Improving access to Comprehensive Geriatric Assessment by improving flow through a Frailty Assessment Area-A QI project.

Early Comprehensive Geriatric Assessment is a key component of the assessment of older adults presenting to hospital with frailty syndromes, often this is facilitated through Acute Frailty Units. In this paper we describe how using QI methodology we improved access to our Frailty Unit using a digital solution. The impact of this improvement was demonstrated via the reduction in length of stay that these patients experienced compared to patients admitted to General Care of the Older Person wards.

Systemic lupus erythematosus mimicking leprosy: A challenge to early diagnosis.

We describe a case of a male patient with systemic lupus erythematosus (SLE) and lupus nephritis. A patient who was initially diagnosed with multibacillary leprosy, an infectious disease, with clinical symptoms for two years. However, after hospitalization and investigation, his diagnosis was revoked and replaced with SLE. The aim of this study is to emphasize the importance of knowing the most important and significant clinical changes in SLE and thus allowing an accurate diagnosis, preventing disease progression with target organ involvement, and allowing better clinical management.

Lack of serological and molecular evidences of Zika virus circulation in non-human primates in three states from Brazil.

BACKGROUND: Zika virus (ZIKV) was discovered in 1947 with the virus isolation from Rhesus monkey (Macaca mulatta) in Uganda forest, Africa. Old World Primates are involved in a sylvatic cycle of maintenance of this arbovirus, however a limited knowledge about the role of New World primates in ZIKV transmission cycles has been established. OBJECTIVE: This work aimed to investigate the presence of enzootic circulation of ZIKV in New World Primates from three Brazilian states: São Paulo, Paraíba, and Paraná. METHODS: We analyzed 100 non-human primate samples collected in 2018 and 2020 from free-ranging and captive environments from São Paulo (six municipalities belonging to Sorocaba region), Paraíba (João Pessoa municipality), and Paraná (Foz do Iguaçu municipality) using reverse transcriptase quantitative polymerase reaction (RT-qPCR) assays, indirect enzyme-linked immunosorbent assay (ELISA), and plaque reduction neutralization test (PRNT). FINDINGS: All samples (n = 141) tested negative for the presence of ZIKV genome from tissue and blood samples. In addition, all sera (n = 58) from Foz do Iguaçu' non-human primates (NHPs) were negative in serological assays. MAIN CONCLUSION: No evidence of ZIKV circulation (molecular and serological) was found in neotropical primates. In addition, the absence of antibodies against ZIKV suggests the absence of previous viral exposure of NHPs from Foz do Iguaçu-PR.

Lack of serological and molecular evidences of Zika virus circulation in non-human primates in three states from Brazil

BACKGROUND Zika virus (ZIKV) was discovered in 1947 with the virus isolation from Rhesus monkey (Macaca mulatta) in Uganda forest, Africa. Old World Primates are involved in a sylvatic cycle of maintenance of this arbovirus, however a limited knowledge about the role of New World primates in ZIKV transmission cycles has been established. OBJECTIVE This work aimed to investigate the presence of enzootic circulation of ZIKV in New World Primates from three Brazilian states: São Paulo, Paraíba, and Paraná. METHODS We analyzed 100 non-human primate samples collected in 2018 and 2020 from free-ranging and captive environments from São Paulo (six municipalities belonging to Sorocaba region), Paraíba (João Pessoa municipality), and Paraná (Foz do Iguaçu municipality) using reverse transcriptase quantitative polymerase reaction (RT-qPCR) assays, indirect enzyme-linked immunosorbent assay (ELISA), and plaque reduction neutralization test (PRNT). FINDINGS All samples (n = 141) tested negative for the presence of ZIKV genome from tissue and blood samples. In addition, all sera (n = 58) from Foz do Iguaçu' non-human primates (NHPs) were negative in serological assays. MAIN CONCLUSION No evidence of ZIKV circulation (molecular and serological) was found in neotropical primates. In addition, the absence of antibodies against ZIKV suggests the absence of previous viral exposure of NHPs from Foz do Iguaçu-PR.

