Comparison and Influence of a Multicomponent Educational Program on the Patient-Reported Outcomes of a Group of Patients With Rheumatoid Arthritis.

BACKGROUND: Rheumatoid arthritis (RA) is a chronic disease that affects different areas of the patient's body. Patient education and health literacy is essential for them to participate actively in follow-up. OBJECTIVES: The aim of this study was to assess differences between clinimetric measurements done by a medical team and patient-reported outcome measures (PROMs) in RA and understand the impact of patient education strategies in order to identify differences between RA assessment methods. METHODS: This is a longitudinal cohort study. It included adult patients with RA and access to digital tools. These were divided into 3 groups by type of education. Group 1 included patients who participated in a multicomponent RA educational program. Group 2 did not have this multicomponent RA education. Group 3 did not receive any education. The 3 groups performed PROMs. Disease activity scales, functional class, and quality of life were measured. Univariate and bivariate analysis (χ 2 and Wilcoxon for paired data) were done. RESULTS: Twenty-eight patients were included in group 1, 26 in group 2, and 37 in group 3. All were women. In group 1, there were no significant differences in clinimetrics between the medical team and patient's PROMs except for fatigue. In group 2 and group 3, significant differences were found. The RAPID3 and PAS variables did not show significant differences when analyzed by intervention subgroups. CONCLUSIONS: This study shows no differences between clinimetrics/PROMs for patients with a high-level education on RA and physicians. On the other hand, when patient did not have any RA education, the clinimetric results differed from physician measurement.

Changes in diversity and species composition in the assemblage of live and dead bats at wind farms in a highly diverse region.

Besides direct mortality, wind farms also affect aerial fauna by modifying their communities, reducing species diversity and richness through disturbance. During three consecutive years, we used mist nets and acoustic recorders, and conducted carcass searches, to characterize the assemblage of bat species and to estimate bat mortality at two nearby wind farms sited <5 km apart in a highly biodiverse region. We asked whether the diversity, richness and evenness of the assemblages varied yearly, predicting it would decrease through time. Richness and evenness did not change, but the diversity of species recorded acoustically, 96% being aerial insectivores, was significantly lower the third year. We estimate 4 - 15.7 fatalities/MW/year by wind farm, with 63% of species found as carcasses being aerial insectivores. We found >40% of dissimilarity in the species composition of bat assemblages between wind farms despite the short distance between them, with species turnover accounting for more than half of the dissimilarity every year. Similarly, species turnover accounted for >15% of the dissimilarity in the composition of the assemblage of live bats (captured and recorded acoustically) and the assemblage obtained through carcass searches. Our findings suggest that nearby wind farms impact bat communities differentially and aerial insectivores disproportionally. Long term, multi-method surveys are needed to characterize bat communities in highly diverse regions and to evaluate the post-construction effects that wind farms have on them.

Consensus in acute myeloid leukemia in Mexico.

Acute myeloid leukemia (AML) comprises a heterogeneous group of hematopoietic cell neoplasms of myeloid lineage that arise from the clonal expansion of their precursors in the bone marrow, interfering with cell differentiation, leading to a syndrome of bone marrow failure. AML is a consequence of genetic and epigenetic changes (point mutations, gene rearrangements, deletions, amplifications, and arrangements in epigenetic changes that influence gene expression) in hematopoietic precursor cells, which create a clone of abnormal cells that are capable of proliferating but cannot differentiate into mature hematopoietic cells or undergo programmed cell death. The diagnosis requires more than 20% myeloid blasts in the bone marrow and certain cytogenic abnormalities. Treatment will depend on age, comorbidities, and cytogenetic risk among the most frequent.

