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Providing tuberculosis preventive treatment (TPT) to close contacts of persons with TB is a core strategy recommended by WHO for the prevention and control of TB. Nigeria rolled out the 3-month Isoniazid-Rifampicin (3HR) shorter regimen TPT as a pilot for use among eligible adult and child contacts. This study assesses acceptance and completion rates of 3HR TPT among contacts and determines the perspectives of healthcare workers (HCWs) and contacts on acceptance and completion of 3HR TPT in Nigeria. In this cross-sectional descriptive study using mixed methods, records of TPT-eligible clients were retrospectively reviewed, while 18 purposely selected HCWs and 18 contacts on 3HR were interviewed. Of the 30,012 eligible contacts, 12,040 (40.1%) were initiated on TPT. Among these, 8213 (68%) were enrolled on 3HR, and 6972 (84.7%) of them completed treatment. Perceived facilitators include belief in its effectiveness, training among HCWs, and a good understanding of TPT from HCW counseling sessions. Barriers reported were linked to stockouts, misconceptions about side effects, non-disclosures, and disincentive follow-up strategies. The acceptance and completion rate for 3HR TPT was good. Scaling up 3HR TPT will require redesigning policies towards addressing identified barriers and utilizing interventions linked to capabilities, opportunities, and motivations among contacts of TB patients and HCWs.

Resumen: Las variaciones de los vasos que surgen del arco aórtico son numerosas1, reportándose según la literatura consultada entre el 6 al 49% en diversos países. La mayoría de las variantes son descritas como asintomáticas. No obstante, algunas se han asociado con síntomas significativos y problemas quirúrgicos serios, causados por efectos de la compresión o presión que ejercen esas variantes sobre la tráquea o el esófago2. Presentamos el caso de una variante que no encontramos descripción previa en la literatura la cual fue un hallazgo transquirúrgico durante una corrección de un paciente neonato con diagnóstico de coartación aortica. Abstract: The variations of the vessels that arise from the aortic arch are numerous, reported according to the literature consulted between 6 to 49% in various countries. Most variants are described as asymptomatic. However, some have been associated with significant symptoms and serious surgical problems, caused by the effects of compression or pressure that these variants exert on the trachea or esophagus. We present the case of a variant that we found no previous description in the literature, which was a trans surgical finding during a correction of a neonatal patient with a diagnosis of aortic coarctation.

ABSTRACT Objective: to determine the surgical indications for glenoid bone grafting associated with better postoperative ranges of motion. Methods: This systematic review was conducted according to PRISMA. The included studies were subdivided according to the criteria used to indicate glenoid bone graft surgery: group for radiological indications only (Group R), group for radiological indications associated with clinical indications (Group R + C), and group for arthroscopic indications (Group A). The extracted and evaluated data were the range of motion of the shoulder. Results: in the electronic search conducted in October 2022, 1567 articles were selected. After applying the inclusion criteria, 14 articles were selected for the systematic review. Regarding the ranges of motion, group A had the highest number of statistically positive results together with group R. Group A showed positive results in elevation parameters, loss of lateral rotation in adduction, and medial rotation in abduction. Group R showed positive results in lateral rotation in adduction and loss of lateral rotation in adduction. On the other hand, Group R + C was the one that presented the highest number of statistically negative results, in the following parameters: elevation, lateral rotation in abduction, loss of lateral rotation in adduction, and medial rotation in abduction. Conclusion: the subgroups presented variable results in the evaluated parameters; however, the groups with arthroscopic and radiological indications showed the highest number of positive results, with the latter group showing the best results regarding lateral rotation. Level of Evidence II, Systematic Reviews.

Resumen: Introducción y objetivos: A medida que la supervivencia de los niños con cardiopatía congénita intervenidos de cirugía cardiaca ha aumentado significativamente, la necesidad de seguimiento en términos de calidad de vida relacionada con la salud se ha vuelto cada vez más importante. En este estudio, describimos la calidad de vida relacionada con la salud en niños con cardiopatía congénita con y sin reparación quirúrgica. Métodos: Estudio descriptivo. Aplicamos el cuestionario Pediatric Quality of Life Inventory (PedsQLTM) en 271 pacientes con edades de 2 a 17 años, de los que acudieron a consulta de cardiología tanto en protocolo prequirúrgico como posquirúrgico. La calidad de vida relacionada con la salud se expresó como puntaje total (100 más alto) y se proporcionó como medianas y porcentajes de 10 a 100. Resultados: Incluimos a 271 pacientes de 2 a 17 años, el 94,8% con un corazón biventricular. La cirugía cardiaca se realizó en el 67,8%. Los principales factores que afectaron de forma negativa en la calidad de vida fueron la fisiología univentricular, la presencia de cortocircuito residual, requerir otra cirugía, el manejo con polifármacos y el acceso quirúrgico por esternotomía media. Conclusión: Los pacientes con cardiopatías congénitas no solo presentan su enfermedad principal, sino que también experimentan una calidad de vida que puede afectarse por factores sociales, educativos y emocionales. La evaluación de la calidad de vida de la salud debe ser parte integral en la evaluación de estos pacientes. Abstract: Introduction and objectives: As the survival of children with congenital heart disease who have undergone cardiac surgery has increased significantly, the need for follow-up in terms of health related quality of life has become increasingly important. In this study, we sought to describe the health related quality of life in children with congenital heart disease with and without surgical repair. Methods: We applied the Pediatric Quality of Life Inventory (PedsQLTM) questionary in 271 patients aged 2 to 17 years, of the patients who attended the cardiology clinic both pre surgery and postsurgery. Health related quality of life was expressed as a total score (highest 100) and provided as medians and percentages from 10 to 100. Results: We included 271 patients from 2 to 17 years old, 94.8% had a biventricular heart. Cardiac surgery was performed in 67.8% The main factor that negatively affected quality of life were univentricular physiology, the presence of residual shunt, requiring another surgery, management with polidrugs, and surgical access through median sternotomy. Conclusion: Patients with congenital heart disease nor only suffer from their main disease, but also experience a quality of life that can be affected by social, educational and emotional factors. The assessment of quality of life by health professionals should be an integral part of the evaluation of these patients.

