Previous Diagnosis Research Articles

Evaluation of an automated platelet aggregation method for detection of congenital or acquired platelet function defects.

Light transmission aggregometry (LTA) is the most widely used laboratory method for an initial screening of patients with a suspected platelet function defect (PFD), and its use has also been proposed for assessing the efficacy of antiplatelet treatment (APT). An automated LTA method has been developed by Sysmex (Kobe, Japan) on a routine coagulation analyzer (CS-2400), together with a new research parameter called PAL (platelet aggregation level) to evaluate patients on APT. We evaluated the performance of CS-2400 compared to a stand-alone lumi-dual-aggregometer device in the diagnosis of PFD and in assessing the efficacy of APT. For these purposes, the study population was represented by a cohort of 23 patients with a previous diagnosis of PFD and a cohort of 28 patients on APT. Compared to healthy volunteers, patients with PFD showed a statistically significant reduction (p<0.05) in the maximal %light transmission, irrespective of the agonist used, both with the CS-2400 and the lumi-dual-aggregometer. As regards PFD patients, CS-2400 was effective in identifying the more severe defects, with a good sensibility and specificity, but less effective in identifying milder forms of PFD, such as platelet secretion defects. Patients on APT showed a statistically significant (p=0.001) reduced median %light transmission and PAL scores compared to healthy controls. Thanks to this LTA technology, CS-2400, a routine coagulation analyzer widely available in routine laboratories, could prove useful for initial assessment of patients with a suspected PFD. Moreover, the PAL scores were a fairly accurate reflection of the platelet response to APT.

Longitudinal mental health state during the COVID-19 pandemic. Longitudinal change of mental symptoms and its predictors during the COVID-19 pandemic: A prospective longitudinal study on Spanish population.

The general objective of this study is to analyze the change in mental health and post-traumatic symptoms over 6 months during the COVID-19 pandemic in a Spanish community sample, with a particular focus on individual differences in longitudinal change in symptoms and its predictors. This longitudinal prospective study surveyed a Spanish community sample three times (T1: during the initial outbreak, T2: after 4 weeks and T3: after 6 months). Four thousand one hundred and thirty-nine participants from all the Spanish regions completed the questionnaires. However, the longitudinal analysis was performed only with participants which responded at least two times (1,423 participants). Mental health assessments included depression, anxiety, and stress (measured by the Depression, Anxiety and Stress Scale (DASS-21) and post-traumatic symptoms were assessed by the Impact of Event Scale-Revised (IES-R). All the mental health variables achieved worse results at T2. Depression, stress, and posttraumatic symptoms did not recover at T3 when compared with the initial measure, while anxiety was practically stable across the timeline. Women, younger age, having a previous mental health diagnosis and contact with individuals with COVID-19 were linked to worse psychological evolution during the 6-months period. A good perception of one's physical health may be a protective factor. After 6 months of the pandemic, the general population's mental health was still worse than at the initial outbreak for most of the variables analyzed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Out of hospital cardiac arrest, first steps to know and follow in Mexico to have cardioprotected territories. A point of view of a group of experts.

Sudden cardiac death is a common occurrence. Out-of-hospital cardiac arrest is a global public health problem suffered by ≈3.8 million people annually. Progress has been made in the knowledge of this disease, its prevention, and treatment; however, most events occur in people without a previous diagnosis of heart disease. Due to its multifactorial and complex nature, it represents a challenge in public health, so it led us to work in a consensus to achieve the implementation of cardioprotected areas in Mexico as a priority mechanism to treat these events. Public access cardiopulmonary resuscitation (CPR) and early defibrillation require training of non-medical personnel, who are usually the first responders in the chain of survival. They should be able to establish a basic and efficient CPR and use of the automatic external defibrillator (AED) until the emergency services arrive at the scene of the incident. Some of the current problems in Mexico and alternative solutions for them are addressed in the present work.

