In 2016, the Colombian Government and the guerrilla group Fuerzas Armadas Revolucionarias de Colombia -Ejército del Pueblo (FARC-EP) signed a peace agreement ending decades of hostilities between the two groups.As part of the agreement, the Comisión para el Esclarecimiento de la Verdad, la Convivencia y la No Repetición (CEV; hereafter the Truth Commission) was created, a temporary institution charged with investigating what happened during the armed conflict, clarifying violations of international humanitarian law, and explaining the conflict in all its complexity to Colombian society.As part of the truth and reconciliation process, the Truth Commission collaborated with the Jurisdicción Especial para la Paz (JEP), a temporary judicial body, and the Human Rights Data Analysis Group (HRDAG) to produce official statistics about the magnitudes and patterns of five human rights violations-forced displacement, enforced disappearance, homicide, kidnapping, and forced recruitment of minors (Amado et al., 2022).These analyses made use of over 100 databases compiled by over 40 organizations, including governmental institutions, civil society organizations, and victims' collectives.

Aim:This survey was conducted to determine the type and frequency of antibiotics (AB) use for the prevention of infections in dental third molar (M3) extraction and implantation procedures (DIP) among UK dentists and the opinions underpinning their practice.Methods and design:Systematic reviews of the evidence were undertaken alongside this survey of practicing dentists in the United Kingdom to identify the opinions and practices of those undertaking the procedures.With ethical approval, a survey was designed for online delivery and was sent to every dental practitioner in the UK with a publicly available email address or social media contact. The opening page provided the project information sheet and proceeding to complete and submit the questionnaire was considered consent to participate. The online survey was circulated to 900 identified addresses and a total of 145 responses were received. Responses were collated in Microsoft® Excel™ and analyzed using IBM® SPSS™ plus thematic analysis of free text responses.Results:There were 42% of participants (n=61) who discouraged AB prophylactic use in M3 extractions in people with no systemic conditions and who also preferred postoperative AB use when required. Where, 57.9% of respondents (n=84) supported the short-term use of ABs (5-7 days) for M3 extraction and 53% (n=77) in DIP placement in patients with no relevant medical history. As an ad hoc finding, dentists reported on the negative impact of heavy smoking and oral parafunctional behavior on DIP success.Conclusion:The use of antibiotics and broad spectrum antibiotics remains higher than current guidelines would recommend. Further research is required to clarify the specific risks arising from underlying medical conditions to further clarify where prophylaxis is required.

Background: A limited number of studies have explored patients’ experience with home parenteral (injectable) therapy (HPT) in the UK. Aim: To explore the immediate-, short-, and long-term experience of patients with self-management of any home parenteral therapy with the intention for developing a guideline for service development in the United Kingdom. Methods and design: An interview-based study of patients receiving HPT. Invitations were posted to all patients on the hospital HPT register. The sessions were conducted by telephone for all consenting patients. The interviews were recorded, transcribed, and analysed thematically. Participants completed the ‘Health Education Impact Questionnaire’ (heiQ) before and after the education session. Results: Of the 640 patients invited to participate in the study, 45 (7%) patients completed the interviews and the education session. An interview analysis revealed that the patients’ experiences of HPT were generally positive, but the levels of training and support received showed wide individual variations. The patients had experienced periods of doubt and uncertainty, where they would have appreciated quick access to professional advice to alleviate their concerns. There was a reliable positive change (10.5–18.4%) from before and after the education sessions in six out of the eight domains on the heiQ questionnaire (health-directed behaviour, self-monitoring and insight, constructive attitudes and approaches, skill and technique acquisition, social integration and support, and emotional distress) and moderate change in two domains (5.3% in positive and negative engagement in life, and 2.6% in health services navigation). Conclusion: Self-administered parenteral therapy at home is a valuable option, but training and preparation standards should be optimised across hospitals and the wider NHS.

