Single-fraction low-energy electronic brachytherapy for conjunctival lymphoma.

PURPOSE: Conjunctival lymphoma represents an uncommon tumor, accounting for 5-10% of total extranodal lymphomas. Although radiotherapy is a frequent treatment option, limited capacities and lack of specialized centers are common problems in Peru, forcing radiation oncologists to apply short courses of radiotherapy. Here, we report a case series of patients treated with a novel single-shot scheme. Additionally, we present a literature review of the current short-course irradiation strategies. CASES PRESENTATION: Three cases of conjunctival marginal zone (B-cell) lymphoma (marginal zone lymphoma [MZL]/mucosa-associated lymphoid tissue [MALT]) of the fornix are presented. Following biopsy and sonographic assessment of the lesion thickness, we applied a focused single dose of 14 Gy kilovoltage brachytherapy (prescribed to the maximum thickness of the lesion). Follow-up was scheduled in quarterly intervals. After 28, 31, and 40 months of follow-up, none of the three patients treated exhibited acute or chronic toxicities and remained local or distant disease-free. CONCLUSIONS: Single dose kilovoltage brachytherapy was effective and safe in this small cohort of patients. Based on the literature, there is an evidence that local treatment in short-course radiotherapy is effective and should be considered amongst therapeutic options for these patients; however, this novel approach should be evaluated prospectively in a larger cohort.

System Design for Emergency Alert Triggered by Falls Using Convolutional Neural Networks.

The world population ageing is on the rise, which has led to an increase in the demand for medical care due to diseases and symptoms prevalent in health centers. One of the most prevalent symptoms prevalent in older adults is falls, which affect one-third of patients each year and often result in serious injuries that can lead to death. This paper describes the design of a fall detection system for elderly households living alone using very low resolution thermal sensor arrays. The algorithms implemented were LSTM, GRU, and Bi-LSTM; the last one mentioned being that which obtained the best results at 93% in accuracy. The results obtained aim to be a valuable tool for accident prevention for those patients that use it and for clinicians who manage the data.

Enfrentamiento de adultos mayores con sospecha de covid-19 en el servicio de urgencia

En Diciembre 2019, surge una enfermedad emergente, COVID-19, que es debida a un coronavirus (SARS-CoV-2) que empieza en Wuhan, China y que se ha propagado rápidamente a nivel mundial. La Organización Mundial de la Salud (OMS) lo declara como pandemia el 12 de Marzo del 2020. En Chile, el día 14 de Marzo se decretó fase 3 y el 16 de Marzo se pasó a fase 4. Al 24 de Marzo del 2020, en Chile existen 922 casos confirmados de COVID-19, con una mediana de edad de 34 años, correspondiendo 51 casos (6%) a adultos mayores (AM).

High-resolution hydrometeorological data from a network of headwater catchments in the tropical Andes.

This article presents a hydrometeorological dataset from a network of paired instrumented catchments, obtained by participatory monitoring through a partnership of academic and non-governmental institutions. The network consists of 28 headwater catchments (<20 km2) covering three major biomes in 9 locations of the tropical Andes. The data consist of precipitation event records at 0.254 mm resolution or finer, water level and streamflow time series at 5 min intervals, data aggregations at hourly and daily scale, a set of hydrological indices derived from the daily time series, and catchment physiographic descriptors. The catchment network is designed to characterise the impacts of land-use and watershed interventions on the catchment hydrological response, with each catchment representing a typical land use and land cover practice within its location. As such, it aims to support evidence-based decision making on land management, in particular evaluating the effectiveness of catchment interventions, for which hydrometeorological data scarcity is a major bottleneck. The data will also be useful for broader research on Andean ecosystems, and their hydrology and meteorology.

