Hepatitis C virus point-of-care microelimination approach in a vulnerable population in the South of Spain.

Background: Since the introduction of direct-acting antivirals, thousands of chronic hepatitis C patients have been successfully treated. However, vulnerable populations have a higher prevalence of hepatitis C virus (HCV) infection and face barriers that impede their access to antivirals. We carried out an HCV microelimination program focused on vulnerable population groups in Malaga. Methods: People in drug addiction treatment centers and homeless shelters in Malaga who participated in the program between October 2020 and October 2021 were included. After providing participants with educational information on HCV, a dry drop test (DDT) was used to collect blood for subsequent screening for HCV infection. The participants who were diagnosed with HCV infection were scheduled for comprehensive healthcare assessments, including blood tests, ultrasonography, elastography, and the prescription of antivirals, all conducted in a single hospital visit. Sustained viral response (SVR) was analysed 12 weeks after end of treatment. Results: Of the 417 persons invited to participate, 271 (65%) agreed to participate in the program. These participants were screened for HCV infection and 28 of them were diagnosed with HCV infection (10%). These hepatitis C-infected patients had a mean age of 53 ± 9 years; 86% were males and 93% were or had been drug users. Among 23 patients with HCV infection, HCV genotype 1a predominated (74%). Medical exams showed that 19% (4/21) had advanced fibrosis (F3-4), and 5% (1/21) had portal hypertension. Finally, 23 infected patients received treatment with glecaprevir/pibrentasvir or sofosbuvir/velpatasvir and SVR was confirmed in 22 patients (96%). Conclusions: Drug users and homeless people have a higher prevalence of HCV infection than the general population. The microelimination program with educational activity and screening tools achieved a high participation rate, easy healthcare access, and a high rate of SVR despite the SARS-CoV-2 pandemic.

The influence of the SARS-CoV-2 pandemic on in-hospital mortality in a gastroenterology service / Influencia de la pandemia por SARS-CoV-2 en la mortalidad intrahospitalaria en un servicio de aparato digestivo

Introduction: The pandemic caused by SARS-CoV-2 has drastically changed the global health landscape. Our objective was to verify if, after the start of the pandemic, there was an increase in in-hospital mortality in patients admitted to a Gastroenterology Service of a 3rd level hospital. Material and methods: The 1039 admissions registered at the Virgen de la Victoria University Hospital in Malaga (Spain) were retrospectively analysed in the period between 1 December 2019 and 30 November 2020 (12 months), which were divided into 4 quarters (pre-wave, first wave, inter-wave and second wave) and mortality and other variables (globally and by disease group) were analysed. Results: No statistically significant differences were observed in terms of overall in-hospital mortality in the different periods. (p 0.23). The greatest burden of disease corresponded to biliopancreatic group and, within them, acute pancreatitis (p 0.04), followed by non-variceal gastrointestinal bleeding. In the second semester, mortality increased in the biliopancreatic group (p 0.01). Patients admitted for gastrointestinal bleeding took longer to request care after the start of the pandemic, especially in the second wave (p 0.03). The same was observed in admissions due to tumours, with the time elapsed until the emergency visit more than double in the second semester, with a consequent increase in mortality (p 0.00). Conclusions: The global in-hospital mortality in a Gastroenterology Service in a 3rd level hospital has not increased with the onset of the SARS-CoV-2 pandemic, however, a higher in-hospital mortality has been recorded in biliopancreatic diseases and digestive tumours diagnosed on an in-patient basis between June and November 2020.(AU)

