IBD-PODCAST Spain: A Close Look at Current Daily Clinical Practice in IBD Management.

BACKGROUND: Crohn's disease (CD) and ulcerative colitis (UC) are inflammatory bowel diseases (IBD) that contributes in part to irreversible bowel damage and long-term complications, reduced quality of life, invalidity, and economic burden. Suboptimal control of IBD is associated with higher healthcare resource utilization (HCRU), impaired quality of life (QoL), and reduced work productivity. AIMS: The IBD-PODCAST study aimed to assess the proportion of IBD patients with suboptimal control and its associated impact. METHODS: IBD-PODCAST is a cross-sectional, multicenter study that aimed to characterize the CD and UC population with optimal or suboptimal control according to the STRIDE-II criteria and patient- and physician-reported measures. Here we present the results of the Spanish cohort (n = 396). RESULTS: A total of 104/196 (53.1%) CD and 83/200 (41.5%) UC patients were found to have suboptimal disease control. Long-term treatment targets according to STRIDE-II were applied in 172 (87.8%) CD and 181 (90.5%) UC patients. 125 of 172 (72.7%) CD and 74 of 181 (40.9%) UC patients were currently treated with targeted immunomodulators. Patients with CD and UC and suboptimal disease control showed impaired QoL, higher HCRU and direct costs, and also loss of work productivity compared to those with optimal control. CONCLUSION: Despite a high rate of targeted immunomodulator therapy, a substantial proportion of IBD patients show suboptimal disease control according to the STRIDE II criteria. Those patients with suboptimal disease control exhibit impaired QoL, less work productivity, and higher HCRU, suggesting that there is considerable need for better treatment approaches in IBD.

Identification of Cryptosporidium parvum and Blastocystis hominis subtype ST3 in Cholga mussel and treated sewage: Preliminary evidence of fecal contamination in harvesting area.

Cryptosporidium parvum and Blastocystis hominis are foodborne parasites known for causing diarrhea. They accumulate in mussels grown on contaminated water bodies, due to the discharge of treated sewage from sewage treatment plants (STP). Despite this, some countries like Chile do not include these parasites in the control or monitoring of sewage water. The objective of this research was to evaluate the contamination of C. parvum. and B. hominis from treated sewage (disinfected by chlorination) and Cholga mussels in a touristic rural cove from the bay of Concepción. Cholga mussels from commercial stores and a treated sewage sample were analyzed. Cryptosporidium spp. was identified by Ziehl-Neelsen-Staining (ZNS) and C. parvum by direct-immunofluorescence assay (IFA) from ZNS-positive samples. Blastocystis hominis was identified by PCR using locus SSU rDNA. C. parvum and B. hominis subtype ST3 were found in 40% and 45% of Cholga mussel samples, respectively, and both parasites were identified in the treated sewage. Blastocystis hominis SSU rDNA gene alignment from Cholga mussels and treated sewage showed 89% of similarity, indicating that could be the same parasite in both samples. We describe the first evidence of possible contamination with these parasites from treated sewage to Cholga mussel suggesting an environmental contamination with high human risk. Based on these results, further studies will consider all the rural coves and STP from the bay to prevent possible contamination of these parasites.

Descriptors of multidrug-resistant TB deaths in Ethiopia.

Deaths related to multidrug-resistant TB among patients who had received a second-line anti-TB drugs in Ethiopia were analysed. Respectively 38/704 (5.4%) and 44/995 (4.4%) deaths were identified in two cohorts (2015 and 2022). In the 2015 cohort, severe malnutrition was less prevalent, previous treatment rates were three times higher, hypokalaemia was more frequent, and the use of the Xpert® MTB/RIF assay, respiratory failure and severe anaemia/pancytopenia were less common than in the 2022 cohort. We observed that there were variations in adverse events when different treatment regimens were used over different time periods. To ensure proper patient care, correct guidance must be consistently implemented.

