Point-of-Care Ultrasound (POCUS) as an Extension of the Physical Examination in Patients with Bacteremia or Candidemia.

BACKGROUND: In general, transthoracic echocardiography (TTE) is the first diagnostic test used for patients with bacteremia or candidemia and clinical signs of Infective Endocarditis (IE). Point-of-care ultrasound (POCUS) may be used in addition to physical examination for the detection of structural heart disease and valve abnormalities. OBJECTIVE: To determine the diagnostic accuracy of POCUS for the detection of signs suggestive of IE, including vegetation, valvular regurgitation, structural heart disease, hepatomegaly, splenomegaly and septic embolisms, in patients with bacteremia or candidemia. DESIGN: Observational, cross-sectional, multicenter study using convenience sampling. SETTING: Six Spanish academic hospitals. PATIENTS: Adult patients with bacteremia or candidemia between 1 February 2018 and 31 December 2020. MEASUREMENTS: The reference test, to evaluate vegetation, valvular regurgitation and structural heart disease, was transesophageal echocardiography (TEE). For patients who did not undergo TEE, transthoracic echocardiography (TTE) was considered the reference test. POCUS was performed by internists, while conventional echocardiography procedures were performed by cardiologists. RESULTS: In 258 patients, for the detection of valvular vegetation, POCUS had sensitivity, specificity, and positive and negative predictive values of 77%, 94%, 82% and 92%, respectively. For valvular regurgitation (more than mild), sensitivity was ≥76% and specificity ≥85%. Sensitivity values for the detection of hepatomegaly and splenomegaly were 92% and 92%, respectively, while those for specificity were 96% and 98%. CONCLUSION: POCUS could be a valuable tool, as a complement to physical examination, at the hospital bedside for patients with bacteremia or candidemia, helping to identify signs suggestive of IE.

Prevalence of bleeding secondary to anticoagulation and mortality in patients with atrial fibrillation admitted with SARS-CoV-2 infection.

Introduction and purpose: Atrial fibrillation (AF) is common in patients admitted with severe COVID-19. However, there is limited data about the management of chronic anticoagulation therapy in these patients. We assessed the anticoagulation and incidence of major cardiovascular events in hospitalized patients with AF and COVID-19. Methods: We retrospectively investigated all consecutive patients with AF admitted with COVID-19 between March and May 2020 in 9 Spanish hospitals. We selected a control group of non-AF patients consecutively admitted with COVID-19. We compared baseline characteristics, incidence of major bleeding, thrombotic events and mortality. We used propensity score matching (PSM) to minimize potential confounding variables, as well as a multivariate analysis to predict major bleeding and death. Results: 305 patients admitted with AF and COVID-19 were included. After PSM, 151 AF patients were matched with 151 control group patients. During admission, low-molecular-weight heparin was the principal anticoagulant and the incidence of major bleeding and mortality were higher in the AF group [16 (10.6%) vs 3 (2%), p = 0.003; 52 (34.4%) vs 35 (23.2%), p = 0.03, respectively]. The multivariate analysis showed the presence of AF as independent predictor of in-hospital major bleeding and mortality in COVID-19 patients. In AF group, a secondary multivariate analysis identified high levels of D-dimer as independent predictor of in-hospital major bleeding. Conclusions: AF patients admitted with COVID-19 represent a population at high risk for bleeding and mortality during admission. It seems advisable to individualize anticoagulation therapy during admission, considering patient specific bleeding and thrombotic risk.

