Hepatitis C Virus positivity prediction from serum samples using NIRS and L1-penalized classification.

AIMS: The hepatitis C virus (HCV) has developed a strategy to coexist with its host resulting in varying degrees of tissue and cell damage, which generate different pathological phenotypes, such as varying degrees of fibrosis, cirrhosis, and hepatocellular carcinoma (HCC). However, there is no integrated information that can predict the evolutionary course of the infection. We propose to combine Near-infrared spectroscopy (NIRS) and machine learning techniques to provide a predictive model. In this work, we propose to discriminate HCV positivity in biobank patient serum samples. METHODS: 126 serum samples from 38 HCV patients in different stages of the disease were obtained from the Biobank of Hospital Universitario Fundación Alcorcon. NIRS spectrum was captured by a FT-NIRS Spectrum 100 (Perkin Elmer) device in reflectance mode. For each patient, the HCV positivity was identified (PCR) and labeled as detectable =1 and undetectable =0. We propose an L1-penalized logistic regression model to classify each spectrum as positive (1) or negative (0) for HCV presence (x). The regularization parameter is selected using 5- fold cross-validation. The penalized model will induce sparsity in the solution so that only a few relevant wavelengths will be different from zero. RESULTS: L1-penalized logistic regression model provided 167 wavelengths different from zero. The accuracy on an independent test set was 0.78. CONCLUSIONS: We present a straightforward promising approach to detect HCV positivity from patient serum samples combining NIRS and machine learning techniques. This result is encouraging to predict HCV progression, among other applications. Clinical relevance- We presented a simple while promising approach to use machine learning and NIRS to analyze viral presence on sample serums.

[Changes in quality of life in patients undergoing bariatric surgery following 24-months: comparison between gastric bypass and tubular vertical gastrectomy]. / Evolución de la calidad de vida a los 24 meses de seguimiento en pacientes sometidos a cirugía bariátrica: comparación entre el bypass gástrico y la gastrectomía vertical tubular.

BACKGROUND: Bariatric surgery has become the procedure of choice to deal with morbid and super-morbid obesity, with the greatest chance of success. The objectives of this study were: a) to analyse the evolution of the percentage of excess BMI lost (PEBMIL) and quality of life in the medium and long term after bariatric surgery; b) to evaluate the differences in PEBMIL and quality of life according to the surgical technique performed; and c) examine the relationship between PEBMIL and quality of life. METHODS: One hundred and ninety-one subjects participated in the present study, undergoing bariatric surgery with follow-up at 12 and 24 months after surgery. The SF-36 and OP-53 questionnaires were administered to assess the quality of life after surgery. RESULTS: There was a statistically significant reduction in the percentage of excess BMI lost at 12 and 24 months; and a significant improvement in quality of life at 12 months, which remained stable at 24 months for most variables. Taking into account the surgical technique, those undergoing gastric bypass surgery show a greater loss of PEBMIL at 12 and 24 months, and significant improvement at one year of evaluation in most of the dimensions that measure quality of life with respect to the tubular vertical gastrectomy technique. CONCLUSION: Bariatric surgery is effective in reducing the excess of BMI lost and significantly improving the quality of life of morbidly obese patients in the long term. Key words. Bariatric surgery. Quality of life. Morbid obesity.

Evolución de la calidad de vida a los 24 meses de seguimiento en pacientes sometidos a cirugía bariátrica: comparación entre el bypass gástrico y la gastrectomía vertical tubular / Changes in quality of life after 24 months in patients undergoing bariatric surgery: comparison between gastric bypass and tubular vertical gastrectomy

Fundamento: La cirugía bariátrica se ha convertido en el procedimiento de elección para afrontar, con las mayores posibilidades de éxito, los casos de obesidad mórbida y super-mórbida. Los objetivos de este estudio son: a) analizar la evolución del porcentaje del exceso de índice de masa corporal perdido (PEIMCP) y la calidad de vida a medio y largo plazo tras la cirugía bariátrica; b) evaluar las diferencias en PEIMCP y calidad de vida en función de la técnica quirúrgica realizada; y c) examinar la relación entre PEIMCP y la calidad de vida. Material y métodos: Han intervenido en el estudio 191 sujetos intervenidos de cirugía baríátrica con seguimiento a los 12 y 24 meses tras la cirugía. Se administraron los cuestionarios SF-36 y OP-53 para evaluar la calidad de vida tras la cirugía de manera autoinformada. Resultados: Se observa una reducción del porcentaje del exceso de índice de masa corporal (IMC) perdido estadísticamente significativa a los 12 y 24 meses y una mejora significativa en la calidad de vida a los 12 meses, que se mantuvo estable a los 24 meses para la mayoría de las variables. Los pacientes intervenidos mediante bypass gástrico muestran una mayor pérdida de PEIMCP a los 12 y 24 meses, y mejora significativa al año de evaluación en la mayoría de las dimensiones que miden calidad de vida con respecto a la técnica de gastrectomía vertical tubular. Conclusión: La cirugía bariátrica es eficaz para disminuir el porcentaje del exceso de IMC perdido y mejorar significativamente la calidad de vida de los pacientes con obesidad mórbida a largo plazo (AU)

