Assessing the relevance of mental health factors in fibromyalgia severity: A data-driven case study using explainable AI.

BACKGROUND AND OBJECTIVE: Fibromyalgia is a chronic disease that causes pain and affects patients' quality of life. Current treatments focus on pharmacological therapies for pain reduction. However, patients' psychological well-being is also affected, with depression and pain catastrophizing being common. This research addresses the clinicians' need to assess the influence of mental health factors on FM severity compared to pain factors. METHODS: A co-development study between FM clinicians and data scientists analyzed data from 166 FM-diagnosed patients to assess the influence of mental health factors on FM severity in comparison to pain factors. The study used the Polysymptomatic Distress Scale (PDS) and Fibromyalgia Impact Questionnaire (FIQ) as FM severity indicators and collected 15 variables including regarding demographics, pain intensity perceived, and mental health factors. The team used an author's developed framework to identify the optimal FM severity classifier and explainability by selecting a number of features that lead to obtaining the best classification result. Machine learning classifiers employed in the framework were: decision trees, logistic regression, support vector machines, random forests, AdaBoost, extra trees, and RUSBoost. Explainability analyses were conducted using the following explainable AI techniques: SHapley Additive exPlanations (SHAP), Partial Dependence Plot (PDP), and Mean Decrease Impurity (MDI). RESULTS: A balanced random forest with 6 features achieved the best performance with PDS (AUC_ROC, mean = 0.81, std = 0.07). Being FIQ the target variable, due to the imbalance in FM severity levels, a binary and a multiclass classification approaches were considered achieving the optimal performance, respectively, a logistic regression classifier (AUC_ROC, mean = 0.83, std = 0.08) with 6 selected features, and a random forest (AUC_ROC, mean = 0.91, std = 0.04) with 8 selected features. Next, the explainability analysis determined mental health factors were found to be more relevant than pain perceived factors for FM severity. CONCLUSIONS: This study's findings, validated by clinicians, are potentially aligned with FM international guidelines that promote non-pharmacological interventions such as promoting mental well-being of FM patients.

Higher adherence to the Mediterranean Diet is associated with better academic achievement in Spanish university students: A multicenter cross-sectional study.

The objective was to assess the association of the overall score and different items of the Mediterranean Diet Adherence Screener (MEDAS) questionnaire with academic achievement in Spanish university students. We hypothesized that university students with greater adherence to the Mediterranean Diet (MedDiet) would have better academic achievement. A cross-sectional study was performed involving 266 first-year students from the University of Castilla-La Mancha, Spain, during the 2017-2018 academic year. Adherence to the Mediterranean diet was evaluated with the 14-item MEDAS questionnaire. As an indicator variable for academic achievement, the average marks of the examinations required for access to Spanish universities were used. A total of 63 participants (23.6%) adhered to MedDiet recommendations. Analysis of covariance models showed that participants with higher adherence to the MedDiet had significantly higher scores on academic achievement than their peers with low adherence (P < .001) after controlling for potential confounders. Additionally, the evaluation of each item of the MEDAS questionnaire showed that a diet rich in olive oil, vegetables, fruits, legumes, fish and shellfish, and a low consumption of sweets and carbonated beverages were positively associated with academic achievement; nevertheless, wine intake was inversely associated. This study showed that Spanish university students had a low prevalence of good adherence to the MedDiet. Additionally, our results suggested that higher adherence to the MedDiet is associated with better academic achievement in Spanish university students. From a public health perspective and because of low adherence, it is important to continue to focus on promoting adherence to the MedDiet as part of a healthy lifestyle pattern to improve the academic performance of young university students.