Introducción:La pandemia ocasionada por el SARS-CoV-2 ha modificado drásticamente el panorama sanitario mundial. Nuestro objetivo fue comprobar si tras el inicio de esta se produjo un aumento en la mortalidad intrahospitalaria en los pacientes ingresados en un servicio de aparato digestivo de un hospital de tercer nivel. Material y métodos: Se analizaron retrospectivamente 1.039 ingresos en el Servicio de Aparato Digestivo del Hospital Universitario Virgen de la Victoria en el periodo comprendido entre el 1 de diciembre de 2019 y el 30 de noviembre de 2020 (12 meses), se dividieron en 4 trimestres (preoleada, primera oleada, interoleada y segunda oleada) y se analizó la mortalidad y otras variables (de forma global y por grupo de enfermedades). Resultados: No se observaron diferencias estadísticamente significativas en cuanto a mortalidad intrahospitalaria global en los diferentes periodos (p=0,23). La enfermedad con mayor predominio fue la biliopancreática y, dentro de ella, las pancreatitis agudas (p=0,04), seguidas del sangrado digestivo no varicoso. En el segundo semestre aumentó la mortalidad en el grupo biliopancreático (p=0,01). Los pacientes que ingresaron por hemorragia digestiva tardaron más en solicitar asistencia tras la pandemia, especialmente en la segunda oleada (p=0,03). Esto mismo se objetivó en los ingresos por tumores, siendo el tiempo transcurrido hasta la consulta a Urgencias mayor del doble en el segundo semestre, con el consecuente aumento en la mortalidad (p=0,00). Conclusiones: La mortalidad global intrahospitalaria en el Servicio de Aparato Digestivo no ha aumentado con la sobrevenida de la pandemia por SARS-CoV-2, si bien se ha registrado una mayor mortalidad intrahospitalaria en las enfermedades biliopancreáticas y los tumores digestivos diagnosticados en régimen de hospitalización entre junio y noviembre de 2020.(AU)

The influence of the SARS-CoV-2 pandemic on in-hospital mortality in a gastroenterology service.

INTRODUCTION: The pandemic caused by SARS-CoV-2 has drastically changed the global health landscape. Our objective was to verify if, after the start of the pandemic, there was an increase in in-hospital mortality in patients admitted to a Gastroenterology Service of a 3rd level hospital. MATERIAL AND METHODS: The 1039 admissions registered at the Virgen de la Victoria University Hospital in Malaga (Spain) were retrospectively analysed in the period between 1 December 2019 and 30 November 2020 (12 months), which were divided into 4 quarters (pre-wave, first wave, inter-wave and second wave) and mortality and other variables (globally and by disease group) were analysed. RESULTS: No statistically significant differences were observed in terms of overall in-hospital mortality in the different periods. (p 0.23). The greatest burden of disease corresponded to biliopancreatic group and, within them, acute pancreatitis (p 0.04), followed by non-variceal gastrointestinal bleeding. In the second semester, mortality increased in the biliopancreatic group (p 0.01). Patients admitted for gastrointestinal bleeding took longer to request care after the start of the pandemic, especially in the second wave (p 0.03). The same was observed in admissions due to tumours, with the time elapsed until the emergency visit more than double in the second semester, with a consequent increase in mortality (p 0.00). CONCLUSIONS: The global in-hospital mortality in a Gastroenterology Service in a 3rd level hospital has not increased with the onset of the SARS-CoV-2 pandemic, however, a higher in-hospital mortality has been recorded in biliopancreatic diseases and digestive tumours diagnosed on an in-patient basis between June and November 2020.

Microbiota diversity in nonalcoholic fatty liver disease and in drug-induced liver injury.

The gut microbiota could play a significant role in the progression of nonalcoholic fatty liver disease (NAFLD); however, its relevance in drug-induced liver injury (DILI) remains unexplored. Since the two hepatic disorders may share damage pathways, we analysed the metagenomic profile of the gut microbiota in NAFLD, with or without significant liver fibrosis, and in DILI, and we identified the main associated bacterial metabolic pathways. In the NAFLD group, we found a decrease in Alistipes, Barnesiella, Eisenbergiella, Flavonifractor, Fusicatenibacter, Gemminger, Intestinimonas, Oscillibacter, Parasutterella, Saccharoferementans and Subdoligranulum abundances compared with those in both the DILI and control groups. Additionally, we detected an increase in Enterobacter, Klebsiella, Sarcina and Turicibacter abundances in NAFLD, with significant liver fibrosis, compared with those in NAFLD with no/mild liver fibrosis. The DILI group exhibited a lower microbial bacterial richness than the control group, and lower abundances of Acetobacteroides, Blautia, Caloramator, Coprococcus, Flavobacterium, Lachnospira, Natronincola, Oscillospira, Pseudobutyrivibrio, Shuttleworthia, Themicanus and Turicibacter compared with those in the NAFLD and control groups. We found seven bacterial metabolic pathways that were impaired only in DILI, most of which were associated with metabolic biosynthesis. In the NAFLD group, most of the differences in the bacterial metabolic pathways found in relation to those in the DILI and control groups were related to fatty acid and lipid biosynthesis. In conclusion, we identified a distinct bacterial profile with specific bacterial metabolic pathways for each type of liver disorder studied. These differences can provide further insight into the physiopathology and development of NAFLD and DILI.

