PTCy, abatacept, and a short course of tacrolimus for GVHD prevention after haploidentical transplantation.

Reducing the incidence of graft-versus-host disease (GVHD) after haploidentical hematopoietic stem cell transplantation (HSCT) is warranted. Posttransplant cyclophosphamide (PTCy) is the main agent used for GVHD prevention in this setting. It remains unknown whether costimulation blockade can be safely combined with PTCy and enhance its efficacy. We performed a phase 1b-2 clinical trial to examine the combination of PTCy, abatacept, and a short course of tacrolimus (CAST) after peripheral blood haploidentical HSCT. The primary end point was the incidence of grades 2-4 acute GVHD by day +120. The study enrolled 46 patients with a median age of 60 years (range, 18-74 years). The cumulative incidences of grades 2-4 and 3 or 4 acute GVHD were 17.4% (95% confidence interval [CI], 9.2-32.9) and 4.4% (95% CI, 1.1-17.1), respectively. With a median follow-up of 15.3 months, the cumulative incidence of 1-year treatment-related mortality was 4.4% (95% CI, 1.1-17.1). The estimated 1-year moderate-to-severe chronic GVHD rate, relapse rate, progression-free survival, overall survival, and GVHD- and relapse-free survival were 15.9% (95% CI, 8-31.7), 11.7% (95% CI, 5-27.2), 84.1% (95% CI, 73.8-95.7), 85.9% (95% CI, 75.9-97.2), and 66.1% (95% CI, 53.4-81.8), respectively. Toxicities were similar to those expected in patients receiving haploidentical HSCT. This clinical trial showed that the CAST regimen is safe and effective in reducing the rate of grades 2-4 acute GVHD after haploidentical peripheral blood HSCT. This trial was registered at www.clinicaltrials.gov as #NCT04503616.

Major adverse events related to endoscopic or laparoscopic procedures in achalasia. A systematic review and meta-analysis.

INTRODUCTION AND AIMS: Surgical or endoscopic treatments play an essential role in the management of achalasia. The probability of adverse events in the performance of said treatments is a relevant aspect, when establishing the risk-benefit balance. The present study aimed to establish the association between serious adverse events and the performance of those procedures, in adult patients with achalasia. MATERIALS AND METHODS: A systemic search of randomized and nonrandomized clinical trials, retrospective cohorts, and cases series on adult patients with achalasia that underwent laparoscopic Heller myotomy (LHM), peroral endoscopic myotomy (POEM), or endoscopic balloon dilation, that reported serious adverse events, was carried out on the Medline, CENTRAL, and EBSCO databases. Serious adverse events were defined as: death at 30 days, Clavien-Dindo grade III or higher classification, esophageal or gastric perforation, pneumothorax, mucosal tear, leakage, emphysema, pneumonia, and chest pain. The methodology included the PRISMA guidelines for reporting systematic reviews. RESULTS: Thirty-five studies were found that reported information on 1,276 patients that underwent POEM, 5,492 that underwent LHM, and 10,346 that underwent endoscopic balloon dilation. The proportions of adverse events for the three techniques were 3.6, 4.9, and 3.1%, respectively. DISCUSSION AND CONCLUSIONS: The 3 therapeutic interventions evaluated had similar proportions of adverse events. There were few reports of death at 30 days as an outcome and the lack of standardization in reporting adverse events in the studies analyzed was prominent.

Concordance of the ACR TI-RADS.

BACKGROUND: Ultrasonography (US) is the method of choice for evaluating thyroid nodules. In 2017, the American College of Radiology (ACR) created a classification system based on US characteristics. For the system to be adopted, it must be reproducible. OBJECTIVES: To determine the intraobserver and interobserver variability of the ACR TI-RADS. METHODS: Cross-sectional study; three radiologists with different levels of experience used the ACR TI-RADS to classify 100 nodules on two occasions one month apart, and we calculated the intraobserver and interobserver variability. RESULTS: Regarding intraobserver variability, the first radiologist had nearly perfect concordance for composition, echogenicity, shape, and margins and substantial concordance for echogenic foci; the second radiologist had nearly perfect concordance for composition, echogenicity, shape, and margins and substantial concordance for echogenic foci, and the third radiologist had nearly perfect concordance for composition, echogenicity, and shape and substantial concordance for margins and echogenic foci. The interobserver concordance was calculated for the two readings; the concordance was substantial except for shape in the first reading and for echogenicity and margins in the second reading, which had moderate concordance. CONCLUSIONS: The ACR TI-RADS classification system is reproducible.

Review of expandable dental implants.

