Prostate cancer detection using e-nose and AI for high probability assessment.

This research aims to develop a diagnostic tool that can quickly and accurately detect prostate cancer using electronic nose technology and a neural network trained on a dataset of urine samples from patients diagnosed with both prostate cancer and benign prostatic hyperplasia, which incorporates a unique data redundancy method. By analyzing signals from these samples, we were able to significantly reduce the number of unnecessary biopsies and improve the classification method, resulting in a recall rate of 91% for detecting prostate cancer. The goal is to make this technology widely available for use in primary care centers, to allow for rapid and non-invasive diagnoses.

Presence of t(14;18) translocation in healthy individuals varies according to ethnic background in the Brazilian population.

Several groups have demonstrated that healthy individuals can present the t(14;18) translocation. In this report, the presence of the translocation was examined in healthy blood donors in Brazil, a country considered an ethnic melting pot. The translocation was detected by nested PCR in 227 peripheral blood samples from individuals with different ethnic backgrounds. The t(14;18) translocation was found in 45 of 85 White individuals (52.94%); in 57 of 72 Black individuals (79.17%); and in 68 of 70 individuals (97.14%) of Japanese-descent. In conclusion, the frequency of the t(14;18) translocation in the Brazilian population varies according to the ethnic background.

A suggested local regions in the Southern Gulf of Mexico using a diatom database (1979-2002) and oceanic hidrographic features.

A diatom data-base of 255 species obtained from 14 oceanographic cruises (14801 entries of 647 sampling sites) together with the analysis of oceanic features were used to establish four local regions in the southern Gulf of Mexico. In addition, common species for each region were designated. This study is based on the application of cluster analysis and the species frequency data. Material for this undertaking consisted of water and net samples obtained between June 1979 and December 2002. Results show that the most frequent species (> 40%) were: Asterionellopsis glacialis, Bacteriastrum delicatulum, B. hyalinum, Chaetoceros affinis, C. coarctatus, C. compresus, C. curvisetus, C. danicus, C. decipiens, C. diversus, C. lorenzianus, C. pelagicus, C. peruvianus, Coscinodiscus radiatus, Cylindrotheca closterium, Guinardia flaccida, Hemiaulus hauckii, H. membranaceus, H. sinensis, Leptocylindrus danicus, Neocalyptrella robusta, Nitzschia bicapitata, Pleurosigma diverse-striatum, Proboscia alata, Pseudo-nitzschia pungens, Pseudosolenia calcar-avis, Rhizosolenia imbricata, R. setigera, Skeletonema costatum, Thalassionema bacillare, T frauenfeldii, T nitzschioides and Thalassiosira eccentrica. The species composition for each region and season are discussed. Itis concluded that sampling site assemblages are related to oceanographic conditions. A total list of species composition is given, forty-seven species taxa being new records for this area.

[Midfemoral nerve block for foot surgery: is there an anatomical-clinical correlation between motor response and latency?]. / Bloqueo mediofemoral para cirugía de pie: existe relación entre la respuesta motora y la latencia? Correlación anatomoclínica.

BACKGROUND AND OBJECTIVE: The latency times of midfemoral sciatic nerve blocks vary greatly. This study investigated the correlation between the type of motor response to nerve stimulation on the one hand and latency and block efficacy on the other. PATIENTS AND METHODS: We enrolled 215 consecutive patients (184 women) undergoing orthopedic foot surgery. A tourniquet was applied above the malleolus. The puncture location was found by palpating to locate the groove between the vastus lateralis and biceps femoris muscles, at the mid-point of the line between the posterior edge of the greater trochanter muscle and the insertion of the biceps femoris muscle in the popliteal fossa. A solution of equal proportions (1:1) of 1.5% mepivacaine (with bicarbonate 1:10) and 0.75% levobupivacaine was injected at a dose of 0.45 mL x kg(-1) (maximum 40 mL) using a 10-cm needle. Nerve stimulation was applied at 100-300 ms, 02-0.4 mA, and 2 Hz. Latency was classified as response in less than 15 minutes, in 15 to 30 minutes, or later than 30 minutes. RESULTS: The evoked motor response was inversion in 30 patients, flexion or extension in 38, plantar flexion in 101, dorsiflexion in 37, and eversion in 9. Shorter latencies (15 minutes) were observed in all patients with inversion or flexion/extension and in 84 (83%) of the 101 patients with plantar flexion. Mid-range latencies were observed in 13% of those with a plantar flexion response and in 29.7% of those with dorsiflexion. All 9 patients with eversion and 17 (45.9%) of the 37 patients with dorsiflexion had the longest latencies. The surgical block was complete for all patients. CONCLUSIONS: This approach provides an effective block with minimum latency in patients who have a flexion or extension motor response in the foot and/or fingers, inversion, or plantar flexion, which assumes that the injection has reached the common trunk of the sciatic or tibial nerve. However, a longer latency is associated with a peroneal motor response, particularly eversion.