Les décès liés à la TB multirésistante chez les patients ayant reçu des médicaments antituberculeux de seconde ligne en Éthiopie ont été analysés. Respectivement 38/704 (5,4%) et 44/995 (4,4%) décès ont été identifiés dans deux cohortes (2015 et 2022). Dans la cohorte 2015, la malnutrition sévère était moins fréquente, les taux de traitement antérieur étaient trois fois plus élevés, l'hypokaliémie était plus fréquente, et l'utilisation du test Xpert® MTB/RIF, l'insuffisance respiratoire et l'anémie/pancytopénie sévère étaient moins fréquentes que dans la cohorte 2022. Nous avons observé des variations dans les effets indésirables lorsque différents schémas thérapeutiques étaient utilisés sur différentes périodes. Pour garantir des soins adéquats aux patients, des consignes appropriées doivent être appliquées de manière régulière.

An attempt to reduce unnecessary surgical procedures... Can ultrasound characteristics help in differentiating adenoma vs carcinoma in follicular thyroid neoplasms?

INTRODUCTION AND OBJECTIVES: Thyroid nodules frequently require ultrasound and Fine Needle Aspiration Cytology (FNAC) evaluation. However, FNA cytology does not allow differentiation between follicular adenoma and carcinoma on Bethesda type IV lesions. This situation leads to many unnecessary surgical procedures because it is not possible to assure the benignity of the lesions, even when most of the specimens correspond to adenomas or even other benign lesions. The objective is this study is to establish if there are any US characteristics that would help us to predict the risk of malignancy of nodules with a pathological diagnosis of follicular neoplasm in order to achieve a more conservative management for non-suspicious nodules. MATERIAL AND METHODS: We studied 61 nodules in 61 patients (51 women and 10 men) that underwent thyroid surgery and had histopathological results of either follicular adenoma or carcinoma. Different US characteristics of the nodules were analysed (composition, echogenicity, margin, calcification status, the presence of halo and overall observer suspicion of malignancy) and were correlated with the histopathological analysis. RESULTS: We have found a statistically significant association between the presence of calcifications, ill-defined borders and overall observer suspicion or impression (defined by well-known suspicious for malignancy ultrasonographic features, such as calcification, poorly defined margin, and a markedly hypoechoic solid nodule; and benign ultrasonographic features, such as predominantly cystic echogenic composition and the presence of a perinodular hypoechogenic halo) with follicular carcinoma. However all those features have shown low sensitivities in the present study (30%, 30% and 50%, respectively). On the other hand, the absence of halo sign has shown a sensitivity of 100% and a negative predictive value (NPV) of 100% in our study. CONCLUSIONS: The presence of calcifications, ill-defined borders and the overall impression or suspicion of malignancy associate with a higher risk for follicular carcinoma in Bethesda type IV thyroid nodules but their absence do not allow to predict benignity in these nodules. Inversely, when a halo sign lesion is observed, benign follicular neoplasm should be considered.

Un intento de reducir intervenciones quirúrgicas innecesarias... ¿Pueden ayudar las características ecográficas a diferenciar el adenoma del carcinoma en las neoplasias tiroideas foliculares? / An attempt to reduce unnecessary surgical procedures... Can ultrasound characteristics help in differentiating adenoma vs carcinoma in follicular thyroid neoplasms?

Introducción y objetivosLos nódulos tiroideos requieren con frecuencia evaluación mediante ecografía y biopsia por aspiración con aguja fina (BAAF). No obstante, la BAAF no permite la diferenciación entre adenoma y carcinoma folicular en lesiones de tipo IV según la clasificación de Bethesda. Esto provoca numerosas intervenciones quirúrgicas innecesarias porque no es posible garantizar el carácter benigno de las lesiones, ni siquiera cuando la mayoría de las muestras corresponden a adenomas o incluso a otras lesiones benignas. El objetivo de este estudio es establecer si hay características ecográficas que nos ayudarían a pronosticar el riesgo de malignidad de los nódulos con un diagnóstico anatomopatológico de neoplasia folicular para conseguir un abordaje más conservador de los nódulos sin sospecha de malignidad.Material y métodosEstudiamos 61 nódulos en 61 pacientes (51 mujeres y 10 varones) que se habían sometido a intervención quirúrgica de la glándula tiroides y tenían resultados histopatológicos de adenoma o carcinoma folicular. Se analizaron diversas características ecográficas de los nódulos (composición, ecogenicidad, borde, estado de calcificación, presencia de halo y sospecha general de malignidad según el observador) y se estableció su correlación con el análisis histopatológico.ResultadosObservamos una relación estadísticamente significativa entre el carcinoma folicular y la presencia de calcificaciones, bordes mal definidos y la sospecha o impresión general del observador (definida por sospecha clara de signos ecográficos de malignidad, como calcificación, borde mal definido y un nódulo sólido marcadamente hipoecoico; y signos ecográficos de benignidad, como composición ecogénica predominantemente quística y presencia de halo hipoecogénico perinodular). Sin embargo, todas estas características han mostrado una sensibilidad baja en el estudio que nos ocupa (30%, 30% y 50%, respectivamente)...(AU)

