Gammapatía monoclonal de significado incierto / Monoclonal gammopathy of uncertain significance

La gammapatía monoclonal de significado incierto es una neoplasia de células plasmáticas premaligna, con una elevada prevalencia en la población mayor de 50 años, y un riesgo anual de progresión del 1%. Numerosos estudios recientes han permitido un avance en la compresión de la patogenia de estos trastornos y su riesgo de progresión a otras enfermedades. Los pacientes requieren un seguimiento de por vida, siendo fundamental un enfoque multidisciplinar y adaptado al riesgo. En los últimos años, cada vez se reconocen más entidades asociadas a la presencia de una paraproteína, conocidas como gammapatías monoclonales de significado clínico (AU)

Monoclonal gammopathy of uncertain significance is a premalignant plasma cell neoplasm with a high prevalence in the population over 50 years of age and an annual risk of progression of 1%. Multiple recent studies have led to advances in understanding both the pathogenesis of these disorders and their risk of progression to other diseases. Patients require lifelong follow-up, and a multidisciplinary and risk-adapted approach is essential. In recent years, an increasing number of entities associated with a paraprotein, known as clinically significant monoclonal gammopathies, have been recognized (AU)

Cribado de la retinopatía diabética mediante teleoftalmología en una zona básica de salud rural / Teleophthalmology-based diabetic retinopathy screening in a rural health basic area

Objetivo: Conocer la prevalencia de retinopatía diabética en una zona básica de salud rural, clasificándola según tipo y grado de severidad y conocer su relación con la presencia de otros factores de riesgo cardiovascular y con el sexo. Diseño: Estudio descriptivo transversal o de prevalencia. Emplazamiento: Zona básica de salud rural en España. Nivel de atención primaria. Participantes: Quinientos pacientes diabéticos mayores de 18 años. Mediciones principales: Estudio de la retina mediante retinografía bajo midriasis, según protocolo de la Joslin Vision Network, incorporando un centro de lectura para diagnóstico. Correlación de la existencia y gravedad de la retinopatía con los factores de riesgo cardiovascular –tabaquismo, hipertensión e hiperlipemia– y las características de la diabetes –tipo, tiempo de evolución, tratamiento, control metabólico y función renal–Resultados: Prevalencia encontrada del 16,4%, sin diferencias significativas entre sexos. Las variables tabaquismo e hipertensión estaban relacionadas con la existencia de retinopatía y la variable años de evolución de la diabetes con su existencia y su gravedad. El 9,6% de las personas afectadas fueron derivadas a oftalmología con carácter preferente, por retinopatía amenazante para la visión y el 6,8% de las personas estudiadas fueron derivadas por otras patologías oftalmológicas. Conclusiones: Es posible el seguimiento oftalmológico del 82% de la población diabética en atención primaria, implicando a sus profesionales y trabajando en equipo con el servicio de oftalmología. Es fundamental considerar esta enfermedad en el contexto global de la persona con diabetes, relacionándola con las otras complicaciones microvasculares y la enfermedad cardiovascular.(AU)

Objective: To investigate the prevalence of diabetic retinopathy in a rural health basic area, and to establish the type, the severity degree and the relationship with sex and with another cardiovascular risk factors. Design: Cross-sectional or prevalence descriptive study. Location: Rural health basic area in Spain. Primary health care level. Participants: 500 patients over 18 years old with diabetes. Main measurements: Study of the retina through retinography under mydriasis, according to the Joslin Vision Network protocol, with the incorporation of a diagnostic reading center. Correlation of the existence and severity of the retinopathy with the cardiovascular risk factors –smoking, hypertension and hyperlipidemia– and the characteristics of the diabetes –type, evolution time, treatment, metabolic control and renal function–.Results: The findings showed a 16.4% prevalence, with no significant differences between both sexes. The variables smoking and high blood pressure were related to the existence of retinopathy, and the variable years of diabetes evolution was correlated to both the existence and the severity of the retinopathy. In the study, 9.6% of the affected people were preferentially referred to the ophthalmologists because of sight-threatening retinopathy, and 6.8% of the people studied were referred due to other ophthalmological pathologies. Conclusions: It is possible to do the ophthalmological follow-up of 82% of the population with diabetes in primary health care, involving its professionals and team-working with the ophthalmologists. It is paramount to consider diabetic retinopathy within the global context of the person with diabetes, relating diabetic retinopathy with the other microvascular complications and cardiovascular diseases.(AU)

Anti-Epstein-Barr Virus BNLF2b for Mass Screening for Nasopharyngeal Cancer.

