lysis showed that patients with high nutritional risk had a higher probability of death at ICU 28-day than those with low nutritional risk (adjusted HR = 2.01, 95% CI 1.22-3.32, P = 0.006). Conclusions A large proportion of critically ill COVID-19 patients had a high nutritional risk, as revealed by their mNUTRIC score. Patients with high nutritional risk at ICU admission exhibited significantly higher mortality of ICU 28-day, as well as twice the probability of death at ICU 28-day than those with low nutritional risk. Therefore, the mNUTRIC score may be an appropriate tool for nutritional risk assessment and prognosis prediction for critically ill COVID-19 patients.Adolescents and young adults, aged 13-24 years, are disproportionately affected by HIV in the United States. Youth with HIV (YHIV) face many psychosocial and structural challenges resulting in poor clinical outcomes including lower rates of medication adherence and higher rates of uncontrolled HIV. The Johns Hopkins Intensive Primary Care clinic, a longstanding HIV care program in Baltimore, Maryland, cares for 76 YHIV (aged 13-24 years). The multidisciplinary team provides accessible, evidenced-based, culturally sensitive, coordinated and comprehensive patient and family-centered HIV primary care. However, the ability to provide these intensive, in-person services was abruptly disrupted by the necessary institutional, state, and national coronavirus disease 2019 (COVID-19) mitigation strategies. As most of our YHIV are from marginalized communities (racial/ethnic, sexual, and gender minorities) with existing health and social inequities that impede successful clinical outcomes and increase HIV disparities, there was heightened concern that COVID-19 would exacerbate these inequities and amplify the known HIV disparities. We chronicle the structural and logistic approaches that our team has taken to proactively address the social determinants of health that will be negatively impacted by the COVID-19 pandemic, while supporting YHIV to maintain medication adherence and viral suppression.Purpose This qualitative study explores the contraceptive health-care needs of transgender and nonbinary young adults assigned female sex at birth. Methods Qualitative interviews were conducted with 20 transgender and nonbinary young adults assigned female sex at birth (ages 22-29 years), recruited via online platforms and community agencies. Semistructured interviews elicited information on participants’ gender and reproductive histories, health-care experiences, sexual practices, and contraceptive use and decision-making processes. Interviews were transcribed and coded using thematic analysis. Results Primary thematic domains centered on contraceptive experiences and needs, testosterone as contraception, and experiences with reproductive health care. Participants generally did not use hormonal contraception to prevent pregnancy; in situations where pregnancy was possible, participants relied on condoms. Some participants believed testosterone use would prevent pregnancy and subsequently did not use a contraceptive method. Participants described the lack of knowledge, among themselves and providers, of the impacts of testosterone on pregnancy risk and interactions with hormonal contraception. They described reproductive health-care experiences in which providers were unfamiliar with the needs of transgender and nonbinary patients; made assumptions about bodies, partners, and identities; and lacked adequate knowledge to provide effective contraceptive care. Conclusions Patient-centered reproductive care requires that providers be sensitive to the stress of gender-affirming care and engage with contraceptive counseling that addresses patients’ behavior, risks, and reproductive functions. In particular, providers should understand and communicate the impacts of testosterone therapy on pregnancy risk.Despite upper airways are functionally excluded, we are the first to report the presence of SARS-CoV-2 in the nasopharyngeal swab of a laryngectomized patient;•The primary nasal viral infection is not a mere anatomical constraint but it underlies an immunological priming that can condition the systemic inflammatory response;•Head and neck cancer patients have very often a significant history of smoking exposure and this makes them more susceptible to SARS-CoV-2 as well as to the development of multiple malignancies.Objective To evaluate surgical outcomes and survival after primary robotic or open surgery in obese women with endometrial cancer (EC). Methods The study included obese women (BMI ≥ 30 kg/m2) with EC who underwent primary surgery before and after the introduction of robotics between 2006 and 2014. Data on complications, survival, and recurrence was obtained through the National Cancer Registry and medical files. Survival curves were calculated for overall (OS), relative (RS) and disease-free survival (DFS). Cox proportional hazards regression models to assess OS and DFS. Results In total, 217 patients were identified, 131 robotic and 86 open surgical procedures. Significantly lower estimated blood loss, surgical time and hospital stay were found in the robotic group and the relative risk ratio of complications grades II-V, using the Clavien Dindo classification, was 0.54 (95% CI 0.31-0.93) for the robotic compared to the open group. A significant difference in OS (p = 0.029) and RS (p = 0.024) in favor of robotics was shown in the univariable survival curves, using log rank tests. No difference was seen for DFS. The 5-year RS was 96.2% (95% CI 89.7-103.3) for the robotic and 81.6% (95% CI 72.1-92.3) for the open group. Multivariable analysis showed high risk histology to be an independent risk factor, for both OS (HR 2.90; 95% CI 1.42-5.93; p less then 0.05) and DFS (HR 2.74; 95% CI 1.45-5.17; p less then 0.05). Robotic surgery was not found a significant independent factor for survival. Conclusions Robotic surgery in obese women with EC had equivalent long-term and disease-free survival compared to open with significantly less complications, lower estimated blood