Summary
Background
Hepatocellular carcinoma (HCC) is a leading cause of liver‐related mortality in people living with HIV, where co‐infection with hepatotropic viruses accelerates the course of ...chronic liver disease.
Aim
To evaluate whether the albumin‐bilirubin (ALBI) grade, a more accurate marker of liver dysfunction in HCC, might identify patients with progressive liver dysfunction in the context of HIV/hepatitis co‐infection.
Methods
Using uni‐ and multi‐variable analyses, we studied the albumin‐bilirubin grade as a predictor of overall survival (OS) in a large, multi‐center cohort of patients with HIV‐associated HCC recruited from 44 centres in 9 countries within the Liver Cancer in HIV study group. Patients who underwent liver transplantation were excluded.
Results
A total of 387 patients, predominantly HCV co‐infected (78%) with balanced representation of all Barcelona Clinic Liver Cancer (BCLC) stages (A = 33%, B = 18%, C = 37%, D = 12%) were recruited. At HCC diagnosis, 84% had been on anti‐retrovirals for a median duration of 8.8 years. The albumin‐bilirubin grade identified significant differences in median survival of 97 months for grade 1 (95% CI 13‐180 months), 17 months for grade 2 (95% CI 11‐22 months) and 6 months for grade 3 (95% CI 4‐9 months, P < .001). A more advanced albumin‐bilirubin grade correlated with lower CD4 counts (464/373/288 cells/mm3 for grades 1/2/3) and higher HIV viraemia (3.337/8.701/61.845 copies/mL for grades 1/2/3, P < .001).
Conclusions
In this large, multi‐center retrospective study, the albumin‐bilirubin grade highlights the interplay between liver reserve and immune dysfunction as prognostic determinants in HIV‐associated HCC.
Linked Content
This article is linked to Giannini and Pinato et al. papers. To view these articles visit https://doi.org/10.1111/apt.14374 and https://doi.org/10.1111/apt.14394.
Several scoring systems predict mortality in alcohol-associated hepatitis (AH), including the Maddrey discriminant function (mDF) and model for end-stage liver disease (MELD) score developed in the ...United States, Glasgow alcoholic hepatitis score in the United Kingdom, and age, bilirubin, international normalized ratio, and creatinine score in Spain. To date, no global studies have examined the utility of these scores, nor has the MELD-sodium been evaluated for outcome prediction in AH. In this study, we assessed the accuracy of different scores to predict short-term mortality in AH and investigated additional factors to improve mortality prediction.
Patients admitted to hospital with a definite or probable AH were recruited by 85 tertiary centers in 11 countries and across 3 continents. Baseline demographic and laboratory variables were obtained. The primary outcome was all-cause mortality at 28 and 90 days.
In total, 3,101 patients were eligible for inclusion. After exclusions (n = 520), 2,581 patients were enrolled (74.4% male, median age 48 years, interquartile range 40.9-55.0 years). The median MELD score was 23.5 (interquartile range 20.5-27.8). Mortality at 28 and 90 days was 20% and 30.9%, respectively. The area under the receiver operating characteristic curve for 28-day mortality ranged from 0.776 for MELD-sodium to 0.701 for mDF, and for 90-day mortality, it ranged from 0.773 for MELD to 0.709 for mDF. The area under the receiver operating characteristic curve for mDF to predict death was significantly lower than all other scores. Age added to MELD obtained only a small improvement of AUC.
These results suggest that the mDF score should no longer be used to assess AH's prognosis. The MELD score has the best performance in predicting short-term mortality.
BackgroundEvidence shows a high rate of unnecessary antibiotic prescriptions for respiratory tract infections (RTIs) in primary care. There is increasing evidence showing that shorter courses for ...RTIs are safe and help in reducing antimicrobial resistance (AMR). Stopping antibiotics earlier, as soon as patients feel better, rather than completing antibiotic courses, may help reduce unnecessary exposure to antibiotics and AMR.ObjectivesThe aim of this study was to explore the perceptions and views of primary care healthcare professionals about customising antibiotic duration for RTIs by asking patients to stop the antibiotic course when they feel better.DesignQualitative research.Setting and participantsA total of 21 qualitative interviews with primary care professionals (experts and non-experts in AMR) were conducted from June to September 2023. Data were audiorecorded, transcribed and analysed thematically.ResultsOverall, experts seemed more amenable to tailoring the antibiotic duration for RTIs when patients feel better. They also found the dogma of ‘completing the course’ to be obsolete, as evidence is changing and reducing the duration might lead to less AMR, but claimed that evidence that this strategy is as beneficial and safe as fixed courses was unambiguous. Non-experts, however, believed the dogma of completing the course. Clinicians expressed mixed views on what feeling better might mean, supporting a shared decision-making approach when appropriate. Participants claimed good communication to professionals and patients, but were sceptical about the risk of medicalisation when asking patients to contact clinicians again for a check-up visit.ConclusionsClinicians reported positive and negative views about individualising antibiotic courses for RTIs, but, in general, experts supported a customised antibiotic duration as soon as patients feel better. The information provided by this qualitative study will allow improving the performance of a large randomised clinical trial aimed at evaluating if this strategy is safe and beneficial.
The increase in energy and fertilizer consumption makes it necessary to develop sustainable alternatives for agriculture. Anaerobic digestion and digestates appeared to be suitable options. However, ...untreated digestates still have high water content and can increase greenhouse gas emissions during storage and land application. In this study, manure-derived digestate and solid fraction of digestate after separation were treated with a novel solar drying technology to reduce their water content, combined with acidification to reduce the gaseous emissions. The acidified digestate and acidified solid fraction of digestate recovered more nitrogen and ammonia nitrogen than their respective non-acidified products (1.5–1.3 times for TN; 14 times for TAN). Ammonia and methane emissions were reduced up to 94% and 72% respectively, compared to the non-acidified ones, while N2O increased more than 3 times. Dried digestate and dried acidified digestate can be labeled as NPK organic fertilizer regarding the European regulation, and the dried solid fraction and the improved dried acidified solid fraction can be labeled as N or P organic fertilizer. Moreover, plant tests showed that N concentrations in fresh lettuce leaves were within the EU limit with all products in all the cases. However, zinc concentration appeared to be a limitation in some of the products as their concentration exceeded the European legal limits.