Abstract Background/Aims To assess the incidence and vulnerability of rheumatology patients to COVID-19 infection in early stages of pandemic. Methods Self completed questionnaire was posted to patients. Results Patients diagnosed with rheumatic diseases were categorised as people at high risk of infection with COVID-19 (pharmacologically immunosuppressed) and with possible worsening outcomes than the general population. This study was a self-completed questionnaire which was sent to all patients registered under a National Health Services specialist rheumatology department in the UK, between May 2020 and May 2021. A total of 610 responses were received and data was analysed statistically. The aim from this survey was to assess COVID19 infection prevalence amongst rheumatology patients under the care of this department, and to examine the profiles of patients with reported COVID-19 infection, their comorbidities, rheumatoid-related medications and infection severity and outcome. Of 610 responders diagnosed with rheumatoid diseases, 12 patients (1.96%) received a diagnosis of COVID-19 based on their clinical presentation. However, when patients undertaken a Polymerase Chain Reaction test, only 2 patients (16.6%) returned positive results. In both the COVID-19 and non-COVID groups 60% were shielding (n = 361). In our sample infection rate was around 30 times (1 in 50 rheumatoid patients, 2% in the sample population) the prevailing rate for the general population in the region (75 in 100,000, 0.075% in the general population). Negative testing did not preclude the presence of disease, but this may reflect poor efficacy and reliability of testing in the early days of the pandemic. The sample means and SD+/- were 63.96/13.23 for age and 27.76/5.79 for BMI. Sample population characteristics presented in Table 1. Conclusion This patient group were more vulnerable to COVID-19 infection compared to the general population but appear not to be at greater risk of severe disease. Disclosure A. El Rashid: None. R. Patil: None. L. Burgress: None. P. Ball: None. H. Morrissey: None. A. Askari: None.

Background and Objectives: Anecdotal evidence suggested variation in practices for antibiotic prescribing around dental procedures including route of administration of antibiotics, timing of the course prescribed (before, after or both), length of course prescribed, narrow vs. broad spectrum agents prescribed, use of single or combination of antibiotics, and the use of loading doses. This review aims to investigate this disparity of practices and the absence of global and local recent consensus on the most appropriate antibiotic interventions around invasive dental procedures. Material and methods: Following PRISMA-P© methodology, a systematic review of randomised controlled clinical trials was designed, reviewed, and entered on the PROSPERO© website prior to commencement. Ethics approval was gained from the University of Wolverhampton Committee. Searches were performed using PubMed©, Science Direct™, and the Cochrane Database, plus the bibliographies of studies identified. They investigated studies examining the efficacy and safety of any antibiotic regimen tested, independent of regimen used, versus a placebo, control, or no therapy, on outcomes in post third molar extraction. Results: The primary outcome of interest was postoperative infection and secondary outcomes were other post-surgical related complications of infectious nature and antibiotic adverse events. Sixteen RCTs were identified that met the selection criteria. Antibiotic use was reported to be safe, causing few adverse events. Meta-analysis of infection events showed antibiotics reduced the risk of an infection by 69%, but routine use for prophylaxis in uncomplicated procedures was not supported, and their role in patients with comorbidities or impaired immunity remains controversial. The effect on the incidence of dry socket showed no difference based upon regimen used. No significant benefit was found with respect to reduction of intraoral inflammation, wound dehiscence, haematoma, and lymphadenopathy. Conclusion: The effect on postoperative pain reduction was inconclusive. Routine use of antibiotics around M3 extraction procedures is not supported, but their use in the presence of co-morbidities and or immunosuppression remains controversial to be confirmed by future studies.

Background and Objectives: This project was developed from anecdotal evidence of varied practices around antibiotic prescribing in dental procedures. The aim of the study was to ascertain if there is evidence to support whether antibiotic (AB) use can effectively reduce postoperative infections after dental implant placements (DIPs). Materials and Methods: Following PRISMA-P© methodology, a systematic review of randomised controlled clinical trials was designed and registered on the PROSPERO© database. Searches were performed using PubMed®, Science Direct® and the Cochrane© Database, plus the bibliographies of studies identified. The efficacy of prophylactic antibiotics, independent of the regimen used, versus a placebo, control or no therapy based on implant failure due to infection was the primary measured outcome. Secondary outcomes were other post-surgical complications due to infection and AB adverse events. Results: Twelve RCTs were identified and analysed. Antibiotic use was reported to be statistically significant in preventing infection (p < 001). The prevention of complications was not statistically significant (p = 0.96), and the NNT was >5 (14 and 2523 respectively), which indicates that the intervention was not sufficiently effective to justify its use. The occurrence of side effects was not statistically significant (p = 0.63). NNH was 528 indicating that possible harm caused by the use of ABs is very small and does not negate the AB use when indicated. Conclusion: The routine use of prophylactic antibiotics to prevent infection in dental implant placement was found to be not sufficiently effective to justify routine use. Clear clinical assessment pathways, such as those used for medical conditions, based on the patients’ age, dental risk factors, such as oral health and bone health, physical risk factors, such as chronic or long-term conditions and modifiable health determinants, such as smoking, are required to prevent the unnecessary use of antibiotics.

