Role of Low-Risk HPV PCR Monoinfection in Screening for HSIL and Anal Cancer in Men Who Have Sex with Men Living with HIV.

To determine the value of low-risk human papillomavirus (HPV) PCR to screen for "high-grade anal squamous intraepithelial lesion and anal cancer" (HSIL-plus), rate of patients with low-grade anal squamous intraepithelial lesion (LSIL) progressing to HSIL-plus, and progression-related factors. Prospective, longitudinal study of consecutive MSM-LHIV attended between May 2010 and December 2021 and followed for 43 months (IQR: 12-76). HIV-related variables were gathered at baseline, performing anal cytology for HPV detection/genotyping, thin-layer cytological study, and high-resolution anoscopy (HRA). Follow-up was annual when HRA was normal or LSIL, and post-treatment in cases of HSIL-plus, re-evaluating sexual behavior, viral-immunological status, and HPV infection of anal mucosa. The 493 participants had mean age of 36 years: CD4 nadir < 200 cells/uL in 23.1%, virological failure in 4.1%, and tetravalent HPV vaccine > 5 years earlier in 15%. HSIL-plus was ruled out in patients with monoinfection by low-risk HPV genotype and normal cytology (100% sensitivity, 91.9% specificity, PPV 2.9%, and NPV 100%). Progression from LISL to HSIL-plus occurred in 4.27% of patients within 12 months (IQR: 12-12): risk factors were acquisition of high-risk (HR: 4.15; 95% CI: 1.14-15.03) and low-risk (HR: 3.68 95% CI: 1.04-12.94) HPV genotypes, specifically genotype 6 (HR: 4.47, 95% CI: 1.34-14.91), and history of AIDS (HR: 5.81 95% CI: 1.78-18.92). Monoinfection by LR-HPV genotypes in patients with normal cytology is not associated with anal cancer or precursor lesions. Progression from LSIL to HSIL-plus, observed in <5% of patients, was related to acquisition of HR and LR HPV genotypes, especially 6, and a history of AIDS.

Risk factors for ≥high-grade anal intraepithelial lesions in MSM living with HIV and the response to topical and surgical treatments.

BACKGROUND: The objective of this study in MSM living with HIV was to determine the incidence of HSIL and ASCC, related factors, and the response to treatment. PATIENTS AND METHODS: Data were gathered in 405 consecutive HIV-infected MSM (May 2010-December 2018) at baseline and annually on: sexual behavior, anal cytology, and HPV PCR and/or high-resolution anoscopy results. They could choose mucosectomy with electric scalpel (from May 2010) or self-administration of 5% imiquimod 3 times weekly for 16 weeks (from November 2013). A multivariate logistic regression model was developed for ≥HSIL-related factors using a step-wise approach to select variables, with a significance level of 0.05 for entry and 0.10 for exit, applying the Hosmer-Lemeshow test to assess the goodness of fit. RESULTS: The study included 405 patients with a mean age of 36.2 years; 56.7% had bachelor´s degree, and 52.8% were smokers. They had a mean of 1 (IQR 1-7) sexual partner in the previous 12 months, median time since HIV diagnosis of 2 years, and mean CD4 nadir of 367.9 cells/uL; 86.7% were receiving ART, the mean CD4 level was 689.6 cells/uL, mean CD4/CD8 ratio was 0.77, and 85.9% of patients were undetectable. Incidence rates were 30.86/1,000 patient-years for ≥high squamous intraepithelial lesion (HSIL) and 81.22/100,000 for anal squamous cell carcinoma (ASCC). The ≥HSIL incidence significantly decreased from 42.9% (9/21) in 2010 to 4.1% (10/254) in 2018 (p = 0.034). ≥HSIL risk factors were infection with HPV 11 (OR 3.81; 95%CI 1.76-8.24), HPV 16 (OR 2.69, 95%CI 1.22-5.99), HPV 18 (OR 2.73, 95%CI 1.01-7.36), HPV 53 (OR 2.97, 95%CI 1.002-8.79); HPV 61 (OR 11.88, 95%CI 3.67-38.53); HPV 68 (OR 2.44, CI 95% 1.03-5.8); low CD4 nadir (OR1.002; 95%CI 1-1.004) and history of AIDS (OR 2.373, CI 95% 1.009-5.577). Among HSIL-positive patients, the response rate was higher after imiquimod than after surgical excision (96.7% vs 73.3%, p = 0.009) and there were fewer re-treatments (2.7% vs 23.4%, p = 0.02) and adverse events (2.7% vs 100%, p = 0.046); none developed ASCC. CONCLUSIONS: HSIL screening and treatment programs reduce the incidence of HSIL, which is related to chronic HPV infection and poor immunological status. Self-administration of 5% imiquimod as first-line treatment of HSIL is more effective than surgery in HIV+ MSM.

