Validación de la reacción de polimerasa en cadena en tiempo real como herramienta diagnóstica en la aspergilosis asociada a COVID-19 en pacientes hospitalizados en Clínica Dávila de Santiago, Chile, durante los años 2020 y 2021

Introducción: Desde el inicio de la pandemia por COVID-19 se han registrado casos de infecciones de aspergilosis pulmonar asociada a esta infección, la cual tiene características diferentes a la aspergilosis pulmonar clásica y, por lo tanto, han significado un desafío diagnóstico. Objetivo: Validar una reacción de polimerasa en cadena (RPC) en tiempo real (sigla en inglés RT-PCR) comercial, como herramienta diagnóstica alternativa a la técnica de galactomanano (GM) en el diagnóstico de aspergilosis pulmonar asociada a COVID-19 (sigla en inglés CAPA). Pacientes y Método: Se analizaron resultados de RT-PCR de Aspergillus spp y GM en lavado bronco-alveolar (LBA) de 72 pacientes, hospitalizados por COVID-19 de Clínica Dávila entre los años 2020 y 2021. De estos pacientes, 33 presentaron CAPA. Resultados: La RT-PCR de Aspergillus y GM presentaron una correlación positiva (r = 0,6351, valor p < 0,0001). La técnica de RT-PCR presentó una sensibilidad (S), especificidad (E), valor predictor positivo (VPP) y valor predictor negativo (VPN) de 100, 44, 66 y 100%, respectivamente, mientras que en GM fueron de 64, 89, 84 y 73%, respectivamente para LBA. Al utilizar ambas técnicas en combinación se obtuvo una S, E, VPP y VPN de 100, 82, 88 y 100%, respectivamente. Conclusión: Este estudio concluyó que usar una técnica de RT-PCR de Aspergillus y GM en conjunto en LBA mejoraron los parámetros de desempeño de ambas técnicas usadas de manera individual para diagnosticar CAPA. Se requieren más estudios para evaluar el desempeño de técnicas combinadas en otros tipos de aspergilosis.

Background: Since the beginning of the COVID-19 pandemic, there have been cases of pulmonary aspergillosis infections associated with this infection, which has different characteristics from classical pulmonary aspergillosis and therefore, have been diagnostic challenges. Aim: To validate a commercial real-time PCR (RT-PCR) method as an alternative diagnostic tool to the galactomannan (GM) technique in the diagnosis of COVID-19-associated pulmonary aspergillosis (CAPA). Methods: Results of RT-PCR of Aspergillus spp and GM in broncho-alveolar lavage (BAL) of 72 patients hospitalized for COVID-19 at Clínica Dávila between 2020 and 2021 were analyzed. Of these patients, 33 presented CAPA. Results: The RT-PCR for Aspergillus and GM showed a positive correlation (r = 0.6351, p-value < 0.0001). The RT-PCR for Aspergillus technique presented a sensitivity (S), specificity (S), positive predictive value (PPV) and negative predictive value (NPV) of 100, 44, 66 and 100% respectively, while the GM technique presented 64, 89, 84 and 73%, respectively for BAL. Using both techniques in combination a S, E, PPV and NPV of 100, 82, 88 and 100% were obtained respectively. Conclusion: This study concluded that using RT-PCR and GM techniques in combination in BAL improved the performance parameters of both techniques from those used individually to diagnose CAPA. Further studies are required to evaluate the performance of combined techniques in other aspergillosis focus.

Human papillomavirus infection and lung adenocarcinoma: special benefit is observed in patients treated with immune checkpoint inhibitors.