Abstract The construction history of a site is partially preserved underground and can be revealed through archaeological investigations, including excavations, integrated with earth observation (EO) methods and technologies that make it possible to overcome some operational limits regarding the areal dimensions and the investigation depths along with the invasiveness of the excavations themselves. An integrated approach based on EO and archaeological records has been applied to improve the knowledge of Machu Picchu. The attention has been focused on the first construction phase of Machu Picchu, and for this reason the investigations were directed to the imaging and characterization of the subsoil of the Plaza principal, considered the core of the whole archaeological area. Archaeological records and multiscale remote sensing (including satellite, UAS, and geophysical surveys) enabled the identification and characterization of the first construction phase of the site, including the preparation phases before building Machu Picchu. The interpretative hypothesis on the constructive history of Machu Picchu started from the identification and use of the quarry, followed by the planification and set of the drainage systems and by the next steps based on diverse reshaping phases of what would be the central plaza.

Abstract Background Formal education surrounding abortion care during pre-clinical years of medical school is limited and will likely decrease with the overturning of Roe v. Wade. This study describes and evaluates the impact of an original abortion didactic session implemented during the pre-clinical years of medical school. Methods We implemented a didactic session at the University of California Irvine outlining abortion epidemiology, pregnancy options counseling, standard abortion care, and the current legislative landscape surrounding abortion. The preclinical session also included an interactive, small group case-based discussion. Pre-session and post-session surveys were obtained to evaluate changes in participants’ knowledge and attitudes and to collect feedback for future sessions. Results 92 matched pre- and post-session surveys were completed and analyzed (response rate 77%). The majority of the respondents identified themselves as more “pro-choice” compared to “pro-life” on the pre-session survey. Results reflected significantly increased comfort discussing abortion care and significantly increased knowledge about abortion prevalence and techniques after the session. Qualitative feedback was overwhelmingly positive and reflected participants’ appreciation for the focus on the medical aspects of abortion care as opposed to an ethical discussion. Conclusions Abortion education targeted to preclinical medical students can be implemented effectively by a medical student cohort with institutional support.

Resumen: Introducción y objetivos: La estenosis carotídea (por sus siglas en inglés, CAS) es un factor importante en las complicaciones neurológicas posteriores a la revascularización coronaria (por sus siglas en inglés, CABG). Las pautas actuales recomiendan tamización de CAS previa a la cirugía cardiaca solo en pacientes mayores de 70 años con síntomas de enfermedad neurológica; sin embargo, sigue siendo un tema controversial. El objetivo de este estudio fue determinar la frecuencia de CAS en pacientes tratados con CABG, además de valorar su influencia en los eventos neurológicos y la mortalidad. Métodos: Estudio prospectivo en el que se realizó ultrasonido carotídeo en pacientes asintomáticos antes de CABG. Se dividió a los pacientes con base en el grado de estenosis carotídea (menor del 50%, 50-70% y mayor del 70%) y se clasificaron con base en la edad en 3 grupos (menor de 60, de 60 a 70 y mayor de 70 años). Se midió la mediana, máximos y mínimos en las variables numéricas continuas y el porcentaje en las categóricas. Se aplicó un análisis de regresión a los parámetros seleccionados para identificar los factores de riesgo de CAS significativa. Resultados: Solo un paciente presentó evento vascular cerebral posterior a CABG. No observamos asociación de la CAS con mortalidad ni con el tiempo hospitalario; sin embargo, sí se encontró asociación con los vasos afectados y el número de comorbilidades. Conclusiones: La CAS es común en pacientes con enfermedad isquémica coronaria y es un marcador de mayor riesgo de eventos cardiovasculares, por lo que consideramos que detectarla es importante para la estratificación del riesgo preoperatorio. Abstract: Introduction and objectives: Carotid stenosis (CAS) is an important factor in neurological complications after coronary artery bypass grafting (CABG). Current guidelines recommend that patients older than 70 years with symptoms of neurological disease should be screened for CAS prior to surgery; however, this remains controversial. The objective of this study was to determine the frequency of CAS in patients undergoing CABG, in addition to assessing its influence on neurological events and mortality. Method: Prospective study where carotid ultrasound was performed in asymptomatic patients prior to CABG. Patients were divided based on the degree of carotid stenosis (less than 50%, 50-70%, and greater than 70%) and classified based on age into 3 groups (less than 60, 60-70, and greater to 70 years). Median, maximum and minimum were measured in continuous numerical variables and percentage in categorical ones. Regression analysis was applied to selected parameters to identify risk factors for significant CAS. Results: Only one patient presented cerebral vascular event after CABG, we did not observe association of CAS with mortality or hospital time, however, an association was found with the affected vessels and the number of comorbidities. Conclusions: CAS is common in patients with ischemic coronary disease and is a marker of increased risk of cardiovascular events, so we believe that detecting it is important for preoperative risk stratification.

Resumen: Presentamos el caso de un paciente escolar, derivado por la presencia de dolor torácico recurrente, que fue valorado por nuestro servicio donde se diagnosticó cor triatriatum, siendo una enfermedad sumamente rara, con una frecuencia del 0,1 al 0,4% de todas las cardiopatías congénitas. Se caracteriza por una membrana fibromuscular que divide la cámara de la aurícula izquierda en 2: una posterior, proximal a la entrada de las venas pulmonares, y otra anterior, que contiene el apéndice auricular y la válvula mitral. Clínicamente puede presentarse como arritmias cardiacas o como una enfermedad obstructiva grave en el periodo neonatal, dependiendo del grado de integridad de la membrana. En este caso se realizó la corrección quirúrgica del defecto, siendo exitosa. Actualmente el paciente se encuentra asintomático y continúa en seguimiento. Abstract: We present the case of a school patient, referred due to the presence of recurrent chest pain, who was evaluated by our service where cor triatriatum was diagnosed, being an extremely rare pathology with a frequency of 0.1 to 0.4% of all congenital heart diseases, characterized by a fibromuscular membrane that divides the left atrium chamber into 2, one posterior, proximal to the entrance of the pulmonary veins, and the other anterior, which contains the atrial appendage and the mitral valve. Clinically it can present as cardiac arrhythmias or as a severe obstructive pathology in the neonatal period, depending on the degree of integrity of the membrane. In this case, the surgical correction of the defect was performed, being successful. The patient is currently asymptomatic and continues to be monitored.

