The Impact of COVID-19 on the Utilization of Public Sector Radiological Services in the Western Cape Province of South Africa.

Background Coronavirus (COVID-19) was officially declared a pandemic in March 2020 and has had a major impact on global healthcare services, including radiology. However, little is known about the full impact of COVID-19 on the utilization of diagnostic imaging in Africa's public healthcare sector. Objectives The objective of this study was to compare public sector diagnostic imaging utilization by modality for the whole Western Cape Province (WCP) of South Africa (SA), as well as its metropolitan and rural areas, in 2019 and 2020 in terms of the absolute number of investigations and investigations per 1000 people. Method We performed a retrospective analysis of Western Cape Government Department of Health and Wellness and Stats SA District Council 2021 Mid-Year Population Estimates data. All diagnostic imaging investigations performed in 2019 and 2020 were collated and stratified by imaging modality, geographic region (metropolitan/rural), and calendar year. Data are presented as the total number of investigations and investigations per 1000 people. We calculated mammography utilization for women aged 40-70 years and compared data for 2019 and 2020. Results Between 2019 and 2020, the provincial population increased by 1.9%, while total imaging investigations and investigations per 1000 people decreased by 19% (1,384,941 vs. 1,123,508, -261,433) and 20% (262/103 vs. 208/103), respectively. Total numerical decline was highest in plain radiographs (1,005,545 vs. 800,641, -204,904), accounting for more than three-quarters (78%) of the total reduction. Percentage decline was most pronounced for mammography, as utilization was almost halved (15.7/103 vs. 8.9/103, -43%), whereas computed tomography was the least impacted (17.9/103 vs. 16.7/103, -12%) with the remaining modalities decreasing between approximately one-quarter and one-fifth (magnetic resonance imaging = 26%, fluoroscopy = 25%, general radiographs = 23%, ultrasound = 16%, chest radiographs = 18%). Proportional metropolitan (-18.7%) and rural decreases (-19.3%) were similar. Conclusion COVID-19 had a substantial impact on WCP imaging services, decreasing overall radiological investigations by almost one-fifth. The greatest impact was on elective investigations, particularly mammography. Although the proportional impact was similar for the metropolitan and rural areas, COVID-19 nonetheless exacerbated existing discrepancies in imaging utilization between the geographical regions. The medium- and long-term clinical impacts of decreased imaging are still to be defined.

Oncological outcomes among young women with non-epithelial ovarian cancer: the YOC-Care study (Young Ovarian Cancer - Care).

OBJECTIVE: To determine oncological outcomes and associated prognostic factors in women younger than 45 years diagnosed with non-epithelial ovarian cancer. METHODS: A retrospective, multicenter Spanish study was performed including women with non-epithelial ovarian cancer younger than 45 years between January 2010 and December 2019. All types of treatments and stages at diagnosis with at least 12 months of follow-up were collected. Women with missing data, epithelial cancers, borderline or Krukenberg tumors, and benign histology, as well as patients with previous or concomitant cancer, were excluded. RESULTS: A total of 150 patients were included in this study. The mean±SD age was 31.45±7.45 years. Histology subtypes were divided into germ cell (n=104, 69.3%), sex-cord (n=41, 27.3%), and other stromal tumors (n=5, 3.3%). Median follow-up time was 58.6 (range: 31.10-81.91) months. Nineteen (12.6%) patients presented with recurrent disease with a median time to recurrence of 19 (range: 6-76) months. Progression-free survival and overall survival did not significantly differ among histology subtypes (p=0.09 and 0.26, respectively) and International Federation of Gynecology and Obstetrics (FIGO) stage (I-II vs III-IV) with p=0.08 and p=0.67, respectively. Univariate analysis identified sex-cord histology with the lowest progression-free survival. Multivariate analysis showed that body mass index (BMI) (HR=1.01; 95% CI 1.00 to 1.01) and sex-cord histology (HR=3.6; 95% CI 1.17 to 10.9) remained important independent prognostic factors for progression-free survival. Independent prognostic factors for overall survival were BMI (HR=1.01; 95% CI 1.00 to 1.01) and residual disease (HR=7.16; 95% CI 1.39 to 36.97). CONCLUSIONS: Our study showed that BMI, residual disease, and sex-cord histology were prognostic factors associated with worse oncological outcomes in women younger than 45 years diagnosed with non-epithelial ovarian cancers. Even though the identification of prognostic factors is relevant to identify high-risk patients and guide adjuvant treatment, larger studies with international collaboration are essential to clarify oncological risk factors in this rare disease.

Platelet preservation in cardiac surgery using minimally invasive extracorporeal circulation versus optimized cardiopulmonary bypass.