Evaluación de las complicaciones clínicas de los pacientes con fractura de cadera y sus factores asociados en una Unidad de Agudos de Ortogeriatría / Assessment of clinical complications and their associated factors in hip-fracture patients in an Acute Geriatric Orthopaedic Unit

Introducción. Las complicaciones clínicas en pacientes con fractura de cadera (FC) son elevadas y variables por su heterogéneo registro. El objetivo del estudio fue evaluar las complicaciones clínicas y sus factores asociados en pacientes con FC ingresados en la Unidad de Ortogeriatría de un hospital universitario de 283 camas que atiende un promedio de 200 FC/año. Material y métodos. Se incluyó a 383 pacientes ingresados consecutivamente en 2013 y en 2014 en un estudio analítico observacional prospectivo. Las complicaciones clínicas se definieron según recomendaciones avaladas por la AOTrauma Network (Red de Trabajo de la Asociación Internacional de Traumatólogos para el estudio de la osteosíntesis). Resultados. Doscientos setenta y tres pacientes (71,28%) presentaron alguna complicación. Las principales fueron el delirium (55,4%), la insuficiencia renal (15,4%) y las complicaciones cardiacas (12,3%). Se asociaron a la presencia de alguna complicación la clasificación ASA III-IV (OR=1,962; IC del 95%, 1,040-3,704; p = 0,038), un índice de Barthel al alta inferior (b = -3,572;IC del 95%, -0,866 a -0,104; p = 0,01), el incremento en la estancia media (b = 2,683; IC del 95%, 3,522-0,325; p < 0,001) y preoperatoria (OR = 1,165; IC del 95%, 1,050-1,294; p = 0,004). Conclusiones. Las complicaciones clínicas más frecuentes son el delirium, la insuficiencia renal y las complicaciones cardiacas. Una puntuación en la escala de ASA III-IV, una peor situación funcional al alta, así como una estancia preoperatoria y media prolongada, son factores asociados a la presencia de alguna complicación clínica. Las complicaciones cardiacas, pulmonares y digestivas son las principales causas de mortalidad en la unidad

Introduction. The incidence of clinical complications in hip fracture (HF) patients is high and variable due to their heterogeneous nature. The aim of the study was to assess the clinical complications and their associated factors in HF patients admitted to the Orthopaedic Geriatric Unit of a 283 bed University Hospital. An average of 200 HF patients is attended yearly. Material and methods. A prospective, observational and analytical study was conducted on 383 consecutive patients admitted to the unit during the years 2013 and 2014. Clinical complications were defined according to recommendations supported by the AOTrauma Network (International Network of Traumatologists for the Study of Osteosynthesis). Results. A total of 273 patients (71.28%) showed some clinical complication. The main ones were, delirium (55.4%), renal failure (15.4%), and cardiac complications (12.3%). An ASA III-IV score of OR = 1.962 (95% CI; 1.040-3.704, P=.038), lower Barthel index at discharge (b = -3.572, 95% CI -0.866 to -0.104, P=.01), the increase in pre-operative stay (OR = 1.165, 95% CI 1.050-1.294, P=.004) and an increased length of stay (b = 2.663, 95% CI 3.522-0.325; P<.001) were factors associated with clinical complications. Conclusions. Delirium, renal failure, and cardiac complications were the most frequent complications according the new recommendations. An ASA III-IV score, worse functional status at discharge, prolonged pre-operative period, and increased length of stay, were risk factors associated with clinical complications. Cardiac, pulmonary, and gastrointestinal complications were the main causes of mortality in the unit

[Assessment of clinical complications and their associated factors in hip-fracture patients in an Acute Geriatric Orthopaedic Unit]. / Evaluación de las complicaciones clínicas de los pacientes con fractura de cadera y sus factores asociados en una Unidad de Agudos de Ortogeriatría.

