External validation of a nomogram for outcome prediction in management of medium-sized (1-2 cm) kidney stones.

BACKGROUND: Stone nomogram by Micali et al., able topredict treatment failure of shock-wave lithotripsy (SWL), retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PNL) in the management of single 1-2 cm renal stones, was developed on 2605 patients and showed a high predictive accuracy, with an area under ROC curve of 0.793 at internal validation. The aim of the present study is to externally validate the model to assess whether it displayed a satisfactory predictive performance if applied to different populations. METHODS: External validation was retrospectively performed on 3025 patients who underwent an active stone treatment from December 2010 to June 2021 in 26 centers from four countries (Italy, USA, Spain, Argentina). Collected variables included: age, gender, previous renal surgery, preoperative urine culture, hydronephrosis, stone side, site, density, skin-to-stone distance. Treatment failure was the defined outcome (residual fragments >4 mm at three months CT-scan). RESULTS: Model discrimination in external validation datasets showed an area under ROC curve of 0.66 (95% 0.59-0.68) with adequate calibration. The retrospective fashion of the study and the lack of generalizability of the tool towards populations from Asia, Africa or Oceania represent limitations of the current analysis. CONCLUSIONS: According to the current findings, Micali's nomogram can be used for treatment prediction after SWL, RIRS and PNL; however, a lower discrimination performance than the one at internal validation should be acknowledged, reflecting geographical, temporal and domain limitation of external validation studies. Further prospective evaluation is required to refine and improve the nomogram findings and to validate its clinical value.

Half dose ChAdOx1 nCoV-19 vaccine was equivalent to full doses to reduce moderate and severe COVID-19 cases.

Objectives: Previously, we presented the effectiveness of ChAdOx1 nCoV-19 half-dose (HD) immunization for preventing new COVID-19 cases. Here, we evaluated the administration of an HD of ChAdOx1 nCoV-19 in the primary immunization protocol (up to two doses) in reducing moderate and severe cases, hospitalizations, and deaths when compared to the administration of full doses (FD) after a long-term follow-up. Methods: We evaluated data from 29,469 participants between January 2021 and November 2022 who received an HD or FD vaccine and crossed this information with their medical records to identify those who developed moderate or severe cases. All participants were classified into four groups according to their immunization status and followed 500 days after the last vaccine administration. Results: The propensity-score matching analysis indicates that the administration of the two HDs of ChAdOx1 nCoV-19 was equivalent to the use of two FDs to reduce moderate and severe COVID-19 cases. The relative risk of being infected and developing moderate or severe conditions after the administration of at least one HD or FD was similar 150 or 500 days after the administration of the immunizers. Conclusion: Administering two HDs can be used safely as a cost-effective alternative to the primary immunization protocol.

Effect of 4 weeks of plyometric training in the pre-competitive period on volleyball athletes' performance.

We aimed to evaluate the effect of 4 weeks of plyometric training (PT), performed in the pre-competitive period, on the vertical jump performance of professional volleyball athletes. We recruited 17 professional female volleyball players (age: 19 ± 3 years; weight: 67.2 ± 5.50 kg; height: 1.81 ± 0.22 m; body fat: 14.4 ± 2.12%; squat 1RM test: 75.5 ± 7.82 kg; training time experience: 6.2 ± 3.4 years) to participate in four weeks of training and assessments. They were divided into an experimental group (EG = 9) and a control group (CG = 8). Both groups were submitted to friendly matches, technical, tactical and resistance training (4 weeks/˜9 sessions per week), and internal load monitoring was carried out. The EG performed PT twice a week. At the beginning and end of the four weeks, jump tests were performed. The main findings are: 1) PT when incorporated into the pre-competitive period can induce greater improvements in jumping performance (EG = 28.93 ± 3.24 cm to 31.67 ± 3.39 cm; CG = 27.91 ± 4.64 cm to 28.97 ± 4.58 cm; when comparing the percentage delta, we found a difference between groups with ES of 1.04 and P = 0.02); 2) this result is observed when the training load is similar between groups and increases over the weeks, respecting the linear progression principle. Therefore, including plyometric training in the preparatory period for volleyball, with low monotony and training strain increment, is an effective strategy for further CMJ performance improvement.

