Diferencias en la presentación clínica de primeros episodios psicóticos entre población de origen marroquí y población autóctona / Comparison between a morocco and a native-born population, in a sample of first episode psychosis

INTRODUCCIÓN: Las diferencias étnicas han sido estudiadas tanto en esquizofrenia como en los primeros episodios psicóticos (PEP).??En estudios realizados en los Países Bajos se ha descrito que en los varones de origen marroquí es más frecuente un episodio psicótico y presentar mayor severidad en la sintomatología. Sin embargo, no existen estudios en España en PEP en población marroquí comparada con autóctona. OBJETIVOS: Explorar las diferencias clínicas entre la población inmigrante de origen marroquí y la población autóctona, en una muestra de PEP recogida en una unidad de hospitalización de agudos. MATERIAL Y MÉTODOS: Se evaluó la sintomatología y el funcionamiento al ingreso y al alta, así como el consumo de cannabis y la dosis de tratamiento antipsicótico y el perfil de efectos adversos en una muestra de 83 pacientes con PEP. Se compararon los pacientes de origen marroquí con los de la población autóctona mediante análisis univariantes y la independencia de las asociaciones fue evaluada mediante análisis de regresión logística. RESULTADOS: El 28,9% de la muestra era de origen marroquí. No se encontraron diferencias en cuanto a la sintomatología al ingreso y al alta. Comparados con los autóctonos, los de origen marroquí eran mayoritariamente hombres, tenían menos años de educación, presentaban peor funcionamiento, menor uso de cannabis, mejor perfil de efectos secundarios y una tendencia al mayor uso de LAI. Tras el análisis multivariante, solo un peor funcionamiento (OR 0,93; IC 95%: 0,88-0,99; p = 0,02) y menos años de educación (OR 0,75; IC 95%: 0,56-1,01; p = 0,05) permanecieron significativamente asociados a ser de origen marroquí. CONCLUSIONES: Existen diferencias sociodemográficas y clínicas entre personas con PEP de origen marroquí y población autóctona. Nuestros resultados señalan que debería contemplarse la trascendencia de la competencia cultural en la evaluación y tratamiento de los PEP

INTRODUCTION: Ethnic differences have been studied previously in schizophrenia and first episodes of psychosis (FEP). Previous studies in Netherlands have reported a higher incidence of psychosis in male Moroccan immigrants and more clinical severity. However there is lack of studies in Spain with morocco population and FEP. OBJECTIVES: This study aims to determine the clinical differences in a sample of FEP between Morocco and Spanish population, recruited in a hospitalisation unit. MATERIAL AND METHODS: Descriptive and cross-sectional study of 83 inpatients (FEP). Functionality and symptomatology were evaluated at entry and discharge, the pattern of use of cannabis was evaluated at entry, the dose of antipsychotic and the pattern of side-effects at discharge. Comparisons between native-born population and Morocco population was made with univariate analysis and logistic regression was made for evaluating the independence of the associations. RESULTS: The 28.9% of the sample was Morocco group. No significance differences were found in clinical characteristics between groups at entry or at discharge. Compared with native-born, the Morocco group were more male, with less years of education, worse functionality, reported less use of cannabis, a better pattern of side effects and a tendency of more prescription of LAis. After the multivariate analysis, just remains a lower functionality (OR 0.93; IC 95%: 0.88-0.99, P=0.02) and lower years of education (OR 0.75; IC 95%: 0.56-1.01, P=0.05), remain significative with being related with Morocco origin. CONCLUSIONS: Our study provides evidence for ethnic differences in Morocco population with FEP. Patients with Morocco ethnicity have more probability of being males, less years of educations. Have lower functionality and a better profile of side effects

Comparison between a morocco and a native-born population, in a sample of first episode psychosis. / Diferencias en la presentación clínica de primeros episodios psicóticos entre población de origen marroquí y población autóctona.

