ABSTRACT
BACKGROUND: While ST-Elevation Myocardial Infarction (STEMI) door-to-balloon times are often below 90 min, symptom to door times remain long at 2.5-h, due at least in part to a delay in diagnosis. OBJECTIVES: To develop and validate a machine learning-guided algorithm which uses a singlelead electrocardiogram (ECG) for STEMI detection to speed diagnosis. METHODS: Data was extracted from the Latin America Telemedicine Infarct Network (LATIN), a population-based Acute Myocardial Infarction (AMI) program that provides care to patients in Brazil, Colombia, Mexico, and Argentina through telemedicine. SAMPLE: the first dataset was comprised of 8511 ECGs that were used for various machine learning experiments to test our Deep Learning approach for STEMI diagnosis. The second dataset of 2542 confirmed STEMI diagnosis EKG records, including specific ischemic heart wall information (anterior, inferior, and lateral), was derived from the previous dataset to test the STEMI localization model. Preprocessing: Detection of QRS complexes by wavelet system, segmentation of each EKG record into individual heartbeats with fixed window of 0.4 s to the left and 0.9 s to the right of main. Training & Testing: 90% and 10% of the total dataset, respectively, were used for both models. CLASSIFICATION: two 1-D convolutional neural networks were implemented, two classes were considered for first models (STEMI/Not-STEMI) and three classes for the second model (Anterior/Inferior/Lateral) each corresponding to the heart wall affected. These individual probabilities were aggregated to generate the final label for each model. RESULTS: The singlelead ECG strategy was able to provide an accuracy of 90.5% for STEMI detection with Lead V2, which also yielded the best results overall among individual leads. STEMI Localization model provided promising results for anterior and inferior wall STEMIs but remained suboptimal for Lateral STEMI. CONCLUSIONS: An Artificial Intelligence-enhanced singlelead ECG is a promising screening tool. This technology provides an autonomous and accurate STEMI diagnostic alternative that can be incorporated into wearable devices, potentially providing patients reliable means to seek treatment early and offers the potential to thereby improve STEMI outcomes in the long run.
Subject(s)
Deep Learning , Myocardial Infarction , ST Elevation Myocardial Infarction , Artificial Intelligence , Electrocardiography , Humans , ST Elevation Myocardial Infarction/diagnosisABSTRACT
The seeds of Hymenaea courbaril (Caesalpiniace), a species widely disseminated in Venezuela, produce a clear and soluble gum. The dietetic fiber content (60.7%) of the gum was used as a good criterion for the formulation of integral bread in a diet for dyslipidemia patients. The proximal composition of the integral bread was determined. The product acceptability evaluation was done by a comparison test and by a hedonic scale. The experimental design was carried out with a total of 30 male volunteers with dyslipidemia. They were divided into two groups: Group A was fed with a modified diet, which included bread prepared with the H. courbaril gum; and Group B received the same diet without the gum, based on the American Dietetic Association recommendations. Both groups were maintained on their respective diets for six weeks. The lipid profile was determined in each patient, before starting the diets and after the specified period. The bread formula contained 17.60% protein, 1.19% fat and 0.97% crude fiber, in accordance with standards established by COVENIN. The paired preference test showed grater acceptance of the bread prepared with a gum concentration of 7% and low fat content. Significant decreases in the concentrations of triacylglycerol and VLDL-cholesterol were observed in Group A. These findings suggest a possible use of the H. courbaril gum, as a diet modifier for dyslipidemic patients.