Effectiveness of COVID-19 Vaccination on Reduction of Hospitalizations and Deaths in Elderly Patients in Rio Grande do Norte, Brazil.

Since the COVID-19 pandemic emerged, vaccination has been the core strategy to mitigate the spread of SARS-CoV-2 in humans. This paper analyzes the impact of COVID-19 vaccination on hospitalizations and deaths in the state of Rio Grande do Norte, Brazil. We analyzed data from 23,516 hospitalized COVID-19 patients diagnosed between April 2020 and August 2021. We excluded the data from patients hospitalized through direct occupancy, unknown outcomes, and unconfirmed COVID-19 cases, resulting in data from 12,635 patients cross-referenced with the immunization status during hospitalization. Our results indicated that administering at least one dose of the immunizers was sufficient to significantly reduce the occurrence of moderate and severe COVID-19 cases among patients under 59 years. Considering the partially or fully immunized patients, the mean age is similar between the analyzed groups, despite the occurrence of comorbidities and higher than that observed among not immunized patients. Thus, immunized patients present lower Unified Score for Prioritization (USP) levels when diagnosed with COVID-19. Our data suggest that COVID-19 vaccination significantly reduced the hospitalization and death of elderly patients (60+ years) after administration of at least one dose. Comorbidities do not change the mean age of moderate/severe COVID-19 cases and the days required for the hospitalization of these patients.

Stochastic Petri net model describing the relationship between reported maternal and congenital syphilis cases in Brazil.

INTRODUCTION: Syphilis is a sexually transmitted disease (STD) caused by Treponema pallidum subspecies pallidum. In 2016, it was declared an epidemic in Brazil due to its high morbidity and mortality rates, mainly in cases of maternal syphilis (MS) and congenital syphilis (CS) with unfavorable outcomes. This paper aimed to mathematically describe the relationship between MS and CS cases reported in Brazil over the interval from 2010 to 2020, considering the likelihood of diagnosis and effective and timely maternal treatment during prenatal care, thus supporting the decision-making and coordination of syphilis response efforts. METHODS: The model used in this paper was based on stochastic Petri net (SPN) theory. Three different regressions, including linear, polynomial, and logistic regression, were used to obtain the weights of an SPN model. To validate the model, we ran 100 independent simulations for each probability of an untreated MS case leading to CS case (PUMLC) and performed a statistical t-test to reinforce the results reported herein. RESULTS: According to our analysis, the model for predicting congenital syphilis cases consistently achieved an average accuracy of 93% or more for all tested probabilities of an untreated MS case leading to CS case. CONCLUSIONS: The SPN approach proved to be suitable for explaining the Notifiable Diseases Information System (SINAN) dataset using the range of 75-95% for the probability of an untreated MS case leading to a CS case (PUMLC). In addition, the model's predictive power can help plan actions to fight against the disease.

GRPR antagonist protects from drug-induced liver injury by impairing neutrophil chemotaxis and motility.

Drug-induced liver injury (DILI) is a major cause of acute liver failure (ALF), where hepatocyte necrotic products trigger liver inflammation, release of CXC chemokine receptor 2 (CXCR2) ligands (IL-8) and other neutrophil chemotactic molecules. Liver infiltration by neutrophils is a major cause of the life-threatening tissue damage that ensues. A GRPR (gastrin-releasing peptide receptor) antagonist impairs IL-8-induced neutrophil chemotaxis in vitro. We investigated its potential to reduce acetaminophen-induced ALF, neutrophil migration, and mechanisms underlying this phenomenon. We found that acetaminophen-overdosed mice treated with GRPR antagonist had reduced DILI and neutrophil infiltration in the liver. Intravital imaging and cell tracking analysis revealed reduced neutrophil mobility within the liver. Surprisingly, GRPR antagonist inhibited CXCL2-induced migration in vivo, decreasing neutrophil activation through CD11b and CD62L modulation. Additionally, this compound decreased CXCL8-driven neutrophil chemotaxis in vitro independently of CXCR2 internalization, induced activation of MAPKs (p38 and ERK1/2) and downregulation of neutrophil adhesion molecules CD11b and CD66b. In silico analysis revealed direct binding of GRPR antagonist and CXCL8 to the same binding spot in CXCR2. These findings indicate a new potential use for GRPR antagonist for treatment of DILI through a mechanism involving adhesion molecule modulation and possible direct binding to CXCR2.

