Large Language Models and Healthcare Alliance: Potential and Challenges of Two Representative Use Cases.

Large language models (LLMS) emerge as the most promising Natural Language Processing approach for clinical practice acceleration (i.e., diagnosis, prevention and treatment procedures). Similarly, intelligent conversational systems that leverage LLMS have disruptively become the future of therapy in the era of ChatGPT. Accordingly, this research addresses the application of LLMS in healthcare, paying particular attention to two relevant use cases: cognitive decline and depression, more specifically, postpartum depression. In the end, the most promising opportunities they represent (e.g., clinical tasks augmentation, personalized healthcare, etc.) and related concerns (e.g., data privacy and quality, fairness, etc.) are discussed to contribute to the global debate on their integration in the sanitary system.

Evaluation of Clinical Results regarding Peristomal Skin Health Associated with the Adjustment and Formulation of the New Moderma Flex One-Piece Ostomy Devices.

In order to determine the perception of ostomized patients about the performance and safety of the new one-piece device Moderma Flex, as well as the evolution of peristomal skin health after its use. The pre- and post-experimental multicenter study after the use of the Moderma Flex one-piece ostomy device on 306 ostomized people from 68 hospitals in Spain. We used a self-made questionnaire on the usefulness of different parts of the device and the perception of peristomal skin improvement. The sample was composed of 54.6% (167) men and had an average age of 64.5 years (standard deviation = 15.43). The type of device most commonly used according to its opening was closed by 45.1% (138). In addition, for the type of barrier, the most frequently used is the flat one; 47.7% (146) and 38.9% (119) used a model of soft convexity. A total of 48% scored with the highest assessment in the perception of skin improvement. The percentage of patients with peristomal skin problems decreased from 35.9% at the first visit to less than 8% after the use of Moderma Flex. Further, 92.4% (257) had no skin problems, the most frequent being erythema. The use of the Moderma Flex device seems to be related to a reduction in peristomal skin complications and a perception of improvement.

Experiencias de cuidadores frente a un programa integral en salud para niños con cardiopatías congénitas

Las enfermedades congénitas complejas son un grave problema de salud pública que afecta a millones de niños y sus cuidadores en el mundo, razón por la cual es necesario generar programas de apoyo formal para favorecer el seguimiento en casa de estos menores y así, incrementar la adherencia al tratamiento y reducir la mortalidad interestadio. El presente estudio tuvo como objetivo describir la percepción de los cuidadores frente a un programa integral en salud, planeado sobre la educación y el uso extenso de las herramientas de telecomunicación para el seguimiento en casa de niños con cardiopatías congénitas complejas, en el marco del proyecto Promesa de la Fundación Cardiovascular de Colombia, a partir de un enfoque cualitativo de diseño fenomenológico. La muestra seleccionada estuvo compuesta por 12 cuidadores con quienes se realizó entrevista a profundidad y grupo focal. Los datos fueron analizados a través del software para el análisis de estudios cualitativos Atlas.ti, estableciendo las siguientes categorías: Valoración del proyecto y del programa integral, Experiencias con el uso de dispositivos médicos, tecnologías de la información y de la comunicación, Comunicación y relación con profesionales, Apoyo institucional y Redes de cuidadores. Se concluye que implementar las Tic en el tratamiento de cardiopatías congénitas complejas es una estrategia novedosa y aceptada por los cuidadores, que se ajusta a las condiciones del sistema de salud colombiano y a las necesidades de los usuarios.

Congenital heart disease are a serious public health problem that affects millions of children and their caregivers around the world, which is why it is necessary to generate formal support programs to promote follow-up at home for these minors and thus increase adherence to treatment and reduce interstage mortality. The objective of this study was to describe the perception of caregivers regarding a comprehensive health program, planned on education and the extensive use of telecommunication tools for home monitoring of children with complex congenital heart disease, within the framework of the project Promise of the Cardiovascular Foundation of Colombia, based on a qualitative approach of phenomenological design. The selected sample consisted of 12 caregivers with whom an in-depth interview and focus group were conducted. The data was analyzed through the software for the analysis of qualitative studies Atlas.ti, establishing the following categories: Assessment of the project and the comprehensive program, Experiences with the use of medical devices, information and communication technologies, Communication and relationship with professionals, institutional support and networks of caregivers. It is concluded that implementing ICTs in the treatment of complex congenital heart diseases is a novel strategy accepted by caregivers, which is adjusted to the conditions of the Colombian health system and the needs of users.

