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Evaluation of molecular and serological testing for imported urogenital schistosomiasis screening in a referral tropical medicine centre in Barcelona, Spain
Get PDFMolecular diagnostics; Real-time PCR; Urogenital schistosomiasisDiagnóstico molecular; PCR en tiempo real; Esquistosomiasis urogenitalDiagnòstic molecular; PCR en temps real; Esquistosomiasi urogenitalBackground
Schistosomiasis, a major neglected tropical disease, is caused by Schistosoma spp. It is estimated that more than 200 million people are affected worldwide, mostly in Africa. The gold standard diagnosis of urogenital schistosomiasis (UGS) is the microscopic visualisation of Schistosoma haematobium eggs in concentrated urine; however, its sensitivity is low. This study aimed to evaluate the effectiveness of molecular and serological testing for imported UGS screening in asymptomatic sub-Saharan migrants in a non-endemic setting.
Methods
A retrospective cross-sectional study between November 2021 and December 2022 was conducted by collecting demographic, clinical and laboratory data from the medical records of migrants from endemic areas screened for UGS at the International Health Unit Vall d’Hebron-Drassanes, Barcelona, Spain. Urine samples were analysed by real-time PCR for S. haematobium DNA and by microscopy for egg detection. Serum samples were tested using a serological assay based on enzyme-linked immunosorbent assay (ELISA). UGS was confirmed by a positive result in real-time PCR and/or microscopy, while possible UGS was defined as a case with only a positive serological result.
Results
A total of 604 patients were included in this study; 32 out of 604 (5.3%) urine samples were positive for S. haematobium by real-time PCR and/or microscopy examination (confirmed UGS cases). Schistosoma haematobium DNA was detected in 28/604 (4.6%) urine samples, while eggs were visualised in 24/604 (3.9%), with 12 discordant cases between both techniques.
Real-time PCR demonstrated a sensitivity of 83.3%, a specificity of 98.6%, and a kappa value of 0.76. Serology was performed in 529/604 cases and exhibited lower specificity, 70.87% (kappa value 0.26). Other laboratory parameters such as leukocyturia, microhaematuria, eosinophilia and elevated IgE were significantly associated with UGS diagnosis.
Conclusions
Real-time PCR proved to be more sensitive than microscopy for diagnosing imported UGS in non-endemic settings, with minimal discordance between methods. The serological test exhibited very low specificity and high sensitivity rates, suggesting its usefulness as a screening test among high-risk populations in non-endemic settings
Deep hierarchical subtyping of multi-organ systemic sclerosis trajectories - a EUSTAR study
Get PDFSystemic sclerosis trajectoriesEsclerosi sistèmica multiorgànicaEsclerosis sistémica multiorgánicaSystemic sclerosis (SSc) is a chronic autoimmune disease with multi-organ involvement. Historically, SSc classification has focused on the type of skin involvement (limited versus diffuse); however, a growing evidence of organ-specific variability suggests the presence of more than two distinct subtypes. We propose a semi-supervised generative deep learning framework leveraging expert-driven definitions of organ-specific involvement and severity. We model SSc disease trajectories in the European Scleroderma Trials and Research (EUSTAR) database, containing 14,000 patients across 67,000 medical visits, and identify clinically meaningful subtypes to enhance patient stratification and prognosis. We systematically evaluate the model’s predictive accuracy, robustness to missing data, and clinical interpretability. We identified five patient clusters, separating patients based on the degree of organ involvement. Notably, a subset with limited skin involvement still showed high risks of lung and heart complications, underscoring the importance of data-driven methods and multi-organ models to complement established insights from clinical practice
Standardization of the surgical technique and reporting for radical right colectomy with central vascular ligation and complete mesocolic excision (RRoC-STAR): Delphi consensus
Get PDFColectomy; Mesocolic excision; Delphi consensusColectomía; Escisión mesocólica; Consenso DelphiColectomia; Excisió mesocòlica; Consens DelphiBackground
Complete mesocolic excision refers to a radical right hemicolectomy for cancer following embryologically defined anatomical planes. However, heterogeneity in definitions and techniques is a barrier to research. The aim of the Radical Right Colectomy—Surgical Technique Approved Report (RRoC-STAR) collaborative is to provide international expert consensus-based definitions and standardized terminology and surgical steps for right hemicolectomy for locally advanced colon cancer.
