Incidence and clinical impact of inappropriate periprocedural and perioperative management of antiplatelet therapy.

BACKGROUND AND AIMS: There is little evidence on the impact of current recommendations on the use of antiplatelet therapy during the perioperative and periprocedural period in our setting. The aim of this study was to analyze the incidence and clinical impact of inappropriate use of antiplatelet therapy in a population of patients undergoing surgery or a diagnostic or therapeutic procedure in "real life" in Spain. METHODS: A prospective multicenter observational study of patients treated with antiplatelet agents requiring intervention was conducted. The incidence of thrombotic and hemorrhagic events at 30 days was analyzed according to peri-intervention management of antiplatelet therapy. RESULTS: We included 643 patients (31.9% women, 39.0% over 75 years of age), most of them (87.7%) receiving aspirin as antiplatelet therapy at a dose of 100mg/day. Indications for antiplatelet therapy were ischemic heart disease (44.9%), cerebrovascular disease (21.7%), and peripheral vascular disease (23.0%). Ischemic risk was low in 74.3%, while 51.6% had a low bleeding risk of the intervention. Periprocedural management was considered appropriate in 61.7% of cases. 30-day incidence of the combined primary endpoint of thrombotic events and major bleeding (12.1% versus 5.0%; p=0.002) and 30-day mortality (5.2% versus 1.5%; p=0.008) were significantly higher in patients with inappropriate periprocedural management of antiplatelet agents. CONCLUSIONS: Despite current recommendations for the use of antiplatelet drugs in the perioperative/periprocedural period, their implementation in the "real world" remains low. Inappropriate use is associated with an increased incidence of adverse events, both thrombotic and hemorrhagic.

Deciphering taxonomic and functional patterns of microbial communities associated with the tiger tail seahorse (Hippocampus comes).

Gaining insight into the diversity, structure, and metabolic functions of microbial communities is essential for understanding their roles in host health and ecosystem dynamics. However, research on the seahorse-associated microbiome remains limited, despite these threatened fish facing increasing human pressures worldwide. Here, we explored the microbial diversity and metabolic functions of the skin and gut of the tiger tail seahorse (Hippocampus comes) and its surrounding environment using shotgun metagenomics and bioinformatics. Members of the Pseudomonadota phylum were dominant in the skin microbiome, whereas Bacteroidota was dominant in the gut. Bacillota, Actinomycetota, and Planctomycetota were also detected in the seahorse-associated microbiome. Statistical analysis revealed significant differences (p<0.01) in species diversity between skin and gut microbiomes, with members belonging to the Moraxellaceae family being dominant on the skin and the Bacteroidaceae family in the gut. Moreover, the surrounding environment (water or sediment) did not have a direct effect on the seahorse microbiome composition. The skin microbiome exhibited a higher abundance of functional genes related to energy, lipid, amino acid metabolism, as well as terpenoids and polyketides metabolism, xenobiotics biodegradation and metabolism compared to the gut. Despite differences among classes, the total abundance of bacteriocins was similar in both gut and skin microbiomes, which is significant in shaping microbial communities due to their antimicrobial properties. A better knowledge of seahorse microbiomes benefits conservation and sustainable aquaculture efforts, offering insights into habitat protection, disease management, and optimizing aquaculture environments, thereby promoting seahorse health and welfare while minimizing environmental impact and enhancing aquaculture sustainability.

Evaluation and application of American College of Radiology Thyroid Imaging Reporting and Data System for improved malignancy detection in paediatric thyroid nodules.

OBJECTIVE: The American College of Radiology Thyroid Imaging Reporting and Data System (TI-RADS) is a widely used method for the management of adult thyroid nodules. However, its use in paediatric patients is controversial because adult fine needle aspiration biopsy (FNAB) recommendations may lead to delayed diagnoses of cancer in children. The objectives of this study were to evaluate the performance of TI-RADS in paediatric thyroid nodules and to tailor FNAB recommendations for children. METHODS: Consecutive surgically resected paediatric thyroid nodules from two tertiary care centres between 2003 and 2021 were reviewed. Ultrasounds were blindly scored by radiologists according to TI-RADS. Management recommendations based on TI-RADS were evaluated. Various modelling methodologies were used to determine the optimal cutoff for FNAB in children. RESULTS: Of the 96 patients, 79 (82%) were female and the median age at surgery was 16.1 years. Fifty (52%) nodules were malignant on surgical pathology. The area under the receiver operating characteristic curve of TI-RADS for predicting malignancy was 0.78. Adult TI-RADS recommendations would have resulted in 4% of cancerous nodules being lost to follow-up. Modifications to TI-RADS (FNAB of all TR3 nodules ≥1.5 cm, FNAB of TR4 and TR5 nodules ≥0.5 cm, surveillance of nodules ≥1 cm, consider surgery for nodules >4 cm) reduced this missed malignancy rate to 0%. CONCLUSIONS: TI-RADS can risk-stratify paediatric thyroid nodules. However, the system requires modifications to reduce the missed malignancy rate in paediatric thyroid nodules. Our data suggest that lower size thresholds for FNAB are warranted in children.