INTRODUCTION: The incidence of clinical complications in hip fracture (HF) patients is high and variable due to their heterogeneous nature. The aim of the study was to assess the clinical complications and their associated factors in HF patients admitted to the Orthopaedic Geriatric Unit of a 283 bed University Hospital. An average of 200 HF patients is attended yearly. MATERIAL AND METHODS: A prospective, observational and analytical study was conducted on 383 consecutive patients admitted to the unit during the years 2013 and 2014. Clinical complications were defined according to recommendations supported by the AOTrauma Network (International Network of Traumatologists for the Study of Osteosynthesis). RESULTS: A total of 273 patients (71.28%) showed some clinical complication. The main ones were, delirium (55.4%), renal failure (15.4%), and cardiac complications (12.3%). An ASA III-IV score of OR = 1.962 (95% CI; 1.040-3.704, P=.038), lower Barthel index at discharge (b = -3.572, 95% CI -0.866 to -0.104, P=.01), the increase in pre-operative stay (OR = 1.165, 95% CI 1.050-1.294, P=.004) and an increased length of stay (b = 2.663, 95% CI 3.522-0.325; P<.001) were factors associated with clinical complications. CONCLUSIONS: Delirium, renal failure, and cardiac complications were the most frequent complications according the new recommendations. An ASA III-IV score, worse functional status at discharge, prolonged pre-operative period, and increased length of stay, were risk factors associated with clinical complications. Cardiac, pulmonary, and gastrointestinal complications were the main causes of mortality in the unit.

Reduced activity in functional networks during reward processing is modulated by abstinence in cocaine addicts.

Cocaine addiction is characterized by alterations in motivational and cognitive processes. Recent studies have shown that some alterations present in cocaine users may be related to the activity of large functional networks. The aim of this study was to investigate how these functional networks are modulated by non-drug rewarding stimuli in cocaine-dependent individuals. Twenty abstinent cocaine-dependent and 21 healthy matched male controls viewed erotic and neutral pictures while undergoing a functional magnetic resonance imaging scan. Group independent component analysis was then performed in order to investigate how functional networks were modulated by reward in cocaine addicts. The results showed that cocaine addicts, compared with healthy controls, displayed diminished modulation of the left frontoparietal network in response to erotic pictures, specifically when they were unpredicted. Additionally, a positive correlation between the length of cocaine abstinence and the modulation of the left frontoparietal network by unpredicted erotic images was found. In agreement with current addiction models, our results suggest that cocaine addiction contributes to reduce sensitivity to rewarding stimuli and that abstinence may mitigate this effect.

Production of selenium nanoparticles in Pseudomonas putida KT2440.

Selenium (Se) is an essential element for the cell that has multiple applications in medicine and technology; microorganisms play an important role in Se transformations in the environment. Here we report the previously unidentified ability of the soil bacterium Pseudomonas putida KT2440 to synthesize nanoparticles of elemental selenium (nano-Se) from selenite. Our results show that P. putida is able to reduce selenite aerobically, but not selenate, to nano-Se. Kinetic analysis indicates that, in LB medium supplemented with selenite (1 mM), reduction to nano-Se occurs at a rate of 0.444 mmol L-1 h-1 beginning in the middle-exponential phase and with a final conversion yield of 89%. Measurements with a transmission electron microscope (TEM) show that nano-Se particles synthesized by P. putida have a size range of 100 to 500 nm and that they are located in the surrounding medium or bound to the cell membrane. Experiments involving dynamic light scattering (DLS) show that, in aqueous solution, recovered nano-Se particles have a size range of 70 to 360 nm. The rapid kinetics of conversion, easy retrieval of nano-Se and the metabolic versatility of P. putida offer the opportunity to use this model organism as a microbial factory for production of selenium nanoparticles.

BAS-drive trait modulates dorsomedial striatum activity during reward response-outcome associations.

According to the Reinforcement Sensitivity Theory, behavioral studies have found that individuals with stronger reward sensitivity easily detect cues of reward and establish faster associations between instrumental responses and reward. Neuroimaging studies have shown that processing anticipatory cues of reward is accompanied by stronger ventral striatum activity in individuals with stronger reward sensitivity. Even though establishing response-outcome contingencies has been consistently associated with dorsal striatum, individual differences in this process are poorly understood. Here, we aimed to study the relation between reward sensitivity and brain activity while processing response-reward contingencies. Forty-five participants completed the BIS/BAS questionnaire and performed a gambling task paradigm in which they received monetary rewards or punishments. Overall, our task replicated previous results that have related processing high reward outcomes with activation of striatum and medial frontal areas, whereas processing high punishment outcomes was associated with stronger activity in insula and middle cingulate. As expected, the individual differences in the activity of dorsomedial striatum correlated positively with BAS-Drive. Our results agree with previous studies that have related the dorsomedial striatum with instrumental performance, and suggest that the individual differences in this area may form part of the neural substrate responsible for modulating instrumental conditioning by reward sensitivity.