INTRODUCTION: Ethnic differences have been studied previously in schizophrenia and first episodes of psychosis (FEP). Previous studies in Netherlands have reported a higher incidence of psychosis in male Moroccan immigrants and more clinical severity. However there is lack of studies in Spain with morocco population and FEP. OBJECTIVES: This study aims to determine the clinical differences in a sample of FEP between Morocco and Spanish population, recruited in a hospitalisation unit. MATERIAL AND METHODS: Descriptive and cross-sectional study of 83 inpatients (FEP). Functionality and symptomatology were evaluated at entry and discharge, the pattern of use of cannabis was evaluated at entry, the dose of antipsychotic and the pattern of side-effects at discharge. Comparisons between native-born population and Morocco population was made with univariate analysis and logistic regression was made for evaluating the independence of the associations. RESULTS: The 28.9% of the sample was Morocco group. No significance differences were found in clinical characteristics between groups at entry or at discharge. Compared with native-born, the Morocco group were more male, with less years of education, worse functionality, reported less use of cannabis, a better pattern of side effects and a tendency of more prescription of LAis. After the multivariate analysis, just remains a lower functionality (OR 0.93; IC 95%: 0.88-0.99, P=0.02) and lower years of education (OR 0.75; IC 95%: 0.56-1.01, P=0.05), remain significative with being related with Morocco origin. CONCLUSIONS: Our study provides evidence for ethnic differences in Morocco population with FEP. Patients with Morocco ethnicity have more probability of being males, less years of educations. Have lower functionality and a better profile of side effects.

Access path angle in transapical aortic valve replacement: risk factor for paravalvular leakage.

BACKGROUND: The aim of this study was to analyze the angle between the left ventricular (LV) long axis and the LV outflow tract (αLV-LVOT) on cardiac computed tomography and to describe its effect on the occurrence of paravalvular leakage (PL), fluoroscopy time, and postoperative creatine kinase-MB levels in transapical transcatheter aortic valve replacement (TA-TAVR). METHODS: High-risk patients with severe aortic stenosis scheduled for TA-TAVR using an Edwards SAPIEN (Edwards Lifesciences, Irvine, CA) prosthesis were retrospectively included. The αLV-LVOT was measured during systole and diastole as far as retrospectively gated data sets were available. The αLV-LVOT was correlated with the occurrence of PL, total fluoroscopy time, and postoperative creatine kinase-MB levels. Interobserver variability was assessed in all cases. RESULTS: The study included 81 patients (57 women [70.4%], 24 men [29.6%]) with an average age of 81.9±5.8 years. The mean αLV-LVOTs were 61.8±9.9 degrees during systole and 61.1±10.0 degrees during diastole. There was a minimal, nonsignificant change in the αLV-LVOT between systole and diastole of 0.2±4.1 degrees (p=0.7). PL was found in 39 patients: grade 0 in 42 (51.9%), grade I in 30 (37.0%), and grade II in 9 (11.1%). Patients with a clinically significant PL (grade≥II) showed a significantly greater mean αLV-LVOT than patients with grade I or without PL (mean difference, 13.8±3.2 degrees; p<0.001). No significant correlation was found between the αLV-LVOT and total fluoroscopy time (r=-0.17, p=0.16) and postoperative creatine kinase-MB levels (r=-0.1, p=0.44). CONCLUSIONS: During TA-TAVR, greater αLV-LVOTs were associated with significantly higher grades of PL. Thus, the αLV-LVOT might influence the selection of the transapical implantation path and could have a significant effect on designs for future stents or novel delivery devices.

The relation between hypointense core, microvascular obstruction and intramyocardial haemorrhage in acute reperfused myocardial infarction assessed by cardiac magnetic resonance imaging.