Subject(s)
Bread , Cholesterol/blood , Dyslipidemias/blood , Dyslipidemias/diet therapy , Food, Formulated , Hymenaea , Triglycerides/blood , Adult , Humans , Male , Middle Aged , Severity of Illness IndexABSTRACT
AIMS: A telemedicine-guided strategy increases the access to and efficiency of ST-elevation myocardial infarction (STEMI) networks resulting in increased access to, and reduced disparities in, acute myocardial infarction (AMI) care between rural and urban areas. METHODS AND RESULTS: The Latin America Telemedicine Infarct Network (LATIN) was developed for poor and remote regions in Brazil and Colombia that lacked coordinated AMI systems of care. It strategically connects small clinics and primary care health centres (spokes) to hubs with 24/7 percutaneous coronary intervention (PCI) capability. Experts at three remote sites provide urgent electrocardiogram (ECG) diagnosis and tele-consultation for the entire network. Data from the busiest LATIN site, the Santa Marcelina Hospital in Sao Paolo, Brazil, were compared with health statistics from Sistema Unico de Saude (Brazilian Public Health System - SUS). A total of 192 centres were networked using standardised and guideline-based protocols for AMI care. Overall, 313,897 patients were remotely screened, 3,572 AMI diagnosed (1.1%), and 1,636 AMI urgently reperfused (45.8%), mainly by primary PCI (n=1,351; 83%). CONCLUSIONS: In conclusion, a comparison between a pre-LATIN cohort from SUS (1,015) and a LATIN cohort from Santa Marcelina Hospital (1,247) revealed increased reperfusion with PCI (65.52% vs 75.2%), increased cost ($2,037.12 vs $2,246.40, p<0.005), a statistically significant reduction in PCI mortality (8.5% vs 4.3% p<0.01) and a non-significant reduction in mortality overall amongst all treatment pathways (9.69% vs 9.43%, p=0.931).
ABSTRACT
Acacia tortuosa produces a clear gum, very soluble in water. Previous reports showed that it was constituted by four fractions, one of them an arabinogalactan-protein complex. The elucidation of the A. tortuosa gum structure by the combination of classical chemical methods, size exclusion chromatography and NMR spectroscopy, was the objective of this investigation. The data obtained show that the heteropolysaccharide is an arabinogalactan type II, highly ramified, with lateral chains at C-2 as well as at C-6 of the galactose 3-O residues; mono-O-substituted galactoses were not detected. There are residues of mannose, the arabinose, pyranose predominantly, is terminal and 2-O-linked. The abundance of the 4-O-methyl-α-d-glucuronic acid was not previously reported. The proteic fraction is probably represented by an arabinogalactan-protein complex that binds poorly with ß-glucosyl Yariv reagent, and two glycoproteins. The NMR spectra suggest that the carbohydrate links to hydroxyproline through the galactose (galactosylation).
Subject(s)
Acacia/chemistry , Galactans/chemistry , Magnetic Resonance Spectroscopy/methods , Glucuronic Acid , Glycoproteins/chemistryABSTRACT
The tree Spondias dulcis, located in Venezuela, exudes a light-brown gum. The polysaccharide, isolated from the original gum, contains galactose, arabinose, mannose, rhamnose, glucuronic acid, and its 4-O-methyl derivative. Application of chemical methods, in combination with 1D and 2D NMR spectroscopy afforded interesting structural features of the gum polysaccharide. The unequivocal presence of rhamnose in the polymer structure was confirmed by chemical and spectral data [1H (1.03 ppm); 13C (16.92 ppm)]. Also confirmed was the existence of 3-O- and 6-O-substitutes galactose residues by the spectral data correlations observed in Heteronuclear Multiple Quantum Coherence (HMQC) and Heteronuclear Multiple Bond Correlation (HMBC). Also observed were unequivocal resonances for beta-D-glucuronic acid and its 4-O-methyl derivative, and the presence of 3-O-alpha-L-arabinofuranose and 3-O-beta-L-arabinopyranose residues.
