Safety of surgery: quality assessment of meta-analyses on the WHO checklist.

Objectives: To assess the quality of the meta-analyses that review the WHO surgical safety checklist. Methods: A systematic review of meta-analysis studies was undertaken using the search terms "World Health Organization Surgical Safety Checklist" in PubMed, Embase, and Lilacs databases. The selected meta-analyses were rated using the AMSTAR 2 assessment tool. Results: In the three meta-analyses evaluated, the checklist was associated with a decrease in the rates of complications and mortality. Overall confidence in the results of the evaluated meta-analysis was critically low. Conclusions: The meta-analysis coincides with obtaining lower complications and mortality rates with the WHO surgical safety checklist. However, the studies included in the meta-analyses were mostly observational, with potential biases, and according to the AMSTAR 2 tool, the overall confidence in the results of the evaluated studies was critically low.

In-situ acetylation followed by liquid-liquid extraction and gas chromatography - mass spectrometry for the determination of bromophenols in urine.

A novel and simple method combining in-situ acetylation, liquid-liquid extraction and gas chromatography-mass spectrometry (GC-MS) has been developed for the quantification of 10 bromophenols in urine, used as biomarkers of exposure to polybrominated diphenyl ethers. The analytical process involves an enzymatic hydrolysis of the bromophenol glucuronide fraction followed by an aqueous derivatization of the phenol group with acetic anhydride. A subsequent liquid-liquid extraction of the sample with hexane allows the injection of the organic layer, using a programmed temperature vaporizer, into a gas chromatograph coupled to a single quadrupole mass spectrometer. Quantification is performed by the standard addition method. Limits of detection are in the pg mL-1 range. Trueness, assessed in terms of percentages of recovery, varies between 100 % and 118 % in synthetic urine and between 79 % and 117 % in human urine. Precision, assessed at two different levels, 0.25 ng mL-1 and 2.5 ng mL-1, shows values of relative standard deviation below 14 % both in intra- and inter-day studies for both matrices. The method has been applied to the analysis of seven urine samples, measuring concentrations higher than the LOQ in three of them. These levels are in agreement with others found in literature, but they have been obtained by applying a much simpler and faster protocol. In addition, the replacement of silylating reagents by acetic anhydride, to derivatize the phenol moiety, provides a greener alternative to other GC-MS procedures published up to date.

Sentinel node in breast cancer as an indicator of quality in medical care: Evaluation of statistics in Colombia.

BACKGROUND: Sentinel lymph node biopsy in breast cancer is considered the standard of staging in cases of clinically negative lymph nodes. Its omission in favor of axillary dissection generates significant morbidity. OBJECTIVE: To determine the total number of sentinel node biopsy procedures in breast cancer in Colombia from 2017 through 2020, model and analyze them as if they were performed only in stage I breast cancer patients, and integrate their results into the concepts of quality of medical care. METHODS: Search in a database of the Ministry of Health and Social Protection of Colombia with sentinel lymph node biopsy codes, and filters of breast cancer and year. Their results are contrasted with the number of cases in stage I of breast cancer. RESULTS: Breast cancer TNM staging was reported in 22154 cases, 3648 stage I. In the same time frame, the number of sentinel lymph node biopsies for breast cancer in Colombia was 1045, 28.64% of the total cases reported in stage I. CONCLUSIONS: Colombia is far from complying with the standard indicator of sentinel lymph node biopsy. It is recommended to concentrate breast cancer cases in hospitals that provide the conditions for its performance.

Mortality from Breast Cancer in Women under 50 Years of Age in Colombia.

OBJECTIVE: To calculate and analyze the mortality rates from breast cancer in women under 50 years of age in Colombia and to compare them with those of other countries in the region. METHODS: Based on data from the registry of deaths in 2018 and the results of the National Population and Housing Census of Colombia for the same year, specific mortality rates in women with breast cancer, specific mortality according to age group, standardized by age, proportional mortality, potential years of life lost, and years of life expectancy lost in women under 50 years of age who died from breast cancer were calculated. The mortality rate of regional countries was consulted on the Global Cancer Observatory webpage. RESULTS: In the group from 20 to 49 years, the specific mortality rate was higher in the age range from 45 to 49 years, with a rate of 23.42 × 100,000, a value that was above the specific mortality rate due to breast cancer in women in Colombia, 15.17 × 100.000. In the age range of 45 to 49 years, the potential years of life lost were 42.16. Of the 0.275 years of life expectancy lost by the population due to this neoplasia, women under 50 years of age represented 0.091 (33%). Colombia is the fifth in the rank of mortality in Latin American countries in this age group. CONCLUSION: Breast cancer in patients from 30 to 59 years is the number one cause for the decrease in life expectancy of women in Colombia. Women under 50 years of age represent one third of this decrease. This neoplasm is also the leading cause of mortality in women younger than 50 years in South America.

