Automatic classification and prioritisation of actionable BI-RADS categories using natural language processing models.

AIM: To facilitate the routine tasks performed by radiologists in their evaluation of breast radiology reports, by enhancing the communication of relevant results to referring physicians via a natural language processing (NLP)-based system to classify and prioritise Breast Imaging Reporting Data System (BI-RADS). MATERIALS AND METHODS: A NLP-based system was developed to classify and prioritise BI-RADS categories from breast ultrasound and mammogram reports, with the potential to streamline and speed up the standard procedures that radiologists must follow to evaluate and categorise breast imaging results. BI-RADS category extraction was divided into two specific tasks: (1) multi-label classification of BI-RADS categories (0-6) and (2) classification of high-priority (BI-RADS 0, 3, 4 and 5) and low priority (BI-RADS 1, 2, and 6) reports according to the previous BI-RADS assessment. RESULTS: To develop the NLP tool, three different Bidirectional Encoder Representations from Transformers (BERT)-based models (XLM-RoBERTa, BETO, and Bio-BERT-Spanish) were trained and tested on three distinct corpora (containing only breast ultrasound reports, only mammogram reports, or both), and achieved an accuracy of 74.29-77.5% in detecting BI-RADS categories and 88.52-91.02% in prioritising reports. CONCLUSION: The system designed can effectively classify all BI-RADS categories present in a single radiology report. In the clinical setting, such an automated tool can assist radiologists in evaluating breast radiology reports and decision-making tasks and enhance the speed of communicating priority BI-RADS reports to referring physicians.

Eleven cases of omeprazole hypersensitivity: diagnosis and study of cross-reactivity

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Systemic dermatitis due to tetrazepam.

Cutaneous adverse reactions to benzodiazepines seem to be rare. We report a 61-year-old man with adverse reactions after ingestion of metamizole, diclofenac, and tetrazepam. Skin prick tests with metamizole, diclofenac, and tetrazepam were negative. Patch tests with metamizole, diclofenac, and tetrazepam (all at 5% in aqueous solution) were performed, and were positive for tetrazepam. Oral challenge was performed with metamizole, acetylsalicylic acid, diclofenac, and tetrazepam with a positive result for diclofenac and tetrazepam. The patient tolerated other benzodiazepines. We present a patient who can tolerate diazepam but who had a type IV hypersensitivity reaction to tetrazepam confirmed by patch testing and oral challenge. The patient also presented an immediate hypersensitivity reaction after taking diclofenac.

Candidemia at a tertiary-care hospital: epidemiology, treatment, clinical outcome and risk factors for death.

The demographic, clinical and microbiological data of patients with candidemia at the "Hopital Universitario La Fe", a tertiary-care hospital in Valencia, Spain, from 1995 to 1997 was analyzed retrospectively. Candida spp. were isolated in blood cultures from 145 patients, 32% of whom were children (25% of these were neonates). The most common species isolated was Candida albicans, followed by Candida parapsilosis, Candida krusei and Candida tropicalis. Risk factors for candidemia included underlying disease, therapy with broad-spectrum antibiotics and the presence of a central venous catheter. The majority of children were treated with amphotericin B, whereas 52% of adults received fluconazole. Overall mortality was 44% (30% in children and 50% in adults), and attributable mortality was 30% (24% in children and 33% in adults). Multivariate analysis indicated that neutropenia, corticosteroid therapy, lack of antifungal treatment, and failure to replace the central venous catheter were factors associated with candidemia-related death. Among the adult population, an APACHE II score greater than 15 predicted candidemia-related death.

Two cases of fungemia due to Candida lusitaniae and a literature review.

Reported here are two cases of candidemia caused by Candida lusitaniae that occurred in two immunocompromised patients at Hospital Universitario "La Fe" in Valencia, Spain. Case 1 involved a low-birth-weight premature infant with congenital nephrotic syndrome who was successfully treated with amphotericin B, and case 2 involved a 50-year old woman with a high-grade malignancy lymphoma who succumbed to the infection. Antifungal susceptibility testing of the Candida lusitaniae isolates recovered from both patients revealed sensitivity to amphotericin, 5-flucytosine and fluconazole. Results are presented and discussed together with a comprehensive review of the literature, covering all previously reported cases of fungemia caused by this emerging pathogen.

[Update on the pharmacological interactions of systemic antifungal agents]. / Actualización de las interacciones farmacológicas de los antifúngicos sistémicos.

The incidence of systemic fungal infections has increased considerably in the last few decades, however the number of available antifungal agents continues to be reduced. Furthermore, these infections tend to affect patients with severe underlying diseases who are treated with different types of medication which may interact with antifungal agents, thus reducing their therapeutic efficacy or increasing their toxicity. In this paper, we discuss the interactions of systemic antifungal agents with other medications and comment on their clinical consequences and the therapeutic approach to adopt in each case.