BACKGROUND: Population screening of asymptomatic persons with Epstein-Barr virus (EBV) DNA or antibodies has improved the diagnosis of nasopharyngeal carcinoma and survival among affected persons. However, the positive predictive value of current screening strategies is unsatisfactory even in areas where nasopharyngeal carcinoma is endemic. METHODS: We designed a peptide library representing highly ranked B-cell epitopes of EBV coding sequences to identify novel serologic biomarkers for nasopharyngeal carcinoma. After a retrospective case-control study, the performance of the novel biomarker anti-BNLF2b total antibody (P85-Ab) was validated through a large-scale prospective screening program and compared with that of the standard two-antibody-based screening method (EBV nuclear antigen 1 [EBNA1]-IgA and EBV-specific viral capsid antigen [VCA]-IgA). RESULTS: P85-Ab was the most promising biomarker for nasopharyngeal carcinoma screening, with high sensitivity (94.4%; 95% confidence interval [CI], 86.4 to 97.8) and specificity (99.6%; 95% CI, 97.8 to 99.9) in the retrospective case-control study. Among the 24,852 eligible participants in the prospective cohort, 47 cases of nasopharyngeal carcinoma (38 at an early stage) were identified. P85-Ab showed higher sensitivity than the two-antibody method (97.9% vs. 72.3%; ratio, 1.4 [95% CI, 1.1 to 1.6]), higher specificity (98.3% vs. 97.0%; ratio, 1.01 [95% CI, 1.01 to 1.02]), and a higher positive predictive value (10.0% vs. 4.3%; ratio, 2.3 [95% CI, 1.8 to 2.8]). The combination of P85-Ab and the two-antibody method markedly increased the positive predictive value to 44.6% (95% CI, 33.8 to 55.9), with sensitivity of 70.2% (95% CI, 56.0 to 81.4). CONCLUSIONS: Our results suggest that P85-Ab is a promising novel biomarker for nasopharyngeal carcinoma screening, with higher sensitivity, specificity, and positive predictive value than the standard two-antibody method. (Funded by the National Key Research and Development Program of China and others; ClinicalTrials.gov number, NCT04085900.).

The cardiac preparticipation sports evaluation.

PURPOSE OF REVIEW: Sudden cardiac death (SCD) is the leading cause of death in young athletes during sports participation. Preparticipation cardiovascular screening aims to identify those at an increased risk of SCD. This review aims to provide a background of SCD in young athletes, to discuss the various screening recommendations of major medical societies, and to review recent evidence and current practice. RECENT FINDINGS: Numerous studies have evaluated various preparticipation screening practices, particularly regarding the inclusion of ECG as part of an initial evaluation to identify conditions with an increased risk of SCD. Some analyses have shown ECG inclusion to provide increased screening sensitivity and specificity, though others have shown no benefit when compared with evaluation with history and physical examination alone. Furthermore, in countries for which more extensive screening protocols have been employed, postimplementation statistics have not shown a significant decrease in SCD. SUMMARY: SCD in young athletes primarily results from underlying cardiac disease. Various preparticipation screening recommendations exist globally, with the common goal of decreasing the rates of SCD by identifying youth at risk during sports participation. Current guidelines in the United States support universal preparticipation evaluation using history and physical examination, with cardiology referral if abnormalities are identified.

Evaluation of Hepatitis C Screening and Treatment Among Psychiatry Inpatients.

