A structured 2-week follow-up visit in the cascade of care for TB increases case detection.

Delayed detection in TB due to structural and diagnostic shortcomings is pivotal for disease transmission, morbidity and mortality. We investigated whether an inclusive screening, followed by a structured clinical follow-up (FU) could improve case-finding.Patients were recruited from health centres in Bissau, Guinea-Bissau, and Gondar, Ethiopia. A routine FU was done at Week 2. If persisting symptoms were found, patients were investigated using chest X-ray (CXR) and Xpert® MTB/RIF, followed by a medical consultation. The main outcome were additional TB patients diagnosed by applying the FU strategy.Of 3,571 adults, 3,285 (95%) were examined at Week 2 FU, where 2,491 (72%) were asymptomatic. Screening patients presenting with cough >2 weeks alone contributed to the diagnosis of 93 patients (45% of all patients diagnosed here), whereas a TBscore >3 increased this by 18 (9%); adding a Week 2 FU yielded an additional 94 (46%) patients. Among the 794 (24%) with persisting symptoms, 25 were diagnosed using Xpert and 69 at clinical FU, which constituted 46% (94/205) of the total TB patients diagnosed.A Week 2 FU visit, which can be nested into routine healthcare, increased the diagnosis of TB patients by two-fold and avoids diagnostic gaps in the cascade-of-care..

Impacto de la evaluación pulmonar ecográfica durante un lavado pulmonar total: caso pediátrico de proteinosis alveolar pulmonar / The impact of lung ultrasound assessment during a whole lung lavage: a paediatric case of pulmonary alveolar proteinosis

El lavado pulmonar total (LPT) es la principal terapia para la proteinosis alveolar pulmonar (PAP). Formulamos la hipótesis de la aplicabilidad de la ecografía pulmonar (EP) para guiar el alcance de la inundación alveolar en un varón de 15 años. El LPT de cada pulmón consistió en la instilación de solución salina, seguida de quinesioterapia y drenaje de líquidos. En el primer LPT, el proceso se repitió hasta observar el aclaramiento macroscópico progresivo del líquido de lavado, con visualización simultánea de las fases de aireación pulmonar mediante EP. En la segunda etapa, se utilizó un patrón de EP para guiar la extensión del lavado. La aparición del patrón de tipo tisular mediante broncograma del fluido definió la terminación temprana de la infusión salina. En conclusión, la EP contribuyó a monitorizar las fases de la desaireación pulmonar a lo largo del LPT, y redujo la cantidad total de solución salina instilada, con el fin de minimizar sus complicaciones inherentes.(AU)

Whole lung lavage (WLL) is the first-line treatment for pulmonary alveolar proteinosis. We hypothesized that lung ultrasound (LUS) would guide flooding during treatment in a 15-year-old boy. WLL of each lung consisted of instillation of saline followed by kinesiotherapy and fluid drainage. In the first WLL, the lung was repeatedly flooded until the lavage fluid was clear on macroscopic examination. During this process, LUS was used to visualise lung aeration. In the second WLL, we used LUS signs to guide the lavage volume. The appearance of the fluid bronchogram sign showed that saline infusion could be stopped earlier than in the first lavage. In conclusion, LUS helped monitor the different stages of controlled lung de-aeration during WLL and reduce the total amount of saline used. This technique will also reduce the risk of WLL-related complications.(AU)

The impact of lung ultrasound assessment during a whole lung lavage: A paediatric case of pulmonary alveolar proteinosis.

Whole lung lavage (WLL) is the first-line treatment for pulmonary alveolar proteinosis. We hypothesized that lung ultrasound (LUS) would guide flooding during treatment in a 15-year-old boy. WLL of each lung consisted of instillation of saline followed by kinesiotherapy and fluid drainage. In the first WLL, the lung was repeatedly flooded until the lavage fluid was clear on macroscopic examination. During this process, LUS was used to visualise lung aeration. In the second WLL, we used LUS signs to guide the lavage volume. The appearance of the fluid bronchogram sign showed that saline infusion could be stopped earlier than in the first lavage. In conclusion, LUS helped monitor the different stages of controlled lung de-aeration during WLL and reduce the total amount of saline used. This technique will also reduce the risk of WLL-related complications.