In the last few years the dental implants market has grown both in developed and developing countries, and is associated with high aesthetic expectations and well-being. Although the success rate of commercial implants is high, some problems associated with a lack of initial stability, marginal bony resorption, and periodontal health, remain, especially with immediate placement and loading. The market offers different designs of dental implants, but cylindrical and tapered devices that are fixed to the bone via an external thread are dominant. One lesser-known but potentially useful design is the expandable dental implant (EDI). This paper presents a review of expandable dental implants that encompasses a survey of the literature, published patents, and available commercial devices. We found 15 articles: prospective human trials (n=4), human case reports (n=3), published independent discussions of other articles (n=2), three big animal trials (n=3), and in silico studies (n=3). A total of 73 published patents were found and two expandable dental implants are commercially available to date. We propose a classification system that differentiates between the expansion mechanism and the origin of the expanding action. Some expandable designs have been shown to provide good primary stability, but evidence to date is limited. We encourage future clinical and biomechanical studies to clarify and optimise the potential benefits of these implants.

Enfermedad de Behcet: un reto diagnóstico en reumatología. Descripción de una serie de casos y revisión de la literatura / Behcet's disease: a diagnostic challenge in rheumatology. Description of a case series and a review of the literature

RESUMEN La enfermedad de Behcet es una entidad clínica autoinflamatoria, de etiología desconocida, generalmente con compromiso sistémico, con un patrón de exacerbación y remisión frecuente que se asocia a retraso en el diagnóstico. El diagnóstico de esta enfermedad es complejo, por esta razón presentamos 4 casos de pacientes con enfermedad de Behcet, que durante el abordaje clínico fueron consideradas otras enfermedades de naturaleza autoinmune. La revisión integrada de la historia clínica, la aparición de úlceras orales y genitales, así como el estudio de tipificación del complejo mayor de histocompatibilidad (HLA) permitieron diagnosticar la enfermedad de Behcet.

ABSTRACT Behcet disease is a rare autoinflammatory disorder of unknown aetiology and is characterised by systemic manifestations with an exacerbation-remission pattern, often associated with diagnostic delay. The diagnostic approach to this disease is complex. A report is given on four cases of patients fulfilling the diagnostic criteria for Behcet disease. Other autoimmune rheumatic diseases were considered in the clinical approach. A meticulous clinical evaluation, taking into consideration relapsing aphthous ulcers in oral mucosa and genitalia, and HLA typing allowed a proper diagnosis of Behcet disease to be made.

Concordance of the ACR TI-RADS. / Concordancia del TIRADS-ACR.

BACKGROUND: Ultrasonography (US) is the method of choice for evaluating thyroid nodules. In 2017, the American College of Radiology (ACR) created a classification system based on US characteristics. For the system to be adopted, it must be reproducible. OBJECTIVES: To determine the intraobserver and interobserver variability of the ACR TI-RADS. METHODS: Cross-sectional study; three radiologists with different levels of experience used the ACR TI-RADS to classify 100 nodules on two occasions one month apart, and we calculated the intraobserver and interobserver variability. RESULTS: Regarding intraobserver variability, the first radiologist had nearly perfect concordance for composition, echogenicity, shape, and margins and substantial concordance for echogenic foci; the second radiologist had nearly perfect concordance for composition, echogenicity, shape, and margins and substantial concordance for echogenic foci, and the third radiologist had nearly perfect concordance for composition, echogenicity, and shape and substantial concordance for margins and echogenic foci. The interobserver concordance was calculated for the two readings; the concordance was substantial except for shape in the first reading and for echogenicity and margins in the second reading, which had moderate concordance. CONCLUSIONS: The ACR TI-RADS classification system is reproducible.

Coarse-grained molecular dynamics simulations of α-1,3-glucan.

In this paper we present a computational study of aggregation in aqueous solutions of α-1,3-glucan captured using a coarse-grained (CG) model that can be extended to other polysaccharides. This CG model captures atomistic geometry (i.e., relative placement of the hydrogen bonding donors and acceptors within the monomer) of the α-1,3-glucan monomer, the directional interactions due to the donor-acceptor hydrogen bonds, and their effect on aggregation of multiple α-1,3-glucan chains without the extensive computational resources needed for simulations with atomistic models. Using this CG model, we conduct molecular dynamics simulations to assess the effect of varying α-1,3-glucan chain length and hydrogen bond interaction strengths on the aggregation of multiple chains at finite concentrations in implicit solvent. We quantify the hydrogen bonding strength needed for multiple chains to aggregate, the distribution of inter- and intra-chain hydrogen bonds within the aggregate and in some cases, the shapes of the aggregate. We also explore the effect of substitution/silencing of some randomly selected or specific hydrogen bonding sites in the chain on the aggregation and aggregate structure. In the unmodified α-1,3-glucan solution, the inter-chain hydrogen bonds cause the chains to aggregate into sheets. Random silencing of hydrogen bonding donor sites only increases the hydrogen bond strength needed for aggregation but retains the same aggregate structure as the unmodified chains. Specific silencing of the hydrogen-bonding site on the C6 carbon leads to the chains aggregating into planar sheets that then fold over to form hollow cylinders at intermediate hydrogen bond strength - 4.7 to 5.3 kcal mol-1. These cylindrical aggregates assemble end-to-end to form larger aggregates at higher hydrogen bond strengths.

