Analisis del impacto de la pandemia por covid-19 en recursos de rehabilitacion psicosocial / Analysis of the impact of the covid-19 pandemic on psychosocial rehabilitation resources

Como se ha podido comprobar, la irrupción de una pandemia como la generada por el COVID-19, así como, las consiguientes restricciones, afectan en mayor medida a los grupos más vulnerables como, entre otros, son las personas con Trastorno Mental Grave (TMG). Los objetivos fundamentales de este estudio pasan por analizar y comparar con la población general a la que pertenecen, el porcentaje de infecciones, hospitalizaciones y fallecimientos relacionados con el COVID-19 en el caso de recursos destinados a la atención a personas con TMG, como son los gestionados por la Línea de Rehabilitación Psicosocial (LRHP) de la organización Hermanas Hospitalarias. A su vez, también se analizan y comparan con periodos previos otras variables que han podido verse afectadas en esta crisis sanitaria tales como ingresos psiquiátricos, abandono de los recursos, intentos autolíticos o suicidios consumados. A diferencia de lo encontrado en la literatura previa, los resultados indican que no existen diferencias estadísticamente significativas entre los porcentajes de infecciones, hospitalizaciones o fallecimientos por COVID-19 entre la LRHP y los registrados en la población general. En cuanto a variables relacionadas con la Salud Mental, se encuentran diferencias estadísticamente significativas entre el año 2020 y el anterior, en el porcentaje de ingresos psiquiátricos y abandono en los recursos ambulatorios, siendo estos menores en 2020. Sin embargo, en el caso de los recursos residenciales, se registra un porcentaje significativamente mayor en el porcentaje de abandonos en 2020. Dichos resultados han de ser tomados con cautela, puesto que existen múltiples limitaciones que pudieran estar afectando a los mismos y pueden ser interpretados teniendo en cuenta los cambios contextuales relacionados con la pandemia respecto al funcionamiento de los recursos hospitalarios o a las restricciones a nivel de movilidad (AU)

As has been seen, the outbreak of a pandemic such as that generated by COVID-19, as well as the consequent restrictions, affect to a greater extent the most vulnerable groups such as, among others, people with Severe Mental Disorder (SMD). The fundamental objectives of this study are to analyze and compare with the general population to which they belong, the percentage of infections, hospitalizations and deaths related to COVID-19 in the case of resources destined to the care of people with TMG, such as those managed by the Linea de Rehabilitacion Psicosocial (LRHP) of the Sisters Hospitallers organization. At the same time, other variables that have been affected in this health crisis such as psychiatric admissions, abandonment of resources, autolytic attempts or completed suicides are also analyzed and compared with previous periods. Unlike what was found in the previous literature, the results indicate that there are no statistically significant differences between the percentages of infections, hospitalizations or deaths from COVID-19 between the LRHP and those registered in the general population. As for variables related to Mental Health, there are statistically significant differences between 2020 and the previous year, in the percentage of psychiatric admissions and abandonment in outpatient resources, these being lower in 2020. However, in the case of residential resources, there is a significantly higher percentage of abandonments in 2020. These results must be taken with caution, since there are multiple limitations that could be affecting them and can be interpreted taking into account the contextual changes related to the pandemic regarding the functioning of hospital resources or restrictions at the level of mobility (AU)

Medición de la microcirculación retiniana luego del tratamiento antihipertensivo / Measuring retinal circulation after antihypertensive treatment

Background and objective: With the development of image processing techniques, it has become possible to measure the changes in retinal vessels of hypertensive patients by means of eye fundus photographs. Patients and method: In this paper we aim to classify retinal vessels automatically into arterioles and venules. In order to do so, we have compared three different strategies based on the colour of the pixels in images through an analysis of 78 hypertensive patients' eye fundus images. The first strategy classifies all the vessels by applying a clustering algorithm. The second divides the retinal image into four quadrants and classifies the vessels that belong to the same quadrant independently from the rest of the vessels. The third strategy classifies the vessels by dividing the retinal image into four quadrants that are rotated inside the mentioned image. Results: The third strategy was the one that obtained the best results, since it minimizes the number of unclassified vessels. In the initially analysed set of 20 images, we correctly classified 86.53% of the vessels, and this percentage remains similar in a set of 58 images examined by three medical experts. This confirms the validity of the method that automatically calculates the arteriovenous ratio (AVR).Conclusion: Our results are an improvement on those previously described in the bibliography, reducing the number of non-classified vessels. Furthermore, the method entails low computational costs.