Floating microplastic pollution in the vicinity of a marine protected area and semi-enclosed bay of Peru.

A baseline survey for floating microplastics (MPs) in the vicinity of a marine protected area and semi-enclosed bay of northern Peru was carried out. An average concentration of 0.22 MPs/L was estimated, primarily dominated by blue polyethylene terephthalate fibers. The distribution of floating MPs suggests that they tend to accumulate within the semi-enclosed Sechura Bay regardless of the sampling season. This behavior may be explained by local surface currents in the bay, which flow inwards and exhibit vorticities that could entrap MPs. Future studies are suggested to investigate the trajectory and fate of floating MPs within semi-enclosed areas. On the other hand, the impact of floating MPs on the trophic chain of coastal marine protected areas requires further research.

Frailty Is More Predictive of Mortality than Age in Patients With Hip Fractures.

OBJECTIVES: To investigate the association between the Comprehensive Geriatric Assessment-based Frailty Index and adverse outcomes in older adult patients undergoing hip fracture surgery. DESIGN: Retrospective cohort study. SETTING: Academic Level 1 Trauma Center. PATIENTS: All patients aged 65 or older who underwent surgical repair of a hip fracture between May 2018 and August 2020 were identified through institutional database review. OUTCOME MEASURES AND COMPARISONS: Data including demographics, FI, injury presentation, and hospital course were collected. Patients were grouped by FI as nonfrail (FI < 0.21), frail (0.21 ≤ FI < 0.45), and severely frail (FI > 0.45). Adverse outcomes of these groups were compared using Kaplan Meier survival analysis. Risk factors for 1-year rehospitalization and 2-year mortality were evaluated using Cox hazard regression. RESULTS: Three hundred sixteen patients were included, with 62 nonfrail, 185 frail, and 69 severely frail patients. The total population was on average 83.8 years old, predominantly white (88.0%), and majority female (69.9%) with an average FI of 0.33 (SD: 0.14). The nonfrail cohort was on average 78.8 years old, 93.6% white, and 80.7% female; the frail cohort was on average 84.5 years old, 92.4% white, and 71.9% female; and the severely frail cohort was on average 86.4 years old, 71.0% white, and 55.1% female. Rate of 1-year readmission increased with frailty level, with a rate of 38% in nonfrail patients, 55.6% in frail patients, and 74.2% in severely frail patients (P = 0.001). The same pattern was seen in 2-year mortality rates, with a rate of 2.8% in nonfrail patients, 36.7% in frail patients, and 77.5% in severely frail patients (P < 0.0001). Being classified as frail or severely frail exhibited greater association with mortality within 2 years than age, with hazard ratio of 17.81 for frail patients and 56.81 for severely frail patients compared with 1.19 per 5 years of age. CONCLUSIONS: Increased frailty as measured by the Frailty Index is significantly associated with increased 2-year mortality and 1-year hospital readmission rates after hip fracture surgery. Degree of frailty predicts mortality more strongly than age alone. Assessing frailty with the Frailty Index can identify higher-risk surgical candidates, facilitate clinical decision making, and guide discussions about goals of care with family members, surgeons, and geriatricians. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Shotgun Metagenomics Reveals Taxonomic and Functional Patterns of the Microbiome Associated with Barbour's Seahorse (Hippocampus barbouri).