Management of Pharmacologic Adverse Effects in Advanced Liver Disease.

As a consequence of the altered hepatic architecture in advanced liver disease, drug metabolism is modified by changes in pharmacokinetic and pharmacodynamic properties, leading to the appearance of adverse effects and drug interactions and increasing the risk of over- or underdosing of medications. However, there are no tests that accurately determine the degree of impairment of liver metabolic function; therefore, general recommendations are established based on the degree of hepatic extraction, degree of hepatic metabolism, and degree of protein binding. Although the hepatic toxicity of some frequently used drugs, such as acetaminophen, is well known, many health care professionals are unaware or not fully aware of the deleterious effects that other drugs can have on patients with advanced liver injury, as is the case for nonsteroidal anti-inflammatory drugs. It is very important to increase awareness among both health care professionals and patients with advanced liver disease to limit the use of inappropriate drugs and prevent drug-induced liver injury.

A Review on Deep Learning Techniques for Video Prediction.

The ability to predict, anticipate and reason about future outcomes is a key component of intelligent decision-making systems. In light of the success of deep learning in computer vision, deep-learning-based video prediction emerged as a promising research direction. Defined as a self-supervised learning task, video prediction represents a suitable framework for representation learning, as it demonstrated potential capabilities for extracting meaningful representations of the underlying patterns in natural videos. Motivated by the increasing interest in this task, we provide a review on the deep learning methods for prediction in video sequences. We first define the video prediction fundamentals, as well as mandatory background concepts and the most used datasets. Next, we carefully analyze existing video prediction models organized according to a proposed taxonomy, highlighting their contributions and their significance in the field. The summary of the datasets and methods is accompanied with experimental results that facilitate the assessment of the state of the art on a quantitative basis. The paper is summarized by drawing some general conclusions, identifying open research challenges and by pointing out future research directions.

Differential iNKT and T Cells Activation in Non-Alcoholic Fatty Liver Disease and Drug-Induced Liver Injury.

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) and idiosyncratic drug-induced liver injury (DILI) could share molecular mechanisms involving the immune system. We aimed to identify activation immunological biomarkers in invariant natural killer T (iNKT) and CD4/CD8+ T cells in NAFLD and DILI. METHODS: We analyzed the activation profile (CD69, CD25, and HLA-DR) and natural killer group 2 member D (NKG2D) on iNKT cells, and CD4/CD8 T cells in peripheral blood mononuclear cells from NAFLD, with or without significant liver fibrosis, and DILI patients. RESULTS: There was an increase in iNKT cells in NAFLD patients compared to DILI or control subjects. Regarding the cellular activation profile, NAFLD with significant liver fibrosis (F ≥ 2) displayed higher levels of CD69+iNKT cells compared to NAFLD with none or mild liver fibrosis (F ≤ 1) and control patients. CD69+iNKT positively correlated with insulin resistance, aspartate aminotransferase (AST) level, liver fibrosis-4 index (FIB4) and AST to Platelet Ratio Index (APRI). DILI patients showed an increase in CD69+ and HLA-DR+ in both CD4+ and CD8+ T cells, detecting the most relevant difference in the case of CD69+CD8+ T cells. CONCLUSIONS: CD69+iNKT may be a biomarker to assess liver fibrosis progression in NAFLD. CD69+CD8+ T cells were identified as a potential distinctive biomarker for distinguishing DILI from NAFLD.

Brote epidémico de hepatitis aguda A en el área sanitaria del Hospital Universitario Virgen de la Victoria (HUVV): un cambio en la epidemiología / Outbreak of acute hepatitis A in the health area served by the Hospital Universitario Virgen de la Victoria (HUVV): a change in epidemiology

En el año 2016 se detectó en la provincia de Málaga un brote de hepatitis A en pacientes con características epidemiológicas especiales, con un predominio de sujetos del sexo masculino. Presentamos 51 casos de hepatitis A aguda con una media de edad de 35,7 años, el 90% varones, con un 55% de casos que reconocían haber mantenido relaciones sexuales con otros hombres en los últimos dos meses. La mitad de ellos requirieron ingreso hospitalario por coagulopatía significativa en el momento del diagnóstico, sin evolución a fallo fulminante, ni encefalopatía en ningún caso. Cuatro casos presentaban ascitis al diagnóstico. Este brote se suma a otros dos publicados en Reino Unido y Holanda con un número de casos similar y epidemiológicamente muy parecidos, lo cual refuerza la importancia de la vigilancia epidemiológica y la necesidad de vacunación en esta población de riesgo, así como de campañas informativas a la población para prevenir la enfermedad

