Diagnostic Performance of Muscle Echo Intensity and Fractal Dimension for the Detection of Frailty Phenotype.

To determine the relationship between muscle echo intensity (EI) and fractal dimension (FD), and the diagnostic performance of both ultrasound parameters for the identification of frailty phenotype. A retrospective interpretation of ultrasound scans from a previous cohort (November 2014-February 2015) was performed. The sample included healthy participants <60 years old, and participants ≥60 divided into robust, pre-frail, and frail groups according to Fried frailty criteria. A region of interest of the rectus femoris from the ultrasound scan was segmented, and histogram function was applied to obtain EI. For fractal analysis, images were processed using two-dimensional box-counting techniques to calculate FD. Statistical analyses were performed with diagnostic performance tests. A total of 102 participants (mean age 63 ± 16, 57 men) were evaluated. Muscle fractal dimension correlated with EI (r = .38, p < .01) and showed different pattern in the scatter plots when participants were grouped by non-frail (control + robust) and frail (pre-frail + frail). The diagnostic accuracy for EI to categorize frailty was of 0.69 (95%CI: 0.59-0.78, p = .001), with high intra-rater (ICC: 0.98, 95%CI: 0.98-0.99); p < .001) and inter-rater (ICC: 0.89, 95%CI: 0.75-0.95; p < .001) reliability and low measurement error for both parameters (EI: -0.18, LOA95%: -10.8 to 10.5; FD: 0.00, LOA95%: -0.09 to 0.10) in arbitrary units. The ROC curve combining both parameters was not better than EI alone (p = .18). Muscle FD correlated with EI and showed different patterns according to frailty phenotype, with EI outperforming FD as a possible diagnostic tool for frailty.

COVID-19 Infection Process in Italy and Spain: Are Data Talking? Evidence From ARMA and Vector Autoregression Models.

COVID-19 (coronavirus disease 2019) has spread successfully worldwide in a matter of weeks. After the example of China, all the affected countries are taking hard-confinement measures to control the infection and to gain some time to reduce the significant amount of cases that arrive at the hospital. Although the measures in China reduced the percentages of new cases, this is not seen in other countries that have taken similar measures, such as Italy and Spain. After the first weeks, the worry was whether or not the healthcare system would collapse rather than its response to the patient's needs who are infected and require hospitalization. Using China as a mirror of what could happen in our countries and with the data available, we calculated a model that forecasts the peak of the curve of infection, hospitalization, and ICU bed numbers. We aimed to review the patterns of spread of the virus in the two countries and their regions, looking for similarities that reflect the existence of a typical path in this expansive virulence and the effects of the intervention of the authorities with drastic isolation measures, to contain the outbreak. A model based on Autorregressive and moving average models (ARMA) methodology and including Chinese disease pattern as a proxy, predicts the contagious pattern robustly. Based on the prediction, the hospitalization and intensive care unit (ICU) requirements were also calculated. Results suggest a reduction in the speed of contagion during April in both countries, earlier in Spain than in Italy. The forecast advanced a significant increase in the ICU needs for Spain surpassing 8,000 units by the end of April, but for Italy, ICU needs would decrease in the same period, according to the model. We present the following predictions to inform political leaders because they have the responsibility to maintain the national health systems away from collapsing. We are confident these data could help them into decision-taking and place the capitals (from hospital beds to human resources) into the right place.