Although body weight (BW) and body surface area (BSA) are utilized to establish the appropriate dosage of anticancer drugs, their distribution in cancer patients is poorly studied, making it challenging to predict the amount of drug use and related costs of BW or BAS-dosed regimens. This study investigates the distribution of BW and BSA in adults with selected cancers who initiated systemic anticancer treatment in the eastern Emilia-Romagna region hospitals between 2011 and 2021. BW and BSA were collected at the first cycle of each new treatment line, with multiple measurements for patients receiving various treatments or treating for other primary malignancies. Results were grouped by sex, tumor site and treatment setting, and the normal distribution hypothesis was tested for each group. Both linear regression model and quantile regression at the 50th, 25th and 75th percentiles were run to explore the factors influencing BSA. The analysis included 20,634 treatment lines and the corresponding BW and BSA measures from a sample of 13,036 patients. The average BW was 68.05kg (64.20kg for females and 75.07kg for males) and the average BSA was 1.76m2 (1.66m2 for females and 1.87m2 for males). In women, the highest BW was in breast and colon groups, while in men, it was associated with prostate and rectum cancers. The model indicated significant association between BSA, age, sex and tumor localization. Notably, stomach and lung cancers were linked to lower BSA for both sexes (for females -0.081 and -0.041m2 respectively compared to those with breast cancer). Advanced settings were related to lower BSA than neoadjuvant treatment, especially for stomach cancer patients, who experienced a weight loss of 3 to 6kg as therapy progressed. The regression models for predicting BSA can assist regulatory bodies in determining reimbursement for new chemotherapy drugs and help hospitals forecast drug utilization and expenditure more accurately.

Idiopathic immune myopathies (IIMs) are autoimmune diseases caused by immune-mediated muscle damage. The etiology remains unclear. Epidemiological and experimental studies, both in animals and humans, hint at viruses as major environmental factors able to trigger aberrant immune responses through many different mechanisms. However, only a few cases of either dermatomyositis or polymyositis following a specific viral infection have been reported in the literature. The objective of this study is to describe the clinical features and the treatment strategy of 2 cases of polymyositis developing shortly after chickenpox and mumps, respectively, and to review the existing literature on the topic. The clinical records of the 2 patients suspected to have developed inflammatory myositis following a viral infection were reviewed. Their clinical history, main laboratory findings, and treatment outcome are presented here. Moreover, a literature search was performed in the PubMed and MEDLINE databases to identify reports describing the association between viral infections and IIMs in patients aged ≥18. The 2 patients reported here developed polymyositis shortly after chickenpox and mumps, respectively, suggesting a causal role for viruses in triggering autoimmunity. Only a few reports published between 1990 and 2020 were found in the literature, possibly linking infections to myositis development. Intravenous immunoglobulin and rituximab were effective for the treatment of viral-triggered polymyositis.

ABSTRACT Anterior shoulder instability causes functional changes that affect patients’ quality of life. The Latarjet procedure is one of the most frequently performed surgeries for cases of recurrent shoulder instability. Objective: To assess the level of satisfaction of patients who underwent the Latarjet procedure in outpatient settings (day hospital) compared with inpatient settings. Methods: A questionnaire was administered to both groups and a descriptive analysis of the results was performed. Results: 51 patients were included, with a mean age of 29.9 years, 82.3% men and 17.6% women. Of the patients who underwent surgery in the day hospital, 46.1% were operated within 100 days of their first outpatient visit; among those in the inpatient group, 76.3% underwent surgery more than 200 days later. Delays occurred in 15.3% of cases in the day hospital compared with 68.4% in the inpatient group. Of the patients in the day hospital, 92.3% felt comfortable contacting the medical team in case of complications and would perform the procedure again in the same setting. Moreover, 63.2% of inpatients would have preferred to have been discharged on the same day. The final satisfaction rate for both groups was 100%. Conclusion: Outpatient surgery guarantees more patient comfort, safety, and can be performed in a timely manner and with fewer delays, which has influenced patients’ decision to have surgery during the COVID-19 pandemic. Level of Evidence V, Cross-sectional Study.

Background: Occurrence of right atrial masses, especially in patients with history of cardiac surgery, is rare. Differential diagnosis between malignant and non-malignant aetiologies might be cumbersome, and surgery is often required to prevent complications or disease evolution. Case: We report the case of a 16-year-old girl from a rural area of Sudan, who underwent surgery for a modified De Vega’s tricuspid annuloplasty, and mitral and aortic valve replacement with mechanical prostheses. The patient was on regular follow-up but demonstrated a poor compliance to anticoagulation therapy with a time in therapeutic range between 52% and 20%. She remained asymptomatic, but a right atrial mass was diagnosed by transthoracic echocardiography during a follow-up visit 41 months after the first operation. Surgical removal of the mass revealed an organized thrombus arising from the point where the Prolene stitches for the tricuspid annuloplasty were previously passed. The patient recovered from surgery, was discharged home on post-operative day 10 and the first follow-up visit at 30 days after discharge confirmed a good clinical status and a normal transthoracic echocardiography (TTE). Conclusions: This case report describes the diagnostic and therapeutic work-out of a thrombus formation on the suture lines of a tricuspid annuloplasty. Moreover, it highlights the importance of a strict and long follow-up after valvular surgery and of the adherence to anticoagulation therapy, especially for patients living in rural areas of developing countries.

