SIPEA: Aplicación web para el Hospital Celia Sánchez Manduley en Manzanillo / SIPEA: Web Application for Celia Sánchez Manduley Hospital in Manzanillo

Anemia is the most common blood disorder in the world, affecting millions of people yearly. It has multiple causes and jeopardizes development, growth and learning. Current tools provide non-hematologist doctors with just numbers. The present paper proposes a web application intended to provide doctors at Celia Sánchez Manduley Hospital in Manzanillo with a tool for determining the morphologic type of anemia, creating a list of possible causes, and also storing patient data in a database for future researches. As an information system, the website constitutes a powerful tool for the decision-making process, in particular, the diagnostic process, intended to provide more detailed information on anemia as well as to foster the information management at the hospital. For the application, HTML, CSS, JavaScript and PHP were used as languages; Apache as a web server; CodeIgniter as a PHP framework; MariaDB as a database management system; and Visual Studio Code as a development environment(AU)

La anemia afecta a millones de personas anualmente, esta obedece a múltiples causas y compromete el crecimiento, desarrollo y aprendizaje. Las herramientas actuales ofrecen al médico no especialista en hematología solo cifras. El presente trabajo propone una aplicación web con la cual se pretende brindar a los médicos del Hospital Celia Sánchez Manduley en Manzanillo una herramienta para la determinación del tipo morfológico de anemia, la elaboración de un listado de las posibles causas que la originan, así como el almacenamiento de datos de los pacientes para futuras investigaciones, y con ello contribuir a la toma de decisiones, en particular, al proceso de diagnóstico, y a una mejor gestión de información en el hospital. Para la aplicación se utilizaron los lenguajes HTML, CSS, JavaScript y PHP, el servidor web Apache, el framework PHP CodeIgniter, el gestor de base de datos MariaDB y el entorno de desarrollo Visual Studio Code(AU)

Conceptualizations of suicide and suicide-related stigma in Latino communities in the United States.

Suicide continues to be a significant public health concern impacting all cultural and ethnic groups in the United States. Although prior studies indicate that Latino individuals die by suicide at lower rates than their non-Hispanic White or Asian peers, recent data in this area indicate that suicide rates for Latino individuals are rising. Currently, little is known about how Latino individuals perceive those who are experiencing suicidal ideation and the factors that are associated with stigma toward people contemplating self-harm. To address this gap, a convenience sample of 248 adults in the United States identifying as Latino participated in an experimental vignette study investigating their perceptions of persons experiencing suicidal ideation. Results show that generation of immigration significantly predicted various domains of stigma toward individuals with suicidal ideation. Older participants and participants with more children were associated with higher levels of stigma. The gender or age of the person experiencing suicidal ideation did not impact the levels of stigma across domains. Results indicate a need to increase the overall health literacy in relation to suicide within Latino communities, particularly in relation to early identification of suicidal ideation. Implications for future research and practice with Latino communities are offered. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Synthesis of covalent bonding MWCNT-oligoethylene linezolid conjugates and their antibacterial activity against bacterial strains.

Nowadays, infectious diseases caused by drug-resistant bacteria have become especially important. Linezolid is an antibacterial drug active against clinically important Gram positive strains; however, resistance showed by these bacteria has been reported. Nanotechnology has improved a broad area of science, such as medicine, developing new drug delivery and transport systems. In this work, several covalently bounded conjugated nanomaterials were synthesized from multiwalled carbon nanotubes (MWCNTs), a different length oligoethylene chain (S n ), and two linezolid precursors (4 and 7), and they were evaluated in antibacterial assays. Interestingly, due to the intrinsic antibacterial activity of the amino-oligoethylene linezolid analogues, these conjugated nanomaterials showed significant antibacterial activity against various tested bacterial strains in a radial diffusion assay and microdilution method, including Gram negative strains as Escherichia coli (11 mm, 6.25 µg mL-1) and Salmonella typhi (14 mm, ≤0.78 µg mL-1), which are not inhibited by linezolid. The results show a significant effect of the oligoethylene chain length over the antibacterial activity. Molecular docking of amino-oligoethylene linezolid analogs shows a more favorable interaction of the S 2-7 analog in the PTC of E. coli.

Immigration Policy Changes and the Mental Health of Mexican-American Immigrants.

In recent years, significant policy changes focused on immigrants migrating through the southern United States border have been implemented. To determine if there was an association between time since immigration and increases in negative mental health symptomology, 249 Mexican-American immigrants ages 18-65 were field recruited to participate in a survey exploring their physical and mental health. Results indicate that inconsistent with the Hispanic Health Paradox, the psychological health of immigrants arriving since 2015 was significantly worse than that of more established immigrants. New arrivals had a .38 increased risk of experiencing clinically significant depression and a .47 increased risk of experiencing global psychological distress. Time since immigration was not significantly related to past 30-day alcohol use. Implications for future research and clinical practice with immigrants are explored, and suggestions on how better identify and assist Mexican-American immigrants with mental health concerns are offered.

Novel Linezolid analogues with antiparasitic activity against Hymenolepis nana.

The stereoselective synthesis and anti- Hymenolepis nana activity of six Linezolid-type compounds, obtained by chemical modification of l-Alanine, are reported in this work. The synthetic strategy was to prepare diasteromeric N,N-dibenzylamino oxazolidinones 1 and 2, and coupling with 4-(4-bromophenyl)morpholine (3) to obtain N,N-dibenzylamino Linezolid analogues 4 and 5. A hydrogenolysis reaction over 4 and 5 resulted in amino-free Linezolid analogues 6 and 7, which were acetylated to reach diasteromeric Linezolid analogues 8 and 9. The six Linezolid analogues 4-9 show in vitro antiparasitic activity against Hymenolepis nana cestode, but not against several bacterial strains. Interestingly, compounds 6, 7 and 9 exhibit high potency, having shorter paralysis and death times after exposure (6-10 and 18-21 min, respectively), shorter than those found with antihelmintic compound Praziquantel (20 and 30 min) at 20 mg/mL. In addition, a cytocompatibility assay of 6-9 with human cells (ARPE-19 cells) demonstrate a non-cytotoxic effect at 0.4 mM. These results show the pharmacological potential of the newly reported Linezolid-type analogues as antiparasitic agents against Hymenolepis nana.

Brain Circuit Alterations and Cognitive Disability in Late-Onset Cobalamin D Disorder.

Neuroimaging studies describing brain circuits' alterations in cobalamin (vitamin B12)-deficient patients are limited and have not been carried out in patients with inborn errors of cobalamin metabolism. The objective of this study was to assess brain functionality and brain circuit alterations in a patient with an ultra-rare inborn error of cobalamin metabolism, methylmalonic aciduria, and homocystinuria due to cobalamin D disease, as compared with his twin sister as a healthy control (HC). We acquired magnetic resonance imaging (including structural, functional, and diffusion images) to calculate brain circuit abnormalities and combined these results with the scores after a comprehensive neuropsychological evaluation. As compared with HC, the patient had severe patterns of damage, such as a 254% increment of ventricular volume, pronounced subcortical and cortical atrophies (mainly at striatum, cingulate cortex, and precuneus), and connectivity alterations at fronto-striato-thalamic circuit, cerebellum, and corpus callosum. In agreement with brain circuit alterations, cognitive deficits existed in attention, executive function, inhibitory control, and mental flexibility. This is the first study that provides the clinical, genetic, neuroanatomical, neuropsychological, and psychosocial characterization of a patient with the cobalamin D disorder, showing functional alterations in central nervous system motor tracts, thalamus, cerebellum, and basal ganglia, that, as far as we know, have not been reported yet in vitamin B12-related disorders.

Histological examination of the potential arrhythmic substrates in the setting of Ebstein's malformation.

Cardiac arrhythmias, notably Wolff-Parkinson-White syndrome, are known to represent a major issue in patients with Ebstein's malformation of the tricuspid valve. Abnormal conducting circuits, however, can also be produced by pathways extending either from the atrioventricular node or the ventricular components of the atrioventricular conduction axis, direct to the crest of the muscular ventricular septum. We hoped to provide further information on the potential presence of such pathways by investigations of six autopsied examples of Ebstein's malformation. All were studied by histological sectioning on the full extent of the atrioventricular conduction axis, with limited sectioning of the right atrioventricular junction supporting the inferior and antero-superior leaflets of the deformed tricuspid valve. We used the criteria established by Aschoff (Verhandlungen der Deutschen Gesellschaft für Pathologie, 14, 1910, 3) and Mönckeberg (Verhandlungen der Deutschen Gesellschaft für Pathologie, 14, 1910, 64) over a century ago to define abnormal connections across the atrioventricular junctions, as these definitions retain their validity for the identification of gross myocardial connections across the insulating tissues of the atrioventricular junctions. In one specimen, we found two discrete accessory myocardial connections across the parietal right atrioventricular junction. In all of the hearts, we found so-called nodoventricular connections, and in one heart we also observed a well-formed connection originating from the penetrating atrioventricular bundle. In addition to accessory myocardial connections across the parietal right atrioventricular junction, therefore, our histological findings demonstrate a potential role for direct connections between the atrioventricular conduction axis and the ventricular myocardium in the setting of Ebstein's malformation.

Design, synthesis and evaluation of the antibacterial activity of new Linezolid dipeptide-type analogues.

Worldwide studies towards development of new drugs with a lower rate in emergence of bacterial resistance have been conducted. The molecular docking analysis gives a possibility to predict the activity of new compounds before to perform their synthesis. In this work, the molecular docking analysis of 64 Linezolid dipeptide-type analogues was performed to predict their activity. The most negative scores correspond to six Fmoc-protected analogues (9as, 9bs, 9bu, 10as, 10ax and 10ay) where Fmoc group interacts in PTC for Linezolid. Twenty-six different Fmoc-protected Linezolid dipeptide-type analogues 9(as-bz) and 10(as-bz) were synthesized and tested in antimicrobial experiments. Compounds 9as, 9ay, 9ax, 10as, 10ay and 9bu show significant activity against group A Streptococcus clinical isolated. Analogue 10ay also display high activity against ATCC 25923 Staphylococcus aureus strain and MRSA-3, MRSA-4 and MRSA-5 clinical isolates, with MIC values lower than Linezolid. The highest activity against multidrug-resistant clinical isolates of Mycobacterium tuberculosis was exhibited by 9bu. Finally, a cytotoxicity assay with ARPE-19 human cells revealed a non-cytotoxic effect of 9bu and 10ay at 50 and 25 µM, respectively.

The influence of posterior visual pathway damage on visual information processing speed in multiple sclerosis.

BACKGROUND: The injury of visual pathway and abnormalities of visual processing speed (VPS) are frequent in MS, but their association remains unexplored. OBJECTIVE: To evaluate the impact of posterior visual pathway structural and functional integrity on VPS of MS patients. METHODS: Cross-sectional study of 30 MS patients and 28 controls, evaluating the association of a VPS tests composite (Salthouse Perceptual Comparison test, Trail Making Test A and Symbol Digit Modalities Test) with 3T MRI visual cortex thickness, optic radiations (OR) diffusion tensor imaging indexes, and medial visual component (MVC) functional connectivity (FC) (MVC-MVC FC (iFC) and MVC-brain FC (eFC)) by linear regression, removing the effect of premorbid IQ, fatigue, and depression. RESULTS: V2 atrophy, lower OR fractional anisotropy (FA) and MVC FC significantly influenced VPS in MS (at none or lesser extent in controls), even after removing the effect of Expanded Disability Status Scale and previous optic neuritis (V2 ( r2 = 0.210): ß = +0.366, p = 0.046; OR FA ( r2 = 0.243): ß = +0.378, p = 0.034; MVC iFC, for example, left cuneus ( r2 = 0.450): ß = -0.613, p < 0.001; MVC eFC, for example, right precuneus-postcentral gyrus ( r2 = 0.368): ß = -0.466, p = 0.002). CONCLUSION: Posterior visual pathway integrity, structural (V2 thickness and OR FA) and functional (MVC FC), may explain respectively up to 24% and 45% of VPS variability in MS.

Percepción de bullying en alumnos de sexto año de la escuela de medicina de una universidad pública de Lima 2015 / Perception of bullying in sixth year students of a Lima public university school of medicine 2015

Introducción. Las conductas agresivas y discriminatorias afectan la salud física y mental incluso de quienes las cometen. Los estudiantes están sometidos a situaciones de estrés, las cuales aumentan el riesgo de desarrollar dichas conductas y a sufrir sus consecuencias. Por otro lado, la Escuela de Medicina tiene como propósito formar integralmente profesionales médicos, con capacidad de evitar situaciones de violencia y convivir pacíficamente. Es por ello el interés de describir este problema en la Escuela de Medicina de la Universidad Nacional Mayor de San Marcos, Lima, Perú. Objetivo. Abordar la situación de violencia (bullying) en estudiantes de Medicina Humana del 6' año que no habían participado en el Programa de Formación Integral en la UNMSM. Diseño. Estudio descriptivo-transversal. Lugar. Sede docente "Instituto Nacional de Salud del Niño", Lima, Perú. Participantes. Muestra conformada por 93 (63%) estudiantes matriculados en el sexto año de la Facultad de Medicina que llevaron el curso de Pediatría durante los meses de julio a noviembre de 2015. Intervenciones. Se utilizó un instrumento desarrollado y validado por la Defensoría del Pueblo de España, modificado y corregido por Hoyos y col. Se calcularon las frecuencias y porcentajes de las respuestas. Resultados. Las conductas de violencia fueron más prevalentes entre estudiantes, entre ellas la conducta de agresión verbal más practicada fue la de expresarse de mala manera (40,8%). Conclusiones. La existencia de violencia se presenta en un alto porcentaje de la población estudiada y están implicados en ella docentes y estudiantes.

Introduction. Aggressive and discriminatory behavior affects physical and mental health even on those who commit them. Students are subjected to stress, which increases the risk of those behaviors and makes them likely to suffer from its consequences. On the other hand, the Medical School aims to educate medical professionals integrally, with abilities to avoid violence and live peacefully. That is why the interest of describing this problem in Universidad Nacional Mayor de San Marcos, Lima, Peru's Medical School. Objective. To address violence in students from the sixth year of Human Medicine who had not participated in the Integral Formation Program in UNMSM. Design: Descriptive, transversal study. Setting. "Instituto Nacional del Niño", Lima, Peru, teaching hospital. Participants. Sample consisted in 93 (63%) students enrolled in the sixth year of the Faculty of Medicine who took the course of Pediatrics during the months of July to November 2015. Interventions. An instrument developed and validated by the Spanish Office of the Ombudsman, modified and corrected by Hoyos et al was used. Frequencies and percentages of responses were calculated. Results. Violent behaviors were more prevalent among students; the most practiced behavior was to express badly (40.8%). Conclusions. The existen ce of violence occurs in a high percentage of the studied population; teachers and students are involved.

Vocación quirúrgica / Surgical vocation

Describir y delimitar el proceso de vocación quirúrgica y las variables que se le asocian. Diseño. Estudio cuali-cuantitativo, transversal, de casos seleccionados, analizados con propósito descriptivo. Metodología. Previo consentimiento informado se realizaron entrevistas en profundidad, audio-grabadas, a un grupo de 40 cirujanos en ejercicio. Principales medidas de resultados. Vocación quirúrgica. Resultados. Fueron de sexo masculino 95 por ciento, edad promedio 65 años (41 a 86 años), promedio de años de experiencia médica 35,4 (10 a 68), promedio de experiencia quirúrgica 30,2 años (3 a 59). De la formación profesional, 85 por ciento correspondió al sistema de residentado quirúrgico universitario y 15 por ciento al de especialidad no escolarizada. La vocación quirúrgica es un proceso que puede iniciarse en diferentes etapas de la vida. Cuando ocurre previo a los estudios universitarios (17,5 por ciento de la muestra estudiada) se asocia a alta influencia familiar (padre o tíos cirujanos). Más frecuentemente (80 por ciento) emerge durante el pregrado, al influjo de diversos estímulos formativos que provee la propia escuela de formación médica y/o docentes paradigmáticos. En un caso (2,5 por ciento), la vocación había nacido muy temprana, sin que el entrevistado pudiera explicar su origen. Conclusiones: La vocación quirúrgica se sustenta en una sólida vocación de servicio. El cirujano con real vocación experimenta placer en la realización de las actividades quirúrgicas, a la par que visualiza el manejo del paciente y su familia de manera integral y ética. Finalmente, se discuten nuevas hipótesis de investigación en esta área surgidas del estudio y se dan recomendaciones para la enseñanza profesional de la cirugía incluyendo la ética como una necesidad básica de ella...

To describe and delimit the surgical vocation process and associated factors. Design. Selected cases cross-sectional study qualitatively and quantitatively analyzed withdescriptive purpose. Methods. Previous informed consent in depth audio-recorded interviews was carried out in 40 surgeons in current professional practice. Main outcome measures. Surgical vocation. Results. Males represented 95 per cent; mean age was 65 years (41-86), mean medical experience 35.4 years (10-68), surgical experience 30.2 years (03-59). Training centers: 85 per cent had university surgical training and 15 per cent non-university training. Surgical vocation is a process that can begin in different periods of the life's cycle. When it does before university studies (17.5 per cent of the studied sample) it is mainly associated to strong family influence (parents or uncles surgeons). More frequently (80 per cent) it emerges during medical undergraduate studies, under the influence of diverse formative stimuli provided by the medical school and/or paradigmatic professors. In one case (2.5 per cent) surgical vocation had emerged at an early age whose origin the interviewed could not explain. Conclusions. Surgical vocation is based on solid service vocation. The surgeon with substantive vocation experiences real pleasure in doing surgical activities being oriented to a comprehensive and ethical management of patient and family. Finally, new research hypothesis produced by this study in this area are discussed and recommendations are given for professional teaching of surgery including Ethics as a basic need in surgeon's training...

Information Flow Between Resting-State Networks.

UNLABELLED: The resting brain dynamics self-organize into a finite number of correlated patterns known as resting-state networks (RSNs). It is well known that techniques such as independent component analysis can separate the brain activity at rest to provide such RSNs, but the specific pattern of interaction between RSNs is not yet fully understood. To this aim, we propose here a novel method to compute the information flow (IF) between different RSNs from resting-state magnetic resonance imaging. After hemodynamic response function blind deconvolution of all voxel signals, and under the hypothesis that RSNs define regions of interest, our method first uses principal component analysis to reduce dimensionality in each RSN to next compute IF (estimated here in terms of transfer entropy) between the different RSNs by systematically increasing k (the number of principal components used in the calculation). When k=1, this method is equivalent to computing IF using the average of all voxel activities in each RSN. For k≥1, our method calculates the k multivariate IF between the different RSNs. We find that the average IF among RSNs is dimension dependent, increasing from k=1 (i.e., the average voxel activity) up to a maximum occurring at k=5 and to finally decay to zero for k≥10. This suggests that a small number of components (close to five) is sufficient to describe the IF pattern between RSNs. Our method--addressing differences in IF between RSNs for any generic data--can be used for group comparison in health or disease. To illustrate this, we have calculated the inter-RSN IF in a data set of Alzheimer's disease (AD) to find that the most significant differences between AD and controls occurred for k=2, in addition to AD showing increased IF w.r.t. CONTROLS: The spatial localization of the k=2 component, within RSNs, allows the characterization of IF differences between AD and controls.

Vocación psiquiátrica / Psychiatry as a vocation

Describir y delimitar el proceso de vocación psiquiátrica y las variables que se le asocian. Diseño: Estudio de casos, transversal, cualitativo, descriptivo y comparativo. Metodología: Previo consentimiento informado se realizaron entrevistas en profundidad, audio-grabadas, en dos grupos seleccionados por criterios de heterogeneidad: 45 psiquiatras en ejercicio actual y 61 médicos residentes de psiquiatría. Resultados y conclusiones: La vocación psiquiátrica comprende varias dimensiones. En ella destaca la consideración integral de la persona, el interés por el aspecto psíquico del paciente y el deseo de aliviar el sufrimiento que causa la enfermedad mental. En el grupo de psiquiatras en ejercicio, la vocación psiquiátrica se aprecia más consolidada y genuina. En el grupo de residentes, ella impresiona más debilitada y, en algunos casos, inexistente. Varios de los residentes entrevistados escogieron la psiquiatría como especialidad por motivos de conveniencia personal, al no haber alcanzado una vacante en la de su preferencia...

To describe and delimit the psychiatric vocation process and its associated factors. Design: Transversal, qualitative, descriptive and comparative study of cases. Methodology: Previous informed consent in depth audio-recorded interviews were carried out in two groups selected by criteria of heterogeneity, 45 psychiatrists currently in practice and 61 residents in psychiatry. Results and conclusions: Psychiatric vocation includes several dimensions. It considers the person as an integral being, showing strong interest on the psychological part of the patient and a need to reduce the suffering caused by mental illness. In the group of psychiatrists, the psychiatric vocation showed itself as more consolidated and genuine. In the group of residents, psychiatric vocation appeared as a weak and in some cases inexistent process. Several residents chose psychiatry as a career on account of personal convenience because they did not reach vacancy in their preferred specialty...

Right fronto-insular white matter tracts link cognitive reserve and pain in migraine patients.