Heterozygous Pyrin (MEFV) E148Q allele carriers indicate a reduced glaucoma risk for Turkish population: a prospective clinical analysis

ABSTRACT Purpose The MEFV gene encodes pyrin, a protein linked to increased severity of symptoms in Familial Mediterranean Fever (FMF). We consider that inflammation due to MEFV variants would increase eye inflammation and damage aqueous humor regulation. The present study is the first analysis investigating a MEFV (E148Q) variant as a marker protecting from glaucoma. Methods In this prospective clinical analyze, we performed detailed gene sequencing focusing on 22 specific regions of the pyrin (MEFV) gene. The study involved two distinct groups: individuals diagnosed with glaucoma (n = 200) and control subjects without glaucoma (n = 100). Both groups were carefully selected to exclude individuals with symptoms or a previous diagnosis of Familial Mediterranean Fever (FMF). The diagnosis of glaucoma for each participant was rigorously established through comprehensive direct ophthalmic examinations. Results A significant odds ratio for protection against glaucoma was found in carriers of the subclinical E148Q allele (OR:2.22; 95%CI: 1.098–4.485). No significant differences were found for other variants. One mutant E148Q-allele could decrease the probability of glaucoma development by approximately 68,9%. We observed no differences in the genotype frequency between glaucoma and healthy for the other MEFV gene variants. Conclusion The pyrin variant of the MEFV gene resulting in a subclinical phenotype appears to reduce the incidence of glaucoma, and heterozygous pyrin (MEFV) E148Q allele carriers confer protection against glaucoma. It is important to consider the limitations arising from the relatively small number of studies conducted on this topic.

Prevalence and prognostic impact of bone disease in chronic heart failure with reduced ejection fraction.

Chronic heart failure is associated with a bone-catabolic state and increases the risk of osteoporosis and fractures. Prospective studies investigating the clinical relevance of bone disease in heart failure are lacking. We aimed to assess the prevalence and prognostic impact of osteoporosis and vertebral fractures (VFs) in chronic heart failure with reduced ejection fraction (HFrEF). Symptomatic outpatients with chronic heart failure and a previous diagnosis of overtly reduced left ventricular ejection fraction<40% on stable, optimal HFrEF therapy and left ventricular ejection fraction<50% at enrolment were included into a prospective single-centre study. Osteoporosis was determined with dual-energy X-ray absorptiometry and defined as a T-score≤2.5 at any site. VFs were assessed using X-ray of both thoracic and lumbar spine applying the semiquantitative Genant score. We enrolled 205 patients (22% women), with a median age of 66 (IQR 58-74) years. Median left ventricular ejection fraction was 37 (IQR 30-43) % and median N-terminal pro B-type natriuretic peptide was 964 (IQR 363-2173) pg/mL. Osteoporosis, as defined by bone mineral density, and at least one VF were prevalent in 31 (15%) and 29 patients (14%). Osteoporosis or VF were present in 55 patients (27%) and 5 patients (2%) had both osteoporosis and a VF. During a median follow-up of 4.7 (IQR 4.0-5.3) years, 18 patients (9%) died due to cardiovascular (CV) cause, and 46 patients (22%) had a worsening heart failure (WHF) hospitalization. In multivariate Cox regression analyses, presence of VF independently predicted CV death (HR 2.82, 95% CI 1.04-7.65, P=0.042), WHF hospitalizations (HR 2.39, 95% CI 1.18-4.82, P=0.015), and a composite endpoint of CV death and WHF hospitalizations (HR 2.44, 95% CI 1.23-4.82, P=0.011). Osteoporosis was not significantly associated with CV events. In a prospective study, bone disease affected every fourth patient with HFrEF, and patients with VF at baseline had a two-fold risk of subsequent CV death or WHF hospitalization. Prevalent bone disease, particularly VF, should be considered as a clinically relevant comorbidity in HFrEF.

Children and adolescents' quality of life in repeated cross-sectional studies during the COVID-19.