Ultrasound-Assisted Extraction, Followed by Gas Chromatography-Mass Spectrometry for the Simultaneous Quantification of Ethinyl Estradiol and Drospirenone in Contraceptive Formulations.

Contraceptive tablets typically contain a combination of two synthetic versions of an estrogen and a progestogen, which work together to inhibit the ovulation process. An accurate and precise quantification of these components is essential for contraceptive producers. In this study, we have developed the first gas chromatography-mass spectrometry (GC-MS) method for the simultaneous quantification of 17α-ethinyl estradiol (EE) and drospirenone (DP) in contraceptive formulations. Under the final working conditions, analytes were extracted from the solid by ultrasound-assisted extraction (15 min) in methanol. The resulting suspension was diluted in ethyl acetate, subjected to centrifugation and, finally, the supernatant was directly injected into the GC-MS system. No derivatization reagents were utilized. To correct for instrumental variations, calibration was performed using the internal standard method, with cholesterol as the internal standard. A good linearity was achieved throughout the calibration range for both EE (3-12 µg mL-1) and DP (300-1200 µg mL-1), with R2 values exceeding 0.99. Trueness, assessed in terms of percentages of recovery, was also found to be satisfactory for both analytes, with recovery rates of 106 ± 8% for EE and 93 ± 9% for DP. Furthermore, intra-day and inter-day precision studies yielded relative standard deviation values below 6% for both analytes. In terms of sensitivity, the instrumental limits of detection were 0.25 µg mL-1 for EE and 6.6 µg mL-1 for DP, and the instrumental limits of quantification 0.82 µg mL-1 for EE and 22 µg mL-1 for DP. The method was successfully applied to the analysis of contraceptive tablets from three different pharmaceutical companies. No differences were observed between the measured and the declared amount of active principle per tablet, demonstrating the applicability of the procedure. In addition, a stability study conducted on both the standards and sample extracts demonstrated that they can be stored at room temperature for a minimum period of seven days.

Assessing the impact of a major electronic music festival on the consumption patterns of illicit and licit psychoactive substances in a Mediterranean city using wastewater analysis.

The consumption patterns of five categories of psychoactive substances (PS), including "conventional" illicit drugs, new psychoactive substances (NPS), therapeutic opioids, alcohol and nicotine, were studied in the city of Split, Croatia, using wastewater-based epidemiology (WBE), with an emphasis on the impact of a large electronic music festival. The study involved the analysis of 57 urinary biomarkers of PS in raw municipal wastewater samples collected in three characteristic periods, including the festival week in the peak-tourist season (July) and reference weeks in the peak-tourist season (August) and the off-tourist season (November). Such a large number of biomarkers allowed the recognition of distinct patterns of PS use associated with the festival, but also revealed some subtle differences between summer and autumn seasons. The festival week was characterized by markedly increased use of illicit stimulants (MDMA: 30-fold increase; cocaine and amphetamine: 1.7-fold increase) and alcohol (1.7-fold increase), while consumption of other common illicit drugs (cannabis and heroin), major therapeutic opioids (morphine, codeine and tramadol) and nicotine remained rather constant. Interestingly, NPS and methamphetamine clearly contributed to the festival PS signature in wastewater, but their prevalence was rather low compared to that of common illicit drugs. Estimates of cocaine and cannabis use were largely consistent with prevalence data from national surveys, whereas differences were found for typical amphetamine-type recreational drugs, particularly MDMA, and for heroin. The WBE data suggest that the largest proportion of morphine came from heroin consumption and that the percentage of heroin users seeking treatment in Split is probably rather low. The prevalence of smoking calculated in this study (30.6 %) was consistent with national survey data for 2015 (27.5-31.5 %), while the average alcohol consumption per capita >15 years (5.2 L) was lower than sales statistics suggest (8.9 L).