BACKGROUND: Intramyocardial haemorrhage (IMH) and microvascular obstruction (MVO) represent reperfusion injury after reperfused ST-elevation myocardial infarction (STEMI) with prognostic impact and "hypointense core" (HIC) appearance in T2-weighted images. We aimed to distinguish between IMH and MVO by using T2 (*)-weighted cardiovascular magnetic resonance imaging (CMR) and analysed influencing factors for IMH development. METHODS AND RESULTS: A total of 151 patients with acute STEMI underwent CMR after primary angioplasty. T2-STIR sequences were used to identify HIC, late gadolinium enhancement to visualise MVO and T2 (*)-weighted sequences to detect IMH. IMH(+)/IMH(-) patients were compared considering infarct size, myocardial salvage, thrombolysis in myocardial infarction (TIMI) flow, reperfusion time, ventricular volumes, function and pre-interventional medication. Seventy-six patients (50%) were IMH(+), 82 (54%) demonstrated HIC and 100 (66%) MVO. IMH was detectable without HIC in 16 %, without MVO in 5% and HIC without MVO in 6%. Multivariable analyses revealed that IMH was associated with significant lower left ventricular ejection fraction and myocardial salvage index, larger left ventricular volume and infarct size. Patients with TIMI flow grade ≤1 before angioplasty demonstrated IMH significantly more often. CONCLUSIONS: IMH is associated with impaired left ventricular function and higher infarct size. T2 and HIC imaging showed moderate agreement for IMH detection. T2 (*) imaging might be the preferred CMR imaging method for comprehensive IMH assessment. KEY POINTS: Intramyocardial haemorrhage is a common finding in patients with acute reperfused myocardial-infarction. T 2 (*) imaging should be the preferred CMR method for assessment of intramyocardial haemorrhage. Intramyocardial haemorrhage can be considered as an important influencing factor on patient's outcome.

Assessment of sub-clinical acute cellular rejection after heart transplantation: comparison of cardiac magnetic resonance imaging and endomyocardial biopsy.

OBJECTIVE: Comparing the diagnostic value of multi-sequential cardiac magnetic resonance imaging (CMR) with endomyocardial biopsy (EMB) for sub-clinical cardiac allograft rejection. METHODS: One hundred and forty-six examinations in 73 patients (mean age 53 ± 12 years, 58 men) were performed using a 1.5 Tesla system and compared to EMB. Examinations included a STIR (short tau inversion recovery) sequence for calculation of edema ratio (ER), a T1-weighted spin-echo sequence for assessment of global relative enhancement (gRE), and inversion-recovery sequences to visualize late gadolinium enhancement (LGE). Histological grade ≥1B was considered relevant rejection. RESULTS: One hundred and twenty-seven (127/146 = 87 %) EMBs demonstrated no or mild signs of rejection (grades ≤1A) and 19/146 (13 %) a relevant rejection (grade ≥1B). Sensitivity, specificity, positive predictive, and negative predictive values were as follows: ER: 63 %, 78 %, 30 %, and 93 %; gRE: 63 %, 70 %, 24 %, and 93 %; LGE: 68 %, 36 %, 13 %, and 87 %; with the combination of ER and gRE with at least one out of two positive: 84 %, 57 %, 23 %, and 96 %. ROC analysis revealed an area under the curve of 0.724 for ER and 0.659 for gRE. CONCLUSION: CMR parameters for myocarditis are useful to detect sub-clinical acute cellular rejection after heart transplantation. Comparable results to myocarditis can be achieved with a combination of parameters. KEY POINTS: • Magnetic resonance imaging is useful for the assessment of cardiac allograft rejection. • CMR has a high negative predictive value for exclusion of allograft rejection. • Diagnostic performance is not yet good enough to replace endomyocardial biopsy.

Dynamic CT angiography after abdominal aortic endovascular aneurysm repair: influence of enhancement patterns and optimal bolus timing on endoleak detection.

