Importance of different topographic, biometric, and retinal parameters for calculating IOL power.

The objective is to evaluate the parameters significantly related to calculating the power of the implanted lens and to determine the importance of different biometric, retina, and corneal aberrations variables. A retrospective cross-sectional observational study used a database of 422 patients who underwent cataract surgery at the Oftalvist Center in Almeria between January 2021 and December 2022. A random forest based on machine learning techniques was proposed to classify the importance of preoperative variables for calculating IOL power. Correlations were explored between implanted IOL power and the most important variables in random forests. The importance of each variable was analyzed using the random forest technique, which established a ranking of feature selections based on different criteria. A positive correlation was found with the random forest variables. Selection: axial length (AL), keratometry preoperative, anterior chamber depth (ACD), measured from corneal epithelium to lens, corneal diameter, lens constant, and astigmatism aberration. The variables coma aberration (p-value = 0,12) and macular thickness (p-value = 0,10) were almost slightly significant. In cataract surgery, the implanted IOL power is mainly correlated with axial length, anterior chamber depth, corneal diameter, lens constant, and preoperative keratometry. New variables such as astigmatism and anterior coma aberration and retina variables such as the preoperative central macular thickness could be included in the new generation of biometric formulas based on artificial intelligence techniques.

Assessment of real-time PCR test in oral fluid samples for screening the serotypes of Actinobacillus pleuropneumoniae circulating in swine herds.

Actinobacillus pleuropneumoniae is the etiological agent of porcine pleuropneumonia, causing remarkable economic losses in the global swine industry. The diversity of A. pleuropneumoniae is generally determined through serotype identification, which is commonly employed for control strategies and surveillance. However, serological methods currently in use still have significant limitations. This study explores the use of real-time polymerase chain reaction (qPCR) to detect circulating serotypes of A. pleuropneumoniae in non-diseased swine herds through testing of oral fluids. The study included three A. pleuropneumoniae-positive and three A. pleuropneumoniae-negative farms located in Quebec, Canada. Tonsil brushings, microbiological growths, and oral fluids were analyzed using qPCR to detect A. pleuropneumoniae and its distinct serotypes. Serological tests were performed using the LPS ELISA available at that time. In negative farms the absence of A. pleuropneumoniae and any serotype confirmed the specificity of the method. Positive farms, on the other hand, confirmed also the sensitivity of the analysis, with oral fluid samples consistently yielding positive results for the serotypes identified by ELISA. The qPCR test conducted on oral fluids offers a noninvasive and cost-effective method for monitoring, complementing traditional serological techniques. It provides qualitative information about serotype distribution, facilitating proactive surveillance and control strategies.

Sepsis mortality prediction with Machine Learning Tecniques.

OBJECTIVE: To develop a sepsis death classification model based on machine learning techniques for patients admitted to the Intensive Care Unit (ICU). DESIGN: Cross-sectional descriptive study. SETTING: The Intensive Care Units (ICUs) of three Hospitals from Murcia (Spain) and patients from the MIMIC III open-access database. PATIENTS: 180 patients diagnosed with sepsis in the ICUs of three hospitals and a total of 4559 patients from the MIMIC III database. MAIN VARIABLES OF INTEREST: Age, weight, heart rate, respiratory rate, temperature, lactate levels, partial oxygen saturation, systolic and diastolic blood pressure, pH, urine, and potassium levels. RESULTS: A random forest classification model was calculated using the local and MIMIC III databases. The sensitivity of the model of our database, considering all the variables classified as important by the random forest, was 95.45%, the specificity was 100%, the accuracy was 96.77%, and an AUC of 95%. . In the case of the model based on the MIMIC III database, the sensitivity was 97.55%, the specificity was 100%, and the precision was 98.28%, with an AUC of 97.3%. CONCLUSIONS: According to random forest classification in both databases, lactate levels, urine output and variables related to acid.base equilibrium were the most important variable in mortality due to sepsis in the ICU. The potassium levels were more critical in the MIMIC III database than the local database.

Clinical impact of remote heart failure management using the multiparameter ICD HeartLogic alert.

