Optimizing MRI-based brain tumor classification and detection using AI: A comparative analysis of neural networks, transfer learning, data augmentation, and the cross-transformer network.

Early detection and diagnosis of brain tumors are crucial to taking adequate preventive measures, as with most cancers. On the other hand, artificial intelligence (AI) has grown exponentially, even in such complex environments as medicine. Here it's proposed a framework to explore state-of-the-art deep learning architectures for brain tumor classification and detection. An own development called Cross-Transformer is also included, which consists of three scalar products that combine self-care model keys, queries, and values. Initially, we focused on the classification of three types of tumors: glioma, meningioma, and pituitary. With the Figshare brain tumor dataset was trained the InceptionResNetV2, InceptionV3, DenseNet121, Xception, ResNet50V2, VGG19, and EfficientNetB7 networks. Over 97 % of classifications were accurate in this experiment, which provided a network's performance overview. Subsequently, we focused on tumor detection using the Brain MRI Images for Brain Tumor Detection and The Cancer Genome Atlas Low-Grade Glioma database. The development encompasses learning transfer, data augmentation, as well as image acquisition sequences; T1-weighted images (T1WI), T1-weighted post-gadolinium (T1-Gd), and Fluid-Attenuated Inversion Recovery (FLAIR). Based on the results, using learning transfer and data augmentation increased accuracy by up to 6 %, with a p-value below the significance level of 0.05. As well, the FLAIR sequence was the most efficient for detection. As an alternative, our proposed model proved to be the most effective in terms of training time, using approximately half the time of the second fastest network.

A co-designed curriculum for cultural safety training of Colombian health professionals: sequential-consensual qualitative study.

Background: Although traditional and cultural health practices are widely used in Colombia, physicians are not trained to address intercultural tensions that arise in clinical practice. Cultural safety encourages practitioners to examine how their own culture shapes their clinical practice and to respect their patients' culture. It requires inviting patients of non-dominant cultures to co-design culturally safe health care. We co-designed a curriculum for cultural safety training of Colombian health professionals. Methods: A sequential-consensual qualitative study defined the learning objectives of the curriculum. Semi-structured questionnaires and focus groups explored the opinions of traditional medicine users, medical students, and intercultural health experts to inform the content of the curriculum. Deliberative dialogue between key intercultural health experts settled the academic content of the curriculum. A member-checking strategy modified and approved the final version. Results: Seven traditional medicine users, six medical students, and four intercultural health experts participated in the study. The stakeholders defined five learning objectives: (a) culturally unsafe practices: acknowledge the intercultural tensions and its consequences; (b) cultural awareness: examine their attitudes, beliefs, and values, and how they shape their professional practice; (c) cultural humility: listen and learn from the patients' traditional practices; (d) cultural competence: describe current pedagogical approaches to address intercultural tensions; and (e) cultural safety: discuss with patients to reach an agreement on their treatment. Conclusion: This study integrated the perspectives of different stakeholders and proposed new applications of cultural safety that are relevant to other countries. Researchers and educators can use these results to inform future cultural safety initiatives.

Contexte: Bien que les pratiques traditionnelles et culturelles en matière de santé soient largement utilisées en Colombie, les médecins ne sont pas formés pour faire face aux tensions interculturelles qui peuvent surgir dans le contexte clinique. La sécurité culturelle encourage les praticiens à s'interroger sur les façons dont leur propre culture influence leur pratique clinique et à respecter la culture de leurs patients. Elle exige qu'ils invitent leurs patients de cultures non dominantes à co-concevoir des soins de santé culturellement sûrs. Nous avons co-conçu un programme de formation en sécurité culturelle pour les professionnels de santé colombiens. Méthodes: Les objectifs d'apprentissage du programme ont été définis sur la base d'une étude qualitative séquentielle-consensuelle. Par le biais de questionnaires semi-structurés et de groupes de discussion, nous avons exploré les opinions d'utilisateurs de la médecine traditionnelle, d'étudiants en médecine et d'experts en santé interculturelle dans le but de définir le contenu du cursus de façon éclairée. Son contenu académique a été finalisé à la suite d'un dialogue délibératif entre les principaux experts en santé interculturelle. Une vérification par les membres a permis de modifier et d'approuver la version finale. Résultats: Sept utilisateurs de la médecine traditionnelle, six étudiants en médecine et quatre experts en santé interculturelle ont participé à l'étude. Les parties prenantes ont défini cinq objectifs d'apprentissage : (a) pratiques culturellement non sécuritaires : reconnaître les tensions interculturelles et leurs conséquences; (b) prise de conscience culturelle : examiner leurs attitudes, croyances et valeurs, et la manière dont elles façonnent s pratiques professionnelles; (c) humilité culturelle : écouter et apprendre des pratiques traditionnelles des patients; (d) compétence culturelle : décrire les approches pédagogiques actuelles sur la question des tensions interculturelles; et (e) sécurité culturelle : discuter avec les patients pour parvenir à un terrain d'entente sur leur traitement. Conclusion: Cette étude intègre les perspectives de différentes parties prenantes et propose de nouvelles applications de la sécurité culturelle qui seraient également pertinentes dans d'autres pays. Les chercheurs et les enseignants peuvent utiliser ces résultats pour alimenter des initiatives futures en matière de sécurité culturelle.

A data set for electric power consumption forecasting based on socio-demographic features: Data from an area of southern Colombia.

In this article, we introduce a data set concerning electric-power consumption-related features registered in seven main municipalities of Nariño, Colombia, from December 2010 to May 2016. The data set consists of 4427 socio-demographic characteristics, and 7 power-consumption-referred measured values. Data were fully collected by the company Centrales Eléctricas de Nariño (CEDENAR) according to the client consumption records. Power consumption data collection was carried following a manual procedure wherein company workers are in charge of manually registering the readings (measured in kWh) reported by the electric energy meters installed at each housing/building. Released data set is aimed at providing researchers a suitable input for designing and assessing the performance of forecasting, modelling, simulation and optimization approaches applied to electric power consumption prediction and characterization problems. The data set, so-named in shorthand PCSTCOL, is freely and publicly available at https://doi.org/10.17632/xbt7scz5ny.3.

Bibliometric assessment of the contributions of literature on Chagas disease in Latin America and the Caribbean.

Chagas disease, considered a parasitic neglected disease, is endemic in Latin America. Although, its mortality rate has decreased over time, it still represents a public health problem in the region. A bibliometric evaluation of the Latin American contributions on this disease was done. This study used SCI (1980-2013), MEDLINE/GOPUBMED (1802-2013), Scopus (1959-2013), SCIELO (2004-2013), and LILACS (1980-2013). Different study types have been characterized by years, origin city/country, journals and most productive authors, by country, cites and H-index. 2988 articles were retrieved from SCI (30.85% of total). Brazil was found to be the highest producer (31.22%), followed by Argentina (18.14%) and México (9.57%); the region received 47241 citations, 28.60% for Brazil (H-index=52), 18.26% of Argentina (Hindex= 43), 11.40% Bolivia (H-index=37). 4484 were retrieved from Scopus (30.20% of the total), 38.58% of which were from Brazil, 12.40% from Argentina and 8.90% from Mexico. From Medline, 6647 records were retrieved (45.58% Brazil). From SciELO, 917 articles (47.66% Brazil). From LILACS, 2165 articles (60.05% Brazil). Brazil has the highest output in the region. Despite advances in controlling Chagas disease, scientific production is low, particularly for regional bibliographic databases, which calls for more research on this disease.

Scientific research in malaria: bibliometric assessment of the Latin-American contributions.

BACKGROUND: Malaria is a parasitic disease of high global impact in public health, including Latin America. There should be more researched, particularly in this region. A bibliometric assessment of the Latin American contributions about malaria was done. METHODS: Bibliometric study at SCI (1980-2013), MEDLINE/ GOPUBMED (1802-2013), Scopus (1959-2013), SCIELO (2004-2013), LILACS (1980-2013). The studies were characterized by study type, year of publication, city/country of origin, journals and more productive authors, citations and H index. RESULTS: At SCI, 2,806 articles were retrieved (5.13% of the total). Brazil was the highest producer (31.41%), followed by Colombia (14.3%) and Mexico (9.5%). The region received 39,894 citations, 32.2% from Brazil (H index=51), 12.75% Mexico (H index=38), 11.2% Colombia (H index=33). At Scopus, there are 4,150 articles (4.9% of the total), 33.0% Brazil, 11.3% Colombia and 8.8% Mexico; 17% in Brazil were from Universidad de São Paulo; 23.6% of Colombia from Universidad de Antioquia; 15.4% of Mexico from Instituto Nacional de Salud Pública. At Medline there were 4,278 records (36.8% Brazil). At SciELO there are 792 records (45.3% Brazil). At LILACS there were 1744 records (34.3% Brazil). CONCLUSIONS: Brazil has the highest output of the region, as Venezuela the scientific production in Malaria was related with the burden of disease. This was not the case for Colombia. Scientific production at bibliographical databases, particularly regionals, is low, compared to the high incidence of this disease that requires more research and control.

Study of the scientific production on leishmaniasis in Latin America.