Ethnic minorities (African American and Hispanic) males prefer prostate cryoablation as aggressive treatment of localized prostate cancer.

INTRODUCTION: Our safety net hospital offers minimally invasive, traditional open and perineal radical prostatectomies, as well as radiation therapy and medical oncological services when appropriate. Historically, only few African American and Hispanic patients elected surgical procedures due to unknown reasons. Interestingly, after initiation of the prostate cryoablation program (Whole Gland) in 2003 at Denver Health Medical Center (DHMC) we noticed a trend towards cryotherapy in these specific patient populations for the treatment of localized prostate cancer. We analyzed the profile of ethnic minority men evaluated for localized prostate cancer and evaluated the associated factors in the decision making for the treatment of localized prostate cancer. MATERIALS AND METHODS: A retrospective review of 524 patients seen for prostate cancer from January 2003 to January 2012 in our safety net hospital was conducted. The treatment selected by the patient after oncologic consultation was then recorded. The health insurance status, demographic data, and personal statements of reasons for elected procedure were obtained. A multivariate logistic regression for associated factors influencing treatment decisions was then formed. Patients were categorized by using the D'Amico risk stratification criteria. RESULTS: The insurance status revealed that only 1% of African American patients had private health insurance versus 5% Hispanic and 26% of Caucasians. African American men were at higher D'Amico risk with more positive metastasis evaluation yet were less likely to undergo surgery and instead often elected for radiation therapy. Conversely, Hispanic and Caucasian men often elected cryoablation and radical prostatectomy for their treatment. Referrals for surgery were primarily Caucasian males with private health insurance. Most minority patients had indigent health coverage. Statistical analysis further revealed that age, marital status, indigent enrollment, D'Amico risk, and the option of cryoablation may influence patient's selection for surgical management of localized prostate cancer. CONCLUSION: Many factors influence treatment selection including race, age, marital status, enrollment in an indigent program, and a high D'Amico risk. The less invasive nature of cryoablation appeared to influence patients' opinion regarding surgery for the treatment of localized prostate cancer, especially in African American men.

Pharmacy clerks' prescribing practices for STD patients in Porto Alegre, Brazil: missed opportunities for improving STD control.

STDs are a significant public health problem in Brazil. A primary control strategy is the immediate treatment of symptomatic individuals. When services are unavailable, STD patients seek care in alternative settings. Probably the most frequently used settings are commercial pharmacies, where pharmacy clerks provide treatment, although Brazilian law prohibits selling antibiotics without prescription. Our objective was to evaluate prescribing practices by pharmacy clerks for STDs. We performed a cross-sectional study. Trained medical students visited 62 pharmacies in the city of Porto Alegre during March 2002. These were randomly chosen from a list of 863 registered pharmacies. The students presented to the pharmacy complaining of dysuria and urethral discharge. After obtaining a prescription, or not, they asked for additional instructions to be followed. Immediately after leaving the premises, the instructions were anonymously recorded. Of the 62 pharmacies visited, a clerk in 56 (90.3%, 95% confidence interval [CI]: 80.1%-96.4%) provided a prescription. Most frequently prescribed drugs were ampicillin with probenecide (29/51.8%) and rosoxacin (11/19.6%). Ministry of Health-recommended treatment was not suggested by any of the clerks. Forty-six additional recommendations were given. The use of condoms was the most frequent additional advice (42/46). Prescribing by pharmacy clerks is very prevalent in Porto Alegre. This may represent a lost opportunity for more comprehensive prevention effort (counselling, partner management, and diagnosing other STDs). Additionally, the most frequently prescribed drugs are not recommended by international or national health authorities for treatment of STDs, and none of these drugs covers chlamydia. We conclude that pharmacy clerks are a potentially important source of STD treatment and control but that their practices are in need of vast improvement.