URB447 Is Neuroprotective in Both Male and Female Rats after Neonatal Hypoxia-Ischemia and Enhances Neurogenesis in Females.

The need for new and effective treatments for neonates suffering from hypoxia-ischemia is urgent, as the only implemented therapy in clinics is therapeutic hypothermia, only effective in 50% of cases. Cannabinoids may modulate neuronal development and brain plasticity, but further investigation is needed to better describe their implication as a neurorestorative therapy after neonatal HI. The cannabinoid URB447, a CB1 antagonist/CB2 agonist, has previously been shown to reduce brain injury after HI, but it is not clear whether sex may affect its neuroprotective and/or neurorestorative effect. Here, URB447 strongly reduced brain infarct, improved neuropathological score, and augmented proliferative capacity and neurogenic response in the damaged hemisphere. When analyzing these effects by sex, URB447 ameliorated brain damage in both males and females, and enhanced cell proliferation and the number of neuroblasts only in females, thus suggesting a neuroprotective effect in males and a double neuroprotective/neurorestorative effect in females.

The Long-Term Neuroprotective Effect of the Endocannabinoid 2-AG and Modulation of the SGZ's Neurogenic Response after Neonatal Hypoxia-Ischemia.

Neonatal hypoxia-ischemia (HI) often causes hypoxic-ischemic encephalopathy (HIE), a neurological condition that can lead to overall disability in newborns. The only treatment available for affected neonates is therapeutic hypothermia; however, cooling is not always effective to prevent the deleterious effects of HI, so compounds such as cannabinoids are currently under research as new therapies. Modulating the endocannabinoid system (ECS) may reduce brain damage and/or stimulate cell proliferation at the neurogenic niches. Further, the long-term effects of cannabinoid treatment are not so clear. Here, we studied the middle- and long-term effects of 2-AG, the most abundant endocannabinoid in the perinatal period after HI in neonatal rats. At middle-term (postnatal day 14), 2-AG reduced brain injury and increased SGZ's cell proliferation and the number of neuroblasts. At post-natal day 90, the treatment with the endocannabinoid showed global and local protection, suggesting long-lasting neuroprotective effects of 2-AG after neonatal HI in rats.

Effects of Cannabidiol, Hypothermia, and Their Combination in Newborn Rats with Hypoxic-Ischemic Encephalopathy.

Therapeutic hypothermia is well established as a standard treatment for infants with hypoxic-ischemic (HI) encephalopathy but it is only partially effective. The potential for combination treatments to augment hypothermic neuroprotection has major relevance. Our aim was to assess the effects of treating newborn rats following HI injury with cannabidiol (CBD) at 0.1 or 1 mg/kg, i.p., in normothermic (37.5°C) and hypothermic (32.0°C) conditions, from 7 d of age (neonatal phase) to 37 d of age (juvenile phase). Placebo or CBD was administered at 0.5, 24, and 48 h after HI injury. Two sensorimotor (rotarod and cylinder rearing) and two cognitive (novel object recognition and T-maze) tests were conducted 30 d after HI. The extent of brain damage was determined by magnetic resonance imaging, histologic evaluation, magnetic resonance spectroscopy, amplitude-integrated electroencephalography, and Western blotting. At 37 d, the HI insult produced impairments in all neurobehavioral scores (cognitive and sensorimotor tests), brain activity (electroencephalography), neuropathological score (temporoparietal cortexes and CA1 layer of hippocampus), lesion volume, magnetic resonance biomarkers of brain injury (metabolic dysfunction, excitotoxicity, neural damage, and mitochondrial impairment), oxidative stress, and inflammation (TNFα). We observed that CBD or hypothermia (to a lesser extent than CBD) alone improved cognitive and motor functions, as well as brain activity. When used together, CBD and hypothermia ameliorated brain excitotoxicity, oxidative stress, and inflammation, reduced brain infarct volume, lessened the extent of histologic damage, and demonstrated additivity in some parameters. Thus, coadministration of CBD and hypothermia could complement each other in their specific mechanisms to provide neuroprotection.

Respuesta a la carta al editor: Crítica al estudio factibilidad de la utilización de la inteligencia artificial para el cribado de pacientes con COVID-19 en Paraguay

[EXTRACTO]. En respuesta a la carta al editor titulada: Critica al estudio de factibilidad de la utilización de la inteligencia artificial para el cribado de pacientes con COVID-19 en Paraguay, los autores del artículo de referencia elevan a consideración la réplica sobre el contenido de esta, con el objeto de esclarecer los cuestionamientos mencionados en la misma. Respecto al primer problema mencionado en la carta al editor; el estudio utilizó el programa de inteligencia artificial (IA) que fue desarrollado por un equipo de informáticos biomédicos, neumólogos y radiólogos (imagenólogos). El programa utilizado dispone de un método de aprendizaje profundo para realizar el diagnóstico rápido de COVID-19; es decir, cuenta con un algoritmo para detectar patologías neumológicas y un algoritmo de diagnóstico de neumopatías compatibles con COVID-19. En cuanto al segundo problema mencionado en la carta al editor; el presente estudio se realizó entre marzo del 2020 y junio del 2021 en 14 hospitales de las 18 regiones sanitarias del Ministerio de Salud Pública y Bienestar Social (MSPBS), que ya contaban con al menos un tomógrafo funcionando al momento del estudio. El informe de diagnóstico del médico radiólogo y el resultado del diagnóstico por IA fueron remitidos luego a un equipo de neumólogos para su valoración, análisis, correlación y validación; los neumólogos correlacionaron los valores porcentuales del diagnóstico por IA con el resultado de los médicos radió- logos, el resultado del análisis molecular (RT-PCR) y el cuadro clínico del paciente para determinar los grados de concordancia o discordancia entre los resultados, y llegar a un diagnóstico definitivo que permitiera informar al médico del hospital donde se trataba al paciente en cuestión. Esto permitió reducir las aglomeraciones en los centros especializados y optimizar el uso de los limitados recursos disponibles. Esta respuesta se refiere a la carta disponible en: https://doi.org/10. 26633/RPSP.2022.193

Fallo multiorgánico neonatal tras asfixia perinatal / Neonatal multiple organ failure after perinatal asphyxia

