The evidence of an association between Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) and chronic herpesviruses infections remains inconclusive. Two reasons for the lack of consistent evidence are the large heterogeneity of the patients' population with different disease triggers and the use of arbitrary cutoffs for defining seropositivity. In this work we re-analyzed previously published serological data related to 7 herpesvirus antigens. Patients with ME/CFS were subdivided into four subgroups related to the disease triggers: S0-42 patients who did not know their disease trigger; S1-43 patients who reported a non-infection trigger; S2-93 patients who reported an infection trigger, but that infection was not confirmed by a lab test; and S3-48 patients who reported an infection trigger and that infection was confirmed by a lab test. In accordance with a sensitivity analysis, the data were compared to those from 99 healthy controls allowing the seropositivity cutoffs to vary within a wide range of possible values. We found a negative association between S1 and seropositivity to Epstein-Barr virus (VCA and EBNA1 antigens) and Varicella-Zoster virus using specific seropositivity cutoff. However, this association was not significant when controlling for multiple testing. We also found that S3 had a lower seroprevalence to the human cytomegalovirus when compared to healthy controls for all cutoffs used for seropositivity and after adjusting for multiple testing using the Benjamini-Hochberg procedure. However, this association did not reach statistical significance when using Benjamini-Yekutieli procedure. In summary, herpesviruses serology could distinguish subgroups of ME/CFS patients according to their disease trigger, but this finding could be eventually affected by the problem of multiple testing.

Background Onychomycosis (OM) and traumatic onychodystrophy (OD) are common causes of toenail changes.A clinical diagnosis is often impossible without mycology. Dermoscopy is helpful in this setting but yet underexplored. Prospective comparative studies between OM and OD onychoscopic findings have not been previously performed.Objectives We sought to determine distinguishing dermoscopic presentations of OM and traumatic OD. MethodsWe performed a prospective, observational study including patients presenting with ≥1 toenail onychodystrophy. All underwent onychoscopy, clinical and mycological examination. Based on these results, patients received a final diagnosis of OM or OD. Dermoscopic presentations of OM and OD patients were classified in patterns and compared.Results In all, 110 cases of OM and 82 of traumatic OD were compared. Statistical analyses revealed that the distal pulverized and the irregular spiked macular dermoscopic patterns were predictors of an OM diagnosis. The regular macular, the non-classifiable, the total and partial homogeneous background dermoscopic patterns correlated with traumatic OD diagnosis. ConclusionsWe demonstrated that OM and traumatic OD have distinctive onychoscopic presentations. Dermoscopy may be an important ancillary tool to guide their differential.

Purpose: To assess the spiritual well-being (SWB) of cancer patients undergoing chemotherapy in an outpatient setting. Method: Quantitative, cross-sectional, and descriptive study. A convenience sample of 150 participants was obtained. Data collection instrument was a self-reported questionnaire that included the SWB Questionnaire (SWBQ), whose scores range from 20 to 100. SPSS software, version 21, was used in data analysis. The study was approved by the institutional ethics committee. Results: Patients’ ages ranged between 35 and 83 years; most were female (64.7%), married (68.0%), Catholic (86.7%), and with breast cancer (35.3%) and colorectal cancer (25.3%). The average SWBQ total score was 65.91 ( SD = 12.177). The highest score of the SWBQ was obtained in females, widows and singles, Evangelic and Catholic, and with lower educational level and professional occupation. The Cronbach α was 0.89, and the subscales αs ranged between 0.78 and 0.94. Conclusion: The SWBQ scores were reasonable. These results can guide nurses’ clinical reasoning, as the assessment of SWB may precede the diagnosis of risk for spiritual distress, readiness for enhanced SWB, or spiritual distress. Thus, the use of this instrument may facilitate spirituality being effectively implemented in clinical practice, favoring holistic health care.

Background/AimsThe role of very early (≤12 hours) endoscopy in nonvariceal upper gastrointestinal bleeding is controversial. We aimed to compare results of very early and early (12–24 hours) endoscopy in patients with upper gastrointestinal bleeding demonstrating low-risk versus high-risk features and nonvariceal versus variceal bleeding. MethodsThis retrospective study included patients with nonvariceal and variceal upper gastrointestinal bleeding. The primary outcome was a composite of inpatient death, rebleeding, or need for surgery or intensive care unit admission. Endoscopy timing was defined as very early and early. We performed the analysis in two subgroups: (1) high-risk vs. low-risk patients and (2) variceal vs. nonvariceal bleeding.ResultsA total of 102 patients were included, of whom 59.8% underwent urgent endoscopy. Patients who underwent very early endoscopy received endoscopic therapy more frequently (p=0.001), but there was no improvement in other clinical outcomes. Furthermore, patients at low risk and with nonvariceal bleeding who underwent very early endoscopy had a higher risk of the composite outcome. ConclusionsVery early endoscopy does not seem to be associated with improved clinical outcomes and may lead to poorer outcomes in specific populations with upper gastrointestinal bleeding. The actual benefit of very early endoscopy remains controversial and should be further clarified.

Finite mixture models have been widely used in antibody (or serological) data analysis in order to help classifying individuals into either antibody-positive or antibody-negative. The most popular models are the so-called Gaussian mixture models which assume a Normal distribution for each component of a mixture. In this work, we propose the use of finite mixture models based on a flexible class of scale mixtures of Skew-Normal distributions for serological data analysis. These distributions are sufficiently flexible to describe right and left asymmetry often observed in the distributions associated with hypothetical antibody-negative and antibody-positive individuals, respectively. We illustrate the advantage of these alternative mixture models with a data set of 406 individuals in which antibodies against six different human herpesviruses were measured in the context of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.