Diseño y Validación de una Aplicación Móvil, para el Diagnóstico de Anemia en Pre-Escolares. Estudio de Precisión Diagnóstica / Design and Validation of a Mobile Application for the Diagnosis of Anemia in Preschoolers. Diagnostic Accuracy Study

La anemia afecta a miles de niños. Para el diagnóstico se cuantifica la hemoglobina (Hb); técnica que no se encuentra al alcance de toda la población. Contar con un instrumento validado de fácil aplicación, puede ayudar al diagnóstico. El objetivo de este estudio fue validar una aplicación móvil (APP) para diagnosticar anemia en niños de 2 a 5 años, aplicable por padres o tutores. Estudio de validación de escalas. Mediante búsqueda bibliografía se recopilaron ítems y dominios relacionados con anemia en niños. Una vez reducidos, se construyó un cuestionario para pilotaje, con tres hematólogos pediatras. El resultado de este fue posteriormente validado por 22 expertos mediante aplicación de escalas tipo Likert. Los ítems validados, se contrastaron con la Hb de niños de 267 niños de 2 a 5 años de los andes ecuatorianos (2.560 msnm). Se determinó asociación de los ítems con Hb y con los resultados obtenidos y se construyó la APP. 14 ítems fueron analizados. Todos ellos puntuaron sobre la mediana de la distribución (35,5 puntos) y fueron valorados por, al menos el 50 % de los expertos. Se seleccionaron palidez palmar, astenia y sueño en horas no habituales. Todos mostraron asociación significativa con anemia (p<0,05), y fueron aplicados como preguntas a padres o tutores y contrastados con el valor de Hb. Sensibilidad y especificidad para palidez fue: 85,1 % y 85,0 %; astenia: 72,3 % y 87,7 %; sueño en horas no habituales: 68,1 % y 87,7 %; palidez más astenia o sueño: 95,7 % y 74,6 %; y debilidad más sueño: 92,5 % y 76,8 %. Se desarrolló y validó una APP para diagnóstico de anemia en niños de 2 a 5 años aplicable por padres o tutores.

SUMMARY: Anemia affects thousands of children, and to reach a diagnosis, hemoglobin (Hb) is quantified. This technique however, is not always accessible to the general population. Therefore, the availability of a validated instrument can be useful in the diagnosis. The aim of this study was to validate a mobile application (APP), to diagnose anemia in children from 2 to 5 years old, applicable by parents or guardians. Scale validation study. Through a bibliographic search, items and domains related to anemia in children were collected. Once reduced, a pilot questionnaire was constructed with three pediatric hematologists. The result was later validated by 22 experts through the application of the Likert-type scales. The validated items were contrasted with the Hb of children of 267 children from 2 to 5 years of age from the Ecuadorian Andes (2,560 meters above sea level). The association of the items with Hb and with the results obtained was determined, and the APP was constructed. 14 items were analyzed. All of them scored above the median of the distribution (35.5 points) and were valued by at least 50 % of the experts. Palmar pallor, asthenia, and sleep at unusual hours were selected. All showed a significant association with anemia (p<0.05) and were applied as questions to parents or guardians and contrasted with the Hb value. Sensitivity and specificity for pallor was: 85.1 % and 85.0 %; asthenia: 72.3 % and 87.7 %; sleep at unusual hours: 68.1 % and 87.7 %; paleness plus fatigue or sleepiness: 95.7 % and 74.6 %; and weakness plus sleep: 92.5 % and 76.8 %. An APP for the diagnosis of anemia in children from 2 to 5 years old applicable by parents or guardians was developed and validated.

Initial validation of a scale to measure methodological quality in prognosis studies: the MInCir proposal / Validación inicial de una escala para medir calidad metodológica en estudios de pronóstico: la propuesta de MInCir

Research in methodological quality (MQ) of prognosis studies (PS) is relevant in view of the important number of studies developed in this scenario. However, currently there are no instruments designed to measure MQ in PS, thus the aim of this study was to validate a scale to determine the MQ in PS. Scale validation study. Two independent researchers applied the scale (10 items/4 domains) in 119 articles found in 13 Journals of high, medium and low impact factor. Criterion validity was determined by contrasting MQ scores with Oxford Centre for Evidence-Based Medicine levels of evidence. Construct validity of extreme groups and high and low impact factors were estimated. Intraclass correlation coefficient was used to determine interobserver reliability, and the cut-off point was calculated using a ROC curve. The best cut-off point was 33, with an under curve area of 82.6 %. Criterion and construct validity were statistically significant with (p<0.001). Interobserver reliability was 0.91 and a scale to measure the MQ in PS was validated.

