Dual corneal involvement by endothelial and epithelial corneal dystrophies in Steinert's disease: A case of triple dystrophy.

INTRODUCTION: A case of dual corneal involvement due to Fuchs endothelial corneal dystrophy and epithelial basement membrane corneal dystrophy in a patient with Steinert's myotonic dystrophy type 1 is described, and a literature review on the triple association is made. CASE DESCRIPTION: A 52-year-old male diagnosed with myotonic dystrophy type 1 presented due to progressive bilateral vision loss during the past year. A full ophthalmological evaluation was made, with biomicroscopy, funduscopy, anterior segment optical coherence tomography, and endothelial cell count using specular microscopy. Exploration revealed bilateral superior palpebral ptosis, visual acuity 0.5 in the right eye and 0.3 in the left eye, and with an intraocular pressure of 11 and 10 mmHg, respectively. Biomicroscopy revealed map-dot-fingerprint lesions characteristic of epithelial basement membrane corneal dystrophy in both eyes, as well as abundant endothelial guttae due to Fuchs endothelial corneal dystrophy (stage II) and bilateral nuclear and posterior subcapsular cataracts. Specular microscopy in turn showed cell loss and a destructured endothelial map. Finally, anterior segment optical coherence tomography revealed the accumulation of epithelial basement membrane and hyperreflective endothelial excrescences corresponding to guttae. CONCLUSION: The association of Fuchs endothelial corneal dystrophy with myotonic dystrophy has been described and explained by a common genetic basis in the expansion of a CTG trinucleotide repeat, though this is the first reported case of the triple association of Fuchs endothelial corneal dystrophy, epithelial basement membrane corneal dystrophy, and myotonic dystrophy type 1. New mutations or still unknown genetic alterations could possibly explain the triple association reported in our case.

Large Scale Shadow Annotation and Detection Using Lazy Annotation and Stacked CNNs.

Recent shadow detection algorithms have shown initial success on small datasets of images from specific domains. However, shadow detection on broader image domains is still challenging due to the lack of annotated training data, caused by the intense manual labor required for annotating shadow data. In this paper we propose "lazy annotation", an efficient annotation method where an annotator only needs to mark the important shadow areas and some non-shadow areas. This yields data with noisy labels that are not yet useful for training a shadow detector. We address the problem of label noise by jointly learning a shadow region classifier and recovering the labels in the training set. We consider the training labels as unknowns and formulate label recovery as the minimization of the sum of squared leave-one-out errors of a Least Squares SVM, which can be efficiently optimized. Experimental results show that a classifier trained with recovered labels achieves comparable performance to a classifier trained on the properly annotated data. These results motivated us to collect a new dataset that is 20 times larger than existing datasets and contains a large variety of scenes and image types. Naturally, such a large dataset is appropriate for training deep learning methods. Thus, we propose a stacked Convolutional Neural Network architecture that efficiently trains on patch level shadow examples while incorporating image level semantic information. This means that the detected shadow patches are refined based on image semantics. Our proposed pipeline, trained on recovered labels, performs at state-of-the art level. Furthermore, the proposed model performs exceptionally well on a cross dataset task, proving the generalization power of the proposed architecture and dataset.

Association Between Erectile Dysfunction and Carotid Subclinical Atherosclerosis in HIV-Infected Patients.