Fundamento y objetivo: El desarrollo de técnicas de procesado de imágenes ha devuelto interés para poder medir de una forma objetiva los cambios en la estructura microvascular del hipertenso a través de las fotografías digitales del fondo de ojo. Pacientes y método: Para clasificar de forma automática los vasos de la retina en arteriolas y vénulas, con una elevada precisión, hemos comparado tres estrategias diferentes basadas en la información del color de los pixeles de la imagen del fondo de ojo, analizando 78 imágenes de fondo de ojo de hipertensos. La primera estrategia clasificaría todos los vasos aplicando un algoritmo de agrupamiento. La segunda divide la retina en cuatro cuadrantes y clasifica los vasos que pertenecen al mismo cuadrante independientemente del resto de los vasos. La tercera estrategia clasifica los vasos dividiendo la retina en cuadrantes que son rotados. Resultados: La mejor estrategia resultó la tercera porque minimiza el error y el número de vasos no clasificados. La característica vectorial más determinante está basada en la media o la mediana del componente gris del espacio de color RGB. Para las 20 imágenes inicialmente analizadas hemos clasificado correctamente el 86.53% de los vasos, y este porcentaje permanece similar en el grupo de 58 imágenes examinadas por tres expertos, lo que confirma la validez del método, para el cálculo del índice arteriovenoso de forma automática. Conclusión: Nuestros resultados son superiores a los descritos previamente, reduciendo además el número de vasos no clasificados. Por otro lado, el costo computacional del método es bajo

Retinal arteriole-to-venule ratio changes and target organ disease evolution in newly diagnosed hypertensive patients at 1-year follow-up.

There is no agreement on the systematic exploration of the fundus oculi (FO) in hypertensive patients, and it is unknown whether the evolution of retinal microcirculatory alterations has prognostic value or not. The aim of this study was to investigate whether the evolution of the arteriole-to-venule ratio (AVR) in newly-diagnosed hypertensive patients is associated with better or worse evolution of target organ damage (TOD) during 1 year. A cohort of 133 patients with newly-diagnosed untreated hypertension was followed for 1 year. At baseline and follow-up, all patients underwent a physical examination, self-blood pressure measurement, ambulatory blood pressure monitoring, blood and urine analysis, electrocardiogram, and retinography. The endpoint was the favourable evolution of TOD and the total amount of TOD, according to the baseline AVR and the baseline and final difference of the AVR. A total of 133 patients were analyzed (mean age, 57 ± 10.7 years; 59% men). No differences were found in the decrease in blood pressure or antihypertensive treatment between quartiles of baseline AVR or baseline-final AVR difference. Patients with a difference between baseline and final AVR in the highest quartile (>0.0817) had a favorable evolution of left ventricular hypertrophy (odds ratio, 14.9; 95% confidence interval, 1.08-206.8) and the amount of TOD (odds ratio, 2.22; 95% confidence interval, 1.03-6.05). No favorable evolution was found of glomerular filtration rate. There is an association between the evolution of the AVR and the favorable evolution of TOD. Patients with greater increase of AVR have significantly better evolution of left ventricular hypertrophy and amount of TOD.

Development of an automated system to classify retinal vessels into arteries and veins.

There are some evidence of the association between the calibre of the retinal blood vessels and hypertension. Computer-assisted procedures have been proposed to measure the calibre of retinal blood vessels from high-resolution photopraphs. Most of them are in fact semi-automatic. Our objective in this paper is twofold, to develop a totally automated system to classify retinal vessels into arteries and veins and to compare the measurements of the arteriolar-to-venular diameter ratio (AVR) computed from the system with those computed from observers. Our classification method consists of four steps. First, we obtain the vascular tree structure using a segmentation algorithm. Then, we extract the profiles. After that, we select the best feature vectors to distinguish between veins and arteries. Finally, we use a clustering algorithm to classify each detected vessel as an artery or a vein. Our results show that compared with an observer-based method, our method achieves high sensitivity and specificity in the automated detection of retinal arteries and veins. In addition the system is robust enough independently of the radii finally chosen, which makes it more trustworthy in its clinical application. We conclude that the system represents an automatic method of detecting arteries and veins to measure the calibre of retinal microcirculation across digital pictures of the eye fundus.