Baricitinib en el tratamiento de infección por SARS-CoV-2 / Baricitinib in the treatment of SARS-CoV-2 infection

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Learning cardiopulmonary resuscitation theory with face-to-face versus audiovisual instruction for secondary school students: a randomized controlled trial. / Ensayo clínico aleatorizado controlado que compara la formación presencial frente a la no presencial en el aprendizaje teórico de la reanimación cardiopulmonar entre los estudiantes de secundaria.

OBJECTIVES: To compare secondary students' learning of basic life support (BLS) theory and the use of an automatic external defibrillator (AED) through face-to-face classroom instruction versus educational video instruction. MATERIAL AND METHODS: A total of 2225 secondary students from 15 schools were randomly assigned to one of the following 5 instructional groups: 1) face-to-face instruction with no audiovisual support, 2) face-to-face instruction with audiovisual support, 3) audiovisual instruction without face-to-face instruction, 4) audiovisual instruction with face-to-face instruction, and 5) a control group that received no instruction. The students took a test of BLS and AED theory before instruction, immediately after instruction, and 2 months later. RESULTS: The median (interquartile range) scores overall were 2.33 (2.17) at baseline, 5.33 (4.66) immediately after instruction (P<.001) and 6.00 (3.33) (P<.001). All groups except the control group improved their scores. Scores immediately after instruction and 2 months later were statistically similar after all types of instruction. CONCLUSION: No significant differences between face-to-face instruction and audiovisual instruction for learning BLS and AED theory were found in secondary school students either immediately after instruction or 2 months later.

OBJETIVO: Comparar la formación presencial, mediante una clase teórica, frente a la formación no presencial, con un método audiovisual con y sin refuerzo posterior, en el aprendizaje teórico del soporte vital básico (SVB) y el desfibrilador externo automático (DEA) entre los estudiantes de secundaria. METODO: Se llevó a cabo un ensayo clínico aleatorizado que incluyó a 2.225 estudiantes de secundaria procedentes de 15 centros educativos que fueron asignados al azar a uno de los siguientes cinco grupos: 1) Grupo formación presencial sin refuerzo; 2) Grupo formación presencial con refuerzo; 3) Grupo formación audiovisual sin refuerzo; 4) Grupo formación audiovisual con refuerzo; 5) Grupo control. Se realizó un test sobre aspectos teóricos del SVB y DEA antes, después y a los 2 meses de la estrategia formativa. RESULTADOS: Los resultados mostraron diferencias estadísticamente significativas en todos los grupos, excepto el grupo control, entre la puntuación obtenida en el test basal 2,33 (RIC 2,17) y el test inmediato 5,33 (RIC 4,66) (p < 0,001), y entre el test basal y el test final 6,00 (RIC 3,33) (p < 0,001). No hubo diferencias en el aprendizaje inmediato y a los 2 meses entre los diferentes tipos de formaciones. CONCLUSIONES: No se encontraron diferencias entre la formación presencial mediante charlas teóricas y la formación no presencial con método audiovisual en el aprendizaje teórico inmediato y a los dos meses en el aprendizaje teórico del SVB y el DEA entre los estudiantes de secundaria.