Hematopoietic Cell Transplantation Cures Adenosine Deaminase 2 Deficiency: Report on 30 Patients.

PURPOSE: Deficiency of adenosine deaminase 2 (DADA2) is an inherited inborn error of immunity, characterized by autoinflammation (recurrent fever), vasculopathy (livedo racemosa, polyarteritis nodosa, lacunar ischemic strokes, and intracranial hemorrhages), immunodeficiency, lymphoproliferation, immune cytopenias, and bone marrow failure (BMF). Tumor necrosis factor (TNF-α) blockade is the treatment of choice for the vasculopathy, but often fails to reverse refractory cytopenia. We aimed to study the outcome of hematopoietic cell transplantation (HCT) in patients with DADA2. METHODS: We conducted a retrospective study on the outcome of HCT in patients with DADA2. The primary outcome was overall survival (OS). RESULTS: Thirty DADA2 patients from 12 countries received a total of 38 HCTs. The indications for HCT were BMF, immune cytopenia, malignancy, or immunodeficiency. Median age at HCT was 9 years (range: 2-28 years). The conditioning regimens for the final transplants were myeloablative (n = 20), reduced intensity (n = 8), or non-myeloablative (n = 2). Donors were HLA-matched related (n = 4), HLA-matched unrelated (n = 16), HLA-haploidentical (n = 2), or HLA-mismatched unrelated (n = 8). After a median follow-up of 2 years (range: 0.5-16 years), 2-year OS was 97%, and 2-year GvHD-free relapse-free survival was 73%. The hematological and immunological phenotypes resolved, and there were no new vascular events. Plasma ADA2 enzyme activity normalized in 16/17 patients tested. Six patients required more than one HCT. CONCLUSION: HCT was an effective treatment for DADA2, successfully reversing the refractory cytopenia, as well as the vasculopathy and immunodeficiency. CLINICAL IMPLICATIONS: HCT is a definitive cure for DADA2 with > 95% survival.

Prevalencia de nueva hemorragia por úlcera péptica en pacientes tratados con inhibidores de la bomba de protones por vía intravenosa / Prevalence of rebleeding from peptic ulcer in patients treated with proton pump inhibitors

Fundamento y objetivo: El objetivo de este estudio es la evaluación de la prevalencia de resangrado por úlcera péptica comparando pacientes que habían recibido omeprazol frente a pantoprazol por vía intravenosa y estudiar los costes derivados de cada tratamiento. Pacientes y métodos: estudio observacional y retrospectivo. Se recogió información sobre el sexo y la edad de los pacientes, el diagnóstico de la hemorragia digestiva alta (HDA) según la clasificación de Forrest, el tipo de inhibidor de la bomba de protones (IBP) utilizado por vía intravenosa y la pauta de tratamiento, presencia o no de resangrado, mortalidad y datos referentes a los costes sanitarios mediante un modelo farmacoeconómico de coste-efectividad. Resultados: Se incluyó a 807 pacientes, 490 de los cuales (60,7%) recibieron pantoprazol y 317 (39,3%) omeprazol. No hubo diferencias entre la edad media de ambos grupos (61,2 frente a 62,3 años, p=0,544), sexo (el 71% de varones frente al 68,6% de mujeres; p=0,78), porcentaje de enfermos dentro del grado I de Forrest (el 35,1 frente al 42%; p=0,05), en el grado II (el 50,2 frente al 40,4%; p=0,006) y en el grado III (el 14,7 frente al 17,7%; p=0,259). El número de viales por día de tratamiento por vía intravenosa fue significativamente inferior en el grupo de pantoprazol desde el tercer al quinto día, sin diferencias en los dos primeros días y a partir del sexto. Hubo resangrado en el 8,2% de los pacientes tratados con pantoprazol y en el 11,7% de los tratados con omeprazol (p=0,098). Falleció el 2,2% de los pacientes tratados con pantoprazol frente al 2,6% de los tratados con omeprazol (p=0,086). El coste esperado de un paciente tratado con pantoprazol es de 2.188,25€ mientras que con omeprazol es de 3.279,02€ (p<0,001). Conclusiones: Si bien los resultados de la administración de omeprazol frente a pantoprazol por vía intravenosa en pacientes con HDA ulcerosa son similares, este último resulta tener mejor perfil de coste-efectividad (AU)

