[Mobile applications in alzheimer's disease. A systematic review of the literature]. / Aplicaciones móviles en la enfermedad de Alzheimer. Una revisión sistemática de la literatura.

INTRODUCTION: New treatment options are emerging to treat Alzheimer's disease (AE) within the field of smartphone technologies. OBJECTIVE: To carry out a systematic review of the literature on the use of mobile applications in AE and to review the app markets in order to extract the main apps, with a view to classifying the describing them in the context of AE. MATERIAL AND METHODS: A systematic review was carried out from 2000 until 2018 on apps for AE. At the same time, a search for mobile applications was conducted in the main mobile application markets. RESULTS: A total of 294 mobile applications were found, which were classified as follows: 178 with potential utility for AE and 116 with a specific design for AE (73 information apps, 8 assessment apps, 31 treatment apps, 3 information and assessment and one assessment and treatment app). CONCLUSIONS: There are multiple apps with potential utility or a specific design for AE. However, the limited number of scientific articles and their poor quality make it impossible to generalise their use. Consequently, future research is needed by health agencies in the context of AE.

Aplicaciones móviles en la enfermedad de Alzheimer. Una revisión sistemática de la literatura / Mobile applications in alzheimer's disease. A systematic review of the literature

INTRODUCCIÓN: Nuevas alternativas terapéuticas están emergiendo en el ámbito de la tecnología, mediante el uso de smartphones en la enfermedad de Alzheimer (EA). OBJETIVO: Realizar una revisión sistemática de la literatura sobre el uso de app en la EA, así como revisar los mercados de app, al objeto de conocer las principales aplicaciones móviles con el fin de clasificarlas y describirlas en el contexto de la EA. Materiales y método: Revisión sistemática de artículos desde el año 2000 hasta el 2018, sobre app relacionadas con la EA. Paralelamente, se llevó a cabo una búsqueda de aplicaciones móviles en los principales mercados de aplicaciones móviles. RESULTADOS: Se hallaron 294 aplicaciones, de las cuales 178 se clasificaron con potencial utilidad en la EA, y 116 con un diseño específico para la EA (73 app de información, 8 de valoración, 31 de tratamiento, 3 de información y valoración y una app de valoración y tratamiento). CONCLUSIONES: Existe un gran número de app con potencial utilidad, así como con diseño específico en el campo de la EA. Sin embargo, el escaso número de artículos científicos y su baja calidad hacen que no se pueda generalizar su uso. Por todo esto, son necesarias futuras investigaciones de regulación promovidas por los organismos sanitarios en el contexto de la EA

INTRODUCTION: New treatment options are emerging to treat Alzheimer's disease (AE) within the field of smartphone technologies. OBJECTIVE: To carry out a systematic review of the literature on the use of mobile applications in AE and to review the app markets in order to extract the main apps, with a view to classifying the describing them in the context of AE. MATERIAL AND METHODS: A systematic review was carried out from 2000 until 2018 on apps for AE. At the same time, a search for mobile applications was conducted in the main mobile application markets. RESULTS: A total of 294 mobile applications were found, which were classified as follows: 178 with potential utility for AE and 116 with a specific design for AE (73 information apps, 8 assessment apps, 31 treatment apps, 3 information and assessment and one assessment and treatment app). CONCLUSIONS: There are multiple apps with potential utility or a specific design for AE. However, the limited number of scientific articles and their poor quality make it impossible to generalise their use. Consequently, future research is needed by health agencies in the context of AE

Novel aqueous chitosan-based dispersions as efficient drug delivery systems for topical use. Rheological, textural and release studies.

The use of a novel cross-linked thiolated chitosan (CTS) was investigated as the main component of aqueous dispersions (at 1% and 3% w/v) for topical drug delivery systems. The nonionic theophiline (Th) and the cationic diltiazem(.)HCl (Dt) (at 0.5% w/v concentration) were used as model drugs. All aqueous dispersions behaved as viscoelastic fluids. The CTS 1% dispersions showed predominance of viscous component and low viscosity. However, in the CTS 3% dispersions, both the elastic component and high viscosities prevailed. So, texture parameters improved from CTS 1% to 3% dispersions and CTS 3%-Dt showed greater cohesion and adhesion than CTS 3%-Th, but always below CTS alone. All dispersions showed a Fickian diffusion mechanism. Despite release profiles of both drugs almost fully overlapped at 1% CTS, diffusion coefficients confirmed Dt released faster than Th at 3% CTS. The rheological behavior and the chemical nature of the drugs explained these results.