BACKGROUND: Minimally invasive extracorporeal circulation (MiECC) is employed as a strategy to attenuate the physiologic disturbance caused by cardiopulmonary bypass. The aim of this study was to compare the coagulation profile of MiECC to an optimized conventional extracorporeal circuit (OpECC) with regards to platelet function, rotational thromboelastometry and blood product usage. METHODS: A retrospective analysis of coronary artery bypass grafting operations using either MiECC or OpECC was performed at a single institution. RESULTS: A total of 112 patients were included, with 61 receiving MiECC and 51 OpECC patients. OpECC patients had a significantly larger BSA (1.95+/- 0.22m2 vs 1.88 +/- 0.18m2, p = 0.034), than those who received MiECC. No difference between groups was observed regarding red blood cell, plasma, and platelet transfusions. Functional platelet count during the warming phase of cardiopulmonary bypass was found to be higher in the MiECC group ((136 (102-171) x109/L vs 109 (94-136) x109/L), p = 0.027), as were functional platelets as a percent of total platelet count ((86 (77-91)% vs 76 (63-82)%), p = 0.003). There were no significant differences between other outcomes such as operative mortality, incidence of stroke, and intensive care unit length of stay. CONCLUSION: While we did not see a difference in blood transfusions, MiECC resulted in a statistically significant advantage over OpECC with regards to preservation of functional platelets.

A 6-year audit of public-sector MR utilisation in the Western Cape province of South Africa.

Background: Disparities in MR access between different countries and healthcare systems are well documented. Determinants of unequal access within the same healthcare system and geographical region are poorly understood. Objective: An analysis of public sector MR utilisation in South Africa's Western Cape province (WCP). Methods: A retrospective study of WCP MR and population data for 2013 and 2018. MR units/106 people, studies, and studies/103 people were calculated for each year, for the whole province and the 'western' and 'eastern' referral pathways, stratified by age (0-14 years, > 14 years). Results: Between 2013 and 2018, the WCP population increased 8% (4.63 vs 5.08 × 106 people) while MR resources were unchanged ('western' = 2 units; 'eastern' = 1), equating to decreasing access (units/106 people) for the province (0.65 vs 0.59; -9.2%), the 'western' (0.97 vs 0.9; -7.2%) and 'eastern' (0.39 vs 0.35; -10.3%) pathways. In 2013, 40% (4005/10 090) of studies were in the 'eastern' pathway serving 55% (2 066 079/4 629 051) of the population. Between 2013 and 2018 'eastern' population growth (n = 286 781) exceeded 'western' (n = 168 469) by 70% (n = 118 312). By 2018, 38% (7939/12 848) of studies were performed in the 'eastern' pathway, then serving 56% (2 849 753/5 084 301) of the population. Among 0-14-year-olds, 'western' utilisation (studies/103 people) exceeded 'eastern' by a factor of approximately 2.4 throughout. In patients > 14 years, the utilisation differential increased from 1.78 to 1.98 in the review period. Conclusion: Ensuring equitable services on the same healthcare platform requires ongoing surveillance of resource and population distribution. MR access can serve as a proxy for equity in highly specialised services.

Coherence of attention and memory biases in currently and previously depressed women.

Previous research has found that depression is characterised by biased processing of emotional information. Although most studies have examined cognitive biases in isolation, simultaneous examination of multiple biases is required to understand how they may interact and influence one another to produce depression vulnerability. In this study, the attention and memory biases of currently depressed, previously depressed, and never depressed women were examined using the same stimuli and a unified methodology. Participants viewed negative, positive, and neutral words while their eye gaze was tracked and recorded. After a distraction task, participants completed an incidental recognition test that included words from the eye-tracking task and new words. The results supported the hypothesised mediation model for positive words: currently depressed women had a reduced attention bias for positive words and, in turn, had poorer memory for positive words relative to never depressed women. Previously depressed women, however, showed a lack of coherence between attention and memory biases for positive words. The groups did not differ in their attention or memory biases for negative words. The findings provide novel evidence in support of a causal link between the absence of protective attention and memory biases for positive information in clinical depression.

Factores que intervienen en la aparición de infecciones en heridas quirúrgicas de pacientes intervenidos en el hospital general milagro en el periodo de agosto 2020 a enero 2021 / Factors intervening in the appearance of infections in surgical wounds of patients operated at the milagro general hospital in the period from august 2020 to january 2021

