A machine learning tool for the diagnosis of SARS-CoV-2 infection from hemogram parameters.

Monocytes and neutrophils play key roles in the cytokine storm triggered by SARS-CoV-2 infection, which changes their conformation and function. These changes are detectable at the cellular and molecular level and may be different to what is observed in other respiratory infections. Here, we applied machine learning (ML) to develop and validate an algorithm to diagnose COVID-19 using blood parameters. In this retrospective single-center study, 49 hemogram parameters from 12,321 patients with clinical suspicion of COVID-19 and tested by RT-PCR (4239 positive and 8082 negative) were analysed. The dataset was randomly divided into training and validation sets. Blood cell parameters and patient age were used to construct the predictive model with the support vector machine (SVM) tool. The model constructed from the training set (5936 patients) achieved an accuracy for diagnosis of SARS-CoV-2 infection of 0.952 (95% CI: 0.875-0.892). Test sensitivity and specificity was 0.868 and 0.899, respectively, with a positive (PPV) and negative (NPV) predictive value of 0.896 and 0.872, respectively (prevalence 0.50). The validation set model (4964 patients) achieved an accuracy of 0.894 (95% CI: 0.883-0.903). Test sensitivity and specificity was 0.8922 and 0.8951, respectively, with a positive (PPV) and negative (NPV) predictive value of 0.817 and 0.94, respectively (prevalence 0.34). The area under the receiver operating characteristic curve was 0.952 for the algorithm performance. This algorithm may allow to rule out COVID-19 diagnosis with 94% of probability. This represents a great advance for early diagnostic orientation and guiding clinical decisions.

Fast measurements of average flow velocity by Low-Field ¹H NMR.

In this paper, we describe a method for measuring the average flow velocity of a sample by means of Nuclear Magnetic Resonance. This method is based on the Carr-Purcell-Meiboom-Gill (CPMG) sequence and does not require the application of any additional static or pulsed magnetic field gradients to the background magnetic field. The technique is based on analyzing the early-time behavior of the echo amplitudes of the CPMG sequence. Measurements of average flow velocity of water are presented. The experimental results show a linear relationship between the slope/y-intercept ratio of a linear fit of the first echoes in the CPMG sequence, and the average flow velocity of the flowing fluid. The proposed method can be implemented in low-cost Low-Field NMR spectrometers allowing a continuous monitoring of the average velocity of a fluid in almost real-time, even if the flow velocity changes rapidly.

[The effectiveness of training schemes in the treatment of acute coronary syndrome at health centers]. / Mejoría en la asistencia al síndrome coronario agudo en los centros de asistencia primaria mediante un plan de formación.

OBJECTIVE: A preliminary evaluation of the impact of a training program on pre-hospitalization care of acute coronary syndrome (ACS). DESIGN: A cross-sectional study. SETTING: Lleida Health Service area. PATIENTS: A total of 661 ACS cases were observed in the Intensive Medical Care Unit from January 1st 2002 to December 31st 2004. INTERVENTIONS: A training program for primary health care medical staff on the pre-hospitalization management of ACS from July 2003 to December 2006 in 29 health care centers was conducted. MAIN ENDPOINTS OF INTEREST: The evolution of 5 pre-hospitalization interventions, (acetylsalicylic acid, nitroglycerine, electrocardiogram, intravenous tube and intravenous morphine) throughout the study period was measured. RESULTS: It was noted during the study that those centers in which training programs were held had a clear increase in the use of the 5 pre-hospitalization interventions. Insertion of an intravenous line, administration of intravenous morphine and administration of acetylsalicylic acid were all observed to have multiplied their use 10, 8 and 3 times, respectively. CONCLUSIONS: A training scheme for general practitioners (GP) is essential to ensure appropriate care of patients with this condition.

Mejoría en la asistencia al síndrome coronario agudo en los centros de asistencia primaria mediante un plan de formación / The effectiveness of training schemes in the treatment of acute coronary syndrome at health centers

Objetivo. Evaluar preliminarmente el impacto de un programa de formación en la atención prehospitalaria al síndrome coronario agudo (SCA). Diseño. Estudio transversal. Ámbito. Área de Salud de Lleida. Pacientes. Seiscientos sesenta y un casos de SCA atendidos en un Servicio de Medicina Intensiva (SMI) del 1 de enero de 2002 al 31 de diciembre de 2004. Intervenciones. Se realizó un plan de formación para médicos de asistencia primaria sobre manejo prehospitalario del SCA entre julio de 2003 y diciembre de 2006 en 29 centros de salud. Principales variables de interés. Se midió la evolución de la prevalencia de aplicación de 5 medidas prehospitalarias (ácido acetilsalicílico, nitroglicerina, electrocardiograma, vía venosa y cloruro mórfico endovenoso) a lo largo del período de estudio. Resultados. En los centros con plan de formación finalizado se observó un incremento evidente en la aplicación de las 5 medidas prehospitalarias a lo largo del período de estudio. La apertura de una vía intravenosa, la administración de cloruro mórfico intravenoso y la administración de ácido acetilsalicílico multiplican su aplicación por 10, 8 y 3 respectivamente. Conclusiones. Un adecuado plan de formación permite mejorar la asistencia de estos pacientes por parte de los médicos de cabecera

