LETHE: A Digital Intervention for Cognitive Decline.

Dementia is the main cause of disability in elderly populations. It has been shown that the risk factors of dementia are a mixture of pathological, lifestyle and heritable factors, with some of those being provably modifiable. Early diagnosis of dementia and approaches to slow down its evolution are currently the most prominent management methodologies due to lack of a cure. For that reason, a plethora of home-based assistive technologies for dementia management do exist, with most of them focusing on the improvement of memory and thinking. The main objective of LETHE is prevention in the whole spectrum of cognitive decline in the elderly population at risk reaching from asymptomatic to subjective or mild cognitive impairment to prodromal Dementia. LETHE will provide a Big Data collection platform and analysis system, that will allow prevention, personalized risk detection and intervention on cognitive decline. Through the subsequent 2-year clinical trial, the LETHE system, as well as the respective knowledge gained will be evaluated and validated. The scope of the current paper is to introduce the LETHE study and its respective novel platform as a holistic approach to multidomain lifestyle intervention trial studies. The present work depicts the architectural perspective and extends beyond state-of-the-art guidelines and approaches to health management systems and cloud platform development.Clinical Relevance - Patient Management Systems as well as lifestyle management platforms have significant clinical relevance as they allow for remote and continuous monitoring of patients' health status. LETHE aims to improve patient outcomes by providing predictive models for cognitive decline and patient adherence to the multimodal lifestyle intervention, enabling prompt and appropriate medical decisions.

Coumarins isolated from Calophyllum brasiliense produce ultrastructural alterations and affect in vitro infectivity of Trypanosoma cruzi.

BACKGROUND: The current drugs for Chagas Disease caused by the protozoan Trypanosoma cruzi have limited therapeutic potential and are associated with serious side effects. Natural products can aid to develop new chemotherapeutic agents. Several natural coumarins, especially Mammea A/BA, have shown significant activity against T. cruzi and low toxicity on human lymphocytes, but its effectivity on a wide range of strains need to be tested, as well as to deepen in their mode of action and safety. HYPOTHESIS/PURPOSE: To discern the effects and explore the action mechanisms of mammea A/BA and a mixture of mammea coumarins isolated from Calophyllum brasiliense on Mexican strains of T. cruzi belonging to different genotypes and compare its effectivity with the drug benznidazole. STUDY DESIGN: We evaluated the trypanocidal activity in vitro of mammea A/BA (93.6%), and a mixture of coumarins, mammea A/BA + A/BB + A/BD (86:10:1%) on Mexican T. cruzi strains belonging to different genotypes Ninoa, Querétaro (TcI) and Ver6 (TcVI). MATERIAL AND METHODS: Mammea A/BA and the mixture of coumarins, were isolated from Calophyllum brasiliense, identified by proton NMR and purity determined by HPLC. The in vitro trypanocidal activity was evaluated on mobility, growth recovery, morphology and infectivity of T. cruzi. The cytotoxicity on mammalian cells was compared with benznidazole. The ultrastructure of the treated epimastigotes was analyzed by transmission electron microscopy (TEM). RESULTS: Mammea A/BA and the mixture of coumarins showed high trypanocidal activity, affecting the mobility, growth recovery, morphology, ultrastructure of epimastigotes, and drastically reduce trypomastigotes infectivity on Vero cells. These substances were four times more potent than benznidazole and showed low cytotoxicity and high selectivity index. The TEM showed severe alterations on the plasmatic membrane, nuclear envelope, as well as, mitochondrial swelling, that leads to the death of parasites. CONCLUSION: Mammea A/BA (93.6%) and a mixture of mammea A/BA + A/BB and A/BD (86: 10: 1%) isolated from the tropical tree C. brasiliense showed higher trypanocidal activity than the current drug benznidazole on three Mexican strains of T. cruzi. These compounds induced severe physiological and morphological alterations. These results suggest their possible use in preclinical studies.

Seguimiento de la adherencia al tratamiento antidepresivo en pacientes que inician su consumo / Adherence to patients antidepressant treatment and the factors associated of non-compiance

OBJETIVO: Conocer la adherencia al tratamiento en pacientes que inician fármacos antidepresivos y analizar los factores asociados al incumplimiento, tanto clínicos como sociodemográficos. DISEÑO: Estudio observacional longitudinal prospectivo. Emplazamiento: Consultas de atención primaria y de salud mental de tres áreas sanitarias de Castilla-La Mancha. Participantes: Un total de 185 pacientes mayores de 18 años que iniciaron tratamiento antidepresivo. Mediciones principales: Cumplimiento terapéutico (test Haynes-Sackett, Morisky-Green, recuento de comprimidos y MEMS), efectos adversos, intensidad de los síntomas depresivos, características sociodemográficas y otras características relacionadas con los antidepresivos o con los participantes. RESULTADOS: Tras 6 meses del inicio del tratamiento antidepresivo, el 46,9% (IC 95%: 36,5-57,3) mostró un cumplimiento inadecuado mediante el método de recuento de comprimidos, y el 28,6% (IC 95%: 19,1-38,0) con el cuestionario de Morisky-Green. A los 15 días la falta de adherencia fue del 48,5% (IC 95%: 40,6-56,4) y del 33,5% (IC 95%: 26,1-41,0), respectivamente. El 38,4% (IC 95%: 31,1-45,7) manifestó algún efecto secundario durante el seguimiento. Mediante un modelo de riesgos proporcionales de Cox las variables relacionadas con incumplimiento fueron menor edad, nivel de instrucción inferior a enseñanza secundaria, prestación farmacéutica como pensionista, no recibir tratamiento psicoterápico, consumir menor número de fármacos no antidepresivos y frecuentación ≤ 3 visitas al médico de familia los 3 meses previos al inicio del estudio. CONCLUSIONES: El incumplimiento del tratamiento antidepresivo es elevado en atención primaria desde las primeras semanas tras iniciarlo. Constituyen factores condicionantes del mismo los relacionados con características sociodemográficas y con otras características de los pacientes como tipo de financiación de prestación farmacéutica y frecuentación a las consultas

