Valeria Reynolds-Cortez

Skin autofluorescence (SAF) is a biomarker of tissue accumulation of advanced glycation end-products, which increase the risk of cardiovascular disease (CVD) and mortality, particularly among individuals with chronic kidney disease (CKD) or diabetes mellitus (DM). The aim was to summarise existing evidence and estimate the association between SAF and all-cause mortality, cardiovascular mortality and CVD. A search of Medline, Scopus, Web of Science and the Cochrane Library was conducted from inception to June 2025. Observational studies estimating the association between SAF and all-cause mortality, cardiovascular mortality and CVD were included. Meta-analyses of these associations were performed by categorising SAF (high vs. low) and by 1 arbitrary unit (AU) increment of SAF, expressed as hazard ratio (HR) or odds ratio (OR) and their 95% confidence intervals. Thirty-two studies were included in the systematic review. Elevated SAF was associated with an increased risk of all-cause mortality, cardiovascular mortality and CVD. Per 1 AU increase, an HR of 1.51 (1.35, 1.69) was obtained for all-cause mortality, an HR of 1.48 (1.16, 1.90) for cardiovascular mortality and an HR of 1.25 (1.13, 1.38) for CVD. However, estimates with OR tended to be higher. Finally, the results were similar in CKD and DM. SAF is a strong predictor of CVD and mortality in general, and in CKD and DM in particular. Integrating SAF measurement into clinical practice could help clinicians implement early and intensive interventions to prevent associated morbidity and mortality, although clinical trials are needed to evaluate its effectiveness.

Noonan syndrome (NS) is a RASopathy, a group of genetic disorders caused by alterations in the RAS/MAPK signalling pathway, and is associated with brain-related disorders, including intellectual developmental disorder (IDD), autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), epilepsy, and depression and anxiety. However, estimates of prior prevalence vary widely. The aim of this systematic review and meta-analysis was to estimate the prevalence of brain-related disorders (i.e., IDD, ASD, ADHD, epilepsy, and depression and anxiety) in NS. A systematic search of Medline, Scopus, Web of Science and the Cochrane Library was conducted from inception to July 2025. Studies that estimated the prevalence of IDD, ASD, ADHD, epilepsy, and depression and anxiety in the population with NS were included. Genotype was considered when possible. Random-effects meta-analyses of prevalence, expressed as proportions (0–1) and their 95% confidence intervals (95% CI), were performed. Twenty-one studies were included in the systematic review, while 20 were included in the meta-analysis. The IDD prevalence was 0.23 (95% CI: 0.12, 0.35), the ASD prevalence was 0.11 (95% CI: 0.05, 0.17); the ADHD prevalence was 0.31 (95% CI: 0.22, 0.41); the epilepsy prevalence was 0.09 (95% CI: 0.03, 0.15) and the depression and anxiety prevalence was 0.23 (95% CI: 0.08, 0.39). There was hardly any genotype-specific data, particularly for minor mutations. NS is strongly associated with brain-related disorders, which reinforces the need for early and periodic screening in this population. Furthermore, genotype–phenotype correlation studies are required, as there is currently little evidence in this area. What is Known: • Noonan syndrome is a RASopathy characterised by short stature, heart disease and brain-related disorders. • Brain-related disorders include intellectual developmental disorder (IDD), autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD), among others. What is New: • IDD, ASD and ADHD were estimated to affect 23%, 11% and 31% of individuals, respectively. This is higher than the prevalence in the general population. • The prevalence of seizure disorders and emotional disorders was also high, although the evidence was more limited.

