Radiomics-Based Assessment of OCT Angiography Images for Diabetic Retinopathy Diagnosis.

Purpose: To evaluate the diagnostic accuracy of machine learning (ML) techniques applied to radiomic features extracted from OCT and OCT angiography (OCTA) images for diabetes mellitus (DM), diabetic retinopathy (DR), and referable DR (R-DR) diagnosis. Design: Cross-sectional analysis of a retinal image dataset from a previous prospective OCTA study (ClinicalTrials.govNCT03422965). Participants: Patients with type 1 DM and controls included in the progenitor study. Methods: Radiomic features were extracted from fundus retinographies, OCT, and OCTA images in each study eye. Logistic regression, linear discriminant analysis, support vector classifier (SVC)-linear, SVC-radial basis function, and random forest models were created to evaluate their diagnostic accuracy for DM, DR, and R-DR diagnosis in all image types. Main Outcome Measures: Area under the receiver operating characteristic curve (AUC) mean and standard deviation for each ML model and each individual and combined image types. Results: A dataset of 726 eyes (439 individuals) were included. For DM diagnosis, the greatest AUC was observed for OCT (0.82, 0.03). For DR detection, the greatest AUC was observed for OCTA (0.77, 0.03), especially in the 3 × 3 mm superficial capillary plexus OCTA scan (0.76, 0.04). For R-DR diagnosis, the greatest AUC was observed for OCTA (0.87, 0.12) and the deep capillary plexus OCTA scan (0.86, 0.08). The addition of clinical variables (age, sex, etc.) improved most models AUC for DM, DR and R-DR diagnosis. The performance of the models was similar in unilateral and bilateral eyes image datasets. Conclusions: Radiomics extracted from OCT and OCTA images allow identification of patients with DM, DR, and R-DR using standard ML classifiers. OCT was the best test for DM diagnosis, OCTA for DR and R-DR diagnosis and the addition of clinical variables improved most models. This pioneer study demonstrates that radiomics-based ML techniques applied to OCT and OCTA images may be an option for DR screening in patients with type 1 DM. Financial Disclosures: Proprietary or commercial disclosure may be found after the references.

ASSESSMENT OF OCCUPATIONAL EXPOSURE IN THE MAIN PAEDIATRIC INTERVENTIONAL RADIOLOGY PROCEDURES.

The aim of this study is to evaluate the personal dose equivalent Hp(10) in the most frequent (non-cardiac) paediatric interventional radiology (PIR) procedures: central venous catheters (CVC), hepatic/biliary and sclerotherapy interventions. i2 active solid-state dosemeters placed over the lead apron were used to monitor the exposure of three interventional radiologists over 18 months. A database was created to register all procedures performed by each radiologist (including the type of procedure and the kerma-area product, PKA). The mean Hp(10) per procedure for CVC, sclerotherapy and hepatic/biliary interventions was respectively 0.01 ± 0.01 mSv, 0.18 ± 0.13 mSv and 0.12 ± 0.06 mSv (k = 2). A similar value of Hp(10)/PKA was found despite the type of procedure or the patient weight (~10 µSv/Gy·cm2). There was high variability among individual interventions, probably due to the variable level of complexity, which led to uncertainties in the measurements' mean higher than those associated with the dosemeter's angular and energy dependence. i2 therefore proved suitable for monitoring Hp(10) in PIR procedures.

From Health-Related Quality of Life (HRQoL) of Patients with Pulmonary Hypertension to Patient Experience with the Care Received: Should We Be More Aware of Current Patient Needs?

INTRODUCTION: Self-perceived health-related quality of life (HRQoL) of patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) and their experience with the care received are important for improving their management. We conducted a study to assess both patient-reported outcomes (PROs) and how they interrelate. METHODS: This was a cross-sectional, observational study of consecutive patients with PAH and CTEPH attending pulmonary hypertension (PH)-specialized units at 25 hospitals in Spain. PRO measurements used included CAMPHOR/EQ-5D-5L questionnaires (HRQoL) and IEXPAC (healthcare experience). Patient characteristics were collected. Relationships were analysed with Pearson's correlation coefficient and linear regression analyses. RESULTS: A total of 185 patients with PAH and 93 patients with CTEPH aged 54.4 ± 14.4 and 64.8 ± 13.4 years were included: 63.6% and 72% were functional class (FC) I-II; median time from diagnosis was 3 and 2 years, respectively. Most patients with PAH received combination oral therapy. CAMPHOR scores indicated moderate-to-high impairment in the "activity" scale (PAH 21.6 ± 6.8; CTEPH 21.0 ± 6.3). EQ-5D-5L index and visual analogue scale (VAS) score (PAH 0.59 ± 0.15 and 65.55 ± 21.54; CTEPH 0.59 ± 0.13 and 66.95 ± 18.71, respectively) indicated moderate HRQoL impairment. HRQoL was mostly affected by FC. IEXPAC scores (PAH 7.08 ± 1.56 and CTEPH 7.13 ± 1.61) indicated good healthcare experience. In patients with PAH, the CAMPHOR "symptom" and "QoL" domains inversely correlated with the IEXPAC "patient self-management" factor. CONCLUSION: In patients with long-standing PAH and CTEPH with good disease control, functional limitations greatly impact HRQoL while symptoms and generic QoL were less affected. Healthcare received was perceived as good; however, use of information and communication technologies, patient associations and promotion of self-management should improve for enhanced patient experience.

