Urinary catheterization of patients with acute heart failure in a hospital emergency department: a factor associated with prognosis. / El sondaje vesical de los pacientes con insuficiencia cardiaca aguda en un servicio de urgencias hospitalario se asocia al pronóstico.

OBJECTIVES: To analyze whether urinary catheterization in a hospital emergency department (ED) affects short-term prognosis in patients with acute heart failure (AHF). MATERIAL AND METHODS: We prospectively recorded baseline and other clinical data in a consecutive cohort of ED patients treated for AHF. Crude and adjusted associations were calculated between catheterization and a primary composite outcome (30-day readmission for AHF and/or death) and secondary outcomes (in-hospital mortality, urinary tract infection [UTI], and duration of hospital stay.). RESULTS: Nine hundred ninety-one patients were admitted for AHF. The mean (SD) age was 66 (10.5) years; 71% were women. Catheterization was required for 29.2% in the ED. The primary composite outcome was observed in 7.7% of the patients who were not catheterized and 12.8% of the catheterized patients (P = .02). In-hospital mortality occurred in 5.9% and 9.7% of non-catheterized and catheterized patients, respectively (P = .04), and UTIs occurred in 19.1% and 26.6% (P = .01). Twelve of the non-catheterized patients (1.7%) were readmitted for AHF (vs 11 (3.8%) of the catheterized patients (P = .06), and there were no differences between the groups in hospital stay (11 vs 10.9 days, P = .78). In the adjusted analysis of associations between catheterization and the primary outcome the odds and hazard ratios (OR and HR, respectively) were OR, 1.7 (95% CI, 1.1-2.7) (P = .02) and HR, 1.6 (95% CI, 1.1-2.5) (P = .03). For secondary outcomes, significant associations emerged between catheterization and UTIs (OR, 1.8 [95% CI, 1.1-2.2]; P = .008) and readmission for AHF (OR, 2.9 [95% CI, 1.2-7.3]; P = .02). CONCLUSION: Routine insertion of a urinary catheter in patients with AHF in the ED is associated with worse 30-day clinical outcomes.

OBJETIVO: Analizar si el sondaje vesical (SV) rutinario en un servicio de urgencias hospitalario (SUH) de pacientes diagnosticados de insuficiencia cardiaca aguda (ICA) está asociado con la evolución a corto plazo. METODO: Se recogieron prospectivamente datos basales y clínicos de una cohorte de pacientes consecutivos que ingresaron por ICA. Se analizó la asociación cruda y ajustada del SV con el evento combinado de muerte o reingreso por insuficiencia cardiaca a 30 días (objetivo primario), así como mortalidad intrahospitalaria, infección del tracto urinario (ITU) y estancia hospitalaria (objetivos secundarios). RESULTADOS: Se incluyeron 991 pacientes hospitalizados por ICA, la edad media fue de 66 años (DE 10,5) y el 71% fueron mujeres. Un 29,2% de los pacientes requirieron SV en el SUH. El evento combinado fue del 7,7% para el grupo no SV y 12,8% para grupo SV (p = 0,02); mortalidad intrahospitalaria fue del 5,9% en el grupo no SV y 9,7% en el grupo SV (p = 0,04); se diagnosticó ITU en el 19,1% de pacientes en el grupo no SV y en el 26,6% en el grupo SV (p = 0,01). A 30 días, 12 pacientes (1,7%) reingresaron por insuficiencia cardiaca en el grupo no SV versus 11 (3,8%) pacientes en el grupo SV (p = 0,06). No hubo diferencias en la estancia hospitalaria (11 versus 10,9 días); p = 0,78). En el análisis ajustado, el SV se asoció con el objetivo primario; [OR = 1,7 (IC 95%: 1,1-2,7; p = 0,02); HR = 1,6 (IC 95%: 1,1-2,5; p = 0,03)]; con la ITU (OR = 1,8; IC 95%: 1,1­2,2; p = 0,008) y con el reingreso por insuficiencia cardiaca (OR = 2,9; IC 95%: 1,2-7,3; p = 0,02). CONCLUSIONES: La inserción rutinaria del SV en el SUH en pacientes con ICA se asoció a peores resultados clínicos a los 30 días.

Analysis of New Colposcopy Techniques in the Diagnosis and Evolution of SIL/CIN: Comparison of Colposcopy with the DSI System (COLPO-DSI Study).