El Ecuador mantiene una alta tasa de mortalidad derivada de las infecciones de heridas quirúrgicas, las post cesárea son las que se presentan comúnmente, donde las bacterias cada vez evolucionan mecanismos de resistencia a los antibióticos. Objetivo: analizar los factores que intervienen en la aparición de infección en herida quirúrgica. Materiales y Métodos: investigación tipo inductivo-deductiva al analizar variables cuantitativas; y la aplicación del razonamiento, con el que se obtuvieron generalizaciones del tema en estudio Resultados: Sexo el 35 % Mujeres y el 65% Varones, el 25 % tienen edad de 15 a 40 años, el 45 % tienen de 41 a 60 años, y el 30 % tienen de 61 años y más. Con respecto al nivel de educación, 50 % no tiene educación, 25% primaria, 15% secundaria y 10% superior, según la residencia el 75% vive en zona rural y 25 % en zona urbana. La mayoría de los procedimientos quirúrgicos involucrados en la complicación de infecciones de la herida fueron de emergencia en un 93,3%; mientras que las que se presentaron en electivas respondieron al 6,7%. Se observó que el 80% de las cirugías realizadas son clasificadas como cirugías limpias contaminadas, y un 20% cirugías contaminadas. Las mismas que tiene un alto riesgo de infectarse el SQ. Conclusiones: A pesar de que las acciones preventivas de preparación de piel y asepsia ­ antisepsia previa al acto quirúrgico se cumplen, las infecciones de la herida quirúrgica se siguen dando en una parte de pacientes intervenidos en el Hospital General Milagro(AU)

Ecuador maintains a high mortality rate derived from surgical wound infections, post-cesarean sections are the ones that commonly occur, where bacteria increasingly evolve mechanisms of resistance to antibiotics. Objective: to analyze the factors that intervene in the appearance of infection in surgical wounds. Materials and Methods: inductive-deductive type research when analyzing quantitative variables; and the application of reasoning, with which generalizations of the subject under study were obtained Results: Sex 35% Women and 65% Men, 25% are between 15 and 40 years old, 45% are between 41 and 60 years old, and 30% are 61 and older. Regarding the level of education, 50% have no education, 25% primary, 15% secondary and 10% higher, according to residence, 75% live in rural areas and 25% in urban areas. Most of the surgical procedures involved in the complication of wound infections were emergency in 93.3%; while those who attended electives responded to 6.7%. It was observed that 80% of the surgeries performed are classified as clean contaminated surgeries, and 20% contaminated surgeries. The same ones that have a high risk of becoming infected with SQ. Conclusions: Although the preventive actions of skin preparation and asepsis - antisepsis prior to the surgical act are fulfilled, infections of the surgical wound continue to occur in a part of patients operated on at the Hospital General Milagro(AU)

Diagnóstico de enfermería del estado emocional en pacientes con insuficiencia renal crónica durante su tratamiento / Nursing diagnosis of the emotional state in patients with chronic renal insufficiency during their treatment

La insuficiencia renal crónica (IRC) provoca cambios bruscos en la vida del individuo, como el desarrollo de trastornos emocionales que pueden conllevar a cuadros de ansiedad, depresión y estrés; afectando su estado emocional. Objetivo: Validar los instrumentos para analizar la influencia de la hemodiálisis en el estado emocional. Materiales y métodos: La investigación fue de diseño transversal con análisis descriptivo no experimental, modalidad cuali-cuantitativo. Los instrumentos utilizados fueron diseñados y validados por juicio de expertos y analizados estadísticamente con alfa de Cronbach, se empleó una prueba piloto compuesta por 15 personas con insuficiencia renal crónica para la validación de los instrumentos. Resultados: El instrumento cuantitativo presentó un coeficiente de fiabilidad de 0.75 en alfa de Cronbach y el instrumento cualitativo de acuerdo a la rúbrica de los expertos obtuvo un promedio de confiabilidad de 96; por lo que los instrumentos son aprobados y pueden aplicarse con resultados confiables. Conclusión: Los instrumentos tienen una validez, pertinencia y coherencia, adecuados para trabajar en la recolección de datos para determinar el estado emocional de los pacientes sometidos a hemodiálisis. El estudio estableció las asociaciones entre las variables de acuerdo a las etapas de la enfermedad será la predisposición a trastornos del estado de ánimo. Los resultados obtenidos validan la utilidad científica y la efectividad de los instrumentos diseñado(AU)

Chronic renal failure (CRF) causes sudden changes in the individual's life, such as the development of emotional disorders that can lead to anxiety, depression and stress; affecting your emotional state. Objective: To validate the instruments to analyze the influence of hemodialysis on the emotional state. Materials and methods: The research was of a cross-sectional design with non-experimental descriptive analysis, qualitative-quantitative modality. The instruments used were designed and validated by expert judgment and statistically analyzed with Cronbach's alpha. A pilot test consisting of 15 people with chronic renal failure was used to validate the instruments. Results: The quantitative instrument presented a reliability coefficient of 0.75 in Cronbach's alpha and the qualitative instrument, according to the experts' rubric, obtained a reliability average of 96; so the instruments are approved and can be applied with reliable results. Conclusion: The instruments have validity, relevance and coherence, adequate to work on data collection to determine the emotional state of patients undergoing hemodialysis. The study established the associations between the variables according to the stages of the disease will be the predisposition to mood disorders. The results obtained validate the scientific usefulness and effectiveness of the instruments designed(AU)