Comparative analyses of holder pasteurization vs. HTST pasteurization for donor milk: a cost-minimization study applicable to human milk banks.

BACKGROUND: High-temperature short-time (HTST) pasteurization (72-75 °C, 15 s) is an alternative treatment to traditional Holder pasteurization (HoP) (62ºC, 30 min) for donor milk. HTST pasteurization guarantees the milk's microbiological safety and retains more of its biologically and nutritionally active compounds, but the cost of implementing this technology for a human milk bank is unknown. METHODS: A cost-minimization study was carried out on the facilities of a regional human milk bank in a public hospital. Total production costs (fixed plus variables) were quantified using HTST pasteurization and HoP in three hypothetical scenarios: (1) costs of the first 10 L of pasteurized milk in a newly opened milk bank; (2) costs of the first 10 L of pasteurized milk in an active milk bank; and (3) costs using the maximum production capacity of both technologies in the first two years of operation. The following costs were analyzed: health care professionals, equipment and software, external services, and consumables. RESULTS: In scenario 1, the total production costs were € 228,097.00 for the HTST method versus € 154,064.00 for the HoP method. In scenario 2, these costs were similar (€ 6,594.00 for HTST pasteurization versus € 5,912.00 for HoP). The cost of healthcare professionals was reduced by more than half when pasteurization was carried out by the HTST method versus the Holder method (€ 84.00 and € 191.00, respectively). In scenario 3, the unit cost of milk pasteurized by the HTST method decreased from the first to the second year by 43.5%, while for the HoP method, it decreased by 30%. CONCLUSIONS: HTST pasteurization requires a high initial investment in equipment; however, it provides a significant minimization of production costs in the long term, pasteurizes large quantities of donor milk per working day and achieves a more efficient management of the time of the health care professionals in charge of the bank's operation compared to HoP.

Use of a guard column coupled to mass spectrometry as a fast semi-quantitative methodology for the determination of plasticizer metabolites in urine.

For the first time, a very simple and fast method combining the use of a guard column coupled to tandem mass spectrometry (guard column-MS/MS) has been proposed for the determination of plasticizer metabolites in urine. Briefly, samples (1.0 mL) were submitted to enzymatic hydrolysis for 10 min, filtered, diluted 1/10 v/v with ultrapure water and directly injected into the system. A fast run of only 2 min (3 min including the injection cycle) allowed the determination of 19 analytes. Enzymatic hydrolysis, filtering material, and guard column-MS/MS conditions were optimized. Intra-day precision at the low-level concentration (expressed as relative standard deviation, %RSD) obtained from the analysis of synthetic urine samples varied between 11 and 20%. Limits of quantification ranged from 2.8 to 60 ng/mL. Trueness values, calculated as apparent recoveries, ranged from 70 to 135%. To correct for matrix effects, analyte concentrations in real urine were quantified by the standard addition method. To confirm the results obtained by guard column-MS/MS, an ultra(high)-performance liquid chromatography tandem mass spectrometry (UHPLC-MS/MS) method was also applied (total chromatographic run time 17 min, including column re-equilibration). Concentrations measured with both methods were in good agreement. Hence, we propose the use of guard column-MS/MS to analyse a large number samples in a very short time (semi-quantification), and apply the chromatographic analysis only to those samples with levels close to/higher than the concentrations equivalent to the safe maximum daily intakes of the parent compounds (confirmation). This double strategy (semi-quantification by guard column-MS/MS and confirmation-when needed-by UHPLC-MS/MS) implies important savings in time and money.