Compared with conventional colposcopy, colposcopy assisted by DSI-map increases the detection of HSIL/CIN2+ and might help to identify the lesions more likely to regress. INTRODUCTION: Comparison of the performance of colposcopy assisted by dynamic spectral imaging (C-DSI) with that of conventional colposcopy (CC) in the diagnosis of cervical intraepithelial neoplasia (HSIL/CIN2 or CIN3). MATERIALS AND METHODS: A total of 1655 women were referred for colposcopy between 2012 and 2020 and included in the study. Of that total, 973 were examined by the same colposcopist with C-DSI, and 682 with CC. Comparisons between CC and C-DSI were made by using the histological diagnosis performed with a punch biopsy or loop electrosurgical excision procedure (LEEP) as the gold standard. A follow-up study was conducted until 2021 to detect progression to HSIL/CIN2 at 6, 12 and 24 months after first examination. RESULTS: C-DSI provided higher sensitivity for the diagnosis of HSIL/CIN2 or CIN 3 than CC (sensitivity of 76.8% and 86.6% vs. 54.2% and 72.2%, respectively). In negative or ASCUS/LSIL Pap smear results, C-DSI showed higher sensitivity than CC (sensitivity of 66.7% and 61.5% vs. 21.4% and 33.3%, respectively). In contrast, these differences were not observed in high-grade Pap smears. The sensitivity of C-DSI in cases with HPV16/18 infection was stronger than that of CC (73.53% vs. 56.67%). The sensitivity of C-DSI to detect the progression to HSIL/CIN2+ during follow-up was 30, 17.6 and 35.7% at 6, 12 and 24 months, respectively. CONCLUSIONS: The present study shows that C-DSI in women referred for colposcopy increases the HSIL/CIN 2-3 detection rate compared to conventional colposcopy. Nevertheless, C-DSI does not seem to be an important tool to predict the evolution of the lesions during follow-up.

Development of an Information Guideline for Kidney Transplant Recipients in a Clinical Trial: Protocol for a Modified Delphi Method.

BACKGROUND: Renal transplantation is the treatment of choice for most cases of end-stage renal disease. Recipients need to lead a healthy lifestyle to minimize the potential side effects of immunosuppressive drugs and improve transplant outcomes. There is not much evidence about the best way to increase adherence to healthy lifestyles in kidney transplant recipients, so one of the objectives set by the nursing team is to train people to acquire the necessary skills and tools to be able to take care of themselves. In this sense, the consensual development of appropriate materials may be useful and of interest. OBJECTIVE: The aim of this study was to develop an information guide for adults with kidney transplants to be assessed in a subsequent clinical trial as an intervention to increase adherence to healthy habits. METHODS: We used a 3-step, methodological, sequential approach: (1) training from a group of experts and item consensus; (2) review of the medical literature available; and (3) use of the Delphi technique with on-site meetings. A total of 5 nurses from the Community of Madrid Kidney Transplantation Unit in Spain were asked to participate. The patients' lifestyle factors that, according to the medical literature available and experts' opinions, have the greatest impact on the survival of the transplanted organ and the recipients themselves were all described. RESULTS: After using the modified Delphi method to reach a consensus on the items to be included and the information needed in each, an information guide for adult kidney transplant patients was developed. This guide facilitates the structuring of health care, information, and recommendations necessary for effective self-care for each person. The result is considered to be an easy-to-understand tool, useful for transplant doctors and nurses, in simple language, with information based on the latest scientific-medical evidence published to date, aspects of which will be evaluated in a clinical trial designed for this purpose. CONCLUSIONS: Currently, this guide is the main intervention variable of a clinical trial (registered on ClinicalTrials.gov; NCT05715580) aimed at improving compliance with healthy habits in kidney transplant recipients in the Community of Madrid, Spain. The method used in its development has been useful and agile, and the result is a guide that can be easily updated periodically following the same procedure. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/46961.

