Imaging update on gallbladder adenomyomatosis and its mimics.

Radiologists across many imaging modalities commonly encounter gallbladder adenomyomatosis. The classic imaging appearances of gallbladder adenomyomatosis are well described and confirm benignity. However, in clinical practice, adenomyomatosis can be challenging to differentiate from other gallbladder pathologies that require cholecystectomy. In this article, we describe the common and uncommon appearances of gallbladder adenomyomatosis on multimodality imaging, helping differentiate adenomyomatosis from non-benign gallbladder abnormalities. Accurately differentiating adenomyomatosis from its mimics provides the surgical team with important clinical and surgical management information, improving patient outcomes.

A Rare Case of Myxedema Coma Precipitated by a Single Dose of Haloperidol in a Patient With Paranoid Schizophrenia.

Myxedema coma is a rare and potentially life-threatening condition that occurs when severe hypothyroidism is untreated or inadequately managed. It is characterized by a rapid drop in mental status, hypothermia, respiratory failure, hypotension, and other symptoms of severe metabolic dysfunction. The condition primarily affects older women with a history of thyroid dysfunction but can occur in any age or gender group. A common trigger for this condition is seen with a drop in atmospheric temperatures or during the cold winter months. However, a rare, poorly documented trigger is recent antipsychotic use in severe hypothyroid states. The diagnosis of myxedema coma requires prompt recognition and treatment, as delays can result in significant morbidity and mortality which is the objective of this case report.

Fracture of the Distal Radius by Tuberculous Osteomyelitis: A Case Report and Review of Literature.

We report a 94-year-old patient with a fractured radius that was being managed conservatively. At 2 months, an abscess was observed overlying the fracture site. An MRI scan was done and samples obtained for microbiological and pathological analyses. The patient was diagnosed with tuberculous osteomyelitis. Surgical debridement of the fracture site was performed, and the bone defect was filled with bone cement impregnated with gentamicin and rifampicin. Anti-tuberculosis therapy was administered for 9 months and the patient made an uneventful recovery. Early diagnosis and correct medical treatment depend on sound evidence of tuberculous osteomyelitis. Surgical debridement is essential if abscesses are present in the bone. Level of Evidence: Level V (Therapeutic).

Political Populism, Institutional Distrust and Vaccination Uptake: A Mediation Analysis.

Politics is ubiquitous in public health, but vaccines had never been weaponized to instill distrust to gain political advantage. In pandemic and post-pandemic scenarios, populist political parties could use vaccine-related issues to generate distrust in evidence-based knowledge. Therefore, some questions arise. What impact could populist political parties impinge on vaccination uptake rates through sowing political discontent? What could the medical institutions do to avoid the adverse effects that these political strategies could infringe? For answering these research questions, we first hypothesized that vaccine uptake was negatively associated with distrust in the institutions. Furthermore, we analyzed whether populism mediates this relationship. In doing so, we hypothesized a positive association between distrust and populism, because populists, mainly fueled by politically discontent citizens, offer hope of a better future, blaming their misfortune on the actions of the elite. Additionally, we hypothesized that those citizens with a higher level of political dissatisfaction, following the claims of the populist political parties, will have lower vaccine uptake results, because they will be discouraged from making the efforts to counter the pandemic. Based on a survey carried out by the European Commission that covered 27 E.U. + U.K. countries (totaling 27,524 respondents), this paper proves that an individual's political discontent fully mediates the relationship between distrust in institutions and vaccine uptake. Targeting the vaccine-hesitant population is quite convenient for populists because they only need to convince a minority of citizens not to be vaccinated to achieve their destabilizing goals. New outbreaks will appear if the minimum herd immunity coverage is not reached, reinforcing a vicious circle of distrust in elites, in consequence. For tackling this matter, recommendations are given to institutional managers from a social marketing standpoint.

Vaccine Hesitancy and Political Populism. An Invariant Cross-European Perspective.

Vaccine-hesitancy and political populism are positively associated across Europe: those countries in which their citizens present higher populist attitudes are those that also have higher vaccine-hesitancy rates. The same key driver fuels them: distrust in institutions, elites, and experts. The reluctance of citizens to be vaccinated fits perfectly in populist political agendas because is a source of instability that has a distinctive characteristic known as the "small pockets" issue. It means that the level at which immunization coverage needs to be maintained to be effective is so high that a small number of vaccine-hesitants have enormous adverse effects on herd immunity and epidemic spread. In pandemic and post-pandemic scenarios, vaccine-hesitancy could be used by populists as one of the most effective tools for generating distrust. This research presents an invariant measurement model applied to 27 EU + UK countries (27,524 participants) that segments the different behaviours found, and gives social-marketing recommendations for coping with the vaccine-hesitancy problem when used for generating distrust.