Transcriptomic and clinical heterogeneity of metastatic disease timing within metastatic castration-sensitive prostate cancer.

BACKGROUND: Metastatic castration-sensitive prostate cancer (mCSPC) is commonly classified into high- and low-volume subgroups which have demonstrated differential biology, prognosis, and response to therapy. Timing of metastasis has similarly demonstrated differences in clinical outcomes; however, less is known about any underlying biologic differences between these disease states. Herein, we aim to compare transcriptomic differences between synchronous and metachronous mCSPC and identify any differential responses to therapy. PATIENTS AND METHODS: We performed an international multi-institutional retrospective review of men with mCSPC who completed RNA expression profiling evaluation of their primary tumor. Patients were stratified according to disease timing (synchronous versus metachronous). The primary endpoint was to identify differences in transcriptomic profiles between disease timing. The median transcriptomic scores between groups were compared with the Mann-Whitney U test. Secondary analyses included determining clinical and transcriptomic variables associated with overall survival (OS) from the time of metastasis. Survival analysis was carried out with the Kaplan-Meier method and multivariable Cox regression. RESULTS: A total of 252 patients were included with a median follow-up of 39.6 months. Patients with synchronous disease experienced worse 5-year OS (39% versus 79%; P < 0.01) and demonstrated lower median androgen receptor (AR) activity (11.78 versus 12.64; P < 0.01) and hallmark androgen response (HAR; 3.15 versus 3.32; P < 0.01). Multivariable Cox regression identified only high-volume disease [hazard ratio (HR) = 4.97, 95% confidence interval (CI) 2.71-9.10; P < 0.01] and HAR score (HR = 0.51, 95% CI 0.28-0.88; P = 0.02) significantly associated with OS. Finally, patients with synchronous (HR = 0.47, 95% CI 0.30-0.72; P < 0.01) but not metachronous (HR = 1.37, 95% CI 0.50-3.92; P = 0.56) disease were found to have better OS with AR and non-AR combination therapy as compared with monotherapy (P value for interaction = 0.05). CONCLUSIONS: We have demonstrated a potential biologic difference between metastatic timing of mCSPC. Specifically, for patients with low-volume disease, those with metachronous low-volume disease have a more hormone-dependent transcriptional profile and exhibit a better prognosis than synchronous low-volume disease.

Acaricidal action of ozone on larvae and engorged females of Rhipicephalus microplus: a dose-dependent relationship.

The tick Rhipicephalus microplus is a vector of infectious agents that causes great economic loss in the productivity of cattle herds. Several studies have sought natural compounds with acaricidal activity to control ticks, without allowing the development of resistance, without causing environmental damage, and without presenting toxicity to the hosts. The activity of ozone on the natural biomolecules of living beings has been studied as an alternative to control arthropods and acaricidal effects were shown on ticks. The aim of the present study was to assess the acaricidal effect on larvae and engorged females of R. microplus according to ozone dose. Larvae (n = 377) were distributed in 10 groups and engorged females (n = 284) were distributed in 14 groups. One group was used as control (not exposed to ozone) and the other groups were exposed to ozone gas for 5-105 min. Ozone had a dose-dependent acaricidal effect on both larvae and engorged females. Dosages between 355 and 2130 mg/L min had a delayed acaricidal effect (12-180 h), leading to the death of all engorged females before laying eggs, whereas doses between 3195 and 7455 mg/L min showed immediate acaricidal effect (5 min to 4 h). Doses between 1775 and 6390 mg/L min had an immediate (up to 5 min) acaricidal effect on the larvae of this species. Further studies should consider longer follow-up times during the assessment of the acaricidal activity against ticks.

Single and combined effects of ultraviolet radiation and triclosan during the metamorphosis of Solea senegalensis.

