Efficacy of a comprehensive strategy for the detection and treatment of hepatitis C infection in a population attending addiction centers.

Background and aims: The burden hepatitis C infection in people with history or current drug use suppose a high risk of hepatic complications and transmission infectious disease. This population is poor linked to heath system and is difficult to achieve them and support treatment because they have high rates of lost follow-up. Our aim was to evaluate an intervention for the diagnosis and treatment of chronic hepatitis C and HIV in this population. Methods: Six-hundred and eighty-three people attended in Drugs and Addictions Centers (DAC) were asked to participate in health counseling and provide blood sample for test HCV, HIV, and syphilis from April 2019 to June 2020. Totally 556 subjects were surveyed and tested. All of them were assigned to a patient navigation program to improve health education and linking to the sanitary system. Hepatitis C infection patients were evaluated in an ampliated medical consult to evaluate hepatic stage with transient liver elastography and initiated Direct Acting Antivirals to achieve Sustained Viral Response. Results: Of the 556 patients who agreed to participate in the study, 33 (5.9%) had active HCV infection. Of the 33 patients infected with HCV, three were lost to follow-up once the diagnosis of HCV infection was made. Twenty-eight patients (93.3%) completed treatment and 26 achieved Sustained Viral Response (78.8%). Of the 30 patients, seven (23.3%) had advanced fibrosis, and of these, four (16.6%) had liver cirrhosis. One of the cirrhotic patients had hepatic space-occupying lesions at the baseline evaluation and was diagnosed with hepatocarcinoma. Conclusions: Our study suggests that the implementation of strategies based on personalized intervention models can contribute to the control of HCV infection in DAC users.

Comparison of hepatitis B and SARS-CoV2 vaccination rates in people who attended Drugs and Addiction Centres.

Background and aims: Persons with substance use disorder are at increased risk for hepatitis B virus (HBV) infection. Although most of them are attached to social health centers, the vaccination rate in this group is low. In this context, we designed a study to evaluate the prevalence of users of drug addiction centers (DAC) not immunized against hepatitis B and to compare the rate of vaccination against hepatitis B with the rate of immunization against SARS-Cov-2 in 2 years of follow-up. Design: Retrospective study that included individuals attended at DAC. Patients were screened at baseline (June 2020-January 2021) for HBV immunization. Individuals with HBsAb < 10 IU/mL were recommended to receive hepatitis B vaccine, during follow-up (January 2021-October 2022). At the end of follow-up, the HBV vaccination rate among candidates was determined and compared with the vaccination rate against SARS-Cov-2 in this population in the same period. Findings: A total of 325 subjects were surveyed and tested. At baseline, the 65% (211/325) of were candidates to initiate vaccination and were advisor to HBV vaccination. During the follow-up 15 individuals received at least one dose of HBV vaccine, supposing a vaccination rate of 7.2%. In the same period, 186 individuals received at least one dose against SARS-Cov-2, representing a vaccination rate of 83%. The comparison between vaccination rates reached statistically significant (p < 0.001). Conclusion: Our study manifests a low rate of immunization against HBV in DAC users, despite a high level of immunization for SARS-Cov-2 during the same period in the same population. Consequently, the lack of immunization against HVB in this population might be related with health policy issue more than to individuals linked to care and awareness. A similar approach for vaccination intended for SARS-CoV2 should be applied in high-risk population to warrant the success of immunization program against other preventable diseases such as HBV.

Transit-guided radiation therapy: proof of concept of an on-line technique for correcting position errors using transit portal images.

Objective.Transitin vivodosimetry methods monitor that the dose distribution is delivered as planned. However, they have a limited ability to identify and to quantify the cause of a given disagreement, especially those caused by position errors. This paper describes a proof of concept of a simplein vivotechnique to infer a position error from a transit portal image (TPI).Approach.For a given treatment field, the impact of a position error is modeled as a perturbation of the corresponding reference (unperturbed) TPI. The perturbation model determines the patient translation, described by a shift vector, by comparing a givenin vivoTPI to the corresponding reference TPI. Patient rotations can also be determined by applying this formalism to independent regions of interest over the patient. Eight treatment plans have been delivered to an anthropomorphic phantom under a large set of couch shifts (<15 mm) and rotations (<10°) to experimentally validate this technique, which we have named Transit-Guided Radiation Therapy (TGRT).Main results.The root mean squared error (RMSE) between the determined and the true shift magnitudes was 1.0/2.4/4.9 mm for true shifts ranging between 0-5/5-10/10-15 mm, respectively. The angular accuracy of the determined shift directions was 12° ± 14°. The RMSE between the determined and the true rotations was 0.5°. The TGRT technique decoupled translations and rotations satisfactorily. In 96% of the cases, the TGRT technique decreased the existing position error. The detection threshold of the TGRT technique was around 1 mm and it was nearly independent of the tumor site, delivery technique, beam energy or patient thickness.Significance.TGRT is a promising technique that not only provides reliable determinations of the position errors without increasing the required equipment, acquisition time or patient dose, but it also adds on-line correction capabilities to existing methods currently using TPIs.