Analysis of predictors of mortality after surgical and non-surgical management in proximal humerus fractures.

BACKGROUND: Proximal humerus fractures are one of the main osteoporotic fractures. Choosing between conservative or surgical treatment is a controversial topic in the literature, as is the functional impact. The main aim of our study was to analyse whether patient comorbidities should influence the final therapeutic decision for these fractures. MATERIAL AND METHODS: We collected data from 638 patients with proximal humerus fractures. The main variable collected was exitus. We also collected the following data: age, gender, type of fracture, laterality, type of treatment, production mechanism, comorbidities and the Charlson comorbidity index (CCI) for each patient. The therapeutic indication used the criteria established by the Upper Limb Unit in our centre. We performed chi-square tests, Fischer's exact tests and Student's t-tests to compare the variables. We used the Kaplan-Meier method to analyse both the overall and disease-specific survival rates. We employed the Cox regression model to analyse factors associated with mortality. RESULTS: Patients with a CCI greater than 5 showed greater mortality (HR = 3.83; p < 0.001) than those with a CCI lower than 5. Within the patients who underwent surgery, those with a CCI higher than 5 had an increased mortality rate (HR = 22.6; p < 0.001) compared with those with a CCI lower than 5. Within the patients who received conservative treatment, those with a CCI over 5 showed greater mortality (HR = 3.64; p < 0.001) than those with a CCI under 5. CONCLUSIONS: Patients with proximal humerus fractures and associated comorbidities (CCI > 5) presented higher mortality than healthier patients. This mortality risk was greater in patients with comorbidities if surgical treatment was indicated rather than conservative treatment. Patient's comorbidities should be a fundamental parameter when planning the therapeutic strategy. LEVEL OF EVIDENCE: Level 3.

Global Vaccine Hesitancy Segmentation: A Cross-European Approach.

Vaccine-preventable diseases are global mainly in a globalized world that is characterized by a continuous movement of people and goods across countries. Vaccine hesitancy, the reluctance or refusal to vaccinate despite the availability of vaccines, is rising worldwide. What if the problem of vaccine hesitancy could be most effectively managed when treated globally rather than on a national or regional basis? What if a global vaccine-hesitant segment exists and the differences among countries are not so significant? Based on the Global Marketing Strategy paradigm, this paper shows that seven different cross-European segments exist based on the beliefs, attitudes, and behaviors collected in 28 European countries. These pan-European segments are differentiable (people in those segments have similar characteristics that are visibly dissimilar from the ones in other segments) and actionable (organizations would be able to propose interventions to the hesitant segments based on their profiles). With segmentation being the starting point of many public health intervention strategies for avoiding vaccine-hesitancy, the results recommend moderating the full-adaptation strategy that follows the "context matters" principle suggested by several political and public health international organizations. Embracing a more standardized strategy will allow the development of better services and strategies that support and enable desirable vaccination behaviors.

Application of 3D printing and distributed manufacturing during the first-wave of COVID-19 pandemic. Our experience at a third-level university hospital.

BACKGROUND: 3D printing and distributed manufacturing represent a paradigm shift in the health system that is becoming critical during the COVID-19 pandemic. University hospitals are also taking on the role of manufacturers of custom-made solutions thanks to 3D printing technology. CASE PRESENTATION: We present a monocentric observational case study regarding the distributed manufacturing of three groups of products during the period of the COVID-19 pandemic from 14 March to 10 May 2020: personal protective equipment, ventilatory support, and diagnostic and consumable products. Networking during this period has enabled the delivery of a total of 17,276 units of products manufactured using 3D printing technology. The most manufactured product was the face shields and ear savers, while the one that achieved the greatest clinical impact was the mechanical ventilation adapters and swabs. The products were manufactured by individuals in 57.3% of the cases, and our hospital acted as the main delivery node in a hub with 10 other hospitals. The main advantage of this production model is the fast response to stock needs, being able to adapt almost in real time. CONCLUSIONS: The role of 3D printing in the hospital environment allows the reconciliation of in-house and distributed manufacturing with traditional production, providing custom-made adaptation of the specifications, as well as maximum efficiency in the working and availability of resources, which is of special importance at critical times for health systems such as the current COVID-19 pandemic.