Antecedentes y objetivos: La fibrilación auricular (FA) es frecuente en pacientes ingresados por COVID-19 grave. Sin embargo, los datos sobre el manejo de la anticoagulación crónica en estos pacientes son escasos. Analizamos la anticoagulación y la incidencia de episodios cardiovasculares mayores en pacientes con FA ingresados por la COVID-19. Métodos: Retrospectivamente, se identificaron todos los pacientes con FA ingresados por la COVID-19 entre marzo y mayo de 2020, en 9 hospitales españoles. Se seleccionó un grupo control de pacientes ingresados consecutivamente por la COVID-19 sin FA. Se compararon las características basales, incidencia de hemorragias mayores, episodios trombóticos y mortalidad. Para reducir potenciales factores de confusión se realizó un emparejamiento por puntuación de propensión, así como un análisis multivariante para predecir hemorragia mayor y mortalidad. Resultados: Se incluyeron 305 pacientes con FA ingresados por la COVID-19. Tras el emparejamiento por puntuación de propensión, 151 pacientes con FA fueron emparejados con 151 controles. Durante el ingreso, la heparina de bajo peso molecular fue el principal anticoagulante y la incidencia de hemorragia mayor y mortalidad fue mayor en el grupo de FA (16[10,6%] vs. 3[2%], p = 0,003; 52[34,4%] vs. 35[23,2%], p = 0,03, respectivamente). El análisis multivariante demostró la presencia de FA como predictor independiente de sangrados y mortalidad intrahospitalaria en los pacientes con la COVID-19. En el grupo de FA, un segundo análisis multivariante identificó valores elevados de dímero-D como predictor independiente de hemorragia mayor intrahospitalaria. Conclusiones: Los pacientes con FA ingresados por la COVID-19 representan una población de alto riesgo de sangrado y mortalidad durante el ingreso. Parece recomendable individualizar la anticoagulación durante el ingreso, considerando el riesgo específico de sangrado y trombosis.

Prevalence of bleeding secondary to anticoagulation and mortality in patients with atrial fibrillation admitted with SARS-CoV-2 infection / Prevalencia de hemorragia secundaria a anticoagulación y mortalidad en pacientes con fibrilación auricular ingresados por infección por SARS-CoV-2

Introduction and purpose:Atrial fibrillation (AF) is common in patients admitted with severe COVID-19. However, there is limited data about the management of chronic anticoagulation therapy in these patients. We assessed the anticoagulation and incidence of major cardiovascular events in hospitalized patients with AF and COVID-19.Methods:We retrospectively investigated all consecutive patients with AF admitted with COVID-19 between March and May 2020 in 9 Spanish hospitals. We selected a control group of non-AF patients consecutively admitted with COVID-19. We compared baseline characteristics, incidence of major bleeding, thrombotic events and mortality. We used propensity score matching (PSM) to minimize potential confounding variables, as well as a multivariate analysis to predict major bleeding and death.Results:305 patients admitted with AF and COVID-19 were included. After PSM, 151 AF patients were matched with 151 control group patients. During admission, low-molecular-weight heparin was the principal anticoagulant and the incidence of major bleeding and mortality were higher in the AF group [16 (10.6%) vs 3 (2%), p=0.003; 52 (34.4%) vs 35 (23.2%), p=0.03, respectively]. The multivariate analysis showed the presence of AF as independent predictor of in-hospital major bleeding and mortality in COVID-19 patients. In AF group, a secondary multivariate analysis identified high levels of D-dimer as independent predictor of in-hospital major bleeding.Conclusions:AF patients admitted with COVID-19 represent a population at high risk for bleeding and mortality during admission. It seems advisable to individualize anticoagulation therapy during admission, considering patient specific bleeding and thrombotic risk. (AU)

Antecedentes y objetivos:La fibrilación auricular (FA) es frecuente en pacientes ingresados por COVID-19 grave. Sin embargo, los datos sobre el manejo de la anticoagulación crónica en estos pacientes son escasos. Analizamos la anticoagulación y la incidencia de episodios cardiovasculares mayores en pacientes con FA ingresados por la COVID-19.Métodos:Retrospectivamente, se identificaron todos los pacientes con FA ingresados por la COVID-19 entre marzo y mayo de 2020, en 9 hospitales españoles. Se seleccionó un grupo control de pacientes ingresados consecutivamente por la COVID-19 sin FA. Se compararon las características basales, incidencia de hemorragias mayores, episodios trombóticos y mortalidad. Para reducir potenciales factores de confusión se realizó un emparejamiento por puntuación de propensión, así como un análisis multivariante para predecir hemorragia mayor y mortalidad.Resultados:Se incluyeron 305 pacientes con FA ingresados por la COVID-19. Tras el emparejamiento por puntuación de propensión, 151 pacientes con FA fueron emparejados con 151 controles. Durante el ingreso, la heparina de bajo peso molecular fue el principal anticoagulante y la incidencia de hemorragia mayor y mortalidad fue mayor en el grupo de FA (16[10,6%] vs. 3[2%], p=0,003; 52[34,4%] vs. 35[23,2%], p=0,03, respectivamente). El análisis multivariante demostró la presencia de FA como predictor independiente de sangrados y mortalidad intrahospitalaria en los pacientes con la COVID-19. En el grupo de FA, un segundo análisis multivariante identificó valores elevados de dímero-D como predictor independiente de hemorragia mayor intrahospitalaria.Conclusiones:Los pacientes con FA ingresados por la COVID-19 representan una población de alto riesgo de sangrado y mortalidad durante el ingreso. Parece recomendable individualizar la anticoagulación durante el ingreso, considerando el riesgo específico de sangrado y trombosis. (AU)