Background: There is growing evidence to suggest a significant role for the adaptive immune system in disease progression and relapse. Therapies targeted the inflammatory responses of epidermal and immune system cells have been demonstrated effect in the treatment of vitiligo. However, more comparative studies are needed to inform the treatment decision making process. Purpose: To discuss the new target therapies modalities which are currently being trialled or recently licenced for the treatment of vitiligo. Method: A semi structured, rapid systematic review of the literature, where the findings from 11 studies was narratively discussed. Findings: The reviewed medications (ruxolitinib, baritininb, tofacitinib, ritlecitinib, afamelanotide, crisaborole and apremilast) all showed reduction in the percentage of depigmented body surface area and were well tolerated. However, no head-to-head studies were identified to compare the medications to each other or to other treatment modalities used in the treatment of vitiligo, to determine superiority.

Background/Aims To assess the incidence and vulnerability of rheumatology patients to COVID-19 infection in early stages of pandemic. Methods Self completed questionnaire was posted to patients. Results Patients diagnosed with rheumatic diseases were categorised as people at high risk of infection with COVID-19 (pharmacologically immunosuppressed) and with possible worsening outcomes than the general population. This study was a self-completed questionnaire which was sent to all patients registered under a National Health Services specialist rheumatology department in the UK, between May 2020 and May 2021. A total of 610 responses were received and data was analysed statistically. The aim from this survey was to assess COVID19 infection prevalence amongst rheumatology patients under the care of this department, and to examine the profiles of patients with reported COVID-19 infection, their comorbidities, rheumatoid-related medications and infection severity and outcome. Of 610 responders diagnosed with rheumatoid diseases, 12 patients (1.96%) received a diagnosis of COVID-19 based on their clinical presentation. However, when patients undertaken a Polymerase Chain Reaction test, only 2 patients (16.6%) returned positive results. In both the COVID-19 and non-COVID groups 60% were shielding (n = 361). In our sample infection rate was around 30 times (1 in 50 rheumatoid patients, 2% in the sample population) the prevailing rate for the general population in the region (75 in 100,000, 0.075% in the general population). Negative testing did not preclude the presence of disease, but this may reflect poor efficacy and reliability of testing in the early days of the pandemic. The sample means and SD+/- were 63.96/13.23 for age and 27.76/5.79 for BMI. Sample population characteristics presented in Table 1. Conclusion This patient group were more vulnerable to COVID-19 infection compared to the general population but appear not to be at greater risk of severe disease. Disclosure A. El Rashid: None. R. Patil: None. L. Burgress: None. P. Ball: None. H. Morrissey: None. A. Askari: None.

This study aims to explore healthcare professional (HCP) training on medication safety, medication error prevention, and reporting.A presentation was developed on the topic including medication use and management (MU&M) best practices and case studies.A joint HCP training session was held in the Kuwaiti MoH to deliver the training to the HCPs from all the hospitals.A SurveyMonkey™ link was then shared with the participants to collect training evaluation data for analyses that would target required improvements in training.In Cohort 1, the first training included 450 attendees, 44% males (n=200) and 56% (n=250) females.There were 22% (n=100) contracted overseas HCPs and the remainder (78%, n=350) were Kuwaiti nationals.While in Cohort 2, the second training also included 450 attendees, 54% males (n=247) and 46% (n=203) females.There were 25% (n=114) contracted overseas HCPs and the remainder (75%, n=336) were Kuwaiti nationals.The largest participants cohort was from Al Sabah Hospital (20%, n=90) in Cohort 1 and was from Al Sabah Hospital (24%, n=110) in Cohort 2. Most HCPs agreed on the importance of the training learning outcomes with an average of 71% agreeing in Cohort 1, whereas 37% agreed in Cohort 2. Overall, most HCPs agreed interactive sessions are more desirable.The most used words were prevention of medication errors through medication management, and case studies as the preferred learning medium.The researcher was able to assess their training delivery methods and enhance the content by using the training program and the feedback from the HCPs.

