years, linked to a common source through a social network, were reported. The public health response should be adapted to this vulnerable population.

N-vinylpyrrolidone dimer (VPD), a novel excipient for oral drugs: repeat-dose oral toxicity in Sprague-Dawley rats.

N-vinylpyrrolidone dimer (VPD), a novel vehicle for preclinical toxicity studies, was evaluated in a standard 28-day oral toxicity study in rats including a 4 week recovery period. In addition, a subgroup of animals was dosed for 13 weeks. In the 28-day study arm, daily dosages of 0 (saline control, 3mL/kg), 300, 1000 or 3000mg/kg at respective dose volumes of 0.3, 1 and 3mL/kg were administered. In the 13 week study arm, animals received daily doses of 0 or 300mg/kg. No test item related mortality or changes in body weight, food consumption, ophthalmology and clinical pathology parameters were observed after 28-days or 13 weeks of administration. VPD induced transient salivation at all tested dose levels after each dose and increased water consumption at doses ≥1000mg/kg (28-day arm). After 28-days of administration, urinalysis revealed slightly higher mean specific gravity in all treated groups. Relevant organ weight changes consisted of increased mean liver weights. Histopathology revealed hepatocellular centrilobular hypertrophy at a dose-related incidence and severity, minimal to slight follicular cell hypertrophy in male thyroids, hypertrophy of basophil/chromophobe cells in pituitaries and an increase in kidney hyaline droplets consistent with α(2µ)-globuline immunohistochemistry. After a 4-week recovery, all changes were partially or completely reversible. Administration of VPD at 300mg/kg for 13 weeks caused similar histopathological findings observed after 28-days dosing. Overall, in rats, repeated high oral doses of VPD produced changes in the liver, thyroid and pituitary, most likely secondary to hepatic microsomal enzyme induction and stimulation of the thyroid via disruption of the hypothalamic-pituitary-thyroid axis. In conclusion, our data suggest that VPD is a promising vehicle for preclinical studies. However, in rats, findings secondary to hepatic microsomal enzyme induction and stimulation of the thyroid need to be taken into consideration, depending on dose and study duration. In order to develop VPD as a preclinical excipient, additional preclinical toxicity studies (non-rodents, different administration routes, chronic and reproductive toxicity) would be beneficial.

Lymphogranuloma venereum: a hidden emerging problem, Barcelona, 2011.

From the beginning of 2007 until the end of 2011, 146 cases of lymphogranuloma venereum (LGV) were notified to the Barcelona Public Health Agency. Some 49% of them were diagnosed and reported in 2011, mainly in men who have sex with men. Almost half of them, 32 cases, were reported between July and September. This cluster represents the largest since 2004. This article presents the ongoing outbreak of LGV in Barcelona.

HIV/STI co-infection among men who have sex with men in Spain.

In Spain, neither the HIV nor the STI national surveillance systems collect information on HIV/STI co-infection. However, there are two networks based on HIV/STI clinics which gather this data. We describe HIV prevalence in men who have sex with men (MSM) diagnosed with infectious syphilis and/or gonorrhoea in 15 STI clinics; and concurrent diagnoses of STI in MSM newly diagnosed with HIV in 19 HIV/STI clinics. In total, 572 MSM were diagnosed with infectious syphilis and 580 with gonorrhoea during 2005-2007. HIV prevalence among syphilis and gonorrhoea cases was 29.8% and 15.2% respectively. In the multivariate analysis, HIV/syphilis co-infection was associated with being Latin American; having a history of STI; reporting exclusively anal intercourse; and having sex with casual or several types of partners. HIV and gonorrhoea co-infection was associated with age older than 45 years; having no education or only primary education completed; and having a history of STI. In total, 1,462 HIV infections were newly diagnosed among MSM during 2003-2007. Of these, 31.0% were diagnosed with other STI at the same time. Factors associated with STI co-infection among new HIV cases in MSM were being Latin American; and having sex with casual partners or with both steady and casual partners. In Spain, a considerable proportion of MSM are co-infected with HIV and STI.

Ensuring financial access to emergency obstetric care: three years of experience with Obstetric Risk Insurance in Nouakchott, Mauritania.

INTRODUCTION: The high cost of emergency obstetric care (EmOC) is a catastrophic health expenditure for households, causing delay in seeking and providing care in poor countries. METHODS: In Nouakchott, the Ministry of Health instituted Obstetric Risk Insurance to allow obstetric risk sharing among all pregnant women on a voluntary basis. The fixed premium (US$21.60) entitles women to an obstetric package including EmOC and hospital care as well as post-natal care. The poorest are enrolled at no charge, addressing the problem of equity. RESULTS: 95% of pregnant women in the catchment area (48.3% of the city's deliveries) enrolled. Utilization rates increased over the 3-year period of implementation causing quality of care to decline. Basic and comprehensive EmOC are now provided 24/7. The program has generated US$382,320 in revenues, more than twice as much as current user fees. All recurrent costs other than salaries are covered. CONCLUSION: This innovative sustainable financing scheme guarantees access to obstetric care to all women at an affordable cost.