Neumoperitoneo como complicación de fibrobroncoscopia. Reporte de un caso / Pneumoperitoneum complicating bronchoscopy. Case report

El uso diagnóstico y terapéutico de la broncoscopia flexible (BF) ha tenido una gran evolución desde que Gustav Killian realizó en 1897 la primera endoscopia traqueal para extraer un cuerpo extraño1. Con el pasar de los años se ha demostrado que es un procedimiento seguro2 con una mortalidad escasa (< 0.1%) siendo sus complicaciones infrecuentes y derivadas principalmente del tipo de técnica, de las propias comorbilidades del paciente y de la sedación3. Dentro de las complicaciones infrecuentes podemos mencionar el neumomediastino y el neumoperitoneo que generalmente se deben a la presencia de una ruptura gástrica. Presentamos el caso de un paciente de 58 años que 15 días tras la realización de una BF, presenta el hallazgo incidental de un neumoperitoneo asintomático sin evidencia de lesión gástrica (AU)

The diagnostic and therapeutic use of flexible bronchoscopy has evolved greatly since Gustav Killian performed the first tracheal endoscopy in 1897 to remove a foreign body. Over the years it has been shown that it is a safe procedure with low mortality (< 0.1%), with a small rate of complications which are mainly due to the type of technique, the patient’s own comorbidities and sedation. Among the infrequent complications we can mention pneumomediastinum and pneumoperitoneum, which are generally due to the presence of a gastric rupture. We present the case of a 58-year-old patient who, 15 days after performing a flexible bronchoscopy, presented an incidental asymptomatic pneumoperitoneum with no evidence of gastric lesion (AU)

Dual trigger vs. Conventional trigger outcomes in In Vitro Fertilization. Systematic review and meta-analysis.

OBJECTIVE: The aim of this study is to analyze the efficacy of the dual trigger (human chorionic gonadotropin (hCG) + GnRH agonists) compared to the conventional trigger (hCG) in terms of oocyte retrieval (number and oocyte maturity), fertilization rate or number of embryos with two pronuclei, number of high-quality embryos, number of transferred embryos, number of cryopreserved embryos, implantation rate, positive ß-hCG rate, ongoing pregnancy rate, abortion rate, and live birth rate. METHODS: This search performed in this systematic review included all literature published in the PubMed database of studies on controlled ovarian stimulation with dual trigger compared with conventional trigger. The meta-analysis included clinical trials and prospective cohort studies. RESULTS: Statistically significant differences between groups (dual trigger vs. hCG trigger) in terms of number of oocytes retrieved and live birth rate favored the dual trigger protocol. No statistically significant differences were found in the other studied variables. A tend favoring the dual trigger protocol was observed in all studied parameters. CONCLUSIONS: Dual trigger seems to be more effective in GnRH antagonist cycles in terms of embryo and pregnancy outcome.

Características epidemiológicas y clínicas de una cohorte de pacientes con el virus de la inmunodeficiencia humana / Epidemiological and clinical characteristics of a cohort of patients infected with HIV / Características epidemiológicas e clínicas de uma coorte de pacientes com o vírus da imunodeficiência humana

Introducción. Los estudios de cohortes han sido fundamentales para describir la evolución de múltiples enfermedades. El Grupo de estudio Uruguayo de VIH, comenzó en 2018 el seguimiento de una cohorte de personas con VIH de diferentes prestadores de salud. Objetivo . Describir las características epidemiológicas y clínicas de las personas incluidas en la cohorte GeUVIH. Pacientes y métodos. Estudio descriptivo, observacional, multicéntrico transversal y prospectivo. Desde 1 de julio de 2018 hasta 31 de mayo de 2021. Se analizaron 795 personas con VIH de centros con consultas ambulatorias públicas y privadas de Montevideo-Uruguay. Resultados. Se analizaron 795. Relación hombre/ mujer 2 a 1. Mediana de edad 46 años. El 56,6% tenía entre 39 y 58 años. Motivaron al diagnóstico de VIH sobre todo controles en salud y enfermedades oportunistas. Al ingresar a la cohorte el 49% llevaba más de 10 años viviendo con VIH y el 25% estaba en estadio SIDA. El 98.4% estaban recibiendo antirretrovirales y de ellos 84% tenían carga viral indetectable. El 1,3% estaba co-infectado con el VHB y 3,9% con el VHC. Fallecieron 4 pacientes de la cohorte. Conclusiones. Se observó una población vinculada a los servicios de salud, que recibe TAR y es adherente. El envejecimiento de la población nos obliga a diagnosticar y tratar precozmente las comorbilidades. Se debe estimular el diagnóstico de VIH durante el control en salud y/o campañas preventivas. El mantenimiento de la cohorte prospectivamente dará información fundamental para la toma de decisiones.

