Revisión sistemática de la aplicación de algoritmos de «machine learning» en la esclerosis múltiple / A systematic review of the application of machine-learning algorithms in multiple sclerosis

Introducción: La aplicación de la inteligencia artificial y en particular de algoritmos de aprendizaje automático o «machine learning» (ML) constituye un desafío y al mismo tiempo una gran oportunidad en diversas disciplinas científicas, técnicas y clínicas. Las aplicaciones específicas en el estudio de la esclerosis múltiple (EM) no han sido una excepción mostrando un creciente interés en los últimos años. Objetivo: Realizar una revisión sistemática de la aplicación de algoritmos de ML en la EM. Material y métodos: Empleando el motor de búsqueda de libre acceso PubMed que accede a la base de datos MEDLINE, se seleccionaron aquellos estudios que incluyeran simultáneamente los dos siguientes conceptos de búsqueda: «machine learning» y «multiple sclerosis». Se rechazaron aquellos estudios que fueran revisiones, estuvieran en otro idioma que no fuera el castellano o el inglés, y aquellos trabajos que tuvieran un carácter técnico y no fueran aplicados para la EM. Se seleccionaron como válidos 76 artículos y fueron rechazados 38. Conclusiones: Tras la revisión de los estudios seleccionados, se pudo observar que la aplicación del ML en la EM se concentró en cuatro categorías: 1) clasificación de subtipos de pacientes dentro de la enfermedad; 2) diagnóstico del paciente frente a controles sanos u otras enfermedades; 3) predicción de la evolución o de la respuesta a intervenciones terapéuticas y por último 4) otros enfoques. Los resultados hallados hasta la fecha muestran que los diferentes algoritmos de ML pueden ser un gran apoyo para el profesional sanitario tanto en la clínica como en la investigación de la EM.(AU)

Introduction: The applications of artificial intelligence, and in particular automatic learning or “machine learning” (ML), constitute both a challenge and a great opportunity in numerous scientific, technical, and clinical disciplines. Specific applications in the study of multiple sclerosis (MS) have been no exception, and constitute an area of increasing interest in recent years. Objective: We present a systematic review of the application of ML algorithms in MS. Materials and methods: We used the PubMed search engine, which allows free access to the MEDLINE medical database, to identify studies including the keywords “machine learning” and “multiple sclerosis.” We excluded review articles, studies written in languages other than English or Spanish, and studies that were mainly technical and did not specifically apply to MS. The final selection included 76 articles, and 38 were rejected. Conclusions: After the review process, we established 4 main applications of ML in MS: 1) classifying MS subtypes; 2) distinguishing patients with MS from healthy controls and individuals with other diseases; 3) predicting progression and response to therapeutic interventions; and 4) other applications. Results found to date have shown that ML algorithms may offer great support for health professionals both in clinical settings and in research into MS.(AU)

A systematic review of the application of machine-learning algorithms in multiple sclerosis.

INTRODUCTION: The applications of artificial intelligence, and in particular automatic learning or "machine learning" (ML), constitute both a challenge and a great opportunity in numerous scientific, technical, and clinical disciplines. Specific applications in the study of multiple sclerosis (MS) have been no exception, and constitute an area of increasing interest in recent years. OBJECTIVE: We present a systematic review of the application of ML algorithms in MS. MATERIALS AND METHODS: We used the PubMed search engine, which allows free access to the MEDLINE medical database, to identify studies including the keywords "machine learning" and "multiple sclerosis." We excluded review articles, studies written in languages other than English or Spanish, and studies that were mainly technical and did not specifically apply to MS. The final selection included 76 articles, and 38 were rejected. CONCLUSIONS: After the review process, we established 4 main applications of ML in MS: 1) classifying MS subtypes; 2) distinguishing patients with MS from healthy controls and individuals with other diseases; 3) predicting progression and response to therapeutic interventions; and 4) other applications. Results found to date have shown that ML algorithms may offer great support for health professionals both in clinical settings and in research into MS.

A systematic review of the application of machine-learning algorithms in multiple sclerosis. / Revisión sistemática de la aplicación de algoritmos de «machine learning¼ en la esclerosis múltiple.