Subject(s)
Anacardiaceae/chemistry , Galactans/analysis , Polysaccharides/analysis , Arabinose/analysis , Carbohydrate Conformation , Carbohydrate Sequence , Chromatography, High Pressure Liquid , Galactans/chemistry , Galactose/analysis , Magnetic Resonance Spectroscopy , Mannose/analysis , Molecular Sequence Data , Molecular Structure , Plant Structures/chemistry , Polysaccharides/chemistry , Rhamnose/analysis , Xylose/analysisABSTRACT
Hymenaea courbaril (Caesalpiniace), especie ampliamente diseminada en Venezuela, produce una goma clara y soluble en la semilla. El contenido de fibra dietética de la goma (60,7%) se usó como criterio para la formulación de un pan integral en la dieta para pacientes con dislipidemia. Se determinó la composición proximal del pan integral. La aceptabilidad del producto se evaluó por una prueba de comparación y por una escala hedónica. El diseño experimental, se hizo con una muestra de 30 voluntarios masculinos que presentaban dislipidemia. Se dividieron en dos grupos: el grupo A, se alimentó con una modificación de la dieta, que contenía un pan preparado con goma de H. courbaril, y el grupo B, recibió la dieta, sin la goma, con base en las recomendaciones de la Asociación Americana de Dietética (Control). Ambos grupos se mantuvieron en sus respectivas dietas durante 6 semanas. El perfil lipídico, se determinó en cada paciente, antes de iniciar la dieta y después del período señalado. El pan formulado, contenía 17,60% de proteínas; 1,19% de grasa y 0,97% de fibra cruda, de conformidad con lo establecido por las normas COVENIN. El Test de par de preferencia, demostró la mayor aceptación por el pan preparado con una concentración de goma al 7,0%, y un bajo contenido de grasa. Se produjo una disminución significativa en la concentración de triacilglicéridos y VLDL-colesterol en el grupo A. Estos hallazgos sugieren un posible uso de la goma de H. courbaril, como una modificación de la dieta, para pacientes con dislipidemia.
The seeds of Hymenaea courbaril (Caesalpiniace), a species widely disseminated in Venezuela, produce a clear and soluble gum. The dietetic fiber content (60.7%) of the gum was used as a good criterion for the formulation of integral bread in a diet for dyslipidemia patients. The proximal composition of the integral bread was determined. The product acceptability evaluation was done by a comparison test and by a hedonic scale. The experimental design was carried out with a total of 30 male volunteers with dyslipidemia. They were divided into two groups: Group A was fed with a modified diet, which included bread prepared with the H. courbaril gum; and Group B received the same diet without the gum, based on the American Dietetic Association recommendations. Both groups were maintained on their respective diets for six weeks. The lipid profile was determined in each patient, before starting the diets and after the specified period. The bread formula contained 17.60% protein, 1.19% fat and 0.97% crude fiber, in accordance with standards established by COVENIN. The paired preference test showed grater acceptance of the bread prepared with a gum concentration of 7% and low fat content. Significant decreases in the concentrations of triacylglycerol and VLDL-cholesterol were observed in Group A. These findings suggest a possible use of the H. courbaril gum, as a diet modifier for dyslipidemic patients.
Subject(s)
Adult , Humans , Male , Middle Aged , Bread , Cholesterol/blood , Dyslipidemias/blood , Dyslipidemias/diet therapy , Food, Formulated , Hymenaea , Triglycerides/blood , Severity of Illness IndexABSTRACT
El desarrollo de las levaduras del género Malassezia requiere condiciones especiales, estos hongos que producen afecciones en la piel, son generalmente cultivados en el medio Dixon. Se ensayaron los exudados gomosos de Spondias dulcis y Spondias mombin como sustratos para Malassezia furfur. Se evaluó también la producción de lipasa. Se determinó la cinética de crecimiento a un determinado intervalo de tiempo (0-168h), y a diferente concentración (0,5; 1%) y pH (4,5; 6,0). La biomasa obtenida para la levadura probada demostró que los sustratos preparados con los exudados gomosos son adecuados para su desarrollo. La mayor actividad de lipasa extracelular se observó al tiempo inicial de estudio (18h) en ambos sustratos, en las condiciones usadas: concentración (0,5 y 1%) y pH(4,5 y 6,0). Estas especies botánicas, ampliamente localizadas en Venezuela, especialmente en los Estados Zulia y Falcón, producen abundante goma. Este hecho, y los resultados obtenidos podrían ser útiles en la obtención de un nuevo sustrato, que pueda competir con el medio Dixon para el aislamiento y la caracterización de especies de Malassezia, y para la producción de lipasa