Background/Objectives: The 20-valent pneumococcal conjugate vaccine (PCV20) was approved for use in children and infants on the basis of studies comparing its safety and immunogenicity with those of the 13-valent vaccine (PCV13). PCV20 offers expanded coverage of seven additional serotypes. This meta-analysis aimed to summarize the available evidence on the comparative immunogenicity between PCV20 and PCV13. Methods: A systematic search of the PubMed, Web of Science, Scopus, Cochrane, and ClinicalTrials.gov databases was conducted in September 2024. The following inclusion criteria were used: (i) design: randomized clinical trials; (ii) outcomes: studies that included immunogenicity outcomes; (iii) compared vaccines: any study directly comparing the immunogenicity of PCV20 and PCV13; and (iv) population: infant population <2 years of age. No language or temporal restrictions were applied in the study. A random-effects meta-analysis was conducted via the Hartung–Knapp–Sidik–Jonkman method, with subgroup analyses according to the serotype and vaccination schedule (3 + 1 and 2 + 1). We used the revised Cochrane risk of bias 2 tool (RoB 2.0) to assess the risk of bias. The following parameters of immunogenicity were estimated: (i) the pooled geometric mean ratio (GMR PCV20/PCV13) of serotype-specific pneumococcal anticapsular antibodies, (ii) the pooled difference (PCV20-PCV13) in the percentage (DP) of participants who achieved predefined antibody levels for each serotype, and (iii) the pooled geometric mean titres (GMTs) of serotype-specific opsonophagocytic activity (OPA) in PCV20 and PCV13, along with their 95% confidence intervals (95% CIs). Results: Four studies (4093 infants aged 42–180 days) that compared the PCV20 and PCV13 vaccines, published between 2021 and 2024, were included in this meta-analysis. The immunogenicity of both groups was compared one month after the primary series and one month after the booster dose. The pooled results indicated that PCV20 elicited lower immune responses for the 13 serotypes shared with PCV13, according to the GMR and OPA outcomes. For the DP outcome, no statistically significant differences were observed between the two groups. Immune responses were higher for the additional serotypes in the PCV20 group; however, these differences were not statistically significant for all serotypes. Conclusions: This meta-analysis offers an overview of the evidence on the comparative immunogenicity of PCV20 and PCV13. Although some outcomes indicate that PCV20 elicits lower immune responses for the 13 serotypes shared with PCV13, it provides immunity against seven additional serotypes associated with IPD. Further studies are warranted to strengthen the evidence base, and continuous IPD surveillance remains essential to monitor shifts in serotype prevalence, assess the impact of current and future vaccines, and guide vaccine policy recommendations.

Background: Artificial intelligence (AI) has the potential to transform primary care by reducing the considerable bureaucratic burden. However, clinicians and patients share concerns regarding data privacy, security, and potential biases in AI algorithms. Objective: This study aimed to provide an in-depth understanding of primary care professionals’ and patients’ perceptions of, barriers to, and facilitators of the use of AI in primary care. Methods: We conducted a systematic review of qualitative studies using MEDLINE (via PubMed), Web of Science, and Scopus databases from inception to June 9, 2024. We used the Sample, Phenomenon of Interest, Design, Evaluation, and Research Type (SPIDER) tool to design the systematic search strategy for qualitative studies. Eligible studies included qualitative analyses—based on interviews, focus groups, or similar methods—of perceptions of, barriers to, and facilitators of the use of AI in primary care, involving primary care professionals or patients. Exclusion criteria included studies on clinical decision support systems, reviews, commentaries, editorials, conference abstracts, and non-English or non-Spanish publications. Methodological quality was assessed using the Joanna Briggs Institute checklist. A thematic synthesis approach was used to structure the results, and the Grading of Recommendations Assessment, Development, and Evaluation–Confidence in the Evidence From Reviews of Qualitative Research (GRADE-CERQual) tool was used to assess the confidence in each finding. Results: We analyzed 316 participants, including primary care physicians, patients, and other health care professionals, from 13 studies across 6 countries selected from 942 screened records. We identified four analytical themes using thematic synthesis: (1) change in the physician-patient relationship, highlighting concerns about loss of empathy, connection, and trust; (2) AI as a partner for efficient time and information management, including its potential to improve workflow and decision-making, alongside skepticism about increased workload; (3) data as the cornerstone of AI development, reflecting concerns about data privacy, quality, bias, and corporate responsibility; and (4) barriers to and facilitators of AI in primary care, emphasizing equity, accessibility, and stakeholder co-design. The GRADE-CERQual assessment provided high confidence in all themes except theme 4, which was rated as moderate confidence. Conclusions: This meta-synthesis includes the perspectives of primary care physicians and patients, but further research is needed on the perspectives of other professionals. Moreover, there was heterogeneity in methods and sampling strategies. This first systematic review synthesizing qualitative evidence on AI perceptions in primary care provides a comprehensive understanding of related barriers and facilitators. The key themes identified suggest that AI may help address workload, decision-making, and data management, improving health care efficiency while ensuring ethical, patient-centered care. Trial Registration: PROSPERO CRD42024560048; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024560048

