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Background: Robotic-assisted thoracic surgery (RATS) is used increasingly frequently in major lung resection for early stage non-small-cell lung cancer (NSCLC) but has not yet been fully evaluated. The aim of this study was to compare the surgical outcomes of lymph node dissection (LND) performed via RATS with those from totally thoracoscopic (TT) four-port videothoracoscopy. Methods: Clinical and pathological data were collected retrospectively from patients with clinical stage N0 NSCLC who underwent pulmonary resection in the form of lobectomy or segmental resection between June 2010 and November 2022. The assessment criteria were number of mediastinal lymph nodes and number of mediastinal stations dissected via the RATS approach compared with the four-port TT approach. Results: A total of 246 pulmonary resections with LND for clinical stages I–II NSCLC were performed: 85 via TT and 161 via RATS. The clinical characteristics of the patients were similar in both groups. The number of mediastinal nodes dissected and mediastinal stations dissected was significantly higher in the RATS group (TT: mean ± SD, 10.72 ± 3.7; RATS, 14.74 ± 6.3 [p < 0.001]), except in the inferior mediastinal stations. There was no difference in terms of postoperative complications. Conclusions: In patients with early stage NSCLC undergoing major lung resection, the quality of hilomediastinal LND performed using RATS was superior to that performed using TT.

Aim: Vaccination against SARS-CoV2 has been proposed as a fundamental element for the control of the pandemic. This study aimed to describe the suspected adverse reactions (ADR) reported by vaccinated hospital workers. Methods: A descriptive study of suspected ADR was conducted between January and March 2021. The suspected ADR were identified using a specifically designed electronic form and spontaneous reporting. Data were also collected regarding the characteristics of the professionals, vaccine administered, severity, and outcome of ADR. Results: 8169 professionals received 2 doses of SARS-CoV2 vaccine (6672 Comirnaty (R) and 1497 Spikevax (R)) and 894 reports of suspected ADR were reported (762 for Comirnaty (R) and 132 for Spikevax (R)), resulting in a cumulative ADR incidence of 10.94% (95%CI: 10.27-11.62). The majority of ADR were reported only after the second dose, 497 (56.2%), while 211 (23.6%) were reported only after the first dose and 186 (21%) after both doses. The symptoms were mostly mild, did not require medical assistance, and disappeared within approximately 3 days. One hundred and seventeen professionals had a history of COVID-19 infection. These studies reported, statistically significant, more suspected ADR after the first dose (42.7%) than those with no history of COVID-19 (20.7%). Among professionals, more ADR occurred after the first dose with the Spikevax (R) vaccine (41.6%) than with the Comirnaty (R) vaccine (20.5%). Conclusion: The majority of suspected ADR reported were described in the summary of product characteristics (SmPC). Professionals with a history of COVID-19 reported more suspected ADR after the first dose than did those without a history.

Background The aim of this study was to determine whether preoperative nutritional status and inflammatory status, specifically the omega fatty acids and the omega 6/3 ratio, would affect postoperative outcomes and complications in patients with lung cancer undergoing lung resection. Methods This prospective observational study included 68 patients with early-stage non-small cell lung cancer who were candidates for radical surgery. A complete nutritional assessment was performed. The primary study variable was postoperative complications and mortality in the first 30 days. Descriptive, bivariate, logistic regression analysis was carried out. Results A total of 50 men (73.53%) and 18 women (26.47%) underwent surgery, with a median age of 64.2 (± 9.74) years. The mean omega 6/3 ratio was 17.39 (± 9.45). A complication occurred in 39.7% of the study sample (n = 27), the most common being persistent air leak, in 23.53% (n = 16). After performing bivariate analysis taking the omega 6/3 ratio as a qualitative variable, we observed that the omega 6/3 ratio had prognostic value for persistent air leak (p = 0.001) independently of age, sex, comorbidity, preoperative respiratory function and approach or type of surgery. The remaining nutritional and inflammatory markers did not have a statistically significant association (p > 0.05) with postoperative complications. On multivariate analysis with an omega 6/3 ratio cut-off of 21, the only variable that remained significant was COPD (p = 0.03; 95% CI: 1.22–53.57). Conclusions Omega 6/3 ratio is a prognostic factor for air leak, independently of the patient’s clinical and pathological characteristics.

Introduction The impact of carcinogenic infections on cancer-related mortality is unknown. Methods The mortality due to cancers attributable to carcinogenic infections was estimated. The attributable fraction for the infectious agents classified as group 1 carcinogenic in human beings was applied to yearly data on causes of cancer mortality over the period 2013–2017 in Spain according to the International Classification of Diseases (ICD-10). Results It was estimated that 9115 deaths (over 110,287 cancer-related deaths, 8.3%) were attributable to infections caused by carcinogenic agents. The estimated number of deaths in men was 5434 (59.6%). The estimated mortality attributable to Helicobacter pylori infection accounted for 48.3% and four agents (H. pylori, HCV, HPV, and HBV) accounted for 96.8% of all cancer deaths attributable to carcinogenic infections. The burden of cancer-related mortality attributable to carcinogenic infections in Spain during the period 2013–2017 was approximately 8%. Conclusions In Spain, one-twelfth of cancer deaths are attributable to carcinogenic infections. Public health measures aiming to reduce the impact of carcinogenic infections are essential.

Background: Patients with relapsing-remitting multiple sclerosis (RRMS) most commonly experience their first symptoms between 20 and 40 years of age. The objective of this study was to investigate how the age at which the first symptoms of RRMS occur has changed over the past decades. Methods: Patients who were followed up in our unit after an initial diagnosis of RRMS using the Poser or McDonald criteria and who experienced their first symptoms between January 1970 and December 2019 were included in the study. The cohort was divided into five groups according to the decade in which the first symptoms appeared. The age at disease onset was compared across decades. Changes in age were also determined after excluding patients with early-onset disease (50 years of age) to avoid bias. Results: The cohort included 1,622 patients with RRMS, 67.6% of whom were women. Among them, 5.9% and 4% had early-onset and late-onset disease, respectively. The mean age ± standard deviation at onset was 31.11 ± 9.82 years, with no differences between men and women. The mean ages at onset were 23.79 ± 10.19 years between 1970 and 1979, 27.86 ± 9.22 years between 1980 and 1989, 30.07 ± 9.32 years between 1990 and 1999, 32.12 ± 9.47 between 2000 and 2009, and 34.28 ± 9.83 years between 2010 and 2019. The ages at disease onset were progressively higher in the later decades; this trend was statistically significant (p < 0.001), with a Pearson linear correlation coefficient R of 0.264 and R2 of 0.070 (p < 0.001). The results were similar when analysing men and women separately. We conducted an analysis of 1,460 patients (mean age at onset: 31.10 ± 7.99 years), after excluding patients with early-onset and late-onset disease. In this specific subgroup, the mean ages at disease onset were 28.38 ± 8.17 years between 1970 and 1979, 29.22 ± 7.51 years between 1980 and 1989, 30.06 ± 8.02 years between 1990 and 1999, 31.46 ± 7.77 years between 2000 and 2009, and 33.37 ± 7.97 years between 2010 and 2019. The trend was also statistically significant (p < 0.001), with a Pearson linear correlation coefficient R of 0.193 and R2 of 0.037 (p < 0.001).