Virus en el tratamiento de cáncer de mama / Viruses in the treatment of breast cancer

Resumen OBJETIVO: Sintetizar las conclusiones de artículos que estudiaron la aplicación de virus en el tratamiento de cáncer de mama humano. METODOLOGÍA: Búsqueda bibliográfica de artículos registrados en PubMed, sin uso de filtros, efectuada en el mes de noviembre de 2019 con los términos: oncolytic virus in breast cancer. Los artículos seleccionados se agruparon en cuadros según el tipo de virus. Se obtuvieron datos del primer autor, año de publicación, vector y conclusiones principales. RESULTADOS: Se encontraron 271 publicaciones de las que se excluyeron 128 en el cribado por título y resumen, 31 por tratarse de artículos de revisión. Si bien no hubo restricción por idioma, se excluyó un artículo en chino y seis cuyo objetivo principal fue el estudio del cáncer de mama en caninos. Las demás exclusiones se hicieron por falta de vínculo con el tema objeto de revisión. De los 143 artículos seleccionados para lectura completa se excluyeron 17 por no ser pertinentes con el objetivo, lo mismo que una comunicación breve. CONCLUSIONES: La información seleccionada de virus para tratamiento de pacientes con cáncer de mama proviene casi toda de investigación preclínica con respuestas que favorecen la acción experimental de los oncovirus. En los estudios de investigación clínica, los resultados aún son escasos, pero insinúan su potencial de desarrollo, sobre todo en combinación con oncovirus o con otros agentes terapéuticos.

Abstract OBJECTIVE: To synthesise the findings of articles that studied the application of viruses in the treatment of human breast cancer. METHODOLOGY: Bibliographic search of articles registered in PubMed, without the use of filters, carried out in November 2019 with the terms: oncolytic virus in breast cancer. The selected articles were grouped in tables according to the type of virus. Data were obtained on the first author, year of publication, vector and main conclusions. RESULTS: With the search terms, 271 publications were found. Of these, 128 were excluded in the screening by title and abstract, 31 of them because they were review articles. Although there was no language restriction, one article in Chinese and six whose main objective was the study of canine breast cancer were excluded. The other exclusions were made because they were not associated with the subject under review. Among the 143 articles that were selected for full reading, 17 of them were also excluded as not relevant for the purpose of this review and one because it was a short communication. CONCLUSIONS: The selected data on viruses for the treatment of breast cancer patients comes almost entirely from preclinical research with responses favoring the experimental action of oncoviruses. In clinical research studies, results are still scarce, but hint at their potential for development, especially in combination with oncoviruses or other therapeutic agents.

Tomosíntesis digital para el cribado de cáncer de mama, revisión sistemática y evaluación de la calidad de los metaanálisis / Digital tomosynthesis for breast cancer screening. Systematic review and quality assessment of meta-analyses

Objetivo: revisar y evaluar los metaanálisis sobre la tomosíntesis digital para el cribado del cáncer de mama. Métodos: se realizó una revisión sistemática de los estudios de metaanálisis utilizando los términos de búsqueda «Digital breast tomosynthesis for breast cancer screening» en las bases de datos PubMed y Embase. Los metaanálisis finalmente seleccionados se calificaron con la herramienta de evaluación AMSTAR 2. Resultados: las búsquedas en las bases de datos encontraron 195 artículos de los cuales, después del cribado y la lectura completa de los artículos seleccionados, finalmente se extrajeron 5 para análisis cualitativo. La calificación de los metaanálisis revisadoscon la herramienta de evaluación AMSTAR 2 encontró que la confianza general de sus resultados es críticamente baja. Conclusiones: los metaanálisis evaluados concluyeron en que hay un aumento en la tasa de detección del cáncer con la inclusión de la tomosíntesis digital en el cribado del cáncer de mama. Sin embargo, este estudio encontró con el uso de la herramienta de evaluación AMSTAR 2, que los resultados de los metaanálisis evaluados, no son confiables en el resumen que hacen de sus estudios. (AU)

Objective: To review and evaluate meta-analyzes on digital tomosynthesis for breast cancer screening. Methods: A systematic review of meta-analyzes studies was undertaken using the search terms “Digital breast tomosynthesis for breast cancer screening” in PubMed and Embase databases. The finally selected meta-analyzes were rated with the AMSTAR 2 assessment tool. Results: The database searches found 195 articles of which after screening and full readings of articles selected, five of them were finally extracted for qualitative analysis. The rating of the meta-analyzes reviewed with the AMSTAR 2 assessment tool found the overall confidence of their results is critically low. Conclusions: The meta-analyzes evaluated concluded that there is an increase in the cancer detection rate with the inclusion of digital tomosynthesis in breast cancer screening. However, this study found with the use of the AMSTAR 2 evaluation tool that the results of the evaluated meta-analyzes are not reliable in the summary they make of their studies. (AU)