The development of genus Malassezia yeasts requires special conditions. This fungus, which produces skin diseases, is generally cultivated in the Dixon medium. Gum exudates from Spondias dulcis and Spondias mombin were tested as substrates for Malassezia furfur. Lipase production was also evaluated. The growth kinetic was determined for a given time range (0-168h) at different concentrations (0.5; 1%) and pH levels (4.5; 6.0). The biomass obtained for the tested yeast showed that substrates prepared with S. dulcis and S.mombin gum exudates are suitable for its development. The highest extracellular lipase activity was observed at 18h on both substrates at given concentrations (0.5; 1%) and pH (4.5; 6.0). These botanical species, widely located in Venezuela, especially in the States of Zulia and Falcon, yield abundant gum. Findings may be useful for obtaining new substrates that could compete with the Dixon medium for isolation and characterization of Malassezia species and for lipase production
Subject(s)
Crop Production , Anacardiaceae , Microbiological Techniques/methods , Malassezia/classification , Malassezia/growth & developmentABSTRACT
Assessment of airway wall remodeling in asthma is difficult in vivo. The thickness of deposited extracellular matrix proteins below the epithelium, the reticular basement membrane, can be assessed by bronchial biopsy of proximal airways. The aim of this study was to determine the relationship between the thickness of the reticular basement membrane in a sample equivalent to a central airway biopsy and the dimensions of the airway wall measured on transverse sections of both central and peripheral airways. Large and small cartilaginous and membranous airways from persons who had died from asthma (fatal asthma, n = 5) or from nonrespiratory causes with asthma (nonfatal asthma, n = 5) or without asthma (control subjects, n = 5) were studied. Reticular basement membrane thickness correlated with the percentage of smooth muscle, submucosal mucous gland, and inner wall area (p < 0.05) in large cartilaginous airways, and with inner wall area and area of smooth muscle (p < 0.01) in small cartilaginous airways, but was not related to airway wall dimensions in membranous airways. These findings show that reticular basement membrane thickness of central airways, which may be assessed by endobronchial biopsy, is correlated with airway remodeling in cartilaginous airways but not with airway wall dimensions of membranous airways.
Subject(s)
Asthma/pathology , Bronchi/pathology , Adult , Asthma/mortality , Basement Membrane/pathology , Case-Control Studies , Female , Humans , Male , Middle AgedABSTRACT
Acacia glomerosa, Anterolobium cyclocarpum e Hymenaea courbaril, especies arbóreas ampliamente disemindas en Venezuela producen gomas con buen rendimiento. La mezcla de estas gomas se ensayó, como estabilizante en la preparación de helados de bajo contenido calórico. La viscosidad, el porcentaje de derretido y las propiedades sensoriales fueron determinados. Estas características físico-químicas se compararon con las exhibidas por los productos obtenidos con base en mezcla de gomas comerciales. La mezcla de gomas de las especies estudiadas incrementó la viscocidad del sistema, por lo tanto, favoreció una excelente incorporación y una distribución uniforme del aire; aportó textura y estabilidad durante el almacenamiento; mejoró la capacidad de expansión de la espuma y las propiedades de derretido. Por otra parte, aportó buenas características sensoriales, como la indica el alto puntaje alcanzado; apariencia (7.78), cremosidad (7.62), sabor (8.01) y bajo puntaje en presencia de cristales de hielo (3.06). Este trabajo evidenció la funcionalidad como estabilizante de la mezcla de gomas investigadas en la preparación de helados bajo en calorías.
Acacia glomerosa, Enterolobium cyclocarpum and Hymenaea courbaril, species widely disseminated in Venezuela, South America, produce gum with good yield. The mixture of these gums was tested as stabilizer in the low fat ice cream preparation. Viscosity, overrun, foam expansion, meltdown, shape factor and sensory properties were determined. These quality characteristics were compared with those exhibited by the product obtained with a mixture of commercial gums. The mixture tested provided the suitable viscosity for the ice cream mix with the corresponding overrun and texture. It gave better foaming properties and air incorporation. On the other hand, it was demonstrated the good sensory attributes by the highest score i.e. appearance (7.78), creaminess (7.62), flavor (8.01) and lowest score of iciness (3.06). This work showed good functionality as stabilizer of the mixture of gums investigated in the low fat ice cream preparation.