BACKGROUND: Erectile dysfunction (ED) is frequent in HIV-infected patients, and it can be associated with atherosclerosis and cardiovascular events. So, the objective was to evaluate whether the presence of moderate-severe ED was a marker of subclinical atherosclerosis (SCA) in HIV-infected patients. METHODS: A cross-sectional study was conducted in a cohort of HIV-infected patients. The presence of ED was assessed using the International Index of Erectile Function (IIEF-5) questionnaire. The presence of SCA was determined by calculating the mean carotid intima-media thickness with Doppler ultrasound. A logistic regression analysis was performed to check the variables associated with SCA. RESULTS: One hundred thirty-nine men of 45 (10) years of age were included, of which 130 (94.9%) received antiretroviral therapy. In 30 (22%) patients, the Framingham score was higher than 10%. In 36 (25.9%) patients, ED was detected in a moderate-severe degree and in 53 (38.1%), SCA was detected. In the multivariate analysis, variables independently associated with the presence of SCA were as follows: older age [odds ratio (OR) = 1.22, confidence interval (CI) 95%: 1.1 to 1.35, P < 0.001] and moderate-severe ED (OR = 4.68, CI 95%: 1.18 to 18.5; P = 0.028). Variables associated with moderate-severe ED were as follows: age (OR = 1.107, CI 95%: 1.041 to 1.17, P < 0.001) and having antibodies for hepatitis C virus (OR = 5.12, CI 95%: 1.54 to 17.03, P < 0.001). CONCLUSIONS: HIV-Infected patients often have moderate-severe ED, especially the elderly and coinfected patients with hepatitis C virus. ED can be an early clinical manifestation of incipient atherosclerosis, so its presence should involve a deep control of cardiovascular risk factors and using a regimen with a better atherogenic profile.

Leave-One-Out Kernel Optimization for Shadow Detection and Removal.

The objective of this work is to detect shadows in images. We pose this as the problem of labeling image regions, where each region corresponds to a group of superpixels. To predict the label of each region, we train a kernel Least-Squares Support Vector Machine (LSSVM) for separating shadow and non-shadow regions. The parameters of the kernel and the classifier are jointly learned to minimize the leave-one-out cross validation error. Optimizing the leave-one-out cross validation error is typically difficult, but it can be done efficiently in our framework. Experiments on two challenging shadow datasets, UCF and UIUC, show that our region classifier outperforms more complex methods. We further enhance the performance of the region classifier by embedding it in a Markov Random Field (MRF) framework and adding pairwise contextual cues. This leads to a method that outperforms the state-of-the-art for shadow detection. In addition we propose a new method for shadow removal based on region relighting. For each shadow region we use a trained classifier to identify a neighboring lit region of the same material. Given a pair of lit-shadow regions we perform a region relighting transformation based on histogram matching of luminance values between the shadow region and the lit region. Once a shadow is detected, we demonstrate that our shadow removal approach produces results that outperform the state of the art by evaluating our method using a publicly available benchmark dataset.

[Bibliometric study of scientific output published by the Revista Panamericana de Salud Pública/Pan American Journal of Public Health from 1997-2012]. / Estudio bibliométrico de la producción científica publicada por la Revista Panamericana de Salud Pública/ Pan American Journal of Public Health en el período de 1997 a 2012.

OBJECTIVE: To characterize the scientific output of the Revista Panamericana de Salud Pública/Pan American Journal of Public Health (RPSP) as a scientific publication of reference in the public health sector in the Americas. METHODS: A descriptive cross-sectional study was conducted based on the articles published in the RPSP from 1997-2012. Bibliometric indicators of productivity (documents published, languages, authorship, and indices of productivity and collaboration); impact (impact factor according to the SciELO Network, Journal Citation Report and SCImago); key words; and bibliographic references, their structure (document type and main nucleus of Bradford) and degree of obsolescence (Burton and Kebler half-life, and Price index), were analyzed. RESULTS: A total of 2 815 articles with a median of 3 authors and 2 institutions per article were published. The percentage of original research articles increased in 2008-2012 compared to 2003-2007 and 1997-2002 (P < 0.001). The predominant language was Spanish, displaced by English in the last 5 years. A total of 88.76% of the key words referred to the Health Sciences Descriptors (DeCS) and had a public health and community orientation related to the Americas. The Burton and Kebler half-life of bibliographic references was 8 years, although it decreased to 5 years in 2012. The Price index was 20.47% and the nucleus of Bradford was made up of 20 mainstream journals. The percentage of self-citation was low (2.07%). CONCLUSIONS: The RPSP is an international publication with bibliometric indicators similar to those of the most representative Latin American health science journals, with improvements in the recent years studied that lead it to fully meet international publishing criteria.

