Improving a Deep Learning Model to Accurately Diagnose LVNC.

Accurate diagnosis of Left Ventricular Noncompaction Cardiomyopathy (LVNC) is critical for proper patient treatment but remains challenging. This work improves LVNC detection by improving left ventricle segmentation in cardiac MR images. Trabeculated left ventricle indicates LVNC, but automatic segmentation is difficult. We present techniques to improve segmentation and evaluate their impact on LVNC diagnosis. Three main methods are introduced: (1) using full 800 × 800 MR images rather than 512 × 512; (2) a clustering algorithm to eliminate neural network hallucinations; (3) advanced network architectures including Attention U-Net, MSA-UNet, and U-Net++.Experiments utilize cardiac MR datasets from three different hospitals. U-Net++ achieves the best segmentation performance using 800 × 800 images, and it improves the mean segmentation Dice score by 0.02 over the baseline U-Net, the clustering algorithm improves the mean Dice score by 0.06 on the images it affected, and the U-Net++ provides an additional 0.02 mean Dice score over the baseline U-Net. For LVNC diagnosis, U-Net++ achieves 0.896 accuracy, 0.907 precision, and 0.912 F1-score outperforming the baseline U-Net. Proposed techniques enhance LVNC detection, but differences between hospitals reveal problems in improving generalization. This work provides validated methods for precise LVNC diagnosis.

A Digital Tool for Measuring Healing of Chronic Wounds Treated with an Antioxidant Dressing: A Case Series.

(1) Abstract: Wound monitoring is an essential aspect in the evaluation of wound healing. This can be carried out with the multidimensional tool HELCOS, which develops a quantitative analysis and graphic representation of wound healing evolution via imaging. It compares the area and tissues present in the wound bed. This instrument is used for chronic wounds in which the healing process is altered. This article describes the potential use of this tool to improve the monitoring and follow-up of wounds and presents a case series of various chronic wounds with diverse etiology treated with an antioxidant dressing. (2) Methods: A secondary analysis of data from a case series of wounds treated with an antioxidant dressing and monitored with the HELCOS tool. (3) Results: The HELCOS tool is useful for measuring changes in the wound area and identifying wound bed tissues. In the six cases described in this article, the tool was able to monitor the healing of the wounds treated with the antioxidant dressing. (4) Conclusions: the monitoring of wound healing with this multidimensional HELCOS tool offers new possibilities to facilitate treatment decisions by healthcare professionals.

Comparación entre las escalas Norton, Braden y EMINA originales y las escalas Braden y EMINA modificadas para pacientes inmovilizados en atención domiciliaria / Comparison between Norton, Braden and EMINA original scales and Braden and EMINA modified scales for immobilized patients in home care

Objetivo: General: Clasificar en niveles de riesgo a los pacientes según las escalas Norton, EMINA y Braden originales y las escalas Braden y EMINA modificadas para pacientes de atención domiciliaria incluidos en programa de inmovilizados. Específicos: a) analizar la concordancia entre las escalas y su nivel de significación; b) determinar la incidencia de lesiones por presión en los pacientes valorados con las escalas Braden y EMINA modificadas para pacientes inmovilizados incluidos en programa de atención domiciliaria. Metodología: Estudio descriptivo longitudinal del total de los pacientes incluidos dentro del programa de atención domiciliaria, inmovilizados, de un cupo de enfermería. Muestra conceptual de 45 pacientes. El estudio se desarrolló en la Unidad de Gestión Clínica de Algarrobo, perteneciente al Área de Gestión Sanitaria Este de Málaga-Axarquía, desde enero 2021 hasta julio 2021. Resultados: Al comparar las escalas originales con la escala Braden modificada para pacientes inmovilizados en atención domiciliaria, se obtuvo un valor de kappa de 0,0727 con la escala Norton, de 0,404 con la escala Braden original y de 0,286 con la escala EMINA original. Los valores de kappa para la comparación entre la escala EMINA modificada para pacientes inmovilizados en atención domiciliaria y las originales arrojaron un resultado de 0,345 con Norton, de 0,503 con Braden original y de 0,5 con EMINA original. Al terminar el estudio se registraron 5 pacientes que habían padecido úlceras por presión, 4 fuera del ámbito de la atención domiciliaria y 1 con úlceras de Kennedy. Conclusiones: Las escalas Norton, Braden y EMINA originales catalogan como de alto riesgo a más pacientes que las escalas Braden y EMINA modificadas para pacientes inmovilizados en atención domiciliaria (AU)

