Reporting of confidence intervals, achievement of intended sample size, and adjustment for multiple primary outcomes in randomised trials of physical therapy interventions: an analysis of 100 representatively sampled trials.

BACKGROUND: The physical therapy profession has made efforts to increase the use of confidence intervals due to the valuable information they provide for clinical decision-making. Confidence intervals indicate the precision of the results and describe the strength and direction of a treatment effect measure. OBJECTIVES: To determine the prevalence of reporting of confidence intervals, achievement of intended sample size, and adjustment for multiple primary outcomes in randomised trials of physical therapy interventions. METHODS: We randomly selected 100 trials published in 2021 and indexed on the Physiotherapy Evidence Database. Two independent reviewers extracted the number of participants, any sample size calculation, and any adjustments for multiple primary outcomes. We extracted whether at least one between-group comparison was reported with a 95 % confidence interval and whether any confidence intervals were interpreted. RESULTS: The prevalence of use of confidence intervals was 47 % (95 % CI 38, 57). Only 6 % of trials (95 % CI: 3, 12) both reported and interpreted a confidence interval. Among the 100 trials, 59 (95 % CI: 49, 68) calculated and achieved the required sample size. Among the 100 trials, 19 % (95 % CI: 13, 28) had a problem with unadjusted multiplicity on the primary outcomes. CONCLUSIONS: Around half of trials of physical therapy interventions published in 2021 reported confidence intervals around between-group differences. This represents an increase of 5 % from five years earlier. Very few trials interpreted the confidence intervals. Most trials reported a sample size calculation, and among these most achieved that sample size. There is still a need to increase the use of adjustment for multiple comparisons.

Is the Bland-Altman plot method useful without inferences for accuracy, precision, and agreement?

ABSTRACT OBJECTIVE This study aims to propose a comprehensive alternative to the Bland-Altman plot method, addressing its limitations and providing a statistical framework for evaluating the equivalences of measurement techniques. This involves introducing an innovative three-step approach for assessing accuracy, precision, and agreement between techniques, which enhances objectivity in equivalence assessment. Additionally, the development of an R package that is easy to use enables researchers to efficiently analyze and interpret technique equivalences. METHODS Inferential statistics support for equivalence between measurement techniques was proposed in three nested tests. These were based on structural regressions with the goal to assess the equivalence of structural means (accuracy), the equivalence of structural variances (precision), and concordance with the structural bisector line (agreement in measurements obtained from the same subject), using analytical methods and robust approach by bootstrapping. To promote better understanding, graphical outputs following Bland and Altman's principles were also implemented. RESULTS The performance of this method was shown and confronted by five data sets from previously published articles that used Bland and Altman's method. One case demonstrated strict equivalence, three cases showed partial equivalence, and one showed poor equivalence. The developed R package containing open codes and data are available for free and with installation instructions at Harvard Dataverse at https://doi.org/10.7910/DVN/AGJPZH. CONCLUSION Although easy to communicate, the widely cited and applied Bland and Altman plot method is often misinterpreted, since it lacks suitable inferential statistical support. Common alternatives, such as Pearson's correlation or ordinal least-square linear regression, also fail to locate the weakness of each measurement technique. It may be possible to test whether two techniques have full equivalence by preserving graphical communication, in accordance with Bland and Altman's principles, but also adding robust and suitable inferential statistics. Decomposing equivalence into three features (accuracy, precision, and agreement) helps to locate the sources of the problem when fixing a new technique.

Evaluation of the Implant Success Rate of Titanium-based Implant Materials: A Systematic Review and Meta-Analysis

ABSTRACT Objective: To investigate the success of implants, the increase of bone integration, and the effect of nanostructure/nanoparticles as Titanium-based implant materials on the success of implants. The present study evaluated the implant success rate of Titanium-based implant materials. Material and Methods: PICO: Population (dental implant), intervention (coated titanium implant surface), comparison (uncoated titanium implant surface), and outcome (bone-implant contact) were considered as a search strategy tool and study inclusion criteria. Searches for systematic literature were conducted on databases from Scopus, Science Direct, PubMed, ISI, Web of Knowledge, and Embase until 12 December 2022. Modified CONSORT Criteria (Reporting guidelines for preclinical in vitro studies on dental materials) were used to evaluate the quality of studies. The fixed effect model and inverse-variance method were used to calculate the 95% confidence interval for mean differences. Stata/MP V. 17 software was used to conduct the meta-analysis. Results: After reviewing the abstracts of 97 articles, studies not related to the inclusion criteria were excluded, and ten studies were selected from the remaining 39 studies after reviewing the full text. The mean difference in boneimplant contact between coated and uncoated dental implants was 0.25 (MD, 0.25 95% CI 0.01, 0.49;p=0.04). Conclusion: The titanium implant surface with nano coating can increase bone-implant contact and cause bone integration.

Coeficientes V de Aiken: diferencias en los juicios de validez de contenido / Aiken's V Coefficient: Differences in Content Validity Judgments / Coeficientes Aiken V: Diferenças nos julgamentos de validade do conteúdo

Resumen: Objetivo: Cuando es estudiada la validez de contenido en dos grupos independientes de jueces expertos, se requiere hacer una prueba formal de las diferencias entre sus juicios, dado que es posible obtener distintos juicios de validez de contenido. Pero, generalmente, la investigación de la validez de contenido no examina esta posible fuente de discrepancias. El presente reporte describe la implementación de un método para evaluar la diferencia de coeficientes V de Aiken aplicado al trabajo investigativo en ciencias del deporte. Metodología: El procedimiento aplica una adaptación para construir el intervalo de confianza de la diferencia entre coeficientes V de Aiken y también implementa un estimador estandarizado del tamaño de la distinción entre los coeficientes V, específicamente, la transformación arcoseno de coeficientes V. Resultados: Se desarrollan dos ejemplos, en un marco de análisis secundario de datos, y se demuestra la diferencia entre la conclusión con base impresionista y la conclusión con base empírica y evaluación formal. Se detectaron distinciones estadísticas no observadas previamente. Conclusiones e implicaciones: El método que estima diferencias de coeficientes de validez de contenido V de Aiken para la investigación permite un avance en la metodología que valida instrumentos de medición. Se valora la aplicabilidad de este procedimiento en el contexto de ciencias del deporte y ciencias de la educación, así como en el diseño de la investigación.

