Design and validation of an artificial intelligence system to detect the quality of colon cleansing before colonoscopy / Diseño y validación de un sistema de inteligencia artificial para detectar la calidad de la limpieza del colon previa a la realización de la colonoscopia

Background and aims Patients’ perception of their bowel cleansing quality may guide rescue cleansing strategies before colonoscopy. The main aim of this study was to train and validate a convolutional neural network (CNN) for classifying rectal effluent during bowel preparation intake as “adequate” or “inadequate” cleansing before colonoscopy.Patients and methodsPatients referred for outpatient colonoscopy were asked to provide images of their rectal effluent during the bowel preparation process. The images were categorized as adequate or inadequate cleansing based on a predefined 4-picture quality scale. A total of 1203 images were collected from 660 patients. The initial dataset (799 images), was split into a training set (80%) and a validation set (20%). The second dataset (404 images) was used to develop a second test of the CNN accuracy. Afterward, CNN prediction was prospectively compared with the Boston Bowel Preparation Scale (BBPS) in 200 additional patients who provided a picture of their last rectal effluent.ResultsOn the initial dataset, a global accuracy of 97.49%, a sensitivity of 98.17% and a specificity of 96.66% were obtained using the CNN model. On the second dataset, an accuracy of 95%, a sensitivity of 99.60% and a specificity of 87.41% were obtained. The results from the CNN model were significantly associated with those from the BBPS (P<0.001), and 77.78% of the patients with poor bowel preparation were correctly classified.ConclusionThe designed CNN is capable of classifying “adequate cleansing” and “inadequate cleansing” images with high accuracy. (AU)

Antecedentes y objetivos La percepción de los pacientes sobre la calidad de su limpieza intestinal puede guiar las estrategias de limpieza de rescate antes de una colonoscopia. El objetivo principal de este estudio fue entrenar y validar una red neuronal convolucional (CNN) para clasificar el efluente rectal durante la preparación intestinal como «adecuado» o «inadecuado».Pacientes y métodosPacientes no seleccionados proporcionaron imágenes del efluente rectal durante el proceso de preparación intestinal. Las imágenes fueron categorizadas como una limpieza adecuada o inadecuada según una escala de calidad de 4 imágenes predefinida. Se recopilaron un total de 1.203 imágenes de 660 pacientes. El conjunto de datos inicial (799 imágenes) se dividió en un conjunto de entrenamiento (80%) y un conjunto de validación (20%). Un segundo conjunto de datos (404 imágenes) se utilizó para evaluar la precisión de la CNN. Posteriormente, la predicción de la CNN se comparó prospectivamente con la escala de preparación colónica de Boston (BBPS) en 200 pacientes que proporcionaron una imagen de su último efluente rectal.ResultadosEn el conjunto de datos inicial, la precisión global fue del 97,49%, la sensibilidad del 98,17% y la especificidad del 96,66%. En el segundo conjunto de datos, se obtuvo una precisión del 95%, una sensibilidad del 99,60% y una especificidad del 87,41%. Los resultados del modelo de CNN se asociaron significativamente con la escala de preparación colónica de Boston (p<0,001), y el 77,78% de los pacientes con una preparación intestinal deficiente fueron clasificados correctamente.ConclusiónLa CNN diseñada es capaz de clasificar imágenes de «limpieza adecuada» y «limpieza inadecuada» con alta precisión. (AU)

Design and validation of an artificial intelligence system to detect the quality of colon cleansing before colonoscopy.

BACKGROUND AND AIMS: Patients' perception of their bowel cleansing quality may guide rescue cleansing strategies before colonoscopy. The main aim of this study was to train and validate a convolutional neural network (CNN) for classifying rectal effluent during bowel preparation intake as "adequate" or "inadequate" cleansing before colonoscopy. PATIENTS AND METHODS: Patients referred for outpatient colonoscopy were asked to provide images of their rectal effluent during the bowel preparation process. The images were categorized as adequate or inadequate cleansing based on a predefined 4-picture quality scale. A total of 1203 images were collected from 660 patients. The initial dataset (799 images), was split into a training set (80%) and a validation set (20%). The second dataset (404 images) was used to develop a second test of the CNN accuracy. Afterward, CNN prediction was prospectively compared with the Boston Bowel Preparation Scale (BBPS) in 200 additional patients who provided a picture of their last rectal effluent. RESULTS: On the initial dataset, a global accuracy of 97.49%, a sensitivity of 98.17% and a specificity of 96.66% were obtained using the CNN model. On the second dataset, an accuracy of 95%, a sensitivity of 99.60% and a specificity of 87.41% were obtained. The results from the CNN model were significantly associated with those from the BBPS (P<0.001), and 77.78% of the patients with poor bowel preparation were correctly classified. CONCLUSION: The designed CNN is capable of classifying "adequate cleansing" and "inadequate cleansing" images with high accuracy.