In 2016, an outbreak of hepatitis A was identified in the Malaga province among patients with specific epidemiological characteristics, which were predominantly males. This is a report of 51 subjects with acute hepatitis A and a mean age of 35.7 years, 90% were male and 55% of cases were men who had had sex with other men within the last two months. Half of them required hospitalization for significant coagulopathy at diagnosis and no cases progressed to fulminant failure or encephalopathy. Four patients had ascites at the time of diagnosis. This outbreak adds to those reported in the United Kingdom and the Netherlands with a similar number of cases and epidemiology. These studies highlight the importance of epidemiological surveillance, the need for vaccination in this particular at risk population and the need for informative campaigns in order to prevent this disease

Outbreak of acute hepatitis A in the health area served by the Hospital Universitario Virgen de la Victoria (HUVV): a change in epidemiology.

In 2016, an outbreak of hepatitis A was identified in the Malaga province among patients with specific epidemiological characteristics, which were predominantly males. This is a report of 51 subjects with acute hepatitis A and a mean age of 35.7 years, 90% were male and 55% of cases were men who had had sex with other men within the last two months. Half of them required hospitalization for significant coagulopathy at diagnosis and no cases progressed to fulminant failure or encephalopathy. Four patients had ascites at the time of diagnosis. This outbreak adds to those reported in the United Kingdom and the Netherlands with a similar number of cases and epidemiology. These studies highlight the importance of epidemiological surveillance, the need for vaccination in this particular at risk population and the need for informative campaigns in order to prevent this disease.

A Quantitative Comparison of Calibration Methods for RGB-D Sensors Using Different Technologies.

RGB-D (Red Green Blue and Depth) sensors are devices that can provide color and depth information from a scene at the same time. Recently, they have been widely used in many solutions due to their commercial growth from the entertainment market to many diverse areas (e.g., robotics, CAD, etc.). In the research community, these devices have had good uptake due to their acceptable levelofaccuracyformanyapplicationsandtheirlowcost,butinsomecases,theyworkatthelimitof their sensitivity, near to the minimum feature size that can be perceived. For this reason, calibration processes are critical in order to increase their accuracy and enable them to meet the requirements of such kinds of applications. To the best of our knowledge, there is not a comparative study of calibration algorithms evaluating its results in multiple RGB-D sensors. Specifically, in this paper, a comparison of the three most used calibration methods have been applied to three different RGB-D sensors based on structured light and time-of-flight. The comparison of methods has been carried out by a set of experiments to evaluate the accuracy of depth measurements. Additionally, an object reconstruction application has been used as example of an application for which the sensor works at the limit of its sensitivity. The obtained results of reconstruction have been evaluated through visual inspection and quantitative measurements.

Computational Analysis of Distance Operators for the Iterative Closest Point Algorithm.

The Iterative Closest Point (ICP) algorithm is currently one of the most popular methods for rigid registration so that it has become the standard in the Robotics and Computer Vision communities. Many applications take advantage of it to align 2D/3D surfaces due to its popularity and simplicity. Nevertheless, some of its phases present a high computational cost thus rendering impossible some of its applications. In this work, it is proposed an efficient approach for the matching phase of the Iterative Closest Point algorithm. This stage is the main bottleneck of that method so that any efficiency improvement has a great positive impact on the performance of the algorithm. The proposal consists in using low computational cost point-to-point distance metrics instead of classic Euclidean one. The candidates analysed are the Chebyshev and Manhattan distance metrics due to their simpler formulation. The experiments carried out have validated the performance, robustness and quality of the proposal. Different experimental cases and configurations have been set up including a heterogeneous set of 3D figures, several scenarios with partial data and random noise. The results prove that an average speed up of 14% can be obtained while preserving the convergence properties of the algorithm and the quality of the final results.

Hernia incisional gigante que contiene estómago y asas intestinales / Giant incisional hernia containing the stomach and bowel loops

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