La leucemia mieloide aguda (LMA) comprende un grupo heterogéneo de neoplasias de células hematopoyéticas de linaje mieloide que surgen de la expansión clonal de sus precursores en la médula ósea, interfiriendo con la diferenciación celular, lo que conlleva a un síndrome de falla medular. La LMA es una consecuencia de cambios genéticos y epigenéticos (mutaciones puntuales, rearreglos de genes, deleciones, amplificaciones y arreglos en cambios epigenéticos que influyen en la expression del gen) en las células hematopoyéticas precursoras, la cual crea una clona de células anormales que son capaces de proliferar, pero no se pueden diferenciar en células hematopoyéticas maduras ni sufrir una muerte celular programada. El diagnostic requiere más del 20% de blastos mieloides en médula ósea y ciertas anormalidades citogénicas. El tratamiento dependerá de la edad, comorbilidades, riesgo citogenético entre las más frecuentes.

Clinical evaluation of the antifungal effect of sertraline in the treatment of cryptococcal meningitis in HIV patients: a single Mexican center experience.

PURPOSE: Cryptococcal meningitis is a potentially fatal fungal infection associated with a significant attributable morbidity and mortality, especially among HIV/AIDS patients. The first-line therapy for the treatment of this clinical entity is the combinatory therapy of amphotericin B plus flucytosine. However, the high cost, toxic effects, and limited repertoire of effective antifungal drugs have led to the investigation of novel molecules. This is a prospective, double-blinded, and randomized study performed in a Mexican tertiary care center to evaluate the antifungal activity of sertraline in the treatment of cryptococcal meningitis in HIV patients. METHODS: During June 2015-December 2016, patients were recruited and included in one of two study groups: group A was given standard antifungal treatment plus sertraline 200 mg/day, while group B was given standard antifungal plus placebo. Lumbar punctures were performed on days 0, 7, and 14 of the study, and cryptococcal antigenemia and quantitative fungal culture in cerebrospinal fluid at each time point were evaluated to measure the rate of fungal clearance. RESULTS: The fungal loads and cryptococcal antigenemia titers showed a marked tendency to decrease by day 14 in both groups. Otherwise, group B exhibited a slightly higher nonstatistical rate of fungal clearance (-0.2868 ± 0.08275 log CFU/ml/day) than group A (-0.2496 ± 0.08340 log CFU/ml/day). CONCLUSIONS: A statistical difference between study groups was not found. This is the first study in Latin America that reports the experience of using sertraline as an adjuvant in the antifungal management of cryptococcal meningitis in HIV patients.

Subclassification of B-acute lymphoblastic leukemia according to age, immunophenotype and microenvironment, predicts MRD risk in Mexican children from vulnerable regions.

Introduction: The decisive key to disease-free survival in B-cell precursor acute lymphoblastic leukemia in children, is the combination of diagnostic timeliness and treatment efficacy, guided by accurate patient risk stratification. Implementation of standardized and high-precision diagnostic/prognostic systems is particularly important in the most marginalized geographic areas in Mexico, where high numbers of the pediatric population resides and the highest relapse and early death rates due to acute leukemias are recorded even in those cases diagnosed as standard risk. Methods: By using a multidimensional and integrated analysis of the immunophenotype of leukemic cells, the immunological context and the tumor microenvironment, this study aim to capture the snapshot of acute leukemia at disease debut of a cohort of Mexican children from vulnerable regions in Puebla, Oaxaca and Tlaxcala and its potential use in risk stratification. Results and discussion: Our findings highlight the existence of a distinct profile of ProB-ALL in children older than 10 years, which is associated with a six-fold increase in the risk of developing measurable residual disease (MRD). Along with the absence of CD34+ seminal cells for normal hematopoiesis, this ProB-ALL subtype exhibited several characteristics related to poor prognosis, including the high expression level of myeloid lineage markers such as MPO and CD33, as well as upregulation of CD19, CD34, CD24, CD20 and nuTdT. In contrast, it showed a trend towards decreased expression of CD9, CD81, CD123, CD13, CD15 and CD21. Of note, the mesenchymal stromal cell compartment constituting their leukemic niche in the bone marrow, displayed characteristics of potential suppressive microenvironment, such as the expression of Gal9 and IDO1, and the absence of the chemokine CXCL11. Accordingly, adaptive immunity components were poorly represented. Taken together, our results suggest, for the first time, that a biologically distinct subtype of ProB-ALL emerges in vulnerable adolescents, with a high risk of developing MRD. Rigorous research on potential enhancing factors, environmental or lifestyle, is crucial for its detection and prevention. The use of the reported profile for early risk stratification is suggested.