Prevalence of bleeding secondary to anticoagulation and mortality in patients with atrial fibrillation admitted with SARS-CoV-2 infection.

INTRODUCTION AND PURPOSE: Atrial fibrillation (AF) is common in patients admitted with severe COVID-19. However, there is limited data about the management of chronic anticoagulation therapy in these patients. We assessed the anticoagulation and incidence of major cardiovascular events in hospitalized patients with AF and COVID-19. METHODS: We retrospectively investigated all consecutive patients with AF admitted with COVID-19 between March and May 2020 in 9 Spanish hospitals. We selected a control group of non-AF patients consecutively admitted with COVID-19. We compared baseline characteristics, incidence of major bleeding, thrombotic events and mortality. We used propensity score matching (PSM) to minimize potential confounding variables, as well as a multivariate analysis to predict major bleeding and death. RESULTS: 305 patients admitted with AF and COVID-19 were included. After PSM, 151 AF patients were matched with 151 control group patients. During admission, low-molecular-weight heparin was the principal anticoagulant and the incidence of major bleeding and mortality were higher in the AF group [16 (10.6%) vs 3 (2%), p=0.003; 52 (34.4%) vs 35 (23.2%), p=0.03, respectively]. The multivariate analysis showed the presence of AF as independent predictor of in-hospital major bleeding and mortality in COVID-19 patients. In AF group, a secondary multivariate analysis identified high levels of D-dimer as independent predictor of in-hospital major bleeding. CONCLUSIONS: AF patients admitted with COVID-19 represent a population at high risk for bleeding and mortality during admission. It seems advisable to individualize anticoagulation therapy during admission, considering patient specific bleeding and thrombotic risk.

Niveles de actividad física y su relación con el nivel socioeconómico en adultos de la comuna La Florida

RESUMEN Fundamento: las medidas de aislamiento inducidas por la pandemia de la COVID-19 provocaron una disminución de los niveles de actividad física y un aumento del sedentarismo. Estas condiciones generaron un aumento de la prevalencia de trastornos derivados de estas conductas sedentarias. Aún se desconoce qué factores se ven involucrados en esta disminución de los niveles de actividad física. Objetivo: verificar si existe relación entre el nivel socioeconómico y los niveles de actividad física en adultos pertenecientes a la Región Metropolitana de Chile. Método: participaron 130 personas que respondieron el cuestionario que mide los niveles de actividad física a través de los equivalentes metabólicos y que contestaron sobre la escala personal que mide el bienestar subjetivo, finalmente se consultó sobre cuál era su nivel socioeconómico durante este periodo. Resultados: se determinó que existieron diferencias significativas (p<0,05) en relación a la cantidad de actividad física realizada por las personas que viven en casas versus departamentos y diferencias según el nivel socioeconómico. Se obtuvo una diferencia entre los grupos media-baja y baja; media-baja y media-alta; media y baja; media y alta; baja y media-alta; baja y alta; media-alta y alta. Respecto a la relación existente entre el nivel de bienestar y la realización de actividad física, esta no tuvo un índice relevante (0,09). Conclusiones: las diferencias estadísticamente significativas en el tipo de vivienda y el nivel de actividad física entre los sujetos indica que podría incidir en que el espacio intradomiciliario, es un factor influyente a la hora de poder realizar algún tipo de actividad física. Se debe considerar una variable relevante al momento de planificar acciones preventivas.