Validación de instrumentos para evaluar la calidad de vida del adulto mayor con insuficiencia renal crónica / Validation of instruments to assess the quality of life of the elderly with chronic renal insufficiency

La insuficiencia renal crónica afecta a toda una población adulta e influye en su calidad de vida. En el Ecuador se reporta que más del 65% de pacientes con hipertensión y diabetes progresan con insuficiencia renal. Objetivo: Validar los instrumentos para evaluar la influencia de la hemodiálisis en la calidad de vida del adulto mayor con insuficiencia renal crónica, Unidad Dialysis Center. Materiales y métodos: La investigación tuvo un enfoque cuali-cuantitativo, diseño no experimental, descriptivo de corte transversal. Se realizó una prueba piloto con los instrumentos a validarse en una muestra conformada por 15 adultos mayores que se encuentran en tratamiento sustitutivo de hemodiálisis. Resultados: El instrumento cuantitativo o encuesta obtuvo un coeficiente de confiabilidad (Alfa de Cronbach) de 0.80 y la entrevista o instrumento cualitativo, una puntuación de 95 según la rúbrica de los expertos, por lo que los instrumentos fueron aprobados y es confiable su aplicación para responder a los objetivos planteados en la investigación. Conclusiones: Con los resultados obtenidos por el plan piloto realizado, se identifica una influencia considerable de la insuficiencia renal crónica en la calidad de vida, comprende repercusiones a nivel emocional desarrollando depresión. Los datos obtenidos validan la efectividad de los instrumentos para el estudio(AU)

Chronic renal failure affects an entire adult population and influences their quality of life. In Ecuador it is reported that more than 65% of patients with hypertension and diabetes progress to kidney failure. Objective: To validate the instruments to evaluate the influence of hemodialysis on the quality of life of the elderly with chronic renal failure, Dialysis Center Unit. Materials and methods: The research had a qualitative-quantitative approach, non-experimental, descriptive cross-sectional design. A pilot test was carried out with the instruments to be validated in a sample made up of 15 older adults who are on hemodialysis replacement therapy. Results: The quantitative instrument or survey obtained a reliability coefficient (Cronbach's Alpha) of 0.80 and the interview or qualitative instrument, a score of 95 according to the experts' rubric, so the instruments were approved and their application is reliable for respond to the objectives set out in the research. Conclusions: With the results obtained by the pilot plan carried out, a considerable influence of chronic renal failure on quality of life is identified, including repercussions at an emotional level, developing depression. The data obtained validate the effectiveness of the instruments for the study(AU)

Evaluation of different internal standardization approaches for the quantification of melatonin in cell culture samples by multiple heart-cutting two dimensional liquid chromatography tandem mass spectrometry.

We evaluate here different analytical strategies for the chromatographic separation and determination of N-acetyl-5-methoxytryptamine (MEL) and its oxidative metabolites N1-acetyl-N2-formyl-5-methoxykynuramine (AFMK), N1-acetyl-5-methoxykynuramine (AMK) and cyclic 3-hydroxymelatonin (c3OHM) in cell culture samples. Two dimensional liquid chromatography (2D-LC) in the multiple heart-cutting mode was compared with regular 1D chromatographic separations of MEL and its oxidative metabolites. Our results showed that the use of trifluoroacetic acid (TFA) as mobile phase modifier was required to obtain a satisfactory resolution and peak shapes particularly for c3OHM. As TFA is not compatible with ESI ionization the application of the MHC mode was mandatory for a proper chromatographic separation. We evaluate also different internal standardization approaches based on the combined use of a surrogate standard (5-methoxytryptophol) and an internal standard (6-methoxytryptamine) for MEL quantification in cell culture samples obtaining unsatisfactory results both by 1D- and 2D-LC-ESI-MS/MS (from 9 ± 2 to 186 ± 38%). We demonstrate that only the application of isotope dilution Mass Spectrometry through the use of an in house synthesized 13C isotopically labelled analogue provided quantitative MEL recoveries both by using 1D- and 2D-LC-ESI-MS/MS (99±1 and 98±1. Respectively) in androgen-insensitive human prostate carcinoma PC3 cells.

Trends in public sector radiological usage in the Western Cape Province, South Africa: 2009-2019.