[Calcium pyrophosphate dihydrate crystal deposition disease as an example of illness presentation in the elderly]. / Enfermedad por depósito de cristales de pirofosfato de calcio como ejemplo de forma de manifestación de la enfermedad en el adulto mayor.

Illness presentation in the elderly may be entirely non-specific, with fatigue, loss of function or the presence of geriatric syndromes. We report a 90 years old male consulting in the emergency room for delirium that persisted throughout hospitalization without finding a cause. During the course of hospitalization mild fever appeared and a left knee swelling became apparent. A synovial fluid aspiration showed a leukocyte count of 360 per field with 60% polymorphonuclear cells. The culture was negative. With a presumptive diagnosis of pseudogout, cochicine and celecoxib were started with remission of the confusional state. The patient was discharged 13 days after admission in good conditions.

Differential neural control in early bilinguals and monolinguals during response inhibition.

We tested the hypothesis that early bilinguals and monolinguals use different brain areas when performing nonlinguistic executive control tasks. For this, we explored brain activity of early bilinguals and monolinguals during a manual stop-signal paradigm. Behaviorally, bilinguals and monolinguals did not show significant differences in the task, which led us to compare brain activation that cannot be attributed to differences in performance. Analyses demonstrated that monolinguals activated the anterior cingulate cortex more than bilinguals when performing the stop-signal task. These results offer direct support for the notion that early bilingualism exerts an effect on neural circuitry responsible for executive control. Consistent with recent reports, we found that bilinguals used the anterior cingulate more efficiently than monolinguals to monitor nonlinguistic cognitive conflicts.

Reward sensitivity is associated with brain activity during erotic stimulus processing.

The behavioral approach system (BAS) from Gray's reinforcement sensitivity theory is a neurobehavioral system involved in the processing of rewarding stimuli that has been related to dopaminergic brain areas. Gray's theory hypothesizes that the functioning of reward brain areas is modulated by BAS-related traits. To test this hypothesis, we performed an fMRI study where participants viewed erotic and neutral pictures, and cues that predicted their appearance. Forty-five heterosexual men completed the Sensitivity to Reward scale (from the Sensitivity to Punishment and Sensitivity to Reward Questionnaire) to measure BAS-related traits. Results showed that Sensitivity to Reward scores correlated positively with brain activity during reactivity to erotic pictures in the left orbitofrontal cortex, left insula, and right ventral striatum. These results demonstrated a relationship between the BAS and reward sensitivity during the processing of erotic stimuli, filling the gap of previous reports that identified the dopaminergic system as a neural substrate for the BAS during the processing of other rewarding stimuli such as money and food.

Prescripción de fármacos en el adulto mayor / Drug prescription in the elderly

El proceso de envejecimiento altera la forma en que los fármacos actúan en el adulto mayor. Cambios tanto en la farmacocinética como la farmacodinamia convierten la prescripción en geriatría en un proceso muy diferente al del adulto joven. El objetivo de este artículo es revisar los cambios fisiológicos del envejecimiento que deben ser considerados para el uso de fármacos en el adulto mayor. Con este fin hemos realizado una revisión bibliográfica de la literatura para generar recomendaciones para la prescripción adecuada en este grupo etario, encasillándolas en listados de fácil uso y acceso sobre medicamentos potencialmente inapropiados, de acuerdo a la calidad de la evidencia disponible y las razones para su evitación en el adulto mayor.