OBJETIVE: To know the adherence to treatment in patients who initiate antidepressant drugs and to analyze the determinant factors of non-compliance, so much clinical as sociodemographic. DESIGN: Prospective longitudinal observational study. Location: Primary Health Care and Mental Health Surgeries of three Castilla-La Mancha Areas. Participants: 185 adults patients who were started in antidepressant treatment were evaluated. Measurements: Treatment adherence (test Haynes-Sackett, test Morisky-Green, count of tablets and MEMS), adverse effects, intensity of depressive symptoms, sociodemographic characteristics and other characteristics related to antidepressants or participants. RESULTS: After 6 months of beginning antidepressing treatment, 46.9% (95% IC: 36.5-57.3) showed an inadequate fulfilment by pill count method and 28.6% (95% IC: 19.1-38.0) with Morisky-Green's questionnaire. To 15 days the lack of adherence was 48.5% (95% IC: 40.6-56.4) and of 33.5% (95% IC: 26.1-41.0). The 38.4% (95% IC: 31.1-45.7) demonstrated some side effect during the follow-up. Using proportional risk model of Cox the variables related to compliance were: younger age, level of instruction lower than secondary studies, free medicines for pensioner, no psychotherapeutic treatment, consume a fewer antidepressants drugs and a frequency ≤ 3 visits to the family doctor 3 months previous to the study. CONCLUSIONS: The non-compliance of antidepressant treatment in primary care is high from the first weeks after initiating it. The conditioning factors are related to sociodemographic characteristics and other patient characteristics as type of financing of pharmaceutical benefit and frequentness at primary care

An integrated healthcare information system for end-to-end standardized exchange and homogeneous management of digital ECG formats.

This paper investigates the application of the enterprise information system (EIS) paradigm to standardized cardiovascular condition monitoring. There are many specifications in cardiology, particularly in the ECG standardization arena. The existence of ECG formats, however, does not guarantee the implementation of homogeneous, standardized solutions for ECG management. In fact, hospital management services need to cope with various ECG formats and, moreover, several different visualization applications. This heterogeneity hampers the normalization of integrated, standardized healthcare information systems, hence the need for finding an appropriate combination of ECG formats and a suitable EIS-based software architecture that enables standardized exchange and homogeneous management of ECG formats. Determining such a combination is one objective of this paper. The second aim is to design and develop the integrated healthcare information system that satisfies the requirements posed by the previous determination. The ECG formats selected include ISO/IEEE11073, Standard Communications Protocol for Computer-Assisted Electrocardiography, and an ECG ontology. The EIS-enabling techniques and technologies selected include web services, simple object access protocol, extensible markup language, or business process execution language. Such a selection ensures the standardized exchange of ECGs within, or across, healthcare information systems while providing modularity and accessibility.

Color compensation in nitrite-reduced meat batters incorporating paprika or tomato paste.

BACKGROUND: Nitrite is a key ingredient the manufacture of meat products, forming a stable pink color characteristic of cured products, retarding the development of rancidity and off-odors and flavors during storage, and preventing microbial growth. The negative aspects of nitrite and the demands for healthy foods result in the need to reduce nitrite in cured meat products. Paprika or tomato has been employed as natural pigments in meat products. The objective of this work was to determine the effect of incorporating paprika powder or tomato paste on the texture, rancidity and instrumental and sensory color compensation in nitrite-reduced meat batters. RESULTS: Addition of tomato paste improved moisture content, resulting in harder but less cohesive samples as compared to control and paprika-containing meat batters. Color characteristics of reduced nitrite samples obtained higher a* red coloration (8.9 for paprika and 7.7-8.0 for tomato paste), as compared to control samples (5.65). Instrumental color was low in control samples, with high values for tomato paste and paprika samples. Nonetheless, tomato paste used to compensate color in nitrite-reduced meat batters was ranked closer to the control sample in sensory evaluation. CONCLUSION: Color characteristics-instrumental and sensory-in these kinds of meat products were enhanced by the addition of 2.5-3.0% of tomato paste, presenting results close to the non-reduced nitrite control. Similarly, antioxidant components of tomato paste or paprika reduced lipid oxidation. Nitrite reduction from 150 to 100 ppm could be achieved employing tomato paste as a natural pigment to improve color and texture.

The earliest evidence of true lambdoid craniosynostosis: the case of "Benjamina", a Homo heidelbergensis child.

BACKGROUND: The authors report the morphological and neuroimaging findings of an immature human fossil (Cranium 14) diagnosed with left lambdoid synostosis. DISCUSSION: The skull was recovered at the Sima de los Huesos site in Atapuerca (Burgos, Spain). Since the human fossil remains from this site have been dated to a minimum age of 530,000 years, this skull represents the earliest evidence of craniosynostosis occurring in a hominid. A brief historical review of craniosynostosis and cranial deformation is provided.