INTRODUCTION To ensure the continuity of nutritional care in Cardiovascular Rehabilitation (CR) during the COVID-19 epidemic emergency, a toolkit for telenutritional follow-up was developed for patients at nutritional risk and patients with modifiable risk factors related to eating habits. The reference method for this work is represented by the Nutrition Care Process and Terminology by the Academy of Nutrition and Dietetics (AND), which pursues the goal of implementing safe, effective, person-centred, timely, efficient and equitable nutritional care. MATERIALS AND METHODS The toolkit is composed of digital records for nutritional teleconsultation aimed at the most fragile (at risk for malnutrition), or overweight/obese, diabetic, dyslipidemic, hypertensive patients. In addition, it provides tools and educational/informative material useful to patients for carrying out the telephone consultation/video call. CONCLUSIONS This work - and telenutrition in general - could optimize the effectiveness of nutritional care and patient’s adherence, by reducing distances, waiting times, costs and other inconveniences. Our future goal is to develop a research project involving CR centers to establish the effectiveness of using the toolkit in clinical practice, in terms of desired outcomes and follow-up dedicated time.

INTRODUZIONE Per garantire la continuità dell’assistenza nutrizionale in Riabilitazione Cardiologica (RC) durante l’epidemia da COVID 19, è stato elaborato un toolkit per il teleconsulto nutrizionale, rivolto a pazienti con fattori di rischio modificabili correlati alle abitudini alimentari ed a pazienti a rischio nutrizionale. Il metodo di riferimento del presente lavoro è quello del Nutrition Care Process Terminology dell’Academy of Nutrition and Dietetics (AND), che persegue l’obiettivo di implementare un’assistenza nutrizionale sicura, efficace, centrata sulla persona, tempestiva, efficiente ed equa. MATERIALI E METODI Il toolkit è composto da cartelle nutrizionali elettroniche per il follow-up telematico rivolte ai pazienti più fragili (a rischio di malnutrizione), o in sovrappeso/obesi, diabetici, dislipidemici, ipertesi. Inoltre, sono stati creati strumenti e materiale didattico informativo utili ai pazienti per lo svolgimento del consulto telefonico/videochiamata nutrizionale. CONCLUSIONI Il ricorso al teleconsulto potrebbe ottimizzare l’efficacia dell’assistenza nutrizionale e l’aderenza dei pazienti, tramite una riduzione delle distanze, dei tempi di attesa, dei costi e dei disagi in generale per i pazienti stessi. La nostra prospettiva è quella di sviluppare un progetto di ricerca presso i Centri di RC per stabilire l’efficacia dell’utilizzo del toolkit nella pratica clinica in termini di outcome desiderati e di tempo dedicato al follow-up dei pazienti.

Abstract Objectives To evaluate the muscular strength of the internal (IR) and external (ER) rotators of the shoulder after Bristow/Latarjet surgery. Methods Cross-sectional study with 18 patients (36 shoulders). The isokinetic evaluation was performed using the Biodex 3 System Pro dynamometer (Biodex Medical System, Inc., Shirley, NY, USA). The athletic shoulder outcome rating scale (ASORS) and the visual analogue scale (VAS) were applied. Results The values of peak torque and maximum work in concentric and eccentric mode on the non-operated shoulder were higher than on the operated side for both the IR and ER (p< 0.01). The conventional and functional balance between the ER and IR showed no differences between the operated and the non-operated side. When comparing patients with postoperative time < 1 year or 1 year, no differences were observed in peak torque values at 60°/s and 240°/s and maximum work at 60°/s and 240°/s of the IR to the operated shoulder. However, the peak torque values of 60°/s and 240°/s and maximum work at 60°/s and 240°/s of the ER were higher in subjects with postoperative time ≥ 1 year in all variables (p< 0.05). Conclusions There was a decrease in the strength of the IR and ER in the operated shoulder compared with the healthy shoulder. However, the conventional and functional balance was maintained.

Resumen: Introducción y objetivos: En los pacientes que presentan anomalías en las válvulas cardiacas la cirugía que se prefiere siempre es la plastia; sin embargo, existen casos en los cuales el reemplazo valvular es la única opción. El objetivo de este estudio es valorar los resultados a corto y largo plazo de pacientes pediátricos que requirieron reemplazo valvular.Material y métodos Previo consentimiento informado firmado por los padres o el tutor legal, se ingresaron los datos de los pacientes menores de 18 años de edad que fueron sometidos a reemplazo valvular entre 2012 y 2020,. Resultados: Se ingresaron 13 pacientes, de los cuales el 84,6% corresponden al género masculino, la media de edad fue de 9 años, el peso medio fue de 29 kg, la válvula más afectada fue la mitral, con el 61,5%, seguida de la aórtica, con el 23,1%. En el 61,5% la presentación corresponde a la doble lesión valvular. En cuanto a la etiología, la más frecuente fue la congénita, con el 84,6%; la prótesis más utilizada fue la St. Jude Medical® número 23, la media de tiempo de circulación extracorpórea fue de 115 min y el de pinzamiento aórtico fue de 75 min; el promedio de seguimiento fue 23 meses. Conclusiones: El reemplazo valvular en la etapa pediátrica siempre es un procedimiento que se intenta postergar el mayor tiempo posible; sin embargo, no es factible en muchas ocasiones y conlleva un alto riesgo tanto quirúrgico como de complicaciones. En nuestra experiencia, los resultados son satisfactorios; sin embargo, nuestra muestra son pacientes mayores de 5 años. Abstract: Introduction and objectives: In paediatric patients with heart valve abnormalities plasty is always preferred; however, there are cases in which valve replacement is the only option. The objective of this study is to assess the short- and long-term results of paediatric patients who required valve replacement. Material and methods: With prior informed consent signed by the patient's parents or legal guardian, the data of patients under 18 years of age who underwent valve replacement were entered from the period between 2012 and 2020. Results: Thirteen patients were admitted of whom 84.6% were male, the mean age was 9 years, the mean weight was 29 kg, the most affected valve was the mitral valve in 61.5%, followed by the aortic valve at 23.1%. In 61.5% presentation was a double valve lesion. In terms of the aetiology; the most frequent aetiology was congenital in 84.6%; the most widely used prosthesis was St. Jude Medical® number 23. The mean time for extracorporeal surgery was 115 min and the mean time for aortic clamping was 75 min. Follow-up was 23 months. Conclusions: valve replacement in the paediatric stage is always a procedure that we should attempt to postpone as long as possible, as it carries a high risk both in surgery and in complications, however this is often not feasible. Although our sample is not in children under 5 years of age, the results are good.