Background: Nutrition is an important factor in the outcome of any disease process. We evaluated the relationship of nutritional status and inflammatory status of non-small cell lung cancer (NSCLC) patients undergoing robotic-assisted thoracic surgery (RATS) with postoperative complications. Methods: This prospective cohort study included 107 NSCLC patients undergoing surgical treatment, between 2019 and 2021. Nutritional status and inflammatory status were assessed before pulmonary resection using anthropometric assessment, blood tests, and body mass index (BMI). Results: The BMI was 27.5 ± 4.4. Based on BMI, 29% (n = 31) were classified as normal weight, 43% (n = 46) as overweight, and 28% (n = 30) as obese. The mean neutrophil/lymphocyte ratio (NLR) was 2.16 ± 0.85, the platelet/lymphocyte ratio (PLR) was 121.59 ± 44.21, and the lymphocyte/monocyte ratio (LMR) was 3.52 ± 1.17. There was no increase in the number of intraoperative complications or bleeding (p = 0.696), postoperative complications (p = 0.569), mean hospital stay (p = 0.258) or duration of chest drain (p = 0.369). Higher inflammatory status, with an NLR > 1.84, was associated with more overall postoperative complications (p = 0.028), only in univariate analysis, but this significance was not maintained on multivariate analysis. Conclusions: BMI was not a predictor of increased postoperative risk in this cohort; therefore, weight should not deter surgeons from using RATS for pulmonary resection.

Background The aim of this study was to assess the effect of the lymphocyte-to-monocyte ratio (LMR), neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio on overall survival and disease-free survival in patients with lung cancer treated with radical surgery. Methods We performed a retrospective review of patients with lung cancer who prospectively underwent radical resection between 2004 and 2012. Blood samples were taken as part of the preoperative workup. The inflammatory markers studied were absolute values of lymphocytes, monocytes, neutrophils and platelets, with subsequent calculation of ratios. Median follow-up was 52 months. Results Two hundred and sixty-eight patients underwent surgery, of whom 218 (81.3%) were men. Mean age was 62.9 ± 8.7 years. A lymphocyte-to-monocyte ratio ≥ 2.5 was independently associated with longer disease-free survival (hazard ratio [HR] 0.476 (0.307–0.738), p = 0.001) and longer overall survival (HR, 0.546; 95% CI: 0.352–0.846; p = 0.007), in models adjusted for age, sex, stage, and type of resection. No other systemic inflammatory marker showed a significant association. Conclusion Preoperative LMR is an independent prognostic factor of overall survival and recurrence-free survival in patients with surgically-resected early stage lung cancer.

Several infectious agents are ascertained causes of cancer, but the burden of cancer mortality attributable to carcinogenic infections in Italy is still unknown. To tackle this issue, we calculated the rate and regional distribution of cancer deaths due to infections sustained by seven pathogens ranked as group 1 carcinogenic agents in humans by the International Agency for Research on Cancer. Population attributable fractions related to these agents were applied to annual statistics of cancer deaths coded according to the 10th International Classification of Diseases. The estimated burden of cancer mortality attributable to carcinogenic infections in Italy during the period 2011&ndash, 2015 was 8.7% of all cancer deaths registered yearly, on average. Approximately 60% of deaths occurred in men, and almost the whole burden was due to four infectious agents (Helicobacter pylori, hepatitis C virus, high-risk human papillomavirus, and hepatitis B virus). The analysis of regional distribution showed a higher number of infection-related cancer deaths in the northern regions, where the estimates reached 30 (Liguria) and 28 (Friuli Venezia Giulia) deaths per 100,000 inhabitants in 2015. Since one-twelfth of cancer deaths were attributable to these modifiable risk factors, the implementation of appropriate prevention and treatment interventions may help to reduce the impact of these infections on cancer mortality.

Background Previous attempts estimated the impact of infectious agents on cancer incidence in Italy, but the burden of carcinogenic infections on cancer mortality remains unknown. Therefore, we aimed to conduct a preliminary analysis in order to estimate this burden at country level. Methods We applied the global, regional, or national population attributable fractions for Helicobacter pylori, hepatitis B virus (HBV), hepatitis C virus (HCV), high-risk human papillomavirus (HPV) types, Epstein-Barr virus (EBV), human herpesvirus type 8 (HHV-8), and human T-cell lymphotropic virus type 1 (HTLV-1) - all microorganisms ranked as group 1 carcinogenic agents in human beings by the International Agency for Research on Cancer - to 2015 cancer-related deaths recorded according to the 10th International Classification of Diseases coding system in Italy. Results We estimated a total of 14,120 deaths attributable to carcinogenic infections, being 8.3% of the total of cancer-related deaths (n = 170,339). 58.8% of those occurred in men. H. pylori, HCV, HBC, and HPV accounted for 96.4% of the whole mortality burden attributable to carcinogenic infections in both sexes. H. pylori was responsible for 8,116 (57.5%) deaths due to gastric carcinoma (non-cardia and non-Hodgkin lymphoma). Hepatitis-related liver cancer accounted for a total 4,372 deaths: 3,812 due to HCV infection and 560 to HBV. Cancers related to HPV infection represented the third most frequent cause of deaths due to carcinogenic infections in women. Conclusions We estimated that one out of 12 cancer deaths in Italy was attributable to an infection sustained by carcinogenic agents. Such mortality burden is potentially avoidable, given that these infections are both potentially preventable and treatable. Thus, these estimates provide actionable metric of the burden for the implementation of specific public health measures. Further analyses will provide more accurate estimates of this disease burden. Key messages In Italy, one out of 12 cancer-related deaths is attributable to infections sustained by preventable or treatable carcinogenic agents. These estimates provide metric of carcinogenic infections for the implementation of specific public health measures to avert the related mortality burden.