Estudio bibliométrico de la producción científica publicada por la Revista Panamericana de Salud Pública/ Pan American Journal of Public Health en el período de 1997 a 2012 / Bibliometric study of scientific output published by the Revista Panamericana de Salud Pública/Pan American Journal of Public Health from 1997-2012

OBJETIVO: Caracterizar la producción científica de la Revista Panamericana de Salud Pública/Pan American Journal of Public Health (RPSP), como publicación científica de referencia en el área de la salud pública en las Américas. MÉTODOS: Estudio descriptivo transversal a partir de los artículos publicados en la RPSP entre 1997 y 2012. Se analizaron indicadores bibliométricos de productividad (documentos publicados, idiomas, autoría, e índices de productividad y colaboración); repercusión (factor de impacto según la Red SciELO, Journal Citation Report y SCImago); palabras clave; y referencias bibliográficas, su estructura (tipo de documento y núcleo principal de Bradford) y grado de obsolescencia (semiperíodo de Burton y Kebler, e índice de Price), entre otros. RESULTADOS: Se publicaron 2 815 artículos con una mediana de 3 autores y 2 instituciones por artículo. La proporción de artículos de investigación original aumentó en 2008-2012 con respecto a 2003-2007 y 1997-2002 (P < 0,001). El idioma predominante fue el español, desplazado por el inglés en los últimos 5 años. De las palabras clave, 88,76% se correspondían con los Descriptores en Ciencias de la Salud (DeCS) y mostraron una orientación salubrista y comunitaria dirigida a las Américas. El semiperíodo de Burton y Kebler de las referencias bibliográficas fue de 8 años, aunque bajó a 5 años en 2012; el índice de Price fue de 20,47%, y el núcleo de Bradford lo conformaron 20 revistas de la corriente principal; el porcentaje de autocitas fue bajo (2,07%). CONCLUSIONES: La RPSP es una publicación internacional con indicadores bibliométricos similares a los de las revistas latinoamericanas más representativas de las ciencias de la salud, con mejoras en los últimos años estudiados que la llevan a cumplir totalmente con los criterios editoriales internacionales.

OBJECTIVE: To characterize the scientific output of the Revista Panamericana de Salud Pública/Pan American Journal of Public Health (RPSP) as a scientific publication of reference in the public health sector in the Americas. METHODS: A descriptive cross-sectional study was conducted based on the articles published in the RPSP from 1997-2012. Bibliometric indicators of productivity (documents published, languages, authorship, and indices of productivity and collaboration); impact (impact factor according to the SciELO Network, Journal Citation Report and SCImago); key words; and bibliographic references, their structure (document type and main nucleus of Bradford) and degree of obsolescence (Burton and Kebler half-life, and Price index), were analyzed. RESULTS: A total of 2 815 articles with a median of 3 authors and 2 institutions per article were published. The percentage of original research articles increased in 2008-2012 compared to 2003-2007 and 1997-2002 (P < 0.001). The predominant language was Spanish, displaced by English in the last 5 years. A total of 88.76% of the key words referred to the Health Sciences Descriptors (DeCS) and had a public health and community orientation related to the Americas. The Burton and Kebler half-life of bibliographic references was 8 years, although it decreased to 5 years in 2012. The Price index was 20.47% and the nucleus of Bradford was made up of 20 mainstream journals. The percentage of self-citation was low (2.07%). CONCLUSIONS: The RPSP is an international publication with bibliometric indicators similar to those of the most representative Latin American health science journals, with improvements in the recent years studied that lead it to fully meet international publishing criteria.

El fenotipo «hipertrigliceridemia-cintura abdominal aumentada» es un factor de riesgo de aterosclerosis subclínica en pacientes con infección por el virus de la inmunodeficiencia humana / Hypertriglyceridemic waist phenotype is a risk factor for subclinical atherosclerosis in human immunodeficiency virus-infected patients