Ultraviolet radiation (UV) and triclosan (TCS) affect the early development of marine fish; however, the corresponding molecular mechanisms are still not fully understood. Therefore, this work aims to study the effects of the single and combined exposure to these stressors during the thyroid-regulated metamorphosis of the flatfish Solea senegalensis. Sub-lethal exposure (5.89 kJ m-2 UV and/or 0.546 and 1.090 mg L-1 TCS for 48 h) was performed at the beginning of metamorphosis (13 days after hatching, dah), followed by a period in clean media until complete metamorphosis (24 dah). Malformations, metamorphosis progression, length, behavior and the expression of thyroid axis-related genes were studied. TCS induced malformations, decreased swimming performance, and induced metamorphosis acceleration at 15 dah, followed by a significant metamorphosis delay. Such effects were more noticeable in the presence of UV. The down-regulation of five thyroid axis-related genes occurred after exposure to TCS (15 dah), and after 9 days in clean media two genes were still down-regulated. UV exposure increased the effect of TCS by further down-regulating gene expression immediately after the exposure. Since several effects persisted after the period in clean media, implications of these stressors (mainly TCS) on the ecological performance of the species are suggested.

Higher carbohydrate quality index is associated with better adequate micronutrient consumption in Brazilian women / El mayor índice de calidad de los carbohidratos se asocia a un mejor consumo adecuado de micronutrientes en mujeres brasileñas

Introduction: inadequate consumption of micronutrients is an emerging public health problem that can compromise health. Objectives: to assess whether the quality of dietary carbohydrates is associated with the consumption of 13 micronutrients in a sample of women monitored by the Brazilian Unified Health System. Methods: this cross-sectional study included 648 women monitored by the Brazilian Unified Health System. The association between quality of dietary carbohydrates and adequacy of consumption of 13 micronutrients was investigated using logistic regression models adjusted for potential confounding variables. Results: the consumption of micronutrients increased as the quality of carbohydrates improved. The micronutrients with the highest prevalence of inadequate intake were vitamin A, magnesium, manganese, and thiamine. After adjustments using logistic regression models, women in the third tertile of the carbohydrate quality index were less likely to have an inadequate consumption of magnesium (odds ratio (OR), 0.29; 95 % confidence interval (CI), 0.14-0.59), manganese (OR, 0.32; 95% CI, 0.21-0.49), and copper (OR, 0.22; 95% CI, 0.12-0.37). Conclusions: intake of a higher quality of dietary carbohydrates is associated with improved adequacy in consumption of most micronutrients in women monitored by the Brazilian Unified Health System, especially magnesium, manganese, and copper, after adjustment using regression models (AU)

Introducción: el consumo inadecuado de micronutrientes es un problema de salud pública emergente que puede comprometer la salud. Objetivos: evaluar si la calidad de los carbohidratos de la dieta está asociada con el consumo de 13 micronutrientes en una muestra de mujeres monitoreadas por el Sistema Único de Salud de Brasil. Métodos: este estudio transversal incluyó a 648 mujeres monitoreadas por el Sistema Único de Salud de Brasil. La asociación entre la calidad de los carbohidratos de la dieta y la adecuación del consumo de 13 micronutrientes se investigó mediante modelos de regresión logística ajustados por posibles variables de confusión. Resultados: el consumo de micronutrientes aumentó a medida que mejoraba la calidad de los carbohidratos. Los micronutrientes con mayor prevalencia de ingesta inadecuada fueron: vitamina A, magnesio, manganeso y tiamina. Después de los ajustes mediante modelos de regresión logística, las mujeres del tercer tercil del índice de calidad de carbohidratos tenían menos probabilidades de tener un consumo inadecuado de magnesio (odds ratio (OR): 0,29; intervalo de confianza (IC) del 95 %: 0,14-0,59), manganeso (OR: 0,32 ; IC del 95 %: 0,21 a 0,49) y cobre (OR: 0,22; IC del 95 %: 0,12 a 0,37). Conclusiones: la ingesta de una mayor calidad de carbohidratos en la dieta se asocia con una mejor adecuación en el consumo de la mayoría de los micronutrientes en mujeres monitoreadas por el Sistema Único de Salud de Brasil, especialmente magnesio, manganeso y cobre, después del ajuste mediante modelos de regresión (AU)

Monitoring non-small cell lung cancer progression and treatment response through hyaluronic acid in sputum.