Methods
Authors of publications reporting on radical right hemicolectomy techniques were invited to complete an ACCORD-compliant Delphi questionnaire (two rounds). A standardized name (for the procedure) and a data sheet for reporting the procedure were proposed, along with 21 items, including terminology and surgical steps. The assembled panel was asked to vote for each item, with consensus considered to have been reached for items that achieved at least 80% agreement.
Results
Of 162 invited authors, 67 completed both Delphi rounds. All but 1 of the 21 items received consensus after 2 rounds. Consensus was reached on the use of the proposed data sheet for reporting, the term radical right colectomy (RRC), and the surgical steps deemed necessary for RRC, namely preservation of mesocolic integrity, sharp dissection of the anterolateral surface of the superior mesenteric vein up to the middle colic vein, ligation at the origin of vessels, and dissection of lymphoadipose tissue around the gastrocolic trunk of Henle.
Conclusion
This study provides an international expert consensus-based definition and standardization of terminology and the surgical steps required to perform RRC. A comprehensive data sheet for reporting RRC is introduced to enable data homogenization from current and future studies.Department of General Surgery, Universita´Tor Vergata, Rome, Italy
Seguretat clínica i eficàcia de l'estimulació elèctrica transcutània i percutània del nervi tibial posterior en pacients amb síndrome de bufeta hiperactiva o disfunció neurògena del tracte urinari inferior refractaris al tractament farmacològic convencional
Get PDFElectrical stimulation therapies; Overactive bladder syndrome; Posterior tibial nerveTeràpies d'estimulació elèctrica; Síndrome de bufeta hiperactiva; Nervi tibial posteriorTerapias de estimulación eléctrica; Síndrome de vejiga hiperactiva; Nervio tibial posteriorSíntesi dels principals resultats de l'informe elaborat per avaluar l’evidència científica disponible sobre la seguretat clínica i l’eficàcia i efectivitat clínica comparativa dels tractaments mitjançant l’ús de l’estimulació elèctrica percutània del nervi tibial posterior (PENS) o transcutània (TENS) en pacients adults amb la síndrome de la bufeta hiperactiva o disfunció neurogènica del tracte urinari inferior refractaris al tractament farmacològic convencional.Síntesis de los principales resultados del informe elaborado para evaluar la evidencia científica disponible sobre la seguridad clínica, así como la eficacia y efectividad clínica comparativa de los tratamientos mediante el uso de la estimulación eléctrica percutánea del nervio tibial posterior (PENS) o transcutánea (TENS) en pacientes adultos con síndrome de vejiga hiperactiva o disfunción neurógena del tracto urinario inferior refractarios al tratamiento farmacológico convencional.Summary of the main results of the report prepared to evaluate the available scientific evidence on the clinical safety, as well as the comparative clinical efficacy and effectiveness of treatments using percutaneous electrical nerve stimulation (PENS) or transcutaneous electrical nerve stimulation (TENS) of the posterior tibial nerve in adult patients with overactive bladder syndrome or neurogenic lower urinary tract dysfunction who are refractory to conventional pharmacological treatment
Abnormal sleep blood pressure patterns are associated with the diffusion tensor imaging along the perivascular space index in cognitively impaired individuals
Get PDFAlzheimer's disease; Blood pressure; GlymphaticMalaltia d'Alzheimer; Pressió arterial; GlimfàticEnfermedad de Alzheimer; Presión arterial; GlinfáticoIntroduction: Blood pressure (BP) physiologically dips during sleep, and a lack of dipping is associated with adverse health outcomes and cognitive decline. Vascular pulsatility is the primary driver of glymphatic cerebrospinal fluid (CSF) transport, which removes metabolic waste products from the brain during sleep. We hypothesized that abnormal sleep BP patterns may affect glymphatic system health and that this relationship may result in lower diffusion tensor imaging along the perivascular space (DTI-ALPS) indices, a proposed neuroimaging index of glymphatic health.