Introduction and objectivesThyroid nodules frequently require ultrasound and Fine Needle Aspiration Cytology (FNAC) evaluation. However, FNA cytology does not allow differentiation between follicular adenoma and carcinoma on Bethesda type IV lesions. This situation leads to many unnecessary surgical procedures because it is not possible to assure the benignity of the lesions, even when most of the specimens correspond to adenomas or even other benign lesions.The objective is this study is to establish if there are any US characteristics that would help us to predict the risk of malignancy of nodules with a pathological diagnosis of follicular neoplasm in order to achieve a more conservative management for non-suspicious nodules.Material and methodsWe studied 61 nodules in 61 patients (51 women and 10 men) that underwent thyroid surgery and had histopathological results of either follicular adenoma or carcinoma.Different US characteristics of the nodules were analysed (composition, echogenicity, margin, calcification status, the presence of halo and overall observer suspicion of malignancy) and were correlated with the histopathological analysis.ResultsWe have found a statistically significant association between the presence of calcifications, ill-defined borders and overall observer suspicion or impression (defined by well-known suspicious for malignancy ultrasonographic features, such as calcification, poorly defined margin, and a markedly hypoechoic solid nodule; and benign ultrasonographic features, such as predominantly cystic echogenic composition and the presence of a perinodular hypoechogenic halo) with follicular carcinoma. However all those features have shown low sensitivities in the present study (30%, 30% and 50%, respectively). On the other hand, the absence of halo sign has shown a sensitivity of 100% and a negative predictive value (NPV) of 100% in our study... (AU)

The Molecular Effects of BDNF Synthesis on Skeletal Muscle: A Mini-Review.

The brain-derived neurotrophic factor (BDNF) is a member of the nerve growth factor family which is generated mainly by the brain. Its main role involve synaptic modulation, neurogenesis, neuron survival, immune regulation, myocardial contraction, and angiogenesis in the brain. Together with the encephalon, some peripheral tissues synthesize BDNF like skeletal muscle. On this tissue, this neurotrophin participates on cellular mechanisms related to muscle function maintenance and plasticity as reported on recent scientific works. Moreover, during exercise stimuli the BDNF contributes directly to strengthening neuromuscular junctions, muscle regeneration, insulin-regulated glucose uptake and ß-oxidation processes in muscle tissue. Given its vital relevance on many physiological mechanisms, the current mini-review focuses on discussing up-to-date knowledge about BDNF production in skeletal muscle and how this neurotrophin impacts skeletal muscle biology.

Influence of root width and dentin wall thickness evaluated by endoscopy upon the outcome of periapical surgery. A cohort study.

BACKGROUND: An analysis was made of the correlation between root width, the thickness of the remaining dentinal wall as determined by endoscopy, and the outcome of periapical surgery. MATERIAL AND METHODS: A retrospective cohort study was carried out involving patients subjected to periapical surgery between 2017 and 2019 at the University of Valencia (Valencia, Spain). One year after surgery, cone-beam computed tomography (CBCT) was used to evaluate healing against the preoperative volumes. The maximum root width was measured on the postoperative CBCT scan at the apical section of the treated root. This measurement was transferred to the intraoperative endoscopic image, where the minimum root width, peripheral dentin thickness, and minimum dentin thickness were recorded. Root measurements, and the position (maxillary or mandibular) and type of tooth (roots of incisors, canines, premolars or molars) were further correlated to periapical surgery outcome. RESULTS: A total of 51 patients, comprising 52 teeth and 62 roots, were included in the study. The mean measurements were: maximum root width (4.13±0.84 mm), minimum root width (2.46±0.72 mm), peripheral dentin thickness (0.77±0.2 mm) and minimum dentin thickness (0.4±0.2 mm). The success rate was 82.2%. Premolar roots showed a greater minimum dentin thickness (0.58±0.25 mm) (p<0.003) than incisor roots. No significant association was found between the different measurements and the healing rate at one year, though the roots that failed to heal showed smaller minimum dentin thickness values than the roots that healed correctly. The position and type of tooth did not influence healing outcome. CONCLUSIONS: The root width and thickness of the remaining dentin wall did not significantly influence healing. However, the roots that failed to heal showed smaller minimum dentin thickness values than the roots that healed correctly.