Objective: To evaluate uptake of hepatitis C virus (HCV) testing and treatment among psychiatry inpatients at Canada's largest mental health institution, the Centre for Addiction and Mental Health (CAMH).Methods: We reviewed medical records for all forensic and long-stay mental health patients from January 2017 to May 2021 to examine rates of HCV testing (antibody and RNA), treatment, and follow-up and completed a logistical regression to identify predictors associated with HCV antibody (Ab) screening among inpatients.Results: Of 1,031 patients, 73% (n = 753) were male, mean age was 44 years (range: 20-92), and mean length of stay was 7.1 months (range: 0 days-24 years). Most, 83% (n = 856), were diagnosed with schizophrenia spectrum disorders. In total, 652/1,031 (63%) of individuals in this cohort received HCV Ab screening. When broken down by admission rather than individual, 570/1,303 (44%) forensic admissions had an associated HCV Ab screening, and 318/1,450 (22%) non-forensic admissions had an associated HCV Ab screening. Individuals admitted to a forensic unit and those diagnosed with schizophrenia or substance use disorders were more likely to undergo HCV Ab screening, while individuals of Asian ethnicity were less likely (all P < .05). HCV Ab positivity was 4.9%, and most (84%, n = 27) HCV Ab-positive individuals had subsequent RNA testing, of whom 56% (n = 15) tested HCV RNA positive. Of 15 RNA-positive individuals, 10 initiated treatments, 7 on-site at CAMH and 3 at a local hepatology center. A total of 7 individuals (1 treated by specialists and 6 on-site) achieved sustained virological response or cure. The remaining 3 were lost to follow-up, 2 of whom were treated at the hepatology clinic.Conclusions: Based on the high prevalence of HCV, mental health inpatients should be included in groups for whom universal screening is recommended. Since on-site treatment was more successful than referral to external hepatology specialists, utilizing inpatient admission as an opportunity for HCV screening and treatment should receive more consideration.

Tuberculosis screening practices and outcomes in an australian dialysis unit.

BACKGROUND: The World Health Organisation (WHO) recommends all dialysis patients undertake routine screening for latent tuberculosis infection (LTBI) in high income countries such as Australia. However, we employ a targeted screening approach in our Australian dialysis unit in line with local and some international guidelines. We analysed our practices to assess the validity of our approach. METHODS: A retrospective review of new dialysis patients during the period 2012-2018 was undertaken. Patient records were reviewed for basic demographic data, comorbidities, LTBI screening using Quantiferon Gold (QFG), and outcomes, including episodes of active TB, to June 2020. RESULTS: 472 patients were included. WHO high risk country of origin patients accounted for 22% (n = 103). 229 patients (48.5%) were screened using QFG. The single main indication for screening was transplantation waitlisting. 34 patients had a positive QFG result. Active tuberculosis developed in two patients during the observation period. Both occurred in the screened cohort, the cases having previously tested negative via QFG at 11 and 16 months, prior to the development of active tuberculosis. No patients in the unscreened cohort developed active tuberculosis during the observation period. WHO high risk country of origin was associated with positive QFG status, odds ratio 10.4 (95% CI 3.3-31.2). CONCLUSION: The data failed to show a benefit from widening of the screening program within our dialysis unit. However, a much larger sample size will be required to confidently assess the impact of the current approach on patient outcomes. Analysis of current screening practices and outcomes across all Australian dialysis services is warranted to assess the risks and benefits of widening the screening practices to include all dialysis patients as recommended by the WHO.

[Interpretation of the important update of the Guideline for the prevention and treatment of hepatitis C (2022 edition)].

In the past 20 years, Chinese Medical Association had issued several versions of hepatitis C prevention and treatment guidelines. In the latest guidelines published in 2022, the Chinese Society of Hepatology and the Society of Infectious Diseases for the Chinese Medical Association organized experts to update their recommendations for hepatitis C screening and treatment. The updated key points on prevention, diagnosis, and treatment proposed in the guidelines are now interpreted, aiming to provide reference for more effective clinical application of the guidelines.

Efficacy of deep learning-based artificial intelligence models in screening and referring patients with diabetic retinopathy and glaucoma.

Purpose: To analyze the efficacy of a deep learning (DL)-based artificial intelligence (AI)-based algorithm in detecting the presence of diabetic retinopathy (DR) and glaucoma suspect as compared to the diagnosis by specialists secondarily to explore whether the use of this algorithm can reduce the cross-referral in three clinical settings: a diabetologist clinic, retina clinic, and glaucoma clinic. Methods: This is a prospective observational study. Patients between 35 and 65 years of age were recruited from glaucoma and retina clinics at a tertiary eye care hospital and a physician's clinic. Non-mydriatic fundus photography was performed according to the disease-specific protocols. These images were graded by the AI system and specialist graders and comparatively analyzed. Results: Out of 1085 patients, 362 were seen at glaucoma clinics, 341 were seen at retina clinics, and 382 were seen at physician clinics. The kappa agreement between AI and the glaucoma grader was 85% [95% confidence interval (CI): 77.55-92.45%], and retina grading had 91.90% (95% CI: 87.78-96.02%). The retina grader from the glaucoma clinic had 85% agreement, and the glaucoma grader from the retina clinic had 73% agreement. The sensitivity and specificity of AI glaucoma grading were 79.37% (95% CI: 67.30-88.53%) and 99.45 (95% CI: 98.03-99.93), respectively; DR grading had 83.33% (95 CI: 51.59-97.91) and 98.86 (95% CI: 97.35-99.63). The cross-referral accuracy of DR and glaucoma was 89.57% and 95.43%, respectively. Conclusion: DL-based AI systems showed high sensitivity and specificity in both patients with DR and glaucoma; also, there was a good agreement between the specialist graders and the AI system.