•A solar drying greenhouse was used to produce organic fertilizers from digestate.•Acidification reduced up to 94% and 72% emissions for NH3 and CH4 respectively.•The resulting products were compared with the current fertilizer EU legislation.•Phytotoxicity of the resulting organic fertilizers was tested with lettuce pot trials.
The Routledge Handbook of Language Awareness is a comprehensive and informative overview of the broad field of language awareness. It contains a collection of state-of-the-art reviews of both ...established themes and new directions, authored and edited by experts in the field. The handbook is divided into three sections and reflects the engaging diversity of language awareness perspectives on language teaching and teachers, language learning and learners, and extending to additional areas of importance that are less directly concerned with language instruction.In their introductory chapter, the editors provide valuable background to the language awareness field along with their summary of the chapters and issues covered. A helpful section giving further reading suggestions for each of the chapters is included at the end of the book. This volume is essential reading for graduate students and researchers working in the sphere of language awareness within applied linguistics, sociolinguistics and across the wider spectrum of language and communication.
Background:
One of the major challenges to total knee arthroplasty (TKA) is optimal pain control. Effective analgesia is capital in fast-track surgery programs to allow patient’s early functional ...outcomes.
Objectives:
Compare length of stay (LOS) short-term pain control, and patients’ satisfaction at 1 month between local infiltration analgesia (LIA) combined with femoral nerve block (FNB) and FNB only in patients undergoing TKA.
Patients and methods:
Two hundred and fifty-four patients were included in a randomized prospective study and distributed in two groups. The first group received an intraoperative LIA (150 mL mixture of ropivacaine 2.0 mg/mL + ketorolac 30 mg + adrenaline 10 μg/mL) combined to an FNB. The control group had only an FNB. Demographical data and visual analog scale (VAS) score were obtained preoperatively, at 36 h after surgery and at the 15-day follow-up. Patients’ satisfaction at 1 month was also evaluated. Statistical analysis data was performed.
Results:
No differences in demographical data and preoperative VAS score were observed between both groups. LIA group had a lower VAS score at 36 h after surgery (1.34 ± 1.31 vs. 3.68 ± 1.932 in the control group, p = 0.00), but these differences were not maintained at the 15-day follow-up (4.51 ± 1.889 vs. 4.11 ± 1.940 in the control group, p > 0.05). LOS and patients’ satisfaction were comparable between groups. Patients with LIA had no additional complications.
Conclusions:
LIA is a safe adjuvant to FNB to reduce perioperative pain during the first 36 h after TKA. Its effects wean with time, but do cover the first crucial hours of rehabilitation in a fast-track program. LIA seems don’t modify postoperative course nor patient’s satisfaction at short-term follow-up. The final impact of LIA on surgical outcome is still to be determined.
This study compares the language proficiency gains of two groups of students taking a business English course module in a bilingual university in Catalonia (Spain). Whereas one of these groups ...followed a 'translanguaging' or 'plurilingual' pedagogy, the other followed a strictly monolingual approach. Participants were 54 mostly Catalan/Spanish bilingual university students of Business (n = 35 translanguaging and n = 19 monolingual). Whereas the teacher in the 'translanguaging group' used and fostered the use of Catalan and Spanish besides English, the teacher in the 'monolingual group' only used English and allowed only English in class. Participants were administered a placement test, and performed a written composition and an oral sales pitch the first and last week of the semester. Participants were also administered a questionnaire before and after the treatment. The EFL development of the participants was measured in terms of fluency, lexical complexity, grammatical complexity and accuracy, but it was also assessed by an expert examiner, who based her ratings on a rubric including four scales: language, communicative achievement, content, and organisation. Results show that both groups experienced comparable gains, but the few significant differences favoured the translanguaging group.
Abstract Introduction General practitioners (GP) in Spain do not have access to rapid tests and adherence to guidelines is usually suboptimal. The aim of the study is to evaluate the estimated number ...of antibiotics that could have been saved if GPs had appropriately used these tests and had followed the guidelines. Design Observational study. Setting Primary care centres from eight Autonomous Communities in Spain. Participants GPs who had not participated in previous studies on rational use of antibiotics. Intervention GPs registered all the cases of pharyngitis and lower respiratory tract infections (LRTI) during 15 working days in 2015, by means of a 47-item audit. Main measurements Actual GPs’ antibiotic prescription and estimated number of antibiotics that could have been saved according to recent guidelines. Results A total of 126 GPs registered 1012 episodes of pharyngitis and 1928 LRTIs. Antibiotics were given or patients were referred in 497 patients with pharyngitis (49.1%) and 963 patients with LRTI (49.9%). If GPs had appropriately used rapid antigen detection tests and C-reactive protein tests and had strictly followed current guidelines, antibiotics would have been given to 7.6% and 15.1%, respectively, with an estimated saving of 420 antibiotics in patients with sore throat (estimated saving of 84.5%; 95% CI: 81.1–87.4%) and 672 antibiotics in LRTIs (estimated saving of 69.8%,95% CI: 67.1–72.5%). Conclusions GP adherence to guidelines and a correct introduction of rapid tests in clinical practice in Spain could result in a considerable saving of unnecessary prescription of antibiotics in pharyngitis and LRTIs.
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