Objective. A preliminary evaluation of the impact of a training program on pre-hospitalization care of acute coronary syndrome (ACS). Design. A cross-sectional study. Setting. Lleida Health Service area. Patients. A total of 661 ACS cases were observed in the Intensive Medical Care Unit from January 1st 2002 to December 31th 2004. Interventions. A training program for primary health care medical staff on the pre-hospitalization management of ACS from July 2003 to December 2006 in 29 health care centers was conducted. Main endpoints of interest. The evolution of 5 pre-hospitalization interventions, (acetylsalicylic acid, nitroglycerine, electrocardiogram, intravenous tube and intravenous morphine) throughout the study period was measured. Results. It was noted during the study that those centers in which training programs were held had a clear increase in the use of the 5 pre-hospitalization interventions. Insertion of an intravenous line, administration of intravenous morphine and administration of acetylsalicylic acid were all observed to have multiplied their use 10, 8 and 3 times, respectively. Conclusions. A training scheme for general practitioners (GP) is essential to ensure appropriate care of patients with this condition

Development of an interest in a career in public health during medical school.

OBJECTIVES: In The Netherlands, approximately 12% of medical graduates spend their professional life in public health, but it is the authors' belief that few of them become interested in such a career during medical school. The aim of this study was to investigate students' development of interest in a career in a public health specialty during medical school. METHODS: A written questionnaire was completed by students of all years at a Dutch medical school in 2002 (n=1371) and 2003 (n=1293). Students indicated their interest in a career in 37 Dutch medical specialties. Three public health specialties were distinguished and compared with the least popular specialty, the most popular specialty and with the average interest over all specialties. RESULTS: Interest in a career in occupational health and social insurance health was low throughout medical school. However, almost 15% of students indicated a high level of interest in youth health care in the first year of medical school, which is over twice as many as for the average specialty. This percentage decreased dramatically during medical school. At graduation, all three public health specialties had interest figures well below the average. CONCLUSIONS: Students have little interest in careers in public health. However, given that approximately 12% of medical graduates spend their professional life in public health, the factors that influence career preferences should be investigated. Targeted measures may yield more primary career preference in this direction. Reasons for the loss of interest in youth health care need to be investigated.

[Parotid gland myoepitheliomas. Differential diagnosis with pleomorphic adenoma]. / Mioepiteliomas de glándula parótida. Diagnóstico diferencial con el adenoma pleomorfo.

Myoepitheliomas are rare benign tumours of head and neck. The parotid gland is the most common site of origin. It consists on proliferation of myoepithelial cells and it shows some features similar to preomorphic adenoma although the ductal elements are very low. Diagnosis requires histology and immunohistochemistry because fine needle aspiration often shows erroneous results. Limited parotidectomy is the choice treatment. We report two cases of parotid gland myoepithelioma confirmed by immunohistochemistry.

Mioepiteliomas de glándula parótida. Diagnóstico diferencial con el adenoma pleomorfo / Parotid gland myoepitheliomas. Differential diagnosis with pleomorphic adenoma

Los mioepiteliomas son tumores benignos poco frecuentes de cabeza y cuello. El lugar de aparición más frecuente es la glándula parótida. Están formados por la proliferación de células mioepiteliales. Presentan algunas características que los asemejan a los adenomas pleomorfos, pero el componente ductal es muy inferior. El diagnóstico requiere el estudio, histológico e inmunohistoquímico porque a menudo la PAAF arroja resultados erróneos. El tratamiento de elección es la parotidectomía limitada. Presentamos 2 casos clínicos de mioepitelioma de glándula parótida confirmados mediante estudio inmunohistoquímico

Myoepithelioma are rare benign tumours of head and neck. The parotid gland is the most common site of origin. It consists on proliferation of myoepithelial cells and it shows some features similar to pleomorphic adenoma although the ductal elements are very low. Diagnosis requires histology and immunohistochemistry because fine ceedle aspiration often shows erroneous results. Limited parotidectomy is the choice treatment. We report two cases of parotid gland myoepithelioma confirmed by immunohistochemistry

[Cidofovir activity in infantile recurrent respiratory papillomatosis]. / Actividad del cidofovir en la papilomatosis respiratoria infantil recidivante.