La asfixia perinatal es un acontecimiento con efectos de gran alcance, pudiendo conducir no solo al desarrollo de encefalopatía neonatal, sino también a un fallo multiorgánico (FMO). Esta afectación posiblemente se deba a la redistribución del flujo sanguíneo, mediante el cual se conserva la irrigación de órganos vitales como el corazón, el cerebro y las glándulas suprarrenales, a expensas de su disminución en otros órganos.El objetivo del presente trabajo fue conocer la incidencia y la etiopatogenia de los órganos más frecuentemente afectados en el FMO neonatal tras la asfixia perinatal.Se realizó una búsqueda bibliográfica sistemática en las bases de datos Pubmed, Scopus y The Cochrane Library empleando los términos MeSH (ischemia AND hypoxia AND multiorgan dysfunction AND neonat*), (asphyxia AND multiorgan dysfunction AND neonat*) y (liver / kidney / digestive OR gastrointestinal / heart injury AND ischemia AND hypoxia AND neonat*). Se incluyeron trabajos clínicos y preclínicos posteriores al año 2000 y se excluyeron series de casos, cartas al director, cohortes sin grupo comparador y abstracts.En el presente trabajo describimos que el fallo multiorgánico asociado a la asfixia perinatal es un fenómeno frecuente y relevante en la morbimortalidad del neonato, pudiendo llegar a producir no solo alteraciones en riñón, hígado y tracto gastrointestinal, sino también miocardiopatía si el fenómeno se prolonga o es de elevada gravedad. (AU)

Perinatal asphyxia is an event with far-reaching consequences that can lead not only to the development of neonatal encephalopathy, but also to multiple organ failure (MOF). This ailment may result from the redistribution of blood flow, which would preserve the perfusion of vital organs such as the heart, brain and adrenal glands at the expense of other organs.The objective of the study was to determine the incidence and aetiopathogenesis of failure in the organs most frequently involved in neonatal MOF following perinatal asphyxia.We conducted a systematic literature search in the PubMed, Scopus and Cochrane Library databases using the MeSH terms (ischemia AND hypoxia AND multiorgan dysfunction AND neonat*), (asphyxia AND multiorgan dysfunction AND neonat*) and (liver/kidney/digestive OR gastrointestinal/heart injury AND ischemia AND hypoxia AND neonat*). We selected clinical and preclinical studies published after 2000 and excluded case series, letters to the editor, cohort studies without comparison groups and abstracts.In this study, we found that MOF associated with perinatal asphyxia is a frequent phenomenon with a relevant impact on neonatal morbidity and mortality, as it can cause changes not only in the kidney, liver and gastrointestinal tract, but also cardiomyopathy if the ailment is protracted or severe. (AU)

Neonatal multiple organ failure after perinatal asphyxia.

Perinatal asphyxia is an event with far-reaching consequences that can lead not only to the development of neonatal encephalopathy, but also to multiple organ failure (MOF). This ailment may result from the redistribution of blood flow, which would preserve the perfusion of vital organs such as the heart, brain and adrenal glands at the expense of other organs. The objective of the study was to determine the incidence and aetiopathogenesis of failure in the organs most frequently involved in neonatal MOF following perinatal asphyxia. We conducted a systematic literature search in the PubMed, Scopus and Cochrane Library databases using the MeSH terms (ischemia AND hypoxia AND multiorgan dysfunction AND neonat*), (asphyxia AND multiorgan dysfunction AND neonat*) and (liver/kidney/digestive OR gastrointestinal/heart injury AND ischemia AND hypoxia AND neonat*). We selected clinical and preclinical studies published after 2000 and excluded case series, letters to the editor, cohort studies without comparison groups and abstracts. In this study, we found that MOF associated with perinatal asphyxia is a frequent phenomenon with a relevant impact on neonatal morbidity and mortality, as it can cause changes not only in the kidney, liver and gastrointestinal tract, but also cardiomyopathy if the ailment is protracted or severe.

[Feasibility of using artificial intelligence for screening COVID-19 patients in ParaguayViabilidade do uso de inteligência artificial na triagem de pacientes com COVID-19 no Paraguai]. / Factibilidad de la utilización de la inteligencia artificial para el cribado de pacientes con COVID-19 en Paraguay.

Objective: Study the feasibility of using artificial intelligence as a sensitive and specific method for COVID-19 screening in patients with respiratory conditions, using chest CT scan images and a telemedicine platform. Methods: From March 2020 to June 2021, the authors conducted an observational descriptive multicenter feasibility study based on artificial intelligence (AI) for COVID-19 screening using chest images of patients with respiratory conditions who presented at public hospitals. The AI platform was used to diagnose chest CT scan images; this was then compared with molecular diagnosis (RT-PCR) to determine whether they matched and to analyze the feasibility of AI for screening patients with suspected COVID-19. A telemedicine platform was used to send images and diagnostic results. Results: Screening of 3 514 patients with a suspected COVID-19 diagnosis was performed in 14 hospitals around the country. Most patients were aged 27 to 59 years, followed by those over 60. The average age was 48.6 years; 52.8% were male. The most frequent findings were severe pneumonia, bilateral pneumonia with pleural effusion, bilateral pulmonary emphysema, and diffuse ground glass opacity, among others. There was an average of 93% matching and 7% mismatching between images analyzed by AI and RT-PCR. Sensitivity and specificity of the AI system, obtained by comparing AI and RT-PCR screening results, were 93% and 80% respectively. Conclusions: The use of sensitive and specific AI for stratified rapid detection of COVID-19 in patients with respiratory conditions by using chest CT scan images and a telemedicine platform in public hospitals in Paraguay is feasible.

Objetivo: Examinar a viabilidade do uso de inteligência artificial como um método sensível e específico de triagem de COVID-19 em pacientes com afecções respiratórias, empregando imagens obtidas por exame de tomografia do tórax e uma plataforma de telemedicina. Métodos: Entre março de 2020 e junho de 2021, foi realizado um estudo observacional descritivo multicêntrico sobre a viabilidade do uso de inteligência artificial (IA) para a triagem de COVID-19, empregando imagens do tórax de pacientes com afecções respiratórias atendidos em hospitais da rede pública. O diagnóstico das imagens obtidas em tomografia do tórax foi realizado por meio de uma plataforma de IA e, em seguida, cotejado com o diagnóstico molecular (RT-PCR) para determinar a concordância entre os métodos utilizados e analisar a viabilidade deste processo para a triagem de pacientes com suspeita de COVID-19. As imagens e os resultados do exame diagnóstico foram disponibilizados em uma plataforma de telemedicina. Resultados: Foi realizada a triagem de 3 514 pacientes com suspeita de COVID-19 atendidos em 14 hospitais de todo o país. Os pacientes, na sua maioria, tinham entre 27 e 59 anos de idade ou pertenciam à faixa etária acima de 60 anos, com média de idade de 48,6 anos, sendo que 52,8% eram do sexo masculino. Os achados mais comuns foram pneumonia grave, pneumonia bilateral com derrame pleural, enfisema pulmonar bilateral e opacidade difusa em vidro fosco, entre outros. Verificou-se, em média, 93% de concordância e 7% de discordância entre as imagens analisadas com uso de IA e os resultados do exame de RT-PCR, com uma sensibilidade de 93% e especificidade de 80% desse sistema de triagem. Conclusões: Demonstrou-se que o uso de um sistema de IA sensível e específico é viável nos hospitais públicos do Paraguai para a detecção rápida estratificada de COVID-19 em pacientes com afecções respiratórias, empregando imagens de exame de tomografia do tórax e uma plataforma de telemedicina.