Subject(s)
Artificially Sweetened Beverages , Gum Arabic , Ice-cold Foods , Disaster Preparedness , Nutritional SciencesABSTRACT
Las levaduras del género Malassezia son hongos que producen afecciones en la piel. El desarrollo de estos microorganismos requiere condiciones especiales. El medio Dixon es generalmente usado para su cultivo. Se ensayo el exudado gomoso de Spondias dulcis como sustrato para Malassezia furfur y Malassezia slooffiae en comparación con el medio Dixon. Se determino la cinética de crecimiento a un determinado rango de tiempo (0-120h), a diferentes concentraciones (1,2 por ciento) y pH (4,0;6,0;7,0). La relativa alta biomasa obtenida para las dos levaduras probadas demostró que el sustrato preparado con el exudado gomoso de S. dulcis es adecuado para su desarrollo. Spondias dulcis especie localizada en Venezuela produce abundante goma. Este hecho, y los resultados obtenidos podría ser útil para preparar un nuevo sustrato que pueda competir con Dixon para el aislamiento y la caracterización de especies de Malassezia.
Malassezia yeasts are fungi that produce skin affections. Growth of these microorganisms requires specific conditions. The Dixon medium has generally been used for their culture and has been tested. The use of Spondias gum as a substrate for Malassezia furfur and Malassezia slooffiae was tried and compared with the Dixon medium. The growth kinetic for a given time range(0-120 h) was determined at different concentrations (1.2 percent) and pH levels (4,0; 6,0;7,0). The relatively high biomass obtained for the two tested yeasts demonstrated that the substrate prepared with S. dulcis gum exudate is suitable for their growth. Spondias dulcis, a species located in Venezuela, yields abundant gum. This fact and the results discussed above indicate that it could be used to prepare a substrate that could compete with Dixon for isolating and characterizing the Malassezia species.
Subject(s)
Anacardiaceae , Malassezia , Skin Diseases, Infectious , Substrate CyclingABSTRACT
Aspergillus niger ATCC 11414 en un medio de cultivo con base en la goma de Anacardium occidentale mostró las características morfológicas (macro-y microscópicas) que permiten su identificación. Se estudiaron varias condiciones de crecimiento en comparación con el medio de referencia Czapeck Dox Agar. El mejor crecimiento del hongo, observado en pH 4,5 y 6,2 y en presencia de iones magnesio, se seleccionó para estudiar la interacción hongo-sustrato, la cual se demostró por la actividad enzimática. La producción de a-D- galactosidasa, está de acuerdo con la presencia de a-D-Galp-(1-6)- Galp en las ramificaciones de la estructura de la goma de A. occidentale y sugiere que la galactosa es usada por el hongo como fuente de carbono. Los resultados muestran que el medio con base en la goma de A. occidentale es adecuado para el crecimiento de A. niger y podría ser útil en aplicación biotecnológica.