Objective: General: Classify in risk levels the patients according to scales Norton, EMINA and Braden originals and Braden and EMINA modified scales for patients in home care included in the immobilized programme. Specifics: a) analysis the concordance between the scales and its significance level; b)determine the incidence of pressure ulcers in patients evaluated with Braden and EMINA scales modified for immobilized patients included in the home care program. Methodology:Longitudinal descriptive study of the total of patients included in the home care program, immobilized, of a nursing quota. Conceptual sample of 45 patients. The study was carried out in the Clinical Management Unit of Algarrobo, belonging to the Area of Health Management East of Málaga-Axarquía. From January 2021 to July 2021. Results: Comparing the original scales with the Braden modified scale for immobilized patients in Home Care, a Kappa value of 0.0727 was obtained with the Norton scale, 0.404 with the original Braden scale and 0.286 with the original EMINA scale. Kappa values for the comparison between the modified EMINA scale for patients immobilized in home care and the original ones yielded a result of 0.345 with Norton, 0.503 with original Braden and 0.5 with original EMINA. At the end of the study, 5 patients were registered having suffered pressure ulcers, 4 outside the scope of home care and 1 with Kennedy ulcers. Conclusions: Norton, Braden and EMINA original scales lists as high-risk more patients than the modified Braden and EMINA scales for patients immobilized in home care. The agreement between the original and modified scales for patients immobilized in home care is mild or moderate, with high levels of significance, due to changes in cut-off points of modified scales for home care. The incidence found there are no studies that refer to modified scales for home care. Non-validated scales continue to be applying for the home care environment(AU)

Técnica modificada Mölndal/Jubilee frente a tratamiento tradicional en heridas quirúrgicas tras cirugía menor en atención primaria / The modified Mölndal/Jubilee technique versus traditional treatment for minor surgical wounds in primary care

Objetivos: General: Comparar la técnica de cura en ambiente húmedo Mölndal/Jubilee modificada para las suturas en cirugía menor ambulatoria, en relación con la cura seca. Específicos: a) medir el tiempo de cicatrización en días entre la técnica Mölndal/Jubilee modificada y la cura seca; b) número de curas realizadas en cada técnica y tiempo en minutos invertido en cada técnica; c) valorar el dolor en cada técnica, y d) comparar las complicaciones aparecidas en cada técnica. Metodología: Ensayo de intervención longitudinal prospectivo multicéntrico y aleatorizado, con grupo control, para evaluar la eficacia de una metodología de cura aplicada tras cirugía menor en atención primaria. La muestra se compone de los pacientes cuyo procedimiento quirúrgico finaliza con sutura. Resultados: Los días hasta la retirada de la sutura invertidos en el grupo intervención fueron de media 9,2 días, con una desviación típica de 2,1, mientras que en el grupo control se emplearon 10,5 días, con una desviación de 2,3. El número de curas que se realizaron en el grupo intervención hasta la retirada de la sutura resultaron de 2 en 45 pacientes (46,9%), 45 pacientes 3 visitas (46,9%) y 6 (6,2%) 4 visitas. En el grupo control no hubo ningún paciente que necesitara menos de 3 visitas; con 3 visitas 18 pacientes (18,8%) del grupo, 4 visitas 41 (42,7%), 5 visitas 30 pacientes (31,2%) y con 7 visitas 7 pacientes (7,3%). El tiempo medio invertido en cada visita para el grupo intervención fue de 2,7 min con una desviación de 0,6 y para el grupo control de 3,1 min con desviación de 0,6. El dolor medio, escala visual analógica, en el grupo intervención se posicionó en 0,5, con desviación típica de 1,0, y de 2,1 para el grupo control con desviación de 1,2. Las complicaciones supusieron el 6,2% en el grupo intervención, 6 complicaciones, en el grupo control se apreciaron 27, el 28,1% (AU)

Objectives: General: Compare the healing technique in a wet environment (Mölndal/Jubilee modified by Grupo Heridas Axarquia) for surgical wounds in minor outpatient surgery, in relation to a dry healing. Specific:a) measure the healing time between the modified technique Mölndal/Jubilee and the dry healing; b) number of cures in each technique and the time spent in both techniques; c) assess the pain in each technique; and d)compare the complications that appear in each technique. Methodology:Multicenter, randomized, control-group, prospective longitudinal intervention trial to evaluate the efficacy of a cure methodology applied after minor surgery in primary care. The sample includes patients whose surgical procedure ends up with suture. Results: The days up to the removal of the inverted suture in the intervention group were on average 9.2 days with a standard deviation of 2.1, while in the control group 10.5 days were used with a deviation of 2.3. The number of cures that were performed in the intervention group until the suture was removed was 2 in 45 patients (46.9%), 3 visits in 45 patients (46.9%) and 4 visits (6.2%) in 6 patients. In the control group there were no patients who needed less than 3 visits; with 3 visits, 18 patients (18.8%) of the group, 4 visits, 41 patients (42.7%), 5 visits 30 patients (31.2%) and with 7 visits 7 patients (7.3%). The average time spent on each visit for the intervention group was 2.7 minutes with a deviation of 0.6 and for the control group 3.1 with a deviation of 0.6. Average pain, analog visual scale, in the intervention group was positioned at 0.5 with standard deviation of 1.0 and 2.1 for control with deviation of 1.2. Complications accounted for 6.2% in the intervention group, 6 complications, and in the control, 27 and 28.1% (AU)