Resolución espontánea de paraparesia por hematoma epidural dorsolumbar asociado a anestesia subaracnoidea y analgesia postoperatoria mediante catéter epidural / Spontaneous resolution of a paraparesis due to a dorsolumbar epidural haematoma associated with subarachnoid anaesthesia and postoperative analgesia using an epidural catheter

El hematoma epidural espinal secundario a anestesia neuroaxial es una complicación grave, aunque poco frecuente. La mayoría de los casos se asocia a tratamiento anticoagulante o circunstancias que favorezcan el sangrado. Por las graves secuelas secundarias a la compresión medular se considera una urgencia quirúrgica, siendo crucial en su pronóstico la precocidad en la descompresión medular. Presentamos un caso de hematoma epidural espinal dorsolumbar asociado a anestesia intradural y analgesia epidural en una paciente con tromboprofilaxis con heparina de bajo peso molecular, con recuperación espontánea con tratamiento conservador(AU)

Spinal epidural haematoma after neuroaxial anaesthesia is a rare but serious complication. Most cases are attributed to anticoagulant therapy or bleeding tendency. It presents as an acute spinal cord compression and usually requires emergency surgical decompression. The interval between the onset of clinical signs and surgical evacuation is very important, influencing the neurological prognosis. We report a case of a spinal epidural haematoma after epidural analgesia in a patient who was treated with low molecular weight heparin for thrombo-prophylaxis in the perioperative period. In some cases, such as the one reported here, good neurological recovery can be achieved with conservative management(AU)

[Spontaneous resolution of a paraparesis due to a dorsolumbar epidural haematoma associated with subarachnoid anaesthesia and postoperative analgesia using an epidural catheter]. / Resolución espontánea de paraparesia por hematoma epidural dorsolumbar asociado a anestesia subaracnoidea y analgesia postoperatoria mediante catéter epidural.

Spinal epidural haematoma after neuroaxial anaesthesia is a rare but serious complication. Most cases are attributed to anticoagulant therapy or bleeding tendency. It presents as an acute spinal cord compression and usually requires emergency surgical decompression. The interval between the onset of clinical signs and surgical evacuation is very important, influencing the neurological prognosis. We report a case of a spinal epidural haematoma after epidural analgesia in a patient who was treated with low molecular weight heparin for thrombo-prophylaxis in the perioperative period. In some cases, such as the one reported here, good neurological recovery can be achieved with conservative management.

Análisis morfométrico y mineralógico de 14 muestras de talco usado para pleurodesis en distintos países de europayamérica* / Morphometric and mineralogical análisis of 14 samples of talc used for pleurodesis in several european and american countries

FUNDAMENTO DEL ESTUDIO: A pesar de que el talco es elagente más utilizado para pleurodesis, hay controversia respecto asu uso a raíz de la publicación de algunas complicaciones relacionadascon el mismo. Bajo la hipótesis de que diferencias en tamañoy composición pudieran asociarse a distinta incidencia de complicaciones,hemos investigado las características físico-químicas demuestras de talco procedentes de varios países de Europa y América.MÉTODOS: Hemos llevado a cabo un estudio morfométrico ymineralógico de 14 talcos diferentes (9 de Brasil, 3 de Francia, 1de España y 1 de USA). El estudio morfométrico se hizo mediantefotografía de microscopía óptica por dos observadores independientesde nuestro grupo, y mediante microscopía electrónica debarrido, y la composición químico-mineralógica se estudiómediante difracción de rayos X y fluorescencia (Instituto de Cienciade Materiales de Sevilla).RESULTADOS: El diámetro menor de las partículas oscilóentre 3,3 μm (Brasil-4) y 18,5 μm (Brasil-2). El porcentaje de partículasmenores de 10 μm osciló entre 10% (Steritalc® aerosol) y97% (Brasil-4). Respecto a la composición química, encontramostalco como componente mayoritario en ocho muestras (Brasil-2, 6y 7, Francia, España y USA); en el resto el componente mayoritariofue dolomita o flogopita, y en menor porcentaje cuarzo y calcita.CONCLUSIÓN: Observamos gran diversidad en cuanto amorfometría y composición química entre las distintas muestras detalco estudiadas; esto nos lleva a recomendar un estricto análisisdel agente esclerosante, no sólo en relación al tamaño de sus partículassino también en relación a su composición química