Abstract: Objective: When two independent groups of expert judges study content validity, a formal test of the differences between their judgments is required, since different content validity judgments can be obtained. But generally, content validity research does not examine this likely source of discrepancies. This report describes the implementation of a method to evaluate the difference in Aiken's V coefficients applied to research work in sports science. Methodology: The procedure applies an adaptation to construct the confidence interval of the difference between Aiken's V coefficients and also implements a standardized estimator of the size of the difference between the V coefficients, specifically the arcsine transformation of V coefficients. Results: In a secondary data analysis framework, two examples are developed, extracting data from both publications, and the difference between the impressionist-based conclusion and the empirical-based conclusion and formal evaluation is demonstrated. Statistical differences not previously observed were detected. Conclusions and implications: The method to estimate differences in Aiken's content validity coefficients for research allows an advance in the methodology to validate measurement instruments. The applicability of this procedure in the context of sports sciences and education sciences, as well as in the research design involved, is assessed.

Resumo: Objetivo: Quando a validade do conteúdo é estudada em dois grupos independentes de juízes especialistas, é necessário um teste formal das diferenças entre seus julgamentos, uma vez que é possível obter diferentes julgamentos de validade de conteúdo. Mas a pesquisa de validade do conteúdo geralmente não examina esta possível fonte de discrepâncias. Este relatório descreve a implementação de um método para avaliar a diferença dos coeficientes V de Aiken aplicada ao trabalho de investigação das ciências do desporto. Metodologia: O procedimento aplica uma adaptação para construir o intervalo de confiança da diferença entre os coeficientes V de Aiken, e também implementa um estimador estandardizado do tamanho da diferença entre os coeficientes V, especificamente a transformação arco-seno dos coeficientes V. Resultados: Dois exemplos são desenvolvidos em uma estrutura secundária de análise de dados, e a diferença entre a conclusão baseada no impressionismo e a conclusão baseada no empirismo com avaliação formal é demonstrada. Diferenças estatísticas não observadas anteriormente foram detectadas. Conclusões e implicações: O método para estimar as diferenças nos coeficientes de validade do conteúdo V de Aiken para a pesquisa permite um avanço na metodologia de validação dos instrumentos de medição. A aplicabilidade deste procedimento no contexto da ciência do esporte e da ciência educacional, assim como no projeto de pesquisa, é avaliada.

Perú: Indicadores de resultados de los programas presupuestales, 2022. Encuesta demográfica y de salud familiar / Peru: Results indicators of budgetary programs, 2022. Demographic and health survey

La presente publicación describe las pautas del monitoreo y evaluación de la gestión presupuestaria a nivel de sectores. La recolección de datos de la ENDES, realizada durante enero a diciembre de 2022, permite presentar las estimaciones de los Indicadores de Resultados para los Programas Presupuestales: Articulado Nutricional, orientado a resultados de desarrollo infantil temprano, salud Materno Neonatal, iv) Acceso de la Población a la Identidad y orientado a resultados de reducción de la violencia contra la mujer. Cada uno de los indicadores se muestran con sus respectivos intervalos de confianza y nivel de precisión. Asimismo, incluye un Resumen ejecutivo y Anexo Metodológico que contiene la Ficha técnica de la ENDES 2022 y las definiciones de términos e indicadores. La Muestra de esta investigación tiene como nivel de inferencia el ámbito nacional, área de residencia, dominios geográficos y región

Economic Impact of the COVID-19 Pandemic among Dentists in One of the Poorest Brazilian States: A Cross-Sectional Study

ABSTRACT Objective: To analyze the impact of the COVID-19 pandemic on dentists' income and to identify associated factors in one of the poorest Brazilian states. Material and Methods: A cross-sectional study including dentists who volunteered to answer an electronic questionnaire in Maranhão. Hierarchical multinomial logistic regression analyses were performed, estimating crude and adjusted odds ratios (OR) and respective 95% confidence intervals (95%CI) (alpha=5%). Results: The COVID-19 pandemic impacted the professionals´ income negatively [55.44% (50.26-60.52%)] and also positively [6.9% (4.55-9.94%)]. The negative impact on income was greater among male dentists (OR=2.54; 95%CI: 1.16-5.53), over 30 years of age (OR=3.03; 95%CI: 1.34-6.87), with family income below two minimum wages (OR=4.63; 95%CI: 1.50-14.30), who worked in the continent instead of in the capital island (OR=2.21; 95%CI: 1.14-4.29) and in the private sector (OR=31.43; 95%CI: 11.59-85.22). Moreover, those who had been tested for COVID-19, with a negative result, had a 21.3-fold greater chance of having an increased household income when compared to those who had not been tested. Conclusion: The COVID-19 pandemic negatively impacted the dentists' income in Maranhão, especially the older, males, with lower incomes, and who worked in the private sector, living far from the capital. The SUS played an important role in the social protection of dentists during the COVID-19 pandemic, mitigating the economic impacts on the public sector working class.

Asociación entre variables de empuje Isométrico de media pierna (EIMP) con variables antropométricas y cualidades físicas en jugadores varones de Rugby Amateurs / Relationships between Isometric Mid-Thigh pull with anthropometric variables and physical qualities in Amateur Rugby players / Relações entre a puxada isométrica do meio da coxa com variáveis antropométricas e qualidades físicas em jogadores amadores de rugby

Objetivo: el objetivo de este estudio es describir el perfil de las variables del EIMP entre las dos posiciones de juego y determinar las posibles asociaciones con las características antropométricas y las cualidades físicas de un grupo de jugadores Rugby amateurs chilenos. Hipótesis: es por eso por lo que podemos plantear como hipótesis la existencia de asociaciones entre las variables de EIMP y las cualidades físicas de los jugadores de RU. Diseño metodológico: este estudio tiene un diseño de cohorte observacional, descriptivo y correlacional. Se investigó la asociación existente entre las variables de EIMP con las pruebas físicas y las variables antropométricas. Fueron evaluados treinta y dos jugadores de rugby varones de nivel amateurs chilenos (promedio ( DE, edad, 23,3 ( 5,4 años). Resultados: para la variable Masa Muscular se encontraron asociaciones grandes (r = 0.53) (p = 0.001) con la FM y asociaciones moderadas (r = 0,48) (r = 0,47) (r = 0,44) (r = 0,46) con F50, F100, F150 y F200 respectivamente. También se pueden observar las asociaciones grandes (R2 = 0,305) (R2 = 0,297) (R2 = 0,267) entre 1RM PB y F200, F100 y F150, respectivamente. Conclusión: en conclusión, este estudio puede demostrar la existencia de asociaciones estadísticamente significativas entre algunas de las variables antropométricas y físicos con las variables de Fuerza de EIMP en jugadores de RU amateurs chilenos.