PURPOSE: To determine the time course of enhancement patterns in the aorta and endoleaks at dynamic computed tomographic (CT) angiography as well as their effect on the endoleak detection rate in patients who have undergone abdominal aortic endovascular aneurysm repair (EVAR). MATERIALS AND METHODS: This retrospective study was approved by the local ethics committee and compliant with the Declaration of Helsinki. All patients gave written informed consent for the scientific analysis of their data. Seventy-one patients (mean age, 72 years ± 8 [standard deviation]) were retrospectively included after EVAR of the abdominal aorta. All patients underwent dynamic CT angiography with 10 unidirectional scan phases, followed by a venous phase. Endoleaks were detected visually in all scan phases; the magnitude of enhancement was assessed by using region-of-interest measurements in the aorta and the detectable endoleaks. Statistical analysis was performed with the χ(2) test, the paired t test, and analysis of variance with repeated measurements. RESULTS: The highest mean aortic enhancement was achieved 12 seconds after the bolus-tracking threshold, and the highest mean endoleak enhancement was achieved 22 seconds after the bolus-tracking threshold. In total, 44 endoleaks were detected. The detection rates differed significantly in between the dynamic CT angiography phases (minimum, seven endoleaks at 2 seconds after the bolus-tracking threshold; maximum, 44 endoleaks at 27 seconds after the bolus-tracking threshold; P = .001). The highest detection rate was achieved when the contrast between aortic and endoleak enhancement reached its maximum. CONCLUSION: Dynamic CT angiography revealed that the peak enhancement of endoleaks is significantly different than that of the aorta and that endoleaks may not be adequately evaluated with conventional biphasic CT protocols. The use of dynamic CT angiography is associated with a significantly increased detection rate of endoleaks compared with the detection rates at the time points of conventional biphasic CT.

Dynamic CT angiography after abdominal aortic endovascular aneurysm repair: differences in contrast agent dynamics in the aorta and endoleaks--preliminary results.

PURPOSE: To assess differences in aortic and endoleak enhancement in patients after endovascular aneurysm repair (EVAR) with dynamic computed tomography (CT) angiography. MATERIALS AND METHODS: Twenty-one consecutive patients (mean age, 74.5 y ± 6; range, 61-88 y) with endoleaks after EVAR of the abdominal aorta were examined on a second-generation dual-source CT unit with 10 unidirectional scan phases (temporal resolution, 5 s; 80 kV; 120 reference-mAs; z-axis field of view, 283 mm), followed by a venous scan phase. Enhancement was assessed in aorta and endoleaks for all phases by density measurements. The diagnostic reliability of endoleak detection was assessed on a five-point confidence scale. RESULTS: In total, 26 endoleaks (type I, n = 1; type II, n = 25) were detected. The highest detection rate was found in phase 5 (22 s after threshold; P < .01 vs other dynamic phases). Mean peak aortic enhancement (560 HU ± 96) was present in an early arterial phase (phase 3, 12 s after threshold), whereas the mean peak endoleak enhancement (398 HU ± 174) for type II endoleaks was present later, in phase 4 (17 s after threshold). Despite perceived high diagnostic confidence in phases 1 and 2 (ie, typical arterial phase of biphasic CT protocol), only 23% and 62% of endoleaks were detected, respectively, whereas peak diagnostic confidence (phases 4 and 5) corresponded well with the maximum endoleak detection rate but decreased significantly in later phases (ie, 6-10). CONCLUSIONS: Preliminary dynamic CT angiography results in post-EVAR follow-up revealed notably different peaks of endoleak and aortic enhancement, which are not covered sufficiently by conventional biphasic CT protocols. Phase 5 demonstrated the highest type II endoleak detection rate, with high diagnostic confidence.

Impact of heart rate and rhythm on radiation exposure in prospectively ECG triggered computed tomography.