El objetivo de este estudio fue validar una escala para determinar calidad metodológica (CM) de estudios de pronóstico (EP). Se realizó un estudio de validación de escalas. La escala, compuesta por 10 ítems y 4 dominios; se aplicó a 119 artículos de 13 revistas, de factores de impacto alto, medio y bajo; por dos investigadores independientes. La validez del criterio se determinó al contrastar las puntuaciones de CM de cada artículo con los niveles de evidencia del Centro de Medicina Basada en la Evidencia de Oxford de la revista en la cual fueron publicados. Se estimó la validez de constructo de grupos extremos (factores de impacto alto y bajo). Se utilizó el coeficiente de correlación intraclase para determinar la confiabilidad interobservador, y el punto de corte se calculó construyendo curvas ROC. El mejor punto de corte fue 33 puntos (área bajo la curva de 82,6 %). La validez de criterio y de constructo fueron estadísticamente significativas (p<0,001). La confiabilidad interobservador fue 0,91. Se validó una escala para medir CM en EP.

Uso de malhas tridimensionais em cirurgia plástica / The use of a three-dimensional mesh in plastic surgery

INTRODUÇÃO: O registro da imagem como conhecemos hoje evoluiu muito desde os primórdios da fotografia por meio da impressão da luz diretamente em um material fotossensível, até os algoritmos matemáticos que constituem malhas tridimensionais, na estereofotogrametria. A tecnologia 3D para captura e extração de informações confiáveis na Cirurgia Plástica tem evoluído muito nos últimos anos; contudo, há necessidade de compreensão do método para que o potencial de aplicabilidade possa ser explorado diretamente pelo cirurgião na sua rotina. O objetivo deste trabalho é abordar os aspectos conceituais, a acurácia da captação e ilustrar aplicações clínicas das malhas tridimensionais, salientando a importância na utilização clínica. MÉTODO: Foi feita uma revisão dos princípios de captação de imagens e da formação de modelos tridimensionais por meio da revisão da literatura, bem como uma descrição da aplicação de testes de acurácia com o uso de scanner de luz estruturada. Indicações clínicas das malhas tridimensionais foram avaliadas tanto no planejamento pré-operatório como no acompanhamento pós-cirúrgico. RESULTADOS: Os princípios das tecnologias de captação da imagem foram estabelecidos e a reprodutibilidade da validação da ferramenta de captação das malhas foi confirmada. A aplicabilidade clínica tanto na programação, quanto no acompanhamento foi exemplificada. CONCLUSÃO: A diferença conceitual entre fotografia e malha tridimensional foi estabelecida, juntamente com a introdução dos princípios da tecnologia 3D. As aplicações clínicas do método foram apresentadas, evidenciando o uso promissor de modelos tridimensionais em Cirurgia Plástica.

INTRODUCTION: Image recording as we know it today has evolved considerably from the beginning of photography by means of light printing directly onto a photosensitive material, up to the mathematical algorithms that constitute three-dimensional (3-D) meshes in stereophotogrammetry. The 3-D technology to capture and extract reliable information in plastic surgery has evolved considerably in recent years. However, the procedure for which the applicability potential can be exploited directly by the surgeon in their routine work should be fully understood. The objective of this work was to address the conceptual aspects and the accuracy of the image capture, and to illustrate clinical applications of 3-D meshes, with emphasis on their importance in clinical use. METHODS: Literature on the principles of image capture and formation of tridimensional models was reviewed, as well as the description of the application of the tests of accuracy with the use of a structured-light scanner. Clinical indications of 3-D meshes were evaluated both in the preoperative planning and postsurgical follow-up. RESULTS: The principles of the image capture technologies were established, and the reproducibility of the validation of the tool to capture meshes was confirmed. The clinical applicability both in programming and monitoring was exemplified. CONCLUSION: The conceptual difference between photography and the 3-D mesh system was established, together with the introduction of the principles of 3-D technology. The clinical applications of the method were presented, evidencing the promising application of dimensional models in plastic surgery.