Phase Ambiguity Correction and Visualization Techniques for Complex-Valued ICA of Group fMRI Data.

Analysis of functional magnetic resonance imaging (fMRI) data in its native, complex form has been shown to increase the sensitivity both for data-driven techniques, such as independent component analysis (ICA), and for model-driven techniques. The promise of an increase in sensitivity and specificity in clinical studies, provides a powerful motivation for utilizing both the phase and magnitude data; however, the unknown and noisy nature of the phase poses a challenge. In addition, many complex-valued analysis algorithms, such as ICA, suffer from an inherent phase ambiguity, which introduces additional difficulty for group analysis. We present solutions for these issues, which have been among the main reasons phase information has been traditionally discarded, and show their effectiveness when used as part of a complex-valued group ICA algorithm application. The methods we present thus allow the development of new fully complex data-driven and semi-blind methods to process, analyze, and visualize fMRI data.We first introduce a phase ambiguity correction scheme that can be either applied subsequent to ICA of fMRI data or can be incorporated into the ICA algorithm in the form of prior information to eliminate the need for further processing for phase correction. We also present a Mahalanobis distance-based thresholding method, which incorporates both magnitude and phase information into a single threshold, that can be used to increase the sensitivity in the identification of voxels of interest. This method shows particular promise for identifying voxels with significant susceptibility changes but that are located in low magnitude (i.e. activation) areas. We demonstrate the performance gain of the introduced methods on actual fMRI data.

In vitro inhibitory activity of sertraline against clinical isolates of Sporothrix schenckii.

BACKGROUND: Sertraline (SRT) is an antidepressant that has proven its activity in vitro against Cryptococcus, Coccidioides, Trichosporon and other fungi. Disseminated sporotrichosis, although rare, has a high mortality and its treatment is difficult and prolonged, often relying in combining two or more antifungals. AIMS: In our study we evaluate the antifungal activity of SRT, alone and in combination with itraconazole (ITC), voriconazole (VRC) and amphotericin B (AMB), against 15 clinical isolates of Sporothrix schenckii. METHODS: We used the broth microdilution method as described by the CLSI to test the susceptibility to antifungals, and the checkerboard microdilution method to evaluate drug interactions. RESULTS: The minimum inhibitory concentration (MIC) with SRT was in the range of 4-8µg/ml, while for AMB, VRC and ITC were 0.5-4µg/ml, 0.5-8µg/ml and 0.125-2µg/ml, respectively. In addition, SRT showed synergy with ITC in one strain, mainly additivity with VRC, and indifference with AMB in others. CONCLUSIONS: The MIC values with SRT for the isolates studied show the potential role of this drug as an adjuvant in the treatment of sporotrichosis, especially in disseminated or complicated cases.

Association between Candida biofilm-forming bloodstream isolates and the clinical evolution in patients with candidemia: An observational nine-year single center study in Mexico.

BACKGROUND: Candidemia is one of the most common nosocomial infections globally and it is associated with considerable excess mortality and costs. Abreast, biofilm-forming strains are associated with even higher mortality rates and poor prognosis for the patient. AIMS: To evaluate a possible association between the biofilm-forming capability of Candida bloodstream isolates and the clinical evolution in patients with candidemia. METHODS: An observational, retrospective study was conducted at a tertiary care university hospital during 9 years (2006-2015). The biofilm quantitation of the Candida bloodstream isolates was determined by crystal violet staining and XTT reduction assay. RESULTS: A total of 218 cases of candidemia had been diagnosed and 89 isolates were obtained. The mortality rate was 36% and the main risk factors were antibiotic exposure and the use of catheters. Candida tropicalis (52.8%) was the most frequent species, followed by Candida albicans (30.4%), Candida parapsilosis sensu stricto (10.1%), Candida orthopsilosis (3.4%), Candida krusei (2.2%) and Candida glabrata sensu stricto (1.1%). All the strains were biofilm producers, which is an important contribution to the patient's mortality. C. tropicalis showed the highest production of biomass biofilm, whereas C. glabrata exhibited the highest metabolic activity. CONCLUSIONS: This study contributes to expand the knowledge about the local epidemiology of candidemia and highlights the impact of Candida biofilm on patient's outcome.