INTRODUCTION AND OBJECTIVES: The multiparametric implantable cardioverter-defibrillator HeartLogic index has proven to be a sensitive and timely predictor of impending heart failure (HF) decompensation. We evaluated the impact of a standardized follow-up protocol implemented by nursing staff and based on remote management of alerts. METHODS: The algorithm was activated in HF patients at 19 Spanish centers. Transmitted data were analyzed remotely, and patients were contacted by telephone if alerts were issued. Clinical actions were implemented remotely or through outpatient visits. The primary endpoint consisted of HF hospitalizations or death. Secondary endpoints were HF outpatient visits. We compared the 12-month periods before and after the adoption of the protocol. RESULTS: We analyzed 392 patients (aged 69±10 years, 76% male, 50% ischemic cardiomyopathy) with implantable cardioverter-defibrillators (20%) or cardiac resynchronization therapy defibrillators (80%). The primary endpoint occurred 151 times in 86 (22%) patients during the 12 months before the adoption of the protocol, and 69 times in 45 (11%) patients (P<.001) during the 12 months after its adoption. The mean number of hospitalizations per patient was 0.39±0.89 pre- and 0.18±0.57 postadoption (P<.001). There were 185 outpatient visits for HF in 96 (24%) patients before adoption and 64 in 48 (12%) patients after adoption (P<.001). The mean number of visits per patient was 0.47±1.11 pre- and 0.16±0.51 postadoption (P<.001). CONCLUSIONS: A standardized follow-up protocol based on remote management of HeartLogic alerts enabled effective remote management of HF patients. After its adoption, we observed a significant reduction in HF hospitalizations and outpatient visits.

Filial cannibalism of Nabis pseudoferus is not evolutionarily optimal foraging strategy.

Using a recursion model with real parameters of Nabis pseudoferus, we show that its filial cannibalism is an optimal foraging strategy for life reproductive success, but it is not an evolutionarily optimal foraging strategy, since it cannot maximize the descendant's number at the end of the reproductive season. Cannibalism is evolutionarily rational, when the number of newborn offspring produced from the cannibalized offspring can compensate the following two effects: (a) The cannibalistic lineage wastes time, since the individuals hatched from eggs produced by cannibalism start to reproduce later. (b) Cannibalism eliminates not only one offspring, but also all potential descendants from the cannibalized offspring during the rest of reproductive season. In our laboratory trials, from conspecific prey Nabis pseudoferus did not produce newborn nymphs enough to compensate the above two effects.

Role of vericiguat in management of patients with heart failure with reduced ejection fraction after worsening episode.

Worsening heart failure (HF) is a vulnerable period in which the patient has a markedly high risk of death or HF hospitalization (up to 10% and 30%, respectively, within the first weeks after episode). The prognosis of HF patients can be improved through a comprehensive approach that considers the different neurohormonal systems, with the early introduction and optimization of the quadruple therapy with sacubitril-valsartan, beta-blockers, mineralocorticoid receptor antagonists, and inhibitors. Despite that, there is a residual risk that is not targeted with these therapies. Currently, it is recognized that the cyclic guanosine monophosphate deficiency has a negative direct impact on the pathogenesis of HF, and vericiguat, an oral stimulator of soluble guanylate cyclase, can restore this pathway. The effect of vericiguat has been explored in the VICTORIA study, the largest chronic HF clinical trial that has mainly focused on patients with recent worsening HF, evidencing a significant 10% risk reduction of the primary composite endpoint of cardiovascular death or HF hospitalization (number needed to treat 24), after adding vericiguat to standard therapy. This benefit was independent of background HF therapy. Therefore, optimization of treatment should be performed as earlier as possible, particularly within vulnerable periods, considering also the use of vericiguat.

Cardiorenal syndrome and diabetes: an evil pairing.

Cardiorenal syndrome (CRS) is a pathology where the heart and kidney are involved, and the deterioration of one of them leads to the malfunction of the other. Diabetes mellitus (DM) carries a higher risk of HF and a worse prognosis. Furthermore, almost half of people with DM will have chronic kidney disease (CKD), which means that DM is the main cause of kidney failure. The triad of cardiorenal syndrome and diabetes is known to be associated with increased risk of hospitalization and mortality. Cardiorenal units, with a multidisciplinary team (cardiologist, nephrologist, nursing), multiple tools for diagnosis, as well as new treatments that help to better control cardio-renal-metabolic patients, offer holistic management of patients with CRS. In recent years, the appearance of drugs such as sodium-glucose cotransporter type 2 inhibitors, have shown cardiovascular benefits, initially in patients with type 2 DM and later in CKD and heart failure with and without DM2, offering a new therapeutic opportunity, especially for cardiorenal patients. In addition, glucagon-like peptide-1 receptor agonists have shown CV benefits in patients with DM and CV disease in addition to a reduced risk of CKD progression.

State-controlled epidemic in a game against a novel pathogen.

The pandemic reminded us that the pathogen evolution still has a serious effect on human societies. States, however, can prepare themselves for the emergence of a novel pathogen with unknown characteristics by analysing potential scenarios. Game theory offers such an appropriate tool. In our game-theoretical framework, the state is playing against a pathogen by introducing non-pharmaceutical interventions to fulfil its socio-political goals, such as guaranteeing hospital care to all needed patients, keeping the country functioning, while the applied social restrictions should be as soft as possible. With the inclusion of activity and economic sector dependent transmission rate, optimal control of lockdowns and health care capacity management is calculated. We identify the presence and length of a pre-symptomatic infectious stage of the disease to have the greatest effect on the probability to cause a pandemic. Here we show that contrary to intuition, the state should not strive for the great expansion of its health care capacities even if its goal is to provide care for all requiring it and minimize the cost of lockdowns.