Cuidados enfermeros según Virginia Henderson. Ámbito de la atención domiciliaria / Nursing care according to Virginia Henderson in the at home care field

Determinar si la aplicación del proceso enfermero (PE), adoptando el modelo conceptual de Virginia Henderson (VH), resulta más efectivo y proporciona algún valor añadido (calidad en los cuidados y seguridad-satisfacción profesional) respecto a la aplicación de otros métodos que no adoptan dicho modelo, en el ámbito de la Atención Domiciliaria

The authors determine if applying the nurse process, by adopting Virginia Henderson´s conceptual model, is more effective and provides any added value in terms of quality care and security or professioanl satisfaction in comparison to the application of other methods which do not adopt Henderson´s model in the field of at home care

Nuevos retos de las infecciones sexualmente transmisibles: papel de los centros de infecciones de transmisión sexual / New goals for control of sexually transmitted diseases: role of centers of sexually transmitted diseases

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[HIV infection and other sexually-transmitted infections among immigrants in Barcelona]. / Infección por el virus de la inmunodeficiencia humana y otras infecciones de transmisión sexual en inmigrantes de Barcelona*

BACKGROUND: Immigration is a recent phenomenon in Spain. Certain subgroups of the immigrant population may be vulnerable to acquiring sexually transmitted infections (STI). MATERIAL AND METHODS: Descriptive study of the seroprevalenceof certain STI (HIV, hepatitis B and syphilis) and the general characteristicsn of persons tested for HIV infection in a specialized clinic in Barcelona during the year 2000. RESULTS: Seroprevalence of HIV was similar in immigrants and native residents(1.8% vs. 1.7% respectively). However, the seroprevalences of hepatitis B virus (anti-HBc) (19.5% vs. 8.3%) and syphilis (RPR 1 TPHA) (3.2% vs. 1.1%), as well as other STI and the practice of prostitution, were higher in immigrants. CONCLUSIONS: Several STI, including hepatitis B and syphilis, were found more frequently in immigrants than in the native population, whereas HIV seroprevalence was similar in the two groups.

[The delivery record: a help to make the right decision]. / La dossier d'accouchement: une aide à la décision.

The delivery record is a key document for risk assessment and proper decision making at the right time during delivery. If it is exhaustive or badly presented, health workers see it as an administrative constraint, not as a help. The authors recall some principles regarding its form and contents. Its different parts are reviewed: administrative data, medical history, antenatal care, admission clinical examination, partograph, delivery, newborn, recent post-partum and exit examinations. An example of a delivery record used in Nouakchott is presented.

[Mortality in a cohort of intravenous drug users before the introduction of potent HIV therapy]. / Mortalidad en una cohorte de usuarios de drogas por vía intravenosa antes de la introducción de la terapia VIH potente.

BACKGROUND: The HIV/AIDS epidemics has contributed to an excess of morbidity and mortality in injecting drug users. The main goal of this study is to estimate incidence and factors associated with mortality from different causes among intravenous drug users. SUBJECTS AND METHODS: Prospective study of patients admitted to a detoxification unit between 1987 and 1990. At baseline they underwent interviews (drug injecting patterns) and venipuncture for HIV and other parameters including T-cell subsets. Viral status was determined for those who returned at least once. Cumulative incidence, overall and cause-specific mortality rates were calculated according to gender, HIV at admission and length of injecting drugs. RESULTS: 420 patients (334 men, 86 women), 69.6% HIV+, were admitted to treatment; the mean age of participants was 26 years and the mean duration of injecting drugs was 73 months. Three hundred and eighty seven patients were followed-up (92% of the initial cohort) for 2,029 persons-years and 101 deaths occurred. The overall mortality rate was 50/1000 persons-year (52/1000 for men and 40/1000 for women). The relative risk (RR) for death among women compared with men was 1.3 (95% CI = 0.8-2.2). The mortality rates for HIV+ was 60/1000 persons-year and 29/1000 persons-year for the seronegatives (RR: 2.1; 95% CI = 1.2-3.4). The HIV+ patients with CD4/microliter < or = 500 showed a threefold increase in mortality rates compared to HIV+ patients without immunosuppression (CI = 1.7-5.3). The cause-specific mortality rates were 27/1000 persons-year for HIV/AIDS, 15/1000 persons-year for drug overdose, 3/1000 persons-year for violence/trauma and 1/1000 persons-year for non-AIDS conditions. CONCLUSIONS: In this hospital cohort, HIV/AIDS and overdose have had a marked effect on mortality among intravenous drug users. Detoxification units may provide clinical services and extensive use of antiretroviral treatment for HIV infected drug users as a strategy to reduce the risk of death from AIDS.