Tratamiento laparoscópico de una paciente con un leiomioma uterino gigante cavitado, con cambio degenerativo mucomixoide / Laparoscopic treatment of a patient with a cavitated giant uterine leiomyoma with mucomyxoid degenerative change

Resumen INTRODUCCIÓN: Un leiomioma con cambios degenerativos poco frecuentes es un desafío diagnóstico difícil de diferenciar de sus homólogos malignos, si se pretende fundamentarlo solo en lo advertido en las imágenes. CASO CLÍNICO: Paciente de 40 años de edad, enviada al servicio de Cirugía de mínima invasión en marzo del 2021 debido al aumento del perímetro abdominal, disminución del apetito y disnea de medianos esfuerzos. El ultrasonido abdomino-pélvico reportó que el útero estaba aumentado de tamaño, con miomas intramurales de medianos elementos. El endometrio heterogéneo. El ovario derecho tenía un quiste complejo, gigante, de 276 mm x 250 mm x 276 mm, con volumen de 10 000 cc. Además, esplenomegalia, hidronefrosis derecha y litiasis renal izquierda. Los marcadores tumorales se reportaron normales. En la cirugía por laparoscopia se observó un tumor que ocupaba toda la cavidad abdominal de 40 x 30 cm, adherido a la pared posterior del útero, con ambos ovarios sin alteraciones, sin líquido libre; se procedió a la histerectomía total. CONCLUSIONES: Los cambios degenerativos en los leiomiomas uterinos pueden distorsionar la estructura habitual del tumor y reflejarla en imágenes típicas de una tumoración quística de ovario; en el estudio inicial esto representa un desafío para el cirujano y debe considerarse parte del diagnóstico diferencial de las masas anexiales. En la paciente del caso, con cirugía de mínima invasión, se consiguió la resección completa de la pieza, a pesar del tamaño aumentado, con menores riesgos de complicaciones en la herida y menos dolor posoperatorio; las incisiones son pequeñas y con desenlaces estéticos favorables y menos días de estancia intrahospitalaria.

Abstract INTRODUCTION: A leiomyoma with rare degenerative changes is a diagnostic challenge difficult to differentiate from its malignant counterparts, if it is intended to be based only on imaging findings. CLINICAL CASE: 40-year-old female patient referred to the Minimally Invasive Surgery service in March 2021 due to increased abdominal perimeter, decreased appetite and dyspnea on medium exertion. Abdomino-pelvic ultrasound reported that the uterus was enlarged, with medium-element intramural fibroids. The endometrium was heterogeneous. The right ovary had a complex, giant cyst, 276 mm x 250 mm x 276 mm, with a volume of 10,000 cc. In addition, splenomegaly, right hydronephrosis and left renal lithiasis. Tumor markers were reported normal. Laparoscopic surgery showed a tumor occupying the entire abdominal cavity measuring 40 x 30 cm and attached to the posterior wall of the uterus, with both ovaries unaltered, with no free fluid; total hysterectomy was performed. CONCLUSIONS: Degenerative changes in uterine leiomyomas can distort the usual tumor structure and reflect it in images typical of an ovarian cystic tumor; in the initial study this represents a challenge for the surgeon and should be considered part of the differential diagnosis of adnexal masses. In the case patient, with minimally invasive surgery, complete resection of the specimen was achieved, despite the increased size, with less risk of wound complications and less postoperative pain; the incisions are small and with favorable esthetic outcomes and fewer days of in-hospital stay.

Comparación entre el coste y el cierre de heridas en una unidad de gestión clínica que incluye una enfermera de práctica avanzada en heridas crónicas complejas / Comparison between the cost and the wound closure in a Clinical Management Unit that includes an Advanced Practice Nurse on Complex Chronic Wounds

Introducción: Las heridas de difícil cicatrización o complejas que aquejan a un alto porcentaje de la población, además de afectar a la calidad de vida de quien las padece, repercute en un alto coste económico, en tiempo de enfermería y en estancias hospitalarias. Objetivo: Conocer el coste económico, las heridas complicadas, el coste medio para el cierre y la media de días para el mismo que ha tenido cada profesional de enfermería comparado con la enfermera de práctica avanzada (EPA) en heridas crónicas complejas (HCC) de la Unidad. Metodología: Estudio descriptivo longitudinal del total de los informes de valoración de heridas generados desde la aplicación de heridas en DIRAYA (sistema de información asistencial corporativo para todo el Servicio Andaluz de Salud, historia de salud única de todos los episodios asistenciales del ciudadano) y que necesitaron materiales de cura en ambiente húmedo suministrados por la Unidad de Gestión Clínica (UGC). El estudio se desarrolló en la UGC de Algarrobo, perteneciente al Área de Gestión Sanitaria Este de Málaga-Axarquía, desde junio 2019 hasta junio 2020. Se trata de una muestra conceptual, ya que se ha incluido a toda la población de enfermeros y enfermeras de la UGC y las correspondientes hojas emitidas por ellos. Resultados: Durante el periodo de estudio se registraron un total de 416 heridas en la Unidad, de las cuales se cerraron 338, el 81,2%. La EPA trató el 22,6% del total de las heridas (94 heridas) y resolvió el 90,4% de ellas, siendo el coste medio para el cierre de las heridas de 21,3 €, en un plazo medio de 30,7 días, mientras que el resto de profesionales tuvo que tratar de media 32,2 heridas y se resolvieron de media el 76,7%, siendo el coste medio para el cierre de una herida de 36,2 € en un plazo medio de 172,1 días (AU)