Factibilidad de la utilización de la inteligencia artificial para el cribado de pacientes con COVID-19 en Paraguay

[RESUMEN]. Objetivo. Estudiar la factibilidad de utilización de la inteligencia artificial como método sensible y específico para el cribado de COVID-19 en pacientes con afecciones respiratorias empleando imágenes de tórax obtenidas con tomógrafo y una plataforma de telemedicina. Métodos. Entre marzo del 2020 y junio del 2021 se realizó un estudio observacional descriptivo multicéntrico de factibilidad basada en inteligencia artificial (IA) para el cribado de COVID-19 en imágenes de tórax de pacientes con afecciones respiratorias que acudieron a hospitales públicos. El diagnóstico de las imágenes tomográficas de tórax se realizó a través de la plataforma de IA; luego, se comparó con el diagnóstico molecular (RT-PCR) para determinar la concordancia entre ambos y analizar su factibilidad para el cribado de pacientes con sospecha de COVID-19. Las imágenes y los resultados diagnóstico se enviaron a través de una plataforma de telemedicina. Resultados. Se realizó el cribado de 3 514 pacientes con sospecha diagnóstica de COVID-19, en 14 hospitales a nivel nacional. La mayoría de los pacientes tenían entre 27 y 59 años, seguidos por los mayores de 60 años. La edad promedio fue de 48,6 años; el 52,8% eran de sexo masculino. Los hallazgos más frecuentes fueron neumonía grave, neumonía bilateral con derrame pleural, enfisema pulmonar bilateral y opacidad difusa en vidrio esmerilado, entre otros. Se determinó un promedio de 93% de concordancia y 7% de discordancia entre las imágenes analizadas mediante IA y la RT-PCR. La sensibilidad y especificidad del sistema de IA, obtenidas comparando el resultado del cribado obtenido por IA con la RT-PCR, fueron de 93% y 80% respectivamente. Conclusiones. Es viable la utilización de IA sensible y específica para la detección rápida estratificada de COVID-19 en pacientes con afecciones respiratorias utilizando imágenes obtenidas mediante tomografía de tórax y una plataforma de telemedicina en los hospitales públicos de Paraguay.

[ABSTRACT]. Objective. Study the feasibility of using artificial intelligence as a sensitive and specific method for COVID-19 screening in patients with respiratory conditions, using chest CT scan images and a telemedicine platform. Methods. From March 2020 to June 2021, the authors conducted an observational descriptive multicenter feasibility study based on artificial intelligence (AI) for COVID-19 screening using chest images of patients with respiratory conditions who presented at public hospitals. The AI platform was used to diagnose chest CT scan images; this was then compared with molecular diagnosis (RT-PCR) to determine whether they matched and to analyze the feasibility of AI for screening patients with suspected COVID-19. A telemedicine platform was used to send images and diagnostic results. Results. Screening of 3 514 patients with a suspected COVID-19 diagnosis was performed in 14 hospitals around the country. Most patients were aged 27 to 59 years, followed by those over 60. The average age was 48.6 years; 52.8% were male. The most frequent findings were severe pneumonia, bilateral pneumonia with pleural effusion, bilateral pulmonary emphysema, and diffuse ground glass opacity, among others. There was an average of 93% matching and 7% mismatching between images analyzed by AI and RT-PCR. Sensitivity and specificity of the AI system, obtained by comparing AI and RT-PCR screening results, were 93% and 80% respectively. Conclusions. The use of sensitive and specific AI for stratified rapid detection of COVID-19 in patients with respiratory conditions by using chest CT scan images and a telemedicine platform in public hospitals in Paraguay is feasible.

[RESUMO]. Objetivo. Examinar a viabilidade do uso de inteligência artificial como um método sensível e específico de triagem de COVID-19 em pacientes com afecções respiratórias, empregando imagens obtidas por exame de tomografia do tórax e uma plataforma de telemedicina. Métodos. Entre março de 2020 e junho de 2021, foi realizado um estudo observacional descritivo multicêntrico sobre a viabilidade do uso de inteligência artificial (IA) para a triagem de COVID-19, empregando imagens do tórax de pacientes com afecções respiratórias atendidos em hospitais da rede pública. O diagnóstico das imagens obtidas em tomografia do tórax foi realizado por meio de uma plataforma de IA e, em seguida, cotejado com o diagnóstico molecular (RT-PCR) para determinar a concordância entre os métodos utilizados e analisar a viabilidade deste processo para a triagem de pacientes com suspeita de COVID-19. As imagens e os resultados do exame diagnóstico foram disponibilizados em uma plataforma de telemedicina. Resultados. Foi realizada a triagem de 3 514 pacientes com suspeita de COVID-19 atendidos em 14 hospitais de todo o país. Os pacientes, na sua maioria, tinham entre 27 e 59 anos de idade ou pertenciam à faixa etária acima de 60 anos, com média de idade de 48,6 anos, sendo que 52,8% eram do sexo masculino. Os achados mais comuns foram pneumonia grave, pneumonia bilateral com derrame pleural, enfisema pulmonar bilateral e opacidade difusa em vidro fosco, entre outros. Verificou-se, em média, 93% de concordância e 7% de discordância entre as imagens analisadas com uso de IA e os resultados do exame de RT-PCR, com uma sensibilidade de 93% e especificidade de 80% desse sistema de triagem. Conclusões. Demonstrou-se que o uso de um sistema de IA sensível e específico é viável nos hospitais públicos do Paraguai para a detecção rápida estratificada de COVID-19 em pacientes com afecções respiratórias, empregando imagens de exame de tomografia do tórax e uma plataforma de telemedicina.

Factibilidad de la utilización de la inteligencia artificial para el cribado de pacientes con COVID-19 en Paraguay / Feasibility of using artificial intelligence for screening COVID-19 patients in Paraguay / Viabilidade do uso de inteligência artificial na triagem de pacientes com COVID-19 no Paraguai

RESUMEN Objetivo. Estudiar la factibilidad de utilización de la inteligencia artificial como método sensible y específico para el cribado de COVID-19 en pacientes con afecciones respiratorias empleando imágenes de tórax obtenidas con tomógrafo y una plataforma de telemedicina. Métodos. Entre marzo del 2020 y junio del 2021 se realizó un estudio observacional descriptivo multicéntrico de factibilidad basada en inteligencia artificial (IA) para el cribado de COVID-19 en imágenes de tórax de pacientes con afecciones respiratorias que acudieron a hospitales públicos. El diagnóstico de las imágenes tomográficas de tórax se realizó a través de la plataforma de IA; luego, se comparó con el diagnóstico molecular (RT-PCR) para determinar la concordancia entre ambos y analizar su factibilidad para el cribado de pacientes con sospecha de COVID-19. Las imágenes y los resultados diagnóstico se enviaron a través de una plataforma de telemedicina. Resultados. Se realizó el cribado de 3 514 pacientes con sospecha diagnóstica de COVID-19, en 14 hospitales a nivel nacional. La mayoría de los pacientes tenían entre 27 y 59 años, seguidos por los mayores de 60 años. La edad promedio fue de 48,6 años; el 52,8% eran de sexo masculino. Los hallazgos más frecuentes fueron neumonía grave, neumonía bilateral con derrame pleural, enfisema pulmonar bilateral y opacidad difusa en vidrio esmerilado, entre otros. Se determinó un promedio de 93% de concordancia y 7% de discordancia entre las imágenes analizadas mediante IA y la RT-PCR. La sensibilidad y especificidad del sistema de IA, obtenidas comparando el resultado del cribado obtenido por IA con la RT-PCR, fueron de 93% y 80% respectivamente. Conclusiones. Es viable la utilización de IA sensible y específica para la detección rápida estratificada de COVID-19 en pacientes con afecciones respiratorias utilizando imágenes obtenidas mediante tomografía de tórax y una plataforma de telemedicina en los hospitales públicos de Paraguay.

ABSTRACT Objective. Study the feasibility of using artificial intelligence as a sensitive and specific method for COVID-19 screening in patients with respiratory conditions, using chest CT scan images and a telemedicine platform. Methods. From March 2020 to June 2021, the authors conducted an observational descriptive multicenter feasibility study based on artificial intelligence (AI) for COVID-19 screening using chest images of patients with respiratory conditions who presented at public hospitals. The AI platform was used to diagnose chest CT scan images; this was then compared with molecular diagnosis (RT-PCR) to determine whether they matched and to analyze the feasibility of AI for screening patients with suspected COVID-19. A telemedicine platform was used to send images and diagnostic results. Results. Screening of 3 514 patients with a suspected COVID-19 diagnosis was performed in 14 hospitals around the country. Most patients were aged 27 to 59 years, followed by those over 60. The average age was 48.6 years; 52.8% were male. The most frequent findings were severe pneumonia, bilateral pneumonia with pleural effusion, bilateral pulmonary emphysema, and diffuse ground glass opacity, among others. There was an average of 93% matching and 7% mismatching between images analyzed by AI and RT-PCR. Sensitivity and specificity of the AI system, obtained by comparing AI and RT-PCR screening results, were 93% and 80% respectively. Conclusions. The use of sensitive and specific AI for stratified rapid detection of COVID-19 in patients with respiratory conditions by using chest CT scan images and a telemedicine platform in public hospitals in Paraguay is feasible.

RESUMO Objetivo. Examinar a viabilidade do uso de inteligência artificial como um método sensível e específico de triagem de COVID-19 em pacientes com afecções respiratórias, empregando imagens obtidas por exame de tomografia do tórax e uma plataforma de telemedicina. Métodos. Entre março de 2020 e junho de 2021, foi realizado um estudo observacional descritivo multicêntrico sobre a viabilidade do uso de inteligência artificial (IA) para a triagem de COVID-19, empregando imagens do tórax de pacientes com afecções respiratórias atendidos em hospitais da rede pública. O diagnóstico das imagens obtidas em tomografia do tórax foi realizado por meio de uma plataforma de IA e, em seguida, cotejado com o diagnóstico molecular (RT-PCR) para determinar a concordância entre os métodos utilizados e analisar a viabilidade deste processo para a triagem de pacientes com suspeita de COVID-19. As imagens e os resultados do exame diagnóstico foram disponibilizados em uma plataforma de telemedicina. Resultados. Foi realizada a triagem de 3 514 pacientes com suspeita de COVID-19 atendidos em 14 hospitais de todo o país. Os pacientes, na sua maioria, tinham entre 27 e 59 anos de idade ou pertenciam à faixa etária acima de 60 anos, com média de idade de 48,6 anos, sendo que 52,8% eram do sexo masculino. Os achados mais comuns foram pneumonia grave, pneumonia bilateral com derrame pleural, enfisema pulmonar bilateral e opacidade difusa em vidro fosco, entre outros. Verificou-se, em média, 93% de concordância e 7% de discordância entre as imagens analisadas com uso de IA e os resultados do exame de RT-PCR, com uma sensibilidade de 93% e especificidade de 80% desse sistema de triagem. Conclusões. Demonstrou-se que o uso de um sistema de IA sensível e específico é viável nos hospitais públicos do Paraguai para a detecção rápida estratificada de COVID-19 em pacientes com afecções respiratórias, empregando imagens de exame de tomografia do tórax e uma plataforma de telemedicina.

Rapid screening for COVID-19 by applying artificial intelligence to chest computed tomography images: A feasibility study.

Aim: The aim of the study was to present the results and impact of the application of artificial intelligence (AI) in the rapid diagnosis of COVID-19 by telemedicine in public health in Paraguay. Methods: This is a descriptive, multi-centered, observational design feasibility study based on an AI tool for the rapid detection of COVID-19 in chest computed tomography (CT) images of patients with respiratory difficulties attending the country's public hospitals. The patients' digital CT images were transmitted to the AI diagnostic platform, and after a few minutes, radiologists and pneumologists specialized in COVID-19 downloaded the images for evaluation, confirmation of diagnosis, and comparison with the genetic diagnosis (reverse transcription polymerase chain reaction (RT-PCR)). It was also determined the percentage of agreement between two similar AI systems applied in parallel to study the viability of using it as an alternative method of screening patients with COVID-19 through telemedicine. Results: Between March and August 2020, 911 rapid diagnostic tests were carried out on patients with respiratory disorders to rule out COVID-19 in 14 hospitals nationwide. The average age of patients was 50.7 years, 62.6% were male and 37.4% female. Most of the diagnosed respiratory conditions corresponded to the age group of 27-59 years (252 studies), the second most frequent corresponded to the group over 60 years, and the third to the group of 19-26 years. The most frequent findings of the radiologists/pneumologists were severe pneumonia, bilateral pneumonia with pleural effusion, bilateral pulmonary emphysema, diffuse ground glass opacity, hemidiaphragmatic paresis, calcified granuloma in the lower right lobe, bilateral pleural effusion, sequelae of tuberculosis, bilateral emphysema, and fibrotic changes, among others. Overall, an average of 86% agreement and 14% diagnostic discordance was determined between the two AI systems. The sensitivity of the AI system was 93% and the specificity 80% compared with RT-PCR. Conclusion: Paraguay has an AI-based telemedicine screening system for the rapid stratified detection of COVID-19 from chest CT images of patients with respiratory conditions. This application strengthens the integrated network of health services, rationalizing the use of specialized human resources, equipment, and inputs for laboratory diagnosis.

Aplicación de tecnologías disruptivas en telemedicina para la cobertura universal de servicios de salud / Application of disruptive technologies in telemedicine for universal coverage of health services

La aplicación de tecnologías disruptivas en telemedicina facilita la accesibilidad a tecnologías diagnósticas de poblaciones remotas sin acceso a especialistas y mejora la cobertura universal de servicios de salud. Este estudio realizado por la Unidad de Telemedicina del Ministerio de Salud Pública y Bienestar Social (MSPBS) en colaboración con el Dpto. de Ingeniería Biomédica e Imágenes del Instituto de Investigaciones en Ciencias (IICS-UNA) sirvió para evaluar la utilidad de aplicaciones de tecnologías disruptivas en telemedicina para la cobertura universal de servicios de salud. Para el efecto se analizaron los resultados obtenidos por la red de telediagnóstico implementado en 67 hospitales del MSPBS. En dicho sentido se analizaron 540.397 diagnósticos remotos realizados entre enero del 2014 y septiembre de 2019. Del total, el 33,174 % (179.274) correspondieron a estudios de tomografía, 64,825 % (350.313) a electrocardiografía (ECG), 1,997 % (10.791) a electroencefalografía (EEG) y 0,004 % (19) a ecografía. La concordancia entre el diagnostico remoto y el diagnóstico "cara a cara" fue del 95 %. Con el diagnostico remoto se logró una reducción del coste que supone un beneficio importante para cada ciudadano del interior del país. Los resultados obtenidos evidencian que la aplicación de tecnologías disruptivas en telemedicina puede contribuir para la cobertura universal de servicios con tecnologías diagnósticas, maximizando el tiempo y productividad del profesional, aumentando el acceso y la equidad, y disminuyendo los costos. Sin embargo antes de su implementación generalizada se deberá contextualizar con el perfil epidemiológico regional. Palabras claves: tecnología disruptiva, aplicación, tecnología diagnóstica, telemedicina, cobertura universal, servicios de salud, innovación tecnológica.

Introduction: The application of disruptive technologies in telemedicine facilitates accessibility to diagnostic technologies of remote populations without access to specialists and improves universal coverage of health services. This study was carried out by the Telemedicine Unit of the Ministry of Public Health and Social Welfare (MSPBS) in collaboration with the Department of Biomedical Engineering and Imaging of the Institute of Research in Sciences (IICS-UNA). Objective: to evaluate the usefulness of disruptive technology applications in telemedicine for universal coverage of health services January 2014 to September 2019. Material and Method: observational and descriptive design study included 540,397 patients. For this purpose, the results obtained by the telediagnostic network implemented in 67 MSPBS hospitals were analyzed. In this regard, 540,397 remote diagnoses carried out between January 2014 and September 2019 were analysed. Results: of the total, 33.174% (179,274) were CT studies, 64.825% (350,313) electrocardiography (ECG), 1.997% (10,791) electroencephalography (EEG) and 0.004% (19) ultrasound. The concordance between remote diagnosis and "face-to-face" diagnosis was 95%. Conclusion: remote diagnosis achieved a cost reduction that is an important benefit for every citizen of the interior of the country. The results show that the application of disruptive technologies in telemedicine can contribute to the universal coverage of services with diagnostic technologies, maximizing the time and productivity of the professional, increasing access and equity, and lowering costs. However, prior to widespread implementation, the regional epidemiological profile should be contextualized. Keywords: Disruptive technology, application, diagnostic technology, telemedicine, universal coverage, health services, technological innovation.

Cannabinoid-mediated Modulation of Oxidative Stress and Early Inflammatory Response after Hypoxia-Ischemia.

In the process of neonatal encephalopathy, oxidative stress and neuroinflammation have a prominent role after perinatal asphyxia. With the exception of therapeutic hypothermia, no therapeutic interventions are available in the clinical setting to target either the oxidative stress or inflammation, despite the high prevalence of neurological sequelae of this devastating condition. The endocannabinoid system (ECS), recently recognized as a widespread neuromodulatory system, plays an important role in the development of the central nervous system (CNS). This study aims to evaluate the potential effect of the cannabinoid (CB) agonist WIN 55,212-2 (WIN) on reactive oxygen species (ROS) and early inflammatory cytokine production after hypoxia-ischemia (HI) in fetal lambs. Hypoxic-ischemic animals were subjected to 60 min of HI by partial occlusion of the umbilical cord. A group of lambs received a single dose of 0.01 µg/kg WIN, whereas non-asphyctic animals served as controls. WIN reduced the widespread and notorious increase in inflammatory markers tumor necrosis factor (TNF)-α and interleukin (IL)-1ß and IL-6 induced by HI, a modulatory effect not observed for oxidative stress. Our study suggests that treatment with a low dose of WIN can alter the profile of pro-inflammatory cytokines 3 h after HI.

[Public health impact of a remote diagnosis system implemented in regional and district hospitals in Paraguay]. / Impacto en la salud pública del sistema de telediagnóstico implementado en Paraguay.