Incidencia de lepra en el municipio Santa Cruz del Sur, Cuba: Treinta años de estudio / [Incidence of Leprosy in the Municipality of Santa Cruz Del Sur, Cuba. Thirty Years of Study]

Introducción: Se realizó un estudio descriptivo con el propósito de determinar la incidencia de la lepra en el municipio Santa Cruz del Sur en un período de 30 años. El universo de estudio estuvo constituido por todos los pacientes notificados de lepra en esta etapa. Métodos: Como fuente de información se utilizaron las historias clínicas de la consulta municipal de Dermatología y los informes anuales del Departamento Municipal de Estadísticas a partir de los cuales se obtuvieron los datos referentes a la incidencia, edad, sexo, color de piel, zona de residencia, formas clínicas, presencia de discapacidad y episodios reaccionales, e influencia psicosocial en la evolución de la enfermedad. Los datos se procesaron utilizando estadísticas descriptivas, distribución de frecuencia y tasas. Resultados: Fueron notificados 76 pacientes con predominio del sexo masculino, mayores de 45 años, piel blanca y zona de residencia urbana. La forma clínica preponderante fue la lepra dimorfa. Un escaso número de pacientes fue diagnosticado con discapacidad y dentro de los episodios reaccionales predominó el eritema nudoso leproso. El estrés laboral y psicológico influyó de manera significativa en la evolución tórpida de la enfermedad. Conclusiones: La tasa de incidencia permaneció estable. (AU)

Introduction: A descriptive study was carried out with the purpose of determining the incidence of leprosy in the Santa Cruz del Sur municipality in a period of thirty years. The study universe consisted of all the patients notified of leprosy at this stage.Methods: As a source of information, the clinical records of the municipal Dermatology consultation and the annual reports of the Municipal Department of Statistics were used, from which the data referring to incidence, age, sex, skin color, area of residence, clinical forms, presence of disability, reactional episodes and psychosocial impact on the evolution of the disease. The data were processed using descriptive statistics, frequency distribution and rates.Results: 76 patients with a predominance of males, older than 45 years, white skin and an urban area of residence were notified. The predominant clinical form was dimorphic leprosy. A small number of patients were diagnosed with disability and within the reactional episodes, erythema nodosum leprosum predominated. Occupational and psychological stress significantly influenced the torpid evolution of the disease.Conclusions: The incidence rate remained stable. (AU)

Without IPv6, there is no digital transformation for healthcare.

BACKGROUND: Originally, digital healthcare was created to support underserved and rural patients gain access to health services. Phones, devices, and computers need IP (Internet Protocol) addresses to connect to the Internet. OBJECTIVE: This paper aims to study the close relationship between the Internet and the transformation of healthcare services. METHODS: The current protocol in use is the Internet Protocol version 4 (IPv4), whose number of Internet addresses has been globally exhausted. The Internet Protocol version 6 (IPv6) with 47 octillion unique addresses for every person on the planet has become the only option for sustainable growth and innovation. However, most of the worldwide industry is still in IPv4. In the era of Artificial Intelligence, Internet of Things, Fifth Generation of Cellular Technology (5G), and Blockchain, there will be a massive need of IP addresses. For 2025, experts predict over 1.5 billion new IPv6 users which will continue to grow exponentially. RESULTS: Nations need to tackle the increasing industry requirements for IPv6 and telehealth adoption to benefit from the full IPv6 connectivity which is the key strategic advantage for the healthcare industry. CONCLUSION: The strategic potential that telehealth brings to the healthcare industry is widely appreciated. However, what are the implications of its expansion around the world? How can we prioritize the poorest and most vulnerable in society without new technologies?

Comportamiento de la enfermedad periodontal inflamatoria crónica en pacientes diabéticos / Behavior of chronic inflammatory periodontal disease in diabetic patients

RESUMEN Introducción: La diabetes promueve alteración en la función de neutrófilos y la deposición en los tejidos periodontales de los productos finales derivados de la glicolización avanzada. Por ello, los diabéticos son vulnerables a la enfermedad periodontal inflamatoria crónica. Estudiar su comportamiento es indispensable para acometer acciones integrales y efectivas para su control y tratamiento. Objetivo: Determinar el comportamiento de la enfermedad periodontal inflamatoria crónica en pacientes de la Consulta de Atención Integral al Paciente Diabético en el Municipio Santa Cruz del Sur. Métodos: Se realizó un estudio descriptivo transversal, desde septiembre 2018 hasta mayo 2019, en el que se incluyeron 60 pacientes que acudieron durante ese período que presentaban más de 10 dientes en boca, afección periodontal inflamatoria crónica y dieron su consentimiento para participar. Se realizó examen clínico periodontal y examen radiográfico periapical. Resultados: El mayor número de pacientes con enfermedad periodontal inflamatoria crónica fue de 41-60 años de edad, predominó el sexo femenino, en ambas variables prevaleció la periodontitis crónica avanzada, afección preponderante también en los pacientes de más de 10 años de padecimiento de la diabetes mellitus. Conclusiones: En los pacientes con control metabólico inadecuado imperó la periodontitis crónica avanzada seguida de la moderada.

ABSTRACT Introduction: Diabetes promotes impaired neutrophil function and deposition in periodontal tissues of end products derived from advanced glycolization. The refore, diabetics are vulnerable to chronic inflammatory periodontal disease. Studying their behavior is essential to undertake comprehensive and effective actions for their control and treatment. Objective: To determine the behavior of chronic inflammatory periodontal disease in patients of the Comprehensive Care Consultation for Diabetic Patients in the Municipality of Santa Cruz del Sur. Methods: A cross-sectional descriptive study was carried out, in the period from September 2018 to May 2019, in which 60 patients who were attended during this period were included, they had more than 10 teeth in the mouth with chronic inflammatory periodontal disease and gave their consent to participate. A periodontal clinical examination and periapical radiographic examination were performed. Results: The largest number of patients with periodontal disease were 41-60 years old, female sex predominated, in both variables advanced chronic periodontitis prevailed, also preponderant in patients with more than 10 years of suffering from diabetes mellitus. Conclusions: Advanced chronic periodontitis prevailed in patients with inadequate metabolic control, followed by moderate.