We report the case of a 4 year old boy that arrived to our department refering a 4 months history of dysphony complicated in the last week with inspiratory estridor. He was diagnosed of respiratory papillomatosis. In the next 10 months he underwent 6 operations to remove papillomas with CO2 laser. In the last operation we decided to add adjuvant therapy with intralesional injections of cidofovir once all papillomas had been removed. After more than a year of monitoring he remains disease free.

Actividad del cidofovir en la papilomatosis respiratoria infantil recidivante / Cidofovir activity in infantile recurrent respiratory papillomatosis

Presentamos el caso de un varón de 4 años que acude a nuestra consulta por presentar disfonía de 4 meses de evolución que en la última semana se ha complicado con estridor inspiratorio. Es diagnosticado de papilomatosis respiratoria. En los siguientes 10 meses es sometido a 6 intervenciones para resección de papilomas con láser CO2. En la última intervención se decide realizar terapia adyuvante mediante inyección intralesional cidofovir en el lecho resultante tras la exéresis. Tras más de un año de seguimiento el paciente permanece libre de enfermedad

We report the case of a 4 year old boy that arrived to our department refering a 4 months history of dysphony complicated in the last week with inspiratory estridor. He was diagnosed of respiratory papillomatosis. In the next 10 months he underwent 6 operations to remove papillomas with CO2 laser. In the last operation we decided to add adjuvant therapy with intralesional injections of cidofovir once all papillomas had been removed. After more than a year of monitoring he remains disease free

Problem-based learning versus lecture-based learning in postgraduate medical education.

OBJECTIVES: The objective of this study was to investigate the effectiveness of problem-based learning in comparison with lecture-based learning in a postgraduate medical training program concerning the management of mental health problems for occupational health physicians. METHODS: A randomized controlled trial in 1999, with a mean follow-up of 14 months after the educational intervention, was used involving postgraduate medical education and training for occupational health physicians in The Netherlands, with 118 physicians in training as occupational health physicians. The experimental program was based on the principles of problem-based learning; the control program used the traditional lecture-based approach. Both programs were aimed at improving knowledge of and performance in the occupational management of work-related mental health problems. As the main outcome measures, knowledge tests consisting of true-or-false and open-answer questions and performance in practice based on self-reports and performance indicators were used. Satisfaction with the course was rated by the participants. RESULTS: In both groups, knowledge had increased equally directly after the programs and decreased equally after the follow-up. The gain in knowledge remained positive. The performance indicator scores also increased in both groups, but significantly more so in the problem-based group. The problem-based group was less satisfied with the course. CONCLUSIONS: Both forms of postgraduate medical training are effective. In spite of less favorable evaluations, the problem-based program appeared to be more effective than the lecture-based program in improving performance. Both programs, however, were equally effective in improving knowledge levels.

[Prevalence of tobacco and alcohol consumption, attitudes and knowledge in high school students of the province of Tarragona (Spain)]. / Prevalencia del consumo de tabaco y alcohol, actitudes y creencias en estudiantes de bachillerato de la provincia de Tarragona (España).

OBJECTIVE: In this study, we provide a descriptive-comparative analysis of legal drug consumption in high school students from a rural area in the province of Tarragona. PATIENTS AND METHOD: A questionnaire of 25 closed-type questions was administered to 569 individuals. Analysis of variables was carried out by using the Chi-square test. RESULTS: We have observed that our prevalence results are similar to those found in other studies, without significant differences between them. In addition to this, use of tobacco and alcohol is determined by many different factors, every factor having a different influence on each individual. CONCLUSIONS: With the results we have obtained, we believe that tobacco smoking and alcohol consumption are determined by multiple factors, mainly psychological and family and social circumstances. We think the problem of alcohol and tobacco use among teenagers should be addressed from a multidisciplinary point-of-view, which would enable us to cover the broad range of factors that influence this pattern of behavior.

[Findings in the middle ear mucosa after a long term dysfunction of the eustachian tube]. / Hallazgos en la mucosa del oído medio tras la disfunción tubárica prolongada.

In the occurrence of long term dysfunction of the tuba eustachii a series of alterations in continuity of the middle ear mucosa are verified. We studied which these changes could be in the mongolian gerbil, when the obstruction is prolonged for a long time.

[The mucosal subepithelial space in the middle ear in prolonged tubal dysfunction]. / El espacio subepitelial de la mucosa del oído medio en la disfunción tubárica prolongada.

Prolonged tubal dysfunction produces changes in the mucosa and subepithelial space. We report the results of an experimental study in Mongolian gerbils.

Assessment and management of opioid withdrawal symptoms in buprenorphine-dependent subjects.