We evaluated whether hyaluronan (HA) levels in the sputum could be used as a noninvasive tool to predict progressive disease and treatment response, as detected in a computed tomography scan in non-small cell lung cancer (NSCLC) patients. Sputum samples were collected from 84 patients with histological confirmation of NSCLC, 33 of which were in early-stage and 51 in advanced-stage disease. Patients received systemic chemotherapy (CT) after surgery (n=36), combined CT and immunotherapy (IO) (n=15), or targeted therapy for driver mutation and disease relapse (N=4). The primary end-point was to compare sputum HA levels in two different concentrations of hypertonic saline solution with overall survival (OS) and the secondary and exploratory end-points were radiologic responses to treatment and patient outcome. Higher concentrations of HA in the sputum were significantly associated to factors related to tumor stage, phenotype, response to treatment, and outcome. In the early stage, patients with lower sputum HA levels before treatment achieved a complete tumor response after systemic CT with better progression-free survival (PFS) than those with high HA levels. We also examined the importance of the sputum HA concentration and tumor response in the 51 patients who developed metastatic disease and received CT+IO. Patients with low levels of sputum HA showed a complete tumor response in the computed tomography scan and stable disease after CT+IO treatment, as well as a better PFS than those receiving CT alone. HA levels in sputum of NSCLC patients may serve as a candidate biomarker to detect progressive disease and monitor treatment response in computed tomography scans.

A self-rated health score predicts severe disease and high mortality in patients with pulmonary TB.

BACKGROUND: Health-related quality of life (HRQoL) in patients with pulmonary TB may be predictive of disease outcome; however, HRQoL instruments are often complicated and unsuitable for use in low-resource settings. A single-item self-rated health (SRH) score may represent a simpler alternative which could be used in clinical decision-making.AIMS: To evaluate internal and external validity of SRH and its correlation with TBscore/TBscoreII in a low-resource setting.METHODS: We used data from our ongoing prospective TB cohort study in Guinea-Bissau. Cohen´s d was used to assess internal validity, and receiver-operating characteristics and mortality statistics to assess external validity. Correlation between SRH and TBscore/TBscoreII was estimated using linear regression.RESULTS: SRH showed satisfactory internal validity and ability to discriminate between fatal cases at high and low scores, although not at middling scores. SRH and TBscore/TBscoreII correlated well at each examination but changes in scores did not, which may be due to ceiling/floor effects and a lag between disease severity and HRQoL.CONCLUSION: SRH shows potential as a quick and simple method to identify patients in need of intensified follow-up during treatment provision. More research is needed to assess its generalisability beyond our setting and to develop models for clinical use of SRH.

Monitoring non-small cell lung cancer progression and treatment response through hyaluronic acid in sputum

We evaluated whether hyaluronan (HA) levels in the sputum could be used as a noninvasive tool to predict progressive disease and treatment response, as detected in a computed tomography scan in non-small cell lung cancer (NSCLC) patients. Sputum samples were collected from 84 patients with histological confirmation of NSCLC, 33 of which were in early-stage and 51 in advanced-stage disease. Patients received systemic chemotherapy (CT) after surgery (n=36), combined CT and immunotherapy (IO) (n=15), or targeted therapy for driver mutation and disease relapse (N=4). The primary end-point was to compare sputum HA levels in two different concentrations of hypertonic saline solution with overall survival (OS) and the secondary and exploratory end-points were radiologic responses to treatment and patient outcome. Higher concentrations of HA in the sputum were significantly associated to factors related to tumor stage, phenotype, response to treatment, and outcome. In the early stage, patients with lower sputum HA levels before treatment achieved a complete tumor response after systemic CT with better progression-free survival (PFS) than those with high HA levels. We also examined the importance of the sputum HA concentration and tumor response in the 51 patients who developed metastatic disease and received CT+IO. Patients with low levels of sputum HA showed a complete tumor response in the computed tomography scan and stable disease after CT+IO treatment, as well as a better PFS than those receiving CT alone. HA levels in sputum of NSCLC patients may serve as a candidate biomarker to detect progressive disease and monitor treatment response in computed tomography scans.

Postpartum headache after epidural anaesthesia: Who to blame?