Pregnancy rates in hair sheep after Ovsynch synchronization and a combined intracervical fixed-time artificial insemination and 10-day mating period.

AIM: This study aimed to evaluate the pregnancy rates in hair ewes using an Ovsynch synchronization protocol under a breeding system that combines fixed-time insemination plus a 10-day mating period as an alternative. MATERIALS AND METHODS: Through an experimental study (n=27), ewes were randomly located into one of three treatments: (1) Pre-synch (n=9): Prostaglandin F2α (PGF2α)+Gonadotropin-releasing hormone (GnRH)+PGF2α+GnRH; (2) Ovsynch (n=9): GnRH+PGF2α+GnRH; and (3) control: Ewes bred by natural mating (NM) (n=9). Ewes were fixed-time inseminated (fixed-time artificial insemination [FTAI]) with fresh semen, collected just before the insemination time through vaginoscopy at 16 h after the second GnRH (gonadorelin) injection. Each experimental group was placed separately during 15 days and, after this time, fertile rams were allowed back with ewes for a 10-day mating period. Control group ewes remained with the rest of the herd suitable for breeding and were bred under NM. Pregnancy diagnosis was performed by ultrasound at 28-, 56-, and 84-day post-breeding to differentiate between FTAI and NM pregnancies. Total (FTAI±NM) pregnancy rates at 56-day post-breeding were used to compared Pre-synch, Ovsynch, and control. For this purpose, two-tailed proportions comparison z-test was used with a 95% confidence level, for testing as the null hypothesis whether two proportions were equal. RESULTS: Pregnancy rates were higher in control ewes (66.4%) than FTAI (46.6%). When pregnancy rates after a 10-day mating period (40%) were added, the final rate (86.6%) was significantly (p<0.05) higher in Ovsynch-based protocols. The pregnancy rate was significantly lower in FTAI ewes compared to FTAI +10-day mating group (p<0.05). The overall pregnancy rate was 88.0, 85.7, and 67.0 (p>0.05) for Pre-synch, Ovsynch, and control ewes, respectively. CONCLUSION: These results provide evidence on the benefits of combined FTAI protocols for improving the reproductive efficiency of sheep.

Gastrointestinal Symptoms and Elevated Levels of Anti-Saccharomyces cerevisiae Antibodies Are Associated with Higher Disease Activity in Colombian Patients with Spondyloarthritis.

BACKGROUND: Spondyloarthritis (SpA) is a group of articular inflammatory rheumatic diseases that their gastrointestinal manifestations are around 10% of their extra-articular symptoms, supporting that the inflammatory response of the intestinal mucosa could be associated with the clinical status. OBJECTIVES: To investigate the association between gastrointestinal symptoms and autoantibodies and disease activity between SpA patients, healthy subjects (HS), and patients with inflammatory bowel disease (IBD). METHODS: 102 SpA patients, 29 IBD patients, and 117 HS were included. Autoantibodies as ASCA, ANCA, anti-tTG, anti-DGP, ANA, and IgA were measured. The patients were assessed to evaluate clinical and gastrointestinal symptoms. An association analysis was performed using Chi square test and a logistic regression. RESULTS: Significant differences were found for ASCA levels in SpA (28.2%) compared to IBD (14.2%) and HS (6.0%) (p = 0.029), as well as for ANAS in SpA (49.5%) and IBD (37.9%) (p < 0.001) and abdominal pain (p = 0.012) between SpA (54.3%) and IBD (27.5%). Significant associations were found between BASDAI > 4 and gastrointestinal symptoms (p < 0.05) and IgA (p = 0.007). The association for abdominal bloating was maintained (OR: 3.93, CI-95%, 1.14-13.56; p = 0.030). CONCLUSIONS: Gastrointestinal symptoms, ASCA, ANAS, and IgA levels were associated with high disease activity in SpA compared with IBD and HS.