This study aimed to investigate the taxonomic and functional patterns of the microbiome associated with Barbour's seahorse (Hippocampus barbouri) using a combination of shotgun metagenomics and bioinformatics. The analyses revealed that Pseudomonadota and Bacillota were the dominant phyla in the seahorse skin microbiome, whereas Pseudomonadota and, to a lesser extent, Bacillota and Bacteroidota were the dominant phyla in the seahorse gut microbiome. Several metabolic pathway categories were found to be enriched in the skin microbiome, including amino acid metabolism, carbohydrate metabolism, cofactor and vitamin metabolism, energy metabolism, nucleotide metabolism, as well as membrane transport, signal transduction, and cellular community-prokaryotes. In contrast, the gut microbiome exhibited enrichment in metabolic pathways associated with the metabolism of terpenoids and polyketides, biosynthesis of other secondary metabolites, xenobiotics biodegradation and metabolism, and quorum sensing. Additionally, although the relative abundance of bacteriocins in the skin and gut was slightly similar, notable differences were observed at the class level. Specifically, class I bacteriocins were found to be more abundant in the skin microbiome, whereas class III bacteriocins were more abundant in the gut microbiome. To the best of our knowledge, this study represents the first comprehensive examination of the taxonomic and functional patterns of the skin and gut microbiome in Barbour's seahorse. These findings can greatly contribute to a deeper understanding of the seahorse-associated microbiome, which can play a pivotal role in predicting and controlling bacterial infections, thereby contributing to the success of aquaculture and health-promoting initiatives.

Effects of mobile phone-related distraction on driving performance at roundabouts: Eye movements tracking perspective.

Modern road infrastructures are complex networks featuring various elements such as roads, bridges, intersections, and roundabouts, with advanced control systems. Roundabouts have gained prominence as a safer alternative to traditional intersections promoting smoother traffic flow and fewer collisions by guiding traffic in one direction, encouraging reduced speed, and minimizing conflict points.This study investigated driver behavior within roundabouts, focusing on gaze behavior, particularly the left-side mirror and window, under mobile phone distraction conditions. In addition, the effects of roundabout specifications (i.e., number of lanes and size of the central island) and the drivers' characteristics (i.e., driving experience) were examined.In total, 43 participants, aged 19-56 years including 30 males and 13 females, held a valid driving license, drove through a virtual simulated urban road containing four roundabouts, implemented in a static driving simulator, under baseline condition (no distraction) as well as mobile-induced distraction. Driving simulator data were collected and drivers' gaze direction and fixation on nine areas of interest were captured with an eye tracker. Results: showed that experienced drivers exhibit a more fixation on the left-side mirror and window and were less distracted. Moreover, the road environment, i.e., the number of cars and the roundabout size, significantly influenced the drivers' attention. As regards the driving performance, the number of infractions increased when the drivers diverted focus from the left side of the car. The outcomes of the present study might help to improve traffic safety at roundabouts.

Why tRNA acquisition could be relevant to bacteriophages?

In this opinion, we discuss the role of tRNAs in phage biology and their importance in DNA replication and phage-host interactions. Phages are a diverse group of obligate bacterial viruses that possess genomes with a wide range of sizes. Among them, we find phages with few genes that depend entirely on their host's translational machinery for replication. However, some phages carry genes for all replication steps and even contain genes for their own translational synthesis. In these cases, the integration of tRNA genes in their genomes is not completely understood, generating different theories about their presence and function during the replication cycle. Although different studies have attempted to elucidate their role, additional studies are needed to clarify the presence and significance of tRNA genes in phages. Moreover, we highlight the importance of tRNA genes in phages from both ecological and therapeutic perspectives.

Citizen Science Studies in Nursing: A Systematic Review.

BACKGROUND: Citizen science is a research approach wherein citizens actively participate alongside professionals in some or all stages of the research process. The bidirectional benefits it generates, especially in the field of health, including empowerment, new hypotheses, and results, and addressing issues truly important to society, justify the necessity to establish a common framework and address barriers to ensure a fruitful evolution of this new approach within nursing research. The aim was to analyze nursing projects with a citizen science focus that have been conducted. METHODS: PRISMA guidelines were employed to conduct a systematic review. Searches were conducted on PubMed, CINHAL, LILACS, IBECS, and Cochrane. Following the identification and screening process, 13 studies were included. The quality of the articles was assessed using the Joanna Brigg Institute (JBI) critical appraisal checklist and the quality of citizen science research using the Citizen Science Appraisal Tool. RESULTS: Citizen science studies in nursing were notably recent (2017-2023). Five research areas were identified, with environmental health being the most predominant. Multiple tools, both technological and traditional, were utilized, with the "Photovoice" and "Our Voice" methodologies being prominent. Citizen participation was limited to data collection and analysis in 7 out of the 13 studies, with most studies working with small samples. Findings regarding the application of this practice were positive, but no study exceeded 26 points on the CSAT scale to be considered high quality in citizen science. CONCLUSIONS: Citizen science can be a promising approach within the field of nursing. There is a need to increase individual participation to fully realize the potential bidirectional benefits. It is imperative to establish a common theoretical framework and continue working on the development of this methodology within nursing.