Introduction: cohort studies are essential to describe the evolution of multiple diseases. In 2018 the Uruguayan group for the study of HIV started to monitor a cohort of individuals infected with HIV in different health care Institutions. Objective: to describe the epidemiological and clinical characteristics of individuals included in an HIV cohort (GeUVIH). Patients and method: descriptive, observational, multi-transversal and prospective study. From July 1, 2018 to May 31, 2021. 795 individuals infected with HIV were analyzed in private and public outpatient consultations in Montevideo, Uruguay. Results: the case of 795 patients was analyzed. Men/women ratio was 2/1. Median age was 46 years old. 65.6% was between 39 and 58 years old. HIV diagnosis mainly resulted from health control and opportunistic diseases. Upon inclusion in the cohort group, 49% of patients had been living with HIV for over 10 years and were in the AIDS stage of infection. 98.3% were under antiretroviral treatment and in 84% of them viral load could not be detected. 1.3% of patients presented HIV-HIB coinfection and 3.9% HIV-HIC coinfection. 4 patients in the cohort died. Conclusions: the studied population was found to be related to the health care services, receiving antiretroviral therapy and showing good adherence to treatment. The aging of population makes it mandatory for the early diagnosis and treatment of comorbilities. Diagnosis of HIV must be encouraged in health care controls or preventive campaigns. The prospective maintenance of the cohort will provide key data for the making of decisions.

Introdução: estudos de coorte têm sido essenciais para descrever a evolução de múltiplas doenças. O Grupo Uruguaio de Estudos de HIV começou a monitorar uma coorte de pessoas com HIV de diferentes prestadores de serviços de saúde em 2018. Objetivo: descrever as características epidemiológicas e clínicas das pessoas incluídas na coorte GeUVIH. Pacientes e métodos : estudo descritivo, observacional, multicêntrico, transversal e prospectivo. No período 1º de julho de 2018 a 31 de maio de 2021 foram analisadas 795 pessoas com HIV de unidades ambulatoriais públicas e privadas em Montevidéu-Uruguai. Resultados: foram incluídas 795 pessoas. A proporção homem/mulher foi 2 para 1, a mediana de idade 46 anos sendo que 56,6% tinham entre 39 e 58 anos. O diagnóstico do HIV foi motivado especialmente por controles de saúde e pela detecção de doenças oportunistas. Ao ingressar na coorte, 49% viviam com HIV há mais de 10 anos e 25% encontravam-se na fase de AIDS. 98,4% estavam recebendo antirretrovirais e 84% deles tinham carga viral indetectável. 1,3% estavam co-infectados com HBV e 3,9% com HCV. Quatro pacientes da coorte morreram. Conclusões: observou-se uma população vinculada aos serviços de saúde, que recebe TARV com adesão ao tratamento. O envelhecimento da população obriga-nos a diagnosticar e tratar precocemente as comorbilidades. O diagnóstico de HIV deve ser incentivado durante controles de saúde e/ou campanhas preventivas. Manter a coorte prospectivamente fornecerá informações essenciais para a tomada de decisões.

Calidad de vida en niños, niñas y adolescentes con VIH. Centro Hospitalario Pereira Rossell. Montevideo, Uruguay, 2019-2020 / Quality of life in children and adolescents with HIV. Pereira Rossell Hospital Centre. Montevideo, Uruguay, 2019- 2020 / Qualidade de vida em crianças e adolescentes com HIV. Centro Hospitalar Pereira Rossell. Montevidéu, Uruguai. 2019-2020

Introducción: la infección por el VIH es una enfermedad de comportamiento crónico. En Uruguay no hay publicaciones aplicando cuestionarios sobre calidad de vida en menores de 18 años con VIH. Objetivos: conocer la calidad de vida en niños, niñas y adolescentes con VIH que se asisten en el Centro Hospitalario Pereira Rossell. Relacionar la calidad de vida de la población encuestada a su estado inmunológico y carga viral. Comprobar si existe una diferencia en la calidad de vida de los niños, niñas y adolescentes de acuerdo a la edad. Conocer la actividad escolar de niños, niñas y adolescentes mayores de 5 años y su relación con la carga viral. Comparar la percepción de calidad de vida de los padres y su visión de la actividad escolar con la de niños mayores de 5 años. Materiales y métodos: se incluyeron niños, niñas y adolescentes con VIH de 1 mes a 18 años. Se aplicó el cuestionario PedsQL 4.0. Se relacionaron los resultados de los niños, niñas y adolescentes con los de sus padres/tutores y con la carga viral. Resultados: la percepción de calidad de vida en esta población es buena y similar en diferentes grupos etarios. La percepción de padres/tutores y la de niños, niñas y adolescentes se correlacionó, al igual que la percepción sobre la actividad escolar. No se encontró asociación entre carga viral indetectable con buena calidad de vida ni con buen puntaje en actividad escolar. Conclusiones: esta patología no parece afectar la vida diaria de esta población según los resultados del cuestionario utilizado.