[All Roads Lead to Rome: Results of Non-Invasive Respiratory Therapies Applied in a Tertiary-Care Hospital Without an Intermediate Care Unit During the COVID-19 Pandemic]. / Todos los caminos llevan a Roma: resultados de las terapias respiratorias no invasivas aplicadas en un centro terciario sin Unidad de Cuidados Intermedios durante la pandemia de COVID-19.

Introduction: Non-invasive respiratory therapies (NRT) were widely used in the first wave of the COVID-19 pandemic in different settings, depending on availability. The objective of our study was to present 90-day survival and associated factors in patients treated with NRT in a tertiary hospital without an Intermediate Respiratory Care Unit. The secondary objective was to compare the outcomes of the different therapies. Methods: Observational study of patients treated with NRT outside of an intensive care or intermediate respiratory care unit setting, diagnosed with COVID-19 and acute respiratory distress syndrome by radiological criteria and SpO2/FiO2 ratio. A multivariate logistic regression model was developed to determine independently associated variables, and the outcomes of high flow nasal cannula and continuous positive airway pressure were compared. Results: In total, 107 patients were treated and 85 (79.4%) survived at 90 days. Before starting NRT, the mean SpO2/FiO2 ratio was 119.8 ± 59.4. A higher SOFA score was significantly associated with mortality (OR 2,09; 95% CI 1.34-3.27), while self-pronation was a protective factor (OR 0.23; 95% CI 0.06-0.91). High flow nasal cannula was used in 63 subjects (58.9%), and continuous positive airway pressure in 41 (38.3%), with no differences between them. Conclusion: Approximately 4 out of 5 patients treated with NRT survived to 90 days, and no significant differences were found between high flow nasal cannula and continuous positive airway pressure.

Food Reward and Food Choice. An Inquiry Through The Liking and Wanting Model.

What if consumers are getting obese because eating less calories is more difficult for persons that have a higher pleasure and desire towards food (Ikeda et al., 2005) and food companies do not help given only a two extreme option choice to satisfy their needs (i.e., low calories vs. high calories or healthy vs. unhealthy)? Reward systems are being described with a new conceptual approach where liking-the pleasure derived from eating a given food-and wanting-motivational value, desire, or craving-can be seen as the significant forces guiding eating behavior. Our work shows that pleasure (liking), desire (wanting), and the interaction between them influence and are good predictors of food choice and food intake. Reward responses to food are closely linked to food choice, inducing to caloric overconsumption. Based on the responses given to a self-administered questionnaire measuring liking and wanting attitudes, we found three different segments named 'Reward lovers,' 'Half epicurious,' and 'Non indulgents'. Their behavior when choosing food is quite different. Results show differential effects on caloric consumption depending on segments. The introduction of more food choices that try to balance their content is a win-win strategy for consumers, companies, and society.

Comparison of Extracellular and Intracellular Blood Compartments Highlights Redox Alterations in Alzheimer's and Mild Cognitive Impairment Patients.

BACKGROUND: Many studies suggest oxidative stress as an early feature of Alzheimer's Disease (AD). However, evidence of established oxidative stress in AD peripheral cells is still inconclusive, possibly due to both, differences in the type of samples and the heterogeneity of oxidative markers used in different studies. OBJECTIVE: The aim of this study was to evaluate blood-based redox alterations in Alzheimer's Disease in order to identify a peculiar disease profile. METHOD: To that purpose, we measured the activity of Superoxide Dismutase, Catalase and Glutathione Peroxidase both in the extracellular and the intracellular blood compartments of AD, MCI and control subjects. The amount of an open isoform of p53 protein (unfolded p53), resulting from oxidative modifications was also determined. RESULTS: Decreased SOD, increased GPx activity and higher p53 open isoform were found in both AD and MCI plasma compared to controls. In blood peripheral mononuclear cells, SOD activity was also decreased in both AD and MCI, and unfolded p53 increased exquisitely in younger AD males compared to controls. CONCLUSION: Overall, these data highlight the importance of considering both extracellular and intracellular compartments, in the determination of antioxidant enzyme activities as well as specific oxidation end-products, in order to identify peculiar blood-based redox alterations in AD pathology.

