Protocolos de diagnóstico acelerado basados en troponina de alta sensibilidad en el diagnóstico del dolor torácico: una revisión sistemática / Accelerated Diagnostic Protocols Based on High-Sensitivity Troponin in the Diagnosis of Thoracic Pain: A Systematic Review

RESUMEN Introducción: Los protocolos de diagnóstico acelerado de dolor torácico, con el avance de la troponina de alta sensibilidad, permiten identificar a los pacientes que ingresan al servicio de urgencias con dolor torácico de bajo riesgo para un evento cardiovascular adverso mayor, que podrían ser dados de alta de forma temprana y segura, con ahorro de tiempo y recursos. Objetivo: Evaluar ensayos clínicos que utilicen protocolos de diagnóstico acelerado basados en troponina de alta sensibilidad. Material y métodos: se realizó una búsqueda de ensayos clínicos aleatorizados que evaluaran protocolos de diagnóstico acelerado basados en troponina de alta sensibilidad en los servicios de urgencias, en las bases de datos MEDLINE/Ovid, Cochrane y EMBASE utilizando los criterios de evaluación del manual Cochrane y la estrategia PRISMA Resultados: Tras una tamización de 3509 estudios se incluyeron 5 ensayos clínicos que incluyeron 1513 pacientes; se identificaron 409 (27%) altas tempranas, el 91% para el protocolo 0/3 h ESC, 72% para el 0/1 h, 48% para el EDACS, 40% para el HEART, 19 y 32% para ADAPT y 8 y 18% para el cuidado usual. El valor predictivo negativo fue alto, en un rango de 99,1 al 100% La duración media de la estancia hospitalaria fue más baja para los protocolos 0/1 h y 0/3 h ESC, con 4,6 y 5,6 horas respectivamente. Conclusiones: Los protocolos de diagnóstico acelerado en dolor torácico que implementan el uso de troponina de alta sensibilidad permiten lograr alta proporción de altas tempranas con baja tasa de eventos cardiovasculares mayores, con disminución del tiempo de estancia y recursos consumidos.

ABSTRACT Background: Accelerated diagnostic protocols for chest pain, with the advancement of high-sensitivity troponin, make it possible to identify patients admitted to the emergency department with chest pain and low risk for a major adverse cardiovascular event, who could be discharged immediately, early and safely, saving time and resources. Objective: The aim of this study was to assess clinical trials using accelerated diagnostic protocols based on high-sensitivity troponin. Methods: A search of randomized clinical trials evaluating accelerated diagnostic protocols based on high-sensitivity troponin in emergency services was carried out in MEDLINE/Ovid, Cochrane and EMBASE database, using the assessment criteria of the Cochrane manual and the PRISMA strategy. Results: After screening 3509 studies, 5 clinical trials, including 1513 patients, were analyzed. Early discharges were identified in 409 (27%) of patients, in 91% of cases for ESC 0/3-h protocols, 72% for 0/1-h, 48% for EDACS, 40% for HEART, 19% and 32% for ADAPT and 8% and 18% for standard care protocols. The negative predictive value was high, in the 99.1-100% range. Mean length of hospital stay was lower for the 0/1-h and ESC 0/3-h protocols, with 4.6 and 5.6 hours, respectively. Conclusions: Accelerated diagnostic protocols in chest pain using high-sensitivity troponin allow a higher proportion of early discharges with a low rate of major cardiovascular events, with reduction in length of hospital stay and resources used.

Evaluación de la movilidad del ácido 2,4-diclorofenoxiacético en suelos ándicos del departamento del Cauca, Colombia

El herbicida ácido 2,4 - diclorofenoxiacético (2,4-D) es un ácido selectivo y sistémico que, desde 1940, es ampliamente utilizado en suelo agrícolas, de todo el mundo. Su uso radica a su selectividad entre la vegetación de hoja ancha y cultivos de gramíneas y como regulador del crecimiento vegetal; sin embargo, este herbicida se puede acumular en el ambiente y, adicionalmente, puede ser transportado por lixiviación, a través del suelo, llegando a contaminar aguas subterráneas, lo que genera un alto riesgo para el ambiente y la salud del ser humano. El estudio de la movilidad del 2,4-D en suelos con alto contenido de materia orgánica permitió conocer, que no solo la materia orgánica se correlaciona indirectamente con la movilidad de este compuesto, sino que, también, influye la humedad, al reducir la lixiviación y el potencial de contaminación del recurso hídrico subterráneo, mientras que la conductividad hidráulica se relaciona, de manera directa, con la lixiviación de este herbicida.