Out-of-hospital self-care in patients receiving injectable antibiotics or biologically derived medicines (biologics) is reported to significantly improve quality of life and reduce hospitalizations, but unexpected complications produce some negative outcomes and patient experience. This study aimed to compare patients' experience with long-term injectable therapies, in and out of the hospital setting. Two systematic reviews and meta-analyses were carried out using the most common out-of-hospital self-administered long-term injectable antibiotic and biologic therapies for patients diagnosed with infections or IBD, RA, or psoriasis. The first review investigated patient preference for self-administering subcutaneous injections at home (intervention) vs. intravenous injections in a hospital inpatient or outpatient setting. There was a statistically significant difference between the homecare (intervention) and hospital (control) group (p = 0.05) favoring the intervention. The second review was on injectable antibiotics. The results demonstrated that the use of injectable antibiotics, at home (intervention) or in hospital (control) produced similar benefits (p = 0.30 cure and p = 0.90 treatment failure) and harm (hospital admission after and during treatment p = 0.64, p = 0.99 respectively, disease complications p = 0.77 and medications side effects p = 0.15). This research found no substantial differences in patient outcomes based on the setting. Home care is an important option to support patient autonomy and well-being. The recent global COVID-19 pandemic further highlighted the importance of an option to continue long-term disease management without hospitalization.

The National Health Service has recognized an increasing need for pharmacists to upskill as an advanced clinical practitioners to practice as part of the wider multi-disciplinary team in primary care but outside of the community pharmacy. This explored community pharmacists’ opinions on independent prescribing training that can equip them to meet the workforce needs. Two activities have undertaken an audit of the independent prescribing pharmacists’ current employability in Wolverham

Objectives: To determine the seroprevalence of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) antibody status amongst healthcare workers (HCWs) working through the first wave of the Coronavirus (COVID-19) pandemic in 2020. To examine the association of seroprevalence and self-reported COVID-19 symptoms with occupation, sex, and ethnicity; and how these factors were associated with physical and mental wellbeing. Design: Single-centre cohort study.Setting: Large public hospital in the United Kingdom.Intervention: All HCWs who had been tested for anti-SARS-CoV-2 immunoglobulin (Ig) G nucleocapsid antibody in summer 2020 were asked to complete an electronic survey focusing on their physical and mental health in Winter 2020-21. This survey was comprised of the Short Form 12v2, Physical Component Summary (PCS), Mental Component Summary (MCS), and Generalised Anxiety Disorder 7-item (GAD-7) questionnaires.Results: 7604/9781 (77.7%) HCWs were antibody tested, of which 1082 completed the full survey. Antibody testing was conducted between 17/06/20-30/07/20, during which time our seroprevalence rate was 28% (299/ 1082). Of those self-reporting COVID-19 symptoms, 51% (201/395) were antibody positive. Antibody-positive participants had lower PCS scores (p = 0.016), indicating poorer physical health. Lower PCS scores were also found in those deemed high risk for COVID-19 by their GP (p = 0.001), and those aged >44 years (p = 0.009). Antibody-negative participants had lower MCS scores (p = 0.044), indicating poorer mental health. Those who self-reported COVID-19 symptoms had lower PCS scores (p=<0.001) than those with no symptoms. Lower MCS scores were found in women (p = 0.001), Caucasians (p = 0.018), non-clinicians (p = 0.001), and those aged <44 years (p = 0.009). Significantly higher GAD-7 anxiety scores were evident in staff aged <44 years (p = 0.023), and those with self-reported COVID symptoms (p = 0.031). Doctors had lower GAD-7 anxiety scores (p = 0.009). Conclusion: Self-reported symptoms did not correlate with seroprevalence; data surrounding this can be useful for future workforce planning. Interventions are needed to reduce the mental and physical burden of the pandemic on HCWs. Further work is needed to identify which particular HCWs may require further support, to ensure well-being and effective patient care.