Introduction: Hard-to-heal or complex wounds that afflict a high percentage of the population, besides affecting the quality of life of the ones who suffer from them, impacts on a high economic cost, on nursing time and on hospital stays. Aims: Knowing the economic cost, complex wounds, average cost for closing and the average number of days for it that every nurse had compared to the Advanced Practice Nurse (APN) on complex chronic wounds from the unit. Methodology: Longitudinal descriptive study of the total injury assessment reports generated from the wounds application on DIRAYA (corporate healthcare information system for the entire Andalusian health service, unique Health Story of all citizen welfare episodes) and that needed healing material in a humid environment supplied by CMU. The study was developed in the Clinical Management Unit (CMU) of Algarrobo, belonging to the East Health Management Area of Málaga - Axarquía, since June 2019 until June 2020. This is a conceptual sample as the entire CMU nurse population and the corresponding pages issued by them have been included. Results: During the study period, a total of 416 wounds were registered in the Unit, of which 338 were closed, 81.2%. The APN treated 22.6% of the total wounds (94 wounds) and resolved the 90.4% of them, being the average cost for the wounds closure of 21.3 €, within an average of 30.7 days. While the rest of the professionals had to treat an average of 32.2 wounds and the average resolved was 76.7%, being the average cost for the wound closure of 36.2 € within an average of 172,1 days. Conclusions: The introduction of the APN on complex chronic wounds in the CMU had led the unit to a better result in terms of spending on materials and shortening the days for the wounds resolution, which influences a better quality of life for those who suffer from them (AU)

Mecanismo y factores de riesgo asociados al desarrollo de la diabetes mellitus tipo 2 / Mechanism and risk factors associated with the development of type 2 diabetes mellitus

Fundamentos: Se reconoce a la diabetes Mellitus tipo 2 como un tipo de enfermedad crónica no transmisible; entre los factores de riesgo a padecerla, destaca el estilo de vida no saludable, específicamente dietas altas en calorías y hábitos sedentarios. El presente estudio tuvo como objetivo, revisar los mecanismos etiológicos y o patológicos que conllevan al desarrollo de la diabetes Mellitus tipo 2 (DM2). Métodos: Se realizó una investigación de tipo documental bibliográfica, de estudios sobre los mecanismos y factores deriesgo, que contribuyen con la aparición de DM2, los cuales se encuentren publicados en revistas médicas en idioma inglés o español, indexadas en Scopus, Elservier, Medline o Scielo, entrelos años 2010 y 2020. Resultados: DM2 es una patología adquirida dependientedel síndrome metabólico, prevenible y tratable, en el que la resistencia a la insulina se vuelve un indicador de riesgo. Las evaluaciones sugieren que se debe corregir el estilo de vida y evitar los factores de riesgo, que son los generadores de ácidos grasos no esterificados y radicales libres exógenos.Conclusiones: La mejor estrategia de control, sigue siendo la aplicación de medicina preventiva e integral. (AU)

Background: Diabetes Mellitus type 2 is recognized among the chronic non-communicable diseases and among the risk factors for developing it, unhealthy lifestyle is described, specifically high calorie diets and sedentary habits. The aim of the present study was to review the etiological and pathologicalmechanisms that lead to the development of type 2 diabetesmellitus (DM2). Methods: A bibliographic documentary research was conducted on the mechanisms and risk factors that contribute to the onset of DM2, which are published in medical journals in English or Spanish, indexed in Scopus, Elservier, Medline or Scielo, between 2010 and 2020. Results: DM2 is an acquired pathology dependent on the metabolic syndrome, preventable and treatable, in which insulin resistance becomes a risk indicator. Evaluations suggest that lifestyle should be corrected and risk factors, which arethe generators of non-esterified fatty acids and exogenous free radicals, should be avoided. Conclusions: The best control strategy remains the application of preventive and integrative medicine. (AU)

Las fronteras invisibles en las comunas 16 y 70 de Medellín (2008-2013): poder, territorio y resistencia / Invisible Borders in Medellin's Communes 16 and 70 (2008-2013): Power, Territory, and Resistance

Resumen En este artículo se analiza la forma en que se desarrolló el fenómeno de las fronteras invisibles en las comunas 16 y 70 de Medellín entre los años 2008 y 2013, momento en que se agudizó el conflicto armado ur bano en la ciudad. Con ese objetivo se entrevistaron actores sociales, institucionales y académicos que experimentaron esos enfrentamientos violentos desde diversas posiciones. Estas voces se analizaron a partir de discusiones teóricas en torno al poder, el territorio y la resistencia, que permitieron explicar la territorialización de una violencia que devino en la imposición de barreras imaginarias sobre la población.