BACKGROUND The coronavirus disease 2019 (COVID-19) is spreading worldwide. Several factors have been studied in relation to SARS-CoV-2 infection. One of the factors that has been related and in an uncertain way has been tobacco consumption. To our knowledge, no studies measuring the association between e-cigarettes and SARS-CoV-2 had been reported. OBJECTIVE The aim of this study was to evaluate, through a cross-sectional survey, the current prevalence estimation of SARS-CoV-2 infection among smokers and e-cigarette users. METHODS : A cross-sectional study was carried out using an online questionnaire-based survey between April 6,2020 to April 19, 2020. Participants were males and females enrolled via link from website. We also posted the link in Facebook, Twitter and anti-tobacco, smokers and e-cigarette users forums. For this analysis, only participants residing in Spain were included. To measure the association between infection and independent variables odds ratios (ORs) were calculated for each category by conditional logistic regression and the corresponding 95% confidence intervals (CIs) and adjusted by age and gender. RESULTS A total of 3,517 participants were included in the study. Of all the participants, 170 reported a diagnosis of SARS-CoV-2 infection (4.6 % 95% CI 3.9-5.1) of which 35 (0,99 %; 95% CI 0.6-1.06) ), reported a confirmed diagnosis and 135 (3.8 %; 95% CI 2.9-4.01) a clinical diagnosis. Rate of daily smokers of conventional tobacco among all participants was of 12.2 % (14.3 % of males and 9.8 of females). The number of smokers (4.7%) and users of electronic cigarettes (3.9%) among the group with infection was lower than the number of non-smokers (10.2%) (p CONCLUSIONS The results must be corroborated by analytical studies. In relation to the electronic cigarette, the basis would be similar to those of conventional cigarettes and based on the role of nicotine in the incidence and progression of SAR-CoV-2 infection.

Typhoid fever is a bacterial infection caused by the Gram-negative bacterium Salmonella enterica subspecies enterica serovar Typhi (S. Typhi), prevalent in many low- and middle-income countries. In high-income territories, typhoid fever is predominantly travel-related, consequent to travel in typhoid-endemic regions; however, data show that the level of typhoid vaccination in travellers is low. Successful management of typhoid fever using antibiotics is becoming increasingly difficult due to drug resistance; emerging resistance has spread geographically due to factors such as increasing travel connectivity, affecting those in endemic regions and travellers alike. This review provides an overview of: the epidemiology and diagnosis of typhoid fever; the emergence of drug-resistant typhoid strains in the endemic setting; drug resistance observed in travellers; vaccines currently available to prevent typhoid fever; vaccine recommendations for people living in typhoid-endemic regions; strategies for the introduction of typhoid vaccines and stakeholders in vaccination programmes; and travel recommendations for a selection of destinations with a medium or high incidence of typhoid fever.

Objectives Tobacco smoking and gambling disorder (GD) often co-occur. However, few studies have assessed the extent to which cigarette smoking may serve to classify and/or better define GD behaviour profiles. Methods Among a large sample of n = 3,652 consecutive treatment-seeking patients with GD (91% men). Smokers were compared to non-smokers across different sociodemographic, clinical, psychopathological and personality variables. The effect sizes for the means and the proportion differences between the groups were estimated. An evaluation of the smoking changes over the last 15 years was also performed. Results From the total sample, 62.4% of gamblers reported tobacco use. A decreasing linear trend in tobacco use was observed within the studied period, women having a more irregular pattern. The use of tobacco was linked to the use of alcohol and other illegal drugs. Gamblers who smoke, as compared to those who don’t, presented lower education levels, lower social position indexes and active employment. They were younger, with an earlier age of onset, shorter duration of the gambling behavior, higher GD severity, more psychological symptoms, higher scores in novelty seeking and lower scores in reward dependence, self-directedness and self-transcendence. Conclusions Gamblers seeking treatment who smoke display particular social, clinical, psychological, temperamental and character features different from non-smoking gamblers, suggesting that the presence or absence of comorbid smoking condition in GD should always be considered when developing an optimal treatment, as gamblers who smoke might need treatment strategies different from non-smoking gamblers.

AimsThe aim of this study was to compare transscleral resection technique performed without hypotensive anaesthesia (TSRWH) with iodine-125 brachytherapy (IBT) in the treatment of choroidal melanoma.Patients and methodsThis was a retrospective surgical cohort study. Nineteen eyes treated with TSRWH were matched with 53 eyes treated with IBT according to: tumour size, distance to fovea, distance to optic nerve, and follow-up time. Best-corrected visual acuity (BCVA), local recurrence, secondary enucleation, metastasis, overall and specific survival, and complications were evaluated.ResultsPatients treated with TSRWH had significantly better BCVA than those treated with IBT. The local recurrence risk was significantly higher when ciliary body was involved (HR=11.4, 95% CI 2.24-49.7, P=0.04). Metastatic disease was observed in 14 of 53 patients (26.4%) in the IBT group vs 3 patients (15.8%) in the TSRWH group (P=0.531). Multivariate analysis showed that iris involvement (HR=16.0, 95% CI 4.2-170.2, P=0.033) and large tumour (HR=2.3, 95% CI 1.2-4.8, P=0.04) increased the probability of metastasis. During follow-up, six patients (11.3%) in IBT group died vs two (10.5%) in the TSRWH group (P≥0.999). Nine patients required secondary enucleation: 5 (9.4%) in the IBT group vs 4 (21.1%) in the TSRWH group (P=0.231). The most common complications in IBT group were radiation-induced retinopathy (45.3%), neovascular glaucoma (28.3%), and macular oedema (24.5%), whereas rhegmatogenous retinal detachment (21.1%), ocular hypertension (21.1%), and submacular haemorrhage (15.8%) were the most frequent complications after TSRWH.ConclusionTSRWH is a technically challenging procedure. However, when performed successfully, this technique achieves better preservation of visual acuity than IBT and without the limitations inherent in hypotensive anaesthesia.