BACKGROUND Artificial intelligence (AI) has the potential to transform primary care by reducing the considerable bureaucratic burden. However, clinicians and patients share concerns regarding data privacy, security, and potential biases in AI algorithms. OBJECTIVE This study aimed to provide an in-depth understanding of primary care professionals’ and patients’ perceptions of, barriers to, and facilitators of the use of AI in primary care. METHODS We conducted a systematic review of qualitative studies using MEDLINE (via PubMed), Web of Science, and Scopus databases from inception to June 9, 2024. We used the Sample, Phenomenon of Interest, Design, Evaluation, and Research Type (SPIDER) tool to design the systematic search strategy for qualitative studies. Eligible studies included qualitative analyses—based on interviews, focus groups, or similar methods—of perceptions of, barriers to, and facilitators of the use of AI in primary care, involving primary care professionals or patients. Exclusion criteria included studies on clinical decision support systems, reviews, commentaries, editorials, conference abstracts, and non-English or non-Spanish publications. Methodological quality was assessed using the Joanna Briggs Institute checklist. A thematic synthesis approach was used to structure the results, and the Grading of Recommendations Assessment, Development, and Evaluation–Confidence in the Evidence From Reviews of Qualitative Research (GRADE-CERQual) tool was used to assess the confidence in each finding. RESULTS We analyzed 316 participants, including primary care physicians, patients, and other health care professionals, from 13 studies across 6 countries selected from 942 screened records. We identified four analytical themes using thematic synthesis: (1) change in the physician-patient relationship, highlighting concerns about loss of empathy, connection, and trust; (2) AI as a partner for efficient time and information management, including its potential to improve workflow and decision-making, alongside skepticism about increased workload; (3) data as the cornerstone of AI development, reflecting concerns about data privacy, quality, bias, and corporate responsibility; and (4) barriers to and facilitators of AI in primary care, emphasizing equity, accessibility, and stakeholder co-design. The GRADE-CERQual assessment provided high confidence in all themes except theme 4, which was rated as moderate confidence. CONCLUSIONS This meta-synthesis includes the perspectives of primary care physicians and patients, but further research is needed on the perspectives of other professionals. Moreover, there was heterogeneity in methods and sampling strategies. This first systematic review synthesizing qualitative evidence on AI perceptions in primary care provides a comprehensive understanding of related barriers and facilitators. The key themes identified suggest that AI may help address workload, decision-making, and data management, improving health care efficiency while ensuring ethical, patient-centered care. CLINICALTRIAL PROSPERO CRD42024560048; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024560048

Hepatitis B virus (HBV) vaccination has been available for over four decades. However, a synthesis of the evidence regarding the effectiveness of this strategy on preventing hepatitis B infection in people who use drugs (PWUD) is lacking. A systematic search of the MEDLINE (via PubMed), SCOPUS, Web of Science, and Cochrane Library databases was conducted up to June 2024. Eight studies reported on the effectiveness of HBV vaccination, defined as a positive result for HBsAg or anti-Hbc in vaccinated versus non-vaccinated PWUD, with a pooled effect size of 52% (95% CI: 28.2–67.9) for HBsAg and 31.89% (95% CI: 14.8–45.5) for anti-Hbc. For sero-immunity, defined as the proportion of vaccinated PWUD with levels of anti-HBs ≥ 10 mIU/mL, we found that 66.2% (95% CI: 0.61–0.71; I2 = 94%) had protective levels of anti-HBs. The results of this meta-analysis indicate that the incidence of HBV infection is lower in vaccinated PWUD than in those who did not receive the vaccine. However, the effectiveness is lower than that observed in the general population. This highlights the need for a thorough review of the factors influencing the prevention of HBV infection in PWUD.

Healthcare-associated infections (HAIs) are a public health problem. Many of the HAIs are preventable by following the 5 Moments for HH from WHO. We compared the degree of compliance of HH(DCHH) and the consumption of alcohol-based solutions (ABS) in our hospital in the years 2017-2019...