INTRODUCTION: The applications of artificial intelligence, and in particular automatic learning or "machine learning" (ML), constitute both a challenge and a great opportunity in numerous scientific, technical, and clinical disciplines. Specific applications in the study of multiple sclerosis (MS) have been no exception, and constitute an area of increasing interest in recent years. OBJECTIVE: We present a systematic review of the application of ML algorithms in MS. MATERIALS AND METHODS: We used the PubMed search engine, which allows free access to the MEDLINE medical database, to identify studies including the keywords "machine learning" and "multiple sclerosis." We excluded review articles, studies written in languages other than English or Spanish, and studies that were mainly technical and did not specifically apply to MS. The final selection included 76 articles, and 38 were rejected. CONCLUSIONS: After the review process, we established 4 main applications of ML in MS: 1) classifying MS subtypes; 2) distinguishing patients with MS from healthy controls and individuals with other diseases; 3) predicting progression and response to therapeutic interventions; and 4) other applications. Results found to date have shown that ML algorithms may offer great support for health professionals both in clinical settings and in research into MS.

Detecting Atrial Fibrillation in Patients With an Embolic Stroke of Undetermined Source (from the DAF-ESUS registry).

Atrial fibrillation (AF) causes a substantial proportion of embolic strokes of undeterminded source (ESUS). Effective detection of subclinical AF (SCAF) has important therapeutic implications. We conducted a prospective study to determine the prevalence of SCAF in patients with ESUS through of a 21-day Holter monitoring. In an early-monitoring group, Holter was initiated immediately after hospital discharge. The results were compared with a previous cohort of patients in whom the Holter was initiated at least 1 week after hospital discharge (late-monitoring group). We included 100 patients (50 each group; 69 ± 13 years, 56% male). Mean time from ESUS to Holter was 1.2 ± 1 day in the early-monitoring group and 30 ± 15 days in the late-monitoring group. SCAF was detected in 22% of patients in the early-monitoring and 6% in the late-monitoring group (p <0.05). Patients with SCAF were older (77 ± 9 vs 67 ± 11 years, p <0.05), with a higher rate of left atrial enlargement (50% vs 20%, p<0.05), renal impairment (28% vs 5%; p<0.01), and a slower mean heart rate (55 ± 6 vs 70 ± 6 beats/min; p<0.001). On multivariate analysis, the presence of persistent bradycardia (≤60 beats/min) in the 21-day Holter was a powerful and significant risk factor for SCAF. In conclusion, the sooner 21-day Holter electrocardiogram monitoring is initiated after ESUS, the more likely SCAF can be detected. Sinus bradycardia is a powerful predictor of SCAF in patients with ESUS.

Percepción de los pacientes sobre la atención recibida por el personal no sanitario en los centros de salud / Patients’ perception on attention received from Health Centres non-sanitary staff

Objetivos. Conocer la percepción que tienen los usuarios sobre algunos aspectos interpersonales y técnicos relacionados con la atención que reciben del personal de atención al ciudadano cuando acuden a los centros de atención primaria. Valorar la posible utilidad de dos modos de medición de la satisfacción. Material y métodos. Estudio observacional descriptivo realizado con usuarios que utilizaron los servicios de atención al ciudadano de los centros de salud. Tras consultar con este personal, los usuarios fueron entrevistados personalmente utilizando dos tipos de preguntas que evaluaron sus opiniones y satisfacción con diferentes aspectos comunicacionales y de tipo técnico relacionados con la demanda realizada. Las preguntas abiertas fueron agrupadas en categorías en un proceso que involucró a tres investigadores de manera independiente. Se realizó un análisis descriptivo e inferencial (test de la X2, p<0,05). Resultados. Más de un 90% (360) de los usuarios encuestados declararon estar satisfechos o muy satisfechos con la atención recibida en atención al ciudadano; sin embargo, entre el 18 y el 36% hicieron sugerencias para mejorar esta atención tras su consulta. Independientemente del dominio explorado, destacaron las sugerencias referidas a la relación/comunicación, capacitación del personal para resolver los problemas, calidad y cantidad de las explicaciones y tiempo de espera. Conclusiones. Las encuestas que incorporan preguntas abiertas parecen más útiles para valorar la calidad de la atención recibida de los administrativos de los centros de salud, detectar problemas en esta atención y planificar nuevas intervenciones de mejora. Los aspectos relacionales e informativos representan un área de mejora prioritaria en este ámbito(AU)