Background Since SBET is a controversial strategy for malaria self-treatment, this study aims to systematically review primary studies on its use amongst travellers. Methods Once studies were independently selected and data extracted, the pooled effect estimates (ES) were calculated through meta-analysis. Number of SBET users, of travellers carrying medications abroad, of subjects experiencing fever, of users complying with correct dosage, of those experiencing adverse effects, of those seeking medical care following SBET use, and those with positive malaria diagnostic test were collected and analysed. Subgroup and sensitive analyses were also performed. Results Of 935 titles and abstracts screened, 9 articles were included in the qualitative synthesis and 7 in the meta-analysis for the main outcome, with a pooled ES of the overall use of SBET in the studied population of 2%. There was significant heterogeneity for all studies. The pooled ES of travellers who carried SBET medications abroad and of SBET users seeking medical care after self-administration was 65% and 52%, respectively. Conclusions This meta-analysis indicated that the vast majority of travellers prescribed with SBET did not use it and the adherence to pre-travel recommendations on SBET use is suboptimal. Further studies to assess SBET cost-effectiveness and safety are needed.

Background Among strategies for malaria prevention, stand-by emergency treatment (SBET) is a possible approach, but scarce evidences exists investigating travellers’ adherence and behaviours toward its use; therefore, the presented study aimed to determine travellers’ compliance toward the SBET when prescribed in travel clinics. Methods A prospective cohort study was performed at the Travel Health Clinic of the Hospital Universitari de Bellvitge, Barcelona, Spain, during 2017. The research was planned on survey-based design, using pre- and post-travel questionnaires. Results In the study period, of 5436 subjects who attended the HUB Travel Medicine Clinic, 145 travellers to malaria-endemic areas were prescribed SBET, and all patients agreed to participate in the study by completing the pre-travel questionnaire. Approximately half the participants were women (n = 75, 51.7%), and the median age of all travellers was 29 years (range 13–57), mainly travelling to South-East Asia (n = 69, 47.6%), with Indonesia and the Philippines as the most popular destinations. The length of travels had a median duration of 29 days (range 10–213). Of the recruited participants, 98 replied to the online post-travel survey, reaching a response rate of 67.6%. A total of 62.2% of travellers to which SBET was prescribed did not buy and carry drugs while travelling abroad. No participants’ baseline or travel characteristic was shown to be significantly associated (p > 0.05) with this behaviour. Four women (4.1%) experienced fever and self-administered SBET, without seeking medical attention. No malaria cases were observed. Conclusions This cohort study addressed travellers’ adherence and behaviour toward SBET, highlighting an incorrect use of the emergency treatment in case of presumptive malaria symptoms. This should be taken into account during pre-travel consultation, since the success of this strategy for malaria prevention depends on travellers’ strong adherence to it.

BACKGROUND As nutritional status plays an important role in outcomes after surgery, this study evaluated the association between preoperative nutritional status (NS) and postoperative outcomes after major resection for lung cancer. METHODS We identified 219 patients with a diagnosis of cancer who underwent pulmonary resection from 2010 to 2012. Preoperative NS was assessed by anthropometric and biological parameters, body mass index (BMI), and the Nutritional Risk Index (NRI). We stratified this population into 4 BMI groups: underweight, normal weight, overweight and obese and 4 NRI groups: well-nourished; mildly malnourished; moderately malnourished and severely malnourished. The outcomes measured were postoperative complications; 30-day postoperative mortality; hospital length of stay (LOS), overall survival (OS) and disease-free survival (DFS). We performed both unadjusted analysis and adjusted multivariable analysis, controlling for statistically significant variables. RESULTS Mean BMI and NRI were, respectively, 26.5 ± 4.3 and 112.4 ± 3.3. There were no significant differences between BMI categories and resection type, pathological stage, or overall postoperative complications. By contrast, significant differences (p

Background Since 2000 universal routine immunization against the hepatitis B virus (HBV) was implemented in Bolivia. This study aimed to assess the seroprevalence of markers against HBV in two different birth cohorts (pre-universal vaccine cohort and post-universal vaccine cohort) from Cochabamba, Bolivia. Methods We performed a school-based seroepidemiological survey (n = 424) of HBV in 2010 in the Cochabamba region. An ELISA test was used to measure antibodies to the hepatitis B surface antigen (anti-HBs IgG) and to the hepatitis B core antigen (anti-HBc IgG). Results The prevalence of anti-HBs IgG in the pre-universal vaccine cohort was 5.8% (95% CI: 3.3-8.3%); it was higher in boys (9.1%), and those living in suburbs (9.7%). The anti-HBs IgG prevalence among post-universal vaccine cohort was 37.9% (95% CI: 28.5-48.1%), and was higher in children who spoke Quechua at home (51.0%), those living in suburbs (53.9%), and those born in 2005 (72.7%). Neither cohort showed differences relating to parental education. The prevalence of anti-HBc IgG was 1.1% among post-universal vaccine cohort and 1.2% among pre-universal vaccine cohort (p > 0.05). Conclusions This study identified a persistent low seroprevalence of hepatitis B infection in spite of a decade of universal immunization, and low long-term humoral immunity against HBV infection in vaccinated children in Cochabamba.

Please cite this paper as: Masuet-Aumatell et al. (2012) Prevention of influenza among travellers attending at a UK travel clinic: beliefs and perceptions. A cross-sectional study. Influenza and Other Respiratory Viruses 7(4), 574–583. Background Travellers’ compliance with measures to prevent influenza through the use of antivirals and influenza vaccine remains very poor despite influenza being one of the commonest travel and vaccine-preventable diseases. A study was undertaken to assess travellers’ beliefs, perceptions and intentions to take antivirals for the treatment and prevention of influenza during the H1N1 pandemic. Methods A cross-sectional survey (n = 96) of travellers who attended the Royal Free Travel Health Centre, London, UK was undertaken in September 2009. A self-administered questionnaire was completed by a traveller in advance of their pre-travel health consultation. Logistic regression identified variables independently associated with compliance. Results Influenza vaccination uptake for the 5 years preceding the study was found to be 20·8%. This was statistically significantly higher for older travellers and those with underlying health conditions (P