Riesgo de depresión, alcoholismo, tabaquismo y consumo de sustancias psicoactivas en personal de enfermería, de dos instituciones hospitalarias del área metropolitana de la ciudad de Medellín / Risk of depression, alcoholism, smoking, and psychoactive substance use among nursing personnel at two institutions in the metropolitan area of Medellin / Risco de depressão, alcoolismo, tabaquismo e consumo de substâncias psicoativas no pessoal de enfermagem, de duas instituições hospitalares da área metropolitana da cidade de Medellín

Objetivo: describir el riesgo de depresión, alcoholismo, tabaquismo, consumo de sustancias psicoactivas y variables asociadas con el consumo en personal de enfermería de dos instituciones hospitalarias del área metropolitana de Medellín. Metodología: estudio transversal, en el que se exploran características sociodemográficas y de consumo. Se aplicó la escala de Zung para determinar riesgo de depresión, la escala CAGE para riesgo de alcoholismo y el test de Fagerstrom para adicción al cigarrillo. Para identificar la prevalencia de consumo en vida de sustancias psicoactivas se usó el autoreporte. Se realizó análisis bivariado para explorar variables asociadas con el consumo. La muestra se constituyó por 157 enfermeras y auxiliares de enfermería de los servicios de cirugía y urgencias. Los datos se analizaron en el programa estadístico SPSS, versión 20. Resultados: el 9.5% del personal de enfermería tiene riesgo de depresión. El 67.5% ha consumido alguna vez en su vida una sustancia psicoactiva y el alcohol fue la sustancia más consumida con el 65%, seguido por: marihuana, alucinógenos, sedantes y benzodiacepinas sin indicación médica. Se halló que en el caso de los hombres se aumenta el riesgo de consumir sustancias psicoactivas (OR 11.07). Conclusión: el consumo de sustancias psicoactivas, el riesgo de alcoholismo, el tabaquismo y la depresión fueron menores y similares a otros estudios específicos en personal de salud, mientras que el estrés y la despersonalización presentaron mayor prevalencia.

Objective: To describe the risk of depression, alcoholism, smoking, and psychoactive substance use and the variables associated to abuse in nursing personnel at two hospitals in the metropolitan area of Medellin. Methodology: Cross-sectional study that explores sociodemographic and abuse characteristics. The Zung scale was administered to determine risk of depression, CAGE questionnaire to evaluate risk of alcoholism, and Fagerstrom test to gauge smoking addiction. Self-report was used to identify prevalence of substance abuse. Bivariate analysis was conducted to explore variables associated to abuse. The sample included 157 operating room and emergency room nurses and auxiliary nurses. Data were analyzed using SPSS, version 20 software. Results: Of all nursing personnel, 9.5% had risk of depression while 67.5% had used some sort of psychoactive substance. Alcohol was the most common (65%), followed by marihuana, hallucinogens, sedatives, and benzodiazepines without medical prescription. It was found that males presented a higher risk of psychoactive substance abuse (OR 11.07). Conclusion: Risk of psychoactive substance abuse, alcoholism, smoking, and depression were lower and similar to other studies conducted in healthcare personnel, whereas stress and depersonalization had a higher prevalence.

Objetivo: descrever o risco de depressão, alcoolismo, tabaquismo, consumo de substâncias psicoativas e variáveis associadas com o consumo no pessoal de enfermagem de duas instituições hospitalares da área metropolitana de Medellín. Metodologia: estudo transversal, no qual se exploram características sócio-demográficas e de consumo. Se aplicou a escala de Zung para determinar o risco de depressão, a escala CAGE para risco de alcoolismo e o teste de Fagerstrom para adição ao cigarro. Para identificar a prevalência de consumo em vida de substâncias psicoativas se usou o auto-relatório. Se realizou análise bivariado para explorar variáveis associadas com o consumo. A amostra se constituiu por 157 enfermeiras e auxiliares de enfermagem dos serviços de cirurgia e urgências. Os dados se analisaram no programa estatístico SPSS, versão 20. Resultados: 9.5% do pessoal de enfermagem tem risco de depressão. 67.5% há consumido alguma vez na sua vida uma substância psicoativa e o álcool foi a substância mais consumida com 65%, seguido por: maconha, alucinógenos, sedantes e benzodiazepina sem indicação médica. Se encontrou que no caso dos homens se aumenta o risco de consumir substâncias psicoativas (OR 11.07). Conclusão: o consumo de substâncias psicoativas, o risco de alcoolismo, o tabaquismo e a depressão foram menores e similares a outros estudos específicos na pessoal de saúde, enquanto que o estresse e a despersonalização apresentaram maior prevalência.