OBJECTIVE: Determine the viability of a remote diagnosis system implemented to provide health care to remote and scattered populations in Paraguay. METHODS: The study was conducted in all regional and general hospitals in Paraguay, and in the main district hospitals in the country's 18 health regions. Clinical data, tomographic images, sonography, and electrocardiograms (ECGs) of patients who needed a diagnosis by a specialized physician were entered into the system. This information was sent to specialists in diagnostic imaging and in cardiology for remote diagnosis and the report was then forwarded to the hospitals connected to the system. The cost-benefit and impact of the remote diagnosis tool was analyzed from the perspective of the National Health System. RESULTS: Between January 2014 and May 2015, a total of 34 096 remote diagnoses were made in 25 hospitals in the Ministry of Health's telemedicine system. The average unit cost of remote diagnosis was US$2.6 per ECG, tomography, and sonography, while the unit cost of "face-to-face" diagnosis was US$11.8 per ECG, US$68.6 per tomography, and US$21.5 per sonography. As a result of remote diagnosis, unit costs were 4.5 times lower for ECGs; 26.4 times lower for tomography, and 8.3 times lower for sonography. In monetary terms, implementation of the remote diagnosis system during the 16 months of the study led to average savings of US$2 420 037. CONCLUSION: Paraguay has a remote diagnosis system for electrocardiography, tomography, and sonography, using low-cost information and communications technologies (ICTs) based on free software that is scalable to other types of remote diagnostic studies of interest for public health. Implementation of remote diagnosis helped to strengthen the integrated network of health services and programs, enabling professionals to optimize their time and productivity, while improving quality, increasing access and equity, and reducing costs.

Recent advances in cochlear hair cell regeneration-A promising opportunity for the treatment of age-related hearing loss.

The objective of this paper is to review current information regarding the treatment of age-related hearing loss by using cochlear hair cell regeneration. Recent advances in the regeneration of the inner ear, including the usefulness of stem cells, are also presented. Based on the current literature, cochlear cell regeneration may well be possible in the short term and cochlear gene therapy may also be useful for the treatment of hearing loss associated with ageing. The present review provide further insight into the pathogenesis of Inner Ear senescence and aged-related hearing loss and facilitate the development of therapeutic strategies to repair hair cells damaged by ageing. More research will be needed in order to translate them into an effective treatment for deafness linked to cochlear senescence in humans.

Impacto en la salud pública del sistema de telediagnóstico implementado en Paraguay / Public health impact of a remote diagnosis system implemented in regional and district hospitals in Paraguay / Impacto sobre a saúde pública do sistema de teledi¬agnóstico implementado em hospitais regionais e dis¬tritais do Paraguai

Objetivo. Determinar la viabilidad y puesta en marcha de un sistema de telediagnóstico para dar asistencia sanitaria a poblaciones remotas y dispersas del Paraguay. Métodos. El estudio fue realizado en todos los hospitales regionales, generales y principales hospitales distritales de las 18 regiones sanitarias del Paraguay. En el sistema se registraron los datos clínicos y las imágenes tomográficas, ecográficas y trazados electrocardiográficos del paciente que precisaba de un diagnóstico por parte de un médico especialista. Esta información se transmitió a los especialistas en imagenología y en cardiología para su diagnóstico remoto y posterior envío del informe a los hospitales conectados al sistema. Se analizó el costo-beneficio e impacto de la herramienta de telediagnóstico desde la perspectiva del Sistema Nacional de Salud. Resultados. Entre enero de 2014 y mayo de 2015 se realizaron 34 096 telediagnósticos distribuidos en 25 hospitales a través del Sistema de Telemedicina del Ministerio de Salud. El costo unitario promedio del diagnóstico remoto fue de USD 2,6 (dólares estadounidenses) para electrocardiograma (ECG), tomografía y ecografía, mientras que el costo unitario para el diagnóstico “cara a cara” fue de UDS 11,8 para ECG; USD 68,6 para tomografía y USD 21,5 para ecografía. La reducción del costo mediante el diagnóstico remoto fue de 4,5 veces para ECG; 26,4 veces para tomografía y de 8,3 veces para ecografía. En términos monetarios, la implementación del sistema de telediagnóstico, durante los 16 meses del estudio, significó un ahorro promedio de USD 2 420 037. Conclusión. Paraguay cuenta con un sistema de telediagnóstico para electrocardiografía, tomografía y ecografía aplicando las tecnologías de la información y comunicación (TIC) de bajo costo, basadas en software libre y escalable a otros tipos de estudios diagnósticos a distancia; de interés para la salud pública. Con una aplicación práctica del telediagnóstico, se contribuyó al fortalecimiento de la red integrada de servicios y programas de salud, lo que permitió maximizar el tiempo del profesional y su productividad, mejorar la calidad, aumentar el acceso y la equidad, y disminuir los costos.

Objective. Determine the viability of a remote diagnosis system implemented to provide health care to remote and scattered populations in Paraguay. Methods. The study was conducted in all regional and general hospitals in Paraguay, and in the main district hospitals in the country’s 18 health regions. Clinical data, tomographic images, sonography, and electrocardiograms (ECGs) of patients who needed a diagnosis by a specialized physician were entered into the system. This information was sent to specialists in diagnostic imaging and in cardiology for remote diagnosis and the report was then forwarded to the hospitals connected to the system. The cost-benefit and impact of the remote diagnosis tool was analyzed from the perspective of the National Health System. Results. Between January 2014 and May 2015, a total of 34 096 remote diagnoses were made in 25 hospitals in the Ministry of Health’s telemedicine system. The average unit cost of remote diagnosis was US$2.6 per ECG, tomography, and sonography, while the unit cost of “face-to-face” diagnosis was US$11.8 per ECG, US$68.6 per tomography, and US$21.5 per sonography. As a result of remote diagnosis, unit costs were 4.5 times lower for ECGs; 26.4 times lower for tomography, and 8.3 times lower for sonography. In monetary terms, implementation of the remote diagnosis system during the 16 months of the study led to average savings of US$2 420 037. Conclusion. Paraguay has a remote diagnosis system for electrocardiography, tomography, and sonography, using low-cost information and communications technologies (ICTs) based on free software that is scalable to other types of remote diagnostic studies of interest for public health. Implementation of remote diagnosis helped to strengthen the integrated network of health services and programs, enabling professionals to optimize their time and productivity, while improving quality, increasing access and equity, and reducing costs.