AIMS OF THE STUDY: Despite talc being the most commonlysclerosant used for pleurodesis, the ocassional reports ofcomplications occurred after its intrapleural instillation have provokedsome controversy. We hypothezised that differences in particlesize and composition might be associated to incidence of complications,and subsequently investigated the physico-chemicalcharacteristics of talc samples from several European and Americancountries.METHODS: A morphometric and mineralogical study wascarried out on 14 samples of talc obtained from different countries(nine from Brazil, three from France, one from Spain and onefrom the U.S.). Morphometry was performed separately by twoindependent observers through computerized image analysis ofphotographs taken by using optical microscopy under polarizedlight. Scan electron microscopy was used also, and X-rays difractionand fluorescence was used for chemical analysis (Instituto deCiencia de Materiales at Sevilla, Spain).RESULTS: The average minor particle diameter ranged from3,3 μm (Brazilian talc #4) and 18,5 μm (Brazilian talc #2). The percentageof particles smaller than 10 μm ranged between 10% (Steritalc® spray French talc) and 97% (Brazilian talc #4). Regardingchemical composition, we found true talc as the main componentonly in eight samples (Brazilian #2, 6 and 7, plus all French, Spanishand North American samples). Dolomite or flogopite were themain components in the remaining samples, and quartz and calcitewere also found as minoritary components in some cases.Conclusion: We have observed wide differences regardingmorphometry and chemical composition of the talcs studied. Therefore,a strict control of this sclerosant agent is advisable, not onlyregarding the size of particles, but also its chemical composition

Tratamiento digital de retinografías para detectar automáticamente lesiones asociadas con la retinopatía diabética / Retinal image analysis to detect lesions associated with diabetic retinopathy

Objetivos: La retinopatía diabética es la causa más frecuente de ceguera en la población activa de los países industrializados. Para retrasar su evolución y evitar así la pérdida de visión, el mejor método de prevención es un seguimiento regular médico. Para ello, se utilizan las imágenes de fondo de ojo o retinografías. Sin embargo, debido al gran número de pacientes, se requiere mucho esfuerzo y tiempo para revisar todas las imágenes. El objetivo de este trabajo es desarrollar un método automático que ayude a detectar los primeros síntomas de la retinopatía diabética mediante un tratamiento digital de las retinografías. Métodos: El método expuesto en este artículo se centra exclusivamente en la detección de exudados duros, uno de los primeros síntomas de la retinopatía diabética. Su localización automática se basa en su color, usando clasificación estadística, y sus bordes definidos, mediante un filtro detector de bordes. Resultados: Aplicando el algoritmo propuesto a 20 retinografías de distinta calidad, iluminación y color, obtuvimos una sensibilidad de 79,62% con una media de 3 falsos positivos por imagen. El número de falso negativos aumentaba sobre todo cuando los exudados aparecían muy cerca de los vasos sanguíneos. Conclusión: El objetivo final de este proyecto es automatizar el seguimiento médico de la retinopatía diabética mediante el tratamiento digital de las retinografias de los pacientes. En esta primera etapa, se ha desarrollado una herramienta que permite la detección automática de una lesión asociada a esta enfermedad: los exudados duros. En futuros trabajos se pretende mejorar los resultados obtenidos y continuar con la localización de otras lesiones(AU)

Purpose: Diabetic retinopathy is a leading cause of vision loss in developed countries. Regular diabetic retinal eye screenings are needed to detect early signs of retinopathy, so that appropriate treatments can be rendered to prevent blindness. Digital imaging is becoming available as a means of screening for diabetic retinopathy. However, with the large number of patients undergoing screenings, medical professionals require a tremendous amount of time and effort in order to analyse and diagnose the fundus photographs. Our aim is to develop an automatic algorithm using digital image analysis for detecting these early lesions from retinal images. Methods: An automatic method to detect hard exudates, a lesion associated with diabetic retinopathy, is proposed. The algorithm is based on their colour, using a statistical classification, and their sharp edges, applying an edge detector, to localise them. Results: A sensitivity of 79.62% with a mean number of 3 false positives per image is obtained in a database of 20 retinal images with variable colour, brightness and quality. It can also be seen that the number of the false negative cases increases when the hard exudates were very close to the vessel tree. Conclusion: The long term goal of the project is to automate the screening for diabetic retinopathy with retinal images. We have described the preliminary development of a tool to provide automatic analysis of digital fundus photographs to localise hard exudates. Future work will address the issue of improving the obtained results and also will focus on detecting other lesions(AU)

[Retinal image analysis to detect lesions associated with diabetic retinopathy]. / Tratamiento digital de retinografías para detectar automáticamente lesiones asociadas con la retinopatía diabética.

PURPOSE: Diabetic retinopathy is a leading cause of vision loss in developed countries. Regular diabetic retinal eye screenings are needed to detect early signs of retinopathy, so that appropriate treatments can be rendered to prevent blindness. Digital imaging is becoming available as a means of screening for diabetic retinopathy. However, with the large number of patients undergoing screenings, medical professionals require a tremendous amount of time and effort in order to analyse and diagnose the fundus photographs. Our aim is to develop an automatic algorithm using digital image analysis for detecting these early lesions from retinal images. METHODS: An automatic method to detect hard exudates, a lesion associated with diabetic retinopathy, is proposed. The algorithm is based on their colour, using a statistical classification, and their sharp edges, applying an edge detector, to localise them. RESULTS: A sensitivity of 79.62% with a mean number of 3 false positives per image is obtained in a database of 20 retinal images with variable colour, brightness and quality. It can also be seen that the number of the false negative cases increases when the hard exudates were very close to the vessel tree. CONCLUSION: The long term goal of the project is to automate the screening for diabetic retinopathy with retinal images. We have described the preliminary development of a tool to provide automatic analysis of digital fundus photographs to localise hard exudates. Future work will address the issue of improving the obtained results and also will focus on detecting other lesions.