Control of Mechanical Stability of Hollow Silica Particles, and Its Measurement by Mercury Intrusion Porosimetry.

Hollow silica particles (HSPs) have become the focus of interest in many laboratories recently, because of their versatility, stemming from the ability to control their size and shape, as well as surface functionalization. Determining the mechanical stability of hollow particles is essential for their use, both in applications in which they need to retain their structure, as well as those in which they need to break down. We have synthesized a series of HSPs (inner diameter of 231 nm) with increasing wall thickness (7-25 nm), using a template approach. Their mechanical stability was measured using mercury intrusion porosimetry (MIP), which represents the novel application of the technique for these materials. The samples with complete shells break at progressively higher pressures, and samples with wall thickness ≥21 nm remain stable to the highest pressure applied (414 MPa). Other characterization methods, namely microscopy, gas adsorption, and small-angle X-ray scattering, shed light on the size parameters of the particles, as well as the porosity of the silica walls. By varying the amount of silica precursor used in the template coating step, we were able to produce hollow silicas with variable stability, thereby allowing for control of their mechanical properties.

[Factors influencing the quality of clinical practice guidelines in ovarian cancer]. / Factores que influyen en la calidad de las guías de práctica clínica de cáncer de ovario.

OBJECTIVE: To identify the characteristics of the published clinical practice guidelines for the management of epithelial ovarian cancer that suggest a good methodological quality. MATERIAL AND METHODS: A literature review was performed on 25 clinical practice guidelines for epithelial ovarian cancer that were identified in different databases (MEDLINE, Guidelines International Network, National Guidelines Clearing house) published between 2007 and 2014. The quality of the guidelines was evaluated using the Appraisal of Guidelines Research and Evaluation II tool. Descriptive and bivariate analyses were performed to assess the association between the quality of the guidelines and of some of their features and their developers. RESULTS: Just under half (48%) of the guidelines were rated as low quality. Scientific societies or independent centres and private funding, or under-reporting the source of funding, were statistically associated with lower quality of clinical practice guidelines (P<.01). The guidelines developed by National Program Guidelines had a median of consistently higher scores in all domains of the Appraisal of Guidelines Research and Evaluation II, with significant differences in the definition of scope and objectives, the participation of stakeholders, the methodological rigour of development, and applicability to the context. CONCLUSIONS: Features such as the nature of the developer and funding of the guidelines are predictors of quality that should be taken into account prior to the use of the recommendations of a document.

Tuning the Perfluorosulfonic Acid Membrane Morphology for Vanadium Redox-Flow Batteries.

The microstructure of perfluorinated sulfonic acid proton-exchange membranes such as Nafion significantly affects their transport properties and performance in a vanadium redox-flow battery (VRB). In this work, Nafion membranes with various equivalent weights ranging from 1000 to 1500 are prepared and the morphology-property-performance relationship is investigated. NMR and small-angle X-ray scattering studies revealed their composition and morphology variances, which lead to major differences in key transport properties related to proton conduction and vanadium-ion permeation. Their performances are further characterized as VRB membranes. On the basis of this understanding, a new perfluorosulfonic acid membrane is designed with optimal pore geometry and thickness, leading to higher ion selectivity and lower cost compared with the widely used Nafion 115. Excellent VRB single-cell performance (89.3% energy efficiency at 50 mA·cm-2) was achieved along with a stable cyclical capacity over prolonged cycling.

Rehabilitación de miembro superior con ambientes virtuales: revisión / Upper limb rehabilitation with virtual environments: a review

Resumen En este artículo se presentan los resultados de un proceso de revisión bibliográfica sobre rehabilitación de miembro superior basada en ambientes virtuales. El estudio parte de los siguientes interrogantes sobre el estado actual del conocimiento en el área mencionada: ¿cómo inciden los entornos virtuales frente a la rehabilitación tradicional?, ¿qué métricas de desempeño se han aplicado en la rehabilitación virtual de miembro superior? y ¿qué dispositivos hardware se utilizan en rehabilitación virtual?. Para responder las anteriores preguntas se realizó una búsqueda de artículos científicos en el motor de búsqueda Google Scholar y en las bases de datos PubMed, HINARI, ProQuest y Science Direct. De la revisión realizada se concluyó que pese a la existencia de decenas de índices de desempeño para cuantificar la habilidad motriz, no existen criterios para seleccionar el indice que mejor se adapta a los objetivos de un determinado proceso de rehabilitación.