Methods: A total of 21 participants with mild-to-moderate cognitive impairment underwent 24-h ambulatory BP monitoring (ABPM), DTI-MRI, and Alzheimer's disease (AD) biomarker assessments. Of them, eight participants were classified as dippers (≥10%) and 13 as non-dippers (< 10%), using the sleep/awake systolic BP (SBP) percentage of change.
Results: We found that the non-dippers had lower DTI-ALPS indices, even after adjusting for age and clinical stage (p = 0.013). Stiffness measures (pulse wave velocity) were negatively correlated with DTI-ALPS (r = −0.5), but the association disappeared after adjusting for age. Positive AD biomarkers were more frequently observed in the individuals who were classified as non-dippers for both systolic and diastolic BP (DBP), compared to the systolic and diastolic dippers (p = 0.041).
Discussion: Our findings suggest that deviations from the physiological BP dipping sleep pattern may be related to poorer glymphatic function and increased AD pathology.The author(s) declare that financial support was received for the research and/or publication of this article. This project was partially funded by a COCKPI-T Funding Research Grant (Takeda Pharmaceutical Company Limited). Gonzalo Sánchez-Benavides was supported by the Instituto de Salud Carlos III (ISCIII) through the project CP23/00039 (Miguel Servet contract)
Cortical macro- and microstructural changes in isolated rapid eye movement sleep behavior disorder
Get PDFNeurodegenerative Diseases; REM Sleep Behavior Disorder; BiomarkersEnfermedades Neurodegenerativas; Trastorno de la Conducta del Sueño REM; BiomarcadoresMalalties Neurodegeneratives; Trastorn de la Conducta del Son REM; BiomarcadorsCortical mean diffusivity (cMD), a marker of cortical microstructural changes in neurodegenerative disorders, remains unexplored in isolated REM sleep behavior disorder (iRBD), a prodromal stage of Lewy body (LB) diseases. Its relationship with cortical thickness (CTh), clinical features, and neuropsychological performance is also unknown. We assessed cMD and CTh in thirty-six patients with iRBD at high risk of conversion and 29 healthy controls (HC), examining associations with clinical and cognitive measures. Effect sizes were calculated using Cohen's d. Patients with iRBD showed increased cMD in rostral and caudal cortical regions compared to HC (d > 0.5). Cortical thinning was restricted to caudal areas. Higher cMD correlated with longer iRBD duration, later onset, MDS-UPDRS III, apathy, and poorer performance on Grooved Pegboard and Symbol-Digit Modality Tests. These findings suggest that cMD may be more sensitive than CTh and serve as a valuable imaging biomarker for detecting early cortical changes in prodromal LB diseases
Clinical outcomes by baseline metastases in patients with renal cell carcinoma treated with lenvatinib plus pembrolizumab versus sunitinib: Post hoc analysis of the CLEAR trial
Get PDFLenvatinib; Pembrolizumab; Renal cell carcinomaLenvatinib; Pembrolizumab; Carcinoma de células renalesLenvatinib; Pembrolizumab; Carcinoma de cèl·lules renalsLenvatinib plus pembrolizumab significantly improved efficacy versus sunitinib in treatment of advanced renal cell carcinoma (aRCC) in the phase 3 CLEAR study. We report results of an exploratory post hoc analysis of tumor response data based on baseline metastatic characteristics of patients who received lenvatinib plus pembrolizumab versus sunitinib, at the final overall survival analysis time point of CLEAR (cutoff: July 31, 2022). Treatment-naïve adults with aRCC were randomized to: lenvatinib (20 mg PO QD in 21-day cycles) plus pembrolizumab (n = 355; 200 mg IV Q3W); lenvatinib plus everolimus (not reported here); or sunitinib (n = 357; 50 mg PO QD; 4 weeks on/2 weeks off). The most common (lenvatinib plus pembrolizumab; sunitinib, respectively) metastatic site was lung (71.0%; 63.9%), followed by lymph node (45.6%; 43.7%), bone (22.5%; 24.9%), and liver (17.7%; 19.6%). Across treatment arms, ≥65% had two or more metastatic organs/sites involved, >80% of patients had nontarget lesions, and ~45% had baseline sums of diameters of target lesions ≥60 mm. Lenvatinib plus