Background: Bariatric surgery has become the procedure of choice to deal with morbid and super-morbid obesity, with the greatest chance of success. The objectives of this study were: a) to analyse the evolution of the percentage of excess BMI lost (PEBMIL) and quality of life in the medium and long term after bariatric surgery; b) to evaluate the differences in PEBMIL and quality of life according to the surgical technique performed; and c) examine the relationship between PEBMIL and quality of life. Methods: One hundred and ninety-one subjects participated in the present study, undergoing bariatric surgery with follow-up at 12 and 24 months after surgery. The SF-36 and OP-53 questionnaires were administered to assess the quality of life after surgery. Results: There was a statistically significant reduction in the percentage of excess BMI lost at 12 and 24 months; and a significant improvement in quality of life at 12 months, which remained stable at 24 months for most variables. Taking into account the surgical technique, those undergoing gastric bypass surgery show a greater loss of PEBMIL at 12 and 24 months, and significant improvement at one year of evaluation in most of the dimensions that measure quality of life with respect to the tubular vertical gastrectomy technique. Conclusion: Bariatric surgery is effective in reducing the excess of BMI lost and significantly improving the quality of life of morbidly obese patients in the long term (AU)

Treatment with bisphosphonates in severe hypercalcemia due to subcutaneous fat necrosis in an infant with hypoxic-ischemic encephalopathy.

Subcutaneous fat necrosis (SCFN) is a rare entity that occurs generally in term or post-term newborns exposed to perinatal stressing factors. These cutaneous lesions appear during the first weeks of life and their potential complications, such as hypercalcemia, determine the prognosis. We present a full-term newborn with SCFN lesions that appeared at the age of 12 days and who, 1 week later, developed moderate hypercalcemia. In our patient, the standard treatment was not enough to normalize calcemia and, in order to prevent secondary effects, etidronate therapy was initiated and it successfully normalized calcium levels. When SCFN is diagnosed, it is important to detect early hypercalcemia and treat it aggressively. This case provides further evidence of etidronate as an alternative and effective treatment for moderate-severe hypercalcemia.

Seguimiento de las recomendaciones sobre psicofarmacología y su repercusión conductual en la discapacidad intelectual / Expert psychopharmacologic recommendations follow-up and its behavioral impact on intellectual disability patients

En la población con discapacidad intelectual (DI) hay una elevada morbilidad psiquiátricaconductual. Se estima que por este motivo entre 1/3 y 3/4 de estas personas reciben antipsicóticos. Existe un consenso de expertos para guiar la toma de decisiones farmacoterapéuticas en estos casos. Su aplicación conseguiría una mayor eficacia del tratamiento, reduciendo los problemas conductuales, mejorando las habilidades adaptativas. El “Inventory for client and agency planning” (ICAP) es un instrumento para valoración y evaluación de servicios para personas con DI, que incluye escalas para puntuación de problemas conductuales y de conductas adaptativas. Para determinar la asociación entre el seguimiento de las recomendaciones farmacoterapeuticas de los expertos y las puntuaciones de los problemas conductuales y las habilidades adaptativas en un grupo de sujetos con DI, se realizó un estudio observación transversal. El tratamiento farmacológico recibido por cada sujeto de un colectivo de sujetos diagnosticados de DI (CIE-10) se clasificó como conforme o no con las recomendaciones de la guía en lo referente a los criterios de indicación, dosis, duración y polifarmacia. Se compararon las puntuaciones de conducta adaptativa y de problemas de conducta del ICAP en función de la conformidad del tratamiento con los criterios. El cumplimiento del criterio de dosis se asoció con mejor conducta adaptativa (p<0,05), el cumplimiento de los criterios de duración y polifarmacia se asociahubo asociación entre cumplimiento del criterio de indicación con la puntuación de problemas de conducta, ni de las habilidades adaptativas (AU)