Objetivo. Avaliar a viabilidade e a implementação de um sistema de telediagnóstico destinado a oferecer assistência de saúde a populações remotas e dispersas do Paraguai. Métodos. O estudo foi realizado em todos os hospitais regionais e gerais e nos principais hospitais distritais das 18 regiões sanitárias do Paraguai. Foram registrados no sistema os dados clínicos, as imagens tomográficas e ecográficas e os traçados eletrocardiográficos de pacientes que precisavam de um diagnóstico por parte de um médico especialista. Estas informações foram transmitidas a especialistas em diagnóstico por imagem e cardiologia para que fizessem o diagnóstico remoto e enviassem então os laudos aos hospitais conectados ao sistema. Analisou-se a relação custo- benefício e o impacto da ferramenta de telediagnóstico da perspectiva do Sistema Nacional de Saúde. Resultados. Entre janeiro de 2014 e maio de 2015, foram realizados 34.096 telediagnósticos em 25 hospitais através do Sistema de Telemedicina do Ministério da Saúde. O custo unitário médio do diagnóstico remoto foi de US$ 2,6 (dólares americanos) para eletrocardiografia (ECG), tomografia e ecografia, enquanto que o custo unitário para o diagnóstico presencial foi de US$ 11,8 para ECG, US$ 68,6 para tomografia e US$ 21,5 para ecografia. A redução do custo pelo uso do diagnóstico remoto foi de 4,5 vezes para ECG, 26,4 vezes para tomografia e 8,3 vezes para ecografia. Em termos monetários, a implementação do sistema de telediagnóstico, ao longo dos 16 meses do estudo, representou uma economia média de US$ 2.420.037. Conclusão. O Paraguai conta com um sistema de telediagnóstico para eletrocardiografia, tomografia e ecografia que utiliza tecnologias da informação e comunicação (TIC) de baixo custo, baseadas em software livre e ampliáveis a outros tipos de exames diagnósticos à distância que são de interesse para a saúde pública. A aplicação prática do telediagnóstico contribuiu para o fortalecimento da rede integrada de serviços e programas de saúde, o que permitiu maximizar o tempo dos profissionais e sua produtividade, melhorar a qualidade, aumentar o acesso e a equidade e reduzir os custos.

Role of Antioxidants in Neonatal Hypoxic-Ischemic Brain Injury: New Therapeutic Approaches.

Hypoxic-ischemic brain damage is an alarming health and economic problem in spite of the advances in neonatal care. It can cause mortality or detrimental neurological disorders such as cerebral palsy, motor impairment and cognitive deficits in neonates. When hypoxia-ischemia occurs, a multi-faceted cascade of events starts out, which can eventually cause cell death. Lower levels of oxygen due to reduced blood supply increase the production of reactive oxygen species, which leads to oxidative stress, a higher concentration of free cytosolic calcium and impaired mitochondrial function, triggering the activation of apoptotic pathways, DNA fragmentation and cell death. The high incidence of this type of lesion in newborns can be partly attributed to the fact that the developing brain is particularly vulnerable to oxidative stress. Since antioxidants can safely interact with free radicals and terminate that chain reaction before vital molecules are damaged, exogenous antioxidant therapy may have the potential to diminish cellular damage caused by hypoxia-ischemia. In this review, we focus on the neuroprotective effects of antioxidant treatments against perinatal hypoxic-ischemic brain injury, in the light of the most recent advances.

Impacto en la salud pública del sistema de telediagnóstico implementado en Paraguay / Public health impact of a remote diagnosis system implemented in regional and district hospitals in Paraguay / Impacto sobre a saúde pública do sistema de telediagnóstico implementado em hospitais regionais e distritais do Paraguai

RESUMEN Objetivo Determinar la viabilidad y puesta en marcha de un sistema de telediagnóstico para dar asistencia sanitaria a poblaciones remotas y dispersas del Paraguay. Métodos El estudio fue realizado en todos los hospitales regionales, generales y principales hospitales distritales de las 18 regiones sanitarias del Paraguay. En el sistema se registraron los datos clínicos y las imágenes tomográficas, ecográficas y trazados electrocardiográficos del paciente que precisaba de un diagnóstico por parte de un médico especialista. Esta información se transmitió a los especialistas en imagenología y en cardiología para su diagnóstico remoto y posterior envío del informe a los hospitales conectados al sistema. Se analizó el costo-beneficio e impacto de la herramienta de telediagnóstico desde la perspectiva del Sistema Nacional de Salud. Resultados Entre enero de 2014 y mayo de 2015 se realizaron 34 096 telediagnósticos distribuidos en 25 hospitales a través del Sistema de Telemedicina del Ministerio de Salud. El costo unitario promedio del diagnóstico remoto fue de USD 2,6 (dólares estadounidenses) para electrocardiograma (ECG), tomografía y ecografía, mientras que el costo unitario para el diagnóstico “cara a cara” fue de UDS 11,8 para ECG; USD 68,6 para tomografía y USD 21,5 para ecografía. La reducción del costo mediante el diagnóstico remoto fue de 4,5 veces para ECG; 26,4 veces para tomografía y de 8,3 veces para ecografía. En términos monetarios, la implementación del sistema de telediagnóstico, durante los 16 meses del estudio, significó un ahorro promedio de USD 2 420 037. Conclusión Paraguay cuenta con un sistema de telediagnóstico para electrocardiografía, tomografía y ecografía aplicando las tecnologías de la información y comunicación (TIC) de bajo costo, basadas en software libre y escalable a otros tipos de estudios diagnósticos a distancia; de interés para la salud pública. Con una aplicación práctica del telediagnóstico, se contribuyó al fortalecimiento de la red integrada de servicios y programas de salud, lo que permitió maximizar el tiempo del profesional y su productividad, mejorar la calidad, aumentar el acceso y la equidad, y disminuir los costos.

ABSTRACT Objective Determine the viability of a remote diagnosis system implemented to provide health care to remote and scattered populations in Paraguay. Methods The study was conducted in all regional and general hospitals in Paraguay, and in the main district hospitals in the country’s 18 health regions. Clinical data, tomographic images, sonography, and electrocardiograms (ECGs) of patients who needed a diagnosis by a specialized physician were entered into the system. This information was sent to specialists in diagnostic imaging and in cardiology for remote diagnosis and the report was then forwarded to the hospitals connected to the system. The cost-benefit and impact of the remote diagnosis tool was analyzed from the perspective of the National Health System. Results Between January 2014 and May 2015, a total of 34 096 remote diagnoses were made in 25 hospitals in the Ministry of Health’s telemedicine system. The average unit cost of remote diagnosis was US$2.6 per ECG, tomography, and sonography, while the unit cost of “face-to-face” diagnosis was US$11.8 per ECG, US$68.6 per tomography, and US$21.5 per sonography. As a result of remote diagnosis, unit costs were 4.5 times lower for ECGs; 26.4 times lower for tomography, and 8.3 times lower for sonography. In monetary terms, implementation of the remote diagnosis system during the 16 months of the study led to average savings of US$2 420 037. Conclusion Paraguay has a remote diagnosis system for electrocardiography, tomography, and sonography, using low-cost information and communications technologies (ICTs) based on free software that is scalable to other types of remote diagnostic studies of interest for public health. Implementation of remote diagnosis helped to strengthen the integrated network of health services and programs, enabling professionals to optimize their time and productivity, while improving quality, increasing access and equity, and reducing costs.