Introduction and objectives When performing surgery on ears with cholesteatoma, we observed a higher prominence of the anterior edge of the tympanosquamous suture (TSS). The aim was to find out whether these surgical findings corresponded to a specific morphology of the tympanosquamous suture (TSS) in cholesteatomas. Material and methods A retrospective analysis was carried out using preoperative computed tomography (CT) of the TSS in patients undergoing surgery for cholesteatoma in the period between January 2006 and December 2008. Patients older than 18 years who had not been previously operated were included, with a CT performed at the hospital and with a histology that proved cholesteatoma (n = 31). The findings of the TSS from these 31 cases were compared with those of 30 healthy ears. The healthy group included 20 cases of unilateral cholesteatoma (20 healthy/31 cholesteatomas) and a control group of 10 healthy patients studied for cochlear implants (n = 10). Measurements of the distance in mm. were made selecting two points A and B of the TSS (A being the furthest point to the edge of the suture and B the nearest). The CT cuts were selected according to the greatest and smallest separation of the TSS. Results Comparing the maximum and minimum distance of the TSS in points A and B in all the ears, according to pathological state (healthy ears vs cholesteatoma ears), we detected a reduced minimal distance in A ( P = .036) and B ( P = .014) in the healthy ears with respect to the cholesteatoma ears. No statistically significant differences were found in maximum distances A and B ( P > .05). Conclusions This study provides objective data on a lesser closure of the TSS in cases of cholesteatoma vs healthy ears. We correlate this finding with the aetiopathogenesis of attic cholesteatoma.

Resumen Introduccion y objetivos Habiamos observado, al intervenir oidos con colesteatoma, una mayor procidencia del extremo anterior de la sutura timpanoescamosa (STE). Queriamos averiguar si estos hallazgos correspondian a una especial morfologia de la STE en los colesteatomas. Material y metodos Realizamos un estudio retrospectivo, mediante tomografia computarizada (TC) preoperatoria, de la STE de pacientes intervenidos por colesteatoma entre enero de 2006 y diciembre de 2008. Se incluyo a pacientes mayores de 18 anos, no intervenidos anteriormente, con TC realizada en el propio hospital e histologia demostrativa de colesteatoma (n=31). Comparamos los hallazgos de la STE de estos 31 casos con los de 30 oidos sanos. El grupo sano incluyo 20 casos con colesteatoma unilateral (20 sanos/31 colesteatomas) y un grupo sano control estudiado con motivo de implante coclear (n=10). Se realizaron mediciones de la distancia en mm considerando dos puntos A y B de la STE (A era el mas distal y B, el mas proximal al extremo de la sutura). Seleccionamos los cortes de TC correspondientes a la maxima y la minima separacion de la STE. Resultados Comparando las distancias maxima y minima de la STE en los puntos A y B de todos los oidos, segun estado patologico (sanos frente a colesteatoma), detectamos una menor distancia minima A (p=0,036) y minima B (p=0,014) en los oidos sanos respecto a los patologicos; no encontramos diferencias estadisticamente significativas de las distancias maximas A y B (p>0,05). Conclusiones Este estudio aporta datos objetivos sobre un menor cierre de la STE en los casos de colesteatoma frente a oidos sanos. Relacionamos este hallazgo con la etiopatogenia del colesteatoma atical.

Objetivo: Determinar la incidencia del cambio inmunitario del porcentaje de linfocitos T CD4+ en pacientes VIH 1/2 positivos en el primer trimestre posvacunación antigripal (P-CIR) y secundariamente comparar las características demográficas y clínicas relacionadas con dicho cambio. Métodos: Se estudiaron 105 pacientes con VIH-sida de una cohorte retrospectiva hospitalaria entre 2001 y 2006. Se consideró P-CIR una disminución >3% del porcentaje de CD4+ prevacunal, y su asociación cruda y ajustada (sexo, edad, terapia antirretroviral, estabilidad clínica, carga viral prevacunal, CD4 total prevacunal) fue evaluada por regresión logística (odds ratio [OR] con intervalo de confianza del 95% [IC95%]). Resultados: La incidencia del P-CIR fue del 33,3%, y fue persistente en un 31,4% durante los siete meses posvacunación independientemente de una viremia alta prevacunal. Asimismo, las variables demográficas y clínicas estudiadas no se relacionaron con la presencia de P-CIR, con una OR cruda de 0,90 (0,17-4,8) y una OR ajustada de 1,09 (0,17-6,8). Conclusiones: Los datos encontrados reflejan que el cambio relevante del estado inmunitario no fue despreciable en la posvacunación, aunque mayoritariamente resultó transitorio.Objective: To determine the incidence of immunologic change in the percentage of CD4+ T lymphocytes in HIV 1/2 positive patients in the first quarter after influenza vaccination (P-CIR) and to compare the demographic and clinical characteristics associated with this change. Methods: We studied 105 patients with HIV/AIDS in a retrospective hospital cohort between 2001-2006. P-CIR was considered as a decrease of >3% in the prevaccination CD4+ percentage. Crude and adjusted OR (sex, age, antiretroviral therapy, clinical stability, prevaccination viremia and prevaccination total CD4) were evaluated by logistic regression (95%CI). Results: The incidence of P-CIR was 33.3%. P-CIR was persistent in 31.4% for 7 months after vaccination regardless of high prevaccination viremia. No association was found between demographic and clinical variables and P-CIR [crude OR: 0.90 (0.17-4.8); adjusted OR: 1.09 (0.17-6.8)]. Conclusions: The results showed that the immunological change after vaccination was not inconsiderable. However, this change was mainly transient.

El objetivo del estudio es estimar la tasa de abstinencia tabaquica posterior al alta hospitalaria en enfermos cardiovasculares que recibieron una intervencion minima de cesacion tabaquica durante el ingreso. Se realizo un estudio prospectivo de una cohorte de 252 fumadores ingresados en el Hospital Universitari de Bellvitge. A las 24 h del alta hospitalaria se mantenia en abstinencia tabaquica el 76,6% de los pacientes. Tras 1, 3, 9 y 12 meses, las tasas de abstinencia habian disminuido al 71,4, el 67,2, el 64,1 y el 62,2%, respectivamente. Los pacientes diagnosticados de cardiopatia isquemica tenian menor probabilidad de recaida tabaquica: hazard ratio = 0,56 (intervalo de confianza del 95%, 0,36-0,87). En nuestro centro, una intervencion minima de cesacion tabaquica durante la hospitalizacion en los enfermos cardiovasculares probablemente no sea suficiente para mantener la abstinencia tabaquica al alta.