During the COVID-19 pandemic, internalizing and externalizing symptoms have impacted the quality of life of children and adolescents. This cross-sectional study evaluated children's quality of life using parental reports, observing associations with mental health problems and sociodemographic variables. Some behavioral measures were linked to lower quality of life, particularly depression symptoms, relationship problems, and inattention. Multiple regression models indicated that reduced children's quality of life (R2 = 36%) was associated with higher levels of internalizing (r = -0.46) and externalizing (r = -0.23) behavioral problems and younger parents (r = -0.08). Children with previous mental disorder diagnoses had lower quality of life than those without (p < 0.001). In summary, children's quality of life during the COVID-19 pandemic was linked to current mental health, parental age, and previous history of mental disorders.

Intermittently Scanned Continuous Glucose Monitoring Performance in Patients With Liver Cirrhosis.

To evaluate the use of intermittently scanned continuous glucose monitoring (isCGM) in patients with liver cirrhosis (LC). Observational study including 30 outpatients with LC (Child-Pugh B/C): 10 without diabetes (DM) (G1), 10 with newly diagnosed DM by oral glucose tolerance test (G2), and 10 with a previous DM diagnosis (G3). isCGM (FreeStyle Libre Pro) was used for 56 days (four sensors/patient). Blood tests were performed at baseline and after 28 and 56 days. No differences were found in the baseline characteristics, except for higher age in G3. There were significant differences between G1, G2 and G3 in glucose management indicator (GMI) (5.28 ± 0.17, 6.03 ± 0.59, 6.86 ± 1.08%, P < .001), HbA1c (4.82 ± 0.39, 5.34 ± 1.26, 6.97 ± 1.47%, P < .001), average glucose (82.79 ± 7.06, 113.39 ± 24.32, 149.14 ± 45.31mg/dL, P < .001), time in range (TIR) (70.89 ± 9.76, 80.2 ± 13.55, 57.96 ± 17.96%, P = .006), and glucose variability (26.1 ± 5.0, 28.21 ± 5.39, 35.31 ± 6.85%, P = .004). There was discordance between GMI and HbA1c when all groups were considered together, with a mean difference of 0.35% (95% SD 0.17, 0.63). In G1, the mean difference was 0.46% (95% SD 0.19, 0.73) and in G2 0.69% (95% SD 0.45, 1.33). GMI and HbA1c were concordant in G3, with a mean difference of -0.10 % (95% SD [-0.59, 0.38]). Disagreements were found between the GMI and HbA1c levels in patients with LC. isCGM was able to detect abnormalities in glycemic control that would not be detected by monitoring with HbA1c, suggesting that isCGM can be useful in assessing glycemic control in patients with LC.

Pre-existing depression, anxiety and trauma as risk factors for the development of post-traumatic stress disorder symptoms following wildfires

The trauma of wildfires leads to one of the most challenging and treatment resistant mental health conditions-namely-post-traumatic stress disorder (PTSD). Research addressing the contribution of pre-existing mental health conditions to the development of PTSD symptoms following traumatization by wildfires is limited. This study examined whether people with pre-existing diagnoses of anxiety, depression, PTSD, insomnia and nightmares, by a mental health professional, are more likely to develop symptoms of PTSD than those with no previous diagnosis following the trauma of wildfires. A total of 126 wildfire survivors from Australia, Canada and the United States of America completed an online survey. An independent sample t-tests revealed that pre-existing diagnosed conditions of depression, an anxiety disorder and PTSD significantly increased the likelihood of developing PTSD symptoms following traumatization by wildfires (t = −2.51, p = 0.014, 95% CI [-18.91 to −2.20], t = −2.61, p = 0.01, 95% CI [-18.91 to −2.57], t = −2.57, p = 0.012, 95% CI [-22.36 to −2.87] respectively). Practitioners working in communities subjected to wildfires need to run a thorough screening of their patients’ pre-existing mental health conditions to provide the right treatment and referral pathways to those affected by the trauma of wildfires.