BACKGROUND: Although global use of medical imaging has increased significantly, little is known about utilisation trends in low- and middle-income countries (LMICs). OBJECTIVES: To evaluate changes over a decade in public sector diagnostic imaging utilisation at provincial level in a middle-income country. METHOD: A retrospective analysis of medical imaging utilisation in the Western Cape Province of South Africa in 2009 and 2019. Use of conventional radiography, ultrasonography (US), fluoroscopy, CT, MRI, digital subtraction angiography (DSA) and whole-body digital radiography was assessed by total studies and studies/103 people, for the whole province, the rural and metropolitan areas. Mammography utilisation was calculated for every 103 females aged 40-70 years. RESULTS: The provincial population and total imaging investigations increased by 25% and 32%, respectively, whilst studies/103 people increased by 5.5% (256 vs 270/103), with marked variation by modality. Provincial US, CT and MRI utilisation/103 people increased by 111% (20 vs 43/103), 78% (10 vs 18/103) and 32% (1.9 vs 2.5/103) respectively, whilst use of fluoroscopy (3.6 vs 3.7/103) and mammography (14.2 vs 15.9/103 women aged 40-70 years) was steady and plain radiography decreased by 20% (216 vs 196/103). For CT, mammography and fluoroscopy, percentage utilisation increases/103 people were higher in the rural than metropolitan areas. CONCLUSION: Population growth is the main driver of overall imaging utilisation in our setting. The relatively constant imaging workload per 1000 people, albeit with increasing ultrasound, CT and MR utilisation, and decreasing use of plain radiography, reflects improved provincial imaging infrastructure, and appropriate use of available resources.

Multiple heart-cutting two dimensional liquid chromatography and isotope dilution tandem mass spectrometry for the absolute quantification of proteins in human serum.

We evaluate here the combination of two-dimensional liquid chromatography (2D-LC) in the multiple heart cutting mode and isotope dilution tandem mass spectrometry for the direct analysis of tryptic digests of serum samples. As a proof of concept, we attempt the quantification of proteotypic peptides of Apolipoprotein AIV (APOA4), Complement C3 (C3) and Vitronectin (VTN) which have been previously identified as potential candidate biomarkers of glaucoma. Using this 2D-LC strategy, analyte enrichment steps are avoided and the sample preparation involved after enzymatic digestion amounted to a simple centrifugation, evaporation of the supernatant and reconstitution in the 1D mobile phase. A mobile phase not compatible with the ESI source (10 mM KH2PO4 at pH 2.7) was used in the first dimension as it provided a satisfactory chromatographic resolution of the peptides and a high buffering capacity avoiding changes in retention times when analyzing complex matrices like human serum. We also demonstrate that using coeluting labelled analogues of the target peptides, protein concentrations were not affected by slight retention time shifts affecting the amount of target peptides transferred to the second dimension. Satisfactory results were obtained when analyzing fortified serum samples (recoveries from 98 to 113%). Precisions in the range of 1-9% RSD were obtained when replicating the analysis of a pooled serum sample. The comparative analysis of serum samples from n = 94 control subjects and n = 91 patients diagnosed with primary open-angle glaucoma did not show significant differences in the APOA4, VTN and C3 concentrations in contrast with previous studies using immunoassays.

Effect assessment of reclaimed waters and carbamazepine exposure on the thyroid axis of Xenopus laevis: Gene expression modifications.

Reclaimed water (RW) obtained from wastewater treatment plants (WWTP) is used for irrigation, groundwater recharge, among other potential uses. Although most pollutants are removed, traces of them are frequently found, which can affect organisms and alter the environment. The presence of a myriad of contaminants in RW makes it a complex mixture with very diverse effects and interactions. A previous study, in which tadpoles were exposed to RW and RW spiked with Carbamazepine (CBZ), presented slight thyroid gland stimulation, as suggested by the development acceleration of tadpoles and histological findings in the gland provoked by RW, regardless of the CBZ concentration. To complement this study, the present work analysed the putative molecular working mechanism by selecting six genes coding for the thyroid-stimulating hormone (TSHß), thyroid hormone metabolising enzymes (DIO2, DIO3), thyroid receptors (THRA, THRB), and a thyroid hormone-induced DNA binding protein (Kfl9). Transcriptional activity was studied by Real-Time PCR (RT-PCR) in brains, hind limbs, and tails on exposure days 1, 7, and 21. No significant differences were observed between treatments for each time point, but slight alterations were noted when the time response was analysed. The obtained results indicate that the effects of RW or RW spiked with CBZ are negligible for the genes analysed during the selected exposure periods.

Towards equity: a retrospective analysis of public sector radiological resources and utilization patterns in the metropolitan and rural areas of the Western Cape Province of South Africa in 2017.