Abstract This article analyses the way in which the phenomenon of invisible borders was developed in the Medellin's communes 16 and 70 between the years 2008 and 2013. It was the moment in which the urban armed conflict was intensified in the city. With this objective in mind, social, Institutional, and academic actors, who experienced these violent clashes were interviewed, from different positions. These voices were analyzed from theoretical discussions around power, territory, and resistance, which allowed to explain the territorialization of a violence that became the imposition of imaginary borders on the population.

Climate change decreases suitable areas for rapeseed cultivation in Europe but provides new opportunities for white mustard as an alternative oilseed for biofuel production.

Oilseed crops, including several mustards, are cultivated as biofuel sources worldwide. However, common mustard crops (e.g., the rapeseed Brassica napus) grow naturally in mesic temperate regions, which are expected to be impaired by global warming and increased aridity. In particular, increased aridity is predicted to reduce the oil concentration and seed yield of rapeseed crops. There is therefore an urgent need to identify alternative bioenergy crops that are preadapted to future climatic conditions. An alternative to conventional Brassica species for biodiesel production is the white mustard Sinapis alba, which is native to the circum-Mediterranean region and has a high seed lipid content. S. alba grows spontaneously in olive groves and other widespread Mediterranean crops; accordingly, it could be easily cultivated by companion planting to improve ecosystem function by decreasing soil loss, controlling microbial disease, and assisting in the maintenance of biodiversity. In this study, using species distribution modeling, we predicted climatically suitable areas for the cultivation of S. alba in Western Europe across the Mediterranean Basin under present climatic conditions and several climate change scenarios. We show that current climatically suitable areas for S. alba cultivation do not overlap with those for B. napus. Unlike B. napus, S. alba could be cultivated throughout most of the circum-Mediterranean region. According to our models, increases in aridity and annual mean temperatures will expand the climatically suitable areas for S. alba in the Mediterranean Basin. However, suitable areas for the cultivation of B. napus will decrease significantly in Western Europe. Our results indicate that S. alba is a strong, environmentally safe candidate for biofuel production throughout the Mediterranean Basin and other Western European countries, especially under climate change scenarios that are expected to impair current oilseed crops.

Epidemiological Characteristics of Dengue Disease in Latin America and in the Caribbean: A Systematic Review of the Literature.

Dengue, an important mosquito-borne virus transmitted mainly by Aedes aegypti, is a major public health issue in Latin America and the Caribbean. National epidemiological surveillance systems, usually based on passive detection of symptomatic cases, while underestimating the true burden of dengue disease, can provide valuable insight into disease trends and excess reporting and potential outbreaks. We carried out a systematic review of the literature to characterize the recent epidemiology of dengue disease in Latin America and the English-speaking and Hispanic Caribbean Islands. We identified 530 articles, 60 of which met criteria for inclusion. In general, dengue seropositivity across the region was high and increased with age. All four virus serotypes were reported to circulate in the region. These observations varied considerably between and within countries and over time, potentially due to climatic factors (temperature, rainfall, and relative humidity) and their effect on mosquito densities and differences in socioeconomic factors. This review provides important insight into the major epidemiological characteristics of dengue in distinct regions of Latin America and the Caribbean, allowing gaps in current knowledge and future research needs to be identified.

Development and characterization of microsatellite primers in the endangered Mediterranean shrub Ziziphus lotus (Rhamnaceae).

PREMISE OF THE STUDY: Microsatellite primers were developed to characterize and evaluate patterns of genetic diversity and structure in the endangered Mediterranean shrub Ziziphus lotus (Rhamnaceae). METHODS AND RESULTS: Twenty microsatellite primers were developed for Z. lotus, of which 14 were polymorphic. We evaluated microsatellite polymorphism in 97 specimens from 18 Spanish and seven Moroccan populations. Between two and eight alleles were found per locus, and the average number of alleles was 5.54. Observed heterozygosity and expected heterozygosity ranged from 0.08 to 0.90 and from 0.08 to 0.82, respectively. Nine of these primers also amplified microsatellite loci in Z. jujuba. CONCLUSIONS: The microsatellite markers described here will be useful in studies on genetic variation, population genetic structure, and gene flow in the fragmented habitat of this species. These markers are a valuable resource for designing appropriate conservation measures for the species in the Mediterranean range.