Concordancia entre observadores en el diagnóstico de atipia epitelial plana. Revisión sistemática / Interobserver agreement in the diagnosis of flat epithelial atypia. A systematic review

Objetivo: Revisar la concordancia entre patólogos en el diagnóstico de atipia epitelial plana de mama.MétodosRevisión sistemática de artículos registrados en la base de datos de Pubmed, Scopus y Embase con los términos «pathologists» y «flat epithelial atypia», «flat epithelial atypia» e «interobserver variability», «interobserver agreement in flat epithelial atypia» (Scopus y Embase) y en la base de datos Lilacs con los términos en español «patólogos» y «atipia epitelial plana», buscando artículos con valoración de concordancia entre observadores en el diagnóstico de atipia epitelial plana mediante el coeficiente kappa. Se excluyeron artículos de revisión, resúmenes de congresos y comentarios.ResultadosCon los términos de búsqueda se encontraron 140 publicaciones. De estas, se excluyeron 121 en el cribado por título y resumen. De la revisión restante de artículos completos, fueron seleccionados 5 para análisis cualitativo. Los valores kappa variaron desde un acuerdo regular, kappa=0,39 en residentes y patólogos en entrenamiento sin aplicación de tutorial hasta un acuerdo casi perfecto de 0,83 en patólogos con un interés especial en patología mamaria y tutorial previo.ConclusionesEste estudio revisa la reproducibilidad entre observadores en el diagnóstico de atipia epitelial plana en biopsias de mama. Una baja concordancia puede darse principalmente en centros que no disponen de patólogos experimentados. Un proceso de enseñanza previo reduce la posibilidad de error, pero preferentemente se deberían remitir estos casos a centros especializados para revisión y diagnóstico. (AU)

Objective: To review the agreement between pathologists in the diagnosis of flat epithelial atypia of the breast.MethodsWe performed a systematic review of articles with the terms “pathologists” and “flat epithelial atypia”, “flat epithelial atypia” and “interobserver variability” registered in the Pubmed, Scopus and Embase databases, those with the terms “interobserver agreement in flat epithelial atypia” in Scopus and Embase, and those with the terms “pathologists” and “flat epithelial atypia” in the Lilacs database. We sought articles with interobserver variability assessment in the diagnosis of flat epithelial atypia using the kappa coefficient. We excluded review articles, conference abstracts and comments.ResultsA total of 140 publications were identified with the search terms. Of these, 121 were excluded in the screening after reading the title and abstract. Of the remaining review of full-text articles, 5 were selected for qualitative analysis. The kappa values ranged from fair agreement, Kappa=0.39 in residents and pathologists in training not receiving prior training, to near perfect agreement of 0.83 in pathologists with a special interest in breast pathology and prior training.ConclusionsThis study reviews the interrater agreement in the diagnosis of flat epithelial atypia in breast biopsies. Low reproducibility occurs mainly in centres without experienced pathologists. A prior teaching process reduces the possibility of error, but these cases should preferably be referred to specialised centres for review and diagnosis. (AU)

Analysis of the Effects of Lockdown on Staff and Students at Universities in Spain and Colombia Using Natural Language Processing Techniques.

The aim of this study is to analyze the effects of lockdown using natural language processing techniques, particularly sentiment analysis methods applied at large scale. Further, our work searches to analyze the impact of COVID-19 on the university community, jointly on staff and students, and with a multi-country perspective. The main findings of this work show that the most often related words were "family", "anxiety", "house", and "life". Besides this finding, we also have shown that staff have a slightly less negative perception of the consequences of COVID-19 in their daily life. We have used artificial intelligence models such as swivel embedding and a multilayer perceptron as classification algorithms. The performance that was reached in terms of accuracy metrics was 88.8% and 88.5% for students and staff, respectively. The main conclusion of our study is that higher education institutions and policymakers around the world may benefit from these findings while formulating policy recommendations and strategies to support students during this and any future pandemics.

Inter-observer agreement in the diagnosis of breast atypical ductal hyperplasia: A systematic review.