BACKGROUND: Human papilloma virus (HPV) has been associated with the development and modulation of response in a series of neoplasms. In the case of lung adenocarcinoma, its role in etiology and pathogenesis is still controversial. Considering that this infection brings foreign epitopes, it could be of prognostic significance in patients with lung adenocarcinoma treated with immunotherapy. METHODS: In a retrospective cohort study we evaluated the presence of HPV genomic material in lung adenocarcinoma primary lesions with the INNO-LiPA platform. Viral replication was also evaluated by detecting the presence of oncoprotein E6/E7 messenger RNA (mRNA) by quantitative RT-PCR. To confirm possible hypotheses regarding viral oncogenesis, vascular endothelial growth factor (VEGF) and hypoxia-inducible factor 1 (HIF1) were evaluated with stromal fibrosis and immunoscore. RESULTS: A total of 133 patients were included in the analysis, of whom 34 tested positive for HPV, reaching an estimated prevalence of 25.6% [95% confidence interval (CI) 18.2% to 32.9%]. E6/7 mRNA was identified in 28 out of the 34 previously positive cases (82.3%). In immune checkpoint inhibitor (ICI)-treated patients, the median overall survival reached 22.3 months [95% CI 19.4 months- not reached (NR)] for HPV-negative and was not reached in HPV-positive (HPV+) ones (95% CI 27.7-NR; P = 0.008). With regard to progression-free survival, HPV- patients reached a median of 9.2 months (95% CI 7.9-11.2 months) compared to 14.3 months (95% CI 13.8-16.4 months) when HPV was positive (P = 0.001). The overall response rate for HPV+ patients yielded 82.4% compared to 47.1% in negative ones. No differences regarding programmed death-ligand 1, VEGF, HIF1, stromal fibrosis, or immunoscore were identified. CONCLUSIONS: In patients with HPV+ lung adenocarcinoma, a significant benefit in overall response and survival outcomes is observed.

Riesgo cardiometabólico en niños con obesidad grave / Cardiometabolic risk in children with severe obesity

Introducción: la obesidad grave ha tenido un mayor aumento que la obesidad no grave en los escolares chilenos durante los últimos años. Desconocemos si el punto de corte actualmente utilizado para definir la obesidad grave (IMC ≥ + 3 DE, curvas OMS-2007) se asocia a un mayor daño biológico en nuestra población pediátrica. Objetivo: describir y comparar el riesgo cardiometabólico en escolares con obesidad grave y no grave. Método: se realizó un análisis secundario de una muestra de 3325 escolares en los que se estudiaron los factores de riesgo cardiometabólico. Se comparó la prevalencia de estos factores en los que presentaban obesidad según fuera esta grave o no, calculándose los OR respectivos. Resultados: de los 589 sujetos con obesidad, con una media de edad de 11,4 ± 0,98 años, el 46 % eran de género femenino y el 11,5 % presentaban obesidad grave, con mayor prevalencia de la mayoría de los factores estudiados y sin diferencias en cuanto a antecedentes parentales de enfermedad crónica u obesidad, educación de los padres y actividad física del niño. Los niños con obesidad grave tenían un mayor riesgo de obesidad central (OR: 12,9), resistencia insulínica (OR: 3,2), HTA (OR: 2,67) y síndrome metabólico (OR:1,92). Conclusión: esta definición de obesidad grave en la niñez favorece la identificación de los niños con mayor comorbilidad cardiometabólica, lo cual permite focalizar los esfuerzos de prevención secundaria y su tratamiento más oportuno (AU)

Introduction: severe obesity has had a greater increase than non-severe obesity in Chilean schoolchildren during the last years. We do not know whether the cut-off point currently used to define severe obesity in children (BMI ≥ + 3 DE, WHO-2007 curves) is associated with a greater biological risk in our population. Objective: to describe and compare cardiometabolic risk in schoolchildren with severe vs. non-severe obesity. Methods: a secondary analysis of a sample of 3,325 schoolchildren was performed, in which cardiometabolic risk factors were studied. The prevalence of these was compared in the subsample of 589 schoolchildren with obesity according to whether it was severe or not, and the respective ORs were calculated. Results: mean age was 11.4 ± 0.98 years, 46 % were girls, and 11.5 % of the sample had severe obesity, with a higher prevalence of most of the factors studied and no differences in chronic disease, obesity or education in parents, or physical activity of the child. The risk of those with severe obesity for central obesity, insulin resistance, high blood pressure, and metabolic syndrome reached an OR of 12.9, 3.2, 2.67, and 1.92, respectively, as compared to those with non-severe obesity. Conclusion: this definition of severe obesity in childhood favors the identification of children with higher cardiometabolic comorbidity, which allows to focus the efforts of secondary prevention and its most timely treatment (AU)

Comparing Articaine brands: A randomized non-inferiority controlled trial.