Fundamento y objetivo. Estudiar la asociación entre el fenotipo «hipertrigliceridemia-cintura abdominal aumentada» y la presencia de aterosclerosis subclínica en pacientes con infección por el virus de la inmunodeficiencia humana (VIH). Pacientes y método. Estudio transversal. Se consideró fenotipo «hipertrigliceridemia-cintura abdominal aumentada» si la cintura era ≥90cm y los trigliceridos ≥2,0mmol/l (178mg/dl) en varones y ≥85cm y ≥1,5mmol/l (133mg/dl), respectivamente, en mujeres. Se utilizó el grosor de la íntima-media (GIM) carotídeo para detectar la presencia de aterosclerosis subclínica. Resultados. Se analizaron 152 pacientes, de los que 128 (84,2%) recibían tratamiento antirretroviral; el 40,7% con inhibidores de la proteasa y un 38,1% con inhibidores de la transcriptasa inversa no nucleósidos. La prevalencia del fenotipo «hipertrigliceridemia-cintura abdominal aumentada» fue del 23,6% (intervalo de confianza del 95% [IC 95%] 16,8-30,3%). Comparados con los pacientes con cintura y valores de triglicéridos normales, los pacientes con fenotipo «hipertrigliceridemia-cintura abdominal aumentada» tuvieron un mayor riesgo cardiovascular según Framingham (media [DE] de 11,09 [7,6] frente a 3,88 [4], p=0,001) y una mayor probabilidad de presentar lipodistrofia (33,3 frente a 13,7%, p=0,039) y síndrome metabólico (69,4 frente a 1,9%, p<0,001). El GIM estuvo elevado en 21 (13,8%) pacientes. Los factores que se relacionaron de forma independiente con GIM elevado fueron el fenotipo «hipertrigliceridemia-cintura abdominal aumentada» (odds ratio [OR] 4,66, IC 95% 1,05-20,6, p=0,043) y el síndrome metabólico (OR 3,74, IC 95% 1,25-11,23, p=0,018). Conclusiones. El fenotipo «hipertrigliceridemia-cintura abdominal aumentada» es un factor de riesgo de aterosclerosis subclínica en pacientes con infección por VIH y podría constituir un marcador indirecto asociado a la presencia de lipodistrofia, síndrome metabólico y riesgo cardiovascular elevado(AU)

Background and objective. To study the association between hypertriglyceridemic waist phenotype and the presence of subclinical atherosclerosis in human immunodeficiency virus (HIV) infected patients. Patients and methods. Cross sectional study. Hypertriglyceridemic waist phenotype was considered if the waist was ≥90cm and triglycerides ≥2.0mmol/l (178mg/dl) in men and ≥85cm and ≥1.5mmol/L (133mg/dl) in women, respectively. We used the intima-media thickness (IMT) to detect carotid subclinical atherosclerosis. Results. We analyzed 152 patients, of whom 128 (84.2%) were receiving antiretroviral therapy, 40.7% were receiving protease inhibitors and 38.1% were treated with non-nucleoside reverse transcriptase inhibitors. The prevalence of hypertriglyceridemic waist phenotype was 23.6% (95% confidence interval [CI] 16.8-30.3%). Patients with hypertriglyceridemic waist phenotype had higher cardiovascular risk according to the Framingham score (11.09 [7.6] vs 3.88 [4], P=0.001) and lipodystrophy (33.3 vs. 13.7%, P=0.032) and metabolic syndrome (69.4 vs. 1.9%, P<0.001) were more frequent. The IMT was elevated in 21 (13.8%) patients. Hypertriglyceridemic waist phenotype (odds ratio [OR] 4.66 [95%CI 1.05-20.6; P = 0.043]) and metabolic syndrome (OR 3.74 [95%CI 1.25-11.23; P = 0.018]) were independently associated with higher IMT. Conclusions. The hypertriglyceridemic waist phenotype is a risk factor for subclinical atherosclerosis in HIV infected patients and it is useful to detect patients with lipodystrophy, metabolic syndrome and high cardiovascular risk(AU)

[Hypertriglyceridemic waist phenotype is a risk factor for subclinical atherosclerosis in human immunodeficiency virus-infected patients]. / El fenotipo "hipertrigliceridemia-cintura abdominal aumentada" es un factor de riesgo de aterosclerosis subclínica en pacientes con infección por el virus de la inmunodeficiencia humana.