Type 2 diabetes risk after gestational diabetes according to country/region of origin. A nationwide register-based study.

The risk of gestational diabetes mellitus (GDM) differs between the Danish population and several migrant groups. However, it is unclear if the incidence and timing of type 2 diabetes mellitus (T2DM) following GDM vary similarly. To investigate the incidence of T2DM according to migration background based on country/region of origin among women with a previous GDM diagnosis and explore the role of time since GDM diagnosis on the association. Using nationwide registry data, we followed women diagnosed with GDM in Denmark during 2004-2018 to Dec 31, 2020. Poisson regression models were used to estimate incidence rates (IRs) of T2DM according to country/region of origin, adjusted for age, education, and body mass index. The study included 20,873 women with a GDM diagnosis, of whom 22.3% were of migrant background and 77.7% were Danish. The mean follow-up time was 7.3 years, and 10.9% were registered with T2DM during the study period. Generally, migrant women had higher IRs of T2DM compared to Danish women, with substantial variations in risk between migrant groups. Women from Pakistan and Sri Lanka had three-four times higher IRs compared to Danish women. The timing of T2DM onset also varied, with women from Sri Lanka and Pakistan having an earlier onset of T2DM compared to other migrant and Danish women. This study demonstrated that country/region of origin is an important risk factor for T2DM in women with GDM. These findings underscore the importance of prevention programs targeting women with GDM and a high-risk origin.

Hepatocellular Carcinoma in Ceará: Epidemiology and Treatment in a Reference Liver Transplant Center in Northeast Brazil

Hepatocellular carcinoma remains a significant worldwide malignancy and an important cause of cancer-related death. The incidence is increasing globally. In Latin America, there is no consistent data on the epidemiology of hepatocellular carcinoma. However, Brazil is considered a country with an intermediate incidence of this liver neoplasm. In the state of Ceará, situated in the northeast region of Brazil, there are no consistent clinical and epidemiologic data on the actual incidence and the treatment of hepatocellular carcinoma. The purpose of this article is to describe epidemiologic characteristics and treatment forms of patients with hepatocellular carcinoma who were treated in a Liver Transplant Center. A retrospective observational study was conducted using the database from the register of 299 patients with hepatocellular carcinoma between June 2004 and February 2022. Only patients born in Ceará were included. Therefore, most patients were eligible, based on the Milan Criteria, to undergo liver transplantation with a Model End Stage Liver Disease score of 12.48 ± 4.66 points, and the waiting list time was approximately 7 months with 8.7% hepatocellular carcinoma recurrence after liver transplant. A total of 38.5 % of cases were outside the Milan criteria at the time of cancer diagnosis, and transarterial chemoembolization was the main treatment choice. In conclusion, the diagnosis of hepatocellular carcinoma in Ceará mainly occurs in male patients with hepatitis C or alcoholism, with a mean age of 61.55 years and a previous diagnosis of liver disease. Liver transplantation was the best curative therapeutic form in patients with cirrhosis and hepatocellular carcinoma in Ceará, where a significant number of patients were diagnosed with intermediate and advanced-stage hepatocellular carcinoma, so public health policies are important for the screening and monitoring of liver disease.

Combined surgical and chemotherapy treatment for invasive primary urethral cancer: a case presentation