Anti-N-methyl-D-aspartate receptor encephalitis: An observational and comparative study in Mexican children and adults.

OBJECTIVE: To present a case series of encephalitis patients with anti-N-methyl-D-aspartate receptor antibodies, attending two neurological referral centers in a three-year period. METHODS: A retrospective, descriptive, comparative study included child and adult patients in two neurological populations, positive for antibodies against the NR1 and NR2 subunits of the glutamate (NMDA) receptor in serum and CSF, as determined during a three-year period. RESULTS: Sixty-six patients were included (40 children and 26 adults). Male patients were more affected (M: F ratio was 1:0.6). No differences in progression or hospitalization time were observed between groups. In children, 35% of patients showed herpetic infection before autoimmune encephalitis (P = 0.01). Among viral prodromal symptoms, upper respiratory tract infection (P = 0.02) and fever (P = 0.001) predominated in children, while infectious gastroenteritis was more frequent in adults (P = 0.03). Among neuropsychiatric signs, mental confusion (P = 0.0001) and orofacial dyskinesia/oromandibular dystonia (P = 0.0001) were frequent in children, while emotional lability (P = 0.03), catatonia (P = 0.0001), and headache (P = 0.005) predominated in adults. The score in the modified Rankin scale on admission was higher in children (4.3 ± 0.8 vs. 2.2 ± 1.3, P = 0.0001), but at one-year of clinical follow up no significant differences were found. CONCLUSIONS: Male patients were predominantly affected in our population. One-third of all patients developed prodromal infection. Neuropsychiatric clinical complaints were different in children and adults. However, post-hospitalization recovery was similar between groups.

Increasing the low residue diet to 3 days does not improve the bowel cleansing in hard to prepare patients: Post hoc analysis of a randomized controlled trial.

BACKGROUND: Recent evidence suggests that the number of low residue diet (LRD) days does not influence the bowel cleansing quality in non-selected patients. However, there are not data in the subgroup of patients with risk factors of inadequate bowel cleansing. OBJECTIVE: The aim of this study was to assess whether a 3-day LRD improved the bowel cleansing quality in patients with risk factors of poor bowel cleansing. PATIENTS AND METHODS: Post hoc analysis of a randomized controlled trial carried out between December 2017 and March 2018 in a tertiary care hospital. Patients with high risk of poor bowel cleansing were selected following a validated score. The patients were randomized to the 1-day LRD or 3-day LRD groups. All patients received a 2-L split-dose of polyethylene glycol plus ascorbic acid. Intention-to-treat (ITT) and per-protocol (PP) analyses were conducted for the main outcome. RESULTS: 135 patients (1-day LRD group=67, 3-day LRD=68) were included. The rate of adequate cleansing quality was not significantly different between the groups in the ITT analysis: 76.1%, 95% CI: [64.6-84.8] vs. 79.4%, 95% CI: [68.2-87.4]; odds ratio (OR) 1.2, 95% CI [0.54-2.73]) or in the PP analysis: 77.3%, 95% CI: [65.7-85.8] vs. 80.3%, 95% CI: [69.0-88.3]; OR 1.2, 95% CI [0.52-2.77]). Compliance with the diet or cleansing solution, satisfaction or difficulties with the LRD and the polyp/adenoma detection rates were not significantly different. CONCLUSION: Our results suggest that 1-day LRD is not inferior to 3-day LRD in patients with risk factors of inadequate bowel cleansing.

[Effectiveness of the implementation of clinical-epidemiological management during Covid-19 in a medium-long-stay hospital.] / Efectividad de la implantación de una gestión clínico-epidemiológica durante la Covid-19 en un hospital de media-larga estancia.

OBJECTIVE: The effects of the Covid-19 health emergency have demonstrated the high vulnerability of people residing in medium and long-stay centers, with high mortality rates. Little data is available about contingency protocols to minimize the spread of the virus in these centers. The goal of this study was to describe the clinical and epidemiological features of patients affected by SARS-CoV-2 and the preventive and management measures adopted at the National Hospital for Paraplegics (Toledo, Castilla-La Mancha, Spain) to minimize the risk of transmission of Covid-19. METHODS: A team of specialists in Preventive and Internal Medicine established a protocol for active surveillance, identification of suspected and confirmed cases, and follow-up of contacts. Also, a Unit for the care of confirmed cases was created with personnel specifically trained in Covid-19, to achieve better patient care and optimize the available resources. Descriptive statistical measures have been used to analyze the data. RESULTS: The prevalence of Covid-19 was 12.2%, with a cumulative incidence of 8.2%. After the protocol was established, control of the disease was achieved without hospital transmission after its application. Due to the alarm generated at the start of the pandemic, up to 45% of the requested RT-PCRs did not meet the criteria of the Ministry of Health, all of which were negative. The clinical characteristics of our patients differed slightly from those observed in other studies published in the general population, with cough and asthenia being the most frequent symptoms, present in 69.2% and 38.5%, respectively. 100% of the infected patients did not present complications that required assistance in the Intensive Care Unit. CONCLUSIONS: With the application of preventive and organizational actions, we consider that we have presented a low incidence of those infected. The preparation of protocols and their supervision is essential for the rapid identification of cases and optimization of the tests requested. Despite being a medium and long-stay hospital, we have not presented any mortality or complications that required admission to the Intensive Care Unit.