OBJECTIVE: The objective of this study is to describe the profile of the EIMP variables between two playing positions and to determine its possible associations with anthropometric characteristics and physical qualities of a group of Chilean amateur rugby players. HYPOTHESIS: There are associations between the EIMP variables and the physical qualities of UR players. METHODOLOGICAL DESIGN: This study has an observational, descriptive and correlational cohort design. The association between the EIMP variables, from the physical tests, and the anthropometric variables was investigated. Thirty-two Chilean amateur-level male rugby players were evaluated (mean ( SD, age, 23.3 ( 5.4 years). RESULTS: For the Muscle Mass variable, large associations were found (r=0.53) (p=0.001) to FM, and moderate associations (r=0.48) (r=0.47) (r=0.44) (r =0.46) to F50, F100, F150, and F200 respectively. Large associations (R2=0.305) (R2=0.297) (R2=0.267) between 1RM PB and F200, F100, and F150, respectively, can also be observed. CONCLUSION: In conclusion, this study can demonstrate the existence of statistically significant associations between some of the anthropometric and physical variables and the EIMP Strength variables in Chilean amateur UR players.

OBJETIVO: O objetivo deste estudo é descrever o perfil das variáveis EIMP entre as duas posições de jogo e determinar as possíveis associações com as características antropométricas e qualidades físicas de um grupo de jogadores amadores de rugby chilenos. HIPÓTESE: É por isso que podemos hipotetizar a existência de associações entre as variáveis do EIMP e as qualidades físicas dos jogadores do RU. DESENHO METODOLÓGICO: Este estudo tem um desenho de coorte observacional, descritivo e correlacional. Investigou-se a associação entre as variáveis do EIMP com os testes físicos e as variáveis antropométricas. Trinta e dois jogadores de rugby masculinos de nível amador chileno foram avaliados (média ( DP, idade, 23,3 ( 5,4 anos). RESULTADOS: Para a variável Massa Muscular foram encontradas grandes associações (r=0,53ejercicio y cualidades físicos) (r=0,47) (r=0,44) (r=0,46) com F50, F100, F150 e F200 respectivamente. Grandes associações (R2=0,305) (R2=0,297) (R2=0,267) entre 1RM PB e F200, F100 e F150 respebaloncestotambém podem ser observadas. CONCLUSÃO: Em conclusão, este estudo pode demonstrar a existência de associações estatisticamente significativas entre algumas das variáveis antropométricas e físicas com as variáveis EIMP Força em jogadores amadores do RU chilenos.

Bounded-width confidence interval following optimal sequential analysis of adverse events with binary data.

In sequential testing with binary data, sample size and time to detect a signal are the key performance measures to optimize. While the former should be optimized in Phase III clinical trials, minimizing the latter is of major importance in post-market drug and vaccine safety surveillance of adverse events. The precision of the relative risk estimator on termination of the analysis is a meaningful design criterion as well. This paper presents a linear programming framework to find the optimal alpha spending that minimizes expected time to signal, or expected sample size as needed. The solution enables (a) to bound the width of the confidence interval following the end of the analysis, (b) designs with outer signaling thresholds and inner non-signaling thresholds, and (c) sequential designs with variable Bernoulli probabilities. To illustrate, we use real data on the monitoring of adverse events following the H1N1 vaccination. The numerical results are obtained using the R Sequential package.

Frecuencia y factores relacionados al no cumplimiento del control prenatal en gestantes de 35 años o más en el Cauca, Colombia, 2016-2018 / Frequency and associated factors of non-adherence to prenatal care in pregnant women 35 years of age or older in Cauca, Colombia, 2016-2018

RESUMEN Objetivos: describir la frecuencia del no cumplimiento del control prenatal en gestantes de 35 años o más del departamento del Cauca, Colombia, y hacer un análisis exploratorio de los factores asociados. Materiales y métodos: estudio descriptivo de corte transversal. Se incluyeron gestantes entre 35 y 41 años afiliadas a la Entidad Administradora de Planes de Beneficios Asociación Indígena del Cauca Entidad Promotora de Salud-I (EAPB AIC-I) e inscritas al programa de control prenatal, entre 2016 y 2018. Se excluyeron pacientes con registros sin información completa. Se analizaron variables sociodemográficas, clínicas y la frecuencia de no asistencia adecuado al control prenatal a través de estadística descriptiva, y se calcularon Odd Ratios con sus intervalos de confianza para los factores asociados. Resultados: en 1016 pacientes entre 35 y 41 años evaluadas se encontró una frecuencia de no cumplimiento de mínimo seis controles prenatales de 61,3 %. El antecedente de aborto (OR ajustado: 0,46; IC 95 % 0,33-0,64,) y gravidez de cinco o más (OR ajustado: 3,22; IC 95 % 1,50-6,91) fueron los factores asociados. Conclusiones: el no cumplimiento de controles prenatales por gestantes de 35 o más años inscritos en la EAPB AIC-I del Cauca es alto. Se requieren nuevos estudios cualitativos que evalúen factores culturales y sociales presentes en estas comunidades que afectan la adherencia al control prenatal, así como estudios prospectivos que confirmen el análisis exploratorio de los factores asociados a la no adherencia. Es importante que las empresas aseguradoras del régimen subsidiado realicen actividades de promoción en estas comunidades para incrementar su cumplimento.