Introduction: HIV disease is a chronic illness. In Uruguay, there are no publications applying quality of life questionnaires in individuals younger than 18 years old with HIV. Objectives: to learn about the quality of life in children and adolescents living with HIV who are seen at the Pereira Rossell Hospital Centre. To relate the quality of life of the surveyed population with their immune condition and viral load. To learn about school activity of children older than 5 years old and adolescents and its relation with viral load. To compare parents' perception of their children´s quality of life and school activity with that of the children themselves. Method: children and adolescents aged between 1 month and 18 years old with HIV were included in the study. PedsQL 4.0 questionnaire was applied. The results of children and adolescents were compared to the results of their parents and tutors and the viral load. Results: the perception of quality of life in this population is good and does not vary across the different age groups. The perception of parents and tutors and that of children and adolescents was correlated, the same as the perception on school activity. No association was found between undetectable viral load and a good quality of life, neither with good school scores. Conclusions: this disease does not seem to affect the daily life of this population according to the results of the questionnaire used.

Introdução: a infecção pelo HIV é uma doença com características crônicas. No Uruguai não existem publicações sobre a aplicação de questionários de qualidade de vida em menores de 18 anos com HIV. Objetivos: conhecer a qualidade de vida de crianças e adolescentes com HIV que frequentam o Centro Hospitalar Pereira Rossell. Relacionar a qualidade de vida da população pesquisada com seu estado imunológico e carga viral. Verificar se há diferença na qualidade de vida de crianças e adolescentes de acordo com a idade. Conheça a atividade escolar de crianças e adolescentes com mais de 5 anos e sua relação com a carga viral. Comparar a percepção de qualidade de vida dos pais e sua visão sobre a atividade escolar, com a de crianças maiores de 5 anos. Materiais e métodos: foram incluídos crianças e adolescentes com HIV de 1 mês a 18 anos de idade. Aplicou-se o questionário PedsQL 4.0. Os resultados das crianças e adolescentes foram relacionados aos de seus pais/responsáveis e à carga viral. Resultados: a percepção de qualidade de vida nessa população é boa e semelhante em diferentes faixas etárias. Correlacionou-se a percepção dos pais/responsáveis e das crianças e adolescentes, assim como a percepção da atividade escolar. Não foi encontrada associação entre carga viral indetectável com boa qualidade de vida ou com bom escore na atividade escolar. Conclusões: esta patologia parece não afetar a vida diária desta população de acordo com os resultados do questionário utilizado.

Risk Factors Associated with CIN2+ in Spanish Patients with L-SIL/ASCUS Cytology Collected from a Madrid Hospital.

The management of patients with L-SIL/ASCUS cytology is controversial and not clearly standardized. OBJECTIVE: To analyze the risk factors associated with H-SIL/CIN2+ in a cohort of patients with ASCUS or L-SIL in a Pap smear. METHODS: Between 2012 and 2022, 1259 eligible women with ASCUS/L-SIL were referred for colposcopy. The risk factors associated with H-SIL/CIN2+ were analyzed. The colposcopic study, conventional or assisted with dynamic spectral imaging (DSI), was performed in all cases. Guided biopsies were performed in cases of abnormal examination or random biopsies when no lesions were found. A LEEP was performed in H-SIL/CIN2+ results or persistent LSIL/CIN. RESULTS: A normal or metaplastic specimen was found in 750 women (63.2%), LSIL/CIN1 in 346 (29.1%), and H-SIL/CIN2+ in 92 (7.7%). The presence of HR-HPV (OR = 2.1; IC 95% = 1.4-3.2), smoking habits (OR = 2.2; IC 95% = 1.4-3.5), and the performance of DSI combined with colposcopy (OR = 0.6; IC 95% = 0.37-0.83) were the factors associated with the detection of H-SIL/CIN2+. A summative effect of HR-HPV and smoking habit (OR = 2.9; IC 95% = 1.7-5.0) was observed in the detection of H-SIL/CIN2+. In multivariate analysis, the presence of HPV 16/18 was the unique independent factor associated with H-SIL/CIN2+. CONCLUSION: In women carrying an ASCUS/LSIL in the Pap smear, the unique independent factor predictive of H-SIL/CIN2+ is the presence of the HPV 16/18 genotype. Smoking women carrying ASCUS/LSIL with HR-HPV should be targeted for stricter follow-up to avoid an unsuspected H-SIL/CIN2+.