ObjectivesThe aim of this study is to analyse the relationship between smoking andaltitude mountain sicknessin a cohort of travellers to 2500 metres above sea level (masl) or higher.SettingTravel Health Clinic at the Hospital Universitari de Bellvitge, in Barcelona, Spain.ParticipantsA total of 302 adults seeking medical advice at the travel clinic, between July 2012 and August 2014, before travelling to 2500 masl or above, who agreed to participate in the study and to be contacted after the trip were included. Individuals who met the following criteria were excluded: younger than 18 years old, taking carbonic anhydrase inhibitors for chronic use, undergoing treatment with systemic corticosteroids and taking any medication that might prevent or treat altitude mountain sickness (AMS) prior to or during the trip. The majority of participants were women (n=156, 51.7%). The mean age was 37.7 years (SD 12.3). The studied cohort included 74 smokers (24.5%), 158 (52.3%) non-smokers and 70 (23.2%) ex-smokers. No statistical differences were observed between different sociodemographic characteristics, constitutional symptoms or drug use and smoking status.OutcomesThe main outcome was the development of AMS, which was defined according to the Lake Louise AMS criteria.ResultsAMS, according to the Lake Louise score, was significantly lower in smokers; the value was 14.9%, 95% CI (6.8 to 23.0%) in smokers and 29.4%, 95% CI (23.5 to 35.3%) in non-smokers with an adjusted OR of 0.54, 95% CI (0.31 to 0.97) independent of gender, age and maximum altitude reached.ConclusionsThese results suggest that smoking could reduce the risk of AMS in non-acclimated individuals. Further studies should be performed in larger cohorts of travellers to confirm these results. Despite the results, smoking must be strongly discouraged because it greatly increases the risk of cardiorespiratory diseases, cancer and other diseases.

We performed a contingent valuation survey to elicit the opportunity cost of bed-days consumed by healthcare-associated infections in 11 European hospitals. The opportunity cost of a bed-day was significantly lower than the accounting cost; median values were €72 and €929, respectively (P < .001). Accounting methods overestimate the opportunity cost of bed-days.Infect Control Hosp Epidemiol 2014;35(10):1294–1297

Background and objective The use of continuous positive airway pressure (CPAP) treatment in patients with obesity hypoventilation syndrome (OHS) and obstructive sleep apnoea (OSA) was evaluated, and factors that might predict CPAP treatment failure were determined. Methods A sleep study was performed in 29 newly diagnosed, clinically stable OHS patients. CPAP treatment was commenced if the apnoea–hypopnoea index was >15. Lung function, night-time oximetry, blood adipokine and C-reactive protein levels were assessed prospectively on enrollment and after 3 months. Treatment failure at 3 months was defined as daytime arterial partial pressure of carbon dioxide (PaCO2) >45 mm Hg and/or oxygen saturation (SpO2) 30% of the night-time oximetry study. Results All patients had severe OSA (median apnoea–hypopnoea index = 74.7 (62–100) with a nocturnal mean SpO2 of 81.4 ± 7), and all patients were treated with CPAP. The percentage of time spent below 90% saturation improved from 8.4% (0.0–39.0%) to 0.3% (0.4–4.0%). Awake PaCO2 decreased from 50 (47–53) mm Hg to 43 (40–45) mm Hg. Seven patients failed CPAP treatment after 3 months. PaCO2 at 1 month and mean night-time SpO2 during the first night of optimal CPAP were associated with treatment failure at 3 months (odds ratio 1.4 (1.03–1.98); P = 0.034 and 0.6 (0.34–0.93); P = 0.027). Conclusions CPAP treatment improves night-time oxygenation and daytime hypoventilation in selected clinically stable OHS patients who also have OSA. Patients with worse night-time saturation while on CPAP and higher daytime PaCO2 at 1 month were more likely to fail CPAP treatment.

BMJ open 3(9), e003126 (2013). doi:10.1136/bmjopen-2013-003126, Published by BMJ Publ., London

Objective. The present study assessed the effectiveness of smoking cessation programs combining individual and telephone counselling, compared to individual or telephone counselling alone. Method. A randomized, multicentre, open-label trial was performed between January 2009 and July 2011 at six smoking cessation clinics in Spain. Of 772 smokers assessed for eligibility, 600 (77%) met inclusion criteria and were randomized. Smokers were randomized to receive individual counselling, combined telephone and individual counselling, or telephone counselling. The primary outcome was biochemically validated continuous abstinence at 52 weeks. Results. The 52-week abstinence rate was significantly lower in the telephone group compared to the combined group (20.1% vs. 29.0%; OR, 1.32; 95% Cl, 1.1-2.7) and to the individual counselling group (20.1% vs. 27.9%; OR, 137; 95% CI, 1.0-2.8). The 52-week abstinence rates were not significantly higher in the combined group than the individual group (OR, 0.97; 95% CI, 0.7-1.4). Conclusion. Individual counselling and combined individual and telephone counselling were associated with higher 52-week abstinence rates than telephone counselling alone. A combined approach may be highly useful in the clinical treatment of smokers, as it involves less clinic visits than individual counselling alone, thus reducing the program cost, and it increases patient compliance compared to telephone counselling alone. (C) 2013 Elsevier Inc. All rights reserved.