[Molecular typing and sensitivity of Candida albicans isolates proceeding from critically ill patients]. / Tipificación molecular y sensibilidad de aislamientos de Candida albicans procedentes de pacientes críticos.

BACKGROUND: Nosocomial infection due Candida albicans in immunocompromised patients are recognized as a significant cause of morbidity and mortality. The endogenous forms of infections may require effective strategies for prevention which are different from those for exogenous infections due to transmission of any organism from patient to patient. Typing by PCR of isolates of C. albicans maybe useful for that. METHODS: Twenty-four isolates in blood cultures of 24 critically ill patients were studied. Typing by interrepeat PCR and in vitro antifungal susceptibility tests was performed by a microdilution. RESULTS: Twenty-one different genotypes were obtained. The isolates with same genotype shown different patterns of susceptibility. With one strain a band pattern very different from that obtained with the remaining isolates. CONCLUSIONS: No were relation between strain of same unit. The isolates with same genotype was different critically unit or year of isolation.

Fluconazole susceptibilities of bloodstream Candida sp. isolates as determined by National Committee for Clinical Laboratory Standards method M27-A and two other methods.

The in vitro activity of fluconazole against 143 Candida spp. obtained from the bloodstreams of 143 hospitalized patients from 1995 to 1997 was studied. Susceptibility tests were carried out by two macrodilution methods, the M27-A and a modified M27-A method (0. 165 M, pH 7/morpholinepropanesulfonic acid-buffered RPMI 1640 medium supplemented with 20 g of D-dextrose per liter), and by the agar diffusion method (with 15-microg fluconazole [Neo-Sensitab] tablets). With 2 microg of fluconazole per ml, 96.92% of 65 C. albicans isolates, 86.2% of 58 C. parapsilosis isolates 7 of 8 C. tropicalis isolates, and 1 of 6 C. glabrata isolates were inhibited. Only one strain of C. albicans and one strain of C. tropicalis were resistant. The agreement between the two macrodilution methods was greater than 90% within +/-2 log2 dilutions for all strains except C. glabrata (83.3%) and C. tropicalis (87.5%). Generally, MICs were 1 log2 dilution lower in glucose-supplemented RPMI 1640 medium. No correlation between zone sizes and MICs was found. All strains susceptible by the diffusion test were susceptible by the dilution method, but the converse was not necessarily true. Interestingly, inhibition zones were smaller for C. albicans, for which the geometric mean MIC was 0.29 microg/ml and the mean inhibition zone diameter was 25.7 mm, while for C. parapsilosis the geometric mean MIC was 0.96 microg/ml and the mean inhibition zone diameter was 31. 52 mm. In conclusion, the two macrodilution methods give similar results. The modified M27-A method with 2% dextrose has the advantage of shortening the incubation time and simplifying the endpoint determination.

[Genograms and the vital cycle of a family]. / Genograma y ciclo vital de la familia.

OBJECTIVES: To evaluate the importance of the genogram in order to identify the family vital cycle stages and demographic aspects related to the first two phases of this cycle. To study frequency of the vital cycle stages in families from 2 health centers and their relationships with behavioral and emotional traits and with health problems. DESIGN: Transversal descriptive study. LOCALE: Primary Health Care; Health Care Centers in Cartuja and Almanjayar. PATIENTS AND OTHER PARTICIPANTS: 347 genograms were compiled and analyzed by 6 licensed nurses. RESULTS: The reading of genograms made it possible to identify the vital family cycle stages in 97% of those studied. We discovered that 28.6% of the families were in Stage IV; 20% in Stage II-A; and 15% in Stage V. It appears that the contraction stage occurs more frequently in the Cartuja Health Center. The starting age of the formative stage has been reducing since the 1960s; at present it is at 21.7 years for males and 19 for females. The average duration which couples took to pass on to the II-A extension stage was 1.62 years. CONCLUSIONS: We believe that a genogram is an excellent tool to use to classify families according to the vital family cycle stages. Furthermore, to be able to identify the point where a family lies in this cycle is an important piece of data in a nurse's work.

[Bacteremia caused by Stenotrophomonas maltophilia: a clinical-epidemiological study and resistance profile]. / Bacteriemia por Stenotrophomonas maltophilia: estudio clínico- epidemiológico y perfil de resistencias.

