gVARVI: A graphical software tool for the acquisition of the heart rate in response to external stimuli.

BACKGROUND AND OBJECTIVE: At present, tools capable of acquiring heart rate data can be found both in commercial and research fields. However, these tools do not allow users to manage experiments comprising sequences of activities or to store the information needed to perform heart rate variability analysis across different activities. One exception is VARVI, a simple software tool developed previously in our research group that does not have a graphical user interface and it works only with visual stimuli. In this paper, we present gVARVI, a software tool aimed at obtaining heart rate data signals while the user is either receiving a sequence of external stimuli or performing a sequence of actions (an activity). METHODS: gVARVI is an open source application developed in Python programming language. It can acquire heart rate data by means of a wireless chest strap using either Bluetooth or ANT+ protocols. Users can define activities of different types (video, sounds, pictures or keyboard controlled actions) which will associate contextual information to the heart rate data. gVARVI allows users to preview this data or to store it to be used for heart rate variability studies. Our tool was validated by 15 researchers, who worked with the application and filled in a usability questionnaire. RESULTS: The outcome of the usability test was satisfactory, giving a mean score of 4.75 in a 1-5 scale (1 - strongly disagree, 5 - strongly agree). Participants also contributed with valuable comments, which we used to include new features in the last version of our tool. CONCLUSIONS: gVARVI is an open source tool that offers new possibilities to both physicians and clinicians to perform heart rate variability studies. It allows users to acquire heart rate data including information on the activity performed by subjects while recording. In this paper, we describe all the functionalities included in gVARVI, and a complete example of use is provided.

Evaluation of a point-of-care blood test for identification of Ebola virus disease at Ebola holding units, Western Area, Sierra Leone, January to February 2015.

Current Ebola virus disease (EVD) diagnosis relies on reverse transcription-PCR (RT-PCR) technology, requiring skilled laboratory personnel and technical infrastructure. Lack of laboratory diagnostic capacity has led to diagnostic delays in the current West African EVD outbreak of 2014 and 2015, compromising outbreak control. We evaluated the diagnostic accuracy of the EVD bedside rapid diagnostic antigen test (RDT) developed by the United Kingdom's Defence Science and Technology Laboratory, compared with Ebola virus RT-PCR, in an operational setting for EVD diagnosis of suspected cases admitted to Ebola holding units in the Western Area of Sierra Leone. From 22 January to 16 February 2015, 138 participants were enrolled. EVD prevalence was 11.5%. All EVD cases were identified by a positive RDT with a test line score of 6 or more, giving a sensitivity of 100% (95% confidence interval (CI): 78.2-100). The corresponding specificity was high (96.6%, 95% CI: 91.3-99.1). The positive and negative predictive values for the population prevalence were 79.0% (95% CI: 54.4-93.8) and 100% (95% CI: 96.7-100), respectively. These results, if confirmed in a larger study, suggest that this RDT could be used as a 'rule-out' screening test for EVD to improve rapid case identification and resource allocation.

gHRV: Heart rate variability analysis made easy.

In this paper, the gHRV software tool is presented. It is a simple, free and portable tool developed in python for analysing heart rate variability. It includes a graphical user interface and it can import files in multiple formats, analyse time intervals in the signal, test statistical significance and export the results. This paper also contains, as an example of use, a clinical analysis performed with the gHRV tool, namely to determine whether the heart rate variability indexes change across different stages of sleep. Results from tests completed by researchers who have tried gHRV are also explained: in general the application was positively valued and results reflect a high level of satisfaction. gHRV is in continuous development and new versions will include suggestions made by testers.

BRUCELLOSIS IN TEREKEKA COUNTY, CENTRAL EQUATORIA STATE, SOUTHERN SUDAN.

OBJECTIVES: To identify factors associated with Brucellosis in patients attending Terekeka Health Facility, Terekeka County, Central Equatoria State, Southern Sudan and to evaluate the utility of the rapid test kit Euracil®. DESIGN: A facility based case-control study. SETTING: Terekeka Health Facility, Terekeka County, Central Equatoria State, Southern Sudan. SUBJECTS: Cases were patients presenting at the Terekeka Health Facility with clinical symptoms suggestive of Brucellosis and tested positive for Brucellosis by rapid antigen test while controls were selected from individuals attending Terekeka Health facility with health problems unrelated to brucellosis or febrile illness. RESULTS: A total of fifty eight cases with clinical symptoms suggestive of and tested positive for Brucellosis by rapid antigen test presented. A total of 116 consented controls were recruited into the study. Males accounted for 52% of the cases and 53% of the controls. The mean age was 31 years for both groups. Cases without formal education were 84% while 40% had no source of income, 20% of the cases and 14% of the controls were cattle keepers while 5% of the cases and 13% of the controls were students. In multivariate analysis there were many factors associated with Brucellosis like consumption of raw meat, living with animals at the same place, raising of goats, farm cleaning contact, eating of aborted and wild animals. Logistic regression revealed two factors associated with the disease; consumption of raw milk (OR=3.9, P-value 0.001, 95% CI 1.6666-9.0700) was a risk factor while drinking boiled milk was protective (OR = 0.09, p-value 0.000, 95% CI, 0.1-0.2). CONCLUSIONS: The main age-groups affected were 20-30 years with males being affected more than females. Drinking of raw milk was significantly associated with Brucellosis while drinking boiled milk was protective. There should be active public health education on the benefits of boiling milk before consumption. Further studies to elucidate the extent and epidemiology of brucellosis in humans and animals in Southern Sudan are recommended.

An open source tool for heart rate variability spectral analysis.

In this paper we describe a software package for developing heart rate variability analysis. This package, called RHRV, is a third party extension for the open source statistical environment R, and can be freely downloaded from the R-CRAN repository. We review the state of the art of software related to the analysis of heart rate variability (HRV). Based upon this review, we motivate the development of an open source software platform which can be used for developing new algorithms for studying HRV or for performing clinical experiments. In particular, we show how the RHRV package greatly simplifies and accelerates the work of the computer scientist or medical specialist in the HRV field. We illustrate the utility of our package with practical examples.

Syphilis among pregnant women in Juba, Southern Sudan.

OBJECTIVE: Determine factors associated with syphilis among pregnant women. DESIGN: Cross-sectional study. SETTING: Antenatal clinics of Juba Teaching Hospital, Malakia National Health Insurance Centre and Munuki Primary Health Care Centre in Juba, Southern Sudan. SUBJECTS: Consenting pregnant women not on syphilis treatment. MAIN OUTCOME MEASURES: Socio-demographic and clinical data, knowledge and behavioural characteristics. RESULTS: Of the 231 pregnant women participants, 51 (22.1%) were positive for syphilis with the rapid plasma reagin test and 79 (34.2%) were positive with the treponema pallidum Haemagglutination assay. Risk factors for syphilis were: housewife (OR 2.808; P= 0.0116), abortion (OR 2.654; P= 0.0116) and partner travel (OR 2.149; P= 0.028). Attending antenatal clinic for previous pregnancy was protective (OR 0.281; P= 0.0004) for syphilis. CONCLUSIONS: This is the first study to determine the prevalence and associated factors in the three clinics in Juba, South Sudan. There is a high prevalence of syphilis in pregnant women attending the selected health facilities. Treponema Pallindum Haemagglulination Assay can be used as a field test for syphilis due to its high sensitivity and specificity. Health education, screening and treating positive expectant mothers can reduce the prevalence of syphilis.

[Automatic detection of pulmonary nodules on computed tomography: a preliminary study]. / Detección automática de nódulos pulmonares en tomografía computarizada.Un estudio preliminar.