Renal fungus balls in neonates and very young infants treated with local amphotericin B deoxycholate: Two case reports and review of the literature / Anfotericina B desoxicolato en el neonato y en el lactante pequeño con bolas fúngicas en el riñón: presentación de 2 casos y revisión de la literatura

Introduction: Fungal urinary tract infections predominantly affect the critically ill premature infant and those with urogenital tract abnormalities. Fungal balls are an uncommon complication which require prompt detection and treatment to prevent morbidity and mortality. The evidence on the management of fungus balls in young infants with Candida urinary tract infections is very scarce. Methods: Case reports and review of the literature. Results: We report two immunocompetent young infants with urogenital abnormalities that received local amphotericin B deoxycholate, and systemic therapy, for the treatment and prevention of Candida urinary tract infection-associated fungus balls. We identified 21 similar cases in the literature, with very limited data about drug compounding, optimal dosages, dwell times and length of treatment. Different management strategies are discussed. Conclusions: Amphotericin B deoxycholate local irrigations were safe and effective for the therapeutic management and prophylaxis of Candida fungus balls in young infants, in combination with systemic antifungal therapy.(AU)

Introducción: Las infecciones urinarias fúngicas afectan preferentemente al prematuro gravemente enfermo o al afecto de malformaciones genitourinarias. Las bolas fúngicas son una complicación infrecuente que requiere un diagnóstico y tratamiento precoces para evitar morbimortalidad asociada. La evidencia científica disponible sobre el manejo de las bolas fúngicas por Candida en lactantes pequeños es muy escasa. Métodos: Casos clínicos y revisión de la literatura. Resultados: Se presentan 2 lactantes inmunocompetentes con malformaciones urogenitales que recibieron tratamiento local con anfotericina B desoxicolato junto a terapia sistémica para el tratamiento y la profilaxis del desarrollo de bolas fúngicas por Candida. Identificamos 21 casos similares en la literatura, con muy pocos datos disponibles sobre la preparación y posología, tiempos de permanencia y duración del tratamiento. Se discuten las distintas estrategias de manejo. Conclusiones: La irrigación local con anfotericina B desoxicolato resultó segura y eficaz en el tratamiento y en la profilaxis de las bolas fúngicas por Candida en el lactante pequeño, junto con el tratamiento antifúngico sistémico.(AU)

Efectos analgésicos de la estimulación eléctrica nerviosa transcutánea en pacientes con fibromialgia: una revisión sistemática / Analgesic effects of transcutaneous electrical nerve stimulation (TENS) in patients with fibromyalgia: A systematic review

Objetivo: Determinar si la estimulación eléctrica nerviosa transcutánea (TENS) tiene un efecto analgésico superior al placebo o a otros tratamientos en pacientes con fibromialgia. Además, se pretendía analizar los parámetros de aplicación óptimos para conseguir una mayor reducción del dolor. Diseño: Revisión sistemática: Fuentes de datos: Ensayos clínicos aleatorizados sobre el efecto del TENS en la fibromialgia en las bases de datos Pubmed, Cochrane y PEDro hasta noviembre de 2016. Selección de estudios: Se seleccionaron 8 estudios de un total de 62. Se incluyeron ensayos clínicos controlados en los que se aplicase TENS a personas con fibromialgia. Extracción de datos: Se analizó el dolor como variable principal, aunque también se incluyeron otras variables como fatiga, calidad de vida e impacto de la enfermedad, recorrido articular y depresión. Resultados: Seis de 8 trabajos obtuvieron una disminución significativa del dolor. En 2 estudios se aplicó el TENS como tratamiento complementario al ejercicio terapéutico con resultados evidenciando una disminución del dolor. El resto de variables estudiadas presentaron gran variabilidad y no se pudieron establecer resultados concluyentes. Conclusiones: El tratamiento con TENS resulta efectivo para la disminución del dolor en personas con fibromialgia. Además, la inclusión del TENS en programas de ejercicio terapéutico parece tener un efecto superior a la realización del ejercicio terapéutico de forma aislada. Sin embargo, no se ha demostrado eficacia en otras variables diferentes al dolor. Son necesarios más estudios que indaguen en la optimización de los parámetros del TENS y un mayor consenso entre las variables utilizadas