Economic evaluation of Chagas disease screening in Spain.

Although Spain is the European country with the highest Chagas disease burden, the country does not have a national control program of the disease. The purpose of this study is to evaluate the efficiency of several strategies for Chagas disease screening among Latin American residents living in Spain. The following screening strategies were evaluated: (1) non-screening; (2) screening of the Latin American pregnant women and their newborns; (3) screening also the relatives of the positive pregnant women; (4) screening also the relatives of the negative pregnant women. A cost-utility analysis was carried out to compare the four strategies from two perspectives, the societal and the Spanish National Health System (SNHS). A decision tree representing the clinical evolution of Chagas disease throughout patient's life was built. The strategies were compared through the incremental cost-utility ratio, using euros as cost measurement and quality-adjusted life years as utility measurement. A sensitivity analysis was performed to test the model parameters and their influence on the results. We found the "Non-screening" as the most expensive and less effective of the evaluated strategies, from both the societal and the SNHS perspectives. Among the screening evaluated strategies the most efficient was, from both perspectives, to extent the antenatal screening of the Latin American pregnant women and their newborns up to the relatives of the positive women. Several parameters influenced significantly on the sensitivity analyses, particularly the chronic treatment efficacy or the prevalence of Chagas disease. In conclusion, for the general Latin American immigrants living in Spain the most efficient would be to screen the Latin American mothers, their newborns and the close relatives of the mothers with a positive serology. However for higher prevalence immigrant population the most efficient intervention would be to extend the program to the close relatives of the negative mothers.

[Outpatient management of patients with deep vein thrombosis and cancer: a study of safety, cost and budget impact]. / Control ambulatorio de los pacientes con trombosis venosa profunda y cáncer: estudio de seguridad, costes e impacto presupuestario.

BACKGROUND AND OBJECTIVE: This is a safety and cost comparison study with an analysis of budgetary impact of ambulatory management of patients with cancer and deep vein thrombosis (DVT) compared with hospital management. MATERIAL AND METHODS: Prospective observational study of patients with known malignancy and diagnosed with DVT from 2003 to 2007. The outcome variables were mortality, relapse and bleeding in one month. We conducted an economic analysis to evaluate the comparative cost of ambulatory patients. RESULTS: Three hundred and seventeen patients, 55 (17%) had cancer. The mean age of patients was 63 ± 11 years. There were 2 hemorrhagic events, 2 recurrences and 6 deaths in one month of follow-up. Of all patients, only 7 (13,7%) required hospitalization. All but one deaths were due to progression of the underlying disease. Economic analysis concluded that outpatient management is 6 times less expensive than hospital management, which would imply a cost reduction of 85%. CONCLUSIONS: Specialized outpatient treatment of cancer patients with DVT is safe and could save significant financial resources.

[Antituberculosis treatment default among the immigrant population: mobility and lack of family support]. / Abandono del tratamiento antituberculoso en la población inmigrante: la movilidad y la falta de apoyo familiar.

OBJECTIVE: To identify antituberculosis treatment outcomes among the immigrant population and determine the variables associated with treatment default. METHODS: We performed a prospective cohort study that included cases of tuberculosis in immigrants older than 15 years diagnosed in 15 public hospitals of the Community of Madrid in 2003. Firstly, a descriptive study was performed. Subsequently, a bivariate/multivariate analysis was performed using logistic regressions. The dependent variable was treatment default vs successful treatment. RESULTS: Of 296 cases, 75.0% successfully completed the treatment, 8.4% defaulted, 2% died, 0.7% showed treatment failure, and 7.1% transferred out; information loss occurred in 6.8%. The variables independently associated with treatment default were female sex (odds ratio [OR]: 0.18; 95% confidence interval [95%CI]: 0.03-0.95), living with relatives (0.23 [0.08-0.66]) and moving to another autonomous community (5.52 [1.17-25.93]) compared with not moving. CONCLUSIONS: Antituberculosis treatment outcomes in the immigrant population need to be improved. To achieve this aim, healthcare coordination should be improved in the mobile population and strategies to increase treatment compliance among persons not living with relatives are required.