UNLABELLED: Leishmaniasis is a highly relevant neglected tropical disease. It has important consequences in affected populations, including a high fatality rate in its visceral form. It is present in Latin America, then it is necessary to promote more research on it. A bibliometric assessment of the Latin American scientific production in leishmaniasis was done. METHODS: Bibliometric study at SCI (1980-2013), MEDLINE/GOPUBMED (1802-2013), Scopus (1959-2013), SCIELO (2004-2013), LILACS (1980-2013). Different study types, characterized by years, city/country of origin, journals and more productive authors, by country, cites and H index. RESULTS: At SCI, 2857 articles were found (17.7% of the total). Brazil was the highest producer (58.1%), followed by Colombia (9.9%) and Venezuela (5.6%); the region received 41186 citations, 54.2% of Brazil (H index=62), 12.1% Colombia (H index=30) and 4.5% of Venezuela (H index=25). At Scopus, there are 3681 (14.7% of the total), 53.2% Brazil, 6.8% Colombia and 6.0% Venezuela; 38.46% at Brazil were from Fundação Oswaldo Cruz; 30.6% of Colombia corresponded to Universidad de Antioquia; 31.34% at Venezuela were from Universidad Central de Venezuela. At Medline there are 4525 records (60.6% of Brazil). At SciELO there are 1068 records (67.5% Brazil). At LILACS, there are 1740 records (56.0% Brazil). CONCLUSIONS: Scientific production of Brazil predominates in the region, with one single institution generating more articles than Colombia and Venezuela together. Scientific production in bibliographical data bases, particularly regional, is still relatively low, and the disease neglected when compared to other tropical conditions such as dengue and malaria.

Bacterial translocation in abdominal trauma and postoperative infections.

BACKGROUND: Bacterial translocation (BT) describes the passage of bacteria residing into the gastrointestinal tract, through the intestinal mucosa barrier to sterile tissues such as mesenteric lymph nodes (MLN) and other organs. This phenomenon has not been thoroughly studied in patients with trauma to date, and an association between BT and postoperative infection has not been well established so far. METHODS: MLNs from 36 patients with abdominal trauma were removed during laparotomy and cultured to detect BT. Postoperative infectious complications in these patients were registered, and both phenotypical and molecular typings (through multilocus sequencing) were carried out for microorganisms isolated from MLN and postoperative infection sites. Associations between clinical variables, BT presence, and postoperative infection development were established. RESULTS: BT was detected in 33% of the patients (n = 12). Postoperative infections were present in 22.2% of the patients (n = 8). A significant statistical difference was found between postoperative infections in patients with BT evidence (41.6%), when compared with patients without BT (12.5%; p = 0.047). Bacteria isolated from infection sites were the same as those cultured in MLN in 40% of the cases (n = 2 of 5), allowing us to establish causality between BT and postoperative infection. CONCLUSIONS: There is higher risk of BT in trauma patients, and it is associated with a significant increase of postoperative infections. An abdominal trauma index ≥10 was found to be associated with the development of BT. This is the first study describing BT among patients with abdominal trauma, where causality is confirmed at molecular level.

Global childhood unintentional injury surveillance in four cities in developing countries: a pilot study.

OBJECTIVE: To determine the frequency and nature of childhood injuries and to explore the risk factors for such injuries in low-income countries by using emergency department (ED) surveillance data. METHODS: This pilot study represents the initial phase of a multi-country global childhood unintentional injury surveillance (GCUIS) project and was based on a sequential sample of children < 11 years of age of either gender who presented to selected EDs in Bangladesh, Colombia, Egypt and Pakistan over a 3-4 month period, which varied for each site, in 2007. FINDINGS: Of 1559 injured children across all sites, 1010 (65%) were male; 941 (60%) were aged >or= 5 years, 32 (2%) were < 1 year old. Injuries were especially frequent (34%) during the morning hours. They occurred in and around the home in 56% of the cases, outside while children played in 63% and during trips in 11%. Of all the injuries observed, 913 (56%) involved falls; 350 (22%), road traffic injuries; 210 (13%), burns; 66 (4%), poisoning; and 20 (1%), near drowning or drowning. Falls occurred most often from stairs or ladders; road traffic injuries most often involved pedestrians; the majority of burns were from hot liquids; poisonings typically involved medicines, and most drowning occurred in the home. The mean injury severity score was highest for near drowning or drowning (11), followed closely by road traffic injuries (10). There were 6 deaths, of which 2 resulted from drowning, 2 from falls and 2 from road traffic injuries. CONCLUSION: Hospitals in low-income countries bear a substantial burden of childhood injuries, and systematic surveillance is required to identify the epidemiological distribution of such injuries and understand their risk factors. Methodological standardization for surveillance across countries makes it possible to draw international comparisons and identify common issues.