INTRODUCTION: Epidural analgesia is considered the preferred analgesic choice during labour. Post dural puncture headache (PDPH) is considered a potential complication of this analgesic technique and is a frequently hypothesis for any headache occurring after delivery. It is essential that anaesthetists and obstetricians are familiar with other possible differential diagnosis for postpartum headache (PPH). CASE DESCRIPTION: 37-year-old female presented after delivery with intense occipital pulsatile headache associated with neck radiation, nausea and vomiting, hemodynamically stable and normal neurologic physical examination. Abnormalities in thyroid hormone levels were found. CT-scan findings suggested pituitary apoplexy. DISCUSSION: There are many differential diagnoses for PPH and some are rarely considered, such as pituitary apoplexy. It is essential to differentiate signs and symptoms of each diagnosis, since many of them overlap. CONCLUSION: Not all postpartum headaches are PDPH and the first suspected diagnosis may not always be accurate.

Undernutrition risk and nutritional screening implementation in hospitals: Barriers and time trends (2019-2020).

BACKGROUND & AIMS: Undernutrition screening is the starting point for high-quality nutrition care. In Portugal, the systematic nutritional risk assessment became mandatory for every inpatient in hospitals of the National Health System in 2019. The aims of this study were to describe the country's nutritional risk prevalence of hospitalized patients, and the experience of implementing a systematic undernutrition screening method, including time trends, barriers, and facilitators. METHODS: This research was carried out in Portuguese Public Hospitals (n = 49) and included both the analysis of data from health information systems between January 2019 and December 2020 and from an online survey. The performance indicators are described for 38 hospitals that use the SClinico electronic health records software provided by the Ministry of Health. The Nutritional Risk Screening 2002 (NRS 2002) was applied to adult patients and the STRONGkids to paediatric patients. In order to assess barriers and facilitators the online survey was applied to all public hospitals (n = 49), including Hospital Centres and Local Health Units. RESULTS: In 2020, 25.5% of the screened patients were nutritionally at risk. There was a significant increase in the proportion of patients screened from the pre- (10.6 ± 1.9%) to the post-adaptation period of the electronic health record (23.3 ± 4.8%, July-December 2019, and 25.4 ± 2.2%, January-June 2020) (p < 0.001). Data from 41 Hospital Centres and Local Health Units (84%) were obtained from the online survey. The major barriers identified were the lack of human resources (89.7%) and equipment (41.0%), as well as insufficient knowledge about the role of undernutrition screening (35.9%). The most-reported facilitators were the integration of undernutrition screening to electronic health records (22.2%) and good multidisciplinary articulation (36.1%). CONCLUSION: The high prevalence of nutritional risk justifies the mandatory nutritional screening, which leads to the improvement of the quality of hospital care. However, local and national efforts are warranted to adapt nutritional screening policies to local conditions and to increase and improve its implementation.

[Ultrasound-guided fascial plane blocks as unique anesthetic technique for total mastectomy in a covid-19 era: a case report]. / Bloqueos del plano fascial ecoguiados, como única técnica anestésica para mastectomía total en la era de la COVID-19: caso clínico.

INTRODUCTION: Regional anesthesia techniques were recently introduced to provide analgesia for breast surgery. These techniques are rarely used as the primary anesthesia due to the complexity of breast innervation, with numerous structures that can potentially be disrupted during breast surgery. CASE REPORT: A female patient in her sixties diagnosed with invasive ductal carcinoma on her left breast was scheduled for a simple mastectomy. After anesthetic evaluation, identification of high risk perioperative cardiovascular complications, it was proposed to perform the surgery only with regional anesthesia. A combination of pectoral nerve block (Pecs II), pecto-intercostal fascial block (PIFB) and supraclavicular nerve block ultrasound-guided were successfully performed. CONCLUSION: This is the first case reporting a novel approach in a patient with severe cardiopulmonary disease who underwent breast surgery in a COVID-19 era.

Ultrasound-guided fascial plane blocks as unique anesthetic technique for total mastectomy in a covid-19 era: A case report.