Subjects with Intellectual Disability (ID) are frequently affected by behavioral and psychiatric co-mobility. As a consequence between 1/3 and ¾ are under antipsychotic treatment. It is available an expert consensus guideline with the purpose of guiding pharmacological treatment decisions. The achievement of expert recommendations may optimize drug therapy efficacy and reduce behavioral problems as well as enhance adaptive abilities. The “Inventory for client and agency planning” (ICAP) is a psychometric tool designed to assess health care to ID patients, and includes items that grade behavioral and adaptive problems. We designed a transversal study in order to determine the association between the follow-up of expert recommendations and the scores achieved on behavioral and adaptive problems items. Drug therapy been prescribed to patients diagnosed of ID (CIE-10) was analyzed and classified into a dichotomous “Do” or “Do not” achieve guideline recommendations in regard of several pharmaceutical aspects such as drug therapy indication, dosage, treatment duration and poly-pharmacy. Scores from ICAP tool as compared to guideline compliance. Follow-up of dose criteria was associated to a better adaptive behavior (p<0,05) and follow-up of poly-pharmacy criteria and duration treatment criteria was associated better behavioral outcomes (p<0,05). We found no association between follow-up of indication criteria and behavioral or adaptive problems (AU)

Evaluación de un protocolo de intercambio terapéutico de antidepresivos de segunda generación: resultados clínicos / Assessing a Therapeutic Exchange Protocol for Second-generation Antidepressants: Clinical Results

Objetivo Diseñar un protocolo de intercambio terapéutico de antidepresivos y evaluarlo clínicamente a través de variables como: grado de cumplimiento, frecuencia de casos con aumento clínicamente significativo en la escala de morbilidad psicofarmacológica Udvalg-für-Kliniske-Undersogelser (UKU), análisis de eventos adversos, análisis de la evolución global de la puntuación en la UKU y grado de aceptación de los pacientes; objetivos secundarios fueron correlacionar aspectos del tratamiento psicofarmacológico con el grado de morbilidad farmacoterapéutica y evaluar el impacto clínico de medidas de optimización farmacoterapéuticas. Método El protocolo se diseñó de acuerdo con una revisión bibliográfica y fue aprobado por la Comisión de Farmacia y Terapéutica. Se realizaron, sobre una muestra de 30 pacientes seleccionados secuencialmente, 3 mediciones (basal, a las 48-72h y a las 1-3 semanas) en las que se cuantificó la morbilidad farmacoterapéutica mediante la escala UKU y la Impresión Clínica Global, implantando medidas de optimización farmacoterapéutica en aquellos sujetos con niveles de morbilidad farmacoterapéutica elevada. Resultados El grado de cumplimiento fue del 73,3%. Un paciente experimentó un aumento ≥ 25% en la escala UKU y otro paciente experimentó un evento adverso. La puntuación final en la escala UKU alcanzó la significación estadística en comparación con las medidas realizadas a las 48-72h (p=0,032) y con la medida basal (p=0,007). El grado de aceptación de los pacientes fue del 90%. El impacto de las medidas de optimización sobre el nivel de morbilidad farmacoterapéutica fue clínica y estadísticamente significativo (p<0,001).Conclusiones El protocolo propuesto presenta una amplia aceptación y puede considerarse seguro para su implementación en un hospital general (AU)

Objective To design a therapeutic exchange protocol for antidepressants and clinically assess variables, such as compliance level, frequency of cases with clinically significant increase on the Udvalg-für-Kliniske-Undersogelser (UKU) psychopharmacological scale, adverse effects analysis, overall analysis of UKU rating development and patients’ level of acceptance. Secondary objectives were to correlate psychopharmacological treatment aspects with the pharmacological morbidity level, and evaluate the clinical impact of pharmacotherapeutic optimisation measures. Method The protocol is designed in accordance with a bibliographical review, which was approved by the Pharmacy and Therapeutics Commission. Sequential study was carried out with a sample of 30 patients. Three measurements were taken (base line, at 48–72h and at 1–3weeks) to calculate the pharmacotherapeutic morbidity with the UKU rating scale and the Global Clinical Impression. Pharmacotherapeutic optimisation measures were used for those patients with high pharmacotherapeutic morbidity levels. Results The compliance level was 73.3%. One patient experienced ≥25% increase on the UKU rating scale and another patient suffered from an adverse effect. The final UKU rating reached statistical significance compared with the measurements taken at 48–72h (P=.032) and with the base line measurement (P=.007). Patient acceptance was 90%. The impact of optimisation measurements on the pharmacotherapeutic morbidity level was clinically and statistically significant (P<.001).Conclusions The proposed protocol has been widely accepted and it is quite certain that it is to be introduced in at a general hospital level (AU)

Assessing a therapeutic exchange protocol for second-generation antidepressants: clinical results.