[Reproducibility of the technique for measuring nitric oxide in exhaled air in healthy subjects]. / Estudio de la reproducibilidad de la técnica de medición de óxido nítrico en aire exhalado en sujetos sanos.

UNLABELLED: Exhaled nitric oxide (NO) has become established as the principal non-invasive marker of airway inflammation. Exhaled NO levels reported in the literature vary greatly, with differences sometimes attributable to measurement technique. OBJECTIVE: To determine the reproducibility of the technique used by our department to measure exhaled NO and to know whether results vary with diet and patient characteristics. METHOD: We studied 20 healthy subjects (10 men and 10 women; mean age 28.21 years). Exhaled NO was measured when the patient was fasting(N1), 30 minutes after intake of vegetables (N2) and 30 minutes after intake of meat/fish (N3). For each measure N1, N2 and N3 we took the average of three consecutive measurements separated by 10 minutes. Exhaled NO was assessed by controlled-flow chemoluminescence after adjusting for trapped air and after generating pressure in the oral cavity that was sufficient to close the soft palate(Eco Physics CLD 77 AM analyzer). RESULTS: The mean concentration was 3.40 1.30 ppb for N1, 4.03 1.00 ppb for N2 and 3.71 1.05 ppb for N3. The differences between measurements were not statistically significant(p > 0.05). Nor were differences between the sets of three measurements significant. The mean concentration was 3.13 0.41 ppb for women and 3.72 0.31 ppb for men (ns). No significant differences were related to body mass index 25 (n = 15) or > 25 (n = 5). CONCLUSIONS: The technique our department uses for measuring exhaled NO is reproducible and differences are unrelated to food intake, sex or body mass index.

Estudio de la reproducibilidad de la técnica de medición de óxido nítrico en aire exhalado en sujetos sanos / Reproducibility of a technique for measuring nitric oxide in exhaled air in healthy subjects

El óxido nítrico exhalado (NOe) ha quedado establecido como el primer marcador no invasivo de inflamación en las vías aéreas. Las cifras de NOe publicadas ponen de manifiesto una gran variabilidad, y en ocasiones estas diferencias son debidas a la técnica de medición empleada.OBJETIVO: Determinar la reproducibilidad de la técnica utilizada por nuestro grupo y si la concentración de NOe obtenida está sometida a variaciones dependientes de características antropométricas y dieta.MÉTODO: Estudiamos a 20 sujetos sanos (10 varones y 10 mujeres) con una edad media de 28,21 años. A todos se les realizaron mediciones seriadas de NOe en ayunas (N1), 30 min tras la ingestión de verduras (N2) y 30 min tras la ingesta de carne/pescado (N3). Cada valor (N1, N2, N3) era la media aritmética de tres mediciones consecutivas separadas 10 min entre sí. Medimos el NOe por método directo de quimioluminiscencia con flujo controlado descartando el aire del espacio muerto y con generación de presión en cavidad oral suficiente para cerrar el paladar blando (analizador Eco Physics CLD 77AM). RESULTADOS: Obtuvimos una concentración media ñ desviación estándar (DE) para N1 de 3,40 ñ 1,30 ppb; para N2 de 4,03 ñ 1,00 ppb y para N3 de 3,71 ñ 1,05 ppb. Las diferencias observadas entre estas tres determinaciones no fueron estadísticamente significativas (p > 0,05). Las mediciones seriadas (separadas 10 min) realizadas tampoco evidenciaron cambios significativos entre las mismas. Al estudiar la influencia del sexo sobre el NOe, encontramos que en ayunas la concentración media ñ DE en las mujeres era de 3,13 ñ 0,41 ppb y en los varones 3,72 ñ 0,31 ppb sin que estas diferencias fueran significativas. Por último, estudiamos la influencia del índice de masa corporal (IMC) en el NOe, sin encontrar diferencias significativas entre los sujetos con IMC 25 (n = 15) y aquellos con IMC > 25 (n = 5).CONCLUSIONES: La técnica empleada por nuestro grupo es reproducible y las concentraciones obtenidas de NOe son independientes de la dieta, sexo e IMC. (AU)