Consenso de leucemia mieloide aguda en México / Mexican consensus in acute myeloid leukemia in Mexico

resumen está disponible en el texto completo

Abstract Acute myeloid leukemia (AML) comprises a heterogeneous group of hematopoietic cell neoplasms of myeloid lineage that arise from the clonal expansion of their precursors in the bone marrow, interfering with cell differentiation, leading to a syndrome of bone marrow failure. AML is a consequence of genetic and epigenetic changes (point mutations, gene rearrangements, deletions, amplifications, and arrangements in epigenetic changes that influence gene expression) in hematopoietic precursor cells, which create a clone of abnormal cells that are capable of proliferating but cannot differentiate into mature hematopoietic cells or undergo programmed cell death. The diagnosis requires more than 20% myeloid blasts in the bone marrow and certain cytogenic abnormalities. Treatment will depend on age, comorbidities, and cytogenetic risk among the most frequent.

General nonunitary constrained ICA and its application to complex-valued fMRI data.

Constrained independent component analysis (C-ICA) algorithms provide an effective way to introduce prior information into the complex- and real-valued ICA framework. The work in this area has focus on adding constraints to the objective function of algorithms that assume a unitary demixing matrix. The unitary condition is required in order to decouple-isolate-the constraints applied for each individual source. This assumption limits the optimization space and, therefore, the separation performance of C-ICA algorithms. We generalize the existing C-ICA framework by using a novel decoupling method that preserves the larger optimization space for the demixing matrix. This framework allows for the constraining of either the sources or the mixing coefficients. A constrained version of the nonunitary entropy bound minimization algorithm is introduced and applied to actual complex-valued fMRI data. We show that constraining the mixing parameters using a temporal constraint improves the estimation of the spatial map and timecourses of task-related components.

Case of chromoblastomycosis with pulmonary involvement.

Chromoblastomycosis is a slowly growing chronic cutaneous mycosis associated with a variety of cutaneous lesions. Extra-dermal involvement is rare. A 58-year-old man was admitted to the hospital with nausea, vomiting, weakness and a history of weight loss. On inspection, he had a large verrucous mass in the sacral region, and two large subcutaneous nodules in the anterior thoracic wall. He claimed the lesions were several years old. Biopsy and histological studies were positive for chromoblastomycosis. Routine chest radiography showed hilar enlargement, and a chest computed tomography was ordered. Pulmonary nodules were evident, and endoscopically acquired samples were also positive for chromoblastomycosis. Extra-dermal and systemic involvement in chromoblastomycosis is exceedingly rare and often associated with immunosuppression. There is only one other case of pulmonary chromoblastomycosis reported in the published work.

Application of independent component analysis with adaptive density model to complex-valued fMRI data.

Independent component analysis (ICA) has proven quite useful for the analysis of real world datasets such as functional resonance magnetic imaging (fMRI) data, where the underlying nature of the data is hard to model. It is particularly useful for the analysis of fMRI data in its native complex form since very little is known about the nature of phase. Phase information has been discarded in most analyses as it is particularly noisy. In this paper, we show that a complex ICA approach using a flexible nonlinearity that adapts to the source density is the more desirable one for performing ICA of complex fMRI data compared to those that use fixed nonlinearity, especially when noise level is high. By adaptively matching the underlying fMRI density model, the analysis performance can be improved in terms of both the estimation of spatial maps and the task-related time courses, especially for the estimation of phase of the time course. We also define a procedure for analysis and visualization of complex-valued fMRI results, which includes the construction of bivariate t-maps for multiple subjects and a complex-valued ICASSO scheme for evaluating the consistency of ICA algorithms.