Medical resource utilization among community-acquired pneumonia patients initially treated with levofloxacin 750 mg daily versus ceftriaxone 1000 mg plus azithromycin 500 mg daily: a US-based study.

OBJECTIVE: The 2007 American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA) guidelines recommend that community-acquired pneumonia (CAP) patients admitted to hospital wards initially receive respiratory fluoroquinolone monotherapy or beta-lactam plus macrolide combination therapy. There is little evidence as to which regimen is preferred, or if differences in medical resource utilization exist between therapies. Thus, the authors compared length of hospital stay (LOS) and length of intravenous antibiotic therapy (LOIV) for patients who received initial levofloxacin 750 mg daily versus ceftriaxone 1000 mg plus azithromycin 500 mg daily ('combination therapy'). RESEARCH DESIGN AND METHODS: Adult hospital CAP cases from January 2005 to December 2007 were identified by principal discharge diagnosis code. Patients with a chest infiltrate and medical notes indicative of CAP were included. Direct intensive care unit admits and healthcare-associated cases were excluded. A propensity score technique was used to balance characteristics associated with initial antimicrobial therapy using multivariable regression to derive the scores. Propensity score categories, defined as propensity score quintiles, rather than propensity scores themselves, were used in the least squares regression model to assess the impact of LOS and LOIV. RESULTS: A total of 495 patients from six hospitals met study criteria. Of these, 313 (63%) received levofloxacin and 182 (37%) received combination therapy. Groups were similar with respect to age, sex, most comorbidities, presenting signs and symptoms, and Pneumonia Severity Index (PSI) risk class. Patients on combination therapy were more likely to have heart failure and receive pre-admission antibiotics. Adjusted least squares mean (+/-SE) LOS and LOIV were shorter with levofloxacin versus combination therapy: LOS, 4.6 +/- 0.17 vs. 5.4 +/- 0.22 days, p < 0.01; and LOIV, 3.6 +/- 0.17 vs. 4.8 +/- 0.21 days, p < 0.01. Results for PSI risk class III or IV patients were: LOS, 5.0 +/- 0.30 vs. 5.9 +/- 0.37 days, p = 0.07; and LOIV, 3.7 +/- 0.33 vs. 5.2 +/- 0.39 days, p < 0.01. Due to the retrospective study design, limited sample size, and scope (single health-network), the authors encourage replication of this study in other data sources. CONCLUSIONS: Given the LOS and LOIV reductions of 0.8 and 1.2 days, respectively, utilization of levofloxacin 750 mg daily for CAP patients admitted to the medical floor has the potential to result in substantial cost savings for US hospitals.

Cutaneous horn in glans penis: a new clinical case.

This report presents a case of a 65-year-old male suffering from a penile cutaneous horn. This lesion is usually seen in sun-exposed areas and its occurrence on the penis is rare. One-third of cases of penile horns are associated with underlying malignancies. Standard treatment is electrosurgical excision with removal of a broad base.

[Massive intestinal resection. Nutritional adaptation process]. / Resección intestinal masiva. Proceso de adaptación nutricional.

INTRODUCTION: Massive small bowel resection (MSBR) with a remnant jejunum shorter than 60 cm produces severe water, electrolytes, vitamins and protein-caloric depletion. While waiting for a viable intestinal transplantation, most of MSBR patients depend on total parenteral nutrition (TPN). CLINICAL CASE: 32 years old male, with MSBR due to sectioning trauma of the superior mesenteric artery root. First surgical intervention: jejunostomy with small bowel, right colon, and spleen resection. Six months later: jejunocolic anastomosis with 12-cm long jejunum remnant and prophylactic cholecystectomy. NUTRITIONAL INTERVENTION: 1st phase. Hemodynamic stabilization and enteral stimulation (6 months): TPN + enteral nutrition with elemental formula + oral glucohydroelectrolitic solution (OGHS) + 15 g/d of oral glutamine + omeprazol. Clinical course indicators: biochemistry, I/L balance. 2a phase. Digestive adaptation with colonic integration (8 months): replacement of TPN by part-time peripheral PN. Progressive cooked diet complemented with pancreatic poly-enzyme preparation, omeprazol, OGHS, glutamine, elemental formula. Clinical course indicators: biochemistry, diuresis, weight and feces. 3a phase. Auto-sufficiency without parenteral dependence: fragmented free oral diet supplemented with pancreatic poly-enzyme preparation, mineralized beverages, enteral formula supplement, Ca and Mg oral supplements, oral multivitamin and mineral preparation, monthly IM vitamin B12. Current situation actual (52 months): slight ponderal gain, diuresis > liter/day, 2-3 normal feces, no clinical signs of any deficiency and normal blood levels of micronutrients. CONCLUSION: It may be possible to withdraw from PN in MSBR considering, as in this case, favorable age and etiology and early implementation of an appropriate protocol of remnant adaptation.