Mimicking chronic glaucoma over 6 months with a single intracameral injection of dexamethasone/fibronectin-loaded PLGA microspheres.

To create a chronic glaucoma animal model by a single intracameral injection of biodegradable poly lactic-co-glycolic acid (PLGA) microspheres (Ms) co-loaded with dexamethasone and fibronectin (MsDexaFibro). MsDexaFibro were prepared by a water-in-oil-in-water emulsion method including dexamethasone in the organic phase and fibronectin in the inner aqueous phase. To create the chronic glaucoma model, an interventionist and longitudinal animal study was performed using forty-five Long Evans rats (4-week-old). Rats received a single intracameral injection of MsDexafibro suspension (10%w/v) in the right eye. Ophthalmological parameters such as clinical signs, intraocular pressure (IOP), neuro-retinal functionality by electroretinography (ERG), retinal structural analysis by optical coherence tomography (OCT), and histology were evaluated up to six months. According to the results obtained, the model proposed was able to induce IOP increasing in both eyes over the study, higher in the injected eyes up to 6 weeks (p < 0.05), while preserving the ocular surface. OCT quantified progressive neuro-retinal degeneration (mainly in the retinal nerve fiber layer) in both eyes but higher in the injected eye. Ganglion cell functionality decreased in injected eyes, thus smaller amplitudes in PhNR were detected by ERG. In conclusion, a new chronic glaucoma animal model was created by a single injection of MsDexaFibro very similar to open-angle glaucoma occurring in humans. This model would impact in different fields such as ophthalmology, allowing long period of study of this pathology; pharmacology, evaluating the neuroprotective activity of active compounds; and pharmaceutical technology, allowing the correct evaluation of the efficacy of long-term sustained ocular drug delivery systems.

Automatic detection of cognitive impairment in elderly people using an entertainment chatbot with Natural Language Processing capabilities.

Previous researchers have proposed intelligent systems for therapeutic monitoring of cognitive impairments. However, most existing practical approaches for this purpose are based on manual tests. This raises issues such as excessive caretaking effort and the white-coat effect. To avoid these issues, we present an intelligent conversational system for entertaining elderly people with news of their interest that monitors cognitive impairment transparently. Automatic chatbot dialogue stages allow assessing content description skills and detecting cognitive impairment with Machine Learning algorithms. We create these dialogue flows automatically from updated news items using Natural Language Generation techniques. The system also infers the gold standard of the answers to the questions, so it can assess cognitive capabilities automatically by comparing these answers with the user responses. It employs a similarity metric with values in [0, 1], in increasing level of similarity. To evaluate the performance and usability of our approach, we have conducted field tests with a test group of 30 elderly people in the earliest stages of dementia, under the supervision of gerontologists. In the experiments, we have analysed the effect of stress and concentration in these users. Those without cognitive impairment performed up to five times better. In particular, the similarity metric varied between 0.03, for stressed and unfocused participants, and 0.36, for relaxed and focused users. Finally, we developed a Machine Learning algorithm based on textual analysis features for automatic cognitive impairment detection, which attained accuracy, F-measure and recall levels above 80%. We have thus validated the automatic approach to detect cognitive impairment in elderly people based on entertainment content. The results suggest that the solution has strong potential for long-term user-friendly therapeutic monitoring of elderly people.