Primary Vitrectomy versus Tap and Inject for Fungal Endophthalmitis: Meta-Analysis and Comparison with Data from a Reference Centre.

PURPOSE: We aimed to compare the visual outcomes after pars plana vitrectomy (PPV) versus tap and inject (T&I) in fungal endophthalmitis (FE) reported in the literature and to compare the findings from the literature with data from a reference centre. METHODS: We performed a systematic review and meta-analysis of studies reporting the use of PPV versus T&I in FE. We also performed a retrospective review of the clinical records of patients with endophthalmitis from a reference centre in Colombia. RESULTS: We included 13 studies with 334 eyes; 53.59% received PPV and 46.4% received T&I. The overall relative risk of improving ≥ 2 lines in PPV versus T&I was 0.98 (95% confidence interval [CI] 0.80-1.22; p = 0.88) with a mean difference of final visual acuity of 0.26 (95% CI 0.12-0.63; p = 0.18). There were no significant differences in subgroup analysis. Data from the reference centre included 32 endophthalmitis cases, 15.6% of which had a fungal aetiology (80% received PPV and 20% T&I). There were no significant differences in the subgroup analysis. CONCLUSIONS: Based on the findings from the literature and the reference centre, T&I is noninferior to PPV. This is the first meta-analysis in the literature evaluating these effects in FE. It is necessary to execute new prospective randomised controlled studies in patients with endophthalmitis.

[Sense of coherence in breastfeeding women: A scoping review].

BACKGROUND: The establishment of breastfeeding may sometimes be stressful. We aimed to analyze the sense of coherence in lactating women to determine the general resistance resources during lactation and the professional interventions that promote a high sense of coherence. METHODS: A search of studies in English, Spanish, or Portuguese on lactating women's sense of coherence was carried out in PubMed, PsycINFO, ScienceDirect, and CINAH databases published between May and November 2022. Study quality and risk of bias were examined according to ICROMS and STROBE criteria. RESULTS: We identified 316 studies, of which eight -all of adequate quality- were included, three qualitative and five quantitative. A high level of maternal sense of coherence was related to longer duration, self-efficacy, attachment, and enjoyment of the breastfeeding experience. The main general resistance resources were to receive social support, particularly from partners, mothers, and health professionals. The interventions that favored the sense of coherence were mainly those related to a close, empathic, personalized, comprehensive, and family-centered professional support. CONCLUSIONS: The detection of the level of sense of coherence in lactating mothers may help identify women with a higher risk of weaning and establish professional intervention strategies that improve the breastfeeding experience.

Sentido de coherencia en mujeres lactantes: una revisión de alcance / Sense of coherence in breastfeeding women: A scoping review

Fundamento. El establecimiento de la lactancia materna puede resultar una situación potencialmente estresante. El objetivo del estudio es analizar el sentido de coherencia en mujeres lactantes, establecer los recursos generales de resistencia que lo modulan, y determinar las intervenciones profesionales que lo promueven. Metodología. Se incluyeron estudios en inglés, español o portugués, que evaluaran el sentido de coherencia de las mujeres lactantes, localizados en las bases de datos PubMed, PsycINFO, ScienceDirect y CINAHL entre marzo y mayo de 2023. La calidad de los estudios y el riesgo de sesgo se evaluaron siguiendo los criterios ICROMS y STROBE. Resultados. Se identificaron 316 registros, de los que se incluyeron un total de ocho estudios, tres cualitativos y cinco cuantitativos, todos con calidad suficiente. Un alto nivel de sentido de coherencia materno se relacionó con mayor duración, autoeficacia y disfrute de la experiencia de lactancia, y mayor apego. Los principales recursos generales de resistencia fueron percibir apoyo social, especialmente de parejas, madres y personal sanitario, además de experiencia previa positiva y una actitud positiva. Las intervenciones que favorecieron el sentido de coherencia fueron las relacionadas con un apoyo profesional estrecho, empático, personalizado, integral y centrado en la familia. Conclusiones. La determinación del nivel de sentido de coherencia en madres lactantes puede ayudar a identificar a mujeres con mayor riesgo de destete temprano, y a establecer estrategias de intervención profesional que mejoren la experiencia de lactancia materna. (AU)