INTRODUCTION: The substitution of reference drugs for similar, new or existing drugs in the market is a dilemma present in daily dental procedures. In order to decide whether or not to adopt a new drug in relation to the reference, a clinical trial can provide the necessary evidence. METHODS: A total of 179 healthy volunteers (18-25 years) requiring extraction of mandibular third molars completed the study. Subjects were randomized into 4 groups: right, left, Arteek-SP and Septanest. Allocations consisted of 4% Articaine hydrochloride with 1:10000 epinephrine. The primary aim of this randomized controlled trial was to determine whether the test drug Arteek-SP was noninferior by a margin of 10% in the proportion of patients with total absence of pain, compared to the reference drug Septanest in the extraction of mandibular third molars using inferior alveolar nerve blocks. Secondary outcomes included, hemodynamic parameters, volume (mL), pain scores assessed during one visit and reported postoperative discomfort assessed during 8 days. Noninferiority was declared if total absence of pain for both groups was equal to 0.9, with a significance level of 5% (P < 0.05) and power at 90% (ß = 0.1) at 95% confidence level. RESULTS: Arteek-SP was applied during the first surgery to 90 volunteers (50.28%) and Septanest was applied to 89 subjects (49.72%). Less than 10% difference was identified, in the proportion of patients with total absence of tooth pain P < 0.05 and in the gum P < 0.1, at 95% CI, when Arteek-SP was applied first in comparison with Septanest, establishing noninferiority. CONCLUSION: The clinical performance of the test drug Arteek-SP is noninferior to the reference drug Septanest. They can be considered interchangeable in terms of cost or convenience. REGISTRATION: ClinicalTrials.org, number NCT4166890.

Electronic nicotine delivery systems (ECs) and COVID-19: the perfect storm for young consumers

The COVID-19 pandemic caused a change in our society and put health systems in crisis worldwide. Different risk factors and comorbidities have been found that increase the risk of mortality when acquiring this infection. The use of alternative devices to the cigarette like the electronic cigarettes, the vapers have been studied widely and generators of great controversy since it has been discovered that they also produce different pulmonary affections. When developing the SARS-CoV2 infection, different theories have been generated about the greater predisposition to a worse prognosis of people who use electronic cigarettes; however, the information on this continues in discovery. A group of experts made up of oncologists, infectologists, pulmonologists, and epidemiologists met to review the literature and then generate theories about the impact of electronic cigarettes on SARS-CoV2 infection (AU)

Electronic nicotine delivery systems (ECs) and COVID-19: the perfect storm for young consumers.

The COVID-19 pandemic caused a change in our society and put health systems in crisis worldwide. Different risk factors and comorbidities have been found that increase the risk of mortality when acquiring this infection. The use of alternative devices to the cigarette like the electronic cigarettes, the vapers have been studied widely and generators of great controversy since it has been discovered that they also produce different pulmonary affections. When developing the SARS-CoV2 infection, different theories have been generated about the greater predisposition to a worse prognosis of people who use electronic cigarettes; however, the information on this continues in discovery. A group of experts made up of oncologists, infectologists, pulmonologists, and epidemiologists met to review the literature and then generate theories about the impact of electronic cigarettes on SARS-CoV2 infection.

Expression of key myogenic, fibrogenic and adipogenic genes in Longissimus thoracis and Masseter muscles in cattle.

Adipogenesis, myogenesis and fibrogenesis are related processes that can contribute to meat quality. Therefore, extending the knowledge of these processes would facilitate the identification of molecular markers that predict intramuscular fat accretion. The main purpose of this work, based on previous results, was to further study the expression of key genes related to adipogenic, myogenic, fibrogenic processes and some cytokines in Longissimus thoracis (LT) and Masseter (MS) muscles of Pirenaica and Holstein young bulls. Longissimus thoracis and MS muscles from Pirenaica (n = 4) and Spanish Holstein (n = 4) were sampled for proximate analysis, determination of adipocyte size distribution and expression of key candidate genes. Fat percentage was lower in LT than in MS muscle in Pirenaica young bulls (P = 0.023) and was higher in LT muscle in Holstein than in Pirenaica young bulls (P = 0.007). Gene expression analysis revealed that the mRNA level of myogenic differentiation 1 (MYOD) was higher in LT than in MS muscles in both groups of animals (P < 0.001) and that myostatin (MSTN) expression was also higher in LT than in MS muscle in Holstein bulls (P = 0.001). On the other hand, MSTN and PPARG showed higher expression in LT and MS in Pirenaica young bulls (P = 0.026), while the expression of fatty acid-binding protein 4 (FABP4) was higher in Holstein young bulls, also in both muscles (P < 0.001). The results suggested that the development of intramuscular adipose depot was directly related to the expression of adipogenic genes, such as FABP4, but inversely related to the expression of the cytokine MSTN and the myogenic gene MYOD, genes which showed a muscle-specific expression.