Ensayo clínico aleatorizado controlado que compara la formación presencial frente a la no presencial en el aprendizaje teórico de la reanimación cardiopulmonar entre los estudiantes de secundaria / Learning cardiopulmonary resuscitation theory with face-to-face versus audiovisual instruction for secondary school students: a randomized controlled trial

Objetivo. Comparar la formación presencial, mediante una clase teórica, frente a la formación no presencial, con un método audiovisual con y sin refuerzo posterior, en el aprendizaje teórico del soporte vital básico (SVB) y el desfibrilador externo automático (DEA) entre los estudiantes de secundaria. Método. Se llevó a cabo un ensayo clínico aleatorizado que incluyó a 2.225 estudiantes de secundaria procedentes de 15 centros educativos que fueron asignados al azar a uno de los siguientes cinco grupos: 1) Grupo formación presencial sin refuerzo; 2) Grupo formación presencial con refuerzo; 3) Grupo formación audiovisual sin refuerzo; 4) Grupo formación audiovisual con refuerzo; 5) Grupo control. Se realizó un test sobre aspectos teóricos del SVB y DEA antes, después y a los 2 meses de la estrategia formativa. Resultados. Los resultados mostraron diferencias estadísticamente significativas en todos los grupos, excepto el grupo control, entre la puntuación obtenida en el test basal 2,33 (RIC 2,17) y el test inmediato 5,33 (RIC 4,66) (p < 0,001), y entre el test basal y el test final 6,00 (RIC 3,33) (p < 0,001). No hubo diferencias en el aprendizaje inmediato y a los 2 meses entre los diferentes tipos de formaciones. Conclusión. No se encontraron diferencias entre la formación presencial mediante charlas teóricas y la formación no presencial con método audiovisual en el aprendizaje teórico inmediato y a los dos meses en el aprendizaje teórico del SVB y el DEA entre los estudiantes de secundaria (AU)

Objective. To compare secondary students' learning of basic life support (BLS) theory and the use of an automatic external defibrillator (AED) through face-to-face classroom instruction versus educational video instruction. Methods. A total of 2225 secondary students from 15 schools were randomly assigned to one of the following 5 instructional groups: 1) face-to-face instruction with no audiovisual support, 2) face-to-face instruction with audiovisual support, 3) audiovisual instruction without face-to-face instruction, 4) audiovisual instruction with face-to-face instruction, and 5) a control group that received no instruction. The students took a test of BLS and AED theory before instruction, immediately after instruction, and 2 months later. Results. The median (interquartile range) scores overall were 2.33 (2.17) at baseline, 5.33 (4.66) immediately after instruction (P<001) and 6.00 (3.33) (P <001). All groups except the control group improved their scores. Scores immediately after instruction and 2 months later were statistically similar after all types of instruction. Conclusion. No significant differences between face-to-face instruction and audiovisual instruction for learning BLS and AED theory were found in secondary school students either immediately after instruction or 2 months later (AU)

Necrobiosis lipoídica / Lipoidic necrobiosis

No disponible

High performance liquid chromatography-tandem mass spectrometry method for quantifying phenylurea herbicides and their main metabolites in amended and unamended soils.

A sensitive multiresidue method for the simultaneous determination of sixteen phenylurea herbicides and their main metabolites in amended soils has been developed. Liquid chromatography tandem-mass spectrometry (LC-MS²) in electrospray ionization positive mode was used for the separation, identification and quantification of these compounds. The procedure involves initial single phase extraction of soil sample with acetonitrile by sonication, followed by liquid-liquid partitioning formed by addition of NaCl. The average recovery by the LC-MS² method obtained for these compounds varied from 76.2 to 107.9% with a relative standard deviation ranging from 2.1 to 5.8%. The method presents good linearity (R²>0.99) over the range assayed 10-1000 µg L⁻¹ (except N-phenylurea 50-1000 µg L⁻¹). The detection limits for the compounds studied varied from 0.1 to 9.0 ng g⁻¹.