Background. The establishment of breastfeeding may sometimes be stressful. We aimed to analyze the sense of coherence in lactating women to determine the general resistance resources during lactation and the professional interventions that promote a high sense of coherence. Methods. A search of studies in English, Spanish, or Portuguese on lactating women's sense of coherence was carried out in PubMed, PsycINFO, ScienceDirect, and CINAH databases published between May and November 2022. Study quality and risk of bias were examined according to ICROMS and STROBE criteria. Results. We identified 316 studies, of which eight -all of adequate quality- were included, three qualitative and five quantitative. A high level of maternal sense of coherence was related to longer duration, self-efficacy, attachment, and enjoyment of the breastfeeding experience. The main general resistance resources were to receive social support, particularly from partners, mothers, and health professionals. The interventions that favored the sense of coherence were mainly those related to a close, empathic, personalized, comprehensive, and family-centered professional support. Conclusions. The detection of the level of sense of coherence in lactating mothers may help identify women with a higher risk of weaning and establish professional intervention strategies that improve the breastfeeding experience. (AU)

The impact of burial depth on Centaurea diluta emergence and modelling of its growth using a nonlinear regression and artificial neural network.

BACKGROUND: Centaurea diluta Aiton (North African knapweed) is a major weed concern in Spain as a result of the limited herbicides capable of controlling it, and the limited knowledge of its biology hinders the development of integrated weed management strategies. RESULTS: The current study presents results from two experiments that aimed to: (i) determine the effect of seed burial on seedling emergence; and (ii) model its phenology progression using sigmoidal (SRM) and artificial neural network models (ANN) based on different cohort emergence times. In the first experiment, burial at 2 cm and 5 cm decreased C. diluta emergence by 54% and 90%, respectively, compared to the emergence at 0 cm. In the second experiment, without crop-weed competition conditions, the emergence delay led to reductions in leaf number, rosette diameter, plant height and dry biomass by 63%, 50%, 59% and 93%, respectively. Seed production per plant exceeded 21 469. According to the growth model, leaf number was the most consistent morphological trait and critical for timing weed control actions, so it was used to compare SRMs and ANNs. On average, ANNs increased the precision in 5.72% (± 2.4 leaves) compared to SRMs. This slight performance of ANNs may be valuable for controlling C. diluta because control methods must be applied at the 4-leaf stage to achieve good efficacy. CONCLUSION: Seed burial at 5 cm depth is an effective method reducing C. diluta emergence. ANNs accurately predicted the leaf number employing environmental variables can help increase the efficiency of C. diluta control actions and reduce the risk of escapes. © 2023 The Authors. Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Spanish version of the Heart Failure Somatic Perception Scale (HFSPS v.3) - psychometric properties.

Background: The Heart Failure Somatic Perception Scale (HFSPS) is an instrument that examine the existence and gravity of physical signs and symptoms in patients with heart failure, as well as early and subtle symptoms of HF that have clinical value, we aimed to translate and adapt the HFSPS from English to Spanish and evaluate the psychometric properties. Method: HFSPS translation and back translation were carried out according to the method established by of Beaton et al. A confirmatory factor analysis (CFA) was performed to test the factor structures. To assess criterion-related validity, HFSPS factor scores were correlated with Kansas City Cardiomyopathy Questionnaire (KCCQ) scores using the Spearman correlation method. The reliability of the internal consistency of the HFSPS was determined by calculating the Cronbach's alpha coefficient and the factor score determination coefficient. Results: Data from 173 patients with a mean age of 80.7 years (SD 9.1), women (51.1%), were analyzed. The majority (74.7%) were NYHA class II/III. The confirmatory factor analysis of four factors after eliminating one item showed fit indices close to the recommended indices: χ2 = 169.237, p < 0.001, CFI = 0.920, TLI = 0.901, RMSEA = 0.057 and SRMR = 0.061. Regarding the validity related to the criterion, all the scores of the HFSPS dimensions were correlated with all the scores of the KCCQ dimensions and were statistically significant. The reliability of the HFSPS factors of the coefficient of determination obtained scores of 0.73 for the dyspnea factor and early and subtle and lower for edema and chest discomfort with fewer items. Cronbach's alpha was acceptable for three of the scales >0.71 and poor 0.52 for chest discomfort with two items. The internal consistency index based on the model was 0.850. Conclusion: The Spanish version of the HFSPS is a valid and reliable instrument that that would be feasible to use in clinical and research setting to evaluate in the perception of symptoms in patients with heart failure.