[Resistant Mycobacterium tuberculosis strains from immigrants in the community of Madrid: current assessment]. / Situación actual de las resistencias de Mycobacterium tuberculosis en la población inmigrante de la Comunidad de Madrid.

OBJECTIVE: Immigration to Spain from countries with high rates of tuberculosis infection is increasing. The aim of this study was to describe and analyze resistance to antituberculosis drugs in strains isolated from foreign-born patients in the Community of Madrid. PATIENTS AND METHODS: A cohort of immigrants was identified at 14 hospitals in the Community of Madrid. To assess the sensitivity of isolated strains, we used the MGIT 960 system and/or the proportion method of Canetti. Clinical and sociodemographic information was recorded for each patient. We compiled descriptive statistics and performed univariate analysis, followed by multiple logistic regression analysis. RESULTS: From a total of 312 cases, 268 strains were isolated. Sensitivity was tested in 221 strains. The proportion of immigrants with no health care coverage was 19.9%. Thirty-one strains (14.0%) were resistant; 24 (12.6%) were in newly diagnosed cases and 6 (27.3%) were in patients who had been treated previously. Ten strains (4.5%) were multidrug resistant. Resistance to isoniazid was detected in 18 strains (9.5%). Multidrug resistance was associated with a history of prior antituberculosis treatment (odds ratio, 5.94; 95% confidence interval, 1.46-24.18). CONCLUSIONS: Barriers to health care faced by immigrants with tuberculosis should be removed. Treatment should begin with 4 drugs while the results of sensitivity tests are pending. A history of prior antituberculosis treatment should raise a suspicion of multidrug resistance.

Los medicamentos en el mundo asimétrico actual: del no acceso al acceso: parte II / Drugs in present asymmetrical world: from the non-access to access: part II

Se realizó una revisión bibliográfica, desde la óptica de las ciencias sociales, sobre las principales características contemporáneas de la industria farmacéutica en la producción y comercialización de los medicamentos. Se evidencia que gracias al desarrollo del sector, hoy se cuenta con un amplio arsenal de fármacos, lo que le confiere a esta tecnología un poderío inigualable en la sociedad. Los informes de diversas agencias de las Naciones Unidas no dejan lugar a duda de que ha aumentado la disparidad social y económica entre los países. Ello originó que el acceso a los medicamentos sea prohibitivo para la mayoría de los países y sus pueblos. Las transnacionales farmacéuticas dedican grandes recursos financieros a promover sus productos, con una fuerte preponderancia mercantil en la información que brindan, con gran influencia sobre los prescriptores y enfermos.

A bibliographic review was made, from the viewpoint of Social Sciences, on the main contemporary features of the pharmaceutical industry in drugs production and marketing. It is obvious that thanks to development of sector, nowadays there is a great variety of drugs, conferring to this technology an unequalled power in society. Reports from diverse NU agencies showed increases in social and economical disparity among countries. It made that access to drugs be prohibitive for the great majority of countries and their peoples. Pharmaceutical transnational consortiums devote great financial resources to promote their products, with a strong mercantile predominance in information supplied, with a big influence on physicians and on patients.

Bioremediation by composting of heavy oil refinery sludge in semiarid conditions.

The present work attempts to ascertain the efficacy of low cost technology (in our case, composting) as a bioremediation technique for reducing the hydrocarbon content of oil refinery sludge with a large total hydrocarbon content (250-300 g kg(-1)), in semiarid conditions. The oil sludge was produced in a refinery sited in SE Spain The composting system designed, which involved open air piles turned periodically over a period of 3 months, proved to be inexpensive and reliable. The influence on hydrocarbon biodegradation of adding a bulking agent (wood shavings) and inoculation of the composting piles with pig slurry (a liquid organic fertiliser which adds nutrients and microbial biomass to the pile) was also studied. The most difficult part during the composting process was maintaining a suitable level of humidity in the piles. The most effective treatment was the one in which the bulking agent was added, where the initial hydrocarbon content was reduced by 60% in 3 months, compared with the 32% reduction achieved without the bulking agent. The introduction of the organic fertiliser did not significantly improve the degree of hydrocarbon degradation (56% hydrocarbon degraded). The composting process undoubtedly led to the biodegradation of toxic compounds, as was demonstrated by ecotoxicity tests using luminescent bacteria and tests on plants in Petri dishes.