BackgroundThe European Association of Urology (EAU) defines primary urethral carcinoma (PUC) as a carcinoma that arises in the urethra without a previous diagnosis of carcinoma elsewhere in the urinary system. It is considered as a rare cancer, accounting for less than 1% of all malignant tumors and 5% of malignant tumors of the urinary system. The difficulty in diagnosis and its rarity can lead to delayed diagnosis and decreased survival. We think that a case report to be made in the literature for this rare disease with no consensus on treatment will contribute to disease management.Case presentationIn this article, we describe the diagnosis and treatment process of a 75-year-old patient who was diagnosed with primary urethral cancer and had urethral discharge and difficulty in urination. The biopsy result from the suspected hyperemic area in the urethra in cystourethroscopy was primary urethral cancer. Urethrectomy followed by urethroplasty was performed on the patient's 2-cm primary urethral cancerous tissue. In the postoperative first month, an F-18 FDG whole-body PET scan for oncological evaluation showed increased pathological F-18 FDG uptake in the periphery of the mass in the penile urethra and indistinguishable boundaries from the prostatic urethra. After this, adjuvant gemcitabine and carboplatin therapy was planned by the oncology team.ConclusionsBased on our outcome in this case, we believe that chemotherapy combined with surgery increases the chance of successful treatment in locally advanced urethral cancer.

Living in disadvantaged neighborhoods linked to less intervention for severe aortic stenosis

To investigate the association between area deprivation index (ADI) and aortic valve replacement (AVR) in patients with severe aortic stenosis (AS). Patients aged 40–95 years with severe AS confirmed by echocardiography were included. The 9-digit zip code of patient residence address was used to identify the ADI ranking, based on which patients were divided into 5 groups (with Group E being most deprived). The rates of AV intervention were compared among 5 groups using competing risks analysis, with death as a competing event. We included 1751 patients with severe AS from 2013 to 2018 followed for a median 2.8 (interquartile range, 1.5–4.8) years. The more distressed ADI groups tended to be younger (P = 0.002), female (P < 0.001), and of African American race (P < 0.001), have higher presentation of sepsis (P = 0.031), arrhythmia (P = 0.022), less likely to have previous diagnosis of AS (P < 0.001); and were less likely to undergo AVR (52.5% vs 46.9% vs 46.1% vs 48.9% vs 39.7%, P = 0.023). Using competing risk analysis, the highest ADI group (E) were the least and the lowest ADI group (A) the most likely to undergo AVR (Gray’s test, P = 0.025). The association between ADI ranking and AVR rates was influenced by sex and race. Within group analysis, there was significant association between race and AVR (Gray’s test, P < 0.001), and between sex and AVR (Gray’s test, P < 0.001). Patients with severe AS living in more deprived neighborhoods were less likely to undergo aortic valve interventions, which was influenced by female gender, and African American race.

Phosphodiesterase Type 5 Inhibitors in Men With Erectile Dysfunction and the Risk of Alzheimer Disease: A Cohort Study.

Repurposing phosphodiesterase type 5 inhibitors (PDE5Is) as drugs for Alzheimer disease (AD) risk reduction has shown promise based on animal studies. However, evidence in humans remains inconclusive. Therefore, we conducted a cohort study to evaluate the association between PDE5I initiation compared with nonuse and the risk of developing AD in men with erectile dysfunction (ED). Using electronic health records from IQVIA Medical Research Data UK (formerly known as the THIN database), we identified men aged ≥40 years with a new diagnosis of ED between 2000 and 2017. Individuals with a previous diagnosis of dementia, cognitive impairment, confusion, or prescription for dementia symptoms were excluded. The occurrence of incident AD was identified using diagnostic read codes. To minimize immortal-time bias, PDE5I initiation was treated as a time-varying exposure variable. Potential confounders were adjusted using inverse probability of treatment weighting based on propensity scores. Cox proportional hazard models were used to estimate the adjusted hazard ratio (HR) with 95% CIs. A secondary analysis explored the association between AD and the cumulative number of PDE5I prescriptions. Sensitivity analyses included lag (delay) periods of 1 and 3 years after cohort entry to address the prodromal stage of AD. The study included 269,725 men, with 1,119 newly diagnosed with AD during a median follow-up of 5.1 (interquartile range 2.9-8.9) years. The adjusted HR in PDE5I initiators compared with nonuse was 0.82 (95% CI 0.72-0.93). The associated risk of AD decreased in individuals issued >20 prescriptions: HR 0.56 (95% CI 0.43-0.73) for 21-50 prescriptions and HR 0.65 (95% CI 0.49-0.87) for >50 prescriptions. Sensitivity analysis with a 1-year lag period supported the primary findings (HR 0.82, 95% CI 0.72-0.94), but the results differed with the inclusion of a 3-year lag period (HR 0.93, 95% CI 0.80-1.08). PDE5I initiation in men with ED was associated with a lower risk of AD, particularly in those most frequently issued prescriptions. The differences between primary and sensitivity analyses highlight the need to explore the optimal lag period. To enhance the generalizability of our findings, a randomized controlled trial including both sexes and exploring various PDE5I doses would be beneficial to confirm the association between PDE5I and AD.