Autonomy of Nursing Students: Methodological Study of Validation of the PALOP Scale Portuguese Short Version.

The cultivation of critical thinking and decision-making skills promotes student autonomy. Only a few instruments measure nursing students' autonomy, and the PALOP® Scale is one of them. This study aimed to semantically and culturally adapt the PALOP® Scale to European Portuguese and assess the psychometric properties of a short version. A methodological study was conducted with 530 second and fourth-year undergraduate nursing students. Content validity was assessed using exploratory and discriminant factor analysis, and reliability was determined through analyses of internal consistency, temporal stability, and floor and ceiling effects. The analysis of the psychometric properties of a short version of the PALOP®-PT Scale revealed complete agreement (100%) among panel members for content validity. The scale also showed discriminative capacity among second- and fourth-year students (t (528) = -7.907, p < 0.001) with a five-factor structure, with a total explained variance of 57.2%. Reliability analysis showed excellent internal consistency (α = 0.935) and moderate temporal stability (95% ICC (3.1) = 0.520 [0.290-0.693], p < 0.01). The short version of the PALOP®-PT Scale is a promising tool to assess nursing students' perceived autonomy and identify necessary adjustments to their professional identity.

Analysis of the Attitudes towards Sexuality in People with Intellectual Disabilities: A Cross-Sectional Study.

The barriers faced by people with intellectual disabilities are many. One of the areas in which many problems have been identified is the sexual domain. This descriptive study aims to analyze the attitudes of the family environment, professional carers, and the general population toward their sexuality. A cross-sectional descriptive study was carried out between 2022 and 2023, using convenience sampling among family members and carers from different centers working with people with intellectual disabilities in Spain, and among the general population not related to people with intellectual disabilities. A total of 583 responses were received and significant differences were found for all variables, with the variables related to family or work proximity being those that provided the most significant and relevant results. It was observed that the male sex has a more paternalistic attitude and that in rural areas there is a more permissive attitude towards the sexuality of people with intellectual disabilities. People who work with people with disabilities have more positive attitudes towards this group, while direct relatives have more paternalistic attitudes. Nursing care in the community and specialized centers should be based on an adequate therapeutic relationship and personalized care.

Long-term outcomes of the global tuberculosis and COVID-19 co-infection cohort.

BACKGROUND: Longitudinal cohort data of patients with tuberculosis (TB) and coronavirus disease 2019 (COVID-19) are lacking. In our global study, we describe long-term outcomes of patients affected by TB and COVID-19. METHODS: We collected data from 174 centres in 31 countries on all patients affected by COVID-19 and TB between 1 March 2020 and 30 September 2022. Patients were followed-up until cure, death or end of cohort time. All patients had TB and COVID-19; for analysis purposes, deaths were attributed to TB, COVID-19 or both. Survival analysis was performed using Cox proportional risk-regression models, and the log-rank test was used to compare survival and mortality attributed to TB, COVID-19 or both. RESULTS: Overall, 788 patients with COVID-19 and TB (active or sequelae) were recruited from 31 countries, and 10.8% (n=85) died during the observation period. Survival was significantly lower among patients whose death was attributed to TB and COVID-19 versus those dying because of either TB or COVID-19 alone (p<0.001). Significant adjusted risk factors for TB mortality were higher age (hazard ratio (HR) 1.05, 95% CI 1.03-1.07), HIV infection (HR 2.29, 95% CI 1.02-5.16) and invasive ventilation (HR 4.28, 95% CI 2.34-7.83). For COVID-19 mortality, the adjusted risks were higher age (HR 1.03, 95% CI 1.02-1.04), male sex (HR 2.21, 95% CI 1.24-3.91), oxygen requirement (HR 7.93, 95% CI 3.44-18.26) and invasive ventilation (HR 2.19, 95% CI 1.36-3.53). CONCLUSIONS: In our global cohort, death was the outcome in >10% of patients with TB and COVID-19. A range of demographic and clinical predictors are associated with adverse outcomes.