Validación de las escalas de Braden y EMINA en pacientes de atención domiciliaria incluidos en programa de inmovilizados / Validity of Braden and EMINA’s scales for patients at home, include in the immobilized patients programmee

Objetivo: comprobar la validez de las escalas Braden y EMINA y seleccionar puntos de corte cuantitativos para discriminar el riesgo de úlcera por presión (UPP) en pacientes domiciliarios. Método: estudio longitudinal o de seguimiento de una cohorte de 6 meses de duración, con cuatro valoraciones, una cada 2 meses. Ámbito de estudio: áreas de gestión sanitaria Este de Málaga-Axarquía y Serranía, de Málaga. Sujetos de estudio: pacientes en programa de inmovilizados sin UPP. Cuestionario confeccionado por los autores que incluye entre otros: datos demográficos, ingreso hospitalario, escalas de Braden y EMINA. Muestra: 353 pacientes, usando muestreo aleatorio simple. Resultado: las escalas originales mantienen consistencia interna con alpha superior a 0,7. Se han establecido nuevos puntos de corte, discriminando pacientes con riesgo de UPP o sin él, resultando una sensibilidad del 61-89% y una especificidad del 64-70%. Las escalas categorizadas tienen exactitud como método diagnóstico igual o superior al 65%. Las odds ratio (OR) son significativas e indican que existen diferencias en el riesgo de UPP en función de nuevos puntos de corte. La determinación de los puntos de corte resultaron: riesgo alto: sensibilidad ≤ 10%, especificidad ≥ 95%, puntuación en la escala de Braden ≤ 10, EMINA 12-15; riesgo moderado: sensibilidad entre el 10% y el 83%, especificidad entre el 64% y el 95%, Braden 11-15 y EMINA 7-11; riesgo bajo: sensibilidad entre el 83% y el 100%, especificidad entre el 0% y el 64%, Braden 16-22 y EMINA 1-6; riesgo nulo: sensibilidad 100%, especificidad 0%, Braden 23, EMINA 0

Aim: Verifying Braden and EMINA's validity and select quantitative cut-off points to differentiate Ulcer by Pressure threat in home-care patients. Method: group monitor progress and longitudinal examination of a cohort of patients during 6 months, evaluating three times, once every two months. Scope of application: Health Care Administration Este Málaga-Axarquía and Serranía, Málaga. Subject of study: Immobilized Programme patients without UPP. Resources: Authors’ questionnaire including among others: demographic data, hospital admission date, Braden and EMINA scales. Sample: 353 patients, simple random sampling. Result: The original scales support internal consistency with alpha superior to 0.7. Establishing new cut-off points discriminating patients with or without UPP threat, resulting sensitivity of 61%- 89% and specificity 64%-70%. The classified scales have a precisions as a diagnostic method equal or superior to 65%. OR are significant, indicating existing differences under threat of UPP according to new cut-off points. Cut-off points’ selected resulted in: High sensitivity threat ≤10% ≥ 95%, Braden’s scale average ≤ 10, EMINA 12-15. Moderate threat 10%,

Neoplasias mucinosas del apéndice / Mucinous Neoplasm of the Appendix

Se presenta el caso de una paciente femenina de 52 años de edad que consulta por dolor abdominal al servicio de urgencias, donde se le realizan estudios imaginológicos y se sospecha de mucocele. Se confirma el diagnóstico por patología de mucocele del apéndice por neoplasia mucinosa apendicular de bajo grado. En este artículo se describe la presentación clínica de la paciente y se analizan los hallazgos en los estudios por imágenes, en cirugía y en patología. Posteriormente se hace una revisión de la literatura de los tumores mucinosos del apéndice, con énfasis en los hallazgos imaginológicos. Estos tumores son raros, presentan diferente histología y no tienen predilección de género. Se presentan principalmente como abdomen agudo, aunque tienen otras formas de presentación que pueden confundir al clínico. Como se describe, los estudios por imágenes cumplen un papel importante en el diagnóstico, seguimiento y detección de complicaciones.

We present the case of a 52- year- old woman who complains of abdominal pain to the emergency room, ultrasound and CT scan suggested the diagnosis of mucocele and was confirmed by pathology as mucocele of the appendix due low grade appendix mucinous neoplasm. In our review we describe clinical presentation of the patient and discuss imaging findings as well as findings in surgery and pathology. Subsequently, there is a literature review and the mucinous tumors of the appendix, with emphasis in the imaging techniques. These tumors are rare, have different histology and no gender predilection. They occur mainly as acute abdomen, although they have other forms of presentation which may mislead the clinician. As described, imaging techniques play an important role in the diagnosis, follow-up, and detection of complications

Fiabilidad de las escalas de Braden y EMINA en pacientes de atención domiciliaria incluidos en programa de inmovilizados / Reliability in Braden and EMINA's scales for patients in domiciliary, included in the immobilized patients' programme