Background: Aortic rupture and suture dehiscence can complicate a cardiac operation, especially in case of infections of the surgical site. Such a complication can be life-threatening and require immediate surgical treatment. Case: We report the case of a 13-year-old girl who suffered a sudden dehiscence of the aortic suture line in the context of deep sternal wound infection, while in the surgical intensive care unit after a double valve replacement. Control of bleeding was obtained by the insertion of an endotracheal tube into the ascending aorta and inflation of the tube cuff to plug the aortic bleeding point. The extracorporeal circulation was then established and under deep hypothermic arrest the defect was successfully repaired. The patient was discharged 14 days after surgery and reviewed at the outpatient clinic in good health. Conclusions: An endotracheal tube can be used in cases of uncontrollable aortic bleeding as a life-saving tool to bridge the patient to adequate surgical treatment.

Abstract The impact of male aging on male fertility has only recently become of interest to the scientific community. This study aims to assess the relationship between age and fertility among a sample of men, considering the individual and pathological characteristics. In this retrospective study data of semen analysis and medical history of 1294 Italian male patients were considered. Semen analysis was performed by light microscopy and transmission electron microscopy mathematically elaborated. A generalized linear model was used to explore the influence of male age on semen quality, considering as confounders wine consumption, smoking habits, presence of varicocele, consanguinity and positive semen bacteriological analysis and urethral swab. The mean age of the participants was 36.41 ± 6.379. Male aging without impact of confounders was correlated with a decrease in sperm concentration and motility and an increased in sperm necrosis. Sperm concentration and progressive motility were negatively related to the presence of confounders as wine consumption (sperm motility), urogenital infection (sperm concentration and motility), varicocele (sperm concentration) and consanguinity (sperm motility). Urogenital infection, varicocele and consanguinity positively correlated with sperm necrosis. The most important finding was the observation of a negative effect of male aging on sperm parameters such as concentration, motility, and viability. It is possible to hypothesize age-dependent changes of testicular environment, probably related to reactive oxygen species production. The demonstration, in a large sample of patients, that aging influences sperm quality strongly motivates further research focused on the mechanisms involved in this phenomenon and its effects on offspring fitness.

Mobile electrocardiogram (ECG) devices are valuable tools for teaching ECG interpretation. The primary purpose of this follow-up study was to determine if an ECG active learning session could be safely and effectively performed during the coronavirus disease 2019 (COVID-19) pandemic using a newly developed mobile 6-lead ECG device. Additionally, we examined the educational impact of these active learning sessions on student knowledge of cardiovascular physiology and the utility of the mobile 6-lead ECG device in a classroom setting. In this study, first-year medical students (MS1) performed four active learning activities using the new mobile 6-lead ECG device. Data were collected from 42 MS1s through a quantitative survey administered in September 2020. Overall, students felt the activity enhanced their understanding of the course material and that the activity was performed safely and in compliance with local COVID-19 guidelines. These results emphasize student preference for hands-on, small group learning activities in spite of the pandemic.

AbstractIntroduction Many types of research have been performed to improve the diagnosis, therapy, and prognosis of oropharyngeal carcinomas (OP-SCCs). Since they arise in lymphoid-rich areas and intense lymphocytic infiltration has been related to a better prognosis, a TREM-1 putative function in tumour progression and survival has been hypothesized.Materials and methods Twenty-seven human papillomavirus (HPV) 16+ OP-SCC specimens have been analyzed to relate TREM-1 expression with histiocytic and lymphocytic markers, HPV presence and patients’ outcome.Results No differences have been shown between intratumoral and stromal CD4+ cells, while intratumoral CD8+ lymphocytes are higher with respect to the tumour stroma (p = .0005). CD68+ cells are more than CD35+ and TREM-1+; their presence is related to CD35± and TREM-1± histiocytes (p = .005 and .026, respectively). Intratumoral CD4+ lymphocytes are higher in p16+ cases (11/27) than in p16− (p = .042); moreover, p16 positivity correlates to a better survival (p = .034). CD4+, CD8+ and CD35+ cells have no impact on survival, while CD68 expression heavily influences progression and bad outcome (p = .037). TREM-1 positivity also leads to worst overall survival (p = .001): peritumoral expression and death-cause relationship are always significant, particularly when the cause is OP-SCC (p = .000).Conclusion While p16 shows to better stratify HPV16+ patients’ outcome, TREM-1+ macrophages suggest their key importance in HPV-related OP-SCCs progression.KEY MESSAGESTREM-1 positivity correlates to the worst overall survival of HPV16-positive OPSCCs-affected patients.p16-positive HPV16 related OPSCCs patients have a better prognosis with respect to p16-negative ones.

Abstract Objective To assess how shoulder specialists have used infiltration in their daily practice. Methods A survey study in which shoulder and elbow specialists answered a questionnaire on the use of infiltration in painful shoulders. Results Most of the doctors (45.9%) have > 10 years of experience in the area and have carried out up to 10 infiltrations in the last 12 months. The main indications for glenohumeral and subacromial infiltration are glenohumeral arthrosis and rotator cuff tendinopathy, respectively. The most used portals are the posterior (52.2%) for glenohumeral infiltration and the lateral (57.5%) for subacromial infiltration. The majority of the doctors (752%) infiltrate in an outpatient setting without imaging methods, and the most commonly used drug is the combination of corticoid and anesthetic. The main contraindication cited is the presence of diabetes, and the most common complication is pain after infiltration. Conclusion Subacromial infiltrations are indicated especially for the treatment of rotator cuff tendinopathies and bursitis, performed by the lateral portal, in an outpatient setting, with low index of long-term complications. Glenohumeral infiltrations are indicated especially for glenohumeral arthrosis, with a combination of a corticoid and anesthetic, performed mostly in an outpatient setting.