Determinantes de adherencia terapéutica en diabéticos consulta externa - Hospital Regional de Sonsonate del ISSS enero - marzo 2017 / Determinants of therapeutic adherence in diabetics Regional Hospital of the ISSS, Sonsonate January - March 2017

La adherencia terapéutica se describe como el acuerdo mutuo entre el paciente y su voluntad de aceptar lo indicado por el médico, con el fin de producir y obtener un resultado deseado. Se realizó un estudio de tipo descriptivo de corte transversal, con el objetivo de determinar el porcentaje de pacientes con terapia insuliníca con mal apego al tratamiento aplicando el cuestionario de determinantes de adherencia (CDA), a través de opciones de respuesta tipo Likert con puntajes que exploran variables psicosociales relacionadas con el apego al tratamiento, con la percepción del paciente hacia el régimen terapéutico y su relación con el profesional de salud, además de describir las características clínicas y sociodemográficas de estos pacientes. Este estudio se realizó en el área de consulta externa del Hospital Regional de Sonsonate del Instituto Salvadoreño del Seguro Social (ISSS), durante el período comprendido entre enero a marzo del 2017, con una muestra de 231 pacientes que asistieron a sus controles y cumplieron criterios de inclusión. Las características sociodemográficas que más destacaron en los pacientes entrevistados en la consulta externa que utilizan insulina fueron mayor de 60 años (58.9%) del sexo femenino (62.8%), viven con sus familiares (91.3%), mientras que dentro de las características clínicas son DM2 (98.7%), más de 5 años de padecer la enfermedad (88.7%) asisten a sus controles de forma regular (83.5%) con comorbilidad asociada (84.4%) y malos hábitos (73.2%). Se identificó con el CDA 54 pacientes con mal apego al tratamiento representando el 23.4%, donde los factores psicosociales influyeron en un 66.7%, seguido de factores relacionados con el régimen terapéutico en un 64.8%.y la interacción con el personal sanitario con un 31.5%. Se recomienda implementar un programa de atención para identificar por medio del CDA a los pacientes diabéticos con mal apego al tratamiento, dándoles seguimiento por un equipo multidisciplinario

Generalized Models for the Classification of Abnormal Movements in Daily Life and its Applicability to Epilepsy Convulsion Recognition.

The identification and the modeling of epilepsy convulsions during everyday life using wearable devices would enhance patient anamnesis and monitoring. The psychology of the epilepsy patient penalizes the use of user-driven modeling, which means that the probability of identifying convulsions is driven through generalized models. Focusing on clonic convulsions, this pre-clinical study proposes a method for generating a type of model that can evaluate the generalization capabilities. A realistic experimentation with healthy participants is performed, each with a single 3D accelerometer placed on the most affected wrist. Unlike similar studies reported in the literature, this proposal makes use of [Formula: see text] cross-validation scheme, in order to evaluate the generalization capabilities of the models. Event-based error measurements are proposed instead of classification-error measurements, to evaluate the generalization capabilities of the model, and Fuzzy Systems are proposed as the generalization modeling technique. Using this method, the experimentation compares the most common solutions in the literature, such as Support Vector Machines, [Formula: see text]-Nearest Neighbors, Decision Trees and Fuzzy Systems. The event-based error measurement system records the results, penalizing those models that raise false alarms. The results showed the good generalization capabilities of Fuzzy Systems.

Indices of Regional Brain Atrophy: Formulae and Nomenclature.

The pattern of brain atrophy helps to discriminate normal age-related changes from neurodegenerative diseases. Albeit indices of regional brain atrophy have proven to be a parameter useful in the early diagnosis and differential diagnosis of some neurodegenerative diseases, indices of absolute regional atrophy still have some important limitations. We propose using indices of relative atrophy for representing how the volume of a given region of interest (ROI) changes over time in comparison to changes in global brain measures over the same time. A second problem in morphometric studies is terminology. There is a lack of systematization naming indices and the same measure can be named with different terms by different research groups or imaging softwares. This limits the understanding and discussion of studies. In this technological report, we provide a general description on how to compute indices of absolute and relative regional brain atrophy and propose a standardized nomenclature.

Síndrome de embolia grasa cerebral: un caso clínico desencadenado tras una fractura humeral y sin distrés respiratorio asociado / Fat embolism syndrome in the brain: a clinical case triggered after fracture of the humerus and without any associated respiratory distress

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