Representaciones sociales del conflicto armado en Colombia en adolescentes de la provincia de Soto Norte, Santander / Social Representations of the Armed Conflict in Colombia in Adolescents of the Province of Soto Norte, Santander

Resumen Se exponen las representaciones sociales del conflicto armado presentes en los adolescentes de la provincia Soto Norte, Santander, esto desde el enfoque cualitativo. Se identificaron tres categorías, a saber: "Opinión y valoración sobre el Conflicto Armado Interno Colombiano [CAIC]", "Origen de la opinión" y "Antecedentes del CAIC en Soto Norte". Se concluye que, las representaciones sociales se encuentran mediadas por la información que han obtenido acerca del fenómeno armado en distintos contextos, y que dicha información es carente de fundamento; por tanto, se sugiere la generación de espacios psicoeducativos que respondan a la necesidad de construir paz desde las regiones.

Abstract The social representations of the armed conflict present in the adolescents of the Province of Soto Norte, Santander, are exposed, from the qualitative approach. Three categories were identified, namely: "Opinion and assessment of the Colombian Internal Armed Conflict [CAIC]", "Origin of the opinion" and "Background of the CAIC in Soto Norte." It is concluded that social representations are mediated by the information that they have obtained about the armed phenomenon in different contexts, and that such information is unfounded. Therefore, the generation of psychoeducational spaces, which respond to the need to build peace, from the regions, is suggested.

Evaluation of Abstraction Capabilities and Detection of Discomfort with a Newscaster Chatbot for Entertaining Elderly Users.

We recently proposed a novel intelligent newscaster chatbot for digital inclusion. Its controlled dialogue stages (consisting of sequences of questions that are generated with hybrid Natural Language Generation techniques based on the content) support entertaining personalisation, where user interest is estimated by analysing the sentiment of his/her answers. A differential feature of our approach is its automatic and transparent monitoring of the abstraction skills of the target users. In this work we improve the chatbot by introducing enhanced monitoring metrics based on the distance of the user responses to an accurate characterisation of the news content. We then evaluate abstraction capabilities depending on user sentiment about the news and propose a Machine Learning model to detect users that experience discomfort with precision, recall, F1 and accuracy levels over 80%.

The Latin America and Caribbean HAB status report based on OBIS and HAEDAT maps and databases.

Harmful Algae Blooms (HAB) have been documented for at least fifty years in Latin America and the Caribbean (LAC), however, their impacts at social, ecological and economic levels are still little known. To contribute to the impact assessment of HABs in LAC region, the available information in HAEDAT, OBIS, CAREC, and CARPHA databases, and scientific literature was analyzed. This historical analysis allows identification of the main syndromes and causal organisms. Considering the existence of two regional working groups of the Intergovernmental Oceanographic Commission (IOC): Algas Nocivas del Caribe (ANCA) and Floraciones Algales Nocivas en Sudamérica (FANSA), representing Central American/Caribbean and South American countries, respectively, the analysis is presented both globally and subregional. For the FANSA region, the HAEDAT data base listed 249 records from 1970 to 2019, with a total of 1432 human intoxications, including 37 fatalities. The majority of these events comprised Paralytic Shellfish Toxins (49%), Diarrhetic Shellfish Toxins (34%), Cyanotoxins (12%) and 6 % other toxins. The total number of harmful taxa in the OBIS database includes 79 species distributed over 25 genera. The most commonly reported species are Alexandrium catenella/tamarense, Gymnodinium catenatum and the Dinophysis acuminata complex. Two new species Prorocentrum caipirignum Fraga, Menezes and Nascimento and Alexandrium fragae Branco and Menezes were newly described from Brazilian waters. In the ANCA region, HAEDAT listed 131 records from 1956 to 2018. The main problems are PSP and Ciguatera and common HAB taxa are Gambierdiscus, Gymnodinium, Pyrodinium, Alexandrium and Dinophysis. The most reported HAB forming species are Gymnodinium catenatum, Pyrodinium bahamense and Gambierdiscus spp. In recent years Margalefidinium polykrikoides blooms have become frequent, causing fish and invertebrates massive mortalities and impacts on touristic activities. In the LAC region, the greatest economic losses were produced by ichthyotoxic massive events causing salmon deaths associated to Pseudochattonella verruculosa and Alexandrium catenella in Chile and tuna deaths related to Tripos furca and Chattonella spp. in the Mexican Pacific. In the last decade, several studies in LAC have linked HAB events with local mesoscale oceanographic and atmospheric phenomena. Trends analyzed up to 2019 are related to the increasing awareness about presence of toxic species, the geographical expansion of already known species, the detection of new toxins for the region, and HAB events duration and/or impacts.