Subject(s)
alpha-Galactosidase , Anacardium , Aspergillus niger/physiology , Culture Media/analysisABSTRACT
Enterolobium cyclocarpum (Mimosaceae), especie localizada en Venezuela, produce goma con excelentes características físicio-químicas y alto rendimiento. Se evaluó la funcionalidad de esta goma como aditivo en la preparación de yogurt líquido semi-descremado. Cinco tratamientos fueron aplicados, control (sin goma) y otros a diferentes concentraciones de goma (0,05; 0,10; 0,15; 0,20 por ciento). Las características físico-químicas del producto (grasa, sólidos no grasos, acidez láctica, pH, viscosidad, sinéresis) y las propiedades sensoriales fueron investigadas. Se aplicó un análisis estadístico (ANOVA). El producto, obtenido con la mayor concentración de goma (0,20 por ciento) difiere estadísticamente (P<0,05) de aquellos obtenidos a las menores concentraciones de goma y del tratamiento control (sin goma). La goma ensayada (0,20 por ciento) proporcionó la viscosidad adecuada al yogurt, con bajo fenómeno de sinéresis y buena textura. Además, el producto exhibió los mejores atributos sensoriales, como lo indica el alto puntaje alcanzado: apariencia (6,98), sabor (7,12) textura (7,18) y aceptación (7,48). Estos resultados muestran una buena funcionalidad de la goma de E.cyclocarpum en la preparación de yogurt líquido semi-descremado
Subject(s)
Food Additives , Rubber , Viscosity , Yogurt , Food Analysis , VenezuelaABSTRACT
Se realizaron estudios morfológicos de las siguientes especies de hongos: Aspergillus flavus, Microsporum canis, Epidermophyton floccosum, Curvularia lunata, Cladosporium carrionii, Nattrassia mangífera (Edo. Scytalidium), Sporothrix schenckii y Rhizopus oligosporus, pertenecientes a las familias Mucedinaceae, Dematiaceae y Mucocaceae, en un medio preparado con el exudado gomoso de Laguncularia racemosa (magle blanco). Este polímero nativo está constituido por galactosa, arabinosa, ramnosa, acidos y urónicos y proteinas y presenta como micronutrientes nitrogeno, calcio y magnesio. La búsqueda de un medio de cultivo económico fue el criterio para la evaluación de un medio preparado con exudado gomoso (4 por ciento) y agar (1,5 por ciento). Los resultados obtenidos demostraron que el exudado gomoso agar (EGA) permite la identificación adecuada de las especies estudiadas y puede ser sustituido del medio Subouraud, ya que la preparación del mismo se basa en un producto natural nativo, de fácil obtención y económico
Subject(s)
Humans , Male , Female , Culture Media , Exudates and Transudates , Fungi/classification , Fungi/pathogenicityABSTRACT
Se presentan los resultados de un estudio de prevalencia de hipertensión arterial en la población vinculada laboralmente a la Universidad de Antioquia, Medellín, Colombia. Se estudiaron 1581 personas, 61.73 por ciento del total de la población, encontrándose una prevalencia general de 17.07 por ciento, considerando como hipertensos a aquellos individuos con cifras mayores o iguales a 160 mmHg de presión sistólica y 90 mmHg de presión diastólica. La frecuencia de hipertensión arterial fue mayor para hombres 20.06 por ciento, siendo la diferencia en relación con las mujeres 13.13 por ciento estadísticamente significativa, p=0,00011. Se encontró diferencia estadísticamente significativa entre la hipertensión arterial y edad, sexo, estado civil, tipo y tiempo de vinculación, tiempo de consumo de anticonceptivos, obesidad, antecedentes familiares por ambas líneas paternas y hermanos hipertensos. En cuanto al consumo de cigarrillo se encontró más prevalencia entre los ex fumadores.
Subject(s)
Vascular Diseases , Prevalence , Hypertension , Pressure , Blood PressureABSTRACT
S.schenckii y Cladosporium carrionii, hongos patógenos, se cultivaron a 20ºC por 11 días en medios a base de los exudados gomosos nativos de Cedrela odorada y Cercidium praecox. El aislamiento y la identificación de esos hongos se llevó a cabo usando la metodología clásica; la determinanción de la biomasa y la curva de crecimiento de S.schenckii fue realizada en los sustratos antes mencionados. La composición de azúcares de los exudados gomosos usados mostró presencia de varios monosacáridos, los cuales podrían ser usadas por los hongos como fuente de carbono y energía. Los resultados obtenidos en los medios de cultivo estudiados, con base en los exudados gomosos, son comparables a los observados en Sabouraud. Los hongos estudiados mostraron sus características inequívocas. Este estudio evidenció que los medios de cultivo con base en exudados gomosos son substratos económicos no convencionales, muy útiles para aislar y caracterizar los hongos S.schenckii y C.carrionii