ABSTRACT Objectives: To describe the frequency and factors associated with non-adherence to prenatal follow-up in pregnant women 35 years of age or older in the department of Cauca, Colombia, between 2016 and 2018. Material and methods: Cross-sectional, descriptive observational study of records of pregnant women between 35 and 41 years of age affiliated to the Cauca Indigenous Association Health Benefit Plan Management Organization-I (EAPB AIC-I) and registered in the prenatal care program, between 2016 and 2018. Duplicate records and records with incomplete information were excluded. Sociodemographic and clinical variables, as well as program outcomes, were analyzed using descriptive statistics. Odds ratios and their confidence intervals were calculated. Results: In 1016 patients between 35 and 41 years of age, a frequency of 61.3 % of non-adherence to at least six prenatal visits was found. History of abortion (adjusted OR: 0.46; 95 % CI 0.33-0.64) and pregnancy of five or more (adjusted OR: 3,22; IC 95 % 1,50-6,91) were the associated factors. Conclusions: Non-adherence to prenatal care by pregnant women of 35 years or more affiliated to the Cauca EAPB AIC-I is high. Further qualitative studies are needed to examine the cultural and social factors present in these communities that may affect adherence to prenatal monitoring, together with prospective studies to confirm the exploratory analysis of factors associated with non-adherence. Insurance organizations in the subsidized regime should be called upon to conduct promotion activities in these communities in order to improve adherence.

Using Conventional Cameras as Sensors for Estimating Confidence Intervals for the Speed of Vessels from Single Images.

In this paper, we describe an image-based approach for estimating the speed of a moving vessel using the wakes that remain on the surface of water after the vessel has passed. The proposed method calculates the speed of the vessel using only one RGB image. In this study, we used the vanishing line of the mean water plane, the camera height concerning the level of the tide, and the intrinsic parameters of the camera to perform geometric rectification on the surface plane of the water. We detected the location of troughs on one of the wake arms and computed the distance between them in the rectified image to estimate the speed of the vessel as a so-called inverse ship wake problem. We used a radar that was designed to monitor ships to validate the proposed method. We used statistical studies to determine the reliability and error propagation of the estimated values throughout the calculation process. The experiments showed that the proposed method produced precise and accurate results that agreed with the actual radar data when using a simple capture device, such as a conventional camera.

Hepatocellular carcinoma: A real-life experience in a specialized center in Bogotá, Colombia / Hepatocarcinoma: experiencia de la vida real en un centro especializado de Bogotá, Colombia

Abstract Introduction: Hepatocellular carcinoma (HCC) is the most frequent malignant primary liver tumor globally. In 2018, it ranked sixth and represented the fourth cause of death from cancer; the five-year overall survival is 18 %. Most cases of HCC develop in patients with cirrhosis of any etiology, especially because of hepatitis B and C viruses, alcohol, and recently nonalcoholic steatohepatitis (NASH). Aim: To analyze the clinical characteristics, diagnostic methods, treatments, prognostic variables, and survival. Materials and methods: This retrospective descriptive study was conducted on a cohort of patients diagnosed with cirrhosis and treated between January 2011 and December 2020 at a health care center in Bogotá. The diagnosis of HCC was confirmed radiologically or by biopsy. We analyzed the information descriptively with absolute frequency measures in the case of categorical variables. For continuous variables, the information was summarized with measures of central tendency (mean or median) and their relevant measures of dispersion. Results: We included 152 patients diagnosed with HCC, with a mean age of 69.4 years; 51.3 % were men. The leading cause of HCC was nonalcoholic fatty liver disease (NAFLD), which accounted for almost a third of cases (32 %); other causes were alcohol (15 %) and hepatitis C virus (14 %). The median manifestation of the tumor was two nodules with a size close to 4 cm. Besides, 35 % of patients had a BCLC (Barcelona Clinic Liver Cancer) stage with curative options, and 25 % received curative treatment options. The first-line systemic therapy used in this cohort was sorafenib®, used in 35 patients (33.7 %). Survival curves showed that women, Child-Pugh class A, and BCLC stage 0 had higher median survival. Multivariate analysis showed a higher risk of death for males (hazard ratio [HR]: 2.16; confidence interval [CI]: 1.24-3.76), Child-Pugh class B (HR: 2.14; CI 1.16-3.95), and Child-Pugh class C (HR: 7.52; CI 2.88-19.57). Conclusions: NAFLD is the leading cause of HCC in this cohort. A third of patients are diagnosed in early BCLC stages with a curative treatment option, and 25 % are treated with curative therapies. Sorafenib was the first-line therapy in advanced HCC. Overall survival after diagnosis of HCC remains low, being necessary to join forces in the follow-up of patients with cirrhosis to improve these outcomes.