The aging process changes the way in which common drugs act in the elderly. Changes in both the pharmacokinetics and pharmacodynamics make prescribing drugs in geriatrics a process very different from that of the young adult. The aim of this article is to review the physiologic changes that occur with aging and that must be considered when indicating drugs in this age group. For this purpose we conducted a literature review of articles from various journals and textbooks devoted to geriatric medicine in order to extract recommendations for appropriate prescribing in the elderly, represented in easy to use listings of potentially inappropriate medications, according to the quality of evidence and rationale for their avoidance in advanced age.

Reward sensitivity modulates connectivity among reward brain areas during processing of anticipatory reward cues.

Reward sensitivity, or the tendency to engage in motivated approach behavior in the presence of rewarding stimuli, may be a contributory factor for vulnerability to disinhibitory behaviors. Although evidence exists for a reward sensitivity-related increased response in reward brain areas (i.e. nucleus accumbens or midbrain) during the processing of reward cues, it is unknown how this trait modulates brain connectivity, specifically the crucial coupling between the nucleus accumbens, the midbrain, and other reward-related brain areas, including the medial orbitofrontal cortex and the amygdala. Here, we analysed the relationship between effective connectivity and personality in response to anticipatory reward cues. Forty-four males performed an adaptation of the Monetary Incentive Delay Task and completed the Sensitivity to Reward scale. The results showed the modulation of reward sensitivity on both activity and functional connectivity (psychophysiological interaction) during the processing of incentive cues. Sensitivity to reward scores related to stronger activation in the nucleus accumbens and midbrain during the processing of reward cues. Psychophysiological interaction analyses revealed that midbrain-medial orbitofrontal cortex connectivity was negatively correlated with sensitivity to reward scores for high as compared with low incentive cues. Also, nucleus accumbens-amygdala connectivity correlated negatively with sensitivity to reward scores during reward anticipation. Our results suggest that high reward sensitivity-related activation in reward brain areas may result from associated modulatory effects of other brain regions within the reward circuitry.

Individual differences in the Behavioral Inhibition System are associated with orbitofrontal cortex and precuneus gray matter volume.

The Behavioral Inhibition System (BIS) is described in Gray's Reinforcement Sensitivity Theory as a hypothetical construct that mediates anxiety in animals and humans. The neuroanatomical correlates of this system are not fully clear, although they are known to involve the amygdala, the septohippocampal system, and the prefrontal cortex. Previous neuroimaging research has related individual differences in BIS with regional volume and functional variations in the prefrontal cortex, amygdala, and hippocampal formation. The aim of the present work was to study BIS-related individual differences and their relationship with brain regional volume. BIS sensitivity was assessed through the BIS/BAS questionnaire in a sample of male participants (N = 114), and the scores were correlated with brain regional volume in a voxel-based morphometry analysis. The results show a negative correlation between the BIS and the volume of the right and medial orbitofrontal cortices and the precuneus. Our results and previous findings suggest that individual differences in anxiety-related personality traits and their related psychopathology may be associated with reduced brain volume in certain structures relating to emotional control (i.e., the orbitofrontal cortex) and self-consciousness (i.e., the precuneus), as shown by our results.

Preventing delirium in an acute hospital using a non-pharmacological intervention.

BACKGROUND: delirium is a clinical syndrome associated with multiple short and long-term complications and therefore prevention is an essential part of its management. This study was designed to assess the efficacy of multicomponent intervention in delirium prevention. METHODS: a total of 287 hospitalised patients at intermediate or high risk of developing delirium were randomised to receive a non-pharmacological intervention delivered by family members (144 patients) or standard management (143 patients). The primary efficacy outcome was the occurrence of delirium at any time during the course of hospitalisation. Three validated observers performed the event adjudication by using the confusion assessment method screening instrument. RESULTS: there were no significant differences in the baseline characteristics between the two groups. The primary outcome occurred in 5.6% of the patients in the intervention group and in 13.3% of the patients in the control group (relative risk: 0.41; confidence interval: 0.19-0.92; P = 0.027). CONCLUSION: the results of this study show that there is a benefit in the non-pharmacological prevention of delirium using family members, when compared with standard management of patients at risk of developing this condition.