BACKGROUND AND OBJECTIVE: To study the association between hypertriglyceridemic waist phenotype and the presence of subclinical atherosclerosis in human immunodeficiency virus (HIV) infected patients. PATIENTS AND METHODS: Cross sectional study. Hypertriglyceridemic waist phenotype was considered if the waist was ≥90cm and triglycerides ≥2.0mmol/l (178mg/dl) in men and ≥85cm and ≥1.5mmol/L (133mg/dl) in women, respectively. We used the intima-media thickness (IMT) to detect carotid subclinical atherosclerosis. RESULTS: We analyzed 152 patients, of whom 128 (84.2%) were receiving antiretroviral therapy, 40.7% were receiving protease inhibitors and 38.1% were treated with non-nucleoside reverse transcriptase inhibitors. The prevalence of hypertriglyceridemic waist phenotype was 23.6% (95% confidence interval [CI] 16.8-30.3%). Patients with hypertriglyceridemic waist phenotype had higher cardiovascular risk according to the Framingham score (11.09 [7.6] vs 3.88 [4], P=0.001) and lipodystrophy (33.3 vs. 13.7%, P=0.032) and metabolic syndrome (69.4 vs. 1.9%, P<0.001) were more frequent. The IMT was elevated in 21 (13.8%) patients. Hypertriglyceridemic waist phenotype (odds ratio [OR] 4.66 [95%CI 1.05-20.6; P = 0.043]) and metabolic syndrome (OR 3.74 [95%CI 1.25-11.23; P = 0.018]) were independently associated with higher IMT. CONCLUSIONS: The hypertriglyceridemic waist phenotype is a risk factor for subclinical atherosclerosis in HIV infected patients and it is useful to detect patients with lipodystrophy, metabolic syndrome and high cardiovascular risk.

Stents intracoronarios en vasos pequeños: resultados clínicos a corto y largo plazo / Coronary Stenting in small vessels: short-term and long-term clinical outcome

Objetivo. Determinar los resultados clínicos de la revascularización con stents intracoronarios en vasos menores de 3 mm. Pacientes y métodos. El tamaño del vaso se evaluó como menor o mayor o igual de 3 mm en el momento del procedimiento y fue medido en el diámetro máximo. Estudiamos a un total de 234 pacientes consecutivos (300 stents en 279 lesiones), con un seguimiento clínico de 17,6 ñ 10 meses, comprendiendo 84 stents implantados en 79 lesiones localizadas en vasos pequeños (< 3 mm).Se usó dilatación del stent a altas presiones (15,8 ñ 2,2 atm) y tratamiento con aspirina y ticlopidina durante un mes. Resultados. La tasa de éxito del implante, sin eventos clínicos hospitalarios, fue del 93,7 por ciento en los vasos < 3 mm y del 93,5 por ciento en los 3 mm (p = NS). La trombosis subaguda del stent ocurrió en tres vasos < 3 mm, frente a ninguna oclusión trombótica en vasos 3 mm (el 3,8 frente al 0 por ciento; p = 0,006). A los dos años, la supervivencia libre de revascularización de la lesión diana fue inferior en vasos pequeños (el 73,6 frente al 90,3 por ciento; p < 0,001). En el análisis multivariado, un vaso < 3 mm fue predictor independiente de revascularización de la lesión diana a largo plazo (p = 0,001). A los dos años, la supervivencia libre de cualquier acontecimiento (muerte [el 4,6 frente al 3,8 por ciento; p = 0,7], infarto de miocardio [el 2,9 frente al 1,1 por ciento; p = 0,3] y revascularización de la lesión diana) para pacientes con implantes en vasos < 3 mm fue del 69,1, frente al 86,6 por ciento para implantes en vasos 3 mm (p < 0,001).Conclusión. El implante de stents en coronarias < 3 mm puede realizarse con éxito inicial similar al de los vasos mayores; sin embargo, se asocia a una mayor incidencia, tanto de trombosis subaguda como de reestenosis clínica (revascularización de la lesión diana) a largo plazo (AU)