OBJECTIVES: Recent years have seen growing interest in the development of algorithms for computer-assisted diagnosis (CAD) for the detection of pulmonary nodules on both plain-film radiographs and computed tomography (CT) studies. The purpose of CAD algorithms in this context is to alert radiologists to suspicious radioopacities that might represent cancer in the images. We are developing a CAD system for the detection of pulmonary nodules on helical CT images. MATERIAL AND METHODS: We collected cases of patients with pulmonary nodules examined with helical CT. A total of 64 nodules, including both calcified and noncalcified lesions, ranging from 3 to 30 mm in diameter were included in the study. Studies were acquired on one 4-slice and one 64-slice CT scanners. Three chest radiologists at two institutions interpreted the studies to determine whether pulmonary nodules were present. We calculated the sensitivity and the number of false positives per image to evaluate the CAD system. RESULTS: We have developed and evaluated an algorithm for the automatic detection of pulmonary nodules on CT images. For a sensitivity of 76%, the false-positive rate was 1.3 per image. CONCLUSIONS: Our preliminary results suggest that the system might be useful for radiologists in the detection of pulmonary nodules on helical CT images.

[Association between refractory hypertension and cardiometabolic risk. The HIPERFRE study]. / Asociación entre hipertensión refractaria y riesgo cardiometabólico. Estudio HIPERFRE.

BACKGROUND AND AIM: Resistant hypertension (R-HT) is defined by the presence of uncontrolled blood pressure in patients treated with three or more drugs, being one of them diuretic. We sough to evaluate the prevalence and features of patients with R-HT attended at Primary Care of our environment. METHOD: 1724 hypertensive patients attended by 35 physicians at 14 Primary Care Units were analyzed in this descriptive, transversal, multicentral study. RESULTS: Patients (41.5% males) with a mean age of 67+/-11 years, being half of them obese. Blood pressure is controlled in 41.6% and the prevalence of R-HT is of 13.2%. This later group of patients is characterized by an older age (69 vs 67 years, p<0.01) and more frequent obesity (62% vs 43%, p<0.001), diabetes (55% vs 11%, p<0.001), hyperlipidemia (68% vs 59%, p<0.05), and metabolic syndrome (68% vs 22%, p<0.001). At least half of them present some kind of end-organ damage. No pharmacologycal treatment is prescribed to 3% of these patients and 37% of them are on monotherapy. There is a higher prescription of angiotensin receptor, calcium channel, beta and alfa-blockers in the group of patients with R-HT. There is an independent and direct relationship between R-HT and age, male gender, diabetes, obesity, metabolic syndrome, and an inverse relationship with ischemic cardiopathy. CONCLUSIONS: The prevalence of R-HT at Primary Care Units is of 13% and is related with age, male gender and metabolic risk factors.

[Aspects concerning behavioural development and socialisation and how they are linked to attention deficit hyperactivity disorder]. / Aspectos relacionados con el desarrollo de la conductay la socialización con mención a sus nexos con eltrastorno por déficit de atención e hiperactividad.

INTRODUCTION: Despite their importance, little attention has been given to the recognition of early markers of hyperactivity in the scientific literature and in everyday practice it can be difficult to separate some of the physiological behaviours displayed by older babies or preschool infants from pathological processes such as attention deficit hyperactivity disorder (ADHD), specific language impairment, autistic spectrum disorders, conduct disorders or bad habits with regard to discipline within the family context. DEVELOPMENT: Knowledge of some of the key points in behavioural development and sociability in children can help reach a correct interpretation of the manifestations observed in this age group. The development of linguistic competencies, a feeling of what is right and what is wrong, the development of an awareness of oneself and the capacity to infer that is established as progress is made in language are some of the keys to proper behavioural development and socialisation. The gene DRD4 is expressed in the prefrontal cortex and has been implicated in some subtypes of ADHD, as well as being linked to a novelty-seeking personality. Recent genetic evidence supports the notion of an association between certain polymorphisms in the DRD4 gene with resistant or disorganised bonds at early ages. CONCLUSIONS: The detection of several dysfunctional signs related to inadequate self-control that appear during behavioural development and socialisation may provide early keys to the future development of ADHD.

Aspectos relacionados con el desarrollo de la conducta y la socialización con mención a sus nexos con el trastorno por déficit de atención e hiperactividad / Aspects concerning behavioural development and socialisation and how they are linked to attention deficit hyperactivity disorder

Introducción. A pesar de su trascendencia, el reconocimientode los marcadores tempranos de hiperactividad ha merecidoescasa importancia en la literatura científica y en la prácticahabitual puede resultar difícil desligar algunas conductas fisiológicasdel lactante mayor o preescolar de procesos patológicoscomo el trastorno por déficit de atención e hiperactividad (TDAH),trastornos específicos del lenguaje, trastornos del espectro autista,trastornos de conducta o malos hábitos de disciplina en el marcofamiliar. Desarrollo. El conocimiento de algunas claves deldesarrollo de la conducta y la sociabilidad en el niño pueden contribuira la correcta interpretación de las manifestaciones observadasen este grupo de edad. El desarrollo de las competenciaslingüísticas, un sentimiento de lo correcto e incorrecto, el desarrollode la conciencia de uno mismo y la capacidad de inferenciaque se instaura en relación con el progreso lingüístico conformanalgunas claves para un adecuado desarrollo de la conducta y lasocialización. El gen DRD4 se expresa en el córtex prefrontal, seha implicado en algunos subtipos de TDAH y se ha ligado a unapersonalidad de búsqueda de emociones. Recientes evidenciasgenéticas apoyan la asociación de determinados polimorfismos enel gen DRD4 con vínculos resistentes o desorganizados a edadestempranas. Conclusión. La detección de algunos signos disfuncionalesen el desarrollo de la conducta y la socialización, relacionadoscon un inadecuado autocontrol, puede proveer de claves precocessobre el desarrollo futuro de un TDAH

Introduction. Despite their importance, little attention has been given to the recognition of early markers ofhyperactivity in the scientific literature and in everyday practice it can be difficult to separate some of the physiologicalbehaviours displayed by older babies or preschool infants from pathological processes such as attention deficit hyperactivitydisorder (ADHD), specific language impairment, autistic spectrum disorders, conduct disorders or bad habits with regard todiscipline within the family context. Development. Knowledge of some of the key points in behavioural development andsociability in children can help reach a correct interpretation of the manifestations observed in this age group. The developmentof linguistic competencies, a feeling of what is right and what is wrong, the development of an awareness of oneself and thecapacity to infer that is established as progress is made in language are some of the keys to proper behavioural development andsocialisation. The gene DRD4 is expressed in the prefrontal cortex and has been implicated in some subtypes of ADHD, as wellas being linked to a novelty-seeking personality. Recent genetic evidence supports the notion of an association between certainpolymorphisms in the DRD4 gene with resistant or disorganised bonds at early ages. Conclusions. The detection of severaldysfunctional signs related to inadequate self-control that appear during behavioural development and socialisation mayprovide early keys to the future development of ADHD

Evaluation of an automated wavelet-based system dedicated to the detection of clustered microcalcifications in digital mammograms.

Mammographic screening programs are delivering reductions in breast cancer mortality. However, breast cancer screening will be cost effective and will provide a real profit only when both high sensitivity and specificity levels are reached. To date, due to human or technical factors, a significant number of breast cancers are still missed or misinterpreted on the mammograms. Computer methodologies, developed to assist radiologists, could represent further amelioration by increasing diagnostic accuracy in the screening programs. We have tested a computerized scheme to detect clustered microcalcifications in digital mammograms, employing 360 mammograms that were randomly selected from the mammographic screening program, currently undergoing at the Galicia Community (Spain). After the digitization process, the breast border was initially determined. A wavelet-based algorithm was employed to detect the clusters of microcalcifications. The performance of the automated system over the test set was evaluated employing Free-response Receiver Operating Characteristic (FROC) methodology. The sensitivity achieved was 74% at a false positive detection rate of 1.83. The corresponding area under the Alternative FROC (AFROC) curve was A1=0.667 +/-0.09.

[Therapeutic approaches in symptomatic hypertrophic obstructive cardiomyopathy]. / Estrategias terapéuticas en la miocardiopatía hipertrófica obstructiva sintomática.