Summary: Background: During the COVID-19 pandemic, the scarcity of resources has necessitated triage of critical care for patients with the disease. In patients aged 65 years and older, triage decisions are regularly based on degree of frailty measured by the Clinical Frailty Scale (CFS). However, the CFS could also be useful in patients younger than 65 years. We aimed to examine the association between CFS score and hospital mortality and between CFS score and admission to intensive care in adult patients of all ages with COVID-19 across Europe. Methods: This analysis was part of the COVID Medication (COMET) study, an international, multicentre, retrospective observational cohort study in 63 hospitals in 11 countries in Europe. Eligible patients were aged 18 years and older, had been admitted to hospital, and either tested positive by PCR for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or were judged to have a high clinical likelihood of having SARS-CoV-2 infection by the local COVID-19 expert team. CFS was used to assess level of frailty: fit (CFS1–3), mildly frail (CFS4–5), or frail (CFS6–9). The primary outcome was hospital mortality. The secondary outcome was admission to intensive care. Data were analysed using a multivariable binary logistic regression model adjusted for covariates (age, sex, number of drugs prescribed, and type of drug class as a proxy for comorbidities). Findings: Between March 30 and July 15, 2020, 2434 patients (median age 68 years [IQR 55–77]; 1480 [61%] men, 954 [30%] women) had CFS scores available and were included in the analyses. In the total sample and in patients aged 65 years and older, frail patients and mildly frail patients had a significantly higher risk of hospital mortality than fit patients (total sample: CFS6–9 vs CFS1–3 odds ratio [OR] 2·71 [95% CI 2·04–3·60], p

Setting Children especially those

Sjögren’s syndrome (SS) is an autoimmune disease that involves the nervous system in about 20% of cases. In 25-92% of patients affected by Sjögren’s syndrome, neurological symptoms may precede the sicca syndrome. A 65-year-old male presented with a seven-month history of episodes of near-syncope, constipation, anhidrosis, disabling fatigue and asthenia. Physical examination was unremarkable, whilst the ECG revealed sinus bradycardia. Laboratory tests showed lymphopenia and normal inflammatory markers. In order to assess a potential autonomic neuropathy, “Deep Breathing Test” (E/I 1.02), “Lying to Standing Test” (R/R’ 0.95), and “Orthostatic Hypotension Tests” (T 120s Systolic reduction >20 mmHg and Diastolic reduction >10 mmHg) were performed, all of which were abnormal. ECG Holter monitoring revealed sinus bradycardia, and right bundle branch block with 24-h blood pressure monitoring revealing a diurnal hypotensive profile. The patient reported a three-month history of worsening dry mouth. On physical examination, the patient had anisocoria in response to light stimulation. Auto-antibody testing was performed to evaluate the presence of any autoimmune disease. The results of these studies included an abnormal elevation of ANA (1:320 speckled pattern), Ro/SS-a (>240U/l), and La/SS-b (162 U/ml) antibodies. The patient was discharged with a diagnosis of “Autonomic Neuropathy Most Likely Due to Primary Sjögren’s Syndrome (SS)” and started the immunotherapy. After one month, he reported a significant improvement in his symptoms with a concomitant normalization of his “Orthostatic Hypotension Tests.” This case underlines the potential for dys-autonomic symptoms to precede the onset of sicca syndrome in patients with Sjogren’s Syndrome.

Neurotoxins such as rotenone, 1-methyl-4-phenylpyridinium (MPP+) and 6-hydroxydopamine (6-OHDA) are well known for their high toxicity on dopaminergic neurons and are associated with Parkinson’s disease (PD) in murine models and humans. In addition, PD patients often have glucose intolerance and may develop type 2 diabetes (T2D), whereas T2D patients have higher risk of PD compared to general population. Based on these premises, we evaluated the toxicity of these three toxins on pancreatic β-cell lines (INS-1 832/13 and MIN6) and we showed that rotenone is the most potent for reducing β-cells viability and altering mitochondrial structure and bioenergetics in the low nanomolar range, similar to that found in dopaminergic cell lines. MPP+ and 6-OHDA show similar effects but at higher concentration. Importantly, rotenone-induced toxicity was counteracted by α-tocopherol and partially by metformin, which are endowed with strong antioxidative and cytoprotective properties. These data show similarities between dopaminergic neurons and β-cells in terms of vulnerability to toxins and pharmacological agents capable to protect both cell types.

SettingKenya, 2012-2015.ObjectiveTo explore whether there is a gender difference in all-cause mortality among smear positive pulmonary tuberculosis (PTB)/ HIV co-infected patients treated for tuberculosis (TB) between 2012 and 2015 in Kenya.DesignRetrospective cohort of 9,026 smear-positive patients aged 15-49 years. All-cause mortality during TB treatment was the outcome of interest. Time to start of antiretroviral therapy (ART) initiation was considered as a proxy for CD4 cell count. Those who took long to start of ART were assumed to have high CD4 cell count.ResultsOf the 9,026 observations analysed, 4,567(51%) and 4,459(49%) were women and men, respectively. Overall, out of the 9,026 patients, 8,154 (90%) had their treatment outcome as cured, the mean age in years (SD) was 33.3(7.5) and the mean body mass index (SD) was 18.2(3.4). Men were older (30% men' vs 17% women in those ≥40 years, p = ConclusionWomen with sputum positive PTB/HIV co-infection have a significantly lower risk of all-cause mortality during TB treatment compared to men. Men were older, had lower BMI and tested later for HIV than women.