Quality Map Thresholding for De-noising of Complex-Valued fMRI Data and Its Application to ICA of fMRI.

Although functional magnetic resonance imaging (fMRI) data are acquired as complex-valued images, traditionally most fMRI studies only use the magnitude of the data. FMRI analysis in the complex domain promises to provide more statistically significant information; however, the noisy nature of the phase poses a challenge for successful study of fMRI by complex-valued signal processing algorithms. In this paper, we introduce a physiologically motivated de-noising method that uses phase quality maps to successfully identify and eliminate noisy areas in the fMRI data so they can be used in individual and group studies. Additionally, we show how the developed de-noising method improves the results of complex-valued independent component analysis of fMRI data, a very successful tool for blind source separation of biomedical data.

An emergency response UAV Surveillance System.

A system using Unmanned Air Vehicles (UAVs), equipped for real time telemetry of video imagery, sensor support data, and GPS/INS navigation, is being developed to provide situational awareness (SA) to the central command of mass casualty incident response. UAVs provide an inexpensive and safe means of acquiring video surveillance in chaotic disaster scenes, while being durable and non-intrusive. The system provides autonomous surveillance of defined perimeters, video tracking and active following of targets of interest, and real time cueing to other imaging UAVs.

Protocolo para el control de calidad de envases de plástico, utilizados en la industria farmacéutica, de cosméticos y de alimentos / Quality control guide of the packing employed in the pharmaceutical, cosmetics and food industry

En este trabajo se evaluaron las tres características fundamentales de desempeño que debe cumplir un envase: protección, funcionalidad y motivación. Para ello, se estudiaron y evaluaron una serie de pruebas reportadas nacional e internacionalmente. Las diferentes pruebas se clasificaron en dos grandes grupos: pruebas físicas y pruebas fisicoquímicas; por otro lado, las pruebas biológicas que son fundamentales para la evaluación de la calidad de estos materiales no están incluidas en el protocolo propuesto, puesto que no se consideran pruebas de control de calidad de rutina. Como resultado de su evaluación experimental, se desarrolló un protocolo unificado y una guía de análisis para el control de calidad fisicoquímico de rutina de los envases y materiales de plástico.

This work evaluated the three fundamental characteristics of performance that must fulfill a package: Protection, functionality and motivation. For it, a series of tests reported at national and international level were evaluated. The tests were classified in two great groups: Physical tests and physical-chemicals tests; in the other hand, the biological tests used to evaluate quality of this kind of materials are not included in the proposed protocol because this quality control test are not considered currently. As resulting from its experimental evaluation, it was developed a unified protocol and a guide for routine quality control test of the packages and plastic material.

Valor predictivo de algunos criterios de selección para el ingreso a la carrera de Medicina / Predictive value of some selection criteria for entering the career of Medicine

Con el objetivo de verificar la capacidad predictiva de las pruebas de aptitud, el índice académico y los exámenes de ingreso, en relación con el rendimiento académico en la carrera de Medicina, se diseñó una investigación de seguimiento longitudinal de los estudiantes que ingresaron en el curso 91-92, utilizando los datos obtenidos durante el proceso selectivo y sus calificaciones durante los primeros 4 años de la carrera para la totalidad de las asignaturas del plan de estudio. Dada la naturaleza continua de la variable dependiente, el análisis estadístico descansó en lo esencial en el modelo de regresión múltiple. Se confirmó la relevancia del índice académico como predictor del rendimiento y se han aportado, tal vez, las primeras evidencias de la capacidad predictiva de los exámenes de ingreso. La capacidad pronóstica de las variables que se registran en el momento del ingreso se disipa a medida que el alumno transita de un curso a otro y su lugar lo ocupan los propios indicadores de rendimiento parcial