A multi-class brain tumor grading system based on histopathological images using a hybrid YOLO and RESNET networks

Gliomas are primary brain tumors caused by glial cells. These cancers’ classification and grading are crucial for prognosis and treatment planning. Deep learning (DL) can potentially improve the digital pathology investigation of brain tumors. In this paper, we developed a technique for visualizing a predictive tumor grading model on histopathology pictures to help guide doctors by emphasizing characteristics and heterogeneity in forecasts. The proposed technique is a hybrid model based on YOLOv5 and ResNet50. The function of YOLOv5 is to localize and classify the tumor in large histopathological whole slide images (WSIs). The suggested technique incorporates ResNet into the feature extraction of the YOLOv5 framework, and the detection results show that our hybrid network is effective for identifying brain tumors from histopathological images. Next, we estimate the glioma grades using the extreme gradient boosting classifier. The high-dimensional characteristics and nonlinear interactions present in histopathology images are well-handled by this classifier. DL techniques have been used in previous computer-aided diagnosis systems for brain tumor diagnosis. However, by combining the YOLOv5 and ResNet50 architectures into a hybrid model specifically designed for accurate tumor localization and predictive grading within histopathological WSIs, our study presents a new approach that advances the field. By utilizing the advantages of both models, this creative integration goes beyond traditional techniques to produce improved tumor localization accuracy and thorough feature extraction. Additionally, our method ensures stable training dynamics and strong model performance by integrating ResNet50 into the YOLOv5 framework, addressing concerns about gradient explosion. The proposed technique is tested using the cancer genome atlas dataset. During the experiments, our model outperforms the other standard ways on the same dataset. Our results indicate that the proposed hybrid model substantially impacts tumor subtype discrimination between low-grade glioma (LGG) II and LGG III. With 97.2% of accuracy, 97.8% of precision, 98.6% of sensitivity, and the Dice similarity coefficient of 97%, the proposed model performs well in classifying four grades. These results outperform current approaches for identifying LGG from high-grade glioma and provide competitive performance in classifying four categories of glioma in the literature.

A nationwide cross-sectional study investigating adherence to the Mediterranean diet, smoking, alcohol and work habits, hormonal dynamics between breast cancer cases and healthy subjects

Background & AimsDespite substantial efforts in promoting prevention and the advancements in surgical and minimally invasive techniques, breast cancer remains a leading cause of mortality among women worldwide. Genetics and risk factors, including diet and lifestyle, play a critical role in determining the susceptibility to this neoplasm. The primary objective of this study is to investigate the pivotal role of adherence to the Mediterranean diet in breast cancer prevention. Additionally, we assessed differences in diet, Body Mass Index (BMI), smoking and alcohol habits, work shifts, exposure to environmental pollutants, and hormonal factors between patients with previously diagnosed breast cancer and healthy subjects. MethodsThe validated CREA questionnaire, alongside additional inquiries, was administered to the Italian population. Adherence to the Mediterranean diet was examined, and respondents were categorized into two groups: the general population and patients with a previous cancer diagnosis. Descriptive and inferential statistics were applied to assess all risk factors among these groups. ResultsResults revealed low adherence to the Mediterranean diet, particularly among less educated individuals, those engaged in 24-hour shift work, smokers, and those with a high BMI. Furthermore, significant differences in working time distribution, consumption of meat, milk, and alcohol, as well as significant differences in hormonal factors such as age of menarche and menopause, age of first pregnancy, number of children and abortions, breastfeeding time, and contraceptive use were observed among these groups. ConclusionsThese findings underscore the importance of targeted interventions and personalized strategies to address specific risk factors and enhance preventive measures for individuals at risk.