Objetivo: comprobar la fiabilidad de las escalas de Braden y EMINA (escalas de valoración del riesgo de úlceras por presión) en atención domiciliaria. Método: estudio observacional de tipo transversal. Ámbito de estudio: Área de Gestión Sanitaria Este de Málaga-Axarquía y Área de Gestión Sanitaria Serranía, ambas de Málaga. Sujetos de estudio: pacientes incluidos dentro del Programa de Inmovilizados sin úlceras por presión. Instrumentos: escalas de Braden y EMINA. Muestra: 30 pacientes, usando una técnica de muestreo aleatorio simple. Resultados: Escala de Braden: Alfa de Cronbach de 0,78 para ambos observadores. Coeficiente de correlación intraclase (CCI) para la puntuación total de la escala, 0,968. El índice kappa ponderado para cada uno de los 6 ítems de la escala oscila entre 0,685 que es el más bajo y corresponde a fricción y deslizamiento y 1,00 para el más alto, que corresponde a percepción sensorial. Escala EMINA: el Alfa de Cronbach oscila entre 0,69 y 0,73 entre observadores. Coeficiente de correlación intraclase para la puntuación total de la escala, 0,974. El índice kappa ponderado para cada uno de los 5 ítems de la escala oscila entre 0,750, el más bajo que corresponde a la actividad, y 1,00 para el más alto, que corresponde a nutrición. Conclusiones: la escala de Braden tiene mayor consistencia interna, aunque el grado de acuerdo cuando se utilizan las escalas de manera categórica es superior en la EMINA. Ambas escalas son instrumentos fiables para el uso en atención domiciliaria, aunque sería conveniente establecer nuevos puntos de corte, para definir o categorizar el riesgo en esta población

Objective: Assessing reliability of the Braden and EMINA scales (Rating Scales for the Risk of pressure sores) in-home care. Method: Cross-sectional study. Population of study from Málaga: area of Heath Management East Málaga-Axarquia and mountainous region. Subjects of study: Patients entered in the programme of immobilize persons without pressure sore. Questionnaires: Braden and EMINA. Sample: 30 patients selected by simple randomisation. Results: Braden Scale: Cronbach's coefficient alpha 0.78 for both ratters. The Intraclass correlation coefficient (ICC) is 0.968. Kappa values for each of the 6 items vary from 0.685 for the friction and slipping item and 1 for the sensorial perception item. EMINA Scale: Cronbach's coefficent alpha 0.69 and 0.73 for each of the two raters, respectively. The Intraclass correlation coefficient (ICC) is 0.974. Kappa values for each of the 6 items vary from 0.750 for the activity item and 1 for the nutrition item Conclusions: The internal consistency of Braden scales is higher than the consistency of the EMINA scale. However, when the individual item agreement between raters was higher for the EMINA than for the Braden. Both scales, as continuous, are reliable instruments to be used for in-home care, although it would be convenient to establish new cut-off points for the scales in order to categorise the risk of pressure sores for this type of population

Glandular trichomes as an inflorescence defence mechanism against insect herbivores in Iberian columbines.

Glandular trichomes play a defensive role against herbivores in the leaves of many plant species. However, their functional role in inflorescences has not been studied, even though theory suggests that tissues with a higher fitness value, such as inflorescences, should be better defended. Using manipulative experiments, we analysed the defensive role of glandular trichomes against herbivorous insects in the inflorescence of Iberian columbines (genus Aquilegia), and its inter-population and inter-taxa variation in relation to herbivore abundance and potential selective pressure. The experiments were conducted in eight populations belonging to four subspecies of two columbines (Aquilegia vulgaris and Aquilegia pyrenaica). For each population, we estimated the density of glandular trichomes in the inflorescences, the abundance of insects stuck in the inflorescences, the abundance of small herbivorous insects, the incidence of damage on flowers and fruits, and the fruit set. The density of glandular trichomes on the inflorescence of A. vulgaris and A. pyrenaica was higher in regions of higher herbivore abundance. We also found that when the plants lose the protection of glandular trichomes, small insects have better access to flowers and fruits, causing more damage and reducing plant fitness. This study concludes that glandular trichomes are part of an adaptive response against phytophagous insect herbivory. The observed variation in herbivore pressure between taxa, likely caused by habitat differentiation, might have played a role in trait differentiation through divergent selection. This result adds evidence to the differentiation of the Iberian columbines through habitat specialization.

Prevalence of antiretroviral drug resistance among treatment-naive and treated HIV-infected patients in Venezuela.

An in-house, low-cost method was developed to determine the genotypic resistance of immunodeficiency virus type 1 (HIV-1) isolates. All 179 Venezuelan isolates analysed belonged to subtype B. Primary drug resistance mutations were found in 11% of 63 treatment-naïve patients. The prevalence of resistance in isolates from 116 HIV-positive patients under antiretroviral treatment was 47% to protease inhibitors, 65% to nucleoside inhibitors and 38% to non-nucleoside inhibitors, respectively. Around 50% of patients in the study harboured viruses with highly reduced susceptibility to the three classical types of drugs after only five years from their initial diagnoses.