Reading Strategies for Children with Developmental Language Disorder.

Developmental language disorder (DLD) is considered a neurodevelopmental disorder that compromises language comprehension and/or expression and constitutes a risk factor for learning to read. The aim of the present study was to analyse the reading strategies used by students with DLD to read sentences. There is evidence in the literature that, when linguistic resources are insufficient, the keyword strategy (identifying some of the words in the sentence with their own semantic content, with barely no processing of the function words) is used to read sentences. A total of 31 primary and secondary school students diagnosed with DLD were evaluated using the PEALE battery. The results reveal that students with DLD present heterogeneous profiles that are below the established reading level for their age. In addition, children with DLD and better reading skills use the keyword strategy to read sentences. In conclusion, clinical and educational implications for reading intervention in individuals with DLD are discussed.

Mujeres ocupando autorías preferenciales de artículos en la revista EMERGENCIAS: análisis de la última década / Women occupying preferential authorship positions for articles in the journal Emergencias: an analysis of authorship during the last decade

Objetivos. Analizar la desigualdad de género en la producción científica de la revista EMERGENCIAS en la última década. Método. Estudio longitudinal retrospectivo que revisó los números publicados entre enero de 2011 y diciembre de 2020. Se analizaron el número de autores, género, tipo y año de publicación y autoría preferencial (primera autoría, autoría de correspondencia o última autoría). La participación de la mujer se calculó en base a valores porcentuales y se analizó la tendencia existente a lo largo de los años. Resultados. Se recogieron 1.240 artículos con un número total de 5.213 firmantes, 1.889 de ellos (36,2%) mujeres. En 384 (31%) artículos, una mujer asumió la primera autoría, en 352 (28,4%) fue autora para correspondencia y en 358 (28,9%) la última autora. A lo largo de la década, se identificó una tendencia creciente en los que una mujer fue primera autora en los artículos originales o metanálisis (p = 0,047). En los editoriales, revisiones, cartas científicas o comunicaciones breves, cartas al editor y otros no existió una tendencia creciente significativa en las autorías preferenciales. Conclusión. La participación de autoras en la producción científica de la revista EMERGENCIAS ha aumentado en la última década. No obstante, comparado con la de hombres, sigue existiendo una menor participación. (AU)

Objective. To analyze gender disparity in scientific productivity reflected by the authorship of articles in the journal Emergencias over the past decade. Methods. Retrospective longitudinal study. We included articles in all issues published between January 2011 and December 2020, analyzing the number of authors, their gender, article type, year of publication, and preferential authorship credit (first author, corresponding author, and last author positioning). The percentages of women named in each position were calculated, and the trend over time was analyzed. Results. A total of 1240 articles signed by 5213 authors were collected; a woman was named in 1889 of the cases (36.2%). A woman was the first author of 384 articles (31%), the corresponding author of 352 (28.4%), and the last author of 358 (28.9%). The number of female authors of original research articles or meta-analyses tended to increase over time (P = .047), but no statistically significant gender trends were observed in the authorship of editorials, narrative reviews, scientific letters or short communications, letters to the editor, or any other publication category. Conclusions. The publication of articles by women in Emergencias has increased over the past decade. However, women continue to author fewer articles than men. (AU)

Value of colposcopy with dynamic spectral imaging in the detection and evolution of high-grade cervical lesions.