Endoscopic findings in periapical surgery. A cross-sectional study of 206 roots.

BACKGROUND: A study is made of the findings of high-magnification rigid endoscopy at the root end surface following apicoectomy of teeth subjected to periapical surgery. MATERIAL AND METHODS: A cross-sectional study was made of patients subjected to periapical surgery at the Unit of Oral Surgery and Implantology (University of Valencia, Valencia, Spain) between 2011 and 2019. Following apicoectomy, the root end surfaces were inspected, with the evaluation of untreated canals, isthmuses, craze lines, crack lines, opaque dentin and gaps. Likewise, an analysis was made of the association between patient age and the tooth type and restoration and the presence of craze lines, cracks, opaque dentin and gaps. RESULTS: The final sample consisted of 168 patients subjected to periapical surgery, with 177 operated teeth and 206 roots. Untreated canals were observed in 14 roots (6.8%). Isthmuses were identified in 74 roots (35.9%), particularly in the mesial root of the lower first molar (94.1%). In turn, craze lines were identified in 8.3% of the roots, cracks in 3.9%, and gaps in 53.4%. The prevalence of opaque dentin was 78.3%, with a greater presence in posterior teeth (90.3% in premolars and 86.2% in molars) than in anterior teeth (50.6%) (p<0.001). Patient age and tooth restoration showed no correlation to the studied parameters. CONCLUSIONS: Craze lines and crack lines were observed in less than 10% of the roots, though opaque dentin was identified in 73% of the roots, particularly in posterior teeth, and gaps were found in over half of the canals.

Cambio de sesiones docentes presenciales a virtuales durante la pandemia de COVID-19 en un servicio de neurología: descripción del proceso y satisfacción de los usuarios / From in-person didactic sessions to videoconferencing during the COVID-19 pandemic: satisfaction survey among participants

Introducción y objetivo: La pandemia de COVID-19 ha trastornado la actividad hospitalaria, incluyendo la docente. Se describe el cambio de un sistema presencial a otro de sesiones en línea en un servicio de neurología, y se analizan la satisfacción y las opiniones de los usuarios. Material y métodos. Exposición de las medidas adoptadas para pasar a modalidad en línea y análisis de una encuesta entre los participantes. Resultados: Se pasó de tres a dos sesiones semanales, con restricción del público presencial. El público virtual superó al presencial. Contestaron la encuesta 49 participantes, un 51% mujeres, con una media de 40,5 años (rango: 25-65). La satisfacción de los asistentes fue mayor para las sesiones presenciales (8,68) que para las en línea (8,12) (p = 0,006). Existía una correlación inversa significativa entre la edad y la satisfacción con las sesiones en línea (r = –0,37; p = 0,01) que no se daba para las sesiones presenciales. El 75,5% fue partidario de mantener las sesiones virtuales cuando se eliminaran las restricciones de aforo. Una mayoría (87,8%) apoyó sesiones interhospitalarias y recomienda que las autoridades sanitarias faciliten aplicaciones informáticas seguras (53,1%). Conclusiones: La introducción de sesiones virtuales es una medida fácil de implementar en un servicio de neurología, con un alto grado de satisfacción de los usuarios, aunque menor que con las sesiones presenciales. Existen problemas no resueltos respecto al uso de plataformas comerciales y conexión interhospitalaria. Sería recomendable que las autoridades sanitarias y educativas desarrollaran aplicaciones seguras y fomentaran la educación médica en línea.(AU)