Association between type 2 diabetes mellitus and the evolution of endodontic pathology.

OBJECTIVE: The purpose of the present study was to assess the influence of type 2 diabetes mellitus (DM) on the evolution of pulpal and periapical pathology. METHOD AND MATERIALS: Two reviewers independently conducted a systematic search for articles published between 1 January 2001 and 31 December 2018 on MEDLINE/PubMed, ISI Web of Science, and Scopus databases. An additional manual search was also carried out. RESULTS: Ten studies fulfilling the inclusion criteria were included in the review (two longitudinal studies with 1-year follow-up comparing the success of primary root canal treatment between type 2 diabetic patients and non-diabetic patients, and eight cross-sectional studies). Analysis of the ten studies showed that inadequate control of type 2 DM may predispose and influence the inflammatory pulpal and periapical disease evolution. CONCLUSIONS: The present systematic review suggests that there are biologic bases to suggest that type 2 DM may act as a risk factor for developing an endodontic pathology, affecting the course of the disease in terms of susceptibility, prevalence, progression, and tissue healing capacity as a consequence of a disrupted immune response. However, more well-designed clinical investigations carrying out suitable research methodologies are needed to elucidate the influence of type 2 DM on the pulpal and periapical disease evolution.

Cortisol Acting Through the Glucocorticoid Receptor Is Not Involved in Exercise-Enhanced Growth, But Does Affect the White Skeletal Muscle Transcriptome in Zebrafish (Danio rerio).

Forced sustained swimming exercise at optimal speed enhances growth in many fish species, particularly through hypertrophy of the white skeletal muscle. The exact mechanism of this effect has not been resolved yet. To explore the role of cortisol, we first subjected wild-type zebrafish to an exercise protocol validated for exercise-enhanced growth, and showed that exercised zebrafish, which indeed showed enhanced growth, had higher cortisol levels than the non-exercised controls. A central role was therefore hypothesized for the steroid hormone cortisol acting through the Glucocorticoid receptor (Gr). Second, we subjected wild-type zebrafish and zebrafish with a mutant Gr to exercise at optimal, suboptimal, and super-optimal speeds and compared them with non-exercised controls. Exercised zebrafish showed growth enhancement at all speeds, with highest growth at optimal speeds. In the Gr mutant fish, exercise resulted in growth enhancement similar to wild-type zebrafish, indicating that cortisol signaling through Gr cannot be considered as a main determinant of exercise-enhanced growth. Finally, the transcriptome of white skeletal muscle tissue was analyzed by RNA sequencing. The results of this analysis showed that in the muscle tissue of Gr mutant fish a lower number of genes is regulated by exercise than in wild-type fish (183 vs. 351). A cluster of 36 genes was regulated by exercise in both wild-type and mutant fish, and in this cluster genes involved in transcriptional regulation and protein ubiquitination were overrepresented. Because these two processes appear to be regulated in both wild type and mutant fish, which both display exercise-enhanced growth, we suggest that they play an important role in the growth of muscles upon exercise.

Hemicraniectomía en pacientes con ataque cerebro vascular isquémico extenso: aspectos relevantes a propósito de una serie de casos / Decompressive hemicranectomy in patients with extensive ischemic stroke discussion issues about a series of case