OBJECTIVE: To review the concordance between pathologists in the diagnosis of atypical ductal hyperplasia of the breast. METHODS: Systematic review of articles registered in the PubMed database with the terms "pathologists" and "atypical ductal hyperplasia", "atypical ductal hyperplasia" and "interobserver variability", in Embase with "interobserver agreement in atypical ductal hyperplasia" and Lilacs with the terms in Spanish "patólogos" and "hiperplasia ductal atípica", without the use of filters, between 03/16/2022 and 03/26/2022 searching for articles that assess inter-observer agreement in the diagnosis of atypical ductal hyperplasia by using the kappa statistic. Review articles, conference proceedings, and commentaries were excluded. RESULTS: With the search terms, 507 publications were found. Of these, 491 were excluded from the screening by title and abstract. Of the full reading of the remaining articles, 6 were selected for qualitative analysis. The kappa values ranged from slight agreement, kappa = 0.17, to substantial agreement, 0.69 obtained from pathologists dedicated or experienced in breast pathology and who received a prior tutorial session to review the general criteria for atypia. CONCLUSIONS: This study reviews the reproducibility in the diagnosis of atypical ductal hyperplasia. A better concordance was obtained with a previous teaching process offered to pathologists dedicated or experienced in breast pathology.

Source identification of amphetamine-like stimulants in Spanish wastewater through enantiomeric profiling.

Amphetamine (AMP), methamphetamine (MAMP) and 3,4-methylenedioxymethamphetamine (MDMA) occur in wastewater not only as a result of illicit consumption, but also, in some cases, from prescription drug use or by direct drug disposal into the sewage system. Enantiomeric profiling of these chiral drugs could give more insight into the origin of their occurrence. In this manuscript, a new analytical methodology for the enantiomeric analysis of amphetamine-like substances in wastewater has been developed. The method consists of a solid-phase extraction (SPE) followed by liquid chromatography-triple quadrupole-tandem mass spectrometry (LC-MS/MS), which showed low quantification limits in the 2.4-5.5 ng L-1 range. The LC-MS/MS method was first applied to characterize a total of 38 solid street drug samples anonymously provided by consumers. The results of these analysis showed that AMP and MDMA trafficked into Spain are synthesized as racemate, while MAMP is exclusively produced as the S(+)-enantiomer. Then, the analytical method was employed to analyse urban wastewater samples collected from the wastewater treatment plants (WWTPs) of five different cities in 2018 and 2019. Consumption estimated through normalized population loads in wastewater showed an increased pattern of AMP use in the Basque Country. Furthermore, the enantiomeric profiling of wastewater samples was contrasted to lisdexamfetamine (LIS) and selegiline (SEL) prescription figures, two pharmaceuticals which metabolize to S(+)-AMP, and to R(-)-AMP and R(-)-MAMP, respectively. From this analysis, and considering uncertainties derived from metabolism and adherence to treatment, it was concluded that LIS is a relevant source of AMP in those cases with low wastewater loads, i.e. up to a maximum of 60% of AMP detected in wastewater in some samples could originate from LIS prescription, while SEL does not represent a significant source of AMP nor MAMP. Finally, removal efficiencies could be evaluated for the WWTP (serving ca. 860,000 inhabitants) with higher AMP influent concentrations. The removal of AMP was satisfactory with rates higher than 99%, whereas MDMA showed an average removal of approximately 60%, accompanied by an enrichment of R(-)-MDMA.

Comparación entre las clasificaciones de hiperplasia endometrial. Revisión sistemática y evaluación de calidad / Comparison between endometrial hyperplasia classifications. Systematic review and quality evaluation