PURPOSE: To evaluate the influence of different heart rates and arrhythmias on scanner performance, image acquisition and applied radiation exposure in prospectively ECG triggered computed tomography (pCT). MATERIALS AND METHODS: An ECG simulator (EKG Phantom 320, Müller & Sebastiani Elektronik GmbH, Munich, Germany) was used to generate different heart rhythms and arrhythmias: sinus rhythm (SR) at 45, 60, 75, 90 and 120/min, supraventricular arrhythmias (e.g. sinus arrhythmia, atrial fibrillation) and ventricular arrhythmias (e.g. ventricular extrasystoles), pacemaker-ECGs, ST-changes and technical artifacts. The analysis of the image acquisition process was performed on a 64-row multidetector CT (Brilliance, Philips Medical Systems, Cleveland, USA). A prospectively triggered scan protocol as used for routine was applied (120 kV; 150 mAs; 0.4s rotation and exposure time per scan; image acquisition predominantly in end-diastole at 75% R-R-interval, in arrythmias with a mean heart rate above 80/min in systole at 45% of the R-R-interval; FOV 25 cm). The mean dose length product (DLP) and its percentage increase from baseline (SR at 60/min) were determined. RESULT: Radiation exposure can increase significantly when the heart rhythm deviates from sinus rhythm. ECG-changes leading to a significant DLP increase (p<0.05) were bifocal pacemaker (61%), pacemaker dysfunction (22%), SVES (20%), ventricular salvo (20%), and atrial fibrillation (14%). Significantly (p<0.05) prolonged scan time (>8 s) could be observed in bifocal pacemaker (12.8 s), pacemaker dysfunction (10.7 s), atrial fibrillation (10.3 s) and sinus arrhythmia (9.3 s). CONCLUSION: In prospectively ECG triggered CT, heart rate and rhythm can provoke different types of scanner performance, which can significantly alter radiation exposure and scan time. These results might have an important implication for indication, informed consent and contrast agent injection protocols.

Novel immunogenic antigens increase classification accuracy in meningioma to 93.84%.

There is growing evidence that simultaneous analysis of multiple autoantibody reactions can be utilized for diagnosis of neoplasms. Using a set of 57 meningioma-associated antigens, we recently separated meningioma patients from individuals without known disease with an accuracy of 90.3%. Here, we ask whether a largely increased set of immunogenic antigens can further improve this discrimination. We used an array with 1,827 human recombinant clones and measured reactivity of serum autoantibodies against the clones by a novel automated image analysis procedure. We were able to separate meningioma sera from sera of healthy controls with a specificity of 95.62%, a sensitivity of 91.83% and an accuracy of 93.84%. Of the analyzed clones, 23 in-frame clones were highly informative for the classification of meningioma vs. normal sera as shown by their AUC values. These results demonstrate that the accuracy of a serum-based diagnostic can be readily and considerably improved by screening extended sets of proteins.

Identification of lung cancer with high sensitivity and specificity by blood testing.

BACKGROUND: Lung cancer is a very frequent and lethal tumor with an identifiable risk population. Cytological analysis and chest X-ray failed to reduce mortality, and CT screenings are still controversially discussed. Recent studies provided first evidence for the potential usefulness of autoantigens as markers for lung cancer. METHODS: We used extended panels of arrayed antigens and determined autoantibody signatures of sera from patients with different kinds of lung cancer, different common non-tumor lung pathologies, and controls without any lung disease by a newly developed computer aided image analysis procedure. The resulting signatures were classified using linear kernel Support Vector Machines and 10-fold cross-validation. RESULTS: The novel approach allowed for discriminating lung cancer patients from controls without any lung disease with a specificity of 97.0%, a sensitivity of 97.9%, and an accuracy of 97.6%. The classification of stage IA/IB tumors and controls yielded a specificity of 97.6%, a sensitivity of 75.9%, and an accuracy of 92.9%. The discrimination of lung cancer patients from patients with non-tumor lung pathologies reached an accuracy of 88.5%. CONCLUSION: We were able to separate lung cancer patients from subjects without any lung disease with high accuracy. Furthermore, lung cancer patients could be separated from patients with other non-tumor lung diseases. These results provide clear evidence that blood-based tests open new avenues for the early diagnosis of lung cancer.

Improving seroreactivity-based detection of glioma.