BACKGROUND: The reduction of inequality is a key United Nations 2030 Sustainable Development Goal (WHO, Human Resources for Health: foundation for Universal Health Coverage and the post-2015 development agenda, 2014; Transforming our world: the 2030 Agenda for Sustainable Development .:. Sustainable Development Knowledge Platform, 2020). Despite marked disparities in radiological services globally, particularly between metropolitan and rural populations in low- and middle-income countries, there has been little work on imaging resources and utilization patterns in any setting (Transforming our world: the 2030 Agenda for Sustainable Development .:. Sustainable Development Knowledge Platform, 2020; WHO, Local Production and Technology Transfer to Increase Access to Medical Devices, 2019; European Society of Radiology (ESR), Insights Imaging 6:573-7, 2015; Maboreke et al., An audit of licensed Zimbabwean radiology equipment resources as a measure of healthcare access and equity, 2020; Kabongo et al., Pan Afr Med J 22, 2015; Skedgel et al., Med Decis Making 35:94-105, 2015; Mollura et al., J Am Coll Radiol 913-9, 2014; Culp et al., J Am Coll Radiol 12:475-80, 2015; Mbewe et al., An audit of licenced Zambian diagnostic imaging equipment and personnel, 2020). To achieve equity, a better understanding of the integral components of the so called "imaging enterprise" is important. The aim was to analyse a provincial radiological service in a middle-income country. METHODS: An institutional review board-approved retrospective audit of radiological data for the public healthcare sector of the Western Cape Province of South Africa for 2017, utilizing provincial databases. We conducted population-based analyses of imaging equipment, personnel, and service utilization data for the whole province, the metropolitan and the rural areas. RESULTS: Metropolitan population density exceeds rural by a factor of ninety (1682 vs 19 people/km2). Rural imaging facilities by population are double the metropolitan (20 vs 11/106 people). Metropolitan imaging personnel by population (112 vs 53/106 people) and equipment unit (1.7 vs 0.7/unit) are more than double the rural. Overall population-based utilization of imaging services was 30% higher in the metropole (289 vs 214 studies/103 people), with mammography (24 vs 5 studies/103 woman > 40 years) and CT (21 vs 6/103 people) recording the highest, and plain radiography (203 vs 171/103 people) the lowest differences. CONCLUSION: Despite attempts to achieve imaging equity through the provision of increased facilities/million people in the rural areas, differential utilization patterns persist. The achievement of equity must be seen as a process involving incremental improvements and iterative analyses that define progress towards the goal.

Spatial Memory and Microglia Activation in a Mouse Model of Chronic Neuroinflammation and the Anti-inflammatory Effects of Apigenin.

Chronic neuroinflammation characterized by microglia reactivity is one of the main underlying processes in the initiation and progression of neurodegenerative diseases such as Alzheimer's disease. This project characterized spatial memory during healthy aging and prolonged neuroinflammation in the chronic neuroinflammatory model, glial fibrillary acidic protein-interleukin 6 (GFAP-IL6). We investigated whether chronic treatment with the natural flavonoid, apigenin, could reduce microglia activation in the hippocampus and improve spatial memory. GFAP-IL6 transgenic and wild-type-like mice were fed with apigenin-enriched or control chow from 4 months of age and tested for spatial memory function at 6 and 22 months using the Barnes maze. Brain tissue was collected at 22 months to assess microgliosis and morphology using immunohistochemistry, stereology, and 3D single cell reconstruction. GFAP-IL6 mice showed age-dependent loss of spatial memory recall compared with wild-type-like mice. Chronic apigenin treatment decreased the number of Iba-1+ microglia in the hippocampus of GFAP-IL6 mice and changed microglial morphology. Apigenin did not reverse spatial memory recall impairment in GFAP-IL6 mice at 22 months of age. GFAP-IL6 mice may represent a suitable model for age-related neurodegenerative disease. Chronic apigenin supplementation significantly reduced microglia activation, but this did not correspond with spatial memory improvement in the Barnes Maze.

The diffusion of doxorubicin drug molecules in silica nanoslits is non-Gaussian, intermittent and anticorrelated.

In this study we investigate, using all-atom molecular-dynamics computer simulations, the in-plane diffusion of a doxorubicin drug molecule in a thin film of water confined between two silica surfaces. We find that the molecule diffuses along the channel in the manner of a Gaussian diffusion process, but with parameters that vary according to its varying transversal position. Our analysis identifies that four Gaussians, each describing particle motion in a given transversal region, are needed to adequately describe the data. Each of these processes by itself evolves with time at a rate slower than that associated with classical Brownian motion due to a predominance of anticorrelated displacements. Long adsorption events lead to ageing, a property observed when the diffusion is intermittently hindered for periods of time with an average duration which is theoretically infinite. This study presents a simple system in which many interesting features of anomalous diffusion can be explored. It exposes the complexity of diffusion in nanoconfinement and highlights the need to develop new understanding.

Perinatal diagnosis and management of early-onset Marfan syndrome: case report and systematic review.