Objectives To determine the seroprevalence of varicella-zoster viral (VZV) infections in schoolchildren from the Cochabamba region (Bolivia), and its association with socio-demographic variables, socio-economic status and geographical location. Methods Seroepidemiological survey (n = 436) on VZV of schoolchildren living in the Cochabamba region of Bolivia in 2010. An ELISA test was used to measure varicella antibodies. Parents or guardians completed a questionnaire regarding socio-demographic information (age, gender, living area, parental educational level, presence of siblings and number of family members in the household), and a blood sample was collected from each child to check for VZV antibodies. A descriptive and bivariate analysis was performed. Results The global prevalence of VZV was 78.2% (95% CI 74.3–82.1). It was higher in females (82.1%), pre-adolescents (aged 10.1–13 years: 81.4%) and adolescents (aged >13 years: 80.2%), in children with less well-educated parents (81.3% to 81.6%), in warmer municipalities (81.4% to 82.2%), in rural areas (80.0%), in children with siblings (80.1%), those who although the latter association was not statistically significant. Conclusions The prevalence of VZV infection in childhood was relatively high for a tropical country, and much closer to that of temperate countries prior to the introduction of varicella vaccine into vaccination programmes. Objectifs Determiner la seroprevalence l'infection par le virus varicelle-zona (VZV) chez les ecoliers de la region de Cochabamba (Bolivie) et son association avec les variables sociodemographiques, le statut socioeconomique et la situation geographique. Methodes Etude seroepidemiologique (n = 436) sur le VZV chez des ecoliers vivant dans la region de Cochabamba, en Bolivie, en 2010. Un test ELISA a ete utilise pour detecter les anticorps contre la varicelle. Les parents ou tuteurs ont rempli un questionnaire concernant les informations sociodemographiques (âge, sexe, lieu de residence, niveau d’education des parents, la premiere langue parlee, la presence de freres et sœurs et le nombre des membres de la famille dans le menage) et un echantillon de sang a ete preleve chez chaque enfant afin de verifier pour les anticorps anti-VZV. Une analyse descriptive et bivariee a ete realisee. Resultats La prevalence globale du VZV etait de 78,2% (IC95%: 74,3 a 82,1). Elle etait plus elevee chez les filles (82,1%), les preadolescents (âges de 10,1 a 13 ans: 81,4%) et les adolescents (âges de > 13 ans: 80,2%), chez les enfants de parents moins instruits (81,3% a 81,6%), dans les municipalites plus chaudes (81,4% a 82,2%), dans les zones rurales (80,0%), chez les enfants ayant des freres et sœurs (80,1%) et chez ceux parlant le quechua a la maison (82,8%), bien que cette derniere association n’etait pas statistiquement significative. Conclusions La prevalence de l'infection par le VZV dans l'enfance etait relativement elevee pour un pays tropical et beaucoup plus proche de celle des pays temperes avant l'introduction du vaccin contre la varicelle dans les programmes de vaccination. La vaccination pourrait etre benefique et rentable pour reduire l'impact du VZV dans la population de Cochabamba Objetivos Determinar la seroprevalencia de las infecciones por el virus de varicela-zoster (VZV) en ninos de la region de Cochabamba (Bolivia) en edad escolar, y su asociacion con variables sociodemograficas, estatus socioeconomico y de localizacion geografica. Metodos Estudio seroepidemiologico (n = 436) de VZV en ninos en edad escolar viviendo en la region de Cochabamba en Bolivia en el 2010. Se utilizo una prueba de ELISA para medir los anticuerpos contra la varicela. Los padres o guardianes completaron un cuestionario con informacion sociodemografica (edad, genero, area en la que habitaban, nivel de educacion de los padres, presencia de hermanos y numero de miembros de la familia en el hogar) y a los ninos se les tomo una muestra de sangre para buscar anticuerpos VZV. Se realizo un analisis descriptivo y bivariado. Resultados La prevalencia global de VZV era del 78.2% (IC 95% 74.3–82.1). Era mayor entre mujeres (82.1%), preadolescentes (edad 10.1–13 anos: 81.4%) y adolescentes (edad > 13 anos: 80.2%), en ninos cuyos padres tenian un menor nivel de educacion (81.3% a 81.6%), en los municipios mas calientes (81.4% a 82.2%), en areas rurales (80.0%), y en ninos con hermanos (80.1%), aunque esta ultima asociacion no era estadisticamente significativa. Conclusiones La prevalencia de infeccion por VZV en ninos era relativamente alta para un pais tropical, y mucho mas cercana a la prevalencia de paises de clima templado antes de la introduccion de la vacuna de varicela en los programas de vacunacion.

Purpose To compare the effectiveness of pars plana vitrectomy endoresection with iodine-125 brachytherapy in the treatment of choroidal melanoma. Design A nested case-control study (1:2) from a surgical cohort. Methods The study comprised 81 choroidal melanoma patients treated with either endoresection or iodine-125 brachytherapy. Twenty-seven patients who had undergone endoresection were matched according to tumor height and postequatorial tumor location with 54 cases treated with iodine-125 brachytherapy. Metastatic disease, overall survival, local tumor recurrence, visual acuity, and secondary enucleation rates were analyzed and compared between groups. Results Metastatic spread was observed in 11 patients in the iodine-125 brachytherapy group vs only 1 patient in the endoresection group (20.4% and 3.7%, respectively, P = .053). Fourteen patients died during follow-up: 11 in the brachytherapy arm vs 3 in the endoresection arm (20.4% and 11.1%, respectively, P = .238). For the iodine-125 brachytherapy and endoresection groups, respectively, the 5-year Kaplan-Meier estimates were as follows: overall survival, 81.5% vs 89.2% (log-rank test, P = .429;); relapse-free survival, 96.6% vs 92.4% ( P = .2); visual acuity retention equal or superior to 20/200, 66.4% vs 59.9% ( P = .083), and eye retention, 85.7% vs 87.8% ( P = .942). Conclusions Endoresection for choroidal melanoma is an effective treatment modality in selected cases of posterior choroidal melanomas, with outcomes similar to those obtained with iodine-125 brachytherapy.

The use of continuous positive airway pressure (CPAP) treatment in patients with obesity hypoventilation syndrome (OHS) and obstructive sleep apnoea (OSA) was evaluated, and factors that might predict CPAP treatment failure were determined.A sleep study was performed in 29 newly diagnosed, clinically stable OHS patients. CPAP treatment was commenced if the apnoea-hypopnoea index was15. Lung function, night-time oximetry, blood adipokine and C-reactive protein levels were assessed prospectively on enrollment and after 3 months. Treatment failure at 3 months was defined as daytime arterial partial pressure of carbon dioxide (PaCO(2))45 mm Hg and/or oxygen saturation (SpO(2))90% for30% of the night-time oximetry study.All patients had severe OSA (median apnoea-hypopnoea index = 74.7 (62-100) with a nocturnal mean SpO(2) of 81.4 ± 7), and all patients were treated with CPAP. The percentage of time spent below 90% saturation improved from 8.4% (0.0-39.0%) to 0.3% (0.4-4.0%). Awake PaCO(2) decreased from 50 (47-53) mm Hg to 43 (40-45) mm Hg. Seven patients failed CPAP treatment after 3 months. PaCO(2) at 1 month and mean night-time SpO(2) during the first night of optimal CPAP were associated with treatment failure at 3 months (odds ratio 1.4 (1.03-1.98); P = 0.034 and 0.6 (0.34-0.93); P = 0.027).CPAP treatment improves night-time oxygenation and daytime hypoventilation in selected clinically stable OHS patients who also have OSA. Patients with worse night-time saturation while on CPAP and higher daytime PaCO(2) at 1 month were more likely to fail CPAP treatment.