Surviving Older Patients Show Preserved Cellular and Humoral Immunological Memory Several Months After SARS-CoV-2 Infection.

Understanding how older people respond to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is critical if we are to confront the coronavirus disease 2019 (COVID-19) pandemic and establish effective vaccination strategies. Immunosenescence reduces the ability to respond to neoantigens and may compromise the life of infected individuals. Here, we analyzed the immunological memory to SARS-CoV-2 in 102 recovered patients aged over 60 years several months after the infection had been resolved. Specific memory T lymphocytes against the virus were measured by interferon-γ (IFN-γ) and granzyme B release by ELISpot; memory B-lymphocyte responses were quantified by detection of anti-S IgG1 producer cells by ELISpot and anti-S and anti-N antibodies were determined by enzyme-linked immunosorbent assay (ELISA). Memory T lymphocytes were found in peripheral blood of most of the studied donors, more than 7 months after the infection in some of them. Fewer patients maintained memory B lymphocytes, but antibodies, mainly anti-S, were highly durable and positively correlated with T responses. More robust humoral responses were found in patients who had more severe symptoms and had been admitted to hospital. We concluded that specific immunity against SARS-CoV-2 is effectively preserved regardless of age, despite the great heterogeneity of their immune responses, and that memory T lymphocytes and anti-S IgG might be more durable than memory B cells and anti-N IgG.

Diagnosis of Subclinical Keratoconus Based on Machine Learning Techniques.

(1) Background: Keratoconus is a non-inflammatory corneal disease characterized by gradual thinning of the stroma, resulting in irreversible visual quality and quantity decline. Early detection of keratoconus and subsequent prevention of possible risks are crucial factors in its progression. Random forest is a machine learning technique for classification based on the construction of thousands of decision trees. The aim of this study was to use the random forest technique in the classification and prediction of subclinical keratoconus, considering the metrics proposed by Pentacam and Corvis. (2) Methods: The design was a retrospective cross-sectional study. A total of 81 eyes of 81 patients were enrolled: sixty-one eyes with healthy corneas and twenty patients with subclinical keratoconus (SCKC): This initial stage includes patients with the following conditions: (1) minor topographic signs of keratoconus and suspicious topographic findings (mild asymmetric bow tie, with or without deviation; (2) average K (mean corneal curvature) < 46, 5 D; (3) minimum corneal thickness (ECM) > 490 µm; (4) no slit lamp found; and (5) contralateral clinical keratoconus of the eye. Pentacam topographic and Corvis biomechanical variables were collected. Decision tree and random forest were used as machine learning techniques for classifications. Random forest performed a ranking of the most critical variables in classification. (3) Results: The essential variable was SP A1 (stiffness parameter A1), followed by A2 time, posterior coma 0°, A2 velocity and peak distance. The model efficiently predicted all patients with subclinical keratoconus (Sp = 93%) and was also a good model for classifying healthy cases (Sen = 86%). The overall accuracy rate of the model was 89%. (4) Conclusions: The random forest model was a good model for classifying subclinical keratoconus. The SP A1 variable was the most critical determinant in classifying and identifying subclinical keratoconus, followed by A2 time.

Growth differentiation factor 15 as mortality predictor in heart failure patients with non-reduced ejection fraction.

AIMS: The prognostic value of biomarkers in patients with heart failure (HF) and mid-range (HFmrEF) or preserved ejection fraction (HFpEF) has not been widely addressed. The aim of this study was to assess whether the prognostic value of growth differentiation factor 15 (GDF-15) is superior to that of N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with HFmrEF or HFpEF. METHODS AND RESULTS: Heart failure patients with either HFpEF or HFmrEF were included in the study. During their first visit to the HF unit, serum samples were obtained and stored for later assessment of GDF-15 and NT-proBNP concentrations. Patients were followed up by the HF unit. The main endpoint was all-cause mortality. A total of 311 patients, 90 (29%) HFmrEF and 221 (71%) HFpEF, were included. Mean age was 72 ± 13 years, and 136 (44%) were women. No differences were found in GDF-15 or NT-proBNP concentrations between both HF groups. During a median follow-up of 15 months (Q1-Q3: 9-30 months), 98 patients (32%) died, most (71%) of cardiovascular causes. Patients who died had higher median concentrations of GDF-15 (4085 vs. 2270 ng/L, P < 0.0001) and NT-proBNP (1984 vs. 1095 ng/L, P < 0.0001). A Cox multivariable model identified New York Heart Association Functional Class III (P = 0.04), systolic blood pressure (P = 0.01), left atrial diameter (P = 0.03), age >65 years (P < 0.0001), and GDF-15 concentrations (P = 0.01) but not NT-proBNP as independent predictors of all-cause mortality. The area under the curve was 0.797 for the basic model including NT-proBNP, and the area under the curve comparing the overall model was 0.819, P = 0.016 (DeLong's test). Integrated discrimination improvement index after the inclusion of GDF-15 in the model with the mortality risk factors was 0.033; that is, the ability to predict death increased by 3.3% (P = 0.004). Net reclassification improvement was 0.548 (P < 0.001); that is, the capacity to improve the classification of the event (mortality) was 54.8%. GDF-15 concentrations were divided in tertiles (<1625, 1625-4330, and >4330 ng/L), and survival curves were evaluated using the Kaplan-Meier technique. Patients in the highest tertile had the poorest 5 year survival, at 16%, whereas the lowest tertile had the best survival, of 78% (P < 0.001). CONCLUSIONS: Growth differentiation factor 15 was superior to NT-proBNP for assessing prognosis in patients with HFpEF and HFmrEF. GDF-15 emerges as a strong, independent biomarker for identifying HFmrEF and HFpEF patients with worse prognosis.