Abstract This article gives the results of a literature review process about upper limb rehabilitation based on virtual environments. The study borns of the following questions about the current state of knowledge in this subject: how virtual environments influence traditional rehabilitation?, Which performance metrics have been aplied in upper limb virtual rehabilitation? and which hardware devices are used in virtual rehabilitation? To answer the above questions a search for scientific articles was made in the search engine Google Scholar and databases PubMed, HINARI, ProQuest and Science Direct. The conducted review concluded that despite the existence of dozens of performance indicators to quantify the driving ability, there are no criteria to select a better index that best suits the objectives of a rehabilitation process.

Revisión narrativa. Complicaciones en la madre, feto y neonato, derivadas del consumo de cocaína durante la gestación / Narrative review. Complications in the mother, fetus, and neonate due to cocaine use during pregnancy / Revisão narrativa. Complicações na mãe, feto e neonato, derivadas do consumo de cocaína durante a gestação

Latinoamérica reporta en las gestantes un consumo de alcohol del 44%, cigarrillo 51.8%, anfetaminas 8.3%, cocaína 2.5% y marihuana 2%. Las gestantes consumidoras representan un problema para las instituciones prestadoras de salud que exige intervenciones intersectoriales e interdisciplinarias por las consecuencias físicas, psicológicas, familiares y sociales que conlleva para la madre, el neonato y el infante. En esta revisión se describen las complicaciones físicas y conductuales en la madre, el feto y el neonato, que surgen por el consumo de cocaína y sus derivados durante la gestación. Se realizó una revisión narrativa a partir de la búsqueda de información científica indexada en las bases de datos Pubmed, Lilacs, Ovid, Science Direct entre el 2000 y el 2015, se utilizaron palabras clave con el fin de realizar una búsqueda estandarizada de información y se incluyeron artículos como productos de investigaciones, revisiones sistemáticas, metaanálisis. Las gestantes consumidoras de cocaína entrañan un factor de riesgo para la salud pública, con consecuencias físicas, psicológicas, familiares, sociales para la madre, el neonato y el infante, tales como hipertensión gestacional, desprendimiento de placenta, retardo del crecimiento intrauterino y síndrome de abstinencia neonatal. Es necesario que los profesionales de salud, las instituciones hospitalarias y Secretarías locales de salud elaboren, adapten y adopten algún protocolo de notificación, manejo y seguimiento a las madres consumidoras y de sus hijos para promover hábitos saludables, prevención de complicaciones obstétricas, neonatales y seguimiento de repercusiones en el desarrollo y crecimiento de los hijos.

Latin America reported the following data regarding substance abuse in pregnant women: 44% alcohol, 51.8% tobacco, 8.3% amphetamines, 2.5% cocaine and 2% cannabis. Pregnant women using these substances are a risk factor for health institutions due to the physical, psychological, social, and family consequences for the mother and the newborn infant. Thus, intersectoral and interdisciplinary interventions are necessary to treat this problem. This review describes the physical and behavioral complications in the mother, fetus, and neonate as a result of the use of cocaine and its derivatives during pregnancy. A narrative review was performed by means of a search of journals indexed in PubMed, Lilacs, Ovid, Science Direct from 2000 to 2015. Keywords were used in order to perform a standardized literature search, and data from research articles, systematic reviews, meta-analyses were included. Pregnant consumers of cocaine involve a risk factor for public health due to the physical, psychological, family, and social consequences for the mother, the newborn, and infant, such as high blood pressure, abruption, intrauterine growth retardation, and neonatal abstinence syndrome. It is necessary for local health departments to develop, adopt, and adapt reporting, management, and monitoring protocols for consuming mothers and their children in order to promote healthy habits, prevention of obstetrics and neonatal complications and to monitor the impact on growth and development in children.

Latino-américa reporta nas gestantes um consumo de álcool de 44%, cigarro 51.8%, anfetaminas 8.3%, cocaína 2.5% e maconha 2%. As gestantes consumidoras representam um problema para as instituições prestadoras de saúde que exige intervenções inter-setoriais e interdisciplinares pelas consequências físicas, psicológicas, familiares e sociais que implica para a mãe, o neonato e o infante. Nesta revisão se descrevem as complicações físicas e de condutas na mãe, o feto e o neonato, que surgem pelo consumo de cocaína e seus derivados durante a gestação. Se realizou uma revisão narrativa a partir da busca de informação científica indexada nas bases de dados Pubmed, Lilacs, Ovid, Science Direct entre 2000 e 2015, se utilizaram palavras chave com o fim de realizar uma busca padrão de informação e se incluíram artigos como produtos de investigações, revisões sistemáticas, meta-análise. As gestantes consumidoras de cocaína entranham um fator de risco para a saúde pública, com consequências físicas, psicológicas, familiares, sociais para a mãe, o neonato e o infante, tais como hipertensão gestacional, desprendimento de placenta, retardo do crescimento intrauterino e síndrome de abstinência neonatal. É necessário que os profissionais de saúde, as instituições hospitalares e Secretarias locais de saúde elaborem, adaptem e adotem algum protocolo de notificação, manejo e seguimento às mães consumidoras e de seus filhos para promover hábitos saudáveis, prevenção de complicações obstétricas, neonatais e seguimento de repercussões no desenvolvimento e crescimento dos filhos.