Resumen Introducción: el hepatocarcinoma (HCC) es el tumor hepático primario maligno más frecuente en el mundo: en 2018 ocupó la sexta posición y representó la cuarta causa de muerte por cáncer; la supervivencia global a 5 años es del 18 %. La mayoría de los casos de HCC se desarrolla en pacientes con cirrosis de cualquier etiología, especialmente por virus de la hepatitis B y C, alcohol y, recientemente, por la esteatohepatitis no alcohólica (NASH). Objetivo: analizar las características clínicas, métodos de diagnóstico, tratamientos, variables pronósticas y supervivencia. Metodología: estudio descriptivo retrospectivo de una cohorte de pacientes con diagnóstico de cirrosis atendidos entre enero de 2011 y diciembre de 2020 en un centro de atención médica de Bogotá, con diagnóstico de HCC confirmado radiológicamente o por biopsia. La información se analizó de forma descriptiva con medidas de frecuencia absoluta en el caso de las variables categóricas; para las variables continuas se resumió la información con medidas de tendencia central (media o medianas) y su respectiva medida de dispersión. Resultados: se incluyeron 152 pacientes diagnosticados con HCC, con edad promedio de 69,4 años, 51,3 % eran hombres. La principal causa de HCC fue el hígado graso no alcohólico (NAFLD), que representó casi una tercera parte de los casos (32 %); otras causas fueron el alcohol (15 %) y el virus de la hepatitis C (14 %). La mediana de presentación del tumor fue de 2 nódulos con un tamaño cercano a 4 cm. El 35 % de los pacientes tenía un estadio BCLC (Barcelona Clinic Liver Cancer) con opciones curativas y el 25 % de los pacientes recibió opciones curativas de tratamiento. La terapia sistémica de primera línea utilizada en esta cohorte fue el sorafenib®, que se utilizó en 35 pacientes (33,7 %). Las curvas de supervivencia mostraron que las mujeres, el estadio Child-Pugh A y el estadio BCLC 0 presentaron mayores medianas de supervivencia. El análisis multivariado evidenció un mayor riesgo de muerte al ser hombre (Hazard ratio [HR]: 2,16; intervalo de confianza [IC]: 1,24 a 3,76), estar en los estadios Child-Pugh B (HR: 2,14; IC: 1,16 a 3,95) y Child-Pugh C (HR: 7,52; IC: 2,88 a 19,57). Conclusiones: el NAFLD es la principal causa de HCC en la presente cohorte, una tercera parte de los pacientes se diagnostica en estadios BCLC tempranos con opción curativa de tratamiento, y un 25 % se trata con terapias curativas. El sorafenib fue la terapia de primera línea en HCC avanzado. La supervivencia global luego del diagnóstico de HCC sigue siendo baja, y es necesario aunar esfuerzos en el seguimiento de los pacientes con cirrosis para mejorar estos resultados.

Prevalência de exposição às situações de violência vividas por estudantes adolescentes brasileiros / Prevalencia de la exposición a situaciones de violencia entre los estudiantes adolescentes brasileños / Prevalence of the exposure to situations of violence experienced by brazilian in-school adolescents

RESUMO Objetivo: descrever e comparar os indicadores de exposição a situações de violência vividas por estudantes adolescentes, de acordo com sexo, tipo de escola e unidades federadas nos anos de 2015 e 2019. Métodos: estudo transversal, descritivo com dados da Pesquisa Nacional de Saúde do Escolar (PeNSE). Foram descritas e comparadas as prevalências e seus respectivos intervalos de confiança de 95% (IC95%) dos indicadores de exposição às situações de violência envolvendo adolescentes. Resultados: apontaram que: faltaram à escola por insegurança no trajeto 11,6% (IC95%:11,1;12,1); faltaram à escola por insegurança na escola 10,8% (IC95%:10,3;11,2); maiores prevalências de violência foram nas meninas e em estudantes de escolas públicas. Dentre os indicadores do estudo, constatou-se a que a prevalência de escolares que estiveram envolvidos em briga com luta física foi de 10,6% (IC95%:10,2;11,0), em briga com utilização de arma de fogo 2,9% (IC95%:2,7;3,1) e uso de arma branca foi de 4,8% (IC95%:4,5;5,1), dos quais a maioria eram meninos que estudavam em escolas públicas. Relataram ter sofrido acidente ou agressão no último ano 18,2% (IC95%:17,7;18,7) e 21,0% (IC95%:20,5;21,6), tendo sido agredidos pela mãe/pai/responsável e a maioria oriunda de escolas particulares. Ocorreu melhorias nos seguintes indicadores entre 2015 e 2019: envolver-se em briga com arma de fogo, de 6,4% (IC95%: 5,6;7,2) em (2015) para 2,9% (IC95%:2,7;3,1) (2019); e envolver-se em briga com arma branca, de 7,9% (IC95%:7,0;8,8) (2015) para 4,8% (IC95%:4,5;5,1) em (2019). Conclusão: os adolescentes estão expostos a violências no âmbito escolar ou comunitária, além de sofrerem violências no ambiente intrafamiliar/doméstico. Essas instituições deveriam ser capazes de garantir a proteção e o desenvolvimento saudável e seguro do adolescente.

RESUMEN Objetivo: describir y comparar los indicadores de exposición a situaciones de violencia de los estudiantes adolescentes según género, tipo de escuela y unidades federadas, en 2015 y 2019. Métodos: estudio transversal, descriptivo con datos de la Encuesta Nacional de Salud Escolar. Se describieron y compararon la prevalencia y los respectivos intervalos de confianza del 95% (IC95%) de los indicadores de exposición a situaciones de violencia que afectan a los adolescentes. Resultados: se registraron ausencias escolares: por inseguridad en el camino a la escuela 11,6% (IC95%:11,1;12,1); por inseguridad en la escuela 10,8% (IC95%:10,3;11,2); la mayor prevalencia fue entre las niñas y los estudiantes de escuelas públicas. Entre los indicadores del estudio: la prevalencia de alumnos implicados en peleas con lucha física fue del 10,6% (IC95%:10,2;11,0), en peleas con armas de fuego del 2,9% (IC95%:2,7;3,1); uso de arma blanca del 4,8% (IC95%:4,5;5,1), la mayoría de ellos eran varones, que estudiaban en escuelas públicas. El 18,2% (IC95%:17,7;18,7) declaró haber sufrido un accidente o una agresión en el último año, el 21,0% (IC95%:20,5;21,6) fue agredido por su madre/padre/cuidador y la mayoría procedía de colegios privados. Se produjeron mejoras en los siguientes indicadores entre 2015 y 2019: involucrarse en una pelea con un arma de fuego, del 6,4% (IC 95%:5,6;7,2) en (2015) al 2,9% (IC 95%:2,7;3,1) (2019); involucrarse en una pelea con un cuchillo: del 7,9% (IC 95%:7,0;8,8) (2015) al 4,8% (IC 95%:4,5;5,1) en (2019). Conclusión: los adolescentes están expuestos a la violencia en el ámbito escolar o comunitario, además de sufrirla en el entorno intrafamiliar/doméstico. Estas instituciones deben ser capaces de garantizar la protección y el desarrollo sano y seguro del adolescente.