OBJECTIVE: To design a therapeutic exchange protocol for antidepressants and clinically assess variables, such as: compliance level, frequency of cases with clinically significant increase on the Udvalg-für-Kliniske-Undersogelser (UKU) psychopharmacological scale, adverse effects analysis, overall analysis of UKU rating development and patients' level of acceptance. Secondary objectives were to correlate psychopharmacological treatment aspects with the pharmacological morbidity level, and evaluate the clinical impact of pharmacotherapeutic optimisation measures. METHOD: The protocol is designed in accordance with a bibliographical review, which was approved by the Pharmacy and Therapeutics Commission. Sequential study was carried out with a sample of 30 patients. Three measurements were taken (base line, at 48-72 hours and at 1-3 weeks) to calculate the pharmacotherapeutic morbidity with the UKU rating scale and the Global Clinical Impression. Pharmacotherapeutic optimisation measures were used for those patients with high pharmacotherapeutic morbidity levels. RESULTS: The compliance level was 73.3%. One patient experienced ≥25% increase on the UKU rating scale and another patient suffered from an adverse effect. The final UKU rating reached statistical significance compared with the measurements taken at 48-72 hours (P=.032) and with the base line measurement (P=.007). Patient acceptance was 90%. The impact of optimisation measurements on the pharmacotherapeutic morbidity level was clinically and statistically significant (P<.001). CONCLUSIONS: The proposed protocol has been widely accepted and it is quite certain that it is to be introduced in at a general hospital level.

Artroplastia vertebral / Vertebral arthroplasty

La artroplastia vertebral es una alternativa terapéutica a la fusión lumbar en el tratamiento de la enfermedad degenerativa discal, que tiene como finalidad restaurar la altura discal, mantener una adecuada movilidad y minimizar las complicaciones, básicamente el deterioro de los segmentos vertebrales adyacentes. Se han desarrollado tres tipos diferentes de artroplastias: las totales, las endoprótesis nucleares y las facetarias, utilizándose fundamentalmente en la columna lumbar y en menor grado en la columna cervical. La indicación de la artroplastia ha de seguir un estricto protocolo de selección del paciente y un programa de rehabilitación específico que garantice su viabilidad. La evidencia actual permite concluir resultados similares entre las artroplastias y las fusiones vertebrales, con algunas ventajas para las primeras en relación con el índice de reintervenciones y movilidad, aunque el avance en los modelos y técnicas quirúrgicas permitirá en un futuro cercano su mayor utilización y mejoría de los actuales resultados clínicos

Intervertebral arthroplasty is an alternative therapeutic option to lumbar fusion for surgical treatment of lumbar degenerative disc disease. Its purpose is to restore disc height, maintain adequate motion and minimize complications, basically deterioration of the adjacent vertebral segments. Three different kind of arthroplasty have been developed: total lumbar joint replacement, nucleus pulposus replacement and facet joints posterior dynamic stabilization, currently used more in lumbar surgery than cervical surgery. Arthroplasty indication has to follow a strict patient selection protocol and specific rehabilitation program that assures its viability. Current evidence makes it possible to conclude similar results between arthroplasties and vertebral fusions. There are some added benefits of restoring and maintaining segmental motion in the arthroplasty surgery, although advances in orthopedic surgical procedures will allow for better clinical results than now in the near future

Artroplastia vertebral / Vertebral arthroplasty

La artroplastia vertebral es una alternativa terapéutica a la fusión lumbar en el tratamiento de la enfermedad degenerativa discal, que tiene como finalidad restaurarla altura discal, mantener una adecuada movilidad y minimizarlas complicaciones, básicamente el deterioro de los segmentos vertebrales adyacentes. Se han desarrollado tres tipos diferentes de artroplastias: las totales, las endoprótesis nucleares y las facetarias, utilizándose fundamentalmente en la columna lumbar y en menor grado en la columna cervical. La indicación de la artroplastia ha de seguir un estricto protocolo de selección del paciente y un programa de rehabilitación específico que garantice su viabilidad. La evidencia actual permite concluir resultados similares entre las artroplastias y las fusiones vertebrales, con algunas ventajas para las primeras en relación con el índice de reintervenciones y movilidad, aunque el avance en los modelos y técnicas quirúrgicas permitirá en un futuro cercano su mayor utilización y mejoría de los actuales resultados clínicos (AU)

Intervertebral arthroplasty is an alternative therapeutic option to lumbar fusion for surgical treatment of lumbar degenerative disc disease. Its purpose is to restore disc height, maintain adequate motion and minimize complications, basically deterioration of the adjacent vertebral segments. Three different kind of arthroplasty have been developed: total lumbar joint replacement, nucleus pulposus replacement and facet joints posterior dynamic stabilization, currently used more in lumbar surgery than cervical surgery. Arthroplasty indication has to follow a strict patient selection protocol and specific rehabilitation program that assures its viability. Current evidence makes it possible to conclude similar results between arthroplasties and vertebral fusions. There are some added benefits of restoring and maintaining segmental motion in the arthroplasty surgery, although advances in orthopedic surgical procedures will allow for better clinical results than now in the near future (AU)

Postnatal neurogenesis in the medial cortex of the tropical lizard Tropidurus hispidus.

Young, adult and presumed old specimens of the tropical lizard Tropidurus hispidus, living in an almost steady warm habitat, have been the subjects of a 5-bromodeoxiuridine immunocytochemical study to label proliferating brain cells. All animals showed abundant 5-bromodeoxiuridine-labeled nuclei in the ependyma of their telencephalic lateral ventricles, with these being especially abundant in the medial cortex ependyma. Surprisingly, adult animals displayed higher numbers of labeled nuclei when compared with those of young specimens. In a second experiment, in order to check the evolution of ependymal-labeled nuclei, adult specimens were allowed 4 h or 2, 4, 7, 15 or 30 days of survival after the 5-bromodeoxiuridine pulse. Most labeled nuclei appeared isolated at short survival times (4 h and 2 days after the 5-bromodeoxiuridine pulse) but from day 4 and beyond, labeled nuclei appeared in couples or groups usually located in the ependyma. Labeled nuclei with vertical fusiform appearance in the inner plexiform layer or even recruited in the medial cortex cell layer were assumed to be migratory. These presumed migratory nuclei were unexpectedly few (less than 30%) when compared with other lizards, and they appeared much later; at 15 and 30 days after the pulse. This situation resembles that of mammals where only a small proportion of postnatally generated neurons can develop and survive.

Revisión de un programa de psicoeducación para enfermos psicóticos / Revision of a psychoeduactional programme for psychotic patients

Se presenta la revisión de un programa psicoeducativo, estructurado en siete sesiones, que ha sido aplicado y evaluado en la unidad de salud mental de Elda (Alicante), con los objetivos de aumentar los conocimientos de los pacientes acerca de la esquizofrenia, mejorar las habilidades de los mismos para afrontar su enfermedad, ayudar a comprender la importancia del tratamiento farmacológico para la evolución a largo plazo y mejorar la relación entre pacientes, familiares y profesionales. Se han utilizado como instrumentos de evaluación un cuestionario de conocimientos, otro de expectativas de los pacientes sobre el grupo y un cuestionario de evaluación de la satisfacción con la experiencia grupal. Los resultados indican que las expectativas de los pacientes son altas, la evaluación del programa ha sido de "muy interesante" y el nivel de conocimientos sobre la enfermedad aumenta de manera significativa (AU)

Actividad proteolítica y proteasas gástricas en ratas tratadas con cloropromacina / Proteolytic activity and gastric proteases in chlorpromazine treated rats

Se plantea que la administración de cloropromacina a ratas albinas machos, por vía intramuscular, en dosis de 10 mg por kg de peso corporal, durante veinte días, no cambia en forma importante el perfil de la curva de actividad proteolítica obtenida en homogeneizados de mucosa gástrica, aunque sí se observa un estrechamiento y un aumento de su amplitud. La actividad proteolítica gástrica total, reflejada por el valor del área debajo de la curva de actividad proteolítica, se incrementa en forma significativa con la administración del fármaco. La enzimoforesis de homogeneizados de mucosa gástrica demuestra, que todas las fracciones de pepsina acentúan su intensidad(AU)