Automatic detection of Parkinson's disease in running speech spoken in three different languages.

The aim of this study is the analysis of continuous speech signals of people with Parkinson's disease (PD) considering recordings in different languages (Spanish, German, and Czech). A method for the characterization of the speech signals, based on the automatic segmentation of utterances into voiced and unvoiced frames, is addressed here. The energy content of the unvoiced sounds is modeled using 12 Mel-frequency cepstral coefficients and 25 bands scaled according to the Bark scale. Four speech tasks comprising isolated words, rapid repetition of the syllables /pa/-/ta/-/ka/, sentences, and read texts are evaluated. The method proves to be more accurate than classical approaches in the automatic classification of speech of people with PD and healthy controls. The accuracies range from 85% to 99% depending on the language and the speech task. Cross-language experiments are also performed confirming the robustness and generalization capability of the method, with accuracies ranging from 60% to 99%. This work comprises a step forward for the development of computer aided tools for the automatic assessment of dysarthric speech signals in multiple languages.

MÉTODOS PARA LA IDENTIFICACIÓN DEL ANTÍGENO DE HISTOCOMPATIBILIDAD HLA-B27: COMPARACIÓN DE CUATRO PROTOCOLOS TÉCNICOS / METHODS FOR IDENTIFICATION OF ANTIGEN HLA-B27 HISTOCOMPATIBILITY: FOUR TECHNICAL COMPARISONS OF PROTOCOLS / MÉTODOS PARA A IDENTIFICAÇÃO DO ANTIGÉNIO DE HISTOCOMPATIBILIDADE HLA-B27: CAMPARAÇAO DE QUATRO PROTOCOLOS TÉCNICOS

Introducción: La asociación del HLA-B27 y las Espondiloartritis, ha hecho evidente que la tipificación del HLA-B27 sea considerada como un apoyo en el diagnóstico de estas enfermedades. Los métodos más empleados para la determinación del antígeno HLA-B27 en los laboratorios clínicos y en investigación son: la microlinfocitotoxicidad (MCTX), la citometría de flujo digital (CMFd), la citometría de flujo análoga (CMFa) y la reacción en cadena de la polimerasa con primers de secuencia específicos (PCR-SSP). Objetivo: Comparar MCTX con la CMFd, la CMFa con la CMFd, y la técnica de CMFd frente a PCR-SSP. Métodos: Se analizaron 4109 solicitudes de HLA-B27 en población con manifestaciones sugestivas de EAS remitidas entre 2009 y 2012 al Hospital Militar Central y al Instituto de Referencia Andino. Se evaluaron las frecuencias obtenidas por Chi cuadrado (X2); para estimar la concordancia metodológica se utilizó el Coeficiente de Correlación Intraclase (CCI). Los análisis se realizaron con el paquete estadístico SPSS V18. Resultados: Al evaluar 467 datos por la técnica de CMFa frente a PCR-SSP, la CMFa mostró 239 resultados entre positivos y en rango indeterminado, de los cuales, luego de ser confirmados PCRSSP, solo 213 demostraron la expresión de HLA-B27 (p<0.05). Se obtuvieron 208 resultados realizados por CMFd y PCR-SSP simultáneamente, observándose una alta correspondencia entre estas técnicas (p<0.05). Para evaluar la concordancia entre la MCTX y CMFd se analizaron 34 datos, revelando un 100% de correspondencia entre esta dos metodologías (CCI=1,p<0.05). Conclusión: La citometría de flujo digital es un método rápido que presenta un desempeño altamente confiable para la identificación de HLA-B27, resultados que se recomiendan confirmar por PCR SSP.