Making a difference? A retrospective review of peripherally inserted central catheters: A single-center experience in Colombia.

Introduction: Peripherally inserted central catheters (PICCs) are an effective tool as a medical device in patients who require them. However, it is a procedure that has been associated with multiple complications and possible negative outcomes for the health of the patients. This paper seeks to describe the main complications derived from the insertion and maintenance of peripherally inserted central venous catheters (PICCs), based on the experience of a vascular accesses group in a cardiovascular center in Colombia. Methods: A retrospective cross-sectional analytical study of the adult population undergoing PICC insertion at the Fundación Cardioinfantil-Instituto de Cardiología, during the period between 2019 and 2020 by the vascular access program, was performed. Results: The frequency of any registered complication was 15.9% for 2019 and 11.2% for 2020. Bleeding at the procedure site occurred in 15.3% during 2019 and 7.0% in 2020, making it the most frequent complication during the procedure. All the variables of complications associated with infection (bacteremia, phlebitis, and catheter-related infection) showed a decrease in 2020 compared to the previous year. The central line-associated bloodstream infection registered for the year 2019 was 1.94 bacteremia's/1000 catheters-day compared to 0.29 bacteremia's/1000 catheters-day. Conclusions: There has been a 4.7% reduction in the frequency of any registered complication after the implementation of the vascular access groups. Global and specific complications decreased significantly from 2019 to 2020. Notably, bacteremia, a common post-procedure complication, showed a substantial decrease in frequency compared to national and worldwide literature. It is also been described that complications associated with infection showed a decrease in 2020 compared to 2019. Whether or not all these findings are directly or somewhat related to the results stemming from the vascular access groups still needs further investigation.

Robotic-assisted para-aortic lymphadenectomy: Technique and indications in gynecological oncology.

The benefits of minimally-invasive surgeries have been documented, and they have been established as the preferred approach for gynecological surgeries. With the development of robotic surgery, many highly complex surgeries can benefit from these advantages. Due to the complexity of aortocaval lymphadenectomy, surgical technique protocols have been described to reduce risks by maximizing benefits. We describe the technique using five ports (4 robotic arms and an assistant) to work the upper abdominal field, and different instruments recommended in each of their positions to reduce errors and optimize surgical time. After the "step by step" description, we summarize indications of aortocaval lymphadenectomy for every gynecological cancer in different stages.

Machine Learning Approach for Screening Cochlear Implant Candidates: Comparing With the 60/60 Guideline.

OBJECTIVE: To develop a machine learning-based referral guideline for patients undergoing cochlear implant candidacy evaluation (CICE) and to compare with the widely used 60/60 guideline. STUDY DESIGN: Retrospective cohort. SETTING: Tertiary referral center. PATIENTS: 772 adults undergoing CICE from 2015 to 2020. INTERVENTIONS: Variables included demographics, unaided thresholds, and word recognition score. A random forest classification model was trained on patients undergoing CICE, and bootstrap cross-validation was used to assess the modeling approach's performance. MAIN OUTCOME MEASURES: The machine learning-based referral tool was evaluated against the 60/60 guideline based on ability to identify CI candidates under traditional and expanded criteria. RESULTS: Of 587 patients with complete data, 563 (96%) met candidacy at our center, and the 60/60 guideline identified 512 (87%) patients. In the random forest model, word recognition score; thresholds at 3000, 2000, and 125; and age at CICE had the largest impact on candidacy (mean decrease in Gini coefficient, 2.83, 1.60, 1.20, 1.17, and 1.16, respectively). The 60/60 guideline had a sensitivity of 0.91, a specificity of 0.42, and an accuracy of 0.89 (95% confidence interval, 0.86-0.91). The random forest model obtained higher sensitivity (0.96), specificity (1.00), and accuracy (0.96; 95% confidence interval, 0.95-0.98). Across 1,000 bootstrapped iterations, the model yielded a median sensitivity of 0.92 (interquartile range [IQR], 0.85-0.98), specificity of 1.00 (IQR, 0.88-1.00), accuracy of 0.93 (IQR, 0.85-0.97), and area under the curve of 0.96 (IQR, 0.93-0.98). CONCLUSIONS: A novel machine learning-based screening model is highly sensitive, specific, and accurate in predicting CI candidacy. Bootstrapping confirmed that this approach is potentially generalizable with consistent results.