A Review of Adult Obesity Research in Malaysia

A literature search of articles as detailed in the paper Bibliography of clinical research in Malaysia: methods and brief results, using the MESH terms Obesity; Obesity, Abdominal; and Overweight; covering the years 2000 till 2015 was undertaken and 265 articles were identified. Serial population studies showed that the prevalence of obesity increased rapidly in Malaysia in the last decade of the twentieth century. This follows the rising availability of food per capita which had been begun two to three decades previously. Almost every birth cohort, even up to those in their seventh decade increased in prevalence of overweight and obesity between 1996 and 2006. However, the rise in prevalence in obesity appears to have plateaued after the first decade of the twentieth century. Women are more obese than men and Malays and Indians are more obese than Chinese. The Orang Asli (Aborigines) are the least obese ethnic group in Malaysia but that may change with socioeconomic development. Neither living in rural areas nor having low income protects against obesity. On the contrary, a tertiary education and an income over RM4,000/month is associated with less obesity. Malaysians are generally not physically active enough, in the modes of transportation they use and how they use their leisure time. Other criteria and measures of obesity have been investigated, such as the relevance of abdominal obesity, and the Asian criteria or Body Mass Index (BMI) cut-offs value of 23.0 kg/m2 for overweight and 27.0 kg/m2 for obesity, with the view that the risk of diabetes and other chronic diseases start to increase at lower values in Asians compared to Europeans. Nevertheless the standard World Health Organization (WHO) guidelines for obesity are still most widely used and hence is the best common reference. Guidelines for the management of obesity have been published and projects to combat obesity are being run. However, more effort needs to be invested. Studies on intervention programmes showed that weight loss is not easy to achieve nor maintain. Laboratory research worldwide has uncovered several genetic and biochemical markers associated with obesity. Similar studies in Malaysia have found some biomarkers with an association to obesity in the local population but none of great significance.

Centímetro cúbico / Cubic Centimeter

Con frecuencia utilizamos soluciones y medicamentos dosificados en unidades de volumen, principalmente centímetros cúbicos. Desafortunadamente, al escribir el símbolo correspondiente a dicha unidad suele cometerse un error inaceptable: CC. El centímetro cúbico pertenece al Sistema Internacional de Unidades (SI), y por lo tanto está sujeto a sus normas, las cuales fueron adoptadas oficialmente en Colombia según el Decreto de la República No. 2416 del 9 de diciembre de 1971, que instituyó al ICONTEC como el ente nacional encargado de su regulación y verificación, y a las gobernaciones y alcaldías como sus rectores. Esta unidad de medida se define como el espacio ocupado por un cuerpo que mida 1 centímetro de longitud por cada una de sus tres dimensiones, y equivale a 1 mililitro (1 mL) de capacidad. El centímetro cúbico denota el volumen del objeto (corpulencia) mientras que el mililitro hace referencia a la capacidad para contener dicho volumen. Estas dos medidas no son exactamente iguales pero son equivalentes, y en consecuencia se pueden utilizar indistintamente para indicar la cantidad de un medicamento o fluido.

Correlation between Serum D-Dimer Level and Volume in Acute Ischemic Stroke

OBJECTIVE: D-dimer is a breakdown product of fibrin mesh after factor XIII stabilization. Previously, many authors have demonstrated a relationship between D-dimer level and stroke progression or type. This study aimed to investigate the relationship between D-dimer level and stroke volume. METHODS: Between January 2008 and December 2009, we analyzed the D-dimer levels of 59 acute ischemic stroke patients in our neurosurgical department both upon admission and after seven days of initial treatment. Each patient's National Institute of Health Stroke Scale score, modified Rankin Scales score, Glasgow outcome score, and infarction volume were also evaluated. RESULTS: Mean D-dimer level at admission was 626.6 microg/L (range, 77-4,752 microg/L) and the mean level measured after seven days of treatment was 238.3 microg/L (range, 50-924 microg/L). Mean D-dimer level at admission was 215.3 microg/L in patients with focal infarctions, 385.7 microg/L in patients with multiple embolic infarctions, 566.2 microg/L in those with 1-19 cc infarctions, 668.8 microg/L in 20-49 cc infarctions, 702.5 microg/L in 50-199 cc infarctions, and 844.0 microg/L in >200 cc infarctions (p=0.044). On the 7th day of treatment, the D-dimer levels had fallen to 201.0 microg/L, 293.2 microg/L, 272.0 microg/L, 232.8 microg/L, 336.6 microg/L, and 180.0 microg/L, respectively (p=0.530). CONCLUSION: Our study shows that D-dimer level has the positive correlation with infarction volume and can be use to predict infarction-volume.