Zinc is a trace nutrient essential for the normal growth and development of human body. The main aim was to evaluate the significant association between measured zinc status in relation to different skin disorders and their severity. PubMed®, Google® Scholar™ and Cochrane© Reviews databases were searched for studies from January 2017 to June 2021, using the terms; zinc serum levels, zinc plasma levels and different dermatosis in the review, only human studies in English language were reviewed and the studies designs were controlled, cross sectional, observational and analytic types. A total of forty-eight research studies were included in this review. All studies have evaluated serum zinc in skin diseases including psoriasis, atopic dermatitis, pityriasis alba, androgenetic alopecia areata, telogen effluvium, vitiligo, melasma, acne, seborrheic dermatitis and hidradenitis suppuritiva. It was found that 33 studies had validated statistically significant differences in serum zinc levels between patients and controls. There is a predominance of low serum zinc levels in all the dermatoses reviewed. The clinical significance of this finding highlights the possible value, and need to investigate, the use of Zinc supplementation as an adjuvant therapy in the management of chronic inflammatory and autoimmune skin diseases proven to manifest altered zinc levels.

Fibromyalgia is a chronic health condition characterized by chronic pain fatigue, sleep disturbances and many other symptoms affecting a patient’s quality of life. Patients with fibromyalgia often visit rheumatology outpatients with a long list of symptoms and often receive multiple medications. Many have seen multiple specialists and have done a lot of reading about alternative modalities of treatment. The limited effectiveness of conventional therapy coupled with widespread media attention raises the question of cannabis use. This review examines the literature on cannabinoid use in fibromyalgia against the context of the international variation in legal frameworks, the available products and the outcomes reported. A detailed review was performed using the EMBASE and PUBMED databases. It was concluded that despite the interest in the use of cannabinoids in the management of fibromyalgia, there is insufficient evidence to prescribe the currently available licensed medicines or to recommend the complementary health products available for legal purchase. There is a need for more global clinical randomised trials to accurately determine medicinal cannabis short and long-term long efficacy and safety for its acute and chronic use.