RESUMEN Antecedentes: La hiperplasia endometrial se clasifica actualmente en hiperplasia sin atipia o benigna y en lesión precancerosa, hiperplasia atípica / neoplasia intraepitelial endometrioide o EIN, según dos sistemas, el de la Organización Mundial de la Salud (OMS) que modificó sus anteriores clasificaciones en 2014 -aunque la de 1994 sigue siendo muy usaday el sistema de neoplasia intraepitelial endometrial (EIN). Aún no está claro qué sistema de clasificación de la hiperplasia endometrial debe utilizarse para el control y tratamiento de las pacientes. Objetivo: Revisar y evaluar metaanálisis que comparen los sistemas de clasificación para la hiperplasia endometrial de la Organización Mundial de la Salud y el sistema EIN. Métodos: Revisión sistemática de estudios de metaanálisis utilizando los términos de búsqueda 'hiperplasia endometrial' en las bases de datos PubMed, Embase y Lilacs. Los metaanálisis finalmente seleccionados se calificaron con la herramienta de evaluación AMSTAR 2. Resultados : Se encontraron 154 artículos de los cuales, después de selección y lectura completa, finalmente se extrajeron tres para análisis cualitativo. La calificación de los metaanálisis revisados con la herramienta de evaluación AMSTAR 2 encontró que la confianza general de sus resultados fue críticamente baja. Conclusiones : Los datos muestran que la morfometría objetiva en el sistema EIN es más confiable que los criterios de la OMS para evaluar el riesgo de progresión de la hiperplasia endometrial a cáncer. La comparación entre el sistema de la OMS y el sistema subjetivo de EIN dio como resultado valores pronósticos similares. Otro metaanálisis mostró una clara discrepancia entre el sistema de la OMS de 1994 y el sistema EIN. La evaluación mediante la herramienta de evaluación AMSTAR-2 mostró que la confianza general en los resultados de los estudios evaluados fue críticamente baja.

ABSTRACT Background : Endometrial hyperplasia is currently classified into non-atypical or benign hyperplasia and precancerous lesion, atypical hyperplasia/endometrioid intraepithelial neoplasia or EIN, according to two systems, the World Health Organization (WHO) which modified its previous classifications in 2014 -although the 1994 classification is still widely usedand the endometrial intraepithelial neoplasia (EIN) system. It is still unclear which classification system for endometrial hyperplasia should be used for patient management and treatment. Objective : To review and evaluate meta-analyses comparing the World Health Organization classification systems for endometrial hyperplasia and the EIN system. Methods : Systematic review of meta-analysis studies using the search terms "endometrial hyperplasia" in PubMed, Embase and Lilacs databases. The meta-analyses finally selected were scored using the AMSTAR 2 assessment tool. Results : We found 154 articles of which, after selection and complete reading, three were finally extracted for qualitative analysis. The rating of the meta-analyses reviewed with the AMSTAR 2 assessment tool found that the overall confidence of their results was critically low. Conclusions : The data show that objective morphometry in the EIN system is more reliable than the WHO criteria for assessing the risk of progression of endometrial hyperplasia to cancer. Comparison between the WHO system and the subjective EIN system resulted in similar prognostic values. Another meta-analysis showed a clear discrepancy between the 1994 WHO system and the EIN system. Evaluation using the AMSTAR-2 assessment tool showed that the overall confidence in the results of the evaluated studies was critically low.

Hospital and outpatient models for Hematopoietic Stem Cell Transplantation: A systematic review of comparative studies for health outcomes, experience of care and costs.

The number of Hematopoietic Stem Cell Transplantations has risen in the past 20 years. The practice of outpatient Hematopoietic Stem Cell Transplantation programs is increasing in an attempt to improve the quality of patient care and reduce the demand for hospital admission. A systematic review of 29 comparative studies between in-hospital and outpatient treatment of Hematopoietic Stem Cell Transplantation, with no restriction by outpatient regime was conducted. This study aims to analyse the current evidence on the effects of the outpatient model on patient-centred outcomes, comparing both in-hospital and outpatient models for autologous and allogeneic HSCT using the Triple Aim framework: health outcomes, costs and experience of care. We found evidence on improved health outcomes and quality of life, on enhanced safety and effectiveness and on reduced overall costs and hospital stays, with similar results on overall survival rates comparing both models for autologous and allogeneic patients. We also found that the outpatient Hematopoietic Stem Cell Transplantation is a safe practice as well as less costly, it requires fewer days of hospital stay both for autologous and allogeneic transplantations. Under a situation of an increasing number of transplants, rising healthcare costs and shortages of hospital capacity, incorporating outpatient models could improve the quality of care for people requiring Hematopoietic Stem Cell Transplantation programs.

The Impact of COVID 19 on University Staff and Students from Iberoamerica: Online Learning and Teaching Experience.