Over a 7-year period (1990-1996), the causal disease, predisposing factors, focus infection, clinical manifestations, complications and evolution of patients presenting bacteremia from Stenotrophomonas maltophilia were analyzed retrospectively in a university hospital. A microbiological study was carried out to determine the percentage of positive blood cultures per episode and the characteristics of bacteremia and to evaluate the antibiotic susceptibility of the isolated strains. Twenty-seven episodes of bacteremia from S. maltophilia were identified in 26 patients, half of whom were women, and the median age was 40 years. A total of 48% of the patients had blood malignancy (12 cases), with acute myeloid leukemia (5 cases) being the most frequent. Seven patients (27%) needed to be admitted to an intensive care unit for some type of vital support and/or intensive treatment. The previous administration of large spectrum antimicrobials (21/26) and the presence of a catheter or central catheter (19/26) were the most frequently found predisposing factors (81% and 73%, respectively). One-quarter of the patients had received treatment with carbapenems. Immunodepression caused by chemotherapy or corticosteroids occurred in 65% of the cases. Half of the patients had undergone a major surgical procedure or had been intubated and submitted to mechanical ventilation. One-third presented granulocytopenia on the detection of bacteremia and 6 of the 12 patients with blood malignancy showed severe neutropenia (<500 neutrophils/mm3). The bacteremia was acquired in hospital in 78% of the cases (21/27). In 26% of these cases, S. maltophilia was diagnosed as the probable cause of bacteremia; in 34% this was just a possibility. The origin of the bacteremia was unknown in 11 cases (40%). Infection from the vascular catheter was the most frequent focus infection (7 cases). An average of 3.6 blood cultures were performed per patient, out of a total of 92, and 54% showed positive. The average time of growth for S. maltophilia in the blood culture bottles was 30 hours. One-third of the bacteremia episodes from S. maltophilia were polymicrobial (9/27). Clinical evolution was favorable in 18 patients, while 8 died (31%), 5 cases (20%) from causes directly related to the bacteremia (4 from septic shock). The mortality associated with the polymicrobial bacteremia was not significantly different from that for single microbial bacteremia from S. maltophilia. Ninety percent of the isolated strains showed susceptibility to co-trimoxazole, 77% to ticarcillin-clavulanic acid, 60% to ciprofloxacin, 62% to ceftazidime, 20% to amikacin and just 18% to imipenem.

[Evolution of resistance in the genus Enterococcus in strains isolated from blood]. / Evolución de las resistencias del género Enterococcus en cepas aisladas en sangre.

The objective of this study was to determine the evolution of the species distribution and the prevalence of resistance to the Enterococcus genus. We studied 281 strains of enterococcus isolated from blood samples: 90 throughout 1984 and 791 from the years 1994 to 1996. identification was made using PosCombo 4Y Microscan-Baxter dehydrated panels and the Rapid ID 32 Strep system (bioMerieux). The MICs were calculated using the agar dilution method according to recommendations of the NCCLS for the following antibiotics: ampicillin, vancomycin, teicoplanin, gentamicin, kanamycin and streptomycin. The production of betalactamases were evaluated using a paper disk with nitrocefin for all the strains. The genotypes with resistance to glycopeptides were determined using PCR. The percentage of E. faecalis for 1984-1986/1994-1996 was 82.2/79.4; of E. faecium 4.4/16.4; and other species 12.214.3. The resistance to ampicillin went from 1.1% to 5.8%; high level resistance to glycopeptides went from 0% to 9.9%; for low level from 7.7% to 2.6%; resistance to a high charge of gentamicin went from 27.7% to 40.8%; and that for kanamycin from 45.5% to 62.8%. Resistance to streptomycin remained constant (45.5%). No strains produced betalactamases. For the species E. faecium, a statistically significant increase was detected for global resistance to ampicillin, gentamicin and kanamycin, with resistance to streptomycin remaining at similar percentages. No high level resistance to glycopeptides was detected in the first time period, but the low level resistance was greater.

[In vitro activity of fluconazole against Candida albicans isolated from blood culture]. / Actividad in vitro de fluconazol sobre Candida albicans aisladas de hemocultivo.

The in vitro activity of fluconazole against 65 Candida albicans isolated from blood culture in 1995, 1996 and 1997 was studied by macrodilution and disk diffusion methods. The MIC ranged from 0.03 to 64 microg/ml, with 93.6% of strains being inhibited with 1 microg/ml fluconazole; the mode MIC was 0.25 microg/ml. Using this method, only one strain was resistant and another was susceptible depending on the dose. By diffusion, eight strains were susceptible, 53 intermediate, and four resistant. The strains susceptible by dilution were also susceptible by diffusion, but the strains resistant by diffusion were not always resistant by dilution. We find it therefore useful to determine the MIC of fluconazole to the C. albicans resistant by diffusion.