Reviewed by: The Creation of the French Royal Mistress: From Agnès Sorel to Madame Du Barry by Tracy Adams and Christine Adams Patrick Ball Adams, Tracy, and Christine Adams, The Creation of the French Royal Mistress: From Agnès Sorel to Madame Du Barry, Philadelphia, Pennsylvania State University Press, 2020; hardback; pp. xii, 236; R.R.P. US$89.95; ISBN 9780271085975. Notwithstanding its somewhat unpromising opening words—'Semiformalized extraconjugal relationships' (p. ix)—this work is written in a highly readable style, rendering it accessible, as well as of potential interest, to non-scholarly individuals, not only academics. That said, its aims are squarely academic. France's 'official' royal mistresses have received attention to date mostly from popular historians, whose aim has been titillation, not serious scrutiny. Tracy Adams and Christine Adams set out, by examining nine of the most prominent, to determine how the phenomenon of the French royal mistress came about. As they stress, though rulers' concubines were nothing new, in France they developed into something unique: not just the king's lover, they had a recognized position at court, and might be influential political advisors. How did this happen? The analytical framework adopted is that of Fernand Braudel's time cycles. While this approach has explanatory power regarding the mistresses themselves, it stresses the connections their history has with things evolving concurrently. The authors argue that the French royal mistress took on her peculiar character when longstanding medieval attitudes to women (that they were as capable as [End Page 145] men, though legally inferior) aligned with the fifteenth-century rise of male royal favourites, who had no claim to power through birth but wielded influence via the king's favour, plus the growing theatricalization of the court in the sixteenth century. With these key criteria satisfied, the stage was set for female favourites who, without formal status, were nonetheless thought competent to offer the monarch advice. To come into being, the role still awaited the right woman and the right king. As can be seen, this book inserts itself into existing scholarship on a range of topics. While the nature of the subject would always have made it relevant to fields such as court history, women's history, and so on, the approach highlights such interconnections. Having foreshadowed their line of attack in a valuable introduction, the authors' development of the role of mistress is then pursued by means of a series of chapters devoted to individuals, beginning with Agnès Sorel, who, they contend, pre-dated the coalescence of factors that brought into being the 'official' royal mistress. The lives and fates of the individuals treated in these chapters, Sorel not least, present their own interest. However, the broader argument commences in the sixteenth century, when court behaviour became more artificial and theatrical in the wake of Castiglione's Book of the Courtier. The authors trace the 'official' mistress's history, from its inception with Anne de Pisseleu d'Heilly and Diane de Poitiers, mistresses of François I and Henri II, through the ill-fated Gabrielle d'Estrées (Henri IV), then the mistresses of Louis XIV and Louis XV, to the Revolution. Essential to the position of mistress, the authors argue—and this will be the volume's main contribution to scholarly debate—was the fact she represented an 'open secret', whereby everybody knew of her presence, and drew on her patronage or influence as needed, but nobody formally acknowledged she existed. That could happen because of the dissimulation now characteristic of the court; it meant that alongside the foreign-born queens, whose loyalties were always suspect, might live another woman, capable of giving the king political advice since her primary devotion was always to him and to France. The mistress therefore became the centre of cultural and political activity at court, with the queen the centre of virtue and propriety. This open secret, however, depended on the mistress having some pre-existing reason for attendance at court: she might herself be an aristocrat or belong to a family of royal officials. Nobody then needed to explain why she was there. Part of the authors' case is that if this 'open secret' came...

A 50-year-old woman with a history of systemic lupus erythematosus and a recent infection with COVID-19 presented to the emergency department with acute shortness of breath twice in 10 days. She was diagnosed with myopericarditis attributed to COVID-19 infection (first admission), and chest X-ray revealed a small left-sided pneumothorax, pericardial effusion (second admission), with no mediastinal shift or other signs of tension. Computed tomography confirmed these results and revealed a few small cysts in the right lung. An echocardiogram demonstrated normal heart anatomy and filling dynamics. The patient was diagnosed with simple pneumothorax and ongoing myopericarditis managed with colchicine, ibuprofen, and low-dose prednisolone. The patient responded to treatment and was discharged. Pneumothorax association with COVID-19 is reported in a small number of publications, but the association is less clear with SLE. Our patient may have been predisposed to developing pneumothorax after COVID-19 infection due to her existing connective tissue disorder.

The signal transducer and activator of transcription (STAT) families and Janus kinase group (JAK) are important intracellular signalling components that affect more than 50 cytokines and growth elements.JAK inhibitors target distinct receptor-associated kinases, inhibiting the activation of inflammatory signals.With the expanding body of evidence supporting the use of targeted medicines, numerous JAK inhibitors, both topical and systemic, have been tested in the treatment of atopic dermatitis, with varying mechanisms of action, effectiveness, and safety.The efficacy and safety of JAK inhibitors used to treat inflammatory and atopic skin diseases are examined in this review study.Their application in the mentioned fields has been characterized by some excellent clinical responses, but wide variability in responses and some serious and even life-threatening side effects.While JAK inhibitors are now beneficial to many patients, further study is needed to better understand this complicated mechanism to improve treatment outcomes and minimize side effects.

The need for filtering intravenous infusions has long been recognized in the field of venous access, though hard scientific evidence about the actual indications for in-line filters has been scarce. In the last few years, several papers and a few clinical studies have raised again this issue, suggesting that the time has come for a proper definition of the type of filtration, of its potential benefit, and of its proper indications in clinical practice. The WoCoVA Foundation, whose goal is to increase the global awareness on the risk of intravenous access and on patients' safety, developed the project of a consensus on intravenous filtration. A panel of experts in different aspects of intravenous infusion was chosen to express the current state of knowledge about filtration and to indicate the direction of future research in this field. The present document reports the final conclusions of the panel.