Hypertrophic cardiomyopathy is a complex and heterogeneous disease. Although most patients experience just a few symptoms, and have a good prognosis, there are others whose symptoms are severe and progressive, determined by different pathophysiological elements such as diastolic dysfunction, myocardial ischemia, arrhythmias and subaortic obstruction. Approximately 20-30% of hypertrophic cardiomyopathy patients develop an intraventricular dynamic gradient, which in some cases, is responsible for severe symptoms which are ameliorated once the obstruction is reduced. In many cases the symptoms can be controlled with medical treatment which includes betablockers, calcium-channel antagonists and dysopiramide, but some patients will still experience severe and refractory symptoms. This subgroup of patients, which represent approximately 5-10% of patients with hypertrophic cardiomyopathy, can be problematic from a management perspective. For many years, septal myectomy and/or mitral valve replacement offered the only effective alternative therapy for these patients. However, the high rates of morbidity and mortality associated with these procedures have necessitated the search for new and less invasive procedures such as ventricular pacing and percutaneous septal ablation. Although the initial results with sequential pacing were encouraging, further studies have suggested a significant placebo effect, which makes its application controversial. In the last 5 years selective embolization of the septal artery precipitating a localized myocardial infarction has been utilized to reduce the subaortic gradient. The potential indications and efficacy of these new forms of treatment, like ventricular pacing and percutaneous septal ablation, are presently under evaluation and are the main subject of this review. Medical treatment, with either beta-blockers, calcium channel antagonists or dysopiramide constitutes the first therapeutic step. Surgery, while alleviating the subaortic obstruction and reducing the intraventicular pressure and mitral insufficiency, produces important and long-lasting symptomatic and functional improvement in most of these patients, and it continues to be an important therapeutic alternative in these cases. If the first results with sequential pacemaker implants were encouraging, today it is alluded to an important placebo effect that causes its application to be controversial. In the last 5 years the path has been made in the creation of a septal infarction located through the embolization of the septal branches to reduce the gradient.

[The clinical practice guidelines of the Sociedad Española de Cardiología on cardiomyopathies and myocarditis]. / Guías de práctica clínica de la Sociedad Española de Cardiología en miocardiopatías y miocarditis.

Myocardial diseases are a extraordinarily heterogeneous group of processes that only have in common the fact that they involve heart muscle and that they cause a wide spectrum of myocardial dysfunction. The approach of the management and treatment of the cardiomyopathies is a continuous matter of discussion because the vast majority of alternatives in this field have not been based on the best scientific possible evidence and, since except for the case of heart failure associated with dilated cardiomyopathy. The majority of different options have not been studied by means of large (or even small) randomized trials. Nevertheless, this chapter has tried to provide the reader with different approaches on how to deal with important clinical problems in dilated, hypertrophic and restrictive cardiomyopathies, and in myocarditis as well. For this, we have utilized the most relevant information found coupled with our best clinical judgment, although we admit that many of the clinical recommendations can be controversial.

A wavelet-based algorithm for detecting clustered microcalcifications in digital mammograms.

A computerized scheme to detect clustered microcalcifications in digital mammograms has been developed. Detection of individual microcalcifications in regions of interest (ROIs) was also performed. The mammograms were previously classified into fatty and dense, according to their breast tissue. The most appropriate wavelet basis and reconstruction levels were selected. To select the wavelet basis, 40 profiles of microcalcifications were decomposed and reconstructed using different types of wavelet functions and different combinations of wavelet coefficients. The symlets with a basis of length 8 were chosen for fatty tissue. For dense tissue, the Daubechies' wavelets with a four-element basis were employed. Two methods to detect individual microcalcifications were evaluated: (a) two-dimensional wavelet transform, and (b) one-dimensional wavelet transform. The second technique yielded the best results, and was used to detect clustered microcalcifications in the complete mammogram. When detecting individual microcalcifications by using two-dimensional wavelet transform we have obtained, for fatty ROIs, a sensitivity of 71.11% at a false positive rate of 7.13 per image. For dense ROIs the sensitivity was 60.76% and the false positive rate, 7.33. The areas (A1) under the AFROC curves were 0.33+/-0.04 and 0.28+/-0.02, respectively. The one-dimensional wavelet transform method yielded 80.44% of sensitivity and 6.43 false positives per image (A1=0.39+/-0.03) for fatty ROIs, and 62.17% and 5.82 false positives per image (A1=0.37+/-0.02) for dense ROIs. For the detection of clusters of microcalcifications in the entire mammogram, the sensitivity was 80.00% with 0.94 false positives per image (A1=0.77+/-0.09) for fatty mammograms, and 72.85% of sensitivity at a false positive detection rate of 2.21 per image (A1=0.64+/-0.07) for dense mammograms. Globally, a sensitivity of 76.43% at a false positive detection rate of 1.57 per image was obtained.