Introduction and aim: COVID-19 pandemic has disturbed many hospital activities, including medical education. We describe the switch from in-person didactic sessions to videoconferencing in a Neurology department. We analyse the opinions and satisfaction of participants. Material and methods: Narrative description of the adopted measures; Online survey among participants. Results: One of the three weekly sessions was cancelled, and two switched to videoconferencing. There were more participants online than in the conference hall. 49 users answered the survey, 51% women, mean age 40.5 years (range 25-65). Satisfaction was higher for previous face-to-face meetings (8.68) than for videoconferencing (8.12) (p=0.006). There was a significant inverse correlation between age and satisfaction with virtual sessions (r=-0.37; p=0.01), that was not found for in-person attendance. Most users (75.5%) would prefer to continue with online sessions when the pandemic is over, and 87.8% support inter-hospital remote meetings, but the safety of web platforms is a concern (53.1%). Conclusions: The change from in-person to virtual sessions is an easy measure to implement in a neurology department, with a good degree of satisfaction among users. There are some unsolved problems with the use of commercial web platforms and inter-hospital connection. Most users recommend leadership and support from educational and health authorities.(AU)

[From in-person didactic sessions to videoconferencing during the COVID-19 pandemic: satisfaction survey among participants]. / Cambio de sesiones docentes presenciales a virtuales durante la pandemia de COVID-19 en un servicio de neurología: descripción del proceso y satisfacción de los usuarios.

INTRODUCTION AND AIM: COVID-19 pandemic has disturbed many hospital activities, including medical education. We describe the switch from in-person didactic sessions to videoconferencing in a Neurology department. We analyse the opinions and satisfaction of participants. MATERIAL AND METHODS: Narrative description of the adopted measures; Online survey among participants. RESULTS: One of the three weekly sessions was cancelled, and two switched to videoconferencing. There were more participants online than in the conference hall. 49 users answered the survey, 51% women, mean age 40.5 years (range 25-65). Satisfaction was higher for previous face-to-face meetings (8.68) than for videoconferencing (8.12) (p=0.006). There was a significant inverse correlation between age and satisfaction with virtual sessions (r=-0.37; p=0.01), that was not found for in-person attendance. Most users (75.5%) would prefer to continue with online sessions when the pandemic is over, and 87.8% support inter-hospital remote meetings, but the safety of web platforms is a concern (53.1%). CONCLUSIONS: The change from in-person to virtual sessions is an easy measure to implement in a neurology department, with a good degree of satisfaction among users. There are some unsolved problems with the use of commercial web platforms and inter-hospital connection. Most users recommend leadership and support from educational and health authorities.

TITLE: Cambio de sesiones docentes presenciales a virtuales durante la pandemia de COVID-19 en un servicio de neurología: descripción del proceso y satisfacción de los usuarios.Introducción y objetivo. La pandemia de COVID-19 ha trastornado la actividad hospitalaria, incluyendo la docente. Se describe el cambio de un sistema presencial a otro de sesiones en línea en un servicio de neurología, y se analizan la satisfacción y las opiniones de los usuarios. Material y métodos. Exposición de las medidas adoptadas para pasar a modalidad en línea y análisis de una encuesta entre los participantes. Resultados. Se pasó de tres a dos sesiones semanales, con restricción del público presencial. El público virtual superó al presencial. Contestaron la encuesta 49 participantes, un 51% mujeres, con una media de 40,5 años (rango: 25-65). La satisfacción de los asistentes fue mayor para las sesiones presenciales (8,68) que para las en línea (8,12) (p = 0,006). Existía una correlación inversa significativa entre la edad y la satisfacción con las sesiones en línea (r = ­0,37; p = 0,01) que no se daba para las sesiones presenciales. El 75,5% fue partidario de mantener las sesiones virtuales cuando se eliminaran las restricciones de aforo. Una mayoría (87,8%) apoyó sesiones interhospitalarias y recomienda que las autoridades sanitarias faciliten aplicaciones informáticas seguras (53,1%). Conclusiones. La introducción de sesiones virtuales es una medida fácil de implementar en un servicio de neurología, con un alto grado de satisfacción de los usuarios, aunque menor que con las sesiones presenciales. Existen problemas no resueltos respecto al uso de plataformas comerciales y conexión interhospitalaria. Sería recomendable que las autoridades sanitarias y educativas desarrollaran aplicaciones seguras y fomentaran la educación médica en línea.

Serum and CSF alpha-synuclein levels do not change in COVID-19 patients with neurological symptoms.