Introduction: The association between HLA-B27 and spondyloarthritis has made clear the fact that identification of HLA-B27 antigen is considered as a support in the diagnosis of these diseases. The most commonly used methods for determination of the HLA-B27 antigen in clinical laboratories as well as in their research, are microlymphocytotoxicity (MCTX), digital flow cytometry (CMFd), analogous flow cytometry (CMFa) and the Single Specific Primer-Polymerase Chain Reaction (PCRSSP). Objective: compare the CMFd against MCTX, CMFa against CMFd and CMFd against PCR-SSP. Methods: 4109 requests for HLA-B27 were analyzed with manifestations suggestive of SpA submitted between 2009 and 2012 at Hospital Militar Central and Instituto de Referencia Andino. To analyze the frequencies Chi square (X2) was evaluated; to estimate the methodological concordance the intraclass correlation coefficient (ICC) was used. All proposed analyzes were performed with SPSS V18. Results: 467 data obtained by CMFa versus PCR-SSP evaluated the CMFA showed 239 results between positive and indeterminate range, which, after being confirmed by molecular biology (PCRSSP), only 213 showed the expression of HLA-B27 (p <0.05). PCR-SSP and CMFd performed 208 results simultaneously, showing a high correlation between these techniques (p <0.05). To evaluate the correlation between CMFd and MCTX, 34 data were analyzed, revealing a 100% match on the positive results from these two methodologies (ICC = 1, p <0.05). Conclusion: The digital flow cytometry is a rapid method that presents a highly reliable for the initial identification of HLA-B27; results confirmed by PCR SSP recommend performance.

Introdução: a associação do HLA-B27 e as Espondilartrite, evidenciou que a tipificação do HLAB27 seja considerada como um suporte no diagnóstico dessas doenças. Os métodos mais usados para a determinação do antígeno HLA-B27 nos laboratórios clínicos e no investigação são: a microlinphocitotoxicity (MCTX), a citometria de fluxo digital (CMFd), a citometria de fluxo análoga (CMFa) e a reação em cadeia de a polimerasa com primers de sequência específicos (PCR-SSP). Objetivo: Comparar MCTX com a CMFd, a CMFa com a CMFd, e a técnica de CMFd com PCRSSP. Métodos: 4109 solicitudes de HLA-B27 em população com manifestações sugestivas de EAS remitidas entre 2009 e 2012 ao Hospital Militar e ao Instituto de Referencia Andino, foram analisadas. Avaliaram-se as frequências obtidas por Chi quadrado (X2); para estimar a concordância metodológica foi utilizado o Coeficiente de Correlação Intraclasse (CCI). Os análises estão feitos com o paquete estadístico SPSS V18. Resultados: A CMFa mostrou 239 resultados entre positivos e em rango indeterminado quando avaliou-se 467 dados com a técnica de CMFa com PCR-SSP. Só 213 deles demostraram a expressão de HLA-27 (p<0.05), depois de ser confirmados PCR-SSP. Foram obtidos 208 resultados por CMFd y PCR-SSP em simultâneo, com uma alta correspondência entre estas técnicas (p<0.05). Para avaliar a concordância entre MCTX y CMFd analisaram-se 34 dados, revelando um 100% de correspondência entre as duas metodologias (CCI=, p<0.05). Conclusão: A citometria de fluxo é um método rápido que tem um desempeno muito confiável para a identificação de HLA-B27, resultados recomendados para confirmar por PCR SSP.

Association of tumor necrosis factor alpha-308 promoter polymorphism with spondyloarthritides patients in Colombia.

The pathogenesis of SpA is considered to be a complex and multi-factorial process and, similar to other autoimmune diseases, includes the activity of proinflammatory cytokines such as TNF alpha. Our study compared the -308 promoter polymorphism of TNF alpha with TNF alpha levels, HLA-B27 status, age at the onset of symptoms, SpA subtype and the clinical degree of activity in Colombian SpA patients and healthy subjects (HS). Comparisons of the TNF alpha-308A genotype among HS and SpA patients (P = 0.004), uSpA patients (P = 0.040), ReA patients (P = 0.001), were significantly different and AS patients (P = 0.110), as were alleles for SpAs (P = 0.007) between patients with SpAs and controls. Initial exploratory analyses demonstrated that the TNF alpha-308 SNP genotype frequencies were different among SpA patients and HS in the Colombian population studied. Furthermore, there was no significant correlation with activity and functional clinical index, serum TNF alpha level or HLA B27 status. Allele frequencies, on the other hand, were correlated with the activity clinical index.

Objective measurements to evaluate glottal space segmentation from laryngeal images.

Objective evaluation of the results of medical image segmentation is a known problem. Applied to the task of automatically detecting the glottal area from laryngeal images, this paper proposes a new objective measurement to evaluate the quality of a segmentation algorithm by comparing with the results given by a human expert. The new figure of merit is called Area Index, and its effectiveness is compared with one of the most used figures of merit found in the literature: the Pratt Index. Results over 110 laryngeal images presented high correlations between both indexes, demonstrating that the proposed measure is comparable to the Pratt Index and it is a good indicator of the segmentation quality.