Simple and Novel Three Dimensional Neuronal Cell Culture Using a Micro Mesh Scaffold

Conventional method of cell culture studies has been performed on two-dimensional substrates. Recently, three-dimensional (3D) cell culture platforms have been a subject of interest as cells in 3D has significant differences in cell differentiation and behavior. Here we report a novel approach of 3D cell culture using a nylon micro mesh (NMM) as a cell culture scaffold. NMM is commonly used in cell culture laboratory, which eliminates the requirement of special technicality for biological laboratories. Furthermore, it is made of a micro-meter thick nylon fibers, which was adequate to engineer in cellular scales. We demonstrate the feasibility of the NMM as a 3D scaffold using E18 rat hippocampal neurons. NMM could be coated with cell adhesive coatings (polylysine or polyelectrolyte) and neurons showed good viability. Cells were also encapsulated in an agarose hydrogel and cultured in 3D using NMM. In addition, the 3D pattern of NMM could be used as a guidance cue for neurite outgrowth. The flexible and elastic properties of NMMs made it easier to handle the scaffold and also readily applicable for large-scale tissue engineering applications.

Manga gástrica laparoscópica: técnica para el tratamiento quirúrgico de la obesidad mórbida: experiencia en 70 casos / Laparoscopic gastric sleeve: a thecnique for the surgical treatment of morbid obesity: experience in 70 cases

Mostrar la eficacia de la manga gástrica laparoscópica como tratamiento de la obesidad, su repercusión en el porcentaje de pérdida exceso de peso (porcentaje de PEP) y en el índice de masa corporal (IMC). Se presenta la experiencia de 70 pacientes a quien se le realizó manga gástrica laparoscópica en el Instituto Clínico la Florida desde junio de 2006 hasta diciembre de 2007 (18 meses). Se analizaron datos demográficos, tiempo quirúrgico, estancia hospitalaria, complicaciones, porcentaje de PEP, IMC. 70 pacientes obesos se les realizó MGL (49 m-21 h), promedio de edad 43 años (18-65), IMC 40.3 kg/m2 (32-55), Tiempo quirúrgico promedio 106 minutos (75-210), promedio de hospitalización 2 días (1-9). Porcentaje de PEP a los 3, 6, 9, 12, 15 y 18 meses fue de 43 por ciento, 57 por ciento, 65 por ciento, 70 por ciento, 73 por ciento y 74 por ciento respectivamente. IMC para el mismo período fue de 35.2, 32.1, 30.5, 30.4 y 29.9 respectivamente. Tuvimos 5 complicaciones mayores (7.1 por ciento): 2 neumonías (2.85 por ciento), 1 sangramiento (1.42 por ciento), 1 delirio (1.42 por ciento), 1 filtración gástrica (1.42 por ciento). 0 mortalidad y 0 reintervenciones. Hasta el momento la MGL ha mostrado ser un método efectivo y seguro para el manejo de la obesidad mórbida y sus implicaciones, sin embargo, como toda técnica novedosa y sobre todo en cirugía bariatrica, amerita soportar la inefable prueba del tiempo.

Umbilical hernia in adults: day case local anaesthetic repair.

INTRODUCTION: The waiting times for elective surgery of Umbilical hernia (UH) in adults are unacceptably long in some cases. During this period, irreducibility and strangulation are possible. We operate on adult patients under local anaesthesia (LA) as day cases to avoid this delay and describe our experience in this paper. AIMS: The aims of our study were to look at the age and sex distribution, body weight, type and amount of local anaesthetic used, morbidity, admission and readmission rates, and waiting times of adult patients operated on for UH under LA. MATERIALS AND METHODS: It was a retrospective study covering a 4 year period from July 1996 to June 2000 including all adult patients undergoing the above procedure under the care of a single consultant general surgeon. A standard Mayo repair using non absorbable material was used without a mesh or a drain. RESULTS: 32 patients with UH were operated on under LA, 23 males and 9 females with a median age of 51 years (range 20 to 86 years). The body weight ranged from 63 to 120 (median 87) kg. The average duration of the procedure was 30 (range 22-40) minutes. Sedation was needed in 4 patients. Two patients developed wound infections, one superficial and one deep. There was no mortality. The median period of follow-up was 24 (range 4-48) months and there was no recurrence. The median waiting time for the operation was 6 weeks. CONCLUSIONS: Day case local anaesthetic repair of UH in adults seems to be safe and feasible with an acceptable morbidity. Suture repair in the right patient has excellent results and the waiting times are acceptable.