SARS-CoV-2 infection can associate diverse neurological manifestations. Several studies have provided proof to support the theory of neurotropic involvement of SARS-CoV-2. Alpha-synuclein has been described as a native antiviral factor within neurons, and upregulation of this protein can be seen in animals that suffered other neuroinvasive infections. To assess if increased expression of this protein takes place in COVID-19 patients with neurological symptoms, we analyzed serum total alpha-synuclein levels in three groups: seven COVID-19 patients with myoclonus, Parkinsonism and/or encephalopathy; thirteen age- and sex-matched COVID-19 patients without neurological involvement and eight age- and sex-matched healthy controls. We did not find differences among them. In a subset of four patients, the change in serum alpha-synuclein before and after the onset of neurological symptoms was not significant either. Cerebrospinal fluid alpha-synuclein levels were also similar between neurological COVID-19 and healthy controls. Overall, these results cannot support the hypothesis of alpha-synuclein upregulation in humans with neurological symptoms in COVID-19. Further research taking into account a larger group of COVID-19 patients including the whole spectrum of neurological manifestations and disease severity is needed.

An attempt to reduce unnecessary surgical procedures... Can ultrasound characteristics help in differentiating adenoma vs carcinoma in follicular thyroid neoplasms? / Un intento de reducir intervenciones quirúrgicas innecesarias... ¿Pueden ayudar las características ecográficas a diferenciar el adenoma del carcinoma en las neoplasias tiroideas foliculares?

INTRODUCTION AND OBJECTIVES: Thyroid nodules frequently require ultrasound and Fine Needle Aspiration Cytology (FNAC) evaluation. However, FNA cytology does not allow differentiation between follicular adenoma and carcinoma on Bethesda type IV lesions. This situation leads to many unnecessary surgical procedures because it is not possible to assure the benignity of the lesions, even when most of the specimens correspond to adenomas or even other benign lesions. The objective in this study is to establish if there are any US characteristics that would help us to predict the risk of malignancy of nodules with a pathological diagnosis of follicular neoplasm in order to achieve a more conservative management for non-suspicious nodules. MATERIAL AND METHODS: We studied 61 nodules in 61 patients (51 women and 10 men) that underwent thyroid surgery and had histopathological results of either follicular adenoma or carcinoma. Different US characteristics of the nodules were analysed (composition, echogenicity, margin, calcification status, the presence of halo and overall observer suspicion of malignancy) and were correlated with the histopathological analysis. RESULTS: We have found a statistically significant association between the presence of calcifications, ill-defined borders and overall observer suspicion or impression (defined by well-known suspicious for malignancy ultrasonographic features, such as calcification, poorly defined margin, and a markedly hypoechoic solid nodule; and benign ultrasonographic features, such as predominantly cystic echogenic composition and the presence of a perinodular hypoechogenic halo) with follicular carcinoma. However all those features have shown low sensitivities in the present study (30%, 30% and 50%, respectively). On the other hand, the absence of halo sign has shown a sensitivity of 100% and a negative predictive value (NPV) of 100% in our study. CONCLUSIONS: The presence of calcifications, ill-defined borders and the overall impression or suspicion of malignancy are associated with a higher risk for follicular carcinoma in Bethesda type IV thyroid nodules but their absence does not allow to predict benignity in these nodules. Inversely, when a halo sign lesion is observed, benign follicular neoplasm should be considered.

The yield of community-based tuberculosis and HIV among key populations in hotspot settings of Ethiopia: A cross-sectional implementation study.