Manejo clínico de la lengua negra vellosa / Black hairy tongue: clinical management

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Artiflex foldable lens for myopia correction results of 10 years of follow-up.

PURPOSE: The aim of this study was to evaluate the long-term efficacy and safety of the Artiflex® lens implant and to follow the evolution of the number of corneal endothelial cells over time. DESIGN: It was a retrospective study of an observational case series of patients who underwent surgery at "The INVISION Ophthalmic Hospital" (Almería, Spain) in 2007 and who were followed for 10 years. METHODS: Setting: Clinical practice. Study population included 53 eyes of 30 patients who underwent an Artiflex® lens implant for the correction of myopia from -4 to -14 D. Each patient included in this study had stable myopia for at least 2 years and a contraindication for corneal refractive surgery. The efficacy index was defined as the quotient between uncorrected distance visual acuity postoperative and best-corrected distance visual acuity (BCDVA) preoperative. The safety index was calculated as the quotient between BCDVA postop and BCDVA preop. RESULTS: The average efficacy and safety indices of the lenses implanted were 1.1 (SD 0.30) and 1.06 (SD 0.2) at 10 years of follow-up. In this period of time there has been a loss of 12% of the corneal endothelial cells. The postoperative complications were pigment dispersion in four eyes (7%) of four patients and decentration of phakic intraocular lens in two eyes (4%) of another two patients. CONCLUSIONS: The Artiflex® foldable phakic lens could be a safe and effective long-term alternative for myopic patients in whom laser surgery was contraindicated.

Impact of Virtual Planning on Surgical Reposition of the Premaxilla Using an Endonasal Approach and Simultaneous Alveoloplasty.

OBJECTIVE: Describe the surgical repositioning of the premaxilla using an innovative minimally invasive endonasal approach and secondary bone graft at the same time. We want to emphasize the importance of virtual surgical planning in this technique. MATERIAL AND METHODS: A total of 6 patients with bilateral complete cleft lip and palate underwent a surgical repositioning of the premaxilla. Virtual surgical planning was performed in all cases. The ages varied between 8 and 12 years and all were male. Five patients were in the mixed dentition phase and 1 patient was in the definitive phase. Three of the patients had been prepared with presurgical nasoalveolar molding. The other 3 were not prepared for various reasons. All patients had primary repair of cleft lip and palate. INTERVENTIONS: An innovative minimally invasive endonasal approach is presented that has allowed a safe 3-D reposition of the premaxilla in patients with bilateral cleft palate. A simultaneous secondary alveoloplasty with the use of absorbable osteosynthesis is a good choice to achieve symmetry and stability. CONCLUSIONS: Virtual surgical planning is an exceptional instrument to make an appropriate presurgical selection of the patients in which combine the 2 procedures.

Endovascular treatment of an intraosseous arteriovenous malformation of the mandible in a child. A case Report.

The modern application of interventional radiology techniques is revolutionizing the treatment of the vascular malformations of the head and neck. In fact, the morbidity related with the surgical extirpation of the malformation might be drastically reduced with the use of an endovascular approach. The present report describes the case of a 11 years old male affected by a large intraosseous arteriovenous malformation of the mandible. The coil embolization of the main drainage vein caused the spontaneous regression of the lesion and avoided a mutilating surgery and severe psychological sequels. A multidisciplinary approach of these case is mandatory. A careful clinical and radiological study of the patient is essential for a proper management. The choice of the treatment should be based on the location and extension of the malformation, age of the patient, experience with endovascular techniques and clinic. Key words:Endovacualr approach, intraosseous arteriovenous malformation, head and neck, child.

Leucoplasia verrucosa proliferativa de la lengua / Proliferative verrucous leukoplakia of the tongue

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