ABSTRACT Objective: to describe and compare the indicators corresponding to exposure to situations of violence experienced by in-school adolescents according to gender, type of school and Federation Units in 2015 and 2019. Methods: A cross-sectional and descriptive study conducted with data from the National School Health Survey (Pesquisa Nacional de Saúde do Escolar, PeNSE). The prevalence values and their respective 95% confidence intervals (85% CIs) of the indicators corresponding to exposure to situations of violence involving adolescents were described and compared. Results: They pointed out that: 11.6% missed classes due to insecurity on the way (95% CI: 11.1-12.1); 10.8% missed classes due to insecurity at school (95% CI: 10.3-11.2); and the highest prevalence values of violence were recorded among girls and public school students. Among the study indicators, it was found that the prevalence of students who were involved in physical fights was 10.6% (95% CI: 10.2-11.0), in fights with firearm use, 2.9% (95% CI: 2.7-3.1), and in fights with melee weapon use, 4.8% (95% CI: 4.5-5.1), most of them boys who attended public schools. 18.2% (95% CI: 17.7-18.7) reported having suffered an accident or aggression in the last year and 21.0% (95% CI: 20.5-21.6) stated having been assaulted by their mother/father/guardian, most of them from private schools. There were improvements in the following indicators between 2015 and 2019: engaging in a fight involving a firearm, from 6.4% (95% CI: 5.6-7.2) in 2015 to 2.9% (95% CI: 2.7-3.1) in 2019; and engaging in a fight involving a melee weapon, from 7.9% (95% CI: 7.0-8.8) in 2015 to 4.8% (95% CI: 4.5-5.1) in 2019. Conclusion: Adolescents are exposed to several types of violence in the school or community settings, in addition to experiencing violence in the family/domestic environment. These institutions should be capable of ensuring protection and healthy and safe development to adolescents.

COVID-19-Associated Pulmonary Aspergillosis in a Series of Complete Autopsies from the Brazilian Amazon.

Between April and July 2020, and, therefore, prior to the broad recommendation of corticosteroids for severe COVID-19, a total of 50 full autopsies were performed in Manaus. We confirmed two invasive cases of aspergillosis through histopathology and gene sequencing (4%) in our autopsy series. The confirmed invasive aspergillosis incidence seems much lower than expected based on the "probable and possible" definitions, and an individualized approach should be considered for each country scenario. Interestingly, a prolonged length of stay in the intensive care unit was not observed in any of the cases. Timely diagnosis and treatment of fungal infection can reduce mortality rates.

Forecasting the Severity of COVID-19 Pandemic Amidst the Emerging SARS-CoV-2 Variants: Adoption of ARIMA Model.

Currently, the global report of COVID-19 cases is around 110 million, and more than 2.43 million related death cases as of February 18, 2021. Viruses continuously change through mutation; hence, different virus of SARS-CoV-2 has been reported globally. The United Kingdom (UK), South Africa, Brazil, and Nigeria are the countries from which these emerged variants have been notified and now spreading globally. Therefore, these countries have been selected as a research sample for the present study. The datasets analyzed in this study spanned from March 1, 2020, to January 31, 2021, and were obtained from the World Health Organization website. The study used the Autoregressive Integrated Moving Average (ARIMA) model to forecast coronavirus incidence in the UK, South Africa, Brazil, and Nigeria. ARIMA models with minimum Akaike Information Criterion Correction (AICc) and statistically significant parameters were chosen as the best models in this research. Accordingly, for the new confirmed cases, ARIMA (3,1,14), ARIMA (0,1,11), ARIMA (1,0,10), and ARIMA (1,1,14) models were chosen for the UK, South Africa, Brazil, and Nigeria, respectively. Also, the model specification for the confirmed death cases was ARIMA (3,0,4), ARIMA (0,1,4), ARIMA (1,0,7), and ARIMA (Brown); models were selected for the UK, South Africa, Brazil, and Nigeria, respectively. The results of the ARIMA model forecasting showed that if the required measures are not taken by the respective governments and health practitioners in the days to come, the magnitude of the coronavirus pandemic is expected to increase in the study's selected countries.

Agregación familiar y factores de riesgo de asma bronquial en individuos afectados / Familial aggregation and risk factors for bronchial asthma in affected individuals

Introducción: La agregación familiar del asma se reconoce desde 1 860 a constatarse en varias generaciones de una familia. Objetivo: Determinar la agregación familiar para asma bronquial y los factores de riesgo. Material y Métodos: Se realizó una investigación observacional, analítica, longitudinal, retrospectiva, casos/control a partir de la población perteneciente al área de salud Darío Calzadilla, en Banes, provincia Holguín, durante octubre 2020-marzo 2021. El universo abarcó la totalidad de individuos diagnosticados y sus familias. Por muestreo aleatorio simple, se obtuvo la muestra de 77 casos. Se conformó el grupo control a razón de 3:1, que incluyó 231 individuos sin antecedentes de enfermedad. Fueron aplicados criterios de inclusión/exclusión. Fueron utilizados los estadígrafos: Chi cuadrado, Odd Ratio (OR) e intervalo de confianza. Se estudiaron las variables: edad, grado de consanguinidad y factores de riesgo. Se obtuvo el árbol genealógico. Se cumplieron los requisitos bioéticos. Resultados: Los familiares de primer grado (47 individuos 17 por ciento) y segundo grado (23 individuos 4,3 por ciento) de consanguinidad mostraron la mayor incidencia de la enfermedad. Los grupos de edades 40-49 años (51 individuos, 22,8 por ciento) y 30-39 años (32 individuos, 22,3 por ciento), resultaron los más afectados. Los factores de riesgos mostraron asociación para la enfermedad (X2=111,15 p ≤ 0,001). El hábito de fumar (X2=132,9 OR=6,18 IC95 por ciento (4,49; 8,51)) y los antecedentes familiares de la enfermedad (X2=13,6 OR=1,73 IC95 por ciento (1,29; 2,32)) expresaron asociación altamente significativa. Se demostró agregación familiar para la enfermedad (X2=185,32 OR=9,97 IC95 por ciento (6,7; 14,84)). Conclusiones: El asma bronquial es una enfermedad multifactorial, compleja, poligénica con agregación familiar demostrada(AU)