AIM:To identify subgroups regarding paediatricians' awareness, attitude, practice and satisfaction about management of Sleep-Disordered Breathing (SDB) in Italy using Latent Class Analysis (LCA). METHODS:A cross-sectional study was conducted on a large sample of Italian paediatricians. Using a self-administered questionnaire, the study collected information on 420 Paediatric Hospital Paediatricians (PHPs) and 594 Family Care Paediatricians (FCPs). LCA was used to discover underlying response patterns, thus allowing identification of respondent groups with similar awareness, attitude, practice and satisfaction. A logistic regression model was used to investigate which independent variables influenced latent class membership. Analyses were performed using R 3.5.2 software. A p-value

IntroductionIsoniazid preventive therapy (IPT) taken by People Living with HIV (PLHIV) protects against active tuberculosis (TB). Despite its recommendation, data is scarce on the uptake of IPT among PLHIV and factors associated with treatment outcomes. We aimed at determining the proportion of PLHIV initiated on IPT, assessed TB screening practices during and after IPT and IPT treatment outcomes.MethodsA retrospective cohort study of a representative sample of PLHIV initiated on IPT between July 2015 and June 2018 in Kenya. For PLHIV initiated on IPT during the study period, we abstracted patient IPT uptake data from the National data warehouse. In contrast, we obtained information on socio-demographic, TB screening practices, IPT initiation, follow up, and outcomes from health facilities' patient record cards, IPT cards, and IPT registers. Further, we assessed baseline characteristics as potential correlates of developing active TB during and after treatment and IPT completion using multivariable logistic regression.ResultsFrom the data warehouse, 138,442 PLHIV were enrolled into ART during the study period and initiated 95,431 (68.9%) into IPT. We abstracted 4708 patients' files initiated on IPT, out of which 3891(82.6%) had IPT treatment outcomes documented, 4356(92.5%) had ever screened for TB at every clinic visit, and 4,243(90.1%) had documentation of TB screening on the IPT tool before IPT initiation. 3712(95.4%) of patients with documented IPT treatment outcomes completed their treatment. 42(0.89%) of the abstracted patients developed active TB,16(38.1%) during, and 26(61.9%) after completing IPT. Follow up for active TB at 6-month post-IPT completion was done for 2729(73.5%) of patients with IPT treatment outcomes. Sex, Viral load suppression, and clinic type were associated with TB development (pConclusionIPT initiation stands at two-thirds of the PLHIV, with a high completion rate. TB screening practices were better during IPT than after completion. Development of active TB during and after IPT emphasizes the need for a keen follow up.

los trastornos de la alimentación e ingesta (TAI) son un complejo conjunto interdimensional de enfermedades mentales que afectan el rendimiento corporal, mental y social. El núcleo de la enfermedad es el miedo a ganar peso. Las estrategias de control de ingesta varían entre: restricción, selección y purga alimentaria. Afectan diferentes sexos, razas, etnias y edades. Con mayor frecuencia en adolescentes y mujeres jóvenes (9: 1). Presentan alta mortalidad, comorbilidad mental y conflictos familiares asociados. Método: integrar información disponible y útil según criterio de experto, orientada al manejo clínico de los TAI. Resultado: debido a que los profesionales de salud de diferentes áreas podrían ser el único contacto que el/la paciente busca para aliviar alguna dolencia aparentemente no relacionada con TAI, es necesario lograr identificar y diagnosticar los estadios patológicos e indicar las primeras conductas, así como hacer una referencia exitosa. El retraso en el diagnóstico causa alteraciones severas y crónicas en la fisiología, el comportamiento, la cognición y el funcionamiento psicosocial. Los objetivos de este estudio son: a. Presentar, en forma integrada, la información disponible de modo de facilitar a los profesionales de la salud la detección precoz de los TAI; b. Ofrecer un conjunto de acciones útiles que faciliten el diagnóstico TAI; c. Organizar la comprensión del riesgo TAI en un diagrama que facilite la construcción de la derivación utilizando las dimensiones: cuerpo, mente, relaciones; d. Mostrar las alternativas psicoterapéuticas en uso e. Proveer información para realizar las primeras intervenciones. Conclusión: reconocer tempranamente el cuadro TAI puede detener el curso patológico y los potenciales daños.

Radiopharmaceuticals targeting the prostate-specific membrane antigen (PSMA) has become the gold standard for PET imaging of prostate cancer. [68Ga]Ga-PSMA-11 has been the forerunner but a [18F]F-PSMA ligand has been developed because of the intrinsic advantages of Fluorine-18. Fluorine-18 labelled compounds are usually prepared in centers with an on-site cyclotron. Since our center has not an on-site cyclotron, we decided to verify the feasibility of producing the experimental 18F-labelled radiopharmaceutical [18F]F-PSMA-1007 with [18F]F- from different external suppliers. A quality agreement has been signed with two different suppliers, and a well-established and correctly implemented quality assurance protocol has been followed. The [18F]F- was produced with cyclotrons, on Nb target, but with different beam energy and current. Extensive validation of the [18F]F-PSMA-1007 synthesis process has been performed. The aim of this paper was the description of all the quality documentation which allowed the submission and approval of the Investigational Medicinal Product Dossier (IMPD) to the Competent Authority, addressing the quality problems due to different external suppliers. The result indicates that no significant differences have been found between the [18F]F- from the two suppliers in terms of radionuclidic and radiochemical purity and [18F]F- impacted neither the radiochemical yield of the labelling reaction nor the quality control parameters of the IMP [18F]F-PSMA-1007. These results prove how a correct quality assurance system can overcome some Regulatory Authorities issue that may represent an obstacle to the clinical use of F-18-labelled radiopharmaceuticals without an on-site cyclotron.

Most vaccinations are recommended within the 15th month of life, in order to reduce risks and to protect children from the initial stages of their lives. A vaccination training session was carried out during the birthing preparation course, aimed at increasing the attitude toward vaccination in maternal-child age. A questionnaire on vaccination awareness was administered before and after the training session and on-site flu vaccination was offered to women and their companions. The percentage of participants who consider the preparatory course a useful tool to obtain information about vaccines increases significantly from 30.34% at pre-intervention to 64.56% at post-intervention (p < 0.001). There is a significant increase in the mean number of vaccinations that the participants want their children to get. The number of participants believing that there is no relationship between vaccination and autism rose from 41.05 to 72.97% (p < 0.001). In total, 48 out of 119 (40.34%) pregnant women participating in the course and 39 companions were vaccinated for influenza. Vaccination knowledge and attitude significantly increased after a training session dedicated to vaccination as a part of the pregnant pre-birth course, whose aim can be therefore extended to the management of the health of the child, well beyond the period of pregnancy, according to the life-course approach to health.