RESUMO Objetivo Avaliar a viabilidade e a implementação de um sistema de telediagnóstico destinado a oferecer assistência de saúde a populações remotas e dispersas do Paraguai. Métodos O estudo foi realizado em todos os hospitais regionais e gerais e nos principais hospitais distritais das 18 regiões sanitárias do Paraguai. Foram registrados no sistema os dados clínicos, as imagens tomográficas e ecográficas e os traçados eletrocardiográficos de pacientes que precisavam de um diagnóstico por parte de um médico especialista. Estas informações foram transmitidas a especialistas em diagnóstico por imagem e cardiologia para que fizessem o diagnóstico remoto e enviassem então os laudos aos hospitais conectados ao sistema. Analisou-se a relação custo-benefício e o impacto da ferramenta de telediagnóstico da perspectiva do Sistema Nacional de Saúde. Resultados Entre janeiro de 2014 e maio de 2015, foram realizados 34.096 telediagnósticos em 25 hospitais através do Sistema de Telemedicina do Ministério da Saúde. O custo unitário médio do diagnóstico remoto foi de US$ 2,6 (dólares americanos) para eletrocardiografia (ECG), tomografia e ecografia, enquanto que o custo unitário para o diagnóstico presencial foi de US$ 11,8 para ECG, US$ 68,6 para tomografia e US$ 21,5 para ecografia. A redução do custo pelo uso do diagnóstico remoto foi de 4,5 vezes para ECG, 26,4 vezes para tomografia e 8,3 vezes para ecografia. Em termos monetários, a implementação do sistema de telediagnóstico, ao longo dos 16 meses do estudo, representou uma economia média de US$ 2.420.037. Conclusão O Paraguai conta com um sistema de telediagnóstico para eletrocardiografia, tomografia e ecografia que utiliza tecnologias da informação e comunicação (TIC) de baixo custo, baseadas em software livre e ampliáveis a outros tipos de exames diagnósticos à distância que são de interesse para a saúde pública. A aplicação prática do telediagnóstico contribuiu para o fortalecimento da rede integrada de serviços e programas de saúde, o que permitiu maximizar o tempo dos profissionais e sua produtividade, melhorar a qualidade, aumentar o acesso e a equidade e reduzir os custos.

Innovación tecnológica en servicios diagnósticos públicos del Paraguay / Technological innovations in public diagnostic services of Paraguay

A través de innovaciones tecnológicas basadas enlas tecnologías de la información y comunicación(TIC) pueden desarrollarse sistemas de telediagnósticoventajosos para mejorar la atención de lasalud de poblaciones remotas que no tienen accesoa los médicos especialistas. Este estudio realizadopor la Unidad de Telemedicina del Ministeriode Salud Pública y Bienestar Social (MSPBS) encolaboración con el Dpto. de Ingeniería Biomédicae Imágenes del Instituto de Investigaciones enCiencias de la Salud de la Universidad Nacional deAsunción (IICS-UNA) y la Universidad del PaísVasco (UPV/EHU) sirvió para evaluar la utilidadde un sistema de telediagnóstico en la salud pú-blica. Fueron analizados los resultados obtenidospor el sistema de telediagnóstico de 54 hospitalesregionales, distritales, especializados y centros desalud del MSPBS. Fueron realizados 182.406 diagnósticosremotos de enero del 2014 a noviembrede 2016 a través del sistema. Del total, el 37,32% (68.085) correspondieron a estudios de tomografía,62,00 % (113.059) a electrocardiografía(ECG), 0,68 % (1243) a electroencefalografía(EEG) y 0,01 % (19) a ecografía. Se observó unadiferencia importante en el coste de diagnóstico remotoen relación al diagnóstico “cara a cara”, enel análisis se incorporaron los costos de implantacióny mantenimiento de la TIC para el diagnósticoremoto y los costos de transporte, alimentación yoportunidad para el diagnóstico “cara a cara”. Lareducción del coste a través del diagnóstico remoto supone un beneficio importante para cada ciudadanodel interior del país toda vez que el costepromedio de diagnóstico remoto para cada hospitalsea igual o inferior al coste total del diagnósticocara a cara...

Through based on information and communicationtechnologies (ICT), advantageous telediagnosticsystems can be developed to improve the healthcare of remote populations that do not have accessto specialist doctors. This study was carried outby the Telemedicine Unit of the Ministry of PublicHealth and Social Welfare (MSPBS – acronym inspanish) in collaboration with the Department of Biomedical Engineering and Medical Imaging ofthe Institute of Research in Health Sciences of theNational University of Asunción (IICS-UNA acronymin spanish) and the University of the BasqueCountry (UPV / EHU acronym in spanish) servedto evaluate the utility of a telediagnostic system inpublic health. The results obtained by the telediagnosticsystem of 54 regional, district, specializedhospitals and health centers of the MoH (MSPBS)were analyzed. A total of 18.406 remote diagnoseswere performed from January 2014 to November2016 through the system. Of the total, 37.32%(68,085) corresponded to tomography studies(CT), 62.00% (113.059) to electrocardiography(ECG), 0.68% (1243) to electroencephalography(EEG) and 0.01% (19) to ultrasound. A significantdifference was observed in the cost of remote diagnosisin relation to the “face-to-face” diagnosis,in the analysis the costs of implementation andmaintenance of the ICT for the remote diagnosisand transport, feeding and opportunity costs forthe diagnosis “face to face” diagnosis,in the analysis the costs of implementation andmaintenance of the ICT for the remote diagnosisand transport, feeding and opportunity costs forthe diagnosis “face to face” were incorporatedinto the analysis. Reducing costs through remotediagnosis is an important benefit for every citizenof the interior of the country, since the average costof remote diagnosis for each hospital is equal toor less than the total cost of face-to-face diagnosis...