Introduction: Familial aggregation of asthma has been recognized since 1860 and observed in several generations in one family. Objective: To determine familial aggregation of bronchial asthma as well as its risk factors. Material and Methods: An observational, analytical, longitudinal, and retrospective case-control study was conducted on the population belonging to Darío Calzadilla health area in Banes, Holguín province, from October 2020 to March 2021. The universe consisted of all the individuals diagnosed and their families. A sample composed of 77 cases was obtained by simple random sampling. The control group was formed at a ratio of 3:1, including 231 individuals without previous history of the disease. Inclusion and exclusion criteria were applied. The following stadigraphs were used: Chi-square test, Odds Ratio (OR), and confidence interval. The variables analyzed included age, degree of consanguinity, and risk factors. The family tree was obtained. Bioethical principles were fulfilled. Results: The first-degree relatives (47 individuals; 17 percent) and second-degree (23 individuals; 4,3 percent) of consanguinity showed a higher incidence of the disease. The age group 40-49 years (51 individuals; 22,8 percent) and 30-39 years (32 individuals; 22,3 percent), resulted to be the most affected. The risk factors evidenced an association with the disease (X2=111,15 p≤0,001). The smoking habit (X2=132,9 OR=6,18 95 percent CI (4,49; 8,51)) and family history of the disease (X2=13,6 OR=1,73 95 percent CI (1,29; 2,32)) expressed a highly significant association. Familial aggregation of the disease was demonstrated (X2=185,32 OR=9,97 95 % CI (6,7;14,84)). Conclusions: Bronchial asthma is a complex, multifactorial, polygenic disease with confirmed familial aggregation(AU)

Efectos del tadalafilo en el deseo sexual y la excitación/lubricación en mujeres postmenopáusicas / Effects of Tadalafil on Sexual Desire and Arousal/Lubrication in Postmenopausal Women

Objetivo Determinar los efectos y la seguridad del tadalafilo en el deseo sexual y la excitación/lubricación en mujeres postmenopáusicas. Métodos Estudio cuasi experimental (con comparación antes de la intervención y después), con seguimiento de la cohorte de pacientes: 228 mujeres mayores de 40 años en postmenopausia, que consultaron por bajo deseo sexual y alteración de la excitación /lubricación, en una clínica sexológica en Armenia (Colombia), entre 2018 y 2019. Las mujeres recibieron 2,5 mg diarios de tadalafilo durante 12 semanas. Se determinaron las puntuaciones del instrumento, el Índice de Función Sexual Femenina (IFSF), cada cuatro semanas. Resultados El promedio de edad fue de 54,36 ± 4,92 años. Antes del tratamiento, la media en la puntuación del IFSF fue de 22,41 puntos (intervalo de confianza del 95% [IC95%]: 7,11­29,76); a las 4 semanas, 24,73 puntos (IC95%: 23,51­30,28); a las 8 semanas, 25,97 puntos (IC95%: 24,26­31,53); y, al final, 26,99 puntos (IC95%: 25,97­32,46), con diferencias estadísticamente significativas entre las 4 medidas pareadas (p < 0,001). La excitación fue el dominio con mayor puntuación tras el tratamiento (4,83 puntos; IC 95%: 4,36­4,91), seguida por la lubricación (4,77 puntos; IC95%: 4,28­4,87). El deseo sexual mostró un significativo incremento al final del estudio (4,29 puntos; IC95%: 4,07­4,39). Se presentaron efectos adversos leves. Se observó una satisfacción con el consumo de tadalafilo del 84,21%. Conclusiones El tratamiento diario con 2,5 mg de tadalafilo genera mejoría en la función sexual de mujeres en la postmenopausia, y el incremento en la puntuación del IFSF demuestra su efecto positivo.

Objective To determine the effects and safety of tadalafil on sexual desire and arousal/lubrication in postmenopausal women. Materials and methods Quasi-experimental study (with a comparison before and after the intervention) with follow-up of the patient cohort: 228 postmenopausal women older than 40 years of age, who consulted due to low sexual desire and altered arousal/lubrication, in a sexology clinic in Armenia (Colombia) between 2018 and 2019. The women received 2.5 mg of tadalafil daily for 12 weeks. The scores on the instrument used, the Female Sexual Function Index, (FSFI), were determined every four weeks. Results The mean age was 54.36 ± 4.92 years. Before the treatment, the mean FSFI score was of 22.41 points (95% confidence interval [95%CI]: 7.11­29.76); at 4 weeks, it was of 24.73 points (95%CI: 23.51­30, 28); at 8 weeks, 25.97 points (95%CI: 24.26­31.53); and, at the end, it was of 26.99 points (95%CI: 25.97­32.46), with statistically significant differences among the four paired measurements (p < 0.001). Arousal was the domain with the highest posttreatment score (4.83 points; 95%CI: 4.36­4.91), followed by lubrication (4.77 points; 95%CI: 4.28­4.87). Sexual desire showed a significant increase at the end of the study (4.29 points; 95%CI: 4.07­4.39). Mild adverse effects occurred. A rate of satisfaction of 84.21% with the intake of tadalafil. Conclusions The daily treatment with tadalafil 2.5 mg results in an improvement in sexual function in postmenopausal women; the increase in the score on the FSFI demonstrates its positive effect.

Head and neck cancer risk factors in the French West Indies.

OBJECTIVES: The incidence of head and neck squamous cell carcinoma (HNSCC) in the French West Indies (FWI) is relatively high, despite a low prevalence of tobacco smoking and alcohol drinking. Little is known about other risk factors in the FWI. We assessed associations between several factors and HNSCC risk, their population attributable fractions (PAF) in the FWI, and compared these PAFs by subsite, sex and age. MATERIALS AND METHODS: We conducted a population-based case-control study (145 cases and 405 controls). We used logistic regression models to estimate adjusted odds-ratios (OR), PAFs and their 95% confidence intervals (CI). RESULTS: Tobacco smoking, alcohol drinking, high-risk HPV, family history of HNC, low BMI and several occupations and industries were significantly associated to the occurrence of HNSCC. The majority of HNSCC cases were attributable to tobacco smoking (65.7%) and alcohol (44.3%). The PAF for the combined consumption of tobacco and/or alcohol was 78.2% and was considerably larger in men (85%) than in women (33%). The PAFs for the remaining risk factors were 9% for family history of HNSCC, 9% for low BMI, 15% for high-risk HPV, and 25% for occupations. The overall PAF for all risk factors combined was 89.0% (95% CI = 82.0-93.2). The combined PAFs by sex were significantly greater in men (93.4%, 95% CI = 87.5-96.5) than in women (56.4%, 95% CI = 18.7-76.6). CONCLUSION: Tobacco and alcohol appeared to have the greatest impact on HNSCC incidence among the studied risk factors, especially among men. Prevention programs for HNSCC in the FWI should target tobacco and alcohol cessation, particularly in men. Future research should emphasise on the role of occupational factors to better understand this disease.