(1) Background: The COVID-19 pandemic has created a great impact on mental health in society. Considering the little attention paid by scientific studies to either students or university staff during lockdown, the current study has two aims: (a) to analyze the evolution of mental health and (b) to identify predictors of educational/professional experience and online learning/teaching experience. (2) Methods: 1084 university students and 554 staff in total from four different countries (Spain, Colombia, Chile and Nicaragua) participated in the study, affiliated with nine different universities, four of them Spanish and one of which was online. We used an online survey known as LockedDown, which consists of 82 items, analyzed with classical multiple regression analyses and machine learning techniques. (3) Results: Stress level and feelings of anxiety and depression of students and staff either increased or remained over the weeks. A better online learning experience for university students was associated with the age, perception of the experience as beneficial and support of the university. (4) Conclusions: The study has shown evidence of the emotional impact and quality of life for both students and staff. For students, the evolution of feelings of anxiety and depression, as well as the support offered by the university affected the educational experience and online learning. For staff who experienced a positive professional experience, with access to services and products, the quality-of-life levels were maintained.

Primary lymphoma of the uterine cervix: case report

ABSTRACT Introduction: Primary lymphoma of the uterine cervix is a rare disease, with nonspecific symptoms, that seldom alters Pap smear results since it develops in the cervical stroma. Chemotherapy, radiation therapy, and surgery, as well as their combination, are some of the medical options available for treatment. The unique location of the lymphoma in the cervix is considered a good prognostic factor. Case presentation: A 49-year-old female patient consulted due to pelvic pain and vaginal discharge and bleeding. She underwent a colposcopy due to cytology findings of ASC-H (atypical squamous cells that do not exclude high-grade squamous intraepithelial lesions). The biopsy reported diffuse large B-cell lymphoma, which was initially treated with three cycles of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone, and was then switched to two cycles with rituximab, ifosfamide, carboplatin and etoposide due to a poor response with the first scheme. A new biopsy was performed after the last cycle of chemotherapy with a report of endocervical polyp and abundant clusters of glandular cells with focal atypia. Post-treatment diagnostic imaging studies reported concentric thickening of the cervix-vagina junction. Seven years after being diagnosed with lymphoma, another biopsy was performed. The result was negative for dysplasia or malignancy. At the time of writing this case report, 10 years after diagnosis, the patient is asymptomatic and disease-free. Conclusions: Primary lymphoma of the uterine cervix is an unusual condition that is rarely detected through an abnormal Pap smear result, as in this case. A colposcopy was done because of this finding, confirming the diagnosis of diffuse large B-cell lymphoma. This case report describes the satisfactory evolution of the patient and disease-free survival after 10 years.

RESUMEN Introducción. El linfoma primario del cuello uterino es una patología infrecuente, de síntomas inespecíficos y que pocas veces altera el examen de citología del cuello uterino dado que se desarrolla en el estroma cervical. Para su tratamiento existen varias opciones, incluyendo quimioterapia, radioterapia y cirugía, así como combinaciones de estas. La localización única del linfoma en el cuello uterino se considera un factor de buen pronóstico. Presentación del caso. Paciente femenina de 49 años, quien consultó por dolor pélvico y flujo y sangrado genital. Se ordenó colposcopia por reporte de ASC-H (células escamosas atípicas que no excluyen lesiones intraepiteliales de alto grado) en citología vaginal. La biopsia reportó linfoma difuso de células B grandes, el cual se trató con rituximab, ciclofosfamida, doxorrubicina, vincristina y prednisolona por tres ciclos, y con rituximab, ifosfamida, carboplatino y etopósido por dos ciclos; este cambio se hizo debido a una mala respuesta con el primer esquema. Se realizó nueva biopsia después del último ciclo de quimioterapia con reporte de pólipo de tipo endocervical y abundantes grupos de células glandulares con atipia focal. Los estudios de imágenes diagnósticas posteriores al tratamiento reportaron engrosamiento concéntrico de la unión entre cuello uterino y vagina. A los 7 años del diagnóstico del linfoma se realizó otra biopsia que resultó negativa para displasia o malignidad. Al momento de la elaboración del presente reporte, 10 años después del diagnóstico, la paciente se encontraba asintomática y libre de enfermedad. Conclusiones. El linfoma primario del cuello uterino es una patología rara que en pocas oportunidades se evidencia con anormalidad en la citología vaginal como en el caso reseñado. Dado este hallazgo se realizó una colposcopia mediante la cual se confirmó el diagnostico de linfoma difuso de células B grandes. Se presenta un caso con evolución satisfactoria y supervivencia libre de enfermedad después de 10 años.