Implantación de programas educativos para prevenir ahogamientos. ¿Qué se puede hacer desde la escuela infantil? / Implementation of educational programs to prevent drowning. What can be done in nursery school?

No disponible

A comprehensive analysis of factors related to carmustine/bevacizumab response in recurrent glioblastoma.

PURPOSE: Patients with recurrent glioblastoma (rGBM) have a poor prognosis, with survival ranging from 25 to 40 weeks. Antiangiogenic agents are widely used, showing a variable response. In this study, we explored the efficacy of carmustine plus bevacizumab (BCNU/Bev) for treating rGBM. METHODS/PATIENTS: In this study, we assessed 59 adult patients with histologically confirmed rGBM who were treated with BCNU/Bev as second-line regimen. The response rate (RR), progression-free survival (PFS) and overall survival (OS) were evaluated according to their molecular expression profile, including CD133 mRNA expression, MGMT methylation (pMGMT), PDGFR amplification, YKL40 mRNA expression, IDH1/2 condition, p53 and EGFRvIII mutation status. RESULTS: Median follow-up was 18.6 months, overall RR to the combination was 56.3%, and median PFS was 9.0 months (95% CI 8.0-9.9). OS from time of diagnosis was 21.0 months (95% CI 13.2-28.7) and from starting BCNU/Bev it was 10.7 months (95% CI 9.5-11.8). IDH1/2 mutations were found in 30.5% of the patients, pMGMT in 55.9% and high CD133 mRNA expression in 57.6%. Factors which positively affected PFS included performance status (p = 0.015), IDH+ (p = 0.05), CD133 mRNA expression (p = 0.009) and pMGMT+ (p = 0.007). OS was positively affected by pMGMT+ (p = 0.05). Meanwhile, YKL40 negatively affected PFS (p = 0.01) and OS (p = 0.0001). Grade ≥ 3 toxicities included hypertension (22%) and fatigue (12%). CONCLUSIONS: BCNU/Bev is a safe and tolerable treatment for rGBM. Patients with MGMT+/IDH+ derive the greatest benefit from the treatment combination in the second-line setting. Nonetheless, high YKL40 expression discourages the use of antiangiogenic therapy.

Evaluación de la corrección angular de la integral velocidad tiempo en ecocardiografía. Estudio piloto / Evaluation of the angular correction of the integral velocity time in echocardiography. Pilot study

Background: Echocardiography has now a pivotal role as a tool for hemodynamic monitoring, particularly in the critically ill. However, the ideal acoustic window for relevant measurements such as the velocity time integral are not always available. We propose to evaluate if angular correction of this variable is accurate in comparison with standard technique. Patients and methods: Adult patients were evaluated in the echocardiography unit during Juny 2017, having velocity time integral measured with angulation and standard technique, with convenience sampling. Analysis included difference, means and correlation between basal results and maximal angulation, in Stata 12. Results: 25 patients were included, mean velocity time integral was 23,01cm and with a mean angulation of 32,56º the integral was 24,27cm, with 5,5% difference, statistically significant, linear correlation had a 0,932 coefficient with R-square of 0,7897. Bland-Altman analysis revealed mean difference -1,256cm and agreement limits of -5,219 to 2,707. Discussion: In this study the result of the velocity time integral with angular correction had a good correlation and acceptable precision compared with non-angled measurements, which could allow its use when the acoustic window is sub-optimal, however, these findings should be replicated in critically ill patients. (AU)

Spectrally resolved helium absorption from the extended atmosphere of a warm Neptune-mass exoplanet.

Stellar heating causes atmospheres of close-in exoplanets to expand and escape. These extended atmospheres are difficult to observe because their main spectral signature-neutral hydrogen at ultraviolet wavelengths-is strongly absorbed by interstellar medium. We report the detection of the near-infrared triplet of neutral helium in the transiting warm Neptune-mass exoplanet HAT-P-11b by using ground-based, high-resolution observations. The helium feature is repeatable over two independent transits, with an average absorption depth of 1.08 ± 0.05%. Interpreting absorption spectra with three-dimensional simulations of the planet's upper atmosphere suggests that it extends beyond 5 planetary radii, with a large-scale height and a helium mass loss rate of ≲3 × 105 grams per second. A net blue-shift of the absorption might be explained by high-altitude winds flowing at 3 kilometers per second from day to night-side.

La calidad percibida y esperada como marketing en la cirugía mayor ambulatoria del área III-IV de la comunidad autónoma de Cantabria / Quality perceived and expected and marketing of ambulatory surgery III-IV area of Cantabria, north of Spain

Justificación: a los requisitos de efectividad y eficiencia se les suma ahora el interés por obtener el valor añadido de la satisfacción del paciente. Obtener la mejora de la calidad percibida y esperada como valoración y marketing en la Cirugía Mayor Ambulatoria (CMA) de la Comunidad Autónoma de Cantabria. Se realiza la valoración del grado de satisfacción percibido y esperado por los pacientes intervenidos por CMA, mediante la evaluación de diferentes áreas como son: accesibilidad y tiempos de espera, grado de información recibida y valoración global del servicio. Se realiza una encuesta de satisfacción en una muestra representativa (7,5% > 5% según los Servicios de Medicina Preventiva) de los pacientes intervenidos por CMA en el área III-IV Sierrallana-Tres Mares durante 2013-2014. La validez se presentó con grado de confianza 1,95 y error 4,5%. La encuesta se realizó vía telefónica, por 7 observadores distintos. El período de consulta fue desde 20 Marzo a 20 Mayo de 2015. Se trata de una muestra de población seleccionada por cumplir criterios de CMA. La calidad percibida positiva es mayoritaria a la esperada en la accesibilidad , tiempos de espera, grado de información recibida y valoración global del servicio. En la actualidad se pretende mejorar esta percepción con el marketing sanitario. En la práctica observamos que los motivos más frecuentes de insatisfacción poco tienen que ver con la efectividad de las intervenciones El estudio del Grado de Satisfacción percibido por los individuos contribuyen enormemente a conocer el marketing y aún más ciertos comportamientos o mecanismos de comportamiento de los individuos

Justification: for the requirements of effectiveness and efficiency are now added interest in obtaining the added value of patient satisfaction. Get improving the perceived and expected quality as valuation and marketing in Ambulatory Surgery (AS) of the Autonomous Community of Cantabria. Assessing the degree of perceived satisfaction is realized and expected by patients operated by AS, by evaluating different areas such as: accessibility and waiting times, degree of information received and overall assessment of the service. A satisfaction survey on a representative sample is performed (7.5%,,> 5% according to the Preventive Medicine Services) of patients operated by AS in the area III-IV Sierrallana-Tres Mares during 2013-2014. The validity was presented with 1.95 confidence level and error 4.5%. The survey was conducted by telephone, for 7 different observers. The consultation period was from March 20 to May 20, 2015. This is a population sample selected to meet criteria AS. The positive perceived quality is majority than expected in accessibility, waiting times, degree of information received and overall assessment of the service. At present it is to improve this perception with health marketing. In practice we see that the most frequent reasons for dissatisfaction have little to do with the effectiveness of interventions The study of the degree of satisfaction perceived by individuals contribute greatly to meet the marketing and even more certain behaviors or mechanisms of behavior of individuals

Bladder transitional cell carcinoma and BK virus in a young kidney transplant recipient.

Kidney transplant recipients have a heightened risk of developing neoplasms. Immunosuppressive treatments decrease the incidence of transplant rejection but increase the risk of infections, including BK virus (BKV). This infection is acquired in childhood and remains latent in the renal and urinary epithelium. In cases of immunodeficiency, BKV has been implicated as a tumor virus, but the role of BKV in cancer is a controversial topic and is difficult to determine. In the tumor cells, it is possible to detect fragments of the viral genome that could alter the control mechanisms of the cell cycle and DNA repair. We report the case of a kidney transplant recipient who developed BKV nephropathy and carcinoma of the bladder, supporting a possible role for BKV in the oncogenic pathway in this clinical setting, but the role of BKV in cancer remains a controversial topic and difficult to determine.

[Double bilateral talocalcaneal and calcaneonavicular coalition in a 15 year-old patient: treatment and results]. / Doble coalición astragalocalcánea y calcaneoescafoidea bilateral en un paciente de 15 años: tratamiento y resultados.

BACKGROUND: We report the case of a male, 15 year-old patient without any remarkable pathologic history, with double talocalcaneal and calcaneonavicular coalition in both feet. He underwent surgery of the left foot due to onset of refractory symptoms after conservative treatment. RESULTS: Both coalitions were resected and pedal muscle was interposed at the level of the calcaneonavicular joint as well as an endorthesis in the tarsal sinus. The patient became totally asymptomatic after surgery. CONCLUSIONS: Multiple bilateral tarsal coalitions, i.e., present in both feet, are very infrequent, except when they are associated with syndromic pictures or conditions such as fibular hemimelus, Alpert syndrome, Nievergelt-Pearlman syndrome, multiple synostosis or hereditary symphalangism. Treatment should be individualized based on the location of the synostosis.

Probabilistic muscle characterization using QEMG: application to neuropathic muscle.

Clinicians who use electromyographic (EMG) signals to help determine the presence or absence of abnormality in a muscle often, with varying degrees of success, evaluate sets of motor unit potentials (MUPs) qualitatively and/or quantitatively to characterize the muscle in a clinically meaningful way. The resulting muscle characterization can be improved using automated analysis. As such, the intent of this study was to evaluate the performance of automated, conventional Means/Outlier and Probabilistic methods in converting MUP statistics into a concise, and clinically relevant, muscle characterization. Probabilistic methods combine the set of MUP characterizations, derived using Pattern Discovery (PD), of all MUPs detected from a muscle into a characterization measure that indicates normality or abnormality. Using MUP data from healthy control subjects and patients with known neuropathic disorders, a Probabilistic method that used Bayes' rule to combine MUP characterizations into a Bayesian muscle characterization (BMC) achieved a categorization accuracy of 79.7% compared to 76.4% using the Mean method (P > 0.1) for biceps muscles and 94.6% accuracy for the BMC method compared to 85.8% using the Mean method (P < 0.01) for first dorsal interosseous muscles. The BMC method can facilitate the determination of "possible," "probable," or "definite" levels for a given muscle categorization (e.g., neuropathic) whereas the conventional Means and Outlier methods support only a dichotomous "normal" or "abnormal" decision. This work demonstrates that the BMC method can provide information that may be more useful in supporting clinical decisions than that provided by the conventional Means or Outlier methods.

Ingesta de alimentos de origen animal versus origen vegetal y riesgo cardiovascular / Intake of animal versus vegetable food and cardiovascular risk

Cardiovascular mortality has been associated with changes in lifestyle and food habits. The occidental diet has been characterized by high intake of animal fat and meat, and it is associated whit increased risk of type 2 diabetes and high blood pressure, an increase in levels of markers of endothelial dysfunction, and presence of pro-thrombotic risk factors. We search the Pubmed database and other review references. Inclusion criteria were: papers published after 1999, randomized controled clinical studies, case-control studies, systematic reviews and methanalyses. Vegetarians groups show less cardiovascular morbidity and mortality than non-vegetarians. The evidence indicated that a decreasing intake of red meat, saturate fat, trans fat, and mainly processed meat, and an increase in the intake of whole grain cereals, fruits, vegetables and fish, are associated with a better overall cardiovascular health and survival.

El aumento de la mortalidad cardiovascular en el último tiempo está fuertemente asociado a cambios en los hábitos de alimentación. La dieta occidental caracterizada por una alta ingesta de alimentos de origen animal, presenta mayor riesgo de diabetes tipo 2 (DM 2), hipertensión arterial (HTA), aumento de marcadores de disfunción endotelial y factores protrombóticos. La búsqueda se realizó en la biblioteca online Pubmed y en referencias de otras revisiones. Los criterios de inclusión fueron: artículos de 1999 en adelante, ensayos clínicos aleatorizados-controlados, estudios caso-control, revisiones sistemáticas y meta análisis. En grupos con alto consumo de alimentos de origen vegetal se ha evidenciado una menor morbi-mortalidad cardiovascular, comparado con los grupos con alta ingesta de alimentos de origen animal. La evidencia apoya que la disminución en el consumo de carnes rojas, grasas saturadas y grasas trans, así como el aumento en el consumo de cereales integrales, frutas, vegetales y pescado, disminuye la morbi-mortalidad global y cardiovascular.