INTRODUCTION: Regional anesthesia techniques were recently introduced to provide analgesia for breast surgery. These techniques are rarely used as the primary anesthesia due to the complexity of breast innervation, with numerous structures that can potentially be disrupted during breast surgery. CASE REPORT: A female patient in her sixties diagnosed with invasive ductal carcinoma on her left breast was scheduled for a simple mastectomy. After anesthetic evaluation, identification of high risk perioperative cardiovascular complications, it was proposed to perform the surgery only with regional anesthesia. A combination of pectoral nerve block (Pecs II), pecto-intercostal fascial block (PIFB) and supraclavicular nerve block ultrasound-guided were successfully performed. CONCLUSION: This is the first case reporting a novel approach in a patient with severe cardiopulmonary disease who underwent breast surgery in a COVID-19 era.

Distribution and abundance of microplastics in coastal sediments depends on grain size and distance from sources.

Microplastic deposition in marine sediments is a geographically widespread problem. This study examines microplastics in intertidal and subtidal sediments at 87 locations in habitats designated as Special Areas of Conservation (SACs) and Special Protection Areas (SPAs) on the coastline of Ireland. Established methodological approaches including, organic matter digestion, density separation, particle extraction and polymer identification were applied. Microplastic abundance was closely related with distance from known sources and concentrations were greater in intertidal as opposed to subtidal sediments. Colourless, polyethylene fibres and polypropylene fragments were the most abundant MP recorded and finer grained sediments were shown to entrap more MPs than coarser sediments. The results demonstrate that an understanding of potential sources of pollution, sediment type and hydrodynamic conditions are very important in terms of MP abundance and distribution in marine sediments and also in terms of effective waste management strategies and policy aimed at reducing the global plastics problem.

Central Pain in Parkinson's Disease: Behavioral and Cognitive Characteristics.

INTRODUCTION: Pain is a major nonmotor symptom of Parkinson's disease (PD), and central parkinsonian pain is the core feature of the putative Park pain subtype of PD. This study aimed to explore the cognitive and behavioral profile of PD patients with central parkinsonian pain. Material and Methods. A structured interview was used to identify and characterize pain in a cohort of 260 consecutive PD patients. The Ford classification of pain was applied. The Dementia Rating Scale-2 (DRS-2) and the Impulse Control Disorders in Parkinson's Disease Short Form (QUIP-S) were administered, and patients' smoking habits were recorded. The Unified Parkinson's Disease Rating Scale (UPDRS) was used to assess motor and nonmotor symptoms in off and on conditions. RESULTS: One hundred and eighty-eight patients (68%) reported pain; and in 41 (22%) of them, the pain was classified as central parkinsonian pain. PD patients with central parkinsonian pain had better cognitive performance in DRS-2 Initiation/Perseveration and Conceptualization subscales but reported more other compulsive behaviors (e.g., hobbyism, punding, and walkabout) and had more current smoking habits than those without pain or with non-central parkinsonian pain. Multiple logistic regression analyses revealed that the DRS-2 Conceptualization subscale, other compulsive behaviors, and smoking habits remained statistically associated with central parkinsonian pain even when other significant covariates were considered. Only patients with pain, regardless of type, had a gambling disorder. Discussion. The study results provide further evidence that pain revealed that patients with central parkinsonian pain are more likely to present compulsive or addictive behaviors, despite having more preserved cognitive performance. Patients with central parkinsonian pain appear to have a distinct phenotype of PD.

Postpartum headache after epidural anaesthesia: Who to blame? / Cefalea posparto tras anestesia epidural: ¿a quién culpar?

INTRODUCTION: Epidural analgesia is considered the preferred analgesic choice during labour. Post dural puncture headache (PDPH) is considered a potential complication of this analgesic technique and is a frequently hypothesis for any headache occurring after delivery. It is essential that anaesthetists and obstetricians are familiar with other possible differential diagnosis for postpartum headache (PPH). CASE DESCRIPTION: 37-year-old female presented after delivery with intense occipital pulsatile headache associated with neck radiation, nausea and vomiting, hemodynamically stable and normal neurologic physical examination. Abnormalities in thyroid hormone levels were found. CT-scan findings suggested pituitary apoplexy. DISCUSSION: There are many differential diagnoses for PPH and some are rarely considered, such as pituitary apoplexy. It is essential to differentiate signs and symptoms of each diagnosis, since many of them overlap. CONCLUSION: Not all postpartum headaches are PDPH and the first suspected diagnosis may not always be accurate.