Metformin is an oral antihyperglycemic drug widely used to treat type 2 diabetes, acting via indirect activation of 5′ Adenosine Monophosphate-activated Protein Kinase (AMPK). Actually, evidence has accumulated of an intriguing anti-inflammatory activity, mainly mediated by AMPK through a variety of mechanisms such as the inhibition of cytokine-stimulated Nuclear Factor-κB (NF-κB) and the downregulation of the Janus Kinase/Signal Transducer and Activator of Transcription (JAK/STAT) signaling pathways. Moreover, AMPK plays an important role in the modulation of T lymphocytes and other pivotal cells of the innate immune system. The current understanding of these AMPK effects provides a strong rationale for metformin repurposing in the management of autoimmune and inflammatory conditions. Several studies demonstrated metformin’s beneficial effects on both animal and human rheumatologic diseases, especially on rheumatoid arthritis. Unfortunately, even though data are large and remarkable, they almost exclusively come from experimental investigations with only a few from clinical trials. The lack of support from prospective placebo-controlled trials does not allow metformin to enter the therapeutic repertoire of rheumatologists. However, a large proportion of rheumatologic patients can currently benefit from metformin, such as those with concomitant obesity and type 2 diabetes, two conditions strongly associated with rheumatoid arthritis, osteoarthritis, and gout, as well as those with diabetes secondary to steroid therapy.

The enteric protist Blastocystis is one of the most frequently reported parasites infecting both humans and many other animal hosts worldwide. A remarkable genetic diversity has been observed in the species, with 17 different subtypes (STs) on a molecular phylogeny based on small subunit RNA genes (SSU rDNA). Nonetheless, information regarding its distribution, diversity and zoonotic potential remains still scarce, especially in groups other than primates. In Brazil, only a few surveys limited to human isolates have so far been conducted on Blastocystis STs. The aim of this study is to determine the occurrence of Blastocystis subtypes in non-human vertebrate and invertebrate animal groups in different areas of the state of Rio de Janeiro, Brazil. A total of 334 stool samples were collected from animals representing 28 different genera. Blastocystis cultivated samples were subtyped using nuclear small subunit ribosomal DNA (SSU rDNA) sequencing. Phylogenetic analyses and BLAST searches revealed six subtypes: ST5 (28.8%), ST2 (21.1%), ST1 and ST8 (19.2%), ST3 (7.7%) and ST4 (3.8%). Our findings indicate a considerable overlap between STs in humans and other animals. This highlights the importance of investigating a range of hosts for Blastocystis to understand the eco-epidemiological aspects of the parasite and its host specificity.

The relationship between the ataxia-telangiectasia mutated (ATM) rs1801516 gene polymorphism and risk of radiation-induced late skin side effects remains a highly debated issue. In the present study, we assessed the role of ATM rs1801516 as risk factor for radiation-induced fibrosis and telangiectasia, using the LENT-SOMA scoring scale in 285 breast cancer patients who received radiotherapy after breast conserving surgery. A systematic review with meta-analysis and trial sequential analysis (TSA) was then conducted to assess reliability of the accumulated evidence in breast cancer patients. In our cohort study, no association was found between ATM rs1801516 and grade ≥ 2 telangiectasia (GA+AA vs GG, HRadjusted: 0.699; 95%CI: 0.273-1.792, P = 0.459) or grade ≥ 2 fibrosis (GA+AA vs GG, HRadjusted: 1.175; 95%CI: 0.641-2.154, P = 0.604). Twelve independent cohorts of breast cancer patients were identified through the systematic review, of which 11 and 9 cohorts focused respectively on the association with radiation-induced fibrosis and radiation-induced telangiectasia. Pooled analyses of 10 (n = 2928 patients) and 12 (n = 2783) cohorts revealed, respectively, no association of ATM rs1801516 with radiation-induced telangiectasia (OR: 1.14; 95%CI: 0.88-1.48, P = 0.316) and a significant correlation with radiation-induced fibrosis (OR: 1.23; 95%CI: 1.00-1.51, P = 0.049), which however did not remain significant after TSA adjustment (TSA-adjusted 95%CI: 0.85-1.78). These results do not support an impact of ATM rs1801516 on late skin reactions of radiotherapy for breast cancer, nevertheless further large studies are still required for conclusive evidences.

Resumen Se analiza literatura sobre la influencia materna que los trastornos alimentarios y de la ingestión de alimentos (TAI) tienen sobre el desarrollo psíquico de los hijos. De 1.096 artículos encontrados en PubMed, PsycINFO, Scielo, ProQuest Health & Medical Collection, 32 aportan información relevante organizada en 6 categorías: 1-Alimentación; 2-Antropometría; 3-Percepción materna de los hijos; 4-Percepción de los hijos hacia sus madres; 5-Estilo parental; 6-Psicopatología de los hijos. La evidencia muestra influencia de TAI materno sobre el psico - desarrollo de los hijos. Se discuten mecanismos involucrados y se sugiere seguir avanzando en investigación y clínica

Pancreatic α cells are exposed to metabolic stress during the evolution of type 2 diabetes (T2D), but it remains unclear whether this affects their survival. We used electron microscopy to search for markers of apoptosis and endoplasmic reticulum (ER) stress in α and β cells in islets from T2D or non-diabetic individuals. There was a significant increase in apoptotic β cells (from 0.4% in control to 6.0% in T2D), but no α cell apoptosis. We observed, however, similar ER stress in α and β cells from T2D patients. Human islets or fluorescence-activated cell sorting (FACS)-purified rat β and α cells exposed in vitro to the saturated free fatty acid palmitate showed a similar response as the T2D islets, i.e. both cell types showed signs of ER stress but only β cells progressed to apoptosis. Mechanistic experiments indicate that this α cell resistance to palmitate-induced apoptosis is explained, at least in part, by abundant expression of the anti-apoptotic protein Bcl2l1 (also known as Bcl-xL).