To verife predictive capacity of a aptitude tests, academic index and entrance examination., in relation to academic yield in medicine career, a longitudinal follow-up research was designed on students admited in 1991-1992 course, using data obtained during selective process and their qualifications in first 4 years of career to all subjects of course of study. Given the continuos nature of dependent variable, statistical analysis was based on the main multiple regression form. We confirmed relevance of academic index as a yield predictor, and perhaps first evidences of predictive ability of entrance examination have been provided. Prognostic abilities of variables registering in entrance, be dissipated as student pass from a course to another one, and his place is occupied by own indicators of partical yield

Capacidad predictiva de varios indicadores de selección para el ingreso a la carrera de medicina / Predictive capacity of various selection indicators for medical school admission

Se estudia la capacidad predictiva de las pruebas de aptitud, el índice académico y los exámenes de ingreso, en relación con el rendimiento académico en el primer año de la carrera de medicina. Para ello se utiliza como muestra de entrenamiento a los estudiantes del X Contingente del Destacamento "Carlos J. Finlay" que ingresaron a la enseñanza superior en el curso 91-92. La información utilizada se obtuvo como parte del proceso selectivo y a partir de las calificaciones del primer año de la carrera para todas las asignaturas del plan de estudio. Se definió el éxito académico como un promedio superior a 4. Dada la naturaleza binaria de la variable dependiente, se utilizaron modelos de regresión logística como procedimiento analítico para el pronóstico. Se confirma la relevancia del índice académico como predictor del rendimiento y se aportan nuevas evidencias acerca de la escasa capacidad predictiva de los exámenes de ingreso. Se obtienen también algunas evidencias favorables al empleo de las pruebas de razonamiento verbal. Por último, se formulan algunas recomendaciones estratégicas respecto de eventuales políticas para el proceso de admisión

The predictive capacity of aptitude tests, the academic index and the college admission tests are studied in relation to the academic results obtained at the end of the first year. To this end, a group of sudents from the X Contingent of the "Carlos J, Finlay" Detachment that entered the university during the course 1991-1992 were taken as a training sample. The information used was obtained as part of the selective process and it was based on the marks attained in the different subjects of the curriculum. An average over 4 was considered as an academic success. Due to the binary nature of the dependent variable, models of logistic regression were used as an analytical procedure for prognosis. It was confirmed the relevance of the academic index as a predictor of the academic results and new evidences about the poor productive capacity of the admission test were given. Some evidences favoring the use of oral reasoning tests were also obtained. To conclude, some strategic recommendations in relation to eventual policies are given for the process of admission

Resultados del estudio de la función pulmonar en un grupo de niños asmáticos en período intercrisis y su comparación con una muestra similar de adultos / Results of the study of pulmonary function in a group of asthmatic children in intercrisis period and its comparison with a similar adult sample

Se realiza un estudio comparativo de dos muestras: una conformada por 24 niños y la otra por 25 adultos, procedentes de los Servicios de Neumología del Hospital Pediátrico Provincial y del Hospital Clinicoquirúrgico Provincial de Pinar del Río, respectivamente, con historia de ingresos reiterados por presentar status asmaticum en el primer semestre de 1986. A todos los pacientes se les realizó estudio espirométrico antes y después de la aplicación de un aerosol de salbutamol al 0,5 %, en las dosis usualmente recomendadas. Los resultados porcentuales para cada paciente fueron obtenidos mediante un programa de computación, en el que se tuvieron en cuenta las tablas de normalidad de Bates; el procesamiento estadístico de los datos se realizó a través de las pruebas de chi cuadrado, de la t de Student y el análisis de correlación. Después de la investigación se pudo apreciar que la proporción de niños y adultos que en período intercrisis tienen obstrucción de vías aéreas, es alrededor del 50 %, sin diferencias significativas entre la edad; asimismo, alrededor del 40 % evidencia un patrón normal en ese período. Se encontró correlación significativa entre el tiempo de evolución y el grado de obstrucción de las vías aéreas. El efecto broncodilatador del salbutamol fue comprobado en la intercrisis, tanto en niños como en adultos, y no se manifestaron diferencias en cuanto al efecto en niños y adultos