Early onset Marfan syndrome is the most severe form of Marfan syndrome diagnosed during perinatal period. Early onset Marfan syndrome is associated with high mortality rates, usually within the first 2 years of life. First, we present a case of prenatally diagnosed early onset Marfan syndrome in a dichorionic diamniotic twin pregnancy, where suspicion was raised at 35 weeks of gestation. Ultrasound and fetal magnetic resonance imaging were used to assess prenatal findings in the affected fetus. She presented right diaphragmatic eventration, elongation of humerus and femur and subluxation of the crystalline lens. She died 3 months after birth. Secondly, we present a PubMed-based review of the published articles on early onset Marfan syndrome, with pre- or postnatal suspicion or diagnosis. We found 39 articles published between 1981 and 2017, arising information on 55 cases. Including ours, early onset Marfan syndrome was prenatally diagnosed in 34.54% of the cases. In these cases, the most frequent prenatal findings were cardiomegaly, dilatation of the great vessels and mitral or tricuspid regurgitation. Mortality rate during the first 15 months after birth was 73.68%. In the postnatally diagnosed cases, the most frequent findings were arachnodactyly, dilatation of the great vessels and mitral or tricuspid regurgitation. Mortality rate was 61.11%. Overall genetic confirmation was performed in 67.27% of the cases. Prenatal diagnosis of early onset Marfan syndrome is challenging but of utmost importance, since management should take place in a tertiary care center, by a multidisciplinary team. Differential diagnosis is essential in order to perform an adequate genetic counseling.

Enhancing Parental Coping with a Child's Heart Condition: A Co-production Pilot Study.

Families of children with congenital heart disease (CHD) can have difficulties coping with the stress of their child's condition and would benefit from assistance to cope better. To address the needs of these parents, the Australian Center for Heart Health/HeartKids Australia/Melbourne Graduate School of Education co-produced Family Coping Project was initiated. This project involved two systematic literature reviews, interviews with parents of children with CHD, and the development and piloting of a manualised parental coping program. The primary aims of the pilot study were to determine whether the program would: attract high needs families; enhance the coping self-efficacy of parents; and be acceptable to parents in terms of content and mode of delivery. The secondary aims were to investigate whether the program would impact on parental coping, parental stress and general stress. Parents completed pre-, post-program and 6-month follow up assessment measures, with parent stress scores being compared to stress scores reported for other chronic condition parent carer groups. Twenty-one parents participated and provided baseline data. They were found to be significantly more stressed than other parent carer groups. Eleven parents completed post-program data and 13 completed 6-month follow-up data. There was a significant increase in parents' coping self-efficacy from pre- to post-program, and from pre- to 6-months. Parents' use of productive coping styles increased significantly from pre- to post-program. The program was rated as highly acceptable in terms of content and delivery mode. The pilot provides strong evidence for upscaling the program in conjunction with individualized psychological support for parents to extend knowledge acquisition and attitude change into enhanced coping skills and demonstrated the benefits of a co-production process.

Determination of Cystatin C in human urine by isotope dilution tandem mass spectrometry.

This work presents the development of a methodology for the accurate and precise quantification of the renal biomarker Cystatin C in human urine by Isotope Dilution Mass Spectrometry (IDMS). The procedure is based on the addition of a known quantity of the proteotypic peptide ALDFAVG*EYNK labelled with 13C2-glycine to the urine sample followed by protein hydrolysis using trypsin. Then, preconcentration and purification of the isotope diluted peptide was carried out by a selective monoclonal antibody bound to magnetic beads and final measurement was done after injection of the sample in a HPLC-MS/MS triple quadrupole instrument. The isotopic distribution of the isotope diluted proteotypic peptide was measured by low resolution selected reaction monitoring. Using this aquisition mode, the bandpass of the first quadrupole was widened (FWHM =13 u) so the whole isotopic clusters for both the natural abundance and the labelled peptides entered the collision cell. The proposed acquisition mode provided similar accuracy and precision than the regular SRM mode (FWHM =0.7 u) but a higher sensitivity was observed. The purification of the sample by antibody based enrichment of the target peptide was shown to remove interfering compounds more efficiently in comparison with a sample purification based on semipreparative liquid chromatography. Using 5 ng of the labelled peptide it was possible to quantify Cystatin C in human urine in patients with normal and impaired renal function. Recoveries from 100 to 104% were obtained in samples containing from 90 to 700 µg L-1 of Cystatin C with relative standard deviations from 0.5 to 6%. The stability of Cystatin C in urine samples was evaluated under different storage conditions showing that only when the urine samples were stored at room temperature during more than 10 days, a significant degradation of Cystatin C was observed.