OBJECTIVE: To determine the yield of tuberculosis (TB) and the prevalence of Human Immuno-deficiency virus (HIV) among key populations in the selected hotspot towns of Ethiopia. METHODS: We undertook a cross-sectional implementation research during August 2017-January 2018. Trained TB focal persons and health extension workers (HEWs) identified female sex workers (FSWs), health care workers (HCWs), prison inmates, homeless, internally displaced people (IDPs), internal migratory workers (IMWs) and residents in missionary charities as key and vulnerable popuaiton. They carried out health education on the importance of TB screening and HIV testing prior to recruitment of the study participants. Symptomatic TB screening and HIV testing was done. The yield of TB was computed per 100,000 background key population. RESULTS: A total of 1878 vulnerable people were screened, out of which 726 (38.7%) presumptive TB cases and 87 (4.6%) TB cases were identified. The yield of TB was 1519 (95% CI: 1218.1-1869.9). The highest proportion (19.5%) and yield of TB case (6,286 (95% CI: 3980.8-9362.3)) was among HCWs. The prevalence of HIV infection was 6%, 67 out of 1,111 tested. IMWs and FSWs represented 49.3% (33) and 28.4% (13) of the HIV infections, respectively. There was a statistically significant association of active TB cases with previous history of TB (Adjusted Odds Ratio (AOR): 11 95% CI, 4.06-29.81), HIV infection (AOR: 7.7 95% CI, 2.24-26.40), and being a HCW (AOR: 2.42 95% CI, 1.09-5.34). CONCLUSIONS: The prevalence of TB in key populations was nine times higher than 164/100,000 national estimated prevalence rate. The prevalence of HIV was five times higher than 1.15% of the national survey. The highest yield of TB was among the HCWs and the high HIV burden was detected among the FSWs and IMWs. These suggest a community and health facility based integrated and enhanced case finding approaches for TB and HIV in hotspot settings.

Patient morbidity after impacted third molar extraction with different flap designs. A systematic review and meta-analysis.

BACKGROUND: To review the literature on the effect of different surgical flaps upon patient morbidity (pain perception, trismus, swelling and osteitis) after impacted third molar extraction. MATERIAL AND METHODS: An electronic and complementary search of main databases and grey literature was performed up to January 2019 to retrieve randomized clinical trials. The Cochrane risk of bias assessment tool was used for methodological appraisal. A random-effects meta-analysis was conducted of pain perception and trismus. RESULTS: From the initially 1314 screened studies, only 11 were included in the qualitative synthesis, and 5 in the meta-analysis. There were no statistically significant differences in pain between the envelope and triangular flap designs over time, except on the sixth postoperative day, when the envelope flap proved more painful. Regarding trismus, statistically significant differences were observed on the seventh postoperative day, with greater mouth opening in the envelope flap group than in the triangular flap group. There were no clear differences in swelling and osteitis among the flap designs. CONCLUSIONS: Despite its limitations, the present meta-analysis found no clear differences in patient morbidity between the different flap designs.

Virulence properties and antimicrobial resistance of Pseudomonas aeruginosa isolated from cave waters at Roraima Tepui, Guayana Highlands.

Pseudomonas aeruginosa is a prominent member of emerging waterborne pathogens. The environmental reservoirs of multi-resistant phenotypes and other virulence factors in this bacterium are poorly understood. Our study aimed to determine the virulence properties of P. aeruginosa isolated from Roraima Sur Cave (RSC) waters at Guayana Highlands. Based on the best identification at species level by biochemical tests, 16S rRNA sequencing and phylogenetic inferences, one RSC isolate named LG11 was characterized for virulence properties in comparison with P. aeruginosa reference strains. PCR amplification of alginate, elastase, exoenzyme S, exotoxin A, neuraminidase and Quorum-Sensing genes showed a high virulence potential in LG11. This isolate demonstrated multi-resistance to ceftriaxone, tigecycline and imipenem. Pyocyanin production was greater in LG11 (0·478 µg ml-1 ) than the strain ATCC 10145 (0·316 µg ml-1 ), but the highest pigment concentration (2·140 µg ml-1 ) was displayed by the clinical strain CVCM 937 (P = 0·000175). Pronounced biomass production on granite and glass (P < 0·05) and well-developed biofilms indicated the ability of P. aeruginosa from RSC to colonize surfaces found in human and healthcare environments. These data suggest that waters from pristine ecosystems such as RSC could be reservoirs of this opportunistic bacterium carrying important virulence properties with potential epidemiological implications. SIGNIFICANCE AND IMPACT OF THE STUDY: This study shows for the first time the occurrence of virulence genes and multi-resistance to antimicrobials in Pseudomonas aeruginosa isolated from cave waters at Guayana Highlands. These findings, together with the biofilm formation on surfaces found in human and healthcare settings, suggest public health risks and the potential of these virulence properties to be transferred from or to native populations in waters. Our results provide important insights to the current knowledge of P. aeruginosa in the environment, setting the basis for future studies driven to assess reservoirs of multi-resistant bacteria and virulence features unknown in pristine ecosystems.

Effects of ivermectin treatment during prepubertal and pubertal period on sexual parameters and sexual behavior in adulthood in rats.