IntroduccIón: cerca del 10% de los pacientes con ataque cerebro vascular isquémico agudo (ACV), presentan una oclusión completa de la arteria cerebral media (ACM) generando una mortalidad que puede alcanzar el 80%. La hemicraniectomía descompresiva (HD) puede reducir dramáticamente la mortalidad; sin embargo se encuentra en discusión su papel frente a la discapacidad asociada en estos pacientes.objetIvo: describir en una cohorte histórica, las consideraciones para la realización de la Hemicraniectomía descompresiva (HD), evaluar los desenlaces en términos de la mortalidad y la funcionalidad evaluada por el Rankin-m y el Barthel al egreso hospitalario.Métodos: análisis descriptivo de pacientes atendidos en el Instituto del Corazón de la Fundación Cardiovascular de Colombia en los últimos 2 años con diagnóstico de ACV extenso, dividiéndolos en dos grupos, un grupo con HD y otro con manejo convencional.resultados: se recolectaron 18 pacientes con ACV extenso, a 7 (38,8%) se les realizó HD y a 11 (61,1%) se les dio manejo médico convencional. La etiología del ACV más frecuente en ambos grupos fue la cardioembólica (61%), no hubo diferencias en cuanto a la severidad del ACV medida por escala NIHSS. Todas las HD se realizaron en las primeras 48 horas. La mortalidad en el grupo con HD fue de 14,2% mientras en el grupo con manejo médico convencional fue 54,5%. En cuanto a la funcionalidad al egreso hospitalario se observó una menor discapacidad en el grupo de HD comparado con el grupo sin HD (Rankin-m p=0,08 y Barthel p=0,03).conclusIón: la hemicraniectomía es una alternativa para pacientes con ACV extenso de la ACM, cuyo objetivo principal es disminuir la mortalidad y evitar el daño del hemisferio contralateral.

Immobilization of acetylcholinesterase on screen-printed electrodes. Application to the determination of arsenic(III).

Enzymatic amperometric procedures for measuring arsenic, based on the inhibitive action of this metal on acetylcholinesterase enzyme activity, have been developed. Screen-printed carbon electrodes (SPCEs) were used with acetylcholinesterase covalently bonded directly to its surface. The amperometric response of acetylcholinesterase was affected by the presence of arsenic ions, which caused a decrease in the current intensity. The experimental optimum working conditions of pH, substrate concentration and potential applied, were established. Under these conditions, repeatability and reproducibility of biosensors were determined, reaching values below 4% in terms of relative standard deviation. The detection limit obtained for arsenic was 1.1 × 10(-8) M for Ach/SPCE biosensor. Analysis of the possible effect of the presence of foreign ions in the solution was performed. The method was applied to determine levels of arsenic in spiked tap water samples.

[Assessment of serum IgG activity correlation against cyclic citrullinated peptide antibodies, topoisomerase I and centromere proteins in Mexican patients with progressive systemic sclerosis]. / Evaluación de la correlación de la actividad de IgG sérica contra péptido citrulinado cíclico, topoisomerasa I y proteínas de centrómero en pacientes mexicanos con esclerosis sistémica progresiva.

OBJECTIVE: To evaluate sera titers for antibodies anti-cyclic citrullinated peptide and their correlation against sera levels of anti-topoisomerase I and anti-centromere antibodies in Mexican patients with systemic sclerosis. PATIENTS AND METHODS: Consecutive outpatients with systemic sclerosis who attending to rheumatology clinic at a second level hospital facility. The antibodies anti-cyclic citrullinated peptide, anti-topoisomerase I and anti-centromere were determined by enzymatic immunoassay (ELISA). STATISTICAL ANALYSIS: Spearman for correlation between numerical variables with nonparametric distribution. Fisher exact test or chi2 to compare proportions and Student t test for dimensional variables. RESULTS: Thirty female patients were included; aged 53 +/- 13, the disease duration at the time of the study was 10 +/- 9. Twenty-three patients (77%) exhibited diffuse disease. Anti-centromere, anti-topoisomerase I, and anti-cyclic citrullinated peptide were detected in nine, nine and three patients respectively. The correlation analysis showed the independence of autoantibodies anti-centromere and anti-topoisomerase I with respect to the levels of anti-cyclic citrullinated peptide. CONCLUSIONS: This study confirms the low frequency of anti-cyclic citrullinated peptide antibodies in patients with systemic sclerosis. A lack of correlation between autoantibodies considered as "mutually excluded" anti-topoisomerase I and anti-centromere, indicating that the analysis of the relevance for anti-cyclic citrullinated peptide in systemic sclerosis must include other clinical and serological variables.