Seroreactivity profiling emerges as valuable technique for minimal invasive cancer detection. Recently, we provided first evidence for the applicability of serum profiling of glioma using a limited number of immunogenic antigens. Here, we screened 57 glioma and 60 healthy sera for autoantibodies against 1827 Escherichia coli expressed clones, including 509 in-frame peptide sequences. By a linear support vector machine approach, we calculated mean specificity, sensitivity, and accuracy of 100 repetitive classifications. We were able to differentiate glioma sera from sera of the healthy controls with a specificity of 90.28%, a sensitivity of 87.31% and an accuracy of 88.84%. We were also able to differentiate World Health Organization grade IV glioma sera from healthy sera with a specificity of 98.45%, a sensitivity of 80.93%, and an accuracy of 92.88%. To rank the antigens according to their information content, we computed the area under the receiver operator characteristic curve value for each clone. Altogether, we found 46 immunogenic clones including 16 in-frame clones that were informative for the classification of glioma sera versus healthy sera. For the separation of glioblastoma versus healthy sera, we found 91 informative clones including 26 in-frame clones. The best-suited in-frame clone for the classification glioma sera versus healthy sera corresponded to the vimentin gene (VIM) that was previously associated with glioma. In the future, autoantibody signatures in glioma not only may prove useful for diagnosis but also offer the prospect for a personalized immune-based therapy.

Novel autoantigens immunogenic in COPD patients.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a respiratory inflammatory condition with autoimmune features including IgG autoantibodies. In this study we analyze the complexity of the autoantibody response and reveal the nature of the antigens that are recognized by autoantibodies in COPD patients. METHODS: An array of 1827 gridded immunogenic peptide clones was established and screened with 17 sera of COPD patients and 60 healthy controls. Protein arrays were evaluated both by visual inspection and a recently developed computer aided image analysis technique. By this computer aided image analysis technique we computed the intensity values for each peptide clone and each serum and calculated the area under the receiver operator characteristics curve (AUC) for each clone and the separation COPD sera versus control sera. RESULTS: By visual evaluation we detected 381 peptide clones that reacted with autoantibodies of COPD patients including 17 clones that reacted with more than 60% of the COPD sera and seven clones that reacted with more than 90% of the COPD sera. The comparison of COPD sera and controls by the automated image analysis system identified 212 peptide clones with informative AUC values. By in silico sequence analysis we found an enrichment of sequence motives previously associated with immunogenicity. CONCLUSION: The identification of a rather complex humoral immune response in COPD patients supports the idea of COPD as a disease with strong autoimmune features. The identification of novel immunogenic antigens is a first step towards a better understanding of the autoimmune component of COPD.

Gradual in silico filtering for druglike substances.

The suitability of decision trees in comparison to support vector machines for the classification of chemical compounds into drugs and nondrugs was investigated. To account for the requirements upon screening virtual compound libraries, schemes for successive filtering steps with gradual increasing computational cost are outlined. The obtained prediction accuracy was similar between decision trees and support vector machine approaches for the applied compound data sets. By using rapidly computable variables such as druglikeness indices, XlogP, and the molar refractivity, at least 39% of the nondrugs can be filtered out, while retaining more than 83% of the actual drugs. Computationally more demanding descriptors such as specific substructure queries and quantum chemically derived variables can be postponed to subsequent classification schemes for the reduced set of compounds, whereby up to 92% of the nondrugs can be sorted out without loosing considerably more drugs. Using all available computed descriptors simultaneously in the first step did not yield significantly better results. Furthermore, the generated decision trees are used to derive guidelines for the design of druglike substances. The numerical margins found at the branching points suggest several criteria that separate drugs from nondrugs: a molecular weight higher than 230, a molar refractivity higher than 40, and the presence of one or more rings as well as one or more functional groups. Also reported are additionally required parameters to compute values for XlogP, SlogP, and the molar refractivity of boron and silicon containing compounds.