Pediculosis is a parasitic disease that is considered a serious global public health problem. It is caused by the ectoparasite that is popularly known as lice, mainly affecting children in early childhood. The most commonly used treatment to combat this parasitosis is the macrocyclic lactone ivermectin (IVM). However, the use of IVM is contraindicated in children who are younger than 5 years old or who weigh <15 kg because some types of drugs that are used during certain periods of brain maturation can lead to behavioral disorders. The present study evaluated the effects of IVM treatment during the prepubertal and pubertal period on sexual behavior in adulthood in male rats. Genital grooming, preputial separation, sexual behavior, sexual motivation, relative organ weight, the gonadosomatic index, and histopathology were evaluated. Oral dose of 0.2 mg/kg (therapeutic dose) of a commercial IVM formulation was administered. IVM affected genital grooming but did not influence preputial separation in prepubertal rats. Prepubertal IVM administration did not impair sexual behavior in adult rats, with the exception of the time of residence with female rats in the sexual motivation test. It did not affect relative organ weights, with the exception of the relative weight of the full seminal vesicle. It did not alter the gonadosomatic index, and no histopathological alterations were observed in different organs. These results indicate that administration of a therapeutic dose of IVM during the prepubertal and pubertal period does not alter parameters of sexual development or sexual behavior in adult male rats.

Prevalence of tuberculosis among mentally ill patients in conflict-stricken Afghanistan: A cross-sectional study.

OBJECTIVES: Tuberculosis (TB) and mental illness share underlying factors such as poverty, malnutrition, and stress. This study's objective was to determine the prevalence of TB among mentally ill patients in Afghanistan. METHODS: A cross-sectional study was conducted in five public and one private health facility. All patients in those centers were screened for TB, and the diagnosis of TB was made with GeneXpert or made clinically by a physician. RESULTS: Out of 8598 patients registered, 8324 (96.8%) were reached and 8073 (93.9%) were screened for TB, of whom 1703 (21.1%) were found to be presumptive TB patients. A total of 275 (16.7%) were diagnosed with all forms of TB, of whom 90.5% were women. Eighty-eight (32%) of them were bacteriologically confirmed and 187 (68%) were clinically diagnosed. The number needed to screen (NNS) was 29.3 and the number needed to test (NNT) was 6.1. The overall prevalence of TB among mentally ill patients was 3,567/100,000-20 times higher than the national incidence rate. TB was independently associated with married and widowed adults, young adults, females, and oral sleep drug users. CONCLUSIONS: TB among mentally ill patients is very high, and we recommend that TB care and prevention services be integrated into mental health centers.

Pathological Findings in Lowland Tapirs (Tapirus terrestris) Killed by Motor Vehicle Collision in the Brazilian Cerrado.

The lowland tapir (Tapirus terrestris) is the largest land mammal in South America. The species faces steady population decline due to poaching, habitat loss and fragmentation, road-kill, pesticide pollution, competition with domestic livestock and fires, among other threats. The lowland tapir is currently listed as vulnerable to extinction. Little information is available about natural disease processes for the species. This study aimed to report the pathological findings recorded in a cohort of 35 lowland tapirs killed by motor vehicle collision (MVC) on highways of Mato Grosso do Sul State, Brazil, between 2015 and 2018. The main gross pathological findings were those associated with MVC, primarily involving skeletal fractures and internal multiorgan damage with extensive bleeding and/or severe central nervous system injury. The most prevalent concurrent histopathological findings, unrelated to the cause of death, were: adrenal gland degeneration, necrosis and loss of fascicular and reticular cells with replacement fibrosis and cortical atrophy (9/15; 60%); interstitial pneumonia (20/34; 59%); glossitis (9/24; 38%); pulmonary anthracosis (12/34; 35%); colitis (9/28; 32%); and cholangitis/pericholangitis (9/35; 26%). The aetiopathogeneses and clinicopathological significance of some of these findings are unclear; however, parasitic infections appear to be common. Our results highlight the importance of wildlife health information obtained through the study of carcasses of roadkills.

[«Salt and pepper¼ sign in the onset of a non-vascular pontine pathology]. / Signo de «sal y pimienta¼ como presentacion de una lesion pontina no vascular.

TITLE: Signo de «sal y pimienta¼ como presentacion de una lesion pontina no vascular.