Aspectos del establecimiento de un programa de salud relacionados con un buen control de la hipertensión arterial esencial / Aspects of establishing a health program related with good control of essential arterial hypertension

OBJETIVO. Evaluar si existe un mejor control de cifras tensionales en los pacientes hipertensos que se ajustan a las actividades propuestas por la Sociedad Española de Hipertensión, con relación a aquéllos que las siguen de una forma más inconstante. DISEÑO. Estudio de casos y controles. EMPLAZAMIENTO. Centro de Salud María Jesús Hereza, Leganés, Madrid. PARTICIPANTES. Cien pacientes de 30 a 65 años de edad, diagnosticados de hipertensión arterial esencial leve o moderada, con al menos 5 años de evolución: 52 con cifras de presión arterial descontroladas y 48 con cifras controladas. Fueron seleccionados aleatoriamente entre 2.000 hipertensos procedentes de seis consultas de Atención Primaria. MEDICIONES PRINCIPALES. Por un lado se midieron las variables sociodemográficas y los antecedentes personales y familiares, y por otro las variables de diagnóstico y manejo de la hipertensión. Se usó la U Mann-Whitney para valorar la adhesión al protocolo, la "t" de Student para variables cuantitativas y la χ2 para las cualitativas. RESULTADOS. Los hipertensos bien controlados tienen una mayor adhesión al protocolo (p = 0,001); (U Mann-Whitney). Los aspectos del protocolo con asociaciones significativas (χ2) con el control de la presión arterial fueron: medición ambulatoria/automedida de presión arterial (MAPA/AMPA) (p < 0,001), dieta hiposódica correcta (p = 0,001), ejercicio físico (p = 0,005) y analítica inicial completa, (p = 0,002). CONCLUSIONES. En nuestro estudio existe un mayor grado de adhesión al protocolo de hipertensión en los pacientes cuyas cifras están controladas. No obstante, los únicos aspectos que se relacionan con un buen control de la presión arterial fueron: MAPA/AMPA, realización de una dieta hiposódica correcta, ejercicio adecuado de forma regular y realización de una analítica inicial completa

OBJECTIVE. Evaluate if there is better control of blood pressure levels in hypertensive patients who adapt to the activities proposed by the Spanish Society of Hypertension in relationship with those who follow them more inconsistently. DESIGN. Case-control study. SITE. Health Care Site María Jesús Hereza, Leganes, Madrid. PARTICIPANTS. A total of 100 patients from 30 to 65 years of age, diagnosed of mild or moderate essential arterial hypertension, with at least five years' evolution. A total of 52 had uncontrolled blood pressure values, 48 controlled values. They were randomly selected among 2000 hypertensive subjects from six primary health care consultations. PRIMARY MEASUREMENTS. A. Sociodemographic variables, personal and family background. B. Diagnostic and hypertension management variables. The Mann-Whitney U test was used to assess adhesion to the protocol, the Student's T test for quantitative variables and the χ2 for the qualitative values. RESULTS. Well-controlled hypertensive subjects have better adhesion to the protocol (p = 0.001); (Mann-Whitney U). The aspects of the protocol with significant associations (χ2) with control of blood pressure were: ambulatory /self-monitoring of blood pressure (ABPM/SMBP), (p < 0.001), correct hyposodium diet (p = 0.001), physical exercise (0 = 0.005) and initial complete laboratory analysis (p = 0.002). CONCLUSIONS. In our study, there was a greater degree of adhesion to the hypertension protocol in patients whose values were controlled. However, the only aspects that are related with good control of blood pressure were ABPM/SMBP, having a correct hyposodium diet, regular adequate exercise and performance of a complete initial laboratory analysis

Psychosis leading to the diagnosis of unrecognized systemic lupus erythematosus: a case report.

We present the case of a woman whose psychiatric clinical picture was the major manifestation of SLE with unrecognized secondary antiphospholipid syndrome. The atypical onset and the subsequent clinical course of the psychiatric manifestations led to the diagnosis. This case demonstrates the heterogeneous progress of SLE, the increasing relevance of the antiphospholipid antibodies in the central nervous system and the difficulty in making an early diagnosis.