FRAX® tool, the WHO algorithm to predict osteoporotic fractures: the first analysis of its discriminative and predictive ability in the Spanish FRIDEX cohort.

BACKGROUND: The WHO has recently published the FRAX® tool to determine the absolute risk of osteoporotic fracture at 10 years. This tool has not yet been validated in Spain. METHODS/DESIGN: A prospective observational study was undertaken in women in the FRIDEX cohort (Barcelona) not receiving bone active drugs at baseline. Baseline measurements: known risk factors including those of FRAX® and a DXA. Follow up data on self-reported incident major fractures (hip, spine, humerus and wrist) and verified against patient records. The calculation of absolute risk of major fracture and hip fracture was by FRAX® website. This work follows the guidelines of the STROBE initiative for cohort studies. The discriminative capacity of FRAX® was analyzed by the Area Under Curve (AUC), Receiver Operating Characteristics (ROC) and the Hosmer-Lemeshow goodness-of-fit test. The predictive capacity was determined using the ratio of observed fractures/expected fractures by FRAX® (ObsFx/ExpFx). RESULTS: The study subjects were 770 women from 40 to 90 years of age in the FRIDEX cohort. The mean age was 56.8 ± 8 years. The fractures were determined by structured telephone questionnaire and subsequent testing in medical records at 10 years. Sixty-five (8.4%) women presented major fractures (17 hip fractures). Women with fractures were older, had more previous fractures, more cases of rheumatoid arthritis and also more osteoporosis on the baseline DXA. The AUC ROC of FRAX® for major fracture without bone mineral density (BMD) was 0.693 (CI 95%; 0.622-0.763), with T-score of femoral neck (FN) 0.716 (CI 95%; 0.646-0.786), being 0.888 (CI 95%; 0.824-0.952) and 0.849 (CI 95%; 0.737-0.962), respectively for hip fracture. In the model with BMD alone was 0.661 (CI 95%; 0.583-0.739) and 0.779 (CI 95%; 0.631-0.929). In the model with age alone was 0.668 (CI 95%; 0.603-0.733) and 0.882 (CI 95%; 0.832-0.936). In both cases there are not significant differences against FRAX® model. The overall predictive value for major fracture by ObsFx/ExpFx ratio was 2.4 and 2.8 for hip fracture without BMD. With BMD was 2.2 and 2.3 respectively. Sensitivity of the four was always less than 50%. The Hosmer-Lemeshow test showed a good correlation only after calibration with ObsFx/ExpFx ratio. CONCLUSIONS: The current version of FRAX® for Spanish women without BMD analysed by the AUC ROC demonstrate a poor discriminative capacity to predict major fractures but a good discriminative capacity for hip fractures. Its predictive capacity does not adjust well because leading to underdiagnosis for both predictions major and hip fractures. Simple models based only on age or BMD alone similarly predicted that more complex FRAX® models.

Evaluation of different antiretroviral drug protocols on naturally infected feline immunodeficiency virus (FIV) cats in the late phase of the asymptomatic stage of infection.

The aim of this study was to evaluate the efficacy of the antiretrovirals: Zidovudine (ZDV) alone; ZDV + Recombinant Human Interferon-α (rHuIFN-α); ZDV + Lamivudine (3TC) and ZDV + valproic acid (Valp) on naturally feline immunodeficiency virus (FIV)-infected cats, in the late phase of the asymptomatic stage of infection. The follow-up was performed over one year, through clinical evaluation and the determination of viral loads and CD4+/CD8+ ratios. Neurological signs were studied by visual and auditory evoked potentials (VEP, AEP) and the responses were abnormal in 80% of the FIV-infected cats. After one year, an improvement in VEP and AEP was observed in the ZDV + Valp group and a worsening in the group receiving ZDV + rHuIFN-α. The CD4+/CD8+ ratio showed a significant increase (both intra and inter-groups) only in ZDV and ZDV + 3TC, between their pre-treatment and one year values, as well as among the other groups. Viral load only showed a significant decrease in ZDV and ZDV + 3TC groups, when comparing the values at one year of treatment vs. pre-treatment values and when the different groups were compared. In addition, the viral load decrease was significantly more pronounced in the ZDV + 3TC vs. ZDV group. We conclude that ZDV and ZDV + 3TC produce significant reductions in viral load and stimulate a recovery of the CD4+/CD8+ ratio, compared with the other protocols. It is clear that the addition of 3TC resulted in a greater reduction in viral load than use of ZDV as a single drug. Therefore, the combination ZDV + 3TC could be more effective than the sole use of ZDV.