Objective: To determine whether transcutaneous electrical nerve stimulation (TENS) has an analgesic effect greater than placebo or other treatments in patients with fibromyalgia. Furthermore, it was intended to analyze the optimal application parameters to achieve a greater reduction of pain. Design: A systematic review. Data source: Randomized clinical trials on the effect of TENS on fibromyalgia in the databases Pubmed, Cochrane and PEDro until November 2016. Selection of studies: 8 studies out of a total of 62 were selected. Controlled clinical trials in which TENS was applied in patients with fibromyalgia were included. Data extraction: Pain was analyzed as the main variable, although other variables such as fatigue, quality of life and impact, range of motion and depression were also included. Results: 6 out of 8 studies obtained a significant decrease of pain. In 2 studies, TENS was applied as complementary treatment to therapeutic exercise with results evidencing a decrease in pain. The rest of the variables studied presented a great variability and conclusive results could not be established. Conclusions: Treatment with TENS is effective for reducing pain in people with fibromyalgia. In addition, the inclusion of TENS in therapeutic exercise programs seems to have a greater effect than practicing therapeutic exercise in isolation. However, no efficacy has been demonstrated in other variables different to pain. Further studies are needed to investigate the optimization of the parameters of the TENS and a greater consensus among the variables used

Potenciación del reaprendizaje motor y la recuperación funcional en pacientes con ictus: estrategias no invasivas de modulación del sistema nervioso central / Enhancement of motor relearning and functional recovery in stroke patients: non-invasive strategies for modulating the central nervous system

Introducción. La mayoría de los pacientes que han sufrido un ictus no recuperan el estado funcional basal de la extremidad superior afecta y sufren una grave limitación que permanece en la fase crónica de la enfermedad y que repercute de manera devastadora en su calidad de vida. Por ello, las estrategias de neurorrehabilitación tratan de evitar o minimizar las posibles disfunciones sensitivomotoras asociadas al ictus mediante la promoción de cambios plásticos en el sistema nervioso central. Desarrollo. La reorganización cerebral que tiene lugar tras el ictus puede promover la recuperación motora y funcional de los sujetos con ictus. No obstante, tras la lesión, también se pueden iniciar cambios neuroplásticos maladaptativos responsables del desarrollo de trastornos sensitivomotores, como el síndrome de espasticidad. Las estrategias no invasivas de estimulación cerebral, como la estimulación con corriente directa y la estimulación magnética transcraneal, son unas técnicas ampliamente utilizadas que, aplicadas sobre la corteza motora primaria, pueden modificar la excitabilidad de los circuitos neuronales y las funciones cognitivas, tanto en las personas sanas como en los pacientes con afectación neuroló- gica. Asimismo, los sistemas de interfaces cerebro-máquina también son capaces de generar esa reorganización por medio de la asociación contingente y simultánea entre la activación cerebral y la estimulación periférica. Conclusiones. Se evidencian los efectos positivos de las estrategias de neurorrehabilitación citadas previamente en la potenciación de la reorganización cortical después del ictus, así como en la paliación de los efectos adversos asociados al desarrollo de la espasticidad (AU)

Introduction. Most of the stroke survivors do not recover the basal state of the affected upper limb, suffering from a severe disability which remains during the chronic phase of the illness. This has an extremely negative impact in the quality of life of these patients. Hence, neurorehabilitation strategies aim at the minimization of the sensorimotor dysfunctions associated to stroke, by promoting neuroplasticity in the central nervous system. Development. Brain reorganization can facilitate motor and functional recovery in stroke subjects. Nonetheless, after the insult, maladaptive neuroplastic changes can also happen, which may lead to the appearance of certain sensorimotor disorders such as spasticity. Noninvasive brain stimulation strategies, like transcranial direct current stimulation or transcranial magnetic stimulation, are widely used techniques that, when applied over the primary motor cortex, can modify neural networks excitability, as well as cognitive functions, both in healthy subjects and individuals with neurological disorders. Similarly, brain-machine-interface systems also have the potential to induce a brain reorganization by the contingent and simultaneous association between the brain activation and the peripheral stimulation. Conclusion. This review describes the positive effects of the previously mentioned neurorehabilitation strategies for the enhancement of cortical reorganization after stroke, and how they can be used to alleviate the symptoms of the spasticity síndrome (AU)