A case-control study of a combination of single nucleotide polymorphisms and clinical parameters to predict clinically relevant toxicity associated with fluoropyrimidine and platinum-based chemotherapy in gastric cancer.

BACKGROUND: Fluoropyrimidine plus platinum chemotherapy remains the standard first line treatment for gastric cancer (GC). Guidelines exist for the clinical interpretation of four DPYD genotypes related to severe fluoropyrimidine toxicity within European populations. However, the frequency of these single nucleotide polymorphisms (SNPs) in the Latin American population is low (< 0.7%). No guidelines have been development for platinum. Herein, we present association between clinical factors and common SNPs in the development of grade 3-4 toxicity. METHODS: Retrospectively, 224 clinical records of GC patient were screened, of which 93 patients were incorporated into the study. Eleven SNPs with minor allelic frequency above 5% in GSTP1, ERCC2, ERCC1, TP53, UMPS, SHMT1, MTHFR, ABCC2 and DPYD were assessed. Association between patient clinical characteristics and toxicity was estimated using logistic regression models and classification algorithms. RESULTS: Reported grade ≤ 2 and 3-4 toxicities were 64.6% (61/93) and 34.4% (32/93) respectively. Selected DPYD SNPs were associated with higher toxicity (rs1801265; OR = 4.20; 95% CI = 1.70-10.95, p = 0.002), while others displayed a trend towards lower toxicity (rs1801159; OR = 0.45; 95% CI = 0.19-1.08; p = 0.071). Combination of paired SNPs demonstrated significant associations in DPYD (rs1801265), UMPS (rs1801019), ABCC2 (rs717620) and SHMT1 (rs1979277). Using multivariate logistic regression that combined age, sex, peri-operative chemotherapy, 5-FU regimen, the binary combination of the SNPs DPYD (rs1801265) + ABCC2 (rs717620), and DPYD (rs1801159) displayed the best predictive performance. A nomogram was constructed to assess the risk of developing overall toxicity. CONCLUSION: Pending further validation, this model could predict chemotherapy associated toxicity and improve GC patient quality of life.

Effect of Antibiotic Prophylaxis on Infectious Complications in Patients with Asymptomatic Bacteriuria Undergoing Urologic Surgery / Efecto de la profilaxis antibiótica sobre las complicaciones infecciosas en pacientes con bacteriuria asintomática programados a cirugía urológica

Objectives To identify the effect of duration of surgical antibiotic prophylaxis (SAP) and other variables on infectious postsurgical complications in patients with asymptomatic bacteriuria (ASB) undergoing urological surgery. Methods We conducted an observational study of a cohort of patients with ASB scheduled for urologic surgery at three health service providers in Colombia. The study population comprised all patients with planned urologic surgery who had ASB prior to surgery from April 2018 to January 2019. The intervention evaluated was the duration of preoperative SAP, and the outcome variable was the development of any postoperative infectious complications for up to 30 days after the procedure. Results The present study included 184 patients with ASB scheduled for urologic surgery. The median duration of preoperative SAP (p = 0.49) or of 1 dose SAP (risk ratio [RR] = 1.24; 95% confidence interval [CI]: 0.45­3.39) were not statistically different in patients with postsurgical infectious complications. Infectious complications were more frequent among patients with benign prostatic hyperplasia (RR = 6.57; 95%CI: 1.98­21.76) and hospitalization in the preceding 3 months (RR = 8.32; 95%CI: 2.69­25.71). Conclusion One dose of antimicrobial therapy is sufficient to avoid infectious complications in patients with ASB. There were other factors associated with postsurgical infectious complications, such as benign prostatic hyperplasia and hospitalization in the preceding 3 months.

Objetivos Identificar el efecto de la duración de la profilaxis antibiótica quirúrgica (PAQ) y otras variables sobre las complicaciones infecciosas posquirúrgicas en pacientes con bacteriuria asintomática (BA) sometidos a cirugía urológica. Métodos Se realizó un estudio observacional de una cohorte de pacientes con BA programados para cirugía urológica en tres instituciones de salud en Colombia. La población de estudio comprendió a todos los pacientes programados para cirugía urológica y con BA en el periodo de Abril del 2018 a Enero 2019. La intervención evaluada fue la duración de la PAQ preoperatoria, y la variable de resultado fue el desarrollo de cualquier complicación infecciosa posoperatoria hasta 30 días después del procedimiento. Resultados El estudio incluyó a 184 pacientes con BA programados para cirugía urológica. La mediana de duración de la PAQ preoperatoria (p = 0,49) o 1 dosis de PAQ (razón de riesgo [RR]: 1,24; intervalo de confianza [IC] del 95%: 0,45 a 3,39) no fueron estadísticamente diferentes en pacientes con complicaciones infecciosas posquirúrgicas. Las complicaciones infecciosas fueron más frecuentes entre los pacientes con hiperplasia prostática benigna (RR: 6,57; IC del 95%: 1,98 a 21,76) y hospitalización en los 3 meses anteriores (RR: 8,32; IC del 95%: 2,69 a 25,71). Conclusión Una dosis de terapia antimicrobiana es suficiente para evitar complicaciones infecciosas en pacientes con BA. Hubo otros factores asociados con complicaciones infecciosas posquirúrgicas, como hiperplasia prostática benigna y hospitalización en los tres meses anteriores.