COVID-19 related change in breast cancer diagnosis, stage, treatment, and case volume: 2019-2021.

PURPOSE: Evaluate the COVID-19 pandemic impact on breast cancer detection method, stage and treatment before, during and after health care restrictions. METHODS: In a retrospective tertiary cancer care center cohort, first primary breast cancer (BC) patients, years 2019-2021, were reviewed (n = 1787). Chi-square statistical comparisons of detection method (patient (PtD)/mammography (MamD), Stage (0-IV) and treatment by pre-pandemic time 1: 2019 + Q1 2020; peak-pandemic time 2: Q2-Q4 2020; pandemic time 3: Q1-Q4 2021 (Q = quarter) periods and logistic regression for odds ratios were used. RESULTS: BC case volume decreased 22% in 2020 (N = 533) (p = .001). MamD declined from 64% pre-pandemic to 58% peak-pandemic, and increased to 71% in 2021 (p < .001). PtD increased from 30 to 36% peak-pandemic and declined to 25% in 2021 (p < .001). Diagnosis of Stage 0/I BC declined peak-pandemic when screening mammography was curtailed due to lock-down mandates but rebounded above pre-pandemic levels in 2021. In adjusted regression, peak-pandemic stage 0/I BC diagnosis decreased 24% (OR = 0.76, 95% CI: 0.60, 0.96, p = .021) and increased 34% in 2021 (OR = 1.34, 95% CI: 1.06, 1.70, p = .014). Peak-pandemic neoadjuvant therapy increased from 33 to 38% (p < .001), primarily for surgical delay cases. CONCLUSIONS: The COVID-19 pandemic restricted health-care access, reduced mammography screening and created surgical delays. During the peak-pandemic time, due to restricted or no access to mammography screening, we observed a decrease in stage 0/I BC by number and proportion. Continued low case numbers represent a need to re-establish screening behavior and staffing.

Enhancing nutrition screening in patients with kidney disease.

Malnutrition is common in patients with kidney disease, and can exacerbate the individual and economic burden of the condition. The identification of malnutrition is essential to inform management interventions and improve patient outcomes, and nutrition screening can be considered the first stage in this process. The development of simple nutrition screening tools has assisted nurses in undertaking widespread, rapid assessments of patients' malnutrition risk. However, generic tools may not be appropriate or accurate in patients with kidney disease. This article explains some of the challenges of identifying malnutrition in this patient group and outlines some disease-specific tools that nurses can use to enhance nutrition screening.

Cervical cancer screening services targeting adult women in Cross River State, Nigeria.

This study employed a randomized controlled trial to investigate the rate of cervical cancer screening among adult women in Cross River State, Nigeria. For the collection of data, a semi-structured questionnaire was used. The women underwent a health education intervention; they were divided into an experimental group with incentives and one without, as well as a control group. At baseline, only 120 (19.6%) of women had adequate knowledge, 139(22.7%) knew Human Papiloma Virus (HPV) is sexually transmitted, 289(47.1%) knew that HPV causes cervical cancer and 46 (7.6%) had been screened. The intervention yielded a net gain of 14.2 in knowledge and 16.0 points in attitude. There was a 60.3% net gain in uptake screening post intervention. McNemar chi-square yielded a statistically significant difference in knowledge (p<0.05), attitude (p<0.05) and uptake (p<0.05) in the intervention groups compared to the control groups. Recommendations include mobile screening centers and Income-based subsidized tests.

Cervical cancer screening in former sex workers in ex-localization area.

Despite the lack of commercial sex activities as the localization has been shut down since 2014, former commercial sex workers (CSW) could be at risk for cervical cancer. Therefore, this study aimed to determine the prevalence of cervical cancer using early detection with Papanicolaou (Pap) smears in former CSW in this ex-localization area. This study was conducted with purposive sampling intended to be limited to former CSW and women who still live around this ex-localization area as a control group. This study included 76 women, 52.6% of whom were former CSW. Pap smear results showed no pre-cancerous lesions of the cervix in any of the participants. Comparisons between the CSW and control groups showed no differences in Pap smear results. Infection findings were found in 36.1% of CSW group. Early detection of human papillomavirus (HPV) DNA is necessary for identifying risk factors for cervical cancer in these populations.