Enfermedad grave por enterovirus en el neonato con síndrome febril / Severe enterovirus disease in febrile neonates

Introducción En el recién nacido, el síndrome febril puede obedecer a una infección invasiva, que puede conllevar una elevada morbi-mortalidad. Nuestro objetivo fue describir las características y evolución clínica de un grupo de neonatos con fiebre sin foco debida a infección grave por enterovirus, en comparación con otro grupo de neonatos con infección bacteriana grave. Pacientes y métodos Estudio prospectivo de todos los recién nacidos (edad38°C) y cultivo bacteriano positivo o detección de enterovirus en muestras estériles, desde septiembre de 2003 a diciembre 2004. Se recogieron datos clínicos y analíticos (recuento leucocitario y proteína C reactiva) en el momento del ingreso, hemocultivo, urinocultivo y cultivo de líquido cefalorraquídeo, detección molecular de enterovirus mediante reacción en cadena de la polimerasa (PCR) y evolución final. Resultados Se recogieron 62 pacientes con infección bacteriana grave: infección del tracto urinario (n=57, incluyendo 8 casos con bacteriemia), sepsis (n=3), meningitis (n=2). La PCR para enterovirus fue positiva en 10 pacientes. La proteína C reactiva fue significativamente más elevada en los niños con infección bacteriana que en los casos de infección por enterovirus (62,3 versus 9mg/L, p=0,008). Dos pacientes, uno con meningitis por Streptococcus agalactiae y otro con sepsis por S aureus, y tres pacientes con infección por enterovirus (manifestadas como miocarditis, hepatitis y meningoencefalitis) requirieron ingreso en la unidad de cuidados intensivos pediátrica. De estos, el recién nacido con infección por S agalactiae y dos de los 3 pacientes con infección por enterovirus fueron exitus. Conclusiones En nuestra serie, la infección por enterovirus fue una causa importante de enfermedad grave. El diagnóstico viral específico podría contribuir al manejo del neonato febril (AU)

Introduction ever in newborn infants may be due to an invasive infection with potential morbidity and mortality. Our aim was to describe the characteristics and outcome of group of febrile neonates with severe enterovirus infection compared to a group of neonates with severe bacterial infection.Patients and methods Prospective study including all neonates (<29 days old) admitted to a teaching hospital for fever (>38°C), with positive bacterial cultures or enterovirus detection in sterile samples, from September 2003 to December 2004. Clinical information, analytical data at admission (complete leukocyte count and C-reactive protein concentrations), blood, urine, and cerebrospinal fluid culture results, molecular detection of enterovirus by polymerase chain reaction (PCR), and outcome were recorded. Results Invasive bacterial infections were observed in 62 patients: urinary tract infection (n=57, including 8 cases of bacteremia), sepsis (n=3), and meningitis (n=2). Molecular tests for enterovirus were positive in 10 patients. C-reactive protein values were significantly higher in neonates with bacterial infection than in those with enterovirus infection (62,3 versus 9mg/L, P=0,008). Two patients with Streptococcus agalactiae meningitis, 1 with Staphylococcus aureus sepsis and 3 with enterovirus infection (manifested as myocarditis, hepatitis, and meningoencephalitis) required admission to the pediatric intensive care unit. Among these, 1 newborn with S. agalactiae and 2 of the 3 with enterovirus infection died. Conclusions In our series, enterovirus infection was an important cause of severe invasive disease. Specific viral diagnosis can contribute to the management of febrile neonates (AU)