[Acute myocardial infarction after anaphylactic reaction to amoxicillin]. / Infarto agudo de miocardio tras reacción anafiláctica por amoxicilina.

A 62-year-old man was admitted to the hospital in a state of shock with electrocardiographic signs of inferior-wall acute myocardial infarction. He was initially diagnosed of cardiogenic shock. An urgent coronary angiography showed an irregular stenosis of 90% in the right coronary artery. Coronary angioplasty was performed, and a stent was placed in this lesion. In-depth questioning of the family revealed that the patient had taken an oral dose of amoxicillin 15 minutes before the onset of the symptoms. Further tests proved that he was allergic to amoxicillin, and was diagnosed of anaphylactic shock, complicated with acute myocardial infarction. There are several reports of myocardial infarction as a complication of anaphylactic reaction. We have found very few cases related to antibiotics, and none associated with amoxicillin. The most frequently quoted mechanism in these cases is coronary artery spasm due to the mediators of anaphylaxis. In the case reported herein, the irregular lesion suggests that disruption of an atherosclerotic plaque and platelet aggregation have occurred.

[The electrocardiogram in apical hypertrophic myocardiopathy. A case report with unique manifestations]. / El electrocardiograma en la miocardiopatía hipertrófica apical. Presentación de un caso con manifestaciones únicas.

We report the case of a 63-year-old female patient with apical hypertrophic cardiomyopathy, diagnosed by the presence of localized apical hypertrophy in the echocardiogram and a typical "spade like" left ventricular angiographic image, but with unique electrocardiographic features, characterized by chronic ST segment elevation, and T wave inversion, in the anterolateral leads. These changes were initially interpreted as a manifestation of acute ischemic heart disease. Chronic ST segment elevation has been occasionally described in patients with hypertrophic cardiomyopathy complicated with apical necrosis and aneurysm formation, but not in uncomplicated cases of apical hypertrophic cardiomyopathy. Its knowledge by the physician could allow avoidance of problems of differential diagnosis with more frequent heart diseases, especially acute atherosclerotic ischaemic heart disease.

Computer-aided diagnosis: automatic detection of malignant masses in digitized mammograms.

A computerized method to automatically detect malignant masses on digital mammograms based on bilateral subtraction to identify asymmetries between left and right breast images was developed. After the digitization, in order to align left and right mammograms the breast border and nipple were automatically detected. Images were corrected to avoid differences in brightness due to the recording procedure. Left and right mammograms were subtracted and a threshold was applied to obtain a binary image with the information of suspicious areas. The suspicious regions or asymmetries were delimited by a region growing algorithm. Size and eccentricity tests were used to eliminate false-positive responses and texture features were extracted from suspicious regions to reject normal tissue regions. The scheme, tested in 70 pairs of digital mammograms, achieved a true-positive rate of 71% with an average number of 0.67 false positives per image. Computerized detection was evaluated by using free-response operating characteristic analysis (FROC). An area under the AFROC (A1) of 0.667 was obtained. Our results show that the scheme may be helpful to the radiologists by serving as a second reader in mammographic screening. The low number of false positives indicates that our scheme would not confuse the radiologist by suggesting normal regions as suspicious.