Conservative treatment with transurethral resection, neoadjuvant chemotherapy followed by radiochemotherapy in stage T2-3 transitional bladder cancer.

PURPOSE: Organ preservation has been investigated in patients (p) with infiltrating transitional cell carcinoma (TCC) of the bladder over the past decade as an alternative to radical cystectomy. This is a trimodal schedule study, including transurethral resection of bladder tumor (TURB), neoadjuvant chemotherapy and concomitant radiochemotherapy (RTC). PATIENTS AND METHODS: From April 1996 until August 2005, 29 evaluable patients (p) with T2-T3NXM0 bladder cancer were enrolled. After a transurethral resection of bladder tumor (TURB), we administered 2 cycles of induction chemotherapy with CMV (15 p) or Gemcitabine-Cisplatin (14 p) followed by radiotherapy 45 Gy 1.8 Gy/fraction and two cycles of concomitant cisplatin 70 mg/m(2). 2-3 weeks later, a cystoscopy with tumor-site biopsy was performed. If complete histological response, p were treated with consolidation radiotherapy until 64.8 Gy. For p with residual or recurrent tumor, cystectomy was performed. RESULTS: We included 28 men and 1 women (median age 63, range 39-72 years) with PS (ECOG) 0-1. The stage was: 21 p T2; 6 p T3a; and 2 p T3b. Toxicity was higher in CMV compared with Gem- Cis: grade (3/4) neutropenia 4/15 (26%) vs 1/14 (7%); febrile neutropenia 3/15 (20%) vs 1/14 (7%); grade (3/4) trombocytopenia 2/15 (13%) vs 1/14 (7%). Toxicities with concomitant RCT were low-moderate: urocystitis (26%) and enteritis (18%). RESPONSE: microscopically complete TURB was obtained in 20 p (69%), but not in 9 p (31%) (7 microscopic, and 2 macroscopic residual tumor). We found a complete histologic response after induction RCT in 25 p (86%). After a median follow-up of 69.4 months (m) (range: 8-97.7), there were 8 deaths, with a overall survival of 72%. Furthermore 14 of 29 p (48%) were alive with intact bladder, and median survival time with intact bladder was 63.6 m (50.1-77.2); were predictive of best outcome T2 stage vs T3 (p < 0.0001), and complete histologic resection in initial TURB vs residual tumor (p = 0.0004). CONCLUSIONS: Combined treatment provide high response rates and can be offered as an alternative option to radical cystectomy in selected patients with TCC. Patients with T2 stage and complete histologic resection in initial TURB had the best outcome.

Conservative treatment with transurethral resection, neoadjuvant chemotherapy followed by radiochemotherapy in stage T2-3 transitional bladder cancer

PURPOSE: Organ preservation has been investigated in patients (p) with infiltrating transitional cell carcinoma (TCC) of the bladder over the past decade as an alternative to radical cystectomy. This is a trimodal schedule study, including transurethral resection of bladder tumor (TURB), neoadjuvant chemotherapy and concomitant radiochemotherapy (RTC). PATIENTS AND METHODS: From April 1996 until August 2005, 29 evaluable patients (p) with T2-T3NXM0 bladder cancer were enrolled. After a transurethral resection of bladder tumor (TURB), we administered 2 cycles of induction chemotherapy with CMV (15 p) or Gemcitabine-Cisplatin (14 p) followed by radiotherapy 45 Gy 1.8 Gy/fraction and two cycles of concomitant cisplatin 70 mg/m(2). 2-3 weeks later, a cystoscopy with tumor-site biopsy was performed. If complete histological response, p were treated with consolidation radiotherapy until 64.8 Gy. For p with residual or recurrent tumor, cystectomy was performed. RESULTS: We included 28 men and 1 women (median age 63, range 39-72 years) with PS (ECOG) 0-1. The stage was: 21 p T2; 6 p T3a; and 2 p T3b. Toxicity was higher in CMV compared with Gem- Cis: grade (3/4) neutropenia 4/15 (26%) vs 1/14 (7%); febrile neutropenia 3/15 (20%) vs 1/14 (7%); grade (3/4) trombocytopenia 2/15 (13%) vs 1/14 (7%). Toxicities with concomitant RCT were low-moderate: urocystitis (26%) and enteritis (18%). RESPONSE: microscopically complete TURB was obtained in 20 p (69%), but not in 9 p (31%) (7 microscopic, and 2 macroscopic residual tumor). We found a complete histologic response after induction RCT in 25 p (86%). After a median follow-up of 69.4 months (m) (range: 8-97.7), there were 8 deaths, with a overall survival of 72%. Furthermore 14 of 29 p (48%) were alive with intact bladder, and median survival time with intact bladder was 63.6 m (50.1-77.2); were predictive of best outcome T2 stage vs T3 (p < 0.0001), and complete histologic resection in initial TURB vs residual tumor (p = 0.0004). CONCLUSIONS: Combined treatment provide high response rates and can be offered as an alternative option to radical cystectomy in selected patients with TCC. Patients with T2 stage and complete histologic resection in initial TURB had the best outcome (AU)