Background Although measles is a highly infectious disease, the live measles vaccine provides protection for over 20 years, and immunity may be lifelong. This study assessed measles seroprevalence in schoolchildren in the Cochabamba region of Bolivia. Methods A seroepidemiological survey of measles immunity in 5–16-year-old schoolchildren ( n = 441) living in the Cochabamba region of Bolivia was performed in March and April of 2010. Representative regional samples of school children from 14 schools were obtained. A parent-administered questionnaire collected sociodemographic and socio-economic status, and serum samples were tested for measles antibodies using an enzyme-linked fluorescent antibody test. The measles prevalence and corresponding 95% confidence intervals (CI) were calculated. A descriptive and bivariate analysis was performed using the ANOVA or the Kruskal–Wallis test according to whether the data were distributed normally (Kolmogorov–Smirnov test p -value Results The global seroprevalence of measles was 69.61% (95% CI 65.32–73.90) and was higher in adolescents (84.16%, 95% CI 77.04–91.28) and Spanish speakers (74.74%, 95% CI 68.56–80.92). The seroprevalence did not differ according to socio-economic status, living area, or number of family members in the household. Conclusions This study found a high prevalence of measles susceptibility in Bolivian children. Thus, herd immunity may not have been established, and some outbreak could occur. Authorities should redress this situation before endemic measles transmission occurs nationally and regionally, and there is an urgent need to conduct more seroprevalence studies in the region.

Background: Previous review studies have suggested that computer games can serve as an alternative or additional form of treatment in several areas (schizophrenia, asthma or motor rehabilitation). Although several naturalistic studies have been conducted showing the usefulness of serious video games in the treatment of some abnormal behaviours, there is a lack of serious games specially designed for treating mental disorders. Aim: The purpose of our project was to develop and evaluate a serious video game designed to remediate attitudinal, behavioural and emotional processes of patients with impulse-related disorders. Method and results: The video game was created and developed within the European research project PlayMancer. It aims to prove potential capacity to change underlying attitudinal, behavioural and emotional processes of patients with impulse-related disorders. New interaction modes were provided by newly developed components, such as emotion recognition from speech, face and physiological reactions, while specific impulsive reactions were elicited. The video game uses biofeedback for helping patients to learn relaxation skills, acquire better self-control strategies and develop new emotional regulation strategies. In this article, we present a description of the video game used, rationale, user requirements, usability and preliminary data, in several mental disorders.

Cristina Masuet Aumatell1, JM Ramon Torrell1, Jane N Zuckerman21International Health Centre, Preventive Medicine Department, Bellvitge Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; 2World Health Organization Collaborating Centre for Reference, Research and Training in Travel Medicine, University College London Medical School, London, UKBackground: Young children are one of the most vulnerable groups who may be infected with cholera. The following literature review of the efficacy of the currently available cholera vaccines provides a clear evidence base for the clinical administration of cholera vaccine, particularly in an epidemic situation.Aim: To assess the efficacy of oral cholera vaccines in preventing cases of cholera in young children.Methods: A systematic literature review was undertaken for the period 1983 to 2011 using PubMed and the search terms “oral cholera vaccines,” “children,” and “efficacy,” limited to “clinical trials” and “human studies”.Results: Oral cholera vaccine provides an acceptable level of protection in young children, with the level of protection being greater at 12 or 24 months following immunization.Conclusions: Children exposed to a potential risk of cholera are recommended to be vaccinated with an oral cholera vaccine, irrespective of whether its constituents include the B subunit.Keywords: efficacy, oral cholera vaccine, children

PURPOSE To evaluate the efficacy and safety of a flexible regimen with intravitreal injections of ranibizumab in patients with naive choroidal neovascularization secondary to age-related macular degeneration and to determine whether the final outcome is related to the number of injections. METHODS Prospective, noncomparative, consecutive case series study. We included 90 eyes of 88 patients that were initially treated with 3 consecutive monthly intravitreal injections of ranibizumab, and thereafter, follow-up visits were progressively spread out to a maximum of 8 weeks apart in the absence of visual acuity loss and signs of lesion activity. The primary end points were changes in visual acuity (Early Treatment Diabetic Retinopathy Study letters), foveal thickness measured by spectral-domain optical coherence tomography, and lesion size (LS) measured by fluorescein angiography. RESULTS The median visual acuity improved from 53 letters at baseline to 60 letters at Month 1 (P < 0.0001), 63 letters at Month 3 (P < 0.0001), and 60 letters at Month 12 (P < 0.0001). A significant reduction was also observed in foveal thickness and LS (P < 0.0001). The mean number of injections was 4.4, and the mean number of visits was 8.0. Treatment consisted of 3 injections for 40% of patients, and 60% of patients received more than 3 injections. No significant association was observed between the visual acuity improvement and the number of injections. No relevant side effects were observed. CONCLUSION A flexible regimen with ranibizumab therapy is efficacious and safe in patients with neovascular age-related macular degeneration, reducing both the burden of injections and follow-up visits. The visual acuity improvement was independent of the number of injections.

We examined hand hygiene practices in surgical wards in 9 countries in Europe and Israel through direct practice observation. There was marked interhospital variation in hand hygiene compliance (range, 14%-76%), as well as glove and alcohol-based handrub use. After multivariable analysis, surgical subspecialty, professional category, type of care activity, and workload were independently associated with compliance. Hand hygiene practices are influenced by numerous factors, and a tailored approach may be required to improve practices.

The objective of this study was to determine the smoking abstinence rate after hospital discharge in cardiovascular patients who had undergone a brief smoking cessation intervention during hospitalization. The prospective cohort study involved 252 smokers who were admitted to the Hospital Universitari de Bellvitge in Catalonia, Spain. Twenty-four hours after hospital discharge, 76.6% of patients were still abstaining from smoking. At 1, 3, 9, and 12 months, the abstinence rate diminished to 71.4%, 67.2%, 64.1%, and 62.2%, respectively. Patients diagnosed with ischemic cardiopathy had a significantly lower probability of a smoking relapse: hazard ratio =0.56 (95% confidence interval, 0.36-0.87). At our center, a brief smoking cessation intervention in cardiovascular patients during hospital admission was found unlikely to result in smoking abstinence following discharge.