Aims. To know patients’ perceptions about relational aspects and technical procedures when they are attended by the administrative staff in Health Centres. To assess the utility of two ways for measuring satisfaction. Material and methods. Cross-sectional study carried out in people attending the administrative sections of Health Centres for diverse reasons. Just after the interaction with the administrative they were interviewed using two different questions for assessing their opinions and satisfaction with communicational and technical aspects related with their demands. Descriptive analysis. Significant differences among mean was explored by X2 test. Open-ended questions were grouped in categories in a process involving three researchers independently. Results. Over than 90% (360) of the attendees declared to be satisfied or very satisfied with the service received from the staff personal. Nevertheless, among 18-36% gave suggestions for improving the service after their consultation. Independently the domain explored, people suggested the communicational, personal capability, quality and quantity of explanations and waiting time as the main aspects to be improved. Conclusions. Surveys with open-ended questions are more useful to assess the quality of the attention the citizens receive from no-sanitary staff in Health Centres. These type of questions are also more useful for detecting problems and planning new interventions. Relational and informative issues seem to be the most prioritary areas to improve in this section of Health Centres(AU)

[Patients' perception on attention received from Health Centres non-sanitary staff]. / Percepción de los pacientes sobre la atención recibida por el personal no sanitario en los centros de salud.

AIMS: To know patients' perceptions about relational aspects and technical procedures when they are attended by the administrative staff in Health Centres. To assess the utility of two ways for measuring satisfaction. MATERIAL AND METHODS: Cross-sectional study carried out in people attending the administrative sections of Health Centres for diverse reasons. Just after the interaction with the administrative they were interviewed using two different questions for assessing their opinions and satisfaction with communicational and technical aspects related with their demands. Descriptive analysis. Significant differences among mean was explored by χ(2) test. Open-ended questions were grouped in categories in a process involving three researchers independently. RESULTS: Over than 90% (360) of the attendees declared to be satisfied or very satisfied with the service received from the staff personal. Nevertheless, among 18-36% gave suggestions for improving the service after their consultation. Independently the domain explored, people suggested the communicational, personal capability, quality and quantity of explanations and waiting time as the main aspects to be improved. CONCLUSIONS: Surveys with open-ended questions are more useful to assess the quality of the attention the citizens receive from no-sanitary staff in Health Centres. These type of questions are also more useful for detecting problems and planning new interventions. Relational and informative issues seem to be the most prioritary areas to improve in this section of Health Centres.

Relationship between insulin resistance, inflammation and liver cell apoptosis in patients with severe obesity.

BACKGROUND: In obesity, insulin resistance appears frequently after activation of proinflammatory molecules. Caspase-generated cytokeratin-18 (CK-18) fragments are produced during the apoptosis of hepatic cells. The main objective in the present study is to investigate the relationship between insulin resistance and caspase-generated CK-18 fragments in patients with severe obesity. METHODS: Sixty-two patients selected for bariatric surgery were clinically studied (sex, age, weight, waist diameter, body mass index, arterial pressure and type 2 diabetes mellitus) and analytic parameters were measured in blood (glucose concentration, cholesterol, triglycerides, insulin, glycosylated hemoglobin, aspartate aminotransferase, alanine aminotransferase, high-sensitivity C-reactive protein, adiponectin, interleukin 6, interleukin 18 and CK-18 fragments). Patient group division was based on 70th percentile of insulin resistance as measured by homeostasis model assessment (HOMA) and also according to liver histology. RESULTS: Patients with greater insulin resistance (percentile > 70th) showed higher values of CK-18 fragments, interleukin 6 and transaminases. A positive correlation between the HOMA score, value of CK-18 fragments and triglyceride level was found. A correlation between CK-18 fragments with interleukin 6, triglycerides and transaminases was also observed. HOMA score and value of CK-18 fragments correlated with the degree of liver fibrosis. CONCLUSIONS: Greater degree of insulin resistance induces apoptosis of hepatic cells as measured by the serum levels of CK-18 fragments.

[A clinical study of adult autoimmune hepatitis in Valencia, Spain]. / Estudio clínico de la hepatitis autoinmune del adulto en Valencia.