pembrolizumab demonstrated greater progression-free survival, objective response rate, and duration of response versus sunitinib across evaluable subgroups regardless of site or size of baseline metastasis or number of metastatic sites at baseline. Overall survival generally trended to favor lenvatinib plus pembrolizumab versus sunitinib; and tumor shrinkage was greater across sites (lung, lymph node, liver, and bone) for patients in the lenvatinib-plus-pembrolizumab arm versus the sunitinib arm. These results further support lenvatinib plus pembrolizumab as a standard-of-care in patients with aRCC regardless of site or size of baseline metastasis or the number of metastatic sites.This study was sponsored by Eisai Inc., Nutley, NJ, USA, and Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA. Medical writing support was funded by Eisai Inc., Nutley, NJ, USA, and Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA
Protocol de vigilància epidemiològica per a la prevenció i el control de la listeriosi a Catalunya
Get PDFListeriosis; Epidemiología; CataluñaListeriosis; Epidemiology; CataloniaListeriosi; Epidemiologia; Seguretat alimentàriaAquest document és un protocol de vigilància epidemiològica per a la prevenció i control de la listeriosi a Catalunya. Descriu la malaltia, els mecanismes de transmissió i els grups de risc, estableix criteris de vigilància i notificació, i inclou mesures preventives i d’actuació en casos i brots. També proporciona recomanacions higièniques i una enquesta epidemiològica per a la recollida de dades.Este El documento es un protocolo de vigilancia epidemiológica para la prevención y control de la listeriosis en Cataluña. Describe la enfermedad, sus mecanismos de transmisión y los grupos de riesgo, establece criterios de vigilancia y notificación, e incluye medidas preventivas y de actuación ante casos y brotes. También proporciona recomendaciones higiénicas y una encuesta epidemiológica para la recopilación de datos.This document is an epidemiological surveillance protocol for the prevention and control of listeriosis in Catalonia. It describes the disease, its transmission mechanisms, and risk groups, establishes surveillance and reporting criteria, and includes preventive measures and actions for cases and outbreaks. It also provides hygiene recommendations and an epidemiological survey for data collection
Enquestes a les persones usuàries dels serveis de salut: què cal tenir en compte? [cartell]
Get PDFEncuestas; Experiencia del paciente; SaludSurveys; Patient experience; HealthEnquestes; Experiència del pacient (EXP); Sistema de salutEste documento explica qué estrategia debe tenerse en cuenta a la hora de diseñar una encuesta.This document explains what strategy should be taken into account when designing a survey.Infografia del Grup de Treball d’Indicadors d’Avaluació de l’EXP del Marc d’experiència de pacient al sistema de salut de Catalunya on es detalla l'estratègia per dissenyar una enquesta
Bases per a la identificació i atenció a les persones fràgils a Catalunya
Get PDFAtención; Personas mayores; FragilidadAttention; Elderly people; FrailtyPersones grans; Fragilitat; EnvellimentAquest document té com a principal objectiu proporcionar les bases conceptuals
per a la identificació i l’atenció a les persones grans fràgils, com a punt de partida
del disseny i desplegament d’un procés d’atenció específic per aquesta població
a Catalunya, per tal d’oferir la millor resposta possible a les necessitats d’aquestes
persones.Este documento tiene como principal objetivo proporcionar las bases conceptuales para la identificación y atención a las personas mayores frágiles, como punto de partida del diseño y despliegue de un proceso de atención específico para esta población en Cataluña, con el fin de ofrecer la mejor respuesta posible a las necesidades de estas personas.The main objective of this document is to provide the conceptual bases for the identification and care of frail elderly people, as a starting point for the design and deployment of a specific care process for this population in Catalonia, in order to offer the best possible response to the needs of these people