The spontaneous physical dependence of buprenorphine was assessed in opioid addicts who switched from heroin to sublingual or intravenous buprenorphine. Twenty-two patients were randomly assigned to double-blind administration of methadone (n = 11) or placebo (n = 11) for 13 days after abrupt withdrawal of buprenorphine. Methadone was administered according to four pre-established dosing schedules depending on the previous amount of daily consumed buprenorphine. No methadone-treated patient required modification of the therapeutic regimen, whereas eight of eleven placebo-treated patients needed treatment with methadone. Buprenorphine withdrawal syndrome was of opioid type, began somewhat more slowly, and showed a peak until day 5. The occurrence, time-course and characteristics of buprenorphine withdrawal syndrome make it necessary to reconsider the abuse potential of this analgesic.

Follow-up after a six-month maintenance period on naltrexone versus placebo in heroin addicts.

Naltrexone and placebo as adjuvant treatment of opioid dependence were compared in a double-blind, controlled clinical trial in 50 heroin addicts. The overall efficacy was assessed by the degree of treatment acceptance, percentage of relapse in heroin consumption, presence of side effects, and overall retention on naltrexone. A total of 50 patients of both sexes, aged from 18 to 30 years, who fulfilled DSM-III-R criteria for opioid dependence were included in the study. All patients completed detoxification with clonidine on an inpatient basis for 2 weeks and subsequently, on an out-patient basis, received oral naltrexone (350 mg per week) for a month. At the beginning of the second month patients were randomly allocated to treatment with naltrexone (28 patients) or placebo (22 patients) until a 6-month treatment period in a double-blind fashion had been completed. During the study period (1 year) all patients followed the same therapeutic schedule. Patients in both groups were comparable in terms of socio-demographic data and toxicological history. The efficacy of naltrexone was not superior to that of placebo as there were no significant differences in acceptance of treatment, retention rates, opioid and other drug consumption, drug compliance or side effects.

Cocaine abuse among heroin addicts in Spain.

Abuse of cocaine is becoming a major problem among heroin addicts in Spain. Between 1987 and 1988, 75% of patients admitted as inpatients for detoxification from opiate dependence had consumed cocaine during the 6 months prior to admission and 25% had abused cocaine daily or several times/week. These cocaine abusers showed more toxicologic and psychopathologic problems than opiate addicts who did not abuse cocaine. The opiate addicts who also abused cocaine had begun using illicit drugs earlier and showed a higher frequency of anti-HIV antibodies. They also had more antisocial personality disorders and persistence of depressive symptoms during opiate detoxification than heroin addicts who did not abuse cocaine. Based on these findings, we insist on the need to develop different treatments for detoxifying patients with this dual addiction.

[Aspergillus osteomyelitis of the sternum. Description of a case and review of the literature]. / Osteomielitis del esternón por Aspergillus. Descripción de un caso y revisión de la literatura.

Fungal infections by Aspergillus are rare in hosts with and uncompromised immunological status, but are not uncommon in immunologically compromised patients. Bone involvement is exceedingly rare, except for infections of the sinuses and periorbital area, and is usually due to the direct extension of the infection from a neighboring organ or to hematogenous dissemination in critically ill patients. The authors report a case of sternal osteomyelitis by Aspergillus flavus in a diabetic, immunologically competent patient, and review the literature on that condition.

[Prevalence of buprenorphine use by heroin addicts undergoing treatment]. / Prevalencia del consumo de buprenorfina en heroinómanos en tratamiento.

After buprenorphine was introduced as an analgesic, several clinical observations have stimulated the investigation of its potential abuse by heroin addicts. To evaluate the prevalence of buprenorphine use by a group of heroin abusers being treated on an outpatient basis, a cross-sectional study was carried out where the information given by the 188 subjects was verified by urine drug analyses. The patients had three different therapeutic modalities: methadone maintenance program (MMP), antagonist maintenance program (AMP), and drug-free program (DFP). The urine samples were analyzed with an enzyme immunoassay technique for the detection of heroin, methadone, dextropropoxyphene, cannabis and benzodiazepines. Buprenorphine was investigated with a radioimmunoassay technique. Overall 66% of the patients admitted having used buprenorphine throughout their toxicologic history (period prevalence) and 6.7% had positive urine controls for this drug (5% in the MMP group, 0% in the AMP group and 12% in the DFP group) (point prevalence). In 72% of the cases the drug was administered intravenously. In addition, a clinically statistically significant association was found between positivity for heroin and buprenorphine. The possible tolerance to the latter is suggested by the fact that the mean current dose was higher than the mean initial dose. In the study population, the use of cannabis and benzodiazepines was also very high. The results suggest that most patients had a previous history of buprenorphine use. This drug could have a higher potential for abuse than that found in previous experimental studies.