Diagnostic deep learning algorithms that use resting EEG to distinguish major depressive disorder, bipolar disorder, and schizophrenia from each other and from healthy volunteers.

BACKGROUND: Mood disorders and schizophrenia affect millions worldwide. Currently, diagnosis is primarily determined by reported symptomatology. As symptoms may overlap, misdiagnosis is common, potentially leading to ineffective or destabilizing treatment. Diagnostic biomarkers could significantly improve clinical care by reducing dependence on symptomatic presentation. METHODS: We used deep learning analysis (DLA) of resting electroencephalograph (EEG) to differentiate healthy control (HC) subjects (N = 239), from those with major depressive disorder (MDD) (N = 105), MDD-atypical (MDD-A) (N = 27), MDD-psychotic (MDD-P) (N = 35), bipolar disorder-depressed episode (BD-DE) (N = 71), BD-manic episode (BD-ME) (N = 49), and schizophrenia (SCZ) (N = 122) and also differentiate subjects with mental disorders on a pair-wise basis. DSM-III-R diagnoses were determined and supplemented by computerized Quