Performance Comparison of Pulmonary Risk Scoring Systems in Lung Resection.

OBJECTIVE: To validate and compare the performance of different pulmonary risk scoring systems to predict postoperative pulmonary complications (PPCs) in lung resection surgery. DESIGN: Retrospective cohort study SETTING: A historic single-center cohort of lung resection surgeries PARTICIPANTS: Adult patients undergoing lung resection surgery under 1-lung ventilation. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The accuracy of the following pulmonary risk scoring systems were used to predict pulmonary complications: the ARISCAT (Assess respiratory RIsk in Surgical patients in CATalonia), the LAS VEGAS (Local Assessment of VEntilatory management during General Anesthesia for Surgery), the SPORC (Score for Prediction of Postoperative Respiratory Complications), and a recent thoracic-specific risk score, named CARDOT. Discrimination and calibration were assessed using the concordance (c) index and the intercept of LOESS (locally estimated scatterplot)-smoothed curves, respectively. Additional models were constructed that incorporated predicted postoperative forced expiratory volume (ppoFEV1) into each scoring system. Of the 2,104 patients undergoing lung surgery, 123 developed postoperative pulmonary complications (PPCs; 5.9%). All scoring systems had poor discriminatory power to predict PPCs (ARISCAT c-index 0.60, 95% confidence interval [CI] 0.55-0.65; LAS VEGAS c-index 0.68, 95% CI 0.63-0.73; SPORC c-index 0.63, 95% CI 0.59-0.68; CARDOT c-index 0.64, 95% CI 0.58-0.70), but the inclusion of ppoFEV1 slightly improved the performance of LAS VEGAS (c-index 0.70, 95% CI 0.66-0.75) and CARDOT (c-index 0.68, 95% CI 0.62-0.73). Analysis of calibration showed a slight overestimation when using ARISCAT (intercept -0.28) and LAS VEGAS (intercept -0.27). CONCLUSIONS: None of the scoring systems appeared to have adequate discriminatory power to predict PPCs among patients undergoing lung resection. An alternative risk score is necessary to better predict patients at risk of PPCs after thoracic surgery.

Contrast-enhanced ultrasound evaluation of residual blood flow to hepatocellular carcinoma after treatment with transarterial chemoembolization using drug-eluting beads: a prospective study.

OBJECTIVES: To evaluate the accuracy and change over time of contrast-enhanced ultrasound (US) imaging for assessing residual blood flow after transarterial chemoembolization of hepatocellular carcinoma with drug-eluting beads at 2 different follow-up intervals. METHODS: Data from 16 tumors treated by transarterial chemoembolization with drug-eluting beads were successfully obtained. As part of the study, patients provided consent to undergo contrast-enhanced US examinations the morning before embolization, 1 to 2 weeks after embolization, and the morning before follow-up contrast-enhanced magnetic resonance imaging (MRI) or computed tomography (CT) (1 month after embolization). Blinded review of contrast-enhanced US and MRI/CT studies were performed by 2 radiologists who evaluated residual flow as no change, partial change, or no residual flow. Inter- and intra-reader variability rates were calculated before discordant individual reads were settled by consensus. RESULTS: The only adverse event reported during the contrast-enhanced US examinations was a single episode of transient back pain. Contrast-enhanced US at 1 to 2 weeks after embolization (n = 14) resulted in 100% sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. Contrast-enhanced US 1 month after embolization (n = 15) resulted in 75% sensitivity, 100% specificity, 100% positive predictive value, 92% negative predictive value, and 93% accuracy. Inter-reader agreement was 86% for contrast-enhanced US at 1 to 2 weeks, 93% for contrast-enhanced US at 1 month, and 100% for contrast-enhanced MRI/CT at 1 month, whereas intra-reader agreement was 71% for contrast-enhanced US at 1 to 2 weeks, 87% for contrast-enhanced US at 1 month, and 91% for MRI/CT. CONCLUSIONS: Contrast-enhanced US imaging at 1 to 2 weeks after the procedure may be a viable alternative to MRI/CT for evaluating residual blood flow after transarterial chemoembolization with drug-eluting beads, albeit with a higher degree of reader variability.

Management of Preoperative Anemia.

Anemia is the most common modifiable risk factor for postoperative morbidity and mortality. Early identification and optimal management are key to restore iron stores and ensure its resolution before surgery. Several therapies have been proposed to treat anemia in the perioperative period, such as iron supplementation and erythropoiesis-stimulating agents, though it remains unclear which is the most optimal to improve clinical outcomes. This article summarizes the most updated evidence on perioperative management of anemia and denotes differences among the international guidelines to reflect the conflicting evidence in this field and the need for further research in specific areas.

[Recommendations for the management of latex allergy in pediatrics]. / Recomendaciones para el manejo de la alergia al látex en pediatría.

Latex allergy, or natural rubber latex allergy (NRLA), is a global health concern, even among the pediatric population, with symptoms varying in severity from mild to potentially life-threatening. Latex is derived from the Hevea Brasiliensis tree, producing twelve million tons annually for use in various everyday and medical products. Despite efforts to mitigate NRLA, its prevalence remains high, especially in at- risk groups such as children with spina bifida. Clinical manifestations include immediate and delayed symptoms, even anaphylactic reactions. Diagnosis involves a detailed medical history and specific tests. Prevention focuses on avoiding exposure, especially in medical and educational settings. Treatment, including immunotherapy, exhibits variable efficacy. NRLA has a strong negative impact on children's quality of life. The objective of this publication is to provide updated information and practical tools for the pediatrician's and allergist's practice.

La alergia al látex del caucho natural (ALCN) es un problema de salud global, incluso en población pediátrica, con síntomas de gravedad variable, desde leves hasta potencialmente mortales. El látex se obtiene del árbol Hevea brasiliensis; se producen doce millones de toneladas anuales que se utilizan en diversos productos cotidianos y médicos. A pesar de los esfuerzos para mitigar la ALCN, su prevalencia sigue siendo alta, especialmente en grupos de riesgo, como niños con espina bífida. Las manifestaciones clínicas incluyen síntomas inmediatos y retardados, hasta reacciones anafilácticas. El diagnóstico requiere una historia clínica detallada y pruebas específicas. La prevención se centra en evitar la exposición, especialmente en entornos médicos y escolares. El tratamiento, incluida la inmunoterapia, muestra eficacia variable. La ALCN tiene un fuerte impacto negativo en la calidad de vida. El objetivo de esta publicación es proveer información actualizada y herramientas prácticas para el consultorio del pediatra y el alergólogo.

Percutaneous cryoablation for recurrent low grade renal cell carcinoma after failed nephron-sparing surgery.

INTRODUCTION: Partial nephrectomy has a 3%-4% incidence of local treatment failure. This study is to present a series of percutaneous cryoablation for locally recurrent renal cell carcinoma after partial nephrectomy. MATERIALS AND METHODS: Five consecutive patients were referred to our quarternary center's multidisciplinary Small Renal Mass (SRM) Center for assessment after failure of partial nephrectomy. Tumor size and location was noted. CT-guided cryoablation was performed using an argon/helium-based system (Healthtronics, Austin, Texas, USA). Patients were admitted overnight for observation. Patients were followed with serial imaging, laboratory tests and examination at our SRM Center. Tumor size, location, and nephrometry scores were documented for each patient. RESULTS: Four tumors were endophytic and one was exophytic. The median tumor size was 2.2 cm (1.8 cm-4.0 cm). Nephrometry scores were 8a, 7x, 4p, 6x, 7p, and 6p prior to cryoablation. Median follow up after cryoablation was 32 months (20-39 months). One patient with a 4.0 cm endophytic tumor developed a second recurrence measuring 2.9 cm 13 months following ablation, which was managed successfully with repeat cryoablation with no evidence of disease after an additional 19 months of follow up. Two patients developed self-limited hematuria which was conservatively managed. There were no other complications, and all patients remained at their pretreatment performance status. CONCLUSIONS: Percutaneous cryoablation appears to be a safe and effective nephron-sparing modality for control of locally recurrent disease following partial nephrectomy. Most recurrent tumors are endophytic. One patient suffered a second local recurrence, which was managed successfully with repeat cryoablation.

Predicting Risk of Severe Toxicity and Early Death in Older Adult Patients Treated with Chemotherapy.

BACKGROUND: Determining the risk of grade 3-5 toxicity and early death (ED) is important to plan chemotherapy in older adult patients with cancer. Our objective was to identify factors predicting these complications at the time of treatment initiation. METHODS: 234 patients aged ≥70 were subjected to a geriatric assessment and variables related to the tumor and the treatment were also collected. Logistic regression multivariable analysis was used to relate these factors with the appearance of grade 3-5 toxicity and ED. Predictive scores for both toxicity and ED were then developed. RESULTS: Factors related to grade 3-5 toxicity were hemoglobin, MAX2 index, ADL, and the CONUT score. Factors related to ED were tumor stage and the GNRI score. Two predictive scores were developed using these variables. ROC curves for the prediction of toxicity and ED were 0.71 (95% CI: 0.64-0.78) and 0.73 (95% CI: 0.68-0.79), respectively. CONCLUSIONS: Two simple and reliable scores were developed to predict grade 3-5 toxicity and ED in older adult patients with cancer. This may be helpful in treatment planning.

Retinopatía diabética y diabetes mellitus pregestacional: una mirada integral desde la oftalmología / Diabetic Retinopathy and Pregestational Diabetes Mellitus: a Comprehensive View from Ophthalmology

El incremento de la prevalencia de diabetes mellitus a nivel global en los últimos años la convierte en un desafío para los sistemas de salud. La retinopatía diabética como una de sus complicaciones crónicas más frecuentes se convierte en una de las principales causas de ceguera prevenible en el mundo, convirtiéndose el embarazo en un factor de riesgo importante para el desarrollo de esta enfermedad. El embarazo en mujeres con diagnóstico previo de diabetes mellitus, puede favorecer la aparición y la progresión de la retinopatía diabética. En esta etapa, las alteraciones metabólicas descritas de la diabetes mellitus se unen a las propias del embarazo con lo que el cuadro clínico se refuerza y acentúa, de hecho, se considera el mayor factor de riesgo y se asocia con un incremento en su prevalencia y gravedad. La presencia de retinopatía diabética no es una contraindicación para el embarazo, pero su diagnóstico y tratamiento precoz para prevenir la pérdida de visión, es esencial para preservar la calidad de vida de las gestantes previa y posterior al parto. La aparición y progresión de la retinopatía diabética en mujeres con diabetes mellitus pregestacional, se puede prevenir o reducir con una adecuada atención preconcepcional, un riguroso seguimiento clínico durante el embarazo y un temprano tratamiento, contribuyendo así a evitar la pérdida visual por esta causa(AU)

The increase in the prevalence of diabetes mellitus globally in recent years makes it a challenge for health systems. Diabetic retinopathy as one of its most frequent chronic complications has become one of the main causes of preventable blindness in the world, and pregnancy has become an important risk factor for the development of this disease. Pregnancy in women previously diagnosed with diabetes mellitus may favor the onset and progression of diabetic retinopathy. At this stage, the metabolic alterations described for diabetes mellitus are added to those of pregnancy itself, so that the clinical picture is reinforced and accentuated, in fact, it is considered the greatest risk factor and is associated with an increase in its prevalence and severity. The presence of diabetic retinopathy is not a contraindication for pregnancy, but its early diagnosis and treatment to prevent vision loss is essential to preserve the quality of life of pregnant women before and after delivery. The onset and progression of diabetic retinopathy in women with pregestational diabetes mellitus can be prevented or reduced with adequate preconception care, rigorous clinical follow-up during pregnancy and early treatment, thus helping to prevent visual loss due to this cause(AU)

Generalidades del tratamiento del edema macular diabético y la indicación de las estatinas / Generalities of the Treatment of Diabetic Macular Edema and the Use of Statins

RESUMEN Introducción: Cualquiera de las formas de retinopatía diabética se puede acompañar de la presencia de edema macular diabético. El uso de las estatinas en personas con diabetes mellitus y edema macular diabético se ha sugerido como una medida terapéutica. Objetivo: Describir de manera general el tratamiento del edema macular diabético y en particular algunos resultados obtenidos con el uso de las estatinas. Métodos: Se realizó una búsqueda de literatura relevante sobre el tema en el primer semestre de 2019. Fueron evaluados artículos de revisión y de investigación provenientes de diferentes bases de datos: PubMed, Cochrane, SciELO y páginas web que, en general, tenían menos de 10 años de publicados, en idioma español, portugués o inglés. Se utilizó como buscador de información científica a Pubmed, Google y Google Académico. Se emplearon como palabras clave: diabetes mellitus, tratamiento, estatinas y edema macular diabético. Fueron excluidos los artículos que no cumplían con los objetivos del presente trabajo. Fueron estudiados 87 artículos, de los cuales 57 fueron referenciados. Conclusiones: Un estricto control glucémico y combatir los factores de riesgo modificables, en los pacientes con diabetes mellitus, representa la medida más importante para evitar y disminuir la aparición y progresión del edema macular diabético. Cuando se encuentra establecido, se debe hacer uso del tratamiento apropiado o específico. El uso de las estatinas pudiera ser un complemento importante en la prevención y tratamiento del edema macular diabético(AU)

ABSTRACT Introduction: Any form of diabetic retinopathy can be accompanied by the presence of diabetic macular edema. The use of statins in patients with diabetes mellitus and diabetic macular edema has been suggested as a therapeutic measure. Objectives: To describe, in a general way, the treatment of diabetic macular edema and, particularly, some outcomes obtained with the use of statins. Methods: A relevant literature search on the subject was carried out in the first half of 2019. Review and research articles published in the last ten years were assessed, taken from different databases, such as PubMed, Cochrane, SciELO, as well as from web pages, written in Spanish, Portuguese or English. Pubmed, Google and Google Scholar were used as engines for searching scientific information. The following keywords were used: diabetes mellitus, tratamiento [treatment], estatinas [statins], and edema macular diabetic [diabetic macular edema]. Articles that did not meet the objectives of the present work were excluded, which allowed the study of 87 articles, of which 57 were referenced. Conclusions: Strict glycemic control and confronting modifiable risk factors in patients with diabetes mellitus represents the most important measure to avoid and reduce the appearance and progression of diabetic macular edema. When established, appropriate or specific treatment should be used. The use of statins could be an important complement for the prevention and treatment of diabetic macular edema(AU)

Two casein kinase 1 isoforms are differentially expressed in Trypanosoma cruzi.

The cDNAs for two casein kinase 1 (CK1) homologues, TcCK1.1 and TcCK1.2, have been isolated from Trypanosoma cruzi. Both isoforms showed strong identity with other known CK1s. Their corresponding genes encode proteins of 312- and 330-amino acid residues with apparent molecular weights of 16 and 37 kDa, respectively. TcCK1.1 is a two-copy gene while TcCK1.2 is tandemly repeated, an arrangement not yet found in any other CK1. TcCK1.1 has been overexpressed in Escherichia coli and the recombinant protein exhibited properties characteristic of the CK1 family. Northern blot indicated that both TcCK1s are expressed differentially during the life stages of the parasite: the isoform TcCK1.1 shows low levels of mRNA expression in epimastigotes and increased expression in trypomastigotes while TcCK1.2 presents an augmented expression in amastigotes as compared with the other two life stages of the parasite. The CK1-like activity of amastigotes and trypomastigotes is significantly higher than that of epimastigotes and, independent of the life stage of the parasite, a constitutive activity is observed which, in the epimastigote forms, is found predominantly in the microsomal fraction. Also in the epimastigote forms, the CK1-like activity increases in the log phase of growth of the parasites, and, through synchronization studies, this activity has been most conspicuously circumscribed to the S and M phases of the cell cycle.

Orbitopatía asociada al tiroides en edades pediátricas / Thyroid-associated orbinopathy at pediatric ages

La enfermedad de Graves es rara en los niños y adolescentes, y aunque cursa con una clínica bastante florida, no siempre se piensa en este diagnóstico, y en no pocas ocasiones llegan a la consulta de Endocrinología remitidos de servicios de Psicología y/o Psiquiatría por un predominio de alteraciones conductuales (hiperquinesia, irritabilidad). La afección ocular puede aparecer en relación o no con los estados de hipertiroidismo, y se presenta en muchos casos con el paciente eutiroideo, por lo que se nombra actualmente orbitopatía asociada al tiroides. Es una enfermedad autoinmune y autolimitada que afecta el tejido conectivo, y su evolución es menos grave que en el adulto. El tratamiento de esta entidad es muy particularizado en las edades pediátricas, debido a que las modalidades terapéuticas por sí mismas no cumplen todos los criterios de efectividad y seguridad. Teniendo en cuenta el grado y la severidad de la orbitopatía se establecen los protocolos de atención. Es válido señalar que en estas edades -por lo general- se presentan formas leves o moderadas. Existen tres líneas de tratamiento: el medicamentoso, con antitiroideos de síntesis; el iodo radiactivo solo, o combinado con terapia esteroidea; o la extirpación quirúrgica de la glándula tiroides. En niños es muy raro que se llegue a la cirugía orbitaria. Con el objetivo de reagrupar información actualizada sobre este tema se presenta esta revisión(AU)

Graves´ disease is rare in children and adolescents, and although it develops with a fairly abundant clinic, this diagnosis is not always taken into account and in many occasions, the patients are referred to the endocrinology service from the psychology and /or psychiatry service because of predominant behavioral alterations (hyperkinesia, irritability). This eye disease may appear, either associated or not, to the conditions of hyperthyroidism, and it occurs many times in the euthyroid patient, so it is presently called thyroid-associated orbinopathy. It is an autoimmune, autolimited disease affecting the connective tissue and its progression is less severe than in the adult. The treatment is very particularized at pediatric ages because the therapeutic modalities as such do not meet all the required effectiveness and safety criteria. Taking into account the degree and the severity of orbinopathy, the respective care protocols are set. Generally speaking, it is worthwhile to point out that at these ages; there are moderate or slight forms of disease. There are also three lines of treatment: medication with synthesis anti-thyroid; the radioiodine therapy alone or in combination with steroidal therapy; and the surgical excision of the thyroid gland. It is very uncommon that a child undergoes orbital surgery. The objective of this review was to reorganize updated information about this topic(AU)

Glaucoma neovascular, complicación de la isquemia retiniana / Neovascular glaucoma, a retinal ischemia complication

Introducción: el glaucoma neovascular es un tipo de glaucoma secundario frecuente en los pacientes diabéticos, se produce por la formación de una membrana fibrovascular a nivel del ángulo camerular, como consecuencia de un estímulo angiogénico producido por enfermedades que generan isquemia ocular. Los pacientes con retinopatía diabética proliferativa pueden sufrir esta enfermedad de difícil tratamiento para el oftalmólogo, y que constituye una amenaza para la visión del paciente.Objetivo: revisar aspectos clínicos, patogenia, métodos para el diagnóstico y tratamiento terapéutico del glaucoma neovascular con vistas a prevenir o reducir la pérdida visual. Desarrollo: el glaucoma neovascular es una complicación de la diabetes mellitus y de otras enfermedades generales, que provoca una disminución importante de la visión, y en muchas ocasiones, ceguera. Las enfermedades oculares que con más frecuencia lo producen son la oclusión de la vena central de la retina, la retinopatía diabética proliferativa y el síndrome isquémico ocular, generando isquemia retiniana y coroidea con la consecuente formación de neovasos. Conclusiones: la educación al paciente diabético y el adecuado tratamiento terapéutico de la retinopatía diabética es importante para prevenir la aparición del glaucoma neovascular(AU)

Introduction: neovascular glaucoma is the type of secondary glaucoma common in diabetic patients; it is caused by the formation of fibrovascular membrane at the camerular angle as a result of angiogenic stimulus due to ocular ischemia-generating diseases. The proliferative diabetic retinopathy patients may suffer this difficult-to-treat disease that represents a threat to the vision of a patient. Objective: to review clinical aspects, pathogenenesis, diagnosis methods and treatment of the neovascular glaucoma with a view to preventing or reducing the vision loss. Development: neovascular glaucoma is a complication of diabetes mellitus and of other general diseases, which brings about significant reduction of vision and often blindness. The most frequent eye diseases responsible for this are central retinal vein occlusion, proliferative diabetic retinopathy and ocular ischemic syndrome, leading to retinal and choroid ischemia with resulting formation of neovessels.Conclusions: education aimed at diabetic patient and the adequate therapeutic treatment of the diabetic retinopathy is important to prevent the occurrence of neovascular glaucoma(AU)

Glaucoma neovascular, complicación de la isquemia retiniana / Neovascular glaucoma, a retinal ischemia complication

Introducción: el glaucoma neovascular es un tipo de glaucoma secundario frecuente en los pacientes diabéticos, se produce por la formación de una membrana fibrovascular a nivel del ángulo camerular, como consecuencia de un estímulo angiogénico producido por enfermedades que generan isquemia ocular. Los pacientes con retinopatía diabética proliferativa pueden sufrir esta enfermedad de difícil tratamiento para el oftalmólogo, y que constituye una amenaza para la visión del paciente. Objetivo: revisar aspectos clínicos, patogenia, métodos para el diagnóstico y tratamiento terapéutico del glaucoma neovascular con vistas a prevenir o reducir la pérdida visual. Desarrollo: el glaucoma neovascular es una complicación de la diabetes mellitus y de otras enfermedades generales, que provoca una disminución importante de la visión, y en muchas ocasiones, ceguera. Las enfermedades oculares que con más frecuencia lo producen son la oclusión de la vena central de la retina, la retinopatía diabética proliferativa y el síndrome isquémico ocular, generando isquemia retiniana y coroidea con la consecuente formación de neovasos. Conclusiones: la educación al paciente diabético y el adecuado tratamiento terapéutico de la retinopatía diabética es importante para prevenir la aparición del glaucoma neovascular(AU)

Introduction: neovascular glaucoma is the type of secondary glaucoma common in diabetic patients; it is caused by the formation of fibrovascular membrane at the camerular angle as a result of angiogenic stimulus due to ocular ischemia-generating diseases. The proliferative diabetic retinopathy patients may suffer this difficult-to-treat disease that represents a threat to the vision of a patient. Objective: to review clinical aspects, pathogenenesis, diagnosis methods and treatment of the neovascular glaucoma with a view to preventing or reducing the vision loss. Development: neovascular glaucoma is a complication of diabetes mellitus and of other general diseases, which brings about significant reduction of vision and often blindness. The most frequent eye diseases responsible for this are central retinal vein occlusion, proliferative diabetic retinopathy and ocular ischemic syndrome, leading to retinal and choroid ischemia with resulting formation of neovessels. Conclusions: education aimed at diabetic patient and the adequate therapeutic treatment of the diabetic retinopathy is important to prevent the occurrence of neovascular glaucoma(AU)

Predicción de la concentración de linfocitos T CD4, con base en la teoría de conjuntos aplicada al seguimiento de pacientes con VIH / Prediction of the concentration of CD4 T lymphocytes based on set theory applied to the monitoring of patients with HIV

Introducción: se desarrolló una metodología predictiva de CD4 a partir del recuento de leucocitos y linfocitos del hemograma para pacientes con VIH/sida, buscando una medida alternativa a la citometría de flujo.Métodos: se evaluó la pertenencia a cuatro conjuntos: A, B, C y D, de tripletas de linfocitos/mm³, leucocitos/mm³ y CD4/μL, tomados de 33 pacientes, recopilando de 4 a 5 muestras por paciente, 144 en total. La evaluación de (A ( C) , (B (D) y (A( C) ∩ (B ( D) permite establecer las predicciones a partir del porcentaje de pertenencia a estos conjuntos. Los resultados fueron ordenados de manera descendente dentro de nueve rangos de 1000 leucocitos. Se estableció el número de pacientes con predicciones acertadas y los rangos de mayor efectividad en la predicción.Resultados: la intersección (A ( C) ∩ (B ( D) mostró una efectividad en la predicción de CD4 del 85,71% en el rango de 4999-4000 leucocitos, del 83,33% en el de 3999-3000 y del 100% en el de menos de 3000.Conclusión: la capacidad predictiva y la utilidad clínica de la metodología desarrollada fueron confirmadas para la predicción de linfocitos T CD4, permitiendo disminuir costos frente a la citometría de flujo en el seguimiento de pacientes en el tiempo.

Introduction: A CD4 predictive methodology from the white cell blood count and lymphocyte blood counts was developed in patients with HIV/AIDS, seeking an alternative measure to flow cytometry.Methods: Membership to four sets: A, B, C and D, of triplets of: cells/mm³, leukocytes/mm³, and CD4 cells/μL, was assessed in samples taken from 33 patients, collecting 3 to 5 samples per patient, for a total of 144 samples. The assessment of (A ( C) , (B ( D) y (A ( C) ∩ (B ( D) allows for predictions based on the percentage of belonging to these groups. The results were arranged in descending order in nine ranges of 1000 leukocytes. The number of patients with accurate predictions and the ranges of greater effectiveness in prediction were established.Results: The intersection (A ( C) ∩ (B ( D) showed effectiveness of 85.71% in predicting CD4 in the range of 4999-4000 leukocytes, 83.33% for 3999-3000, and 100% in the range lesser than 3,000.Conclusion: The predictive ability and clinical usefulness of the methodology developed were confirmed for the prediction of T CD4 lymphocites, allowing to lower costs compared to flow cytometry in monitoring patients with HIV/AIDS over time.

Mid- to long-term outcome of cementless total hip arthroplasty in younger patients.

PURPOSE: To assess mid- to long-term outcomes of cementless primary total hip arthroplasty (THA) in younger patients. METHODS: Records of 28 women and 34 men (75 hips) aged 18 to 55 (mean, 38) years who underwent primary THA using a hydroxyapatite-coated stem and a threaded cup and had been followed up for a mean of 10 (6-15) years were reviewed. 13 of the patients had bilateral THAs. Clinical and radiographic outcomes were evaluated. RESULTS: After a minimum follow-up of 7 (range, 7-14) years, 12 (16%) of the hips were revised, of which 8 (11%) were for the cup. The causes for revision were late deep infections (n=2), aseptic loosening of the cup (n=4), and polyethylene wear (n=6). No stem was revised for aseptic loosening. Osteolysis was noted in 24 (38%) hips. Of the 63 unrevised hips, the mean Harris Hip Score was 92 (range, 45-100) and the mean D'Aubigne and Postel score was 17 (range, 9-18). The survival of the threaded cup was 88% at 10 years, using revision surgery as the end point. 27 (41%) of the hips showed signs of polyethylene wear; 15 were >2 mm. CONCLUSION: In younger patients undergoing THA, rates of polyethylene wear and pelvic osteolysis are high, and thus long-term follow-up is crucial.

Evaluación de arritmias con base en el método de ayuda diagnóstica de la dinámica cardiaca basado en la teoría de la probabilidad / Arrhythmias assessment based on a support diagnostic method of cardiac dynamics based on the theory of probability

Objetivo: confirmar la capacidad diagnóstica de una metodología basada en la teoría de probabilidad en casos de arritmia. Materiales y métodos: se realiza un estudio ciego, en el que se analizaron 10 Holter normales y 90 con diferentes tipos de arritmia, de pacientes mayores de 21 años. Se enmascara el diagnóstico convencional y se calcula la probabilidad de rangos de frecuencias cardiacas máximas, mínimas e intermedias cada hora, y de número de latidos por hora, para determinar el diagnóstico matemático de acuerdo con los tres parámetros establecidos previamente. Finalmente, se desenmascara el diagnóstico convencional, que fue tomado como Estándar de Oro, y se realiza un análisis de la concordancia diagnóstica para diferenciar normalidad y arritmia aguda. Resultados: los Holternormales, presentan valores matemáticos característicos de normalidad o en evolucióna enfermedad, mientras que todos los casos patológicos son diagnosticados por la metodología como en evolución a enfermedad o enfermos. Se obtiene una sensibilidad del 100%, una especificidad del 70%, un VPP de 93,33% y un VPNde 100%, y el coeficiente Kappa presenta un valor de 0,82. Conclusiones: la aplicación de la metodología en el estudio de alteraciones arrítmicas, evidencia un orden matemático mediante el cual se logra diferenciar normalidad de enfermedad y detectar estados de evolución a la enfermedad aun en estados clínicos con diagnóstico normal, de posible utilidad preventiva a nivel clínico.