Prevalence of antiretroviral drug resistance among treatment-naive and treated HIV-infected patients in Venezuela

An in-house, low-cost method was developed to determine the genotypic resistance of immunodeficiency virus type 1 (HIV-1) isolates. All 179 Venezuelan isolates analysed belonged to subtype B. Primary drug resistance mutations were found in 11 percent of 63 treatment-naïve patients. The prevalence of resistance in isolates from 116 HIV-positive patients under antiretroviral treatment was 47 percent to protease inhibitors, 65 percent to nucleoside inhibitors and 38 percent to non-nucleoside inhibitors, respectively. Around 50 percent of patients in the study harboured viruses with highly reduced susceptibility to the three classical types of drugs after only five years from their initial diagnoses.

[Ontogenic development of the incudostapedial joint]. / Desarrollo ontogénico de la articulación incudoestapedial.

OBJECTIVE: To study the development of the incudostapedial joint in human embryos and foetuses. MATERIAL AND METHOD: 46 temporal bones with specimens between 9 mm and newborns were studied. The preparations were sliced serially and dyed using the Martins trichrome technique. RESULTS: The incudostapedial joint takes on the characteristics of a spheroidal joint at 16 weeks of development. The cartilage covering the articular surfaces is formed by different strata that develop in succession: the superficial stratum at 19 weeks, the transitional between 20 and 23 weeks, and the radial from 24 weeks on. The subchondral bone develops after 29 weeks by the mechanisms of apposition and extension of the periosteal and endosteal bones, but it is not until week 34 that it completely covers the articular surfaces, following constitution of the bone fascicles transmitting the lines of force. The articular capsule is formed from the inter-zone, the surface zone develops the capsular ligament, and the internal surface develops the synovial membrane. CONCLUSIONS: At the time of birth, the incudostapedial joint is completely developed.

Desarrollo ontogénico de la articulación incudoestapedial / Ontogenic development of the incudostapedial joint

Objetivo: Estudiar el desarrollo de la articulación incudoestapedial en embriones y fetos humanos. Material y método: Se han estudiado 46 huesos temporale scon ejemplares comprendidos entre 9 mm y recién nacidos. Las preparaciones estaban cortadas en serie y teñidas con la técnica de tricrómico de Martins. Resultados: La articulación incudoestapedial adquiere las características de una articulación sinovial de tipo enartrosisa las 16 semanas de desarrollo. El cartílago que recubre las superficies articulares está formado por diferentes estratos que se desarrollan sucesivamente: el superficial, a las 19 semanas; el de transición, entre las 20 y las 23 semanas, y el radial, a partir de las 24 semanas. El hueso subcondral se desarrolla a partir de las 29 semanas por los mecanismos de aposición y extensión del periostal y el endostal, pero no es hasta la semana 34 cuando recubre por completo las superficies articulares, constituidos los fascículos óseos por los que se transmitirán las líneas de fuerza. La cápsula articularse forma a partir de la interzona, la zona superficial desarrolla el ligamento capsular y la interna, la sinovial. Conclusiones: En el momento del nacimiento la articulación incudoestapedial está completamente desarrollada (AU)

Objective: To study the development of the incudostapedial joint in human embryos and foetuses. Material and method: 46 temporal bones with specimens between 9 mm and new-borns were studied. The preparations were sliced serially and dyed using the Martins trichrome technique. Results: The incudostapedial joint takes on the characteristics of a spheroidal joint at 16 weeks of development. The cartilage covering the articular surfaces is formed by different strata that develop in succession: the superficial stratum at 19 weeks, the transitional between 20 and 23 weeks, and the radial from 24 weeks on. The subchondral bone develops after 29 weeks by the mechanisms of apposition and extension of the periosteal and endosteal bones, but it is not until week 34 that it completely covers the articular surfaces, following constitution of the bone fascicles transmitting the lines of force. The articular capsule is formed from the inter-zone, the surface zone develops the capsular ligament, and the internal surface develops the synovial membrane. Conclusions: At the time of birth, the incudostapedial joint is completely developed (AU)

[Connections between bone marrow and mesenchyme of the middle ear]. / Conexiones entre la médula ósea de los osículos y el mesénquima del oído medio.

OBJECTIVE: To investigate the presence of connections between the bone marrow of the ossicles and the mesenchyme that fills the future tympanic cavity. MATERIAL AND METHODS: Ninety temporal bones from embryos and foetuses were examined, selecting 15 aged between 20th to 30th weeks of development, to show connections between ossicle marrow and mesenchyme. RESULTS: The connections are transitory and appear in the malleus and the incus between 20th to 24th weeks of development, while in the stapes appear later, being between 24th to 28th weeks. CONCLUSIONS: These connections may have an important role in the phagocytosis of the mesenchymal remains and join in the detritus elimination mechanisms produced during the regression.