BACKGROUND: Structural white matter abnormalities in pain-modulating, regions are present in migraine. Whether they are associated with pain chronification and with cognitive reserve is unclear. METHODS: Prospective, cohort, six-month study of adult patients with episodic or chronic migraine, and controls. Cognitive reserve, quality of life, impact of pain on daily living, depression and anxiety were assessed. Participants underwent a diffusion-tensor MRI to establish the integrity of white matter tracts of three regions of interest (ROIs) implicated in pain modulation, emotion, cognition and resilience (anterior insula, anterior cingulate gyrus, and uncinate fasciculus). RESULTS: Fifty-two individuals were enrolled: 19 episodic migraine patients, 18 chronic migraine patients, and 15 controls. The analysis of the fractional anisotropy in the ROIs showed that those patients with the poorest prognosis (i.e., those with chronic migraine despite therapy at six months--long-term chronic migraneurs) had a significantly lower fractional anisotropy in the right ROIs. Participants with higher cognitive reserve also had greater fractional anisotropy in the right anterior insula and both cingulate gyri. Multivariate analysis showed a significant association between cognitive reserve, migraine frequency, and fractional anisotropy in the right-sided regions of interest. CONCLUSIONS: Long-term chronic migraine patients show abnormalities in anterior white matter tracts, particularly of the right hemisphere, involved in pain modulation emotion, cognition and resilience. Robustness in these areas is associated with a higher cognitive reserve, which in turn might result in a lower tendency to migraine chronification.

Crystal structure of ethyl 2,4-di-chloro-quinoline-3-carboxyl-ate.

In the crystal structure of the title compound, C12H9Cl2NO2, the mean planes through the quinoline and carboxyl-ate groups have r.m.s. deviations of 0.006 and 0.021 Å, respectively, and form a dihedral angle of 87.06 (19)°. In the crystal, mol-ecules are linked via very weak C-H⋯O hydrogen bonds, forming chains, which propagate along the c-axis direction.

Hydrotherapy as a recovery strategy after exercise: a pragmatic controlled trial.

BACKGROUND: Our aim was to evaluate the recovery effects of hydrotherapy after aerobic exercise in cardiovascular, performance and perceived fatigue. METHODS: A pragmatic controlled repeated measures; single-blind trial was conducted. Thirty-four recreational sportspeople visited a Sport-Centre and were assigned to a Hydrotherapy group (experimental) or rest in a bed (control) after completing a spinning session. Main outcomes measures including blood pressure, heart rate, handgrip strength, vertical jump, self-perceived fatigue, and body temperature were assessed at baseline, immediately post-exercise and post-recovery. The hypothesis of interest was the session*time interaction. RESULTS: The analysis revealed significant session*time interactions for diastolic blood pressure (P=0.031), heart rate (P=0.041), self perceived fatigue (P=0.046), and body temperature (P=0.001); but not for vertical jump (P=0.437), handgrip (P=0.845) or systolic blood pressure (P=0.266). Post-hoc analysis revealed that hydrotherapy resulted in recovered heart rate and diastolic blood pressure similar to baseline values after the spinning session. Further, hydrotherapy resulted in decreased self-perceived fatigue after the spinning session. CONCLUSIONS: Our results support that hydrotherapy is an adequate strategy to facilitate cardiovascular recovers and perceived fatigue, but not strength, after spinning exercise. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01765387.

Appropriateness of lumbar spine magnetic resonance imaging in Spain.

OBJECTIVES: To determine the minimum percentage of lumbar spine magnetic resonance imaging (LSMRI) which are inappropriately prescribed in routine practice. METHODS: LSMRI performed prospectively on 602 patients in 12 Radiology Services across 6 regions in Spain, were classified as "appropriate", "uncertain" or "inappropriate" based on the indication criteria established by the National Institute for Clinical Excellence, the American College of Physicians and Radiology, and current evidence-based clinical guidelines. Studies on patients reporting at least one "red flag" were classified as "appropriate". A logistic regression model was developed to identify factors associated with a higher likelihood of inappropriate LSMRI, including gender, reporting of referred pain, health care setting (private/public), and specialty of prescribing physician. Before performing the LSMRI, the radiologists also assessed the appropriateness of the prescription. RESULTS: Eighty-eight percent of LSMRI were appropriate, 1.3% uncertain and 10.6% inappropriate. The agreement of radiologists' assessment with this classification was substantial (k=0.62). The odds that LSMRI prescriptions were inappropriate were higher for patients without referred pain [OR (CI 95%): 13.75 (6.72; 28.16)], seen in private practice [2.25 (1.20; 4.22)], by orthopedic surgeons, neurosurgeons or primary care physicians [2.50 (1.15; 5.56)]. CONCLUSION: Efficiency of LSMRI could be improved in routine practice, without worsening clinical outcomes.