Nomogram to preoperatively predict the probability of requiring epididymovasostomy during vasectomy reversal.

PURPOSE: Up to 6% of men who undergo vasectomy may later undergo vasectomy reversal. Most men require vasovasostomy but a smaller subset requires epididymovasostomy. Outcomes of epididymovasostomy depend highly on specialized training in microsurgery and, if predicted preoperatively, might warrant referral to a specialist in this field. We created a nomogram based on preoperative patient characteristics to better predict the need for epididymovasostomy. MATERIALS AND METHODS: We evaluated patients who underwent primary vasectomy reversal during a 5-year period. Preoperative and intraoperative patient data were collected in a prospectively maintained database. We evaluated the ability of age, years since vasectomy, vasectomy site, epididymal fullness and granuloma presence or absence to preoperatively predict the need for epididymovasostomy in a given patient. The step-down method was used to create a parsimonious model, on which a nomogram was created and assessed for predictive accuracy. RESULTS: Included in the study were 271 patients with a mean age of 42 years. Patient age was not positively associated with epididymovasostomy. Mean time from vasectomy to reversal was 9.7 years. Time to reversal and a sperm granuloma were selected as important predictors of epididymovasostomy in the final parsimonious model. The nomogram achieved a bias corrected concordance index of 0.74 and it was well calibrated. CONCLUSIONS: Epididymovasostomy can be preoperatively predicted based on years since vasectomy and a granuloma on physical examination. Urologists can use this nomogram to better inform patients of the potential need for epididymovasostomy and whether specialist referral is needed.

Immune-endocrine interactions in treated and untreated cats naturally infected with FIV.

Feline immunodeficiency virus (FIV) is a lentivirus that causes a progressive disruption of immune function in cats. The neuroendocrine and immune systems communicate bidirectionally, mediated by cytokines such as tumour necrosis factor-α (TNF), several interleukins (IL-1, IL-6, IL-10), and through signals induced by the ratio of IL-10 to IL-12. FIV can affect both pituitary adrenal and thyroid axis function. Twenty FIV-infected cats in similar stages of the disease were evaluated for six months. A cross-sectional study in which the twenty cats were divided into two groups was performed. Ten were treated with Zidovudine (ZDV: 5mg/kg/d, PO, q12h, for six months) and 10 were untreated. Plasma concentrations of adrenocorticotropic hormone (ACTH), cortisol, T4, FT4, T3, IL-10, IL-12 and viral load (VL) were evaluated after six months. ACTH was found in significantly lower concentrations (p<0.0001) in the treated group whereas cortisol did not show significant differences between the two groups. Both T4 and FT4 had high values in untreated individuals (p<0.001) compared with Zidovudine treated cats. T3 did not show significant differences between the two groups. Both IL-10 and IL-12 were found in significantly higher concentrations in ZDV treated cats (p<0.001). By contrast, the IL10/IL-12 ratio values were significantly lower in untreated cats. Viral load was significantly lower in the treated cats after six months of therapy, compared with values detected pre-treatment (p<0.002). Untreated cats showed a significant increase of VL (p<0.04) compared with the values at the beginning of the study. In treated cats, VL showed lower numbers of viral copies than in untreated cats (p<0.01). In summary, Zidovudine treatment appeared to contribute to the normalization of both the adrenal and thyroid axes. This effect could be attributed to the decrease observed in VL, resulting in a change in cytokine patterns.

Detoxifying toxicants: interactions between sulfide and iron toxicity in freshwater wetlands.