Background and objective: The aim of this study is to assess the prevalence of peptic ulcer rebleeding by comparing patients who received omeprazole versus pantoprazole i.v. as well as to study the costs of each treatment.Patients and methods: Retrospective and observational study. Information was gathered on sex and age of the patients, the diagnosis of upper gastrointestinal bleeding (UGB) according to the classification of Forrest, the type of proton pump inhibitor (PPI) i.v. used and the treatment regimen, presence or absence of rebleeding, mortality and data on health costs through a pharmacoeconomic cost-effectiveness analysis. Results: We included 807 patients, 490 of whom (60.7%) received pantoprazole and 317 (39.3%) omeprazole. There was no difference between the average age of both groups, 61.2 years vs 62.3, p=0.544; sex, 71% men vs 68.6%, P=.78; the percentage of patients within Forrest I was 35.1% vs 42%, P=.05, in grade II was 50.2% vs 40.4%, P=.006 and in grade III was 14.7% vs 17.7%, P=.259. The number of vials per day of treatment was significantly lower in the pantoprazole group from the third to fifth day, with no differences in the first two days and the sixth. There was rebleeding in 8.2% of patients treated with pantoprazole and 11.7% with omeprazole, P=.098. 2.2% of patients treated with pantoprazole died vs 2.6% treated with omeprazole, P=.086. The expected cost of a patient treated with pantoprazole was 2188.25€ vs 3279.02€ with omeprazole, P<.001. Conclusions: While the results of the administration of omeprazole vs pantoprazole i.v. in patients with UGB are similar, the latter turns out to have a better cost-effectiveness profile (AU)

[Prevalence of rebleeding from peptic ulcer in patients treated with proton pump inhibitors]. / Prevalencia de nueva hemorragia por úlcera péptica en pacientes tratados con inhibidores de la bomba de protones por vía intravenosa.

BACKGROUND AND OBJECTIVE: The aim of this study is to assess the prevalence of peptic ulcer rebleeding by comparing patients who received omeprazole versus pantoprazole i.v. as well as to study the costs of each treatment. PATIENTS AND METHODS: Retrospective and observational study. Information was gathered on sex and age of the patients, the diagnosis of upper gastrointestinal bleeding (UGB) according to the classification of Forrest, the type of proton pump inhibitor (PPI) i.v. used and the treatment regimen, presence or absence of rebleeding, mortality and data on health costs through a pharmacoeconomic cost-effectiveness analysis. RESULTS: We included 807 patients, 490 of whom (60.7%) received pantoprazole and 317 (39.3%) omeprazole. There was no difference between the average age of both groups, 61.2 years vs 62.3, p=0.544; sex, 71% men vs 68.6%, P=.78; the percentage of patients within Forrest I was 35.1% vs 42%, P=.05, in grade II was 50.2% vs 40.4%, P=.006 and in grade III was 14.7% vs 17.7%, P=.259. The number of vials per day of treatment was significantly lower in the pantoprazole group from the third to fifth day, with no differences in the first two days and the sixth. There was rebleeding in 8.2% of patients treated with pantoprazole and 11.7% with omeprazole, P=.098. 2.2% of patients treated with pantoprazole died vs 2.6% treated with omeprazole, P=.086. The expected cost of a patient treated with pantoprazole was 2188.25 euro vs 3279.02 euro with omeprazole, P<.001. CONCLUSIONS: While the results of the administration of omeprazole vs pantoprazole i.v. in patients with UGB are similar, the latter turns out to have a better cost-effectiveness profile.