Joan Valls

Background: Cervical cancer is largely preventable, yet major gaps persist in detection and timely management of cervical precancer, particularly in low- and middle-income countries. Using data from the ESTAMPA multicentric study, we derived stratified absolute risk estimates for cervical precancer and cancer based on HPV testing, cervical cytology, and colposcopic impression. Methods: ESTAMPA recruited women aged 30–64 years across 12 centres in nine Latin American countries. Women were screened with HPV testing and cervical cytology. Those with positive screening results were referred to colposcopy using a standardised protocol including colposcopic impression, directed biopsies, and treatment as indicated. Women with normal colposcopy or histology less than CIN2 were recalled after 18 months for repeat HPV testing and colposcopy if HPV-positive. Absolute risks of histologically confirmed CIN3+ detected at baseline or follow-up were estimated integrating HPV testing, cytology, and colposcopic impression. Findings: 44,135 women with a valid HPV test were included, of whom 6,236 (14·1%) were HPV-positive. Overall, 764 CIN3+ lesions were detected (1·73%; 95% CI 1·61–1·86). CIN3+ risk was 12·0% (747/6,236; 95% CI 11·2–12·8) among HPV-positive women compared with 0·04% (17/37,899; 95% CI 0·03–0·07) among HPV-negative women. Among HPV-positive women, risk increased with cervical cytological severity, reaching 62·9% (95% CI 57·1–68·5) for HSIL+, 22·4% (95% CI 18·4–26·8) for LSIL, and 19·1% (95% CI 15·1–23·6) for ASC-US; a positive colposcopic impression further increased CIN3+ risk to 70·2% (95% CI 64·1–75·9), 28·5% (95% CI 23·5–34·0), and 24·5% (95% CI 19·4–30·2), respectively. Among HPV16/18-positive women, CIN3+ risk was 32·8% (95% CI 28·9–37·0) increasing to 46·2% (95% CI 40·8–51·6) when abnormal colposcopy was present. Interpretation: We confirmed a high underlying risk of CIN3+ in the Latin American population, with risk strongly stratified by HPV positivity, increasing cervical cytological severity, and positive colposcopic impression. These estimates may support WHO-aligned cervical screening and risk-based management strategies in LMICs and contribute to accelerating cervical cancer elimination.

Background: Ultrasound‐guided cannulation of vascular access devices (VADs) is one of the fastest‐growing invasive procedures due to its benefits, but complications continue to arise. Objectives: To determine the risk factors for failure of ultrasound‐cannulated VAD by a vascular access team (VAT) due to complications in adult inpatients and to develop a model to predict the risk of complications. Methods: An observational and retrospective study was carried out. All patients who were treated by a VAT in a secondary care hospital were included. A dataset including demographic and clinical variables, pertaining to VAD and its associated complications, was systematically collected. Bivariate and multivariate logistic regression models were used. Furthermore, a sequential classification tree was determined. Results: A total of 1454 patients were included, 55.9% were male, with a mean age of 67.4 years. The types of catheters that were cannulated included 42.7% peripherally inserted central catheter, 56.7% midlines, and 0.6% short peripheral intravenous cannulation. A total of 15.4% of the patients presented a failure of VAD. The multivariate model determined the following set of independent predictive factors associated with a higher risk of complications: age < 66 years; left arm puncture; cephalic vein cannulation; and less than seven days with catheter. Additionally, two high‐risk factors were identified: cannulation in the cephalic vein in either arm at any age or cannulation in noncephalic veins in the left arm in patients younger than 66 years. Conclusion: Cephalic vein cannulation or left arm puncture in patients younger than 66 years is associated with a higher risk of complications after ultrasound‐guided catheter cannulation. Trial Registration: Clinical trial.gov.identifier; NCT06770361.

To evaluate whether preventive treatment can modify endothelial and oxidative biomarkers of vascular disease risk in patients with high-frequency episodic and chronic migraine. In this observational, prospective pilot study, 88 prophylactic treatment-naïve patients with episodic and chronic migraine and 56 healthy sex/age matched controls underwent ultrasonography exams and blood tests at baseline, and again in the migraine patients after 3 months’ treatment with metoprolol or topiramate. Biomarkers for endothelial function and oxidative stress were analyzed. At baseline, patients with migraine in the low-frequency episodic group had differences exclusively in nitrates 17.6 versus 27.33 µM; p = 0.046 compared to the controls. However, when comparing the group comprised of patients with high-frequency episodic migraine and chronic migraine versus controls, statistically significant differences appeared in hsCRP 2.68 versus 1.64 mg/dL; p = 0.049, vWF antigen (133% vs. 110%; p = 0.020, vWF activity (111% vs. 90%; p = 0.010) and isoprostane levels (181 vs. 238 µM; p = 0.05). Only in the chronic migraine subgroup did we found statistically significant differences in CIMT (0.60 vs. 0.54 mm; p = 0.042) which were significantly greater than in the controls. After treatment, patients who respond to preventive treatment exhibited significantly higher levels of nitrates (24.2–13.8 µM; p = 0.022) and nitrites (10.4–3.43 µM; p = 0.002) compared than non-responders. Moreover, biomarker levels improved in treatment-responsive patients with migraine; hsCRP levels decreased from 2.54 to 1.69 mg/dL (p < 0.05), vWF activity levels decreased from 124 to 103 IU/dL (p = 0.003) and prothrombin activity decreased from 1.01 to 0.93 (p = 0.01). These differences were also observed in the high-frequency and chronic migraine subgroup and reach statistical significance in the case of hsCRP, which decreased from 2.12 to 0.83 mg/dL (p = 0.048). Patients with migraines have differences in biomarker levels compared to controls, suggesting endothelial and oxidative dysfunction. The greatest differences in biomarker levels compared to controls are observed in migraine patients in the high-frequency and chronic migraine subgroups. Based on our results, preventive treatment is capable of modifying markers of endothelial dysfunction and oxidative stress in migraine patients, even in cases of chronic and high-frequency migraine.