The effect of tooth bleaching on substance P expression in human dental pulp.

The purpose of this study was to quantify the effect of tooth bleaching on substance P (SP) expression in healthy human dental pulp. Forty pulp samples were obtained from healthy premolars in which extraction was indicated for orthodontic reasons. Thirty of these premolars were assigned into three different tooth-bleaching protocols: group 1 (n = 10): Opalescence Xtra Boost (Ultradent Products, South Jordan, UT) (38% H(2)O(2)) for 15 minutes; group 2 (n = 10): Lase Peroxide (DMC, Brazil) (35% H(2)O(2)) activated with infrared laser diode (Biolux; BioArt, Brazil) for 3 minutes, and group 3 (n = 10): Zoom! Whitening System (Discuss Dental, Culver City, CA) (25% H(2)O(2)) light activated for 20 minutes. The remaining 10 healthy premolars serve as a control group. Teeth were anesthetized immediately after bleaching and were extracted 10 minutes later. All pulp samples were processed and SP was measured by radioimmunoassay. Greater SP expression was found in the Zoom! Whitening System, followed by the Lase Peroxide group, Opalescence Xtra Boost, and the lower SP values were for the control group. Analysis of variance showed statistically significant differences between groups (p = 0.0001). Tukey HSD post hoc tests showed significant differences in the light (p < 0.01) and laser (p < 0.05) activated bleaching systems when compared with control values. It can be concluded that light- and laser-activated tooth-bleaching systems increase SP expression in human dental pulp significantly higher than normal values.

Uso del metotrexate oral en pacientes con artritis reumatoidea / Use of oral metotrexate in rheumatoid arthritis

Estudio retospectivo en el que se analizaron un total de 47 historias clínicas de pacientes diagnosticados de artritis reumatoidea de 1992 a 1994 en el Hospital del Seguro Social Teodoro Maldonado Carbo. El 82 por ciento de los pacientes fueron de sexo femenino; las articulaciones mayormente afectadas fueron las metacarpofalángicas. Las principales causas de abandono del tratamiento con metotrexate fueron las gastrointestinales y hematológicas. Es necesario resaltar que todos los pacientes tratados con metotrexate experimentaron mejoría clínica incluyendo los que debieron abandonar temporal o permanentemente su uso por algún efecto colateral mayor o menor. Entre los fármacos coadyuvantes más usados tenemos los aines...

Evaluación nutricional comparada entre pacientes en hemodiálisis y diálisis peritoneal continua ambulatoria / Compared nutritional evaluation among patients in hemodialysis and ambulatory continuous peritoneal dialysis

Se estudiaron 30 pacientes, 21 en hemodiálisis y 9 en DPCA, con promedio de edades y de antigüedad en tratamiento comparables. Dos de los pacientes de DPCA son diabéticos tipo I. Se evaluó el estado nutricional de ambas poblaciones a través de: ingestas calórica y proteicas, albúmina sérica y los índices antropométricos: peso (P), área grasa del brazo (AGB) y área muscular del brazo (AMB), indicadores respectivamente de la reserva calórica y de las proteínas somáticas. En los pacientes en DPCA se incluye en la ingesta calórica la absorción peritoneal de dextrosa. Resultó que la ingesta diaria de calorías y proteínas fue mayor en pacientes en DPCA que la de los de hemodiálisis; dichas ingestas se adecuan a lo recomendado para cada tipo de tratamiento. Excluyendo los dos pacientes diabéticos, el grupo DPCA mostró los tres índices antropométricos en valores normales; en hemodiálisis se observó en promedio disminución leve del peso y del área muscular del brazo y reducción moderada a severa del área grasa del brazo. La albúmina sérica fue normal en hemodiálisis y subnormal en DPCA, con diferencia estadísticamente significatica. En conclusión, ambos grupos mostraron ingestas de proteínas y calorías dentro de lo recomendado para cada grupo de tratamiento, pero los pacientes en hemodiálisis conservaron mejor la albúmina sérica, en tanto que los de DPCA mostraron mayor reserva calórica y de proteínas somáticas