Comparison of complications and length of hospital stay between orthopedic and orthogeriatric treatment in elderly patients with a hip fracture.

Hip fractures in the elderly individuals are a complex problem. Our objective was to determine whether orthogeriatric treatment is effective in terms of reducing length of hospital stay, morbidity, and mortality of elderly patients with a hip fracture compared with orthopedic (traditional) treatment. From July 2009 to May 2011, patients older than 65 years with a hip fracture were followed prospectively. They were co-treated by geriatric and orthopedic teams. This cohort was compared with a retrospective cohort followed from January 2007 to June 2009 that was managed by the orthopedic surgery team only. Epidemiology, pre- and postoperative hematocrit, and renal function were registered. Also, in-hospital and distant mortality data (determined by consulting the national registry), mortality-associated factors, postoperative complications, hospital stay length, and transfers to other services were registered. One hundred and eighty-three patients in the retrospective group and 92 in the prospective group were included in this study with a median follow-up of 26 months (interquartile range: 13-41). The average age was 84 years and 74% of patients were female. Intertrochanteric fracture accounted for 51% of the cases. There was no difference between groups with regard to hospital stay length, hematocrit at discharge, in-hospital mortality, long-term survival, or transfers to internal medicine or the intensive care unit. It did show differences in the transfer to the intermediate care unit, prolonged hospitalizations (>20 days), and diagnosis of delirium and anemia requiring transfusion. In the present study, orthogeriatric treatment is slightly more effective than traditional treatment in terms of morbidity, but there is no difference in hospital stay length or mortality. Further studies and longer follow-up are needed to draw more conclusions.

Estimación de riesgo cardiovascular en trabajadores de una empresa molinera: Antofagasta, 2005 / Estimation of cardiovascular risk in workers of a mill company: Atofagasta 2005

In order to detect existence of cardiovascular risk associate to the work was examined 15 workers of a mill company of Antofagasta, having identified variable personal, environmental and procedural. The obtained results indicate that more than two thirds of the studied group it presented displayed overweight and obesity type 1, in addition to high and moderately high percentage of greasy mass with a positive variable of associated cardiovascular risk to the obesity and the excessive percentage of fat. In 12 cases an index was detected waist high and moderate hip, whereas 10 workers presented displayed arterial hypertension. The physiological service load described like moderate according to rate of pulse frequency, and like low according to the intraaural corporal temperature. Occupational heat exhibition the studied according to TGBH indicated absence of exhibition to physical risk according to law 16.744. The 1,867 kilocalories per day by food ingestion was calculated, situation that are not correlated with the high index of corporal mass, the percentage of greasy mass and the demanded physical loado An ergonomic strategy based on objective indicators sets out to orient the preventive management on the part of the company and continuous qualification of the workers in the matter of own health-care.

Para detectar existencia de riesgo cardiovascular asociado al trabajo se examinó 15 trabajadores de una empresa molinera de Antofagasta, identificando variables personales, ambientales y procedimentales. Se determinó sobrepeso y obesidad tipo 1 en más de dos tercios del grupo estudiado, además de porcentajes altos y moderadamente altos de masa grasa con una variable positiva de riesgo cardiovascular asociado a la obesidad y al porcentaje de grasa excesivo. En 12 casos se detectó un índice cintura cadera alto y moderado, en tanto que 10 trabajadores presentaron hipertensión arterial. La carga de trabajo fisiológico calificó como moderada según tasa de frecuencia de pulso, y como baja según la temperatura corporal intraaural. La exposición a calor ocupacional estudiada según temperatura de globo y bulbo húmedo indicó ausencia de exposición a riesgo físico según la ley 16.744. La ingesta de alimentos calculada fue de 1.867 kilocalorías por día, situación que no se correlaciona con el alto índice de masa corporal, el porcentaje de masa grasa y la carga física demandada.