The herbicide 2,4-dichlorophenoxyacetic acid (2,4-D) is a selective and systemic acid that has been widely used in agricultural soils since 1940. Its use lies in its selectivity between broadleaf vegetation and grass crops, and as a regulator of plant growth. However, this herbicide can accumulate in the environment, and additionally, it can be transported by leaching through the soil, contaminating groundwater, which generates a high risk for the environment and human health. In this study, the mobility of 2,4-D in organic-matter-rich soils was assessed. The results revealed that not only the organic material is indirectly correlated with the mobility of this compound but also influences humidity and reduces leaching and potential pollution of groundwater resources, whereas hydraulic conductivity is directly related to herbicide leaching.

Diagnostic Strategies for Breast Cancer Detection: From Image Generation to Classification Strategies Using Artificial Intelligence Algorithms.

Breast cancer is one the main death causes for women worldwide, as 16% of the diagnosed malignant lesions worldwide are its consequence. In this sense, it is of paramount importance to diagnose these lesions in the earliest stage possible, in order to have the highest chances of survival. While there are several works that present selected topics in this area, none of them present a complete panorama, that is, from the image generation to its interpretation. This work presents a comprehensive state-of-the-art review of the image generation and processing techniques to detect Breast Cancer, where potential candidates for the image generation and processing are presented and discussed. Novel methodologies should consider the adroit integration of artificial intelligence-concepts and the categorical data to generate modern alternatives that can have the accuracy, precision and reliability expected to mitigate the misclassifications.

Convolutional Neural Network and Motor Current Signature Analysis during the Transient State for Detection of Broken Rotor Bars in Induction Motors.

Although induction motors (IMs) are robust and reliable electrical machines, they can suffer different faults due to usual operating conditions such as abrupt changes in the mechanical load, voltage, and current power quality problems, as well as due to extended operating conditions. In the literature, different faults have been investigated; however, the broken rotor bar has become one of the most studied faults since the IM can operate with apparent normality but the consequences can be catastrophic if the fault is not detected in low-severity stages. In this work, a methodology based on convolutional neural networks (CNNs) for automatic detection of broken rotor bars by considering different severity levels is proposed. To exploit the capabilities of CNNs to carry out automatic image classification, the short-time Fourier transform-based time-frequency plane and the motor current signature analysis (MCSA) approach for current signals in the transient state are first used. In the experimentation, four IM conditions were considered: half-broken rotor bar, one broken rotor bar, two broken rotor bars, and a healthy rotor. The results demonstrate the effectiveness of the proposal, achieving 100% of accuracy in the diagnosis task for all the study cases.

Maternal autoimmune antibodies alter the dendritic arbor and spine numbers in the infragranular layers of the cortex.

An association between maternal IgG antibodies reactive against proteins in fetal brain and an outcome of autism in the child has been identified. Using a mouse model of prenatal intraventricular administration of autism-specific maternal IgG, we demonstrated that these antibodies produce behavioral alterations similar to those in children with ASD. We previously demonstrated that these antibodies bind to radial glial stem cells (RG) and observed an increase in the number of divisions of translocating RG in the developing cortex. We also showed an alteration in brain size and as well as a generalized increased of neuronal volume in adult mice. Here, we used our intraventricular mouse model of antibody administration, followed by Golgi and Neurolucida analysis to demonstrate that during midstages of neurogenesis these maternal autism-specific antibodies produced a consistent decrease in the number of spines in the infragranular layers in the adult cortical areas analyzed. Specifically, in the frontal cortex basal dendrites of layer V neurons were decreased in length and volume, and both the total number of spines-mature and immature-and the spine density were lower than in the control neurons from the same region. Further, in the occipital cortex layer VI neurons presented with a decrease in the total number of spines and in the spine density in the apical dendrite, as well as decrease in the number of mature spines in the apical and basal dendrites. Interestingly, the time of exposure to these antibodies (E14.5) coincides with the generation of pyramidal neurons in layer V in the frontal cortex and in layer VI in the occipital cortex, following the normal rostro-caudal pattern of cortical cell generation. We recently demonstrated that one of the primary antigens recognized by these antibodies corresponds to stress-induced phosphoprotein 1 (STIP1). Here we hypothesize that the reduction in the access of newborn cells to STIP1 in the developing cortex may be responsible for the reduced dendritic arborization and number of spines we noted in the adult cortex.

Situación bucal de pobladores con discapacidades en el distrito de SanLuis - Lima / Dental Status of people with special needs from the District of San Luis - Lima