Migraine and atrial fibrillation: a systematic review and meta-analysis.

Patients with migraines, particularly those with auras, may present with stroke. Atrial fibrillation is a known risk factor for stroke. With common pathophysiological factors between migraines and atrial fibrillation, we aimed to clarify the association between migraine and atrial fibrillation in this systematic review and meta-analysis. A literature search was conducted in EMBASE, PubMed, Scopus and Cochrane electronic bibliographic databases from inception to 5 September 2022 with the following inclusion criteria: (a) cohort or cross-sectional studies; (b) studies that included only patients aged ≥18 years; and (c) studies that examined the association between atrial fibrillation and migraines. Exclusion criteria were case-control studies and the studies that included patients with previous diagnosis of atrial fibrillation or nonmigrainous headache. The Newcastle-Ottawa Scale was used to assess the quality of studies. Six studies were included, demonstrating a pooled prevalence of atrial fibrillation of 1.61% (95% confidence interval [CI] 0.51, 3.29) in migraine with aura and 1.32% (95% CI 0.17, 3.41) in migraine without aura. The overall prevalence of atrial fibrillation in migraine was 1.39% (95% CI 0.24, 3.46). In this systematic review and meta-analysis, the overall prevalence of atrial fibrillation in patients with migraine was low. Further studies are needed to clarify this relationship.

Follow-up of breast cancer: why is it necessary to start a Consensus in 2024?

In Italy, breast cancer is the most frequently diagnosed cancer in women, with 55,900 new cases in 2023 (over 90% in the early stages). Due to the screening, early diagnosis and adjuvant treatment, these patients have a 5-years survival rate of 87% after the diagnosis. There are 834,154 women in Italy with a previous diagnosis of breast cancer: most of these women require a follow-up. The AIOM, ESMO and ASCO Guidelines recommend for early breast cancer (EBC) a clinical follow-up with only physical examination (and eliciting of symptoms) and an annual X-ray mammography, on the basis of the results of two randomized trials published in 1994 that showed no benefit in overall survival with intensive follow-up. However, an Italian survey reported the application by 80% of oncologists of an intensive follow-up based on the individual patient’s risk of recurrence. In fact, the oncologists believe that an early diagnosis of locoregional or distant recurrence may allow an early start of very effective therapies. In this lack of up-to-date scientific data, many questions about follow-up remain unanswered and the few ongoing studies will provide results in several years. Non-compliance with guideline recommendations leads to increased costs for the healthcare system. Furthermore, management varies widely from centre to centre with regard to guideline recommendations, resulting in inequalities between patients. For these reasons, the follow-up of breast cancer should be reconsidered. In the absence of recent scientific evidence, a multidisciplinary group of breast cancer experts has initiated a Consensus on the follow-up of EBC according to the mini-Delphi methodology. The project will be completed by the end of 2024.