OBJETIVO: Los efectos de la emergencia sanitaria por la Covid-19 han demostrado la alta vulnerabilidad de las personas que residen en centros de media y larga estancia, con altas tasas de mortalidad. Se disponen de pocos datos acerca de los protocolos de contingencia para minimizar la propagación del virus en estos centros. El objetivo de este estudio fue describir las características clínicas y epidemiológicas de los pacientes afectados por el SARS-CoV-2, así como las medidas preventivas y de gestión adoptadas en el Hospital Nacional de Parapléjicos (Toledo) para minimizar el riesgo de transmisión de la Covid-19. METODOS: Un equipo formado por especialistas en Medicina Preventiva y en Medicina Interna del Hospital Nacional de Parapléjicos estableció un protocolo de vigilancia activa, identificación de casos sospechosos y confirmados, así como de seguimiento de contactos. Además, se creó una Unidad para la atención de los casos confirmados, con personal formado específicamente en Covid-19, para intentar lograr una mejor atención de los pacientes y optimización de los recursos materiales disponibles. Para el análisis de los datos se han utilizado medidas estadísticas descriptivas. RESULTADOS: La prevalencia de la Covid-19 fue del 12,2%, con una incidencia acumulada del 8,2%. Tras la instauración del protocolo se logró el control de la enfermedad, sin transmisión intrahospitalaria posterior a su aplicación. Debido a la alarma generada al inicio de la pandemia, hasta un 45% de las RT-PCR solicitadas no cumplían los criterios del Ministerio de Sanidad, siendo todas negativas. Las características clínicas de nuestros pacientes difirieron ligeramente de las observadas en otros estudios publicados en población general, siendo la tos y la astenia los síntomas más frecuentes, presentes en el 69,2% y el 38,5% respectivamente. El 100% de los pacientes infectados no presentaron complicaciones que precisaran asistencia en Unidad de Cuidados Intensivos. CONCLUSIONES: Con la aplicación de las acciones preventivas y organizativas consideramos que hemos presentado una incidencia baja de infectados. Es indispensable la elaboración de protocolos y su supervisión para la rápida identificación de casos y optimizar las pruebas solicitadas. Pese a ser un hospital de media y larga estancia, no hemos presentado mortalidad ni complicaciones que requirieran ingreso en Unidad de Cuidados Intensivos.

Prenatal exposure to VOCs and NOx and lung function in preschoolers.

BACKGROUND: Several studies have shown that exposure to air pollutants affects lung growth and development and can result in poor respiratory health in early life. METHODS: We included a subsample of 772 Mexican preschoolers whose mothers participated in a Prenatal Omega-3 fatty acid Supplements, GRowth, And Development birth cohort study with the aim to evaluate the impact of prenatal exposure to volatile organic compounds and nitrogen oxides on lung function measured by oscillation tests. The preschoolers were followed until 5 years of age. Anthropometric measurements and forced oscillation tests were performed at 36, 48, and 60 months of age. Information on sociodemographic and health characteristics was obtained during follow up. Prenatal exposure to volatile organic compounds and nitrogen oxides was evaluated using a land use regression models and the association between them was tested using a lineal regression and longitudinal linear mixed effect models adjusting for potential confounders. RESULTS: Overall, the mean (standard deviation) of the measurements of respiratory system resistance and respiratory system reactance at 6, 8, and 10 Hz during the follow-up period was 11.3 (2.4), 11.1 (2.4), 10.3 (2.2) and -5.2 (1.6), -4.8 (1.7), and -4.6 hPa s L-1 (1.6), respectively. We found a significantly positive association between respiratory resistance (ßRrs6 = 0.011; 95%CI: 0.001, 0.023) (P < .05) and prenatal exposure to nitrogen dioxide and a marginally negatively association between respiratory reactance (ßXrs6 = -11.40 95%CI: -25.26, 1.17 and ßXrs8 = -11.91 95%CI: -26.51, 1.43) (P = .07) and prenatal exposure to xylene. CONCLUSION: Prenatal exposure to air pollutants was significantly associated with the alteration of lung function measured by oscillation tests in these preschool children.

Attitudes Toward Violence and Gender as Predictors of Interpersonal Violence Interventions.

The purpose of the research was to determine whether attitudes toward violence (ATV) and participant sex would influence notions about interpersonal violence (IPV) intervention by university students. It was anticipated those who held stronger cultural and reactive violence attitudes and males would be less in favor of intervention, but it was not certain whether gender or attitudes would be the stronger predictor for intervention approaches. An IPV intervention scale was developed to measure preferred approaches for intervention, which resulted in four approaches (affirmative intervention, no intervention, police intervention, and intervention threshold). A total of 420 university student volunteers completed the IPV intervention questionnaire followed by an ATV scale on an electronic data collection site. Results indicated ATV subtypes were stronger predictors of affirmative intervention than gender, but when considering cultural acceptability of violence, gender was the single predictor for a threshold of intervention. The findings have relevance for university and community intervention programs and public policy makers when attempting to alter the acceptability of violence to promote effective interventions.

Efectividad de la implantación de una gestión clínico-epidemiológica durante la Covid-19 en un hospital de media-larga estancia / Effectiveness of the implementation of clinical-epidemiological management during Covid-19 in a medium-long-stay hospital

OBJETIVO: Los efectos de la emergencia sanitaria por la Covid-19 han demostrado la alta vulnerabilidad de las personas que residen en centros de media y larga estancia, con altas tasas de mortalidad. Se disponen de pocos datos acerca de los protocolos de contingencia para minimizar la propagación del virus en estos centros. El objetivo de este estudio fue describir las características clínicas y epidemiológicas de los pacientes afectados por el SARS-CoV-2, así como las medidas preventivas y de gestión adoptadas en el Hospital Nacional de Parapléjicos (Toledo) para minimizar el riesgo de transmisión de la Covid-19. MÉTODOS: Un equipo formado por especialistas en Medicina Preventiva y en Medicina Interna del Hospital Nacional de Parapléjicos estableció un protocolo de vigilancia activa, identificación de casos sospechosos y confirmados, así como de seguimiento de contactos. Además, se creó una Unidad para la atención de los casos confirmados, con personal formado específicamente en Covid-19, para intentar lograr una mejor atención de los pacientes y optimización de los recursos materiales disponibles. Para el análisis de los datos se han utilizado medidas estadísticas descriptivas. RESULTADOS: La prevalencia de la Covid-19 fue del 12,2%, con una incidencia acumulada del 8,2%. Tras la instauración del protocolo se logró el control de la enfermedad, sin transmisión intrahospitalaria posterior a su aplicación. Debido a la alarma generada al inicio de la pandemia, hasta un 45% de las RT-PCR solicitadas no cumplían los criterios del Ministerio de Sanidad, siendo todas negativas. Las características clínicas de nuestros pacientes difirieron ligeramente de las observadas en otros estudios publicados en población general, siendo la tos y la astenia los síntomas más frecuentes, presentes en el 69,2% y el 38,5% respectivamente. El 100% de los pacientes infectados no presentaron complicaciones que precisaran asistencia en Unidad de Cuidados Intensivos. CONCLUSIONES: Con la aplicación de las acciones preventivas y organizativas consideramos que hemos presentado una incidencia baja de infectados. Es indispensable la elaboración de protocolos y su supervisión para la rápida identificación de casos y optimizar las pruebas solicitadas. Pese a ser un hospital de media y larga estancia, no hemos presentado mortalidad ni complicaciones que requirieran ingreso en Unidad de Cuidados Intensivos

OBJECTIVE: The effects of the Covid-19 health emergency have demonstrated the high vulnerability of people residing in medium and long-stay centers, with high mortality rates. Little data is available about contingency protocols to minimize the spread of the virus in these centers. The goal of this study was to describe the clinical and epidemiological features of patients affected by SARS-CoV-2 and the preventive and management measures adopted at the National Hospital for Paraplegics (Toledo, Castilla-La Mancha, Spain) to minimize the risk of transmission of Covid-19. METHODS: A team of specialists in Preventive and Internal Medicine established a protocol for active surveillance, identification of suspected and confirmed cases, and follow-up of contacts. Also, a Unit for the care of confirmed cases was created with personnel specifically trained in Covid-19, to achieve better patient care and optimize the available resources. Descriptive statistical measures have been used to analyze the data. RESULTS: The prevalence of Covid-19 was 12.2%, with a cumulative incidence of 8.2%. After the protocol was established, control of the disease was achieved without hospital transmission after its application. Due to the alarm generated at the start of the pandemic, up to 45% of the requested RT-PCRs did not meet the criteria of the Ministry of Health, all of which were negative. The clinical characteristics of our patients differed slightly from those observed in other studies published in the general population, with cough and asthenia being the most frequent symptoms, present in 69.2% and 38.5%, respectively. 100% of the infected patients did not present complications that required assistance in the Intensive Care Unit. CONCLUSIONS: With the application of preventive and organizational actions, we consider that we have presented a low incidence of those infected. The preparation of protocols and their supervision is essential for the rapid identification of cases and optimization of the tests requested. Despite being a medium and long-stay hospital, we have not presented any mortality or complications that required admission to the Intensive Care Unit

Quality evaluation of malaria diagnosis in the local laboratories network and in intermediate laboratories in a setting towards the disease elimination in Ecuador / Evaluación de la calidad del diagnóstico de malaria en la red local de laboratorios y en los laboratorios intermedios en el contexto de la eliminación de la enfermedad en Ecuador

Introduction: To reach the goal of malaria elimination in Ecuador for the year 2020, it is necessary to have a laboratory network with the capacity to perform microscopic diagnosis according to the WHO/PAHO quality standards and to provide the adequate treatment of cases. Objective: To determine the level of competence for parasitological diagnosis of the microscopists from the local public network and the performance of intermediate reference laboratories. Materials and methods: We conducted a cross-sectional study based on the information collected in workshops carried out to appraise the competence for microscopic diagnosis of the local laboratory network (zonal health coordinating offices 1 to 8) using a slide panel to evaluate diagnosis agreement, as well as the diagnostic performance of the intermediate laboratories using an external quality assessment program. The results were compared against the reference standards of the supranational laboratory in Perú. Results: We evaluated the competencies of 191 microscopists in 11 workshops and 153 (80.1%) of them were approved. The medians of the indicators were the following: concordance for parasite detection, 100% (Q1- Q3: 96-100), concordance for species identification, 100% (Q1- Q3: 93-100), and concordances for stage identification, 93.0% (Q1- Q3: 86-95) and parasite counting, 77.0% (Q1- Q3: 71-82). In the external quality assessment, the three intermediate laboratories obtained 100% in parasite detection concordance and 96% for species detection concordance. Conclusions: The results for the primary network and the performance indicators for the intermediate laboratories showed the high-quality standards of the training program implemented in the country.

Introducción. El cumplimiento de la meta de eliminación de la malaria en Ecuador en el 2020 exige contar con la capacidad requerida para el diagnóstico microscópico ajustado a los estándares de calidad de la Organización Mundial de la Salud (OMS) y de la Organización Panamericana de la Salud (OPS) y proveer el tratamiento adecuado a los pacientes. Objetivo. Conocer la idoneidad o competencia de los microscopistas de la red pública local para el diagnóstico parasitológico de la malaria y el desempeño de los laboratorios intermedios de referencia. Materiales y métodos. Se hizo un estudio descriptivo de corte transversal a partir de la información obtenida en los talleres de evaluación de idoneidad en el diagnóstico microscópico de la red de laboratorios en las coordinaciones zonales de salud utilizando un panel de láminas para evaluar la concordancia del diagnóstico. Además, se calificó el desempeño de los laboratorios intermedios en el diagnóstico en el marco del programa de evaluación externa del desempeño. Los resultados se compararon con los obtenidos por el laboratorio supranacional de Perú. Resultados. En los 11 talleres realizados, se evaluó la idoneidad de 191 microscopistas, de los cuales 153 (80,1 %) aprobaron las pruebas. Las medianas de los indicadores fueron las siguientes: concordancia entre la detección y el resultado, 100 % (Q1- Q3: 96-100); concordancia en la especie, 100 % (Q1- Q3: 93-100); concordancia en el estadio, 93,0 % (Q1- Q3: 86-95) y concordancia en el recuento, 77 % (Q1- Q3: 71-82). En el programa de evaluación externa de desempeño, los tres laboratorios intermedios obtuvieron una concordancia del 100 % en el resultado y una del 96 % en la especie. Conclusiones. Los indicadores de competencia de la red local y de desempeño de los laboratorios intermedios alcanzaron altos estándares de calidad acordes con el proceso de entrenamiento implementado en el país.

Evaluación de la calidad del diagnóstico de malaria en la red local de laboratorios y en los laboratorios intermedios en el contexto de la eliminación de la enfermedad en Ecuador / Quality evaluation of malaria diagnosis in the local laboratories network and in intermediate laboratories in a setting towards the disease elimination in Ecuador

Resumen Introducción. El cumplimiento de la meta de eliminación de la malaria en Ecuador en el 2020 exige contar con la capacidad requerida para el diagnóstico microscópico ajustado a los estándares de calidad de la Organización Mundial de la Salud (OMS) y de la Organización Panamericana de la Salud (OPS) y proveer el tratamiento adecuado a los pacientes. Objetivo. Conocer la idoneidad o competencia de los microscopistas de la red pública local para el diagnóstico parasitológico de la malaria y el desempeño de los laboratorios intermedios de referencia. Materiales y métodos. Se hizo un estudio descriptivo de corte transversal a partir de la información obtenida en los talleres de evaluación de idoneidad en el diagnóstico microscópico de la red de laboratorios en las coordinaciones zonales de salud utilizando un panel de láminas para evaluar la concordancia del diagnóstico. Además, se calificó el desempeño de los laboratorios intermedios en el diagnóstico en el marco del programa de evaluación externa del desempeño. Los resultados se compararon con los obtenidos por el laboratorio supranacional de Perú. Resultados. En los 11 talleres realizados, se evaluó la idoneidad de 191 microscopistas, de los cuales 153 (80,1 %) aprobaron las pruebas. Las medianas de los indicadores fueron las siguientes: concordancia entre la detección y el resultado, 100 % (Q1- Q3: 96-100); concordancia en la especie, 100 % (Q1- Q3: 93-100); concordancia en el estadio, 93,0 % (Q1- Q3: 86-95) y concordancia en el recuento, 77 % (Q1- Q3: 71-82). En el programa de evaluación externa de desempeño, los tres laboratorios intermedios obtuvieron una concordancia del 100 % en el resultado y una del 96 % en la especie. Conclusiones. Los indicadores de competencia de la red local y de desempeño de los laboratorios intermedios alcanzaron altos estándares de calidad acordes con el proceso de entrenamiento implementado en el país.

Abstract Introduction: To reach the goal of malaria elimination in Ecuador for the year 2020, it is necessary to have a laboratory network with the capacity to perform microscopic diagnosis according to the WHO/PAHO quality standards and to provide the adequate treatment of cases. Objective: To determine the level of competence for parasitological diagnosis of the microscopists from the local public network and the performance of intermediate reference laboratories. Materials and methods: We conducted a cross-sectional study based on the information collected in workshops carried out to appraise the competence for microscopic diagnosis of the local laboratory network (zonal health coordinating offices 1 to 8) using a slide panel to evaluate diagnosis agreement, as well as the diagnostic performance of the intermediate laboratories using an external quality assessment program. The results were compared against the reference standards of the supranational laboratory in Perú. Results: We evaluated the competencies of 191 microscopists in 11 workshops and 153 (80.1%) of them were approved. The medians of the indicators were the following: concordance for parasite detection, 100% (Q1- Q3: 96-100), concordance for species identification, 100% (Q1- Q3: 93-100), and concordances for stage identification, 93.0% (Q1- Q3: 86-95) and parasite counting, 77.0% (Q1- Q3: 71-82). In the external quality assessment, the three intermediate laboratories obtained 100% in parasite detection concordance and 96% for species detection concordance. Conclusions: The results for the primary network and the performance indicators for the intermediate laboratories showed the high-quality standards of the training program implemented in the country.

Impact of a 1-day versus 3-day low-residue diet on bowel cleansing quality before colonoscopy: a randomized controlled trial.

BACKGROUND: The aim of this study was to assess whether a 3-day low-residue diet (LRD) improved bowel cleansing quality compared with a 1-day LRD regimen. METHODS: Consecutive patients scheduled for outpatient colonoscopy were randomized to the 1-day LRD or 3-day LRD groups. All patients received a 2-L split-dose of polyethylene glycol plus ascorbic acid. The primary outcome was bowel cleansing quality as evaluated using the Boston Bowel Preparation Scale (BBPS) (adequate cleansing ≥ 2 points per segment). Secondary outcomes were adherence to and level of satisfaction with the LRD, difficulty following the dietary recommendations, and willingness to repeat the same LRD in the future. Intention-to-treat (ITT) and per-protocol (PP) analyses were conducted for the primary outcome. A superiority analysis was performed to demonstrate that a 3-day LRD regimen was superior to a 1-day LRD regimen with a margin of 10 %. RESULTS: 390 patients (1-day LRD group = 196, 3-day LRD = 194) were included. The cleansing quality was not significantly different between the groups: ITT analysis 82.7 % (95 % confidence interval [CI] 77.4 to 88.0) vs. 85.6 % (95 %CI 80.7 to 90.5), with odds ratio (OR) 1.2 (95 %CI 0.72 to 2.15); PP analysis 85.0 % (95 %CI 79.9 to 90.1) vs. 88.6 % (95 %CI 84.0 to 93.2), with OR 1.4 (95 %CI 0.88 to 2.52). No differences were found regarding adherence to the diet or cleansing solution, satisfaction or difficulty with the LRD, and the polyp/adenoma detection rates. CONCLUSION: 3-day LRD did not offer advantages over 1-day LRD in preparation for colonoscopy.

Síndrome de Tolosa Hunt / Tolosa-Hunt syndrome

RESUMEN El síndrome de Tolosa-Hunt es una entidad poco frecuente cuya etiopatogenia y mecanismos fisiopatológicos se mantienen controversiales. La cefalea asociada a parálisis de uno o más pares craneales, así como diplopía, estrabismo y ptosis palpebral causan un gran temor en el paciente que la padece. Su diagnóstico es por exclusión. Con el objetivo de describir y actualizar el conocimiento sobre esta enfermedad se presenta el cuadro de una paciente que acudió a consulta por cefalea marcada y dolor retroocular. Los hallazgos clínicos y la resonancia magnética confirman el diagnóstico del síndrome de Tolosa Hunt (AU).

ABSTRACT The Tolosa-Hunt syndrome is a few frequent entity whose etiopathogeny and physio-pathological mechanisms are still controversial. The headache associated to the paralysis of one or more cranial paired nerves, and also diplopia, strabismus, and palpebral ptosis cause a great fear in patients suffering it. Its diagnosis is by exclusion. With the objective of describing and up-dating the knowledge on this disease, it is presented the history of a patient who assisted the consultation because of remarked headache and retro-ocular pain. The clinical findings and magnetic resonance confirm the diagnosis of Tolosa-Hunt syndrome (AU).

Síndrome de Tolosa Hunt / Tolosa-Hunt syndrome

RESUMEN El síndrome de Tolosa-Hunt es una entidad poco frecuente cuya etiopatogenia y mecanismos fisiopatológicos se mantienen controversiales. La cefalea asociada a parálisis de uno o más pares craneales, así como diplopía, estrabismo y ptosis palpebral causan un gran temor en el paciente que la padece. Su diagnóstico es por exclusión. Con el objetivo de describir y actualizar el conocimiento sobre esta enfermedad se presenta el cuadro de una paciente que acudió a consulta por cefalea marcada y dolor retroocular. Los hallazgos clínicos y la resonancia magnética confirman el diagnóstico del síndrome de Tolosa Hunt (AU).

ABSTRACT The Tolosa-Hunt syndrome is a few frequent entity whose etiopathogeny and physio-pathological mechanisms are still controversial. The headache associated to the paralysis of one or more cranial paired nerves, and also diplopia, strabismus, and palpebral ptosis cause a great fear in patients suffering it. Its diagnosis is by exclusion. With the objective of describing and up-dating the knowledge on this disease, it is presented the history of a patient who assisted the consultation because of remarked headache and retro-ocular pain. The clinical findings and magnetic resonance confirm the diagnosis of Tolosa-Hunt syndrome (AU).

Video Caso Clínico: Tumores Subepiteliales del Estómago / Case Report: Subepithelial Tumors of the Stomach

INTRODUCCIÓN: Las lesiones subepiteliales son aquellas estructuras ubicadas debajo de una mucosa normal que se ven como bultos o protuberancias, en cualquier parte de la luz del tracto digestivo. Los estudios informan que estas protuberancias ocurren en 1 de cada 300 endoscopias [1] o en 1 % de las endoscopias digestivas altas, con una incidencia de 0.76 % en Ecuador [2]. Uno de ellos es el pólipo fibroide inflamatorio, representa el tumor benigno menos frecuente entre el 1 al 4 %, con una incidencia de 0.1 % [3] y otro es el GIST, el más común de los tumores gastrointestinales, principalmente en el estómago con frecuencia entre el 60 al 70 % [4].Los tumores subepiteliales se encuentran principalmente en el estómago con un 60 a 70 %, seguido de intestino delgado con un 20 a 30 %, luego colon con 5 % y en esófago en menos del 5 % [5]. En el estómago los tumores más comunes son los GIST, se originan de las células intersticiales de Cajal con un CD117 positivo que detecta un componente celular llamado c-kit en el 95 % de estas. En el video se ilustra las técnicas usadas en estos dos pacientes para obtener una muestra y orientar la conducta.

BACKGROUND: Subepithelial lesions are those structures located below a normal mucosa that are seen as lumps or bulges located in any part of the lumen of the digestive tract. Studies report that these bulges occur in 1 in 300 endoscopies [1] or in 1 % of upper digestive endoscopies or with an incidence of 0.76 % in Ecuador [2]. One of them is the inflammatory fibroid poly; it represents the less frequent benign tumor between 1 to 4 %, with an incidence of 0.1 % [3] and another is the GIST which represents the most common subepithelial lesions, with a frequency between 60 to 70 % in the stomach [4]. Subepithelial tumors are found mainly in the stomach with 60 to 70 %, followed by small intestine with 20 to 30 %, then colon with 5 % and in the esophagus in less than 5 % [5]. In the stomach, the most common tumors are GIST, they originate from the interstitial cells of Cajal with a positive CD-117 that detects a cellular component called c-kit in 95 % of these. The video illustrates the techniques used in these two patients to obtain a sample and guide behavior.

Simultaneous quantification of four antiretroviral drugs in breast milk samples from HIV-positive women by an ultra-high performance liquid chromatography tandem mass spectrometry (UPLC-MS/MS) method.

The primary strategy to avoid mother-to-child transmission of human immunodeficiency virus (HIV) through breastfeeding is administration of highly active antiretroviral therapy (HAART) to HIV-positive pregnant women. Because significant changes in the pharmacokinetics of antiretroviral (ARV) drugs occur during pregnancy, quantifying HAART and the viral load in breast milk in this population is essential. Here, we developed an analytical assay for the simultaneous quantification of four ARV drugs in breast milk using ultra-performance liquid chromatography coupled to tandem mass spectrometry. We validated this method following Mexican and international guidelines. ARV drugs. We extracted the ARV drugs from 200 µL samples of breast milk and detected these drugs in a triple quadrupole mass spectrometer with positive electrospray ionization. The validated concentration ranges (ng/mL) for zidovudine, lamivudine, lopinavir, and ritonavir were 12.5-750, 50-2500, 100-5000 and 5 to 250, respectively. Additionally, the absolute recovery percentages (and matrix effects) were 91.4 (8.39), 88.78 (28.75), 91.38 (11.77) and 89.78 (12.37), respectively. We determined that ARV drugs are stable for 24 h at 8°C and 24°C for 15 days at -80°C. This methodology had the capacity for simultaneous detection; separation; and accurate, precise quantification of ARV drugs in human breast milk samples according to Mexican standard laws and United States Food and Drug Administration guidelines.

The impact of indigenous cultural identity and cultural engagement on violent offending.

BACKGROUND: Possessing a strong cultural identity has been shown to protect against mental health symptoms and buffer distress prompted by discrimination. However, no research to date has explored the protective influences of cultural identity and cultural engagement on violent offending. This paper investigates the relationships between cultural identity/engagement and violent recidivism for a cohort of Australian Indigenous people in custody. METHODS: A total of 122 adults from 11 prisons in the state of Victoria completed a semi-structured interview comprising cultural identification and cultural engagement material in custody. All official police charges for violent offences were obtained for participants who were released from custody into the community over a period of 2 years. RESULTS: No meaningful relationship between cultural identity and violent recidivism was identified. However a significant association between cultural engagement and violent recidivism was obtained. Further analyses demonstrated that this relationship was significant only for participants with a strong Indigenous cultural identity. Participants with higher levels of cultural engagement took longer to violently re-offend although this association did not reach significance. CONCLUSIONS: For Australian Indigenous people in custody, 'cultural engagement' was significantly associated with non-recidivism. The observed protective impact of cultural engagement is a novel finding in a correctional context. Whereas identity alone did not buffer recidivism directly, it may have had an indirect influence given its relationship with cultural engagement. The findings of the study emphasize the importance of culture for Indigenous people in custody and a greater need for correctional institutions to accommodate Indigenous cultural considerations.

Protective effect of phenolic compounds on carbonyl-amine reactions produced by lipid-derived reactive carbonyls.

The degradation of phenylalanine initiated by 2-pentenal, 2,4-heptadienal, 4-oxo-2-pentenal, 4,5-epoxy-2-heptenal, or 4,5-epoxy-2-decenal in the presence of phenolic compounds was studied to determine the structure-activity relationship of phenolic compounds on the protection of amino compounds against modifications produced by lipid-derived carbonyls. The obtained results showed that flavan-3-ols were the most efficient phenolic compounds followed by single m-diphenols. The effectiveness of these compounds was found to be related to their ability to trap rapidly the carbonyl compound, avoiding in this way the reaction of the carbonyl compound with the amino acid. The ability of flavan-3-ols for this reaction is suggested to be related to the high electronic density existing in some of the aromatic carbons of their ring A. This is the first report showing that carbonyl-phenol reactions involving lipid-derived reactive carbonyls can be produced more rapidly than carbonyl-amine reactions, therefore providing a satisfactory protection of amino compounds.