Experiencia en el manejo quirúrgico del síndrome de compartimento abdominal en el Hospital Occidente de Kennedy / Experience in the Surgical Management of Abdominal Compartment Syndrome in the Hospital Occidente de Kennedy

Introducción El síndrome de compartimento abdominal (SCA) es resultado de una serie de alteraciones fisiológicas locales y sistémicas, producidas por un aumento anormal de la presión intraabdominal, que, en algunos casos, requiere la descompresión quirúrgica de la cavidad abdominal. Métodos: Es un estudio descriptivo, retrospectivo, de una serie de 28 pacientes con SCA que requirieron tratamiento quirúrgico en el Hospital Occidente de Kennedy, entre 1999 y 2003. Evaluamos retrospectivamente el rendimiento de la ecuación de McNelis para predicción de su desarrollo. Resultados: La patología desencadenante más frecuente fue la infección intraabdominal (n=6 21,4%). El tiempo transcurrido entre el diagnóstico y la descompresión quirúrgica fue menor de cuatro horas en el 75% (n=21) de los casos. Las variables que mejoraron significativamente tras la descompresión quirúrgica fueron la presión venosa central (PVC) (T:4,0; p:0,0001), la presión inspiratoria máxima (PIM) (T:2,7; p:0,004), la presión intraabdominal (PIA) (T1,8; p:0,034) y el gasto urinario (T:-2,4; p:0,02). Los niveles de BUN, la creatinina y la inestabilidad hemodinámica no presentaron mejoría. La estancia promedio en la unidad de cuidados intensivos (UCI) fue de once días (SD:9) y la estancia hospitalaria, de dieciocho (SD13). La mortalidad global fue del 67,9% (n=19) y la mortalidad directamente atribuible al síndrome fue del 30% (n=8). El comportamiento de la ecuación de McNelis fue errático. Conclusiones: Las características demográficas y las patologías causantes del síndrome corresponden a las descritas en la literatura. La correlación de las variables fisiológicas asociadas al diagnóstico del síndrome es heterogénea entre diferentes pacientes. La mortalidad del síndrome en nuestra institución está dentro de lo esperado según la literatura mundial. El rendimiento de la ecuación de McNelis parece depender excesivamente del balance hídrico.

The abdominal compartment syndrome (ACS) is the result of various physiological alterations produced by an abnormal increase of the intra-abdominal pressure. Some of these patients will undergo a surgical procedure for its management. Methods: This is a retrospective case series of 28 patients with ACS who required surgical treatment at the Hospital Occidente de Kennedy between 1999 and 2003. We assessed retrospectively the behavior of McNelis's equation for prediction of the development of the ACS. Results: The leading cause of ACS in our study was intraabadominal infection (n=6 21,4%). Time elapsed between diagnosis and surgical decompression was less than 4 hours in 75% (n=21) of the cases. The variables that improved significantly after the surgical decompression were CVP (T: 4,0 p: 0,0001), PIM (T: 2,7; p: 0,004), PIA (T1,8; p:0,034) and Urine Output (T:-2,4; p:0,02). The values of BUN, Creatinine and the cardiovascular instability did not show improvement. The ICU and hospital length of stay were 11 days (SD: 9) and 18 days (SD13) respectively. Global mortality was 67,9% (n=19) and mortality directly attributable to the syndrome was 30% (n=8). The behavior of the McNelis's equation was erratic. Conclusions: The demographic characteristics as well as disease processes associated with ACS are consistent with the literature. The association between physiological variables and ACS is heterogeneous between patients. Mortality rates attributable to ACS in our institution are within the range described world-wide. The behavior of the McNelis's equation seems to depend greatly upon fluid balance.

Colecistectomia laparoscopica ambulatoria: modelo de programa costo-eficiente de cirugia laparoscopica / Ambulatory laparoscopic cholecystectomy: a cost-efficient model of laparoscopic surgery

La colecistectomía laparoscópica es el patrón oro en el tratamiento de la enfermedad de la vesícula biliar y se ha demostrado una mejor relación costo-efectividad- eficiencia frente a la cirugía abierta. En Latinoamérica la colecistectomía se continúa practicando de manera abierta en la mayoría de instituciones y en las que se hace por laparoscopia se realiza en el ambiente hospitalario. El principal argumento para no hacer colecistectomías por laparoscopia es el alto costo y para no realizarlas ambulatorias son los potenciales riesgos y temor a acciones médico-legales. La experiencia del Centro de Cirugía Ambulatoria de Bogotá, en Colombia, ha demostrado que la práctica de la colecistectomía laparoscópica ambulatoria es una excelente opción, tiene la misma efectividad que se obtiene en un hospital, pero con mayores ventajas médicas, sociales y financieras para el sistema. El presente trabajo muestra las características de este nuevo modelo y las compara con el modelo hospitalario actual