loss, shorter surgical time and hospital stay.Objective To determine associations between adoption of Medicaid expansion (ME) and changes in insurance status, early stage diagnosis, and cancer survival among women with endometrial carcinoma (EC). Methods The National Cancer Database (NCDB) was queried for patients diagnosed with EC between the age 40-64 from 2004 to 2015. Difference-in-differences analysis quantified the impact of ME on the proportion of new EC diagnoses with insurance (vs. uninsured), the proportion diagnosed with stage I (vs. II-IV), and overall survival. Results 156,253 patients were included. Among 65,019 women living in ME states, ME is associated with an increase in the percent of EC cases who are insured of 1.4% (95% CI 0.9-2.0%, p less then 0.0001), with strongest effects among Hispanic women, women in the lowest income quartile, and women in the second age quartile (age 53-57). There was no overall impact of ME on stage, though an increase of early stage diagnoses by 2.4% (95% CI 0.3-4.5%, p = 0.022) was observed among women age 53-57. There was a trend towards improved overall survival with ME, which was strongest in women age 53-57 (HR = 0.83, 95% CI 0.70-0.99, p = 0.037). Conclusions Among women with EC, ME positively impacted insurance coverage, an important hurdle in accessing health care. In women aged 53-57, ME was associated with earlier stage at diagnosis and improved survival, suggesting that the magnitude of the improvement in insurance coverage may correlate with important clinical outcomes. Efforts should continue to understand the complexity of barriers to health care access and to develop effective strategies to surmount them.Background The benefit of adding ovarian function suppression (OFS) to tamoxifen in the adjuvant treatment of premenopausal women with breast cancer is uncertain. We conducted a meta-analysis of randomized controlled trials that addressed this question. Methods Systematic search of PubMed, the web of science, and the meeting library of ASCO, ESMO, and SABCS was conducted using the following keywords tamoxifen, ovarian suppression, and breast cancer. Eligible studies were those recruiting patients with breast cancer randomized to receive adjuvant tamoxifen and OFS versus tamoxifen alone. Pooled hazard ratio [HR]) for disease-free (DFS) and overall survival (OS) with 95% confidence interval (CI) were calculated using the fixed effect model. Results We searched a total of 845 records, of which 5 clinical trials, including 7557 patients, were eligible for our analysis. Adding OFS to tamoxifen improved DFS with pooled HR 0.88 (95% CI 0.80-0.96, P= 0.004) and OS (pooled HR 0.87 95% CI 0.77-0.98, P= 0.02) compared to tamoxifen alone. The benefit of the addition of OFS to tamoxifen was mostly observed in patients younger than 40 years where the pooled HRs of DFS was 0.76 (95% CI 0.63-0.91; P= 0.004), and in those who received adjuvant chemotherapy with pooled HRs of DFS 0.80 (95% CI 0.65-0.99, P= 0.042). There was an increase in the incidence of all grade musculoskeletal symptoms and high-grade hot flushes with the addition of OFS with risk ratios of 1.12 (95% CI 1.07-1.17, P less then 0.001) and 2.14 (95% CI 1.01-4.51, P= 0.047) respectively. Conclusion Our analysis indicates that the addition of OFS to tamoxifen improves DFS and OS. This strategy could be considered in patients in which tamoxifen alone is not deemed sufficient or in case of poor tolerance to OFS with aromatase inhibitors.End-stage temporomandibular joint (TMJ) disease is caused by a multitude of pathological processes that impair TMJ anatomy and function. In many cases, end-stage TMJ disease and dentofacial skeletal deformities coexist. The optimal treatment for such conditions is total alloplastic joint replacement and orthognathic surgery. Such procedures have historically been conducted in two separate stages. Furthermore, while technological improvements resulting from the widespread adoption of virtual reality initially led to significant improvements in the field of orthognathic planning, the adoption of virtual design techniques to optimize TMJ reconstruction was a later achievement. Therefore, planning for TMJ replacement and orthognathic surgery did not develop in parallel, leading to various combinations of planning for orthognathic surgery and TMJ replacement with the aim of performing both procedures simultaneously in one stage. Nowadays, improvements in virtual planning and three-dimensional printing have allowed these procedures to be conducted in the same surgical step based on fully digital planning and entirely customized surgery. This paper introduces a fully digital protocol for the treatment of end-stage TMJ disease and associated acquired dentofacial deformities, in which all surgical steps are customized and the whole surgery is performed in succession using automated procedures, thanks to the combined use of virtual surgical planning, surgical guides, custom-designed TMJ prostheses, and patient-fitted osteosynthesis devices.Objective To determine the frequency of avoidable adverse events (AAEs) in Primary Care (PC). Design Retrospective cohort study. Location Family medicine and paediatric clinics in Andalusia, Aragon, Castilla-La Mancha, Catalonia, Madrid, Navarre, and Valencia. Participants A review was performed on a designated sample of 2,397 medical records (95% confidence level and 2% accuracy). The sample was stratified by age group as regards the frequency of physician consultations and considering equal distribution of male and female patients. Main measurements Number and severity of identified AAEs from February 2018 to September 2019. Results A total of 2,557 medical records were reviewed (1,928, 75.4% of adult patients, and 629, 24.6% paediatrics). A total of 182 (7.1%, 95% CI 6.1-8.1%) AAEs that affected 168 patients were identified, which included 7.6% (95% CI 6.4-8.8%) in adults and 5.7% (95% CI 3.9-7.5%) in paediatric patients. The number of AAEs in women was higher than in men (P = 0.006). The incidence of AAEs in boys and girls was similar (P = 0.