Colorectal Cancer Screening Pilot Project in Tehran-Iran, a Feasibility Study.

BACKGROUND: Colorectal cancer (CRC) is the third most common cancer in Iran, where there is no organised CRC-screening programme. This study aimed to evaluate feasibility of CRC screening using a qualitative fecal immunochemical test (FIT) among Iranian average-risk adults. METHODS: In this feasibility study, 7039 individuals aged 50-75 years were invited by community health workers (CHWs) in southern Tehran and its suburban districts between April 2018 and November 2019. The CHWs performed a qualitative FIT with cut-off level 50 ng Hb/mL buffer and referred those with positive-FIT for colonoscopy to the endoscopy center of Shariati hospital in Tehran. Outcomes included acceptance rate, FIT positivity rate, colonoscopy compliance, detection rates and positive predictive values (PPVs) with 95% confidence interval for CRC and advanced adenomas (AAs). RESULTS: Acceptance rate at initial invitation was 71.7%. From 4974 average-risk adults (1600 males and 3374 females) who were offered FIT, 96.8% (n=4813) provided valid samples, of whom 471 (9.8%) tested positive. Among FIT-positive participants, 150 (31.8%) underwent colonoscopy; CRC was detected in 2.0% (n=3) and adenomas in 27.3% (n=41). Detection rate of CRC and AAs per 1000-FIT-screened participants was 0.6 (0.1-1.8) [males: 0.7 (0.01-3.6), females: 0.6 (0.07-2.0)] and 4.2 (2.5-6.4) [males: 5.9 (2.6-11.0), females: 3.4 (1.7-6.0)], respectively. PPVs were 2.0% (0.4-5.7) for CRC and 13.3% (8.3-19.8) for AAs. There was no association between gender and the studied outcomes. CONCLUSION: Our results partially support the feasibility of scaling up organized CRC-screening through the existing healthcare system in Iran; it remains to be discussed carefully to ensure the capacity of healthcare system for adequate colonoscopy services.

The aggregate value of cancer screenings in the United States: full potential value and value considering adherence.

BACKGROUND: Although cancer mortality has been decreasing since 1991, many cancers are still not detected until later stages with poorer outcomes. Screening for early-stage cancer can save lives because treatments are generally more effective at earlier than later stages of disease. Evidence of the aggregate benefits of guideline-recommended single-site cancer screenings has been limited. This article assesses the benefits in terms of life-years gained and associated value from major cancer screening technologies in the United States. METHODS: A mathematical model was built to estimate the aggregate benefits of screenings for breast, colorectal, cervical, and lung cancer over time since the start of US Preventive Services Task Force (USPSTF) recommendations. For each type, the full potential benefits under perfect adherence and the benefits considering reported adherence rates were estimated. The effectiveness of each screening technology was abstracted from published literature on the life-years gained per screened individual. The number of individuals eligible for screening per year was estimated using US Census data matched to the USPSTF recommendations, which changed over time. Adherence rates to screening protocols were based on the National Health Interview Survey results with extrapolation. RESULTS: Since initial USPSTF recommendations, up to 417 million people were eligible for cancer screening. Assuming perfect adherence to screening recommendations, the life-years gained from screenings are estimated to be 15.5-21.3 million (2.2-4.9, 1.4-3.6, 11.4-12.3, and 0.5 million for breast, colorectal, cervical, and lung cancer, respectively). At reported adherence rates, combined screening has saved 12.2-16.2 million life-years since the introduction of USPSTF recommendations, ~ 75% of potential with perfect adherence. These benefits translate into a value of $8.2-$11.3 trillion at full potential and $6.5-$8.6 trillion considering current adherence. Therefore, single-site screening could have saved an additional 3.2-5.1 million life-years, equating to $1.7-$2.7 trillion, with perfect adherence. CONCLUSIONS: Although gaps persist between the full potential benefit and benefits considering adherence, existing cancer screening technologies have offered significant value to the US population. Technologies and policy interventions that can improve adherence and/or expand the number of cancer types tested will provide significantly more value and save significantly more patient lives.