Photocatalytic degradation of five sulfonylurea herbicides in aqueous semiconductor suspensions under natural sunlight.

In the present study, the photocatalytic degradation of five sulfonylurea herbicides (chlorsulfuron, flazasulfuron, nicosulfuron, sulfosulfuron and triasulfuron) has been investigated in aqueous suspensions of zinc oxide (ZnO), tungsten (VI) oxide (WO(3)), tin (IV) oxide (SnO(2)) and zinc sulfide (ZnS) at pilot plant scale under natural sunlight. Photocatalytic experiments, especially those involving ZnO photocatalysis, showed that the addition of semiconductors in tandem with the oxidant (Na(2)S(2)O(8)) strongly enhances the degradation rate of the herbicides in comparisons carried out with photolytic tests. The degradation of the herbicides follows a first order kinetics according to the Langmuir-Hinshelwood model. In our conditions, the amount of time required for 50% of the initial pesticide concentration to dissipate (t(½)) ranged from 8 to 27 min (t(30W)=0.3-1.2 min) for sulfosulfuron and chlorsulfuron, respectively in the ZnO/Na(2)S(2)O(8) system. None of the studied herbicides was found after 120 min of illumination (except chlorsulfuron, 0.2 µg L(-1)).

Opinión de las enfermeras de atención primaria en el area sanitaria de A Coruña sobre la utilización de los diagnósticos de enfermería / The opinion of the primary health care nurses from the Health Area of A Coruña on the use of nursing diagnoses

Diversos estudios muestran la baja utilización de los diagnósticos de enfermería en el primer nivel de atención sanitaria. Se realizó un estudio cualitativo mediante una técnica de grupo de discusión, cuyo objetivo fue conocer la opinión de las enfermeras del área sanitaria de A Coruña sobre las causas de la baja utilización de los diagnósticos de enfermería (DdE) en atención primaria. Se hicieron 2 grupos, uno formado por ex alumnos de la Escuela Universitaria de Enfermería Juan Canalejo, titulados durante los cursos 1999/2000 y 2000/2001, que habían realizado sus prácticas clínicas en distintos centros de salud, y otro compuesto por enfermeras de atención primaria que desempeñaban su actividad en diferentes centros de salud, con distintas formación pregrado y vinculación laboral. Las opiniones identificadas, mediante análisis de contenido, se clasificaron según las características de los participantes (ex alumnos, profesionales) y según 3 aspectos: utilización de los DdE, factores que influyen en la no utilización y estrategias para su implantación. Resultados. La opinión de ambos grupos fue que los DdE no son de uso habitual. Los ex alumnos pusieron de manifiesto los siguientes factores que influyen en la no utilización: algunos profesionales los consideran innecesarios, complejidad de la estructura y vocabulario, falta de formación, deficiencia de recursos e interés personal del profesional. Los profesionales establecieron los siguientes factores: el modelo médico hegemónico, recursos humanos insuficientes, inmovilismo y falta de motivación, convivencia de distintos modelos de atención, heterogeneidad de los profesionales, incertidumbre en la efectividad de los DdE en la mejora de la salud de la población. Ambos grupos opinaban que la obligación o imposición "con o sin formación" sería la estrategia más adecuada para la implantación de los DdE. Discusión. La falta de conocimientos no aparece como la causa principal de la no utilización de los DdE entre los profesionales, cuando sí lo era en estudios previos. La metodología cualitativa permite identificar los factores relacionados con la no utilización de los DdE, no puestos de manifiesto hasta el momento, así como sugerir las vías para su implantación (AU)