How do men and women differ in their depressive symptomatology? A gendered network analysis of depressive symptoms in a French population-based cohort

BackgroundThe experience of depressive manifestations and the presentation of symptoms in clinical settings may differ in men and women. Despite the extensive literature, it remains unclear how depressive manifestations interact at symptom levels in men and women. First, we aimed to describe and compare depressive networks by sex. Second, we examined symptom connections to Clinical depression and Functional Limitations as a proxy of self-recognition of a depressive episode. MethodsWe estimated networks from the 20 CES-D items in men and women from a large population-based French cohort. We computed centrality measures and ran comparisons. Then, we re-estimated two networks in men and women separately, adding, on the one hand, Clinical Depression and, on the other hand, Limitations due to a depressive episode. ResultsOver 200,000 participants were included in this study. Women were twice as likely to have a previous diagnosis of depression. Sex-ratio was less pronounced (1,7:1) for Limitations due to depression. Centrality measures revealed similar symptom patterns. However, network structures differed between men and women. We found some symptom connections to Clinical depression and Limitations to be non-invariant according to sex. LimitationsCross-sectional data does not capture the direction of the connections between symptoms and an eventual diagnosis. We lacked data about the diagnosis's context and could not account for other factors influencing depressive symptomatology. ConclusionsNetwork structures differed, suggesting gender-specific mechanisms in activating symptoms and depressive states. Addressing central symptoms evoking depressed moods with tailored interventions may serve to tackle depressive states in men and women.

Genital and Oral HPV Geno-Prevalence Measured through Urine and Saliva Samples in Young Adults in Italy.

The aims of the study were to determine, in the urine and oral samples of young adults, the genotype-specific prevalence of Human Papilloma Virus (HPV) infection, the HPV DNA type-specific prevalence in unvaccinated and vaccinated individuals, and the determinants of HPV infection. Selected participants were asked to fill in a self-administered questionnaire and to self-collect urine and saliva samples. Among the 1002 participants, 81 (8.1%) resulted positive for HPV DNA. The most common low-risk genotype was HPV 42 (2.2%), followed by HPV 43 (0.8%), and 40 (0.5%). The HPV 51 was the most common high-risk genotype (1.5%) followed by HPV 66 (1%) and HPV 68 (1%), and no participants were infected with HPV genotypes 18, 33, 45. Females, those who have had one or more occasional sexual partner, those who never/rarely/sometimes used condoms during their sexual activity, those with a previous diagnosis of sexually transmitted infection, and those who were not vaccinated were more likely to be tested positive for HPV infection. The low prevalence of genital HPV infections has provided evidence of the effectiveness of HPV vaccination both in vaccinated and not yet vaccinated subjects through herd immunity and indicated its decisive role in the changing epidemiology of circulating HPV genotypes in the population.

Clinical and economic impact of the introduction of pre-biopsy MRI-based assessment on a large prostate cancer centre diagnostic population and activity: 10years on.

Prostate mpMRI was introduced in 2011 as a secondary test and subsequently integrated into a prostate cancer (PCa) diagnostics unit representing a population of approximately 550,000 people. The following represents an audit of its step-wise introduction between 2 index years, 2009 and 2018, focusing on the activity, patient outcomes and economic benefits. PATIENTSAND METHODS: The 2 distinct years were selected for relying on a transrectal ultrasound biopsy pathway in 2009 to an mpMRI-based pathway in 2018. All referrals were retrospectively screened and compared for age, PSA levels, DRE findings, biopsy history, biopsy and mpMRI allocation data. Cost analysis was determined using local unit procedure costs. Patients referred included 648 in 2009 and 714 in 2018. mpMRI seldomly informed decision to biopsy in 2009 (9.8%), while in 2018 it was performed in the pre-biopsy setting in 87.9% cases and enabled biopsy avoidance in 137 patients. In 2018, there was a 31.8% decrease in the number of biopsies in patients without previous PCa diagnosis, coupled with an increase in diagnostic rates of csPCa, from 28.6 to 49.0% (p < 0.0001) and a reduction in negative biopsy rates from 52.3 to 33.8%. mpMRI had a positive impact on the system with reduced patient morbidity and post-procedural complications. The estimated overall cost savings amount to approximately £75,000/year for PCa diagnosis and £11,000/year due to reduced complications. Our evaluation shows the mpMRI-based pathway has improved early detection of csPCa and reduction of repeat biopsies, resulting in significant financial benefits for the local healthcare system.