Protocolo de vía aérea difícil en obstetricia / Practical guideline for the management of difficult intubation in obstetrics

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Rabdomiólisis grave por virus Coxsackie B complicada con síndrome compartimental / Serious rhabdomyolysis dueto Coxsackie B virus complicated with compartment syndrome

La rabdomiólisis como complicación de un síndrome compartimental agudo es algo habitual, pero lo contrario es infrecuente. Presentamos el caso de un hombre de 74 años con una infección aguda por virus Coxsakie B que desarrolló una rabdomiólisis con un nivel de creatinfosfocinasa (CPK) máximo de 161.757 UI/l. Se complicó con un fracaso renal agudo y con un síndrome compartimental de la pierna derecha. La función renal se normalizó en unas semanas, pero a consecuencia del síndrome compartimental desarrolló un pie equino, a pesar de la realización de fasciotomías, precisando una ortesis para deambular. El síndrome compartimental es una complicación a tener en cuenta en rabdomiólisis graves, porque puede pasar desapercibida con facilidad, y se puede asociar a secuelas

Rhabdomyolysis as a complication of an acute compartimental syndrome is somewhat common, but on the contrary, is rare. We present the case of a 74 year man with acute infection by Coxsackie B virus who developed a rhabdomyolysis with a maximum CPK of 161, 757 IU/l. It became complicated with acute renal failure and compartment syndrome of the right leg. Renal function normalized in a few weeks, however, due to the compartment syndrome, he developed an equinus foot in spite of the performance of fasciotomies and required an orthesis to walk. Compartment syndrome is a complication to be considered in serious rhabdomyolysis because it may go unnoticed easily and can be associated to sequels

Tratamiento con infliximab en la enfermedad de Crohn fistulizante y active: nuestra experiencia / Our experience in treatment of with anti-tumor necrosis factor antibody (infliximab) in Crohn's disease

Introducción. El infliximab es un anticuerpo sintético IgG1, compuesto por una región constante humana y una región variable murina dirigido contra el factor de necrosis tumoral, de tipo quimérico, indicado en la enfermedad de Crohn (EC) refractaria al tratamiento convencional. Objetivo. Valorar la tasa de respuesta y remisión clínica en la enfermedad de Crohn activa refractaria y en la fistulosa tratados con infliximab, y conocer el número de dosis necesarias para remisión clínica (RC/RP). Pacientes y métodos. 14 pacientes con EC (5 varones) edad media 33.3±10 años. Se indicó tratamiento por enfermedad fistulosa (13 casos) y por broto agudo de corticorresistente (1 caso). Administramos 5mg/kg. De infliximab en perfusión durante 2 horas a las 0, 2 y 6 semanas. Tres de los pacientes con fístula perianal se les administró una cuarta dosis. El paciente con brote grave recibió una sola dosis. Definimos como remisión clínica la del CDAI <150 puntos y como respuesta clínica la reducción de 70 puntos del CDAI desde la medición basal. En el paciente fistuloso definimos como respuesta completa (RC) el cierre total de las fístulas, con ausencia de drenaje y por respuesta parcial (RP) el cierre al menos el 50% de todas las fístulas. Resultados. Siete pacientes (60%) con fístulas obtuvieron RC tras la segunda dosis, tres (29%) con RP tras cuatro dosis de infliximab y tres (20%) no mejoraron y tuvieron que ser intervenidos quirúrgicamente. El paciente con brote grave obtuvo una mejoría total y se suspendió la 2º dosis por presentar como efectos secundarios taquicardia, disnea y calor, siendo el único que presentó efectos adversos. Todos habían recibido tratamiento con inmunosupresores. Conclusiones. El infliximab ha demostrado ser eficaz en el tratamiento de la enfermedad de Crohn fistulizada y en el manejo de la enfermedad aguda moderada a grave. Los efectos secundarios fueron generalmente leves y transitorios. En nuestro caso la respuesta al infliximab tuvo lugar con la segunda dosis en el 60%, con ganancial parcial del 20% con cuatro dosis

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