Decision support for QEMG.

For clinicians to use quantitative electromyography (QEMG) to help determine the presence or absence of neuromuscular disease, they must manually interpret an exhaustive set of motor unit potential (MUP) or interference pattern statistics to formulate a clinically useful muscle characterization. A new method is presented for automatically categorizing a set of quantitative electromyographic (EMG) data as characteristic of data acquired from a muscle affected by a myopathic, normal or neuropathic disease process, based on discovering patterns of MUP feature values. From their numbers of occurrence in a set of training data, representative of each muscle category, discovered patterns of MUP feature values are expressed as conditional probabilities of detecting such MUPs in each category of muscle. The conditional probabilities of each MUP in a set of MUPs acquired from an examined muscle are combined using Bayes' rule to estimate conditional probabilities of the examined muscle being of each category type. Using simulated and clinical data, the ability of a "pattern discovery" based Bayesian (PD-based Bayesian) method to correctly categorize sets of test MUP data was compared to conventional methods which use data means and outliers. The simulated data were created by modeling the effects of myopathic and neuropathic diseases using a physiologically based EMG signal simulator. The clinical data was from controls and patients with known neuropathic disorders. PD-based Bayesian muscle characterization had an accuracy of 84.4% compared to 51.9% for the means and outlier based method when using all MUP features considered. PD-based Bayesian methods can accurately characterize a muscle. PD-based Bayesian muscle characterization automatically maximizes both sensitivity and specificity and provides transparent rationalizations for its characterizations. This leads to the expectation that clinicians using PD-based Bayesian muscle characterization will be provided with improved decision support compared to that provided by the status quo means and outlier based methods.

Bayesian characterization of external anal sphincter muscles using quantitative electromyography.

OBJECTIVES: Based on the analysis of electromyographic (EMG) data muscles are often characterized as normal or affected by a neuromuscular disease process. The objective of this work was to compare the accuracy of Bayesian muscle characterization to conventional means and outlier analysis of motor unit potential (MUP) feature values. METHODS: Quantitative MUP data from the external anal sphincter muscles of control subjects and patients were used to compare the sensitivity, specificity, and accuracy of the methods under examination. RESULTS: The results demonstrated that Bayesian muscle characterization achieved similar accuracy to combined means and outlier analysis. Thickness and number of turns were the most discriminative MUP features for characterizing the external anal sphincter (EAS) muscles studied in this work. CONCLUSIONS: Although, Bayesian muscle characterization achieved similar accuracy to combined means and outlier analysis, Bayesian muscle characterization can facilitate the determination of "possible", "probable", or "definite" levels of pathology, whereas the conventional means and outlier methods can only provide a dichotomous "normal" or "abnormal" decision. Therefore, Bayesian muscle characterization can be directly used to support clinical decisions related to initial diagnosis as well as treatment and management over time. Decisions are based on facts and not impressions giving electromyography a more reliable role in the diagnosis, management, and treatment of neuromuscular disorders. SIGNIFICANCE: Bayesian muscle characterization can help make electrophysiological examinations more accurate and objective.

Motor unit potential characterization using "pattern discovery".

Typically in clinical practice, electromyographers use qualitative auditory and visual analysis of electromyographic (EMG) signals to help infer if a neuromuscular disorder is present and if it is neuropathic or myopathic. Quantitative EMG methods exist that can more accurately measure feature values but require qualitative interpretation of a large number of statistics. Electrophysiological characterization of a neuromuscular system can be improved through the quantitative interpretation of EMG statistics. The aim of the present study was to compare the accuracy of pattern discovery (PD) characterization of motor unit potentials (MUPs) to other classifiers commonly used in the medical field. In addition, a demonstration of PD's transparency is provided. The transparency of PD characterization is a result of observing statistically significant events known as patterns. Using clinical MUP data from normal subjects and patients with known neuropathic disorders, PD achieved an error rate of 30.3% versus 29.8% for a Naïve Bayes classifier, 30.1% for a Decision Tree and 29% for discriminant analysis. Similar results were found for simulated EMG data. PD characterization succeeded in interpreting the information extracted from MUPs and transforming it into knowledge that is consistent with the literature and that can be valuable for the capture and transparent expression of clinically useful knowledge.