Salpingooforectomía bilateral profiláctica en pacientes con BRCA1 o BRCA2 / Prophylactic bilateral salpingo-oophorectomy in patients with BRCA1 or BRCA2

Resumen OBJETIVO: Determinar la prevalencia, factores clínicos o epidemiológicos de cáncer oculto en pacientes BRCA1 o BRCA2 operadas para salpingooforectomía bilateral profiláctica. Evaluar las complicaciones quirúrgicas en las cirugías laparoscópicas. MATERIALES Y MÉTODOS: Estudio observacional, retrospectivo, llevado a cabo en el Hospital Gregorio Marañón entre 2012 y 2018. Se revisaron las salpingooforectomías bilaterales profilácticas practicadas a pacientes con mutaciones confirmadas BRCA1 o 2, no diagnosticadas previamente de cáncer de ovario o trompa. Las principales variables analizadas fueron: antecedentes familiares, edad, índice de masa corporal, hábito tabáquico, mutación genética, cirugías abdominales previas, cáncer de mama, fecha de la cirugía, tiempo quirúrgico, tipo de cirugía, técnica de entrada a la cavidad abdominal y complicaciones quirúrgicas. El análisis estadístico se efectuó con SPSS 17.0. RESULTADOS: Se estudiaron 59 pacientes. La prevalencia de cáncer oculto fue 5 de 59. La edad media de las pacientes con diagnóstico de cáncer oculto en el momento de la cirugía fue 47.8 años. Se encontró antecedente de cáncer de mama en 43 de las 59 pacientes; en este subgrupo se encontró cáncer oculto en 2 pacientes. En el subgrupo sin antecedente de cáncer de mama, la frecuencia fue 3 de 16. No se encontraron diferencias estadísticamente significativas entre ambos grupos (p = 0.118). Todas las pacientes a quienes se diagnosticó cáncer oculto, salvo una, eran fumadoras. La tasa de complicaciones intraoperatorias fue 2 de 51 y 1 de 51 las postoperatorias CONCLUSIONES: Las pacientes con BRCA1 o BRCA2 son un grupo de alto riesgo oncológico que requiere seguimiento y asesoramiento específicos en unidades especializadas de hospitales de tercer nivel de atención.

Abstract OBJECTIVE: To determine the prevalence of occult cancer in BRCA1 and/or BRCA2 patients undergoing prophylactic bilateral salpingo-oophorectomy. To determine associated clinical or epidemiological factors. To evaluate surgical complications in surgeries performed via laparoscopy. MATERIAL AND METHODS: Retrospective observational study conducted at the Gregorio Marañón hospital between 2012 and 2018. Review of prophylactic bilateral salpingo-oophorectomies performed in patients with confirmed BRCA1 and/or 2 mutations and not previously diagnosed with ovarian and/or fallopian cancer. Main variables: family history, age, body mass index, smoking habit, genetic mutation, previous abdominal surgeries, breast cancer, surgery date, surgical time, type of surgery, technique of the entrance to the abdominal cavity, surgical complications. The statistical analysis was performed using SPSS 17.0. RESULTS: 59 patients were included. The prevalence of occult cancer was 5/59. The average age (at the time of surgery) of patients diagnosed with occult cancer was 47.8 years. 43/59 had a history of breast cancer; in this group occult cancer was found in two patients. In the group with no history of breast cancer, frequency of occult cancer was 3/16. No statistically significant differences were found between both groups (p = 0.118). All patients diagnosed with occult cancer, except one, were smokers. The rate of intraoperative complications was 2/51 and 1/51 postoperative. CONCLUSIONS: Patients with BRCA1 and/or BRCA2 mutations are a group of high cancer risk that require specific monitoring and advice in specialized units of third level hospitals.

Isotope dilution LC-ESI-MS/MS and low resolution selected reaction monitoring as a tool for the accurate quantification of urinary testosterone.

A new analytical method for the quantification of testosterone in human urine samples by isotope dilution mass spectrometry is proposed. A standard solution of 13C2-testosterone is added to the samples at the beginning of the sample preparation procedure and then the measurements are carried out by UHPLC-ESI-MS/MS. In the proposed method, the resolution of the first quadrupole of the tandem MS instrument is reduced to transmit the whole precursor ion cluster to the collision cell and measure the isotopic distribution of the in-cell product ions with a small number of SRM transitions. The construction of a methodological calibration graph is avoided using a labelled analogue previously characterised in terms of concentration and isotopic enrichment in combination with multiple linear regression. In this way, the molar fractions of natural and labelled testosterone are calculated in each sample injection and the amount of endogenous testosterone computed from the known amount of labelled analogue. Recovery values between 97 and 107% and precisions between 0.4 and 3.7% (as %RSD) were obtained for testosterone concentrations in urine in the range of 1 to 8 ng g-1. The proposed low resolution SRM methodology was compared for the analysis of human urine samples with the traditional IDMS method based on a calibration graph and the IDMS method based on multiple linear regression combined with standard resolution SRM. A similar accuracy and precision was obtained by the three tested approaches. However, using the low resolution SRM method there was no need to resort to calibration graphs or to specific dedicated software to calculate isotopic distributions by tandem MS and a higher sensitivity was obtained. The proposed low resolution SRM method was successfully applied to the analysis of the certified freeze-dried human urine NMIA MX005.