Objetivo: Establecer el estado de la salud bucal de personas con diversas discapacidades, residentes en un distrito de clase media-baja de la ciudad de Lima. Materiales y métodos: Se examinó a residentes registrados en la Oficina Municipal de Atención de la Persona con Discapacidad - OMAPED, de San Luis, como parte de la primera fase del desarrollo del Sistema de atención Odontológico Especializado a implementar. La clasificación utilizada, incluía la discapacidad a) Motora b) Sensorial y c) Mental. La información bucal recabada, fue el CPOD, apiñamiento dentario (Van der Linden), el Índice de Higiene Oral simplificado de Greene y Vermillion (IHOs), y la presencia de bolsas periodontales, piezas extruidas y atrición dental. Resultados: El total examinado fue de 102 personas, considerando válidos finalmente 89. Las edades oscilaron entre 6 y 93 años. Del total, el 42,2% presentaban discapacidad motora; 35,3% discapacidad mental y el 9,8% discapacidad sensorial. El CPOD, reflejaba un incremento progresivo con el paso de los años, siendo mas pronunciado a partir de los 51 años, donde se observó, el valor mínino de 18 y el máximo de 32. Entre los componentes del CPOD, las piezas perdidas prevalecieron enlos 3 grupos de discapacidad, siendo mayor en los subgrupos motor y sensorial. También llama la atención que las obturaciones eran muy escasas. Conclusiones: La condición bucal de las personas con discapacidad se deteriora rápidamente con la edad.

Objective: To establish the dental status of people with special needs, who live in a district of a Low-Middle Economical class in Lima. Materials and methods: People registered at the office for people with special needs of the City Hall of District of San Luis (OMAPED) were examined. This study is a first stage of the development of an Specialized System of Dental Care. The classification of the special needs included: a) mobility handicap, b) sensorial handicap; c) mental handicap. The dental status included information of DMF-t; crowding (Van der Linden classification), Oral Hygiene Green Vermillion index, presence of periodontal pockets, extruded teeth, and dental attrition. Results: A total of 102 people with special needs were examined, only 89 were considered in the data. Age ranged from 6 to 93 years old. 42.2% of the total examined people had mobility handicap, 35.5% had mental handicap, and 9.8% had sensorial handicap. DMF-t showed a progressive rise as people grew older, it reached its highest value at the age of 51, with a minimum value of 18 and a maximum value of 32. Regarding the components of DMF-t, missing teeth component was more frequent in the three groups of handicapped; the highest values were observed in the motor and sensorial handicap. It also calls the attention the very few restored teeth. Conclusions: The dental status of people with special needs deteriorates rapidly with aging.

Two-year experience with telemedicine in the follow-up of patients in home peritoneal dialysis.

We evaluated the use of telemedicine in the long-term control of stable patients undergoing peritoneal dialysis at home. From September 2003 to August 2005, patients were randomly selected from current cases and invited to join study group A, in which they had telemedicine support. Patients not selected for this group, or who refused the invitation, were placed in study group B, and used for comparison. There were 25 patients in group A and 32 patients in group B. Videoconferencing equipment was installed in each patient's home, connected to a videoconferencing unit at the hospital by three ISDN lines. Patients in group A were followed for a mean of 8 months (range 3-24) with alternate months of teleconsultations and hospital visits. A total of 172 teleconsultations were conducted. A mean of 22 min (SD 9) were spent on each teleconsultation, significantly less than in hospital consultations, which took a mean of 33 min (SD 8) (P<0.01). In 148 teleconsultations (89%) medical treatment was modified. In 4 cases (2%) patients needed a hospital visit. In all instances (100%) the condition of the catheter exit site and the presence of oedema could be evaluated. In group A, the estimated cost of telemedicine was euro198 and that of a hospital visit was euro177. The mean hospitalization rate was 2.2 days/patient/year in group A and 5.7 days/patient/year in group B (P<0.05). Home telemedicine appears to be clinically useful in the long-term follow-up of stable patients undergoing peritoneal dialysis, and the costs and savings also seem to be encouraging.

Tuberculosis miliar con afectación miocárdica / Miliary tuberculosis with myocardium involvement

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[A study of bone mineral density in adult patients with cystic fibrosis]. / Estudio de la densidad mineral ósea en pacientes adultos con fibrosis quística.

BACKGROUND AND OBJECTIVE: Due to recent medical advances, patients with cystic fibrosis (CF) can expect longer survival rates and, as a result, face previously unreported complications such as osteoporosis. Our goal was to determine the mineral bone density in young adult patients with CF attended in the adult CF Unit, and correlate these findings with other clinical variables of interest in this patient population. PATIENTS AND METHOD: We carried out a transversal study from 1999 to 2002 of 34 patients with CF (19 males and 15 females. Mean age 23 years). Upon enrollment in the study, patient gender and age were recorded along with Schwachman and Brasfield scores, pulmonary function test results (spirometry) and sputum analysis, phosphorus and calcium balance, vitamin D intake, and dual energy X-ray absorptiometry (DEXA) findings of the spinal column (L2-L4) and femur. RESULTS: 54.5% of all study patients were found to have an abnormal mineral bone density. Fifteen patients met criteria for osteopenia and 3 for osteoporosis. Age, treatment with inhaled corticosteroids, and pulmonary function test results correlated with bone density. CONCLUSIONS: DEXA scans should be performed in young adults with CF at least once during the course of their illness on the basis of the high prevalence of mineral bone density abnormalities in this population.