OBJECTIVE: To analyze the performance of colposcopy assisted with dynamic spectral imaging (CC-DSI) compared to conventional colposcopy (CC) in diagnosing cervical intraepithelial neoplasia 2+ (CIN2+). METHODS: In total, 973 consecutive women were referred for colposcopy between 2012 and 2016 and were examined simultaneously by CC and CC-DSI; 877 were eligible. Comparisons between CC and CC-DSI were performed against the histological diagnosis performed by either punch biopsy or loop electrosurgical excision procedure (LEEP). RESULTS: In final histology, 494 women had no CIN, 250 had CIN1 and 133 had CIN2+. The sensitivity to identify women with CIN2+ was significantly higher for CC-DSI compared to CC for the entire group and in the subgroup of 675 women referred with ASCUS or LSIL. In women with HPV16/18 infections, the sensitivity of CC increased with the addition of DSI from 53% to 79% (p < 0.001). Using a multivariant Cox regression model, CC-DSI was an independent factor for progression of the cervical lesions (HR: 2.29, 95% CI 1.07-4.90). Other predictive factors were the number of sexual partners (HR: 1.05, 95% CI: 1.01-1.09) and anal intercourse (HR: 2.45, 95% CI 1.23-5.02). CONCLUSION: CC-DSI improves the ability to detect cervical lesions compared to CC and could help predict their potential to progress.

Women occupying preferential authorship positions for articles in the journal Emergencias: an analysis of authorship during the last decade. / Mujeres ocupando autorías preferenciales de artículos en la revista EMERGENCIAS: análisis de la última década.

OBJECTIVES: To analyze gender disparity in scientific productivity reflected by the authorship of articles in the journal Emergencias over the past decade. MATERIAL AND METHODS: Retrospective longitudinal study. We included articles in all issues published between January 2011 and December 2020, analyzing the number of authors, their gender, article type, year of publication, and preferential authorship credit (first author, corresponding author, and last author positioning). The percentages of women named in each position were calculated, and the trend over time was analyzed. RESULTS: A total of 1240 articles signed by 5213 authors were collected; a woman was named in 1889 of the cases (36.2%). A woman was the first author of 384 articles (31%), the corresponding author of 352 (28.4%), and the last author of 358 (28.9%). The number of female authors of original research articles or meta-analyses tended to increase over time (P = .047), but no statistically significant gender trends were observed in the authorship of editorials, narrative reviews, scientific letters or short communications, letters to the editor, or any other publication category. CONCLUSION: The publication of articles by women in Emergencias has increased over the past decade. However, women continue to author fewer articles than men.

OBJETIVO: Analizar la desigualdad de género en la producción científica de la revista EMERGENCIAS en la última década. METODO: Estudio longitudinal retrospectivo que revisó los números publicados entre enero de 2011 y diciembre de 2020. Se analizaron el número de autores, género, tipo y año de publicación y autoría preferencial (primera autoría, autoría de correspondencia o última autoría). La participación de la mujer se calculó en base a valores porcentuales y se analizó la tendencia existente a lo largo de los años. RESULTADOS: Se recogieron 1.240 artículos con un número total de 5.213 firmantes, 1.889 de ellos (36,2%) mujeres. En 384 (31%) artículos, una mujer asumió la primera autoría, en 352 (28,4%) fue autora para correspondencia y en 358 (28,9%) la última autora. A lo largo de la década, se identificó una tendencia creciente en los que una mujer fue primera autora en los artículos originales o metanálisis (p = 0,047). En los editoriales, revisiones, cartas científicas o comunicaciones breves, cartas al editor y otros no existió una tendencia creciente significativa en las autorías preferenciales. CONCLUSIONES: La participación de autoras en la producción científica de la revista EMERGENCIAS ha aumentado en la última década. No obstante, comparado con la de hombres, sigue existiendo una menor participación.

The Effect of Borderline Pulmonary Hypertension on Survival in Chronic Lung Disease.