ABSTRACT Background: the isolation measures induced by the COVID-19 pandemic caused an increase in sedentary lifestyle and a decrease in physical activity levels. These conditions generated an increase in the prevalence of disorders derived from these sedentary behaviors. It is still unknown what factors are involved in this decrease in physical activity levels. Objective: to verify if there is a relationship between the socioeconomic level and the levels of physical activity in adults belonging to the Chile Metropolitan Region. Method: 130 people participated who answered the questionnaire that measures the levels of physical activity through the metabolic equivalents and who answered on the personal scale that measures subjective well-being and finally, they were asked about their socioeconomic level during this period. Results: it was determined that there were significant differences (p<0.05) in relation to the amount of physical activity in people living in houses versus apartments and differences according to socioeconomic level. It was obtained a difference between the medium-low and low groups; medium-low and medium-high; medium and low; medium and high; low and medium-high; low and high; medium-high and high. Regarding the relationship between the level of well-being and the performance of physical activity, this did not have a relevant index (0.09). Conclusions: the statistically significant differences in the type of housing and the level of physical activity between the subjects indicate that it could influence that the intradomiciliary space is an influential factor when it comes to being able to carry out some type of physical activity. A relevant variable should be considered when planning preventive actions.

Síndrome de burnout en docentes de salud de Universidades en Chile durante la pandemia de COVID-19 / Burnout syndrome in university health teachers in Chile during the COVID-19 pandemic

Objetivos: El objetivo fue evaluar el Síndrome de Burnout en docentes de ciencias de la salud de Universidades en Chile durante la pandemia de COVID-19. Material y Métodos: Se realizó un estudio cuantitativo, observacional y transversal. Resultados: La prevalencia de SB fue de 4,4. Todas las correlaciones fueron débiles, destacando edad y número de hijos (r = 0,435), edad y horas dedicadas a actividades relacionadas con los hijos (r = 0,451). El promedio de la dimensión agotamiento emocional y realización personal es nivel medio y la despersonalización bajo. Se encontraron diferencias significativas entre hombres y mujeres en agotamiento emocional con medias de 21,85 (DS 11,54) v/s 26,02 (DS 10,79), respectivamente Conclusión: Los resultados muestran diferencias entre hombres y mujeres en la dimensión de agotamiento emocional y, además relaciones entre la edad y número de hijos, y número de hijos y la cantidad de horas destinadas a ellos (AU)

Objectives: The objective was to evaluate the Burnout Syndrome in health sciences teachers from Universities in Chile during the COVID-19 pandemic. Material and Methods: A quantitative, observational and cross-sectional study was carried out. Results: The prevalence of BS was 4.4. All the correlations were weak, highlighting age and number of children (r = 0.435), age and hours spent on activities related to their children (r = 0.451). The average level of emotional exhaustion and personal fulfillment dimension is medium and depersonalization low. Significant differences were found between men and women in emotional exhaustion with means of 21.85 (SD 11.54) v / s 26.02 (SD 10.79), respectively Conclusion: The results show differences between men and women in the dimension of emotional exhaustion and, in addition to relationships between age and number of children, and number of children and the number of hours devoted to them (AU)

Medical sequels of COVID-19.

COVID-19 pandemic has impacted the world population, with a high rate of morbidity and mortality. While the evidence to date has attempted to describe clinical feature of acute illness, recent reports have also begun to describe persistent symptoms that extend beyond the initial period of illness. Adverse outcomes, in addition to respiratory, have been found to occur at different levels: cardiovascular, neurological, or immunological; skin, gastrointestinal or renal manifestations. The detrimental effect on mental health has also been described, not only in COVID-19 patients. The burden of disease secondary to this pandemic is likely to be enormous and not limited to acute disease alone, thus epidemiological studies are needed to further investigate the long-term impact of this disease. This review summarizes the current evidence on short-term effects and describes the possible long-term sequelae of COVID-19.

La pandemia de COVID-19 ha impactado gravemente en la población mundial, con una gran tasa de morbilidad y mortalidad. Si bien la evidencia hasta la fecha ha intentado describir la clínica de la enfermedad aguda, informes recientes también han comenzado a describir síntomas persistentes que se extienden más allá del período inicial de enfermedad. Se ha encontrado que los resultados adversos, además de respiratorios, se presentan a diferentes niveles: cardiovascular, neurológico o inmunológico; manifestaciones cutáneas, gastrointestinales o renales. También se ha descrito el efecto perjudicial sobre la salud mental, no solo en pacientes con COVID-19. Es probable que la carga de enfermedad secundaria a esta pandemia sea enorme y no se limite únicamente a la enfermedad aguda, por lo que se necesitan estudios epidemiológicos que investiguen más a fondo el impacto a largo plazo de esta enfermedad. Esta revisión resume la evidencia actual sobre los efectos a corto plazo y describe las posibles secuelas a largo plazo del COVID-19.