OBJECTIVE: the clinical phenotype of autoimmune hepatitis (AIH) varies among geographical areas. The aim of this study is to determine the salient features of AIH in adult patients from the province of Valencia, Spain. MATERIAL AND METHODS: eighty-one patients with AIH attended to in eight acute-care hospitals between 1994 and 2003. New patients diagnosed with AIH during year 2003 were evaluated prospectively. Data from patients currently attending follow-up visits and diagnosed before 2003 were collected retrospectively. RESULTS: a total of 94% of patients were females. Forty-three percent were asymptomatic, 27% had acute hepatitis, and 30% had chronic hepatitis. Type 1 AIH was diagnosed in 90% of cases. Type 2 AIH was more frequent in younger patients, and presented with an acute pattern. One third of patients had cirrhosis at onset. Patients with cirrhosis were older than 60 years more frequently. Immunosuppressants were given to 57 patients, with complete or partial remission in 87.7%. There were no significant differences in response to immunosuppression according to presentation pattern or AIH subtype. CONCLUSIONS: AIH in Valencia was predominantly diagnosed in asymptomatic women. Most cases were type 1, and in 25% of patients another autoimmune disease coexisted. At the time of diagnosis one third of patients had cirrhosis, particularly those over 60 years.

Evolución a largo plazo de la dosis de toxina botulínica en las distonías laríngea y cervical / Long term evolution of the doses of botulinum toxin used in laryngeal and cervical distonias

Introduction. Dystonia is a neurological condition characterised by involuntary movements that give rise to abnormal postures. Different strategies have been used in the treatment of focal dystonias, but the most widely accepted at the present time involves the use of botulinum toxin type A (BTA) injections. Yet, despite its widespread use, the ideal dosages for long-term treatment are still not known with precision. Aims. The purpose of this study is to report on our experience with long-term BTA therapy in laryngeal (LD) and in cervical dystonia (CD). Patients and methods. We reviewed the data concerning the dosages of BTA injected in 10 patients with LD who received treatment in our centre over a period of eight years. We also analysed the data regarding the doses of BTA injected over an eight-year period in 17 patients with CD. The data were analysed using an ANOVA for paired data. Results. No significant differences were found in the highest dosages of BTA needed for the treatment of LD throughout the progression of the disease (p = 0.84). These data contrast with those obtained from the analysis of the treatment of CD, which do show a gradual increase in the dose of toxin that is required (p < 0.0001). Conclusions. These findings suggest that the long-term response to treatment is different in the two conditions (AU)

Introducción. La distonía es una entidad neurológica caracterizada por movimientos involuntarios que ocasionan posturas anómalas. En el tratamiento de las distonías focales se han utilizado diferentes estrategias, pero la más aceptada en la actualidad es la inyección de toxina botulínica de tipo A (TBA). Sin embargo, a pesar de su uso extendido, no se conoce con precisión cuáles son las dosis idóneas para el tratamiento a largo plazo. Objetivo. Mostrar nuestra experiencia en el tratamiento a largo plazo con TBA en la distonía laríngea (DL) y en la cervical (DC). Pacientes y métodos. Revisamos los datos correspondientes a las dosis de TBA inyectadas a 10 pacientes con DL tratados en nuestro centro durante ocho años, y analizamos los datos correspondientes a la dosis de toxina botulínica inyectada durante ocho años a 17 pacientes con DC. Analizamos los datos con el estadístico ANOVA para datos apareados. Resultados. No encontramos diferencias significativas en las dosis máximas autorizadas de TBA necesaria para el tratamiento de la DL a lo largo de la evolución de la enfermedad (p = 0,84). Estos datos contrastan con los obtenidos al analizar el tratamiento de la DC, en la que sí se observa un aumento gradual de la dosis necesaria de toxina (p < 0,0001). Conclusión. Estos hallazgos hacen pensar en una diferente respuesta a largo plazo al tratamiento en ambas entidades (AU)

[Long-term evolution of the doses of Botulinum toxin used in laryngeal and cervical dystonias]. / Evolución a largo plazo de la dosis de toxina botulínica en las distonías laringea y cervical