BACKGROUND: The impact of the new "borderline" hemodynamic class for pulmonary hypertension (PH) (mean pulmonary artery pressure [mPAP], 21-24 mm Hg and pulmonary vascular resistance, [PVR], ≥3 wood units, [WU]) in chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD) is unclear. OBJECTIVES: The aim of this study was to assess the effect of borderline PH (BLPH) on survival in COPD and ILD patients. METHOD: Survival was analyzed from retrospective data from 317 patients in 12 centers (Italy, Spain, UK) comparing four hemodynamic groups: the absence of PH (NoPH; mPAP <21 mm Hg or 21-24 mm Hg and PVR <3 WU), BLPH (mPAP 21-24 mm Hg and PVR ≥3 WU), mild-moderate PH (MPH; mPAP 25-35 mm Hg and cardiac index [CI] ≥2 L/min/m2), and severe PH (SPH; mPAP ≥35 mm Hg or mPAP ≥25 mm Hg and CI <2 L/min/m2). RESULTS: BLPH affected 14% of patients; hemodynamic severity did not predict survival when COPD and ILD patients were analyzed together. However, survival in the ILD cohort for any PH level was worse than in NoPH (3-year survival: NoPH 58%, BLPH 32%, MPH 28%, SPH 33%, p = 0.002). In the COPD cohort, only SPH had reduced survival compared to the other groups (3-year survival: NoPH 82%, BLPH 86%, MPH 87%, SPH 57%, p = 0.005). The mortality risk correlated significantly with mPAP in ILD (hazard ratio [HR]: 2.776, 95% CI: 2.057-3.748, p < 0.001) and notably less in COPD patients (HR: 1.015, 95% CI: 1.003-1.027, p = 0.0146). CONCLUSIONS: In ILD, any level of PH portends worse survival, while in COPD, only SPH presents a worse outcome.

Early Treatment of Acute Myocardial Infarction with Melatonin: Effects on MMP-9 and Adverse Cardiac Events.

BACKGROUND: Matrix metalloproteinase-9 (MMP-9) is crucial in tissue remodeling after an adverse cardiac event. In experimental studies, melatonin has been found to attenuate MMP-9 activation. The present study assessed the effects of systemic melatonin administration on the prognosis of patients with acute myocardial infarction (AMI) successfully treated with primary percutaneous coronary intervention, and to examine the effects on MMP-9 levels. METHODS: We conducted a randomized controlled trial, enrolling patients who underwent primary percutaneous coronary intervention due to AMI. They were assigned to two groups for melatonin or placebo. The primary endpoint was a combined event of mortality and heart failure readmission at 2 years. The secondary endpoint was the levels of MMP-9 after the percutaneous coronary intervention. RESULTS: Ninety-four patients were enrolled, 45 in the melatonin group and 49 in the control group. At 2 years of follow-up, 13 (13.8%) patients suffered the primary endpoint (3 deaths and 10 readmissions due to heart failure), 3 patients in the melatonin group and 10 in the placebo group. The difference in the restricted mean survival time was 87.5 days (p = 0.02); HR = 0.3 (95% CI 0.08-1.08; p = 0.06); Log-rank test 0.04. After controlling for confounding variables, melatonin administration reduced MMP-9 levels to 90 ng/mL (95% CI 77.3-102.6). CONCLUSIONS: This pilot study demonstrated that compared to placebo, melatonin administration was associated with better outcomes in AMI patients undergoing primary percutaneous coronary intervention.

Multiskilled personnel assignment problem under uncertain demand: A benchmarking analysis.

The personnel assignment problem in different service industries aims to minimize the staff surplus/shortage costs. However, uncertainty in the staff demand challenges the accomplishment of that objective. This research studies the personnel assignment problem considering uncertain demand and multiskilled workforce configured through a 2-chaining strategy. We develop a two-stage stochastic optimization (TSSO) approach to calculate the multiskilling requirements that minimize the training costs and the expected costs of staff surplus/shortage. Later, we evaluate and compare the performance of the TSSO approach solutions with the solutions of two alternative optimization approaches under uncertainty - robust optimization (RO) and closed-form equation (CF). These two alternative approaches were published in Henao et al. [1] and Henao et al. [2], respectively. In addition, we compare the performance of the TSSO approach solutions with the solution of the deterministic (DT) approach and the solutions of myopic multiskilling approaches. To make performance comparisons between the different approaches, we used both real and simulated data derived from a retail store operating in Chile. The results show that, for different demand variability levels, TSSO, RO, and CF always belong to the set of approaches with the lowest average total cost. That is, in this group, there are no statistical differences from one approach to another, so these approaches are the most cost-effective. We also provide insights to retail decision-makers for addressing two key aspects. First, the methodology allows to address two fundamental multiskilling issues: how much multiskilling to add and how it should be added. Second, it is provided understanding on how to select the most suitable approach according to the balance between the conservatism and the reliability associated with the solutions delivered by each approach. Finally, we identify some methodological challenges for future research, such as the evaluation of k-chaining strategies with k≥2.