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1.
Medicine (Baltimore) ; 99(40): e22598, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019480

RESUMO

BACKGROUND: Early diagnosis and treatment of the osteonecrosis of the femoral head (ONFH), a refractory disease, is imperative to prevent femoral head collapse; however, the existing solutions remain controversial. This study assessed the safety and efficacy of extracorporeal shock wave therapy (ESWT) combined with multiple drilling and intramedullary drug injection, a novel cocktail therapy, as a randomized controlled trial (RCT) model to postulate an alternative therapy for patients with early-stage ONFH. METHODS: Femoral head necrosis patients aged 20 to 60 years with stage ARCO I-II were recruited. One hundred twenty eligible participants were randomized into four groups in a 1:1:1:1 ratio: extracorporeal shock wave therapy combined with multiple drilling and intramedullary drug injection (group EMI), extracorporeal shock wave therapy (group E), multiple drilling combined with intramedullary drug injection (group MI), and multiple drilling ("positive" control group; group M). The primary outcomes included effective rate, subchondral collapse rate of the femoral head, lesion size, and grade of bone marrow edema. Secondary outcomes included the Harris Hip Score and the visual analog scale. All outcomes were measured at the screening visit (baseline) and at the planned time intervals during treatment and follow-up, and the efficacy was statistically analyzed according to the intention-to-treat sub-populations and per-protocol sub-populations. OBJECTIVES: To examine the clinical efficacy of ESWT combined with multiple drilling and intramedullary drug injection to provide a safe and more effective method for treating early-stage ONFH. TRIAL REGISTRATION NUMBER: ChiCTR1900020888; Pre-results.


Assuntos
Tratamento por Ondas de Choque Extracorpóreas/métodos , Necrose da Cabeça do Fêmur/terapia , Cabeça do Fêmur/patologia , Infusões Intraósseas/instrumentação , Adulto , Artroplastia Subcondral/efeitos adversos , Artroplastia Subcondral/métodos , Doenças da Medula Óssea/patologia , Protocolos Clínicos , Terapia Combinada/métodos , Diagnóstico Precoce , Edema/induzido quimicamente , Feminino , Cabeça do Fêmur/efeitos dos fármacos , Necrose da Cabeça do Fêmur/classificação , Seguimentos , Humanos , Infusões Intraósseas/métodos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Segurança , Resultado do Tratamento , Escala Visual Analógica
2.
G Ital Nefrol ; 37(5)2020 Oct 05.
Artigo em Italiano | MEDLINE | ID: mdl-33026200

RESUMO

The epidemic wave that hit Italy from February 21st, 2020, when the Italian National Institute of Health confirmed the first case of SARS­CoV­2 infection, led to a rapid and efficient reorganization of Dialysis Centers' activities, in order to contain large-scale spread of disease in this clinical setting. We herein report the experience of the Hemodialysis Unit of Parma University Hospital (Azienda Ospedaliero-Universitaria, Parma, Italy) and the Dialysis Centers of Parma territory, in the period from March 1st, 2020 to June 15, 2020. Among patients undergoing chronic haemodialysis, 37/283 (13%) had positive swabs for SARS­CoV­2, 9/37 (24%) died because of COVID-19. Twenty-three patients required hospitalization, while the remaining were managed at home. The primary measures applied to contain the infection were: the strengthening of personal protective equipment use by doctors and nurses, early identification of infected subjects by performing oro-pharyngeal swabs in every patient and in the healthcare personnel, the institution of a triage protocol when entering Dialysis Room, and finally the institution of two separate sections, managed by different doctors and dialysis nurses, to physically separate affected from unaffected patients and to manage "grey" patients. Our experience highlights the importance and effectiveness of afore-mentioned measures in order to contain the spread of the virus; moreover, we observed a higher lethality rate of COVID-19 in dialysis patients as compared to the general population.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Unidades Hospitalares de Hemodiálise/organização & administração , Reestruturação Hospitalar , Falência Renal Crônica/terapia , Pandemias , Pneumonia Viral/epidemiologia , Diálise Renal , Betacoronavirus/isolamento & purificação , Técnicas de Laboratório Clínico , Comorbidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/prevenção & controle , Diagnóstico Precoce , Emergências , Unidades Hospitalares de Hemodiálise/estatística & dados numéricos , Hemodiálise no Domicílio/estatística & dados numéricos , Mortalidade Hospitalar , Hospitais Universitários/estatística & dados numéricos , Humanos , Controle de Infecções/métodos , Itália/epidemiologia , Falência Renal Crônica/epidemiologia , Nasofaringe/virologia , Pandemias/prevenção & controle , Isolamento de Pacientes , Diálise Peritoneal , Equipamento de Proteção Individual , Pneumonia Viral/prevenção & controle , Utilização de Procedimentos e Técnicas , Triagem
3.
J Contemp Dent Pract ; 21(7): 769-775, 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-33020361

RESUMO

AIMS AND OBJECTIVES: Early detection of rheumatoid injury in the temporomandibular joint using CT, which accurately detects bone changes before the clinical symptoms start appearing to protect the joint from irreversible damage, and the correlation of those radiological changes with the duration of rheumatoid arthritis disease. MATERIALS AND METHODS: It included 45 people aged 27-74 years who reviewed the internal medicine and rheumatology clinics at Al-Mouwasat Hospital during 2016-2018 and are affected with rheumatoid arthritis according to the criteria American College of Arthritis (ACR) European League against Rheumatism (EULAR) 2010 criteria. The informed consent of the patient and the approval of the Scientific Research Council were obtained to conduct the research. RESULTS: Computed tomography revealed the radiological changes in the left and right side, respectively, in terms of p value <0.05: (1) Erosion of condyle (42.22-53.34%). (2) Decreased in the joint space (53.33-60.00%). (3) Mandibular subchondral cysts in both sides (77.14%). (4) Erosion of the articular fossa (48.89-57.78%). (5) Flattening of condyle (46.67-55.55%). (6) Effusion (2.22-4.44%). (7) Bone marrow edema (26.67-40.00%). (8) Subchondral sclerosis (60.00-73.33%). Conclusion and clinical significance: The occurrence of bone damage in the condyle and articular fossa of the temporomandibular joint despite the fact that the sample members have no clinical complaint indicates the ability of CT scan of early and accurate disclosure of rheumatoid injury in the temporomandibular joint.


Assuntos
Artrite Reumatoide/diagnóstico por imagem , Articulação Temporomandibular/diagnóstico por imagem , Adulto , Idoso , Diagnóstico Precoce , Humanos , Pessoa de Meia-Idade , Radiografia , Tomografia Computadorizada por Raios X , Estados Unidos
4.
Vestn Oftalmol ; 136(5. Vyp. 2): 155-162, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33063958

RESUMO

Laser corneal confocal microscopy (CCM) is a method of objective visualization of thin corneal nerve fibers (CNF), the structure of which changes in patients with diabetes mellitus (DM). PURPOSE: To conduct comparative analysis of the results of CNF assessment using CCM and other known neurological instrumental techniques as well as evaluate their applicability to the early diagnosis of diabetic polyneuropathy (DPN). MATERIAL AND METHODS: We examined a total of 46 patients (85 eyes) with type 1 DM and either subclinical (24 patients), or clinical-stage DPN (22 patients) and 50 patients (87 eyes) with type 2 DM (subclinical DPN in 27 patients and clinical-stage DPN in 23 patients). The control group consisted of 34 healthy volunteers (68 eyes). All patients underwent standard ophthalmological examination, CCM with nerve tortuosity assessment (including calculation of coefficients of CNF orientation anisotropy, KΔL, and symmetry, Ksym) and interocular asymmetry, electroneuromyography (ENMG), and quantitative sensory testing (QST). RESULTS: Analysis of the CCM results revealed a reliable decrease in the average KΔL values in patients with type 1 and type 2 DM compared with the control group. In the group of patients with type 1 DM and subclinical DPN, correlations were revealed between the CNF tortuosity coefficients and a number of ENMG parameters, such as the M-response amplitude of the peroneal nerve (r=0.73, p≤0.02), M-response amplitude of the tibial nerve (r=0.58, p≤0.01), residual latency (r= -0.62, p≤0.05), and peroneal nerve conduction velocity (r=0.57, p≤0.01). Ksym values correlated with the warm sensitivity threshold (r=0.6, p≤0.008). Among patients with type 2 DM and subclinical DPN, the KΔL coefficient correlated with the peroneal nerve conduction velocity (r=0.46, p≤0.02), M-response amplitude of the tibial nerve (r=0.6, p≤0.04), and residual latency of the peroneal nerve (r=-0.56, p≤0.05). CONCLUSION: The state of thin corneal nerves correlates with functional changes in the peripheral nerves. Pathological changes in CNF in patients with DM can be detected at an early (subclinical) stage of DPN using laser CCM and a program for corneal nerve tortuosity analysis.


Assuntos
Diabetes Mellitus , Neuropatias Diabéticas , Córnea/diagnóstico por imagem , Neuropatias Diabéticas/diagnóstico , Diagnóstico Precoce , Humanos , Microscopia Confocal , Fibras Nervosas
6.
BMC Med Imaging ; 20(1): 111, 2020 10 02.
Artigo em Inglês | MEDLINE | ID: mdl-33008329

RESUMO

BACKGROUND: To develop and validate a nomogram for early identification of severe coronavirus disease 2019 (COVID-19) based on initial clinical and CT characteristics. METHODS: The initial clinical and CT imaging data of 217 patients with COVID-19 were analyzed retrospectively from January to March 2020. Two hundred seventeen patients with 146 mild cases and 71 severe cases were randomly divided into training and validation cohorts. Independent risk factors were selected to construct the nomogram for predicting severe COVID-19. Nomogram performance in terms of discrimination and calibration ability was evaluated using the area under the curve (AUC), calibration curve, decision curve, clinical impact curve and risk chart. RESULTS: In the training cohort, the severity score of lung in the severe group (7, interquartile range [IQR]:5-9) was significantly higher than that of the mild group (4, IQR,2-5) (P < 0.001). Age, density, mosaic perfusion sign and severity score of lung were independent risk factors for severe COVID-19. The nomogram had a AUC of 0.929 (95% CI, 0.889-0.969), sensitivity of 84.0% and specificity of 86.3%, in the training cohort, and a AUC of 0.936 (95% CI, 0.867-1.000), sensitivity of 90.5% and specificity of 88.6% in the validation cohort. The calibration curve, decision curve, clinical impact curve and risk chart showed that nomogram had high accuracy and superior net benefit in predicting severe COVID-19. CONCLUSION: The nomogram incorporating initial clinical and CT characteristics may help to identify the severe patients with COVID-19 in the early stage.


Assuntos
Infecções por Coronavirus/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Nomogramas , Pneumonia Viral/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Criança , Diagnóstico Precoce , Humanos , Pessoa de Meia-Idade , Pandemias , Distribuição Aleatória , Estudos Retrospectivos , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X , Adulto Jovem
7.
Artigo em Inglês | MEDLINE | ID: mdl-33017933

RESUMO

Early prediction of sepsis is essential to give the patient timely treatment since each hour of delayed treatment has been associated with an increase in mortality. Current sepsis detection systems rely on empirical Clinical Decision Rules(CDR)s, which are based on vital signs that can be collected from the bedside. The main disadvantages of CDRs include questions of generalizability and performance variance when applied to the populations different from the groups used for derivation and often take years to develop and validate. This paper proposes a deep learning model using Bi-Directional Gated Recurrent Units(GRU), which uses a wide range of parameters that are associated with vitals, laboratory, and demographics of patients. The proposed model has an area under the receiver operating characteristic (AUROC) of 0.97, outperforming all the existing systems in the current literature. The model can handle the missing data, and irregular sampling intervals frequently present in medical records.Clinical relevance-The proposed model can be used to predict the onset of sepsis 6 hours ahead of time by the use of a machine learning algorithm. This proposed method outperforms the sepsis prediction machine learning models found in the current literature.


Assuntos
Sepse , Bases de Dados Genéticas , Diagnóstico Precoce , Humanos , Aprendizado de Máquina , Sepse/diagnóstico , Sinais Vitais
8.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 1031-1034, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018161

RESUMO

Blood infection due to different circumstances could immediately develop to an extreme body reaction that leads to a serious life-threatening condition, called Sepsis. Currently, therapeutic protocols through timely antibiotic resuscitation strategies play an important role to fight against the adverse conditions and improve survival. Therefore, timing, and more specifically early diagnosis of the illness, is crucially important for an effective treatment. Studies have indicated that vital signals such as heart rate variability (HRV) could provide potential prognostic biological markers that can help with early detection of sepsis before it is clinically diagnosed through its actual symptoms. Therefore, this study employs neonatal and pediatric electrocardiogram (ECG) to extract 52 hourly sets of linear and non-linear features from the HRV, starting from 24 hours prior to the clinical diagnosis of sepsis in patients with positive blood cultures (n=14). Similar sets of features were also obtained from a non-sepsis control group to create an evaluation benchmark (n=14).In particular, this study initially demonstrates how the variations within the 24 hours values of specific HRV feature-sets could effectively reveal prognostic information about the evolution of sepsis, prior to the actual clinical diagnosis. Moreover, this study demonstrates that differences in the values of a particular set of features at 22 hours before the actual clinical diagnosis/symptoms can be reliably used to train a convolutional neural network for automatic classification between the individuals in the sepsis and non-sepsis groups with 88.89±7.86% accuracy.


Assuntos
Redes Neurais de Computação , Sepse , Criança , Diagnóstico Precoce , Frequência Cardíaca , Humanos , Unidades de Terapia Intensiva Pediátrica , Prognóstico , Sepse/diagnóstico
9.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 1100-1103, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018178

RESUMO

Alzheimer's disease (AD) is a degenerative brain disease and the most common cause of dementia. Early stage ß-amyloid oligomers (AßOs) and late stage Aß plaques are the pathological hallmarks of AD brains. AßOs are known to be more neurotoxic and contribute to neuronal damage. Most current approaches are focused on detecting Aß plaques, which occurs at the late stage of AD, and are limited by poor sensitivity and/or contrast agent toxicity. In previous studies, we developed a new curcumin-conjugated magnetic nanoparticle (Cur-MNPs) to target the Aß pathologies. In this study, we investigate the in vivo feasibility of this novel Cur-MNPs to detect Aß pathologies at the early and late stages of AD in transgenic AD mice and perform immunohistochemical examinations to validate the specific targeting of various form of Aß pathologies.


Assuntos
Doença de Alzheimer , Doença de Alzheimer/diagnóstico , Peptídeos beta-Amiloides , Animais , Diagnóstico Precoce , Imagem por Ressonância Magnética , Camundongos , Placa Amiloide/diagnóstico por imagem
10.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 2752-2755, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018576

RESUMO

Intervention in the early stages of cardiovascular and kidney diseases is proven to be more effective in preventing disease progression. Large artery stiffness measurement can be a potential early predictor of future risks. The purpose of the study reported in this work was to demonstrate the feasibility of our ARTSENS® Pen device as a high-throughput vascular screening tool for risk assessment. The study was performed during a medical camp conducted for awareness and early-stage detection of kidney diseases. Screening procedures included biosample tests and blood pressure measurements. Alongside, various clinically relevant measures of the arterial stiffness were evaluated using the ARTSENS® Pen, by measuring vessel wall dynamics via our proprietary image-free ultrasound algorithms. Stiffness measurement from the left common carotid artery on 85 participants could be completed within 4 hours, employing two units of ARTSENS® Pen; this also includes time taken for all the procedures enlisted in the study protocol. The associations of carotid stiffness indices with age-, gender-, and risk factor-dependent variations were established.


Assuntos
Insuficiência Renal Crônica , Rigidez Vascular , Diagnóstico Precoce , Humanos , Insuficiência Renal Crônica/diagnóstico , Processamento de Sinais Assistido por Computador , Ultrassonografia
11.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 3204-3207, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018686

RESUMO

Alzheimer's disease (AD) affects approximately 30 million people worldwide, and this number is predicted to triple by 2050 unless further discoveries facilitate the early detection and prevention of the disease. Computerized walkways for simultaneous assessment of motor-cognitive performance, known as a dual-task assessment, has been used to associate changes in gait characteristics to mild cognitive impairment (MCI) with early-stage disease. However, to our best knowledge, there is no validated method to detect MCI using the collective analysis of these gait characteristics. In this paper, we develop a machine learning approach to analyze the gait data from the dual-task assessment in order to detect subjects with cognitive impairment from healthy individuals. We collected dual-task gait data from a computerized walkway of a total of 92 subjects with 31 healthy control (HC) and 61 MCI. Using support vector machine (SVM) and gradient tree boosting, we developed a classifier to differentiate MCI from HC subjects and compared the results with a paper-based questionnaire assessment that has been commonly used in clinical practice. SVM provided the highest accuracy of 77.17% with 81.97% sensitivity and 67.74% specificity. Our results indicate the potential of machine learning + dual-task assessment to enable early diagnosis of cognitive decline before it advances to dementia and AD, so that early intervention or prevention strategies can be initiated.


Assuntos
Doença de Alzheimer , Disfunção Cognitiva , Doença de Alzheimer/diagnóstico , Disfunção Cognitiva/diagnóstico , Diagnóstico Precoce , Marcha , Humanos , Aprendizado de Máquina
12.
Infect Dis Poverty ; 9(1): 141, 2020 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-33046120

RESUMO

In the past five months, success in control the national epidemic of coronavirus disease 2019 (COVID-19) has been witnessed in China. The implementation of public health measures accounts for the success which include different interventions in the early or later stages of the outbreak. It is clear that although not all measures were universally effective worldwide, their achievements have been significant. More solidarity is needed to deal with this global pandemic with more learning and understanding. Understanding which of the public health interventions implemented in China were effective may provide ideas for international epidemic control.


Assuntos
Infecções por Coronavirus/prevenção & controle , Controle de Infecções/métodos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Saúde Pública/métodos , Betacoronavirus/isolamento & purificação , China/epidemiologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Transmissão de Doença Infecciosa/prevenção & controle , Diagnóstico Precoce , Humanos , Controle de Infecções/normas , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Saúde Pública/normas
13.
Emergencias ; 32(5): 340-344, 2020 09.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33006834

RESUMO

OBJECTIVES: To assess the diagnostic yield of point-of-care ultrasound imaging in patients suspected of having noncritical severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection but no apparent changes on a chest radiograph. MATERIAL AND METHODS: Cross-sectional analysis of a case series including patients coming to an emergency department in March and April 2020 with mild-moderate respiratory symptoms suspected to be caused by SARS-CoV-2. A point-of-care ultrasound examination of the lungs was performed on all participants as part of routine clinical care. Ultrasound findings were compared according to the results of SARS-CoV-2 test results. RESULTS: Fifty-eight patients with a median (interquartile range) age of 44.5 (34-67) years were enrolled; 42 (72.4%) were women. Twenty-seven (46.5%) had confirmed SARS-CoV-2 infection. Ultrasound findings were consistent with interstitial pneumonia due to coronavirus disease 2019 (COVID-19) in 33 (56.9%). Most were in cases with testconfirmed COVID-19 (100% vs 22.2% of cases with no confirmation; P < .001). The most common ultrasound findings in confirmed COVID-19 cases were focal and confluent B-lines in the basal and posterior regions of the lung (R1, 85.2%; R2, 77.8%; L1, 88.9%; and L2, 88.9%) and associated pleural involvement (70.4%, 70.4%, 81.5%, and 85.2%, respectively). The sensitivity of point-of-care ultrasound in the diagnosis of COVID-19 was 92.6% (95% CI, 75.7%-99.1%). Specificity was 85.2% (95% CI, 66.3%-95.8%); positive predictive value, 75.8% (95% CI, 59.6%- 91.9%); negative predictive value, 92% (95% CI, 74.0%-99.0%); and positive and negative likelihood ratios, 6.2 (95% CI, 6.0-6.5) and 0.1 (95% CI, 0.1-0.1), respectively. CONCLUSION: Point-of-care lung ultrasound could be useful for the diagnosis of noncritical SARS-CoV-2 infection when chest radiographs are inconclusive.


Assuntos
Betacoronavirus , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Pandemias , Pneumonia Viral/diagnóstico por imagem , Sistemas Automatizados de Assistência Junto ao Leito , Adulto , Idoso , Infecções por Coronavirus/diagnóstico , Estudos Transversais , Diagnóstico Precoce , Feminino , Humanos , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Doenças Pulmonares Intersticiais/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade , Design de Software , Ultrassonografia
15.
Hipertens. riesgo vasc ; 37(3): 115-124, jul.-sept. 2020. tab, graf, ilus
Artigo em Espanhol | IBECS | ID: ibc-193520

RESUMO

INTRODUCCIÓN Y OBJETIVO: La obesidad y el síndrome metabólico (SM) continúan siendo un problema a nivel socioeconómico, causando elevada morbilidad y mortalidad en la población adulta, por lo que se debería realizar una prevención de factores de riesgo desde temprana edad. En la actualidad no existe un consenso del momento oportuno para iniciar la intervención y tratamiento con respecto al SM. El objetivo del estudio es describir el fenotipo para predecir diagnóstico temprano de SM en escolares. MATERIALES Y MÉTODOS: Estudio observacional, prospectivo, transversal y analítico en escolares de seis a 15 años, aplicado en Guayaquil. Se realizó valoración antropométrica y encuesta escrita, tras firma del consentimiento informado. Se utilizó para los cálculos de asociación la plataforma de inteligencia artificial (IA) Watson de IBM y su software Modeler Flow. RESULTADOS: Se examinó una población de 1.025 estudiantes entre seis y 15 años (media de 12 años para varones y 13 años para mujeres), de los cuales 62,3% fueron hombres y 37,7% mujeres. El 23,9% de la población presentó sobrepeso y 14% obesidad. Se observó una mayor tendencia a la alteración del peso en varones que en mujeres (51,37% vs. 47,79%), y menor perímetro de cintura en varones (85 cm vs. 87 cm, respectivamente). Los varones tuvieron mayor nivel de presión arterial sistólica (PAS), encontrándose dentro del percentil 90 (PAS media de 123 mmHg) un 61,2%, en comparación con un 38,8% de las mujeres, con una p < 0,001. El sedentarismo es similar en ambos grupos, con una media de 4,79 horas frente a la pantalla y/o videojuegos. Se demostró correlación estadísticamente significativa entre la presión arterial y el índice cintura /talla (I c/t) en el percentil 90 y percentil 95 (X2 9,075, p < 0,028, y X2 23,54, p < 0,000, respectivamente), así como relación entre el P95 de la presión arterial y el sexo (X2 11,57, p < 0,001). El sistema Modeler Flow, nos demostró que, si se observa un I c/t > 0,46, peso > 56,1 kg, talla > 1,61 m, y sedentarismo puro mayor a tres horas de tiempo frente a la pantalla, hay una probabilidad de presentar SM de 82,4%. El modelado matemático del árbol de decisiones (basado en inteligencia artificial) tiene una precisión predictiva del 90% (desviación de error de 0,009). La importancia de los predictores de SM, van de un 97,57% a un 100%. CONCLUSIONES: Se observó en escolares de seis a 15 años, una prevalencia del 33,9% de SM, con puntos de corte patológicos de: I c/t ≥ 0,46, peso ≥ 56,1 kg, sedentarismo puro mayor a tres horas frente a la pantalla/videojuegos, y PAS dentro del P90 (> 123 mmHg). Con estos cuatro indicadores, podemos predecir una probabilidad de diagnóstico temprano de SM de 97% al 100%


INTRODUCTION AND OBJECTIVES: Obesity and metabolic syndrome (MS) continue to be a problem at a socioeconomic level, causing high morbidity and mortality in the adult population. Prevention of risk factors should be carried out from an early age. Currently, there is no consensus on the opportune moment to start an intervention or treatment, regarding metabolic syndrome. The objective of the study is to describe the phenotype to predict early diagnosis of metabolic syndrome in schoolchildren. MATERIAL AND METHODS: Observational, prospective, cross-sectional and analytical study in schoolchildren from 6 to 15 years old, conducted in Guayaquil. Anthropometric measurements and a survey were performed, obtaining signing informed consent. The IBM Watson artificial intelligence (AI) platform with its software Modeler Flow, were used for the analysis. RESULTS: A population of 1025 students between 6 and 15 years old (mean of 12 years for men and 13 years for women) was examined, of whom 62.3% were men and 37.7% women. 23.9% of the population was overweight and 14% obese. A greater tendency to weight alteration was observed in men than in women (51.37% vs 47.79%), and a lower waist circumference in men (85 cm vs 87 cm, respectively). Males had a higher level of systolic blood pressure (SBP), being within the 90th percentile (mean SBP of 123 mmHg) 61.2%, compared to 38.8% of women, with a p < 0.001. Sedentary lifestyle is similar in both groups, with an average of 4.79 hours in front of the screen and/or video games. A statistically significant correlation was demonstrated between SBP and the waist/height ratio (WHtR) in the 90th percentile and 95th percentile (X2 9.075, p < 0.028, and X2 23,54, p < 0,000 respectively), as well as a relationship between 95th percentile and sex (X2 11.57, p < 0.001). The Modeler Flow software showed us that if WHtR, > 0.46, weight > 56.1 kg and height > 1.61 m, the probability of presenting metabolic syndrome, was of 82.4%. The statistic of this study has a predictive accuracy of 90% (error deviation of 0.009). The importance in the predictors of metabolic syndrome, range from 97.57% to 100%. CONCLUSIONS: A prevalence of 33.9% of metabolic syndrome was observed in schoolchildren from 6 to 15 years old, with pathological cut-off points of: WHtR > 0.46, weight > 56.1 kg, pure sedentary lifestyle > 3 hours in front of the screen/playing video games, and SBP within the 90th percentile (> 123 mmHg). With these four indicators, we can predict a probability of early diagnosis of metabolic syndrome of 97% to 100%


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Diagnóstico Precoce , Síndrome Metabólica/diagnóstico , Fenótipo , Pressão Sanguínea , Estudos Prospectivos , Estudos Transversais , Antropometria , Inteligência Artificial , Estudantes/estatística & dados numéricos , Relação Cintura-Quadril
16.
An. psicol ; 36(2): 247-253, mayo 2020. tab
Artigo em Inglês | IBECS | ID: ibc-192061

RESUMO

OBJECTIVE: The GHQ-12 is one of the most widely used questionnaires in the adult population, but there are not as many studies exploring its applicability in adolescents. The main problem is the diversity of results on its factorial structure, as different studies have shown one, two or three dimensions. The purpose of this study was to explore the GHQ-12 factorial structure for adolescents. METHOD: An observational multicenter cross-sectional descriptive study was designed for schools in the city of Madrid. A random sample of n = 2,171, 14-16-year-olds was stratified by the school's development level and funding (public, private or mixed). Unrestricted factor analysis was applied based on the polychoric or tetrachoric correlations matrix (depending on the test scoring method). RESULTS: The optimized parallel analysis provided an unequivocal one-factor structure, confirmed by unidimensionality assessment. Around 30% of male and 42% of female adolescents were found to be at risk of developing mental health problems. CONCLUSIONS: The GHQ-12 is a one-dimensional test for screening psychological distress, with excellent psychometric properties for its application in an adolescent population. The use of adequate statistical methods can overcome old controversies and promote proper application and interpretation of the results provided by the test


OBJETIVO: El General Health Questionnaire-12 (GHQ-12) es de los cuestionarios más utilizados en la población adulta, pero hay pocos estudios que exploren su aplicabilidad en adolescentes. El principal problema es la diversidad de resultados en su estructura factorial, ya que diferentes estudios han encontrado una, dos o tres dimensiones. El propósito de este estudio fue explorar la estructura factorial del GHQ-12 en adolescentes. MÉTODO: Estudio descriptivo observacional multicéntrico transversal para centros educativos de la ciudad de Madrid. Se estratificó una muestra aleatoria de n = 2171 jóvenes de 14-16 años según el nivel de desarrollo y financiación de la escuela (pública, privada o mixta). Se aplicó un análisis factorial sin restricciones basado en la matriz de correlaciones policóricas o tetracóricas (dependiendo del método de puntuación de la prueba). RESULTADOS: El análisis paralelo optimizado proporcionó una estructura inequívocamente unifactorial. El 30% de los varones y el 42% de las adolescentes presentaban riesgo de mala salud mental. CONCLUSIONES: El GHQ-12 es un test uni-dimensional para el cribado del riesgo de mala salud mental, con excelentes propiedades psicométricas para su aplicación en población adolescente. El uso de métodos estadísticos adecuados puede superar viejas controversias y promover la correcta interpretación de los resultados de la prueba


Assuntos
Humanos , Masculino , Adolescente , Saúde Mental/estatística & dados numéricos , Inquéritos e Questionários/estatística & dados numéricos , Psicologia do Adolescente/estatística & dados numéricos , Análise Fatorial , Estudos Transversais , Diagnóstico Precoce
18.
PLoS One ; 15(9): e0239443, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32946512

RESUMO

OBJECTIVE: In the setting of the Coronavirus Disease 2019 (COVID-19) global pandemic caused by SARS-CoV-2, a potential association of this disease with stroke has been suggested. We aimed to describe the characteristics of patients who were admitted with COVID-19 and had an acute ischemic stroke (AIS). METHODS: This is a case series of PCR-confirmed COVID-19 patients with ischemic stroke admitted to an academic health system in metropolitan Atlanta, Georgia (USA) between March 24th, 2020 and July 17th, 2020. Demographic, clinical, and radiographic characteristics were described. RESULTS: Of 396 ischemic stroke patients admitted during this study period, 13 (2.5%) were also diagnosed with COVID-19. The mean age of patients was 61.6 ± 10.8 years, 10 (76.9%) male, 8 (61.5%) were Black Americans, mean time from last normal was 4.97 ± 5.1 days, and only one received acute reperfusion therapy. All 13 patients had at least one stroke-associated co-morbidity. The predominant pattern of ischemic stroke was embolic with 4 explained by atrial fibrillation. COVID-19 patients had a significantly higher rate of cryptogenic stroke than non-COVID-19 patients during the study period (69% vs 17%, p = 0.0001). CONCLUSIONS: In our case series, ischemic stroke affected COVID-19 patients with traditional stroke risk factors at an age typically seen in non-COVID populations, and mainly affecting males and Black Americans. We observed a predominantly embolic pattern of stroke with a higher than expected rate of cryptogenic strokes, a prolonged median time to presentation and symptom recognition limiting the use of acute reperfusion treatments. These results highlight the need for increased community awareness, early identification, and management of AIS in COVID-19 patients.


Assuntos
Betacoronavirus , Isquemia Encefálica/etiologia , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Acidente Vascular Cerebral/etiologia , Afro-Americanos , Idoso , Fibrilação Atrial/complicações , Isquemia Encefálica/etnologia , Isquemia Encefálica/virologia , Comorbidade , Infecções por Coronavirus/etnologia , Gerenciamento Clínico , Diagnóstico Precoce , Embolia/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/etnologia , Acidente Vascular Cerebral/etnologia , Acidente Vascular Cerebral/virologia
19.
Internist (Berl) ; 61(10): 1094-1105, 2020 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-32897404

RESUMO

BACKGROUND: The early detection and treatment of diabetic nephropathy (DN) is of crucial importance as patients with diabetes mellitus represent the largest proportion of patients on dialysis, with the highest morbidity and mortality. Currently, the first clinical sign of incipient DN is microalbuminuria, but its precision is not optimal. Many studies now report that proteins and peptides are new biomarkers in urine that primarily depict the pathophysiology of DN and thus allow for improved diagnosis of DN. OBJECTIVES: The presentation of new concepts for the early detection and treatment of DN for better patient management. MATERIAL AND METHODS: A systematic literature search was carried out. RESULTS: Many potential markers have been described in the search for new biomarkers to diagnose DN by urinary proteome analysis. However, many of these studies were not meaningful due to the small number of samples. This limitation led to inadequate validation of proteins that could not be confirmed as markers. However, the diagnostic benefit of CKD 273, a multimarker of 273 protein fragments, was sustainably demonstrated for the early diagnosis of DN. This multi-marker shows significant advantages in the precision of diagnosis and prognosis compared to albuminuria. Furthermore, many of its peptide markers map the molecular pathophysiology of DN. CONCLUSIONS: Clinical urinary proteome analysis shows great benefits and is already an appropriate tool for the early detection of incipient DN.


Assuntos
Diabetes Mellitus Tipo 2 , Nefropatias Diabéticas/diagnóstico , Nefropatias Diabéticas/urina , Proteoma/análise , Proteômica/métodos , Albuminúria/diagnóstico , Albuminúria/urina , Biomarcadores/sangue , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/urina , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/urina , Diagnóstico Precoce , Humanos
20.
Ann Ist Super Sanita ; 56(3): 359-364, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32959802

RESUMO

Current literature shows that secondary bacterial infections, although less frequent than in previous influenza pandemics, affect COVID-19 patients. Mycoplasma pneumoniae, Staphylococcus aureus, Legionella pneumophila, Streptococcus pneumoniae, Haemophilus and Klebsiella spp. are the main species isolated. Of note, Mycobacterium tuberculosis-COVID-19 coinfections are also reported. However, bacterial coinfection rates increase in patients admitted in the intensive care units, and those diseases can be due to super-infections by nosocomial antibiotic-resistant bacteria. This highlights the urgency to revise frequent and empiric prescription of broad-spectrum antibiotics in COVID-19 patients, with more attention to evidence-based studies and respect for the antimicrobial stewardship principles.


Assuntos
Infecções Bacterianas/epidemiologia , Betacoronavirus , Coinfecção/epidemiologia , Infecções por Coronavirus/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Gestão de Antimicrobianos , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/microbiologia , Infecções Bacterianas/transmissão , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/transmissão , Resistência Microbiana a Medicamentos , Diagnóstico Precoce , Humanos , Unidades de Terapia Intensiva , Itália/epidemiologia , Micoses/epidemiologia , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/microbiologia , Especificidade da Espécie , Tuberculose/epidemiologia
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