In many Dutch freshwater wetlands, concentrations of sulfate in the surface water and groundwater have increased. It is especially in peaty areas that this can lead to problems, including the reduction of sulfate to toxic sulfide. Our aquarium experiments showed that even low sulfide concentrations of 50 micromol/L are toxic to the freshwater macrophyte Nitella flexilis and the freshwater oligochaete Ophidonais serpentina. Sulfide toxicity can be modified by the availability of free iron in soil moisture or sediment from iron-rich groundwater discharge. The iron precipitates the sulfide, thereby immobilizing it and decreasing its toxicity. However, iron itself can be a toxicant as well. We found a detoxifying effect of moderate iron concentrations on sulfide toxicity, as well as a toxic effect of high iron concentrations on the growth of Potamogeton acutifolius. At the intermediate range, the formation of metal sulfides can simultaneously decrease metal and sulfide toxicity. Results of the experiments are discussed in relation to hydrological changes in freshwater wetlands.

Aplicación de la medicina tradicional a un grupo de mujeres con displasia mamaria / Application of traditional herb medicine to a group of women with breast dysplasia

Se hizo un estudio de 100 pacientes de la consulta de mastología en el año 1999, con el diagnóstico de displasia mamaria demostrado por la clínica y la citología aspirativa con aguja fina. El objetivo principal fue hacer un enfoque sistémico, dinámico y abierto del que está dotada la medicina tradicional, así como la repercusión social y el beneficio económico de este tratamiento. Se sustituyeron métodos con efectos secundarios que al cesar puede recidivar la enfermedad, por métodos inocuos con fines curativos y con efectos permanentes, de fácil aplicación. El más duradero y mejor tolerado fue la auriculoterapia, predominaron las mujeres de 21 a 30 años, obesas, ansiosas, fumadoras, tomadoras de café, té y píldoras anticonceptivas(AU)

Aplicación de la medicina tradicional a un grupo de mujeres con displasia mamaria / Application of traditional herb medicine to a group of women with breast dysplasia

Se hizo un estudio de 100 pacientes de la consulta de mastología en el año 1999, con el diagnóstico de displasia mamaria demostrado por la clínica y la citología aspirativa con aguja fina. El objetivo principal fue hacer un enfoque sistémico, dinámico y abierto del que está dotada la medicina tradicional, así como la repercusión social y el beneficio económico de este tratamiento. Se sustituyeron métodos con efectos secundarios que al cesar puede recidivar la enfermedad, por métodos inocuos con fines curativos y con efectos permanentes, de fácil aplicación. El más duradero y mejor tolerado fue la auriculoterapia, predominaron las mujeres de 21 a 30 años, obesas, ansiosas, fumadoras, tomadoras de café, té y píldoras anticonceptivas

Innovaciones en la atención de la salud sexual y reproductiva: dos Experiencias en Bolivia / sss

Los estudios de caso presentados aquí exploran características y experiencias de proyectos de atención y capacitación en salud de La Casa de la Mujer en Santa Cruz, Bolivia, y del Centro de Información y Desarrollo de la Mujer (CIDEM) en El Alto, Bolivia. El estudio hace parte de una serie de investigaciones apoyados por Family Health Internacional para describir proyectos de salud reproductiva que son innovadores y orientados hacía las mujeres...

Infección hospitalaria. Prevalencia puntual de venipunturas infectadas. Hospital Provincial Clínico Quirúrgico Docente. "Dr. Gustavo Aldereguía Lima". Marzo 1988. Cienfuegos

Se realiza una encuesta de prevalencia puntual de venipunturas infectadas a 489 pacientes ingresados en el Hopsital Clínico Quirúrgico Provincial Docente "Dr. Gustavo Aldereguía Lima". Marzo 1988. Cienfuegos.En 176 pacientes que recibieron una o varias venipunturas con la finalidad de perfundir líquidos en venase detectaron 53 infecciones locales, Flebitis y Celulitis, además de 12 cuadros clínicos clasificados como irritaciones o lesiones químicas no infectadas el labado de las manos y el incorrecto tratamiento de la piel del enfermo en el punto de puntura (AU)

Infección hospitalaria. Prevalencia puntual de venipunturas infectadas. Hospital Provincial Clínico Quirúrgico Docente. Dr. Gustavo Aldereguía Lima. Marzo 1988. Cienfuegos

Se realiza una encuesta de prevalencia puntual de venipunturas infectadas a 489 pacientes ingresados en el Hopsital Clínico Quirúrgico Provincial Docente "Dr. Gustavo Aldereguía Lima". Marzo 1988. Cienfuegos.En 176 pacientes que recibieron una o varias venipunturas con la finalidad de perfundir líquidos en venase detectaron 53 infecciones locales, Flebitis y Celulitis, además de 12 cuadros clínicos clasificados como irritaciones o lesiones químicas no infectadas el labado de las manos y el incorrecto tratamiento de la piel del enfermo en el punto de puntura