INTRODUCTION: Dystonia is a neurological condition characterised by involuntary movements that give rise to abnormal postures. Different strategies have been used in the treatment of focal dystonias, but the most widely accepted at the present time involves the use of botulinum toxin type A (BTA) injections. Yet, despite its widespread use, the ideal dosages for long-term treatment are still not known with precision. AIMS: The purpose of this study is to report on our experience with long-term BTA therapy in laryngeal (LD) and in cervical dystonia (CD). PATIENTS AND METHODS: We reviewed the data concerning the dosages of BTA injected in 10 patients with LD who received treatment in our centre over a period of eight years. We also analysed the data regarding the doses of BTA injected over an eight-year period in 17 patients with CD. The data were analysed using an ANOVA for paired data. RESULTS: No significant differences were found in the highest dosages of BTA needed for the treatment of LD throughout the progression of the disease (p=0.84). These data contrast with those obtained from the analysis of the treatment of CD, which do show a gradual increase in the dose of toxin that is required (p<0.0001). CONCLUSIONS: These findings suggest that the long-term response to treatment is different in the two conditions.

Clinical evaluation of drug-induced hepatitis.

OBJECTIVE: To ascertain the epidemiological characteristics, clinical symptoms, and evolution of drug-induced hepatitis over the last 22 years. EXPERIMENTAL DESIGN AND SUBJECTS: An observational, retrospective study between 1982 and 1993, and prospective study between 1994 and 2003. All patients in our department diagnosed with having drug-induced hepatitis were studied analyzing epidemiological (age, sex, cases per year, hospitalization) and clinical features (previous liver disease, hepatic symptoms, laboratory results), and follow-up (complete recovery or chronicity). RESULTS: A total of 61 patients were diagnosed as having drug-induced hepatitis, 26 men and 35 women (57%), mean age 52.4 years +/- 17 years, of which 72.2% were older than 40 years. A total of 43% were admitted to hospital. In 87% of cases, two or more drugs were involved, the most frequent being antituberculosis (19 cases), psychotropic (26 cases), and non-steroidal anti-inflammatory drugs (45 cases). Evolution showed that 94% of patients recovered after the withdrawal of suspected causal drugs. CONCLUSIONS: The incidence of drug-induced hepatitis is higher in patients over 40 years of age, it being more common in females. Non-steroidal anti-inflammatory, psychotropic, and anti-tuberculosis agents were the main drugs involved. Most patients made a complete recovery after withdrawal of the suspected causal drug.

Incidence and epidemiological factors of hepatocellular carcinoma in Valencia during the year 2000.

AIM: to ascertain the incidence and epidemiological factors of hepatocellular carcinoma in the Province of Valencia, Spain. DESIGN: a prospective study was made of hepatocellular carcinoma during the year 2000 collecting all diagnosed cases from four hospitals during that year. RESULTS: a total of 64 cases of hepatocellular carcinoma with a male predominance (42/22) and a mean age of 73.4 years (range of 42-90) were diagnosed. Incidence rate was 8.2 per 100,000, and cirrhosis was known to pre-exist in most cases, half of which were Child-Pugh A. Anti-VHC positive, alone or alcohol or virus B related was detected in 3 of every 4 cases. In the majority of the cases the tumours were located in the right hepatic lobe and the size at first diagnosis was less than 3 cm in 37.3% of the cases. Alpha-fetoprotein levels only exceeded 200 mg/ml in 37.3% of the patients and bore a good size relation to the tumour (R=0.245, p=0.003. No relation vis-à-vis aetiology with age, sex, tumour location or Child-Pugh stage was found. CONCLUSIONS: the incident rate of hepatocellular carcinoma in Valencia province during 2000 was 8.2 per 100,000 individuals. This lesion appeared more frequently in men between the ages of 60-80. Hepatitis C virus was the main etiologic agent found. Key words: Hepatocellular carcinoma. Incidence. Hepatitis C virus. Epidemiology. Child-Pugh grade. Alpha-fetoprotein.

[Breast feeding in a metropolitan area: (I). Analysis of the current situation]. / La lactancia materna en un área metropolitana: (I). Análisis de la situación actual.

In order to elaborate a program to promote breast-feeding, it is necessary to know in advance the difficulties encountered by the mothers in the target population. For this purpose, we surveyed a sample of 400 mothers who were representative of those who gave birth in Móstoles in 1989. We found that 56% of the mothers did not exceed two months of breast-feeding. Breast-feeding was shorter in low-income families. Its duration was influenced by the husband's and grandmother's opinions and also by previous failure with elder siblings. Mothers made their choice of feeding method before getting pregnant. We also found that most health professionals acted unsatisfactorily. Other unfavorable factors included excessive insecurity of the mother and misinformation.