Secuelas médicas de la COVID-19 / Medical sequels of COVID-19

La pandemia de COVID-19 ha impactado gravemente en la población mundial, con una gran tasa de morbilidad y mortalidad. Si bien la evidencia hasta la fecha ha intentado definir la clínica de la enfermedad aguda, informes recientes también han comenzado a describir síntomas persistentes que se extienden más allá del período inicial de la enfermedad. Se ha encontrado que los resultados adversos, además de respiratorios, se presentan a diferentes niveles: cardiovascular, neurológico o inmunológico, manifestaciones cutáneas, gastrointestinales o renales. También se ha descrito el efecto perjudicial sobre la salud mental, no solo en pacientes con COVID-19. Es probable que la carga de enfermedad secundaria a esta pandemia sea enorme y no se limite únicamente a la enfermedad aguda, por lo que se necesitan estudios epidemiológicos que investiguen más a fondo el impacto a largo plazo de esta patología. Esta revisión resume la evidencia actual sobre los efectos a corto plazo y describe las posibles secuelas a largo plazo de la COVID-19. (AU)

COVID-19 pandemic has impacted the world population, with a high rate of morbidity and mortality. While the evidence to date has attempted to describe clinical feature of acute illness, recent reports have also begun to describe persistent symptoms that extend beyond the initial period of illness. Adverse outcomes, in addition to respiratory, have been found to occur at different levels: cardiovascular, neurological, or immunological; skin, gastrointestinal or renal manifestations. The detrimental effect on mental health has also been described, not only in COVID-19 patients. The burden of disease secondary to this pandemic is likely to be enormous and not limited to acute disease alone, thus epidemiological studies are needed to further investigate the long-term impact of this disease. This review summarizes the current evidence on short-term effects and describes the possible long-term sequelae of COVID-19. (AU)

Updating the bionomy and geographical distribution of Anopheles (Nyssorhynchus) albitarsis F: A vector of malaria parasites in northern South America.

Anopheles albitarsis F is a putative species belonging to the Albitarsis Complex, recognized by rDNA, mtDNA, partial white gene, and microsatellites sequences. It has been reported from the island of Trinidad, Venezuela and Colombia, and incriminated as a vector of malaria parasites in the latter. This study examined mitochondrially encoded cytochrome c oxidase I (MT-CO1) sequences of An. albitarsis F from malaria-endemic areas in Colombia and Venezuela to understand its relations with other members of the Complex, revised and update the geographical distribution and bionomics of An. albitarsis F and explore hypotheses to explain its phylogenetic relationships and geographical expansion. Forty-five MT-CO1 sequences obtained in this study were analyzed to estimate genetic diversity and possible evolutionary relationships. Sequences generated 37 haplotypes clustered in a group where the genetic divergence of Venezuelan populations did not exceed 1.6% with respect to Colombian samples. Anopheles albitarsis F (π = 0.013) represented the most recent cluster located closer to An. albitarsis I (π = 0.009). Barcode gap was detected according to Albitarsis Complex lineages previously reported (threshold 0.014-0.021). Anopheles albitarsis F has a wide distribution in northern South America and might play an important role in the transmission dynamics of malaria due to its high expansion capacity. Future studies are required to establish the southern distribution of An. albitarsis F in Venezuela, and its occurrence in Guyana and Ecuador.

Medical sequels of COVID-19. / Secuelas médicas de la COVID-19.

COVID-19 pandemic has impacted the world population, with a high rate of morbidity and mortality. While the evidence to date has attempted to describe clinical feature of acute illness, recent reports have also begun to describe persistent symptoms that extend beyond the initial period of illness. Adverse outcomes, in addition to respiratory, have been found to occur at different levels: cardiovascular, neurological, or immunological; skin, gastrointestinal or renal manifestations. The detrimental effect on mental health has also been described, not only in COVID-19 patients. The burden of disease secondary to this pandemic is likely to be enormous and not limited to acute disease alone, thus epidemiological studies are needed to further investigate the long-term impact of this disease. This review summarizes the current evidence on short-term effects and describes the possible long-term sequelae of COVID-19.

Tellurite Promotes Stress Granules and Nuclear SG-Like Assembly in Response to Oxidative Stress and DNA Damage.

Tellurium oxyanion, tellurite (TeO 3 -2), is a highly toxic compound for many organisms. Its presence in the environment has increased over the past years due to industrial manufacturing processes and has been associated with adverse effects on human health. Although tellurite induces the phosphorylation of eIF2α, DNA damage and oxidative stress, the molecular mechanisms related to the cellular responses to tellurite-induced stress are poorly understood. In this work, we evaluated the ability of tellurite to induce phosphorylation of eIF2α, stress granules (SGs) assembly and their relationship with DNA damage in U2OS cells. We demonstrate that tellurite promotes the assembly of bona fide cytoplasmic SGs. Unexpectedly, tellurite also induces the assembly of nuclear SGs. Interestingly, we observed that the presence of tellurite-induced nuclear SGs correlates with γH2AX foci. However, although H2O2 also induce DNA damage, no nuclear SGs were observed. Our data show that tellurite promotes the assembly of cytoplasmic and nuclear SGs in response to oxidative stress and DNA damage, revealing a new aspect of cellular stress response mediated by the assembly of nuclear stress granules.

High-dose corticosteroid pulse therapy increases the survival rate in COVID-19 patients at risk of hyper-inflammatory response.

OBJECTIVE: Test whether high dose corticosteroid pulse therapy (HDCPT) with either methylprednisolone or dexamethasone is associated with increased survival in COVID-19 patients at risk of hyper-inflammatory response. Provide some initial diagnostic criteria using laboratory markers to stratify these patients. METHODS: This is a prospective observational study, 318 met the inclusion criteria. 64 patients (20.1%) were treated with HDCPT by using at least 1.5mg/kg/24h of methylprednisolone or dexamethasone equivalent. A multivariate Cox regression (controlling for co-morbidities and other therapies) was carried out to determine whether HDCPT (among other interventions) was associated with decreased mortality. We also carried out a 30-day time course analysis of laboratory markers between survivors and non-survivors, to identify potential markers for patient stratification. RESULTS: HDCPT showed a statistically significant decrease in mortality (HR = 0.087 [95% CI 0.021-0.36]; P < 0.001). 30-day time course analysis of laboratory marker tests showed marked differences in pro-inflammatory markers between survivors and non-survivors. As diagnostic criteria to define the patients at risk of developing a COVID-19 hyper-inflammatory response, we propose the following parameters (IL-6 > = 40 pg/ml, and/or two of the following: C-reactive protein > = 100 mg/L, D-dimer > = 1000 ng/ml, ferritin > = 500 ng/ml and lactate dehydrogenase > = 300 U/L). CONCLUSIONS: HDCPT can be an effective intervention to increase COVID-19 survival rates in patients at risk of developing a COVID-19 hyper-inflammatory response, laboratory marker tests can be used to stratify these patients who should be given HDCPT. This study is not a randomized clinical trial (RCT). Future RCTs should be carried out to confirm the efficacy of HDCPT to increase the survival rates of COVID-19.

Neumomediastino espontáneo en pacientes con COVID-19 / Spontaneous mediastinal emphysema in patients with COVID-19

No disponible

El diagnostico COVID-19 a través de la imagen / COVID-19 diagnosis through the image

No disponible

Prognostic factors in patients with vulvar cancer: the VULCAN study.

OBJECTIVE: This study aimed to analyze the prognostic factors for overall and progression-free survival in patients with vulvar cancer. METHODS: This international, multicenter, retrospective study included 2453 patients diagnosed with vulvar cancer at 100 different institutions. Inclusion criteria were institutional review board approval from each collaborating center, pathologic diagnosis of invasive carcinoma of the vulva, and primary treatment performed at the participating center. Patients with intraepithelial neoplasia or primary treatment at non-participating centers were excluded. Global survival analysis and squamous cell histology subanalysis was performed. RESULTS: After excluding patients due to incomplete data entry, 1727 patients treated for vulvar cancer between January 2001 and December 2005 were registered for analysis (1535 squamous, 42 melanomas, 38 Paget's disease and 112 other histologic types). Melanomas had the worse prognosis (p=0.02). In squamous vulvar tumors, independent factors for increase in local recurrence of vulvar cancer were: no prior radiotherapy (p<0.001) or chemotherapy (p=0.006), and for distant recurrence were the number of positive inguinal nodes (p=0.025), and not having undergone lymphadenectomy (p=0.03) or radiotherapy (p<0.001), with a HR of 1.1 (95% CI 1.2 to 1.21), 2.9 (95% CI 1.4 to 6.1), and 3.1 (95% CI 1.7 to 5.7), respectively. Number of positive nodes (p=0.008), FIGO stage (p<0.001), adjuvant chemotherapy (p=0.001), tumor resection margins (p=0.045), and stromal invasion >5 mm (p=0.001) were correlated with poor overall survival, and large case volume (≥9 vs <9 cases per year) correlated with more favorable overall survival (p=0.05). CONCLUSIONS: Advanced patient age, number of positive inguinal lymph nodes, and lack of adjuvant treatment are significantly associated with a higher risk of relapse in patients with squamous cell vulvar cancer. Case volume per treating institution, FIGO stage, and stromal invasion appear to impact overall survival significantly. Future prospective trials are warranted to establish these prognostic factors for vulvar cancer.

Genetic diversity of HIV in seminal plasma remains higher than in blood after short-term antiretroviral therapy.

OBJECTIVE: To provide insight on viral kinetics and genetic diversity of HIV in seminal plasma at baseline and 1 month after initiating antiretroviral therapy (ART). PATIENTS AND METHODS: Blood and seminal samples from patients with newly diagnosed HIV were obtained before ART initiation (T0) and 1 month after ART initiation (T1). HIV env genetic diversity was studied using deep sequencing Nextera and V3 chemistry in a MiSeq Illumina platform. The number of viral quasispecies (5% cut-off) and Shannon Index were used to analyse diversity. RESULTS: Forty-seven ART-naive patients were recruited between September 2016 and November 2018. At enrolment, the number of quasispecies in blood (median 4 (IQR 2-5)) was lower than in the seminal compartment (median 6, (IQR 4-8)) (p<0.01); the Shannon Index was also higher (p<0.001) in the seminal compartment than in blood (1.77 vs 0.64). At T1, for the 13 patients with detectable HIV in both blood/seminal plasma, viral diversity remained higher (p=0.139) in seminal plasma (median 2 (IQR 1-4.5)) than in blood (median 1 (IQR 1-1.5)) Integrase inhibitors (INI)-based regimens achieved higher levels of undetectability and led more frequently to lower variability (p<0.001) than protease inhibitors (PI) or non-nucleoside reverse transcriptase inhibitors (NNRTI). CONCLUSION: We provide here further evidence of a larger genetic diversity in seminal plasma, both at diagnosis and short term after ART initiation. Our results strengthen previous findings on HIV diversity in seminal plasma. In addition, INIs decrease variability more rapidly than PI and NNRTI in both blood and seminal plasma.

Diagnostic Capacity of Pocket-Sized Ultrasound Devices at Point of Care by a Non-radiologist Resident in Patients with Suspected Abdominal Pathology.

Studies have reported the usefulness and tolerability in practice of abdominal ultrasound performed by non-radiologists in various clinical situations. This prospective observational single-center study included 184 patients hospitalized in an internal medicine department who underwent conventional abdominal ultrasound. A medical resident with basic training performed point-of-care clinical ultrasound using a pocket-sized device. The concordance obtained between the researcher and the radiologist was good (k >0.6) for the gallbladder, splenomegaly, longitudinal diameter of the kidney, presence of renal cysts and hydronephrosis. The specificity was >90% for all parameters assessed except normal renal size. A negative predictive value >90% was obtained for all variables studied except the presence of hepatic space-occupying lesions and gallbladder pathology, the negative predictive values for which were >80%. A positive predictive value >80% was obtained for all of these variables, except the presence of adenopathies, hepatomegaly, space-occupying lesions, echogenicity and/or enlargement of the biliary tract, left renal atrophy and right renal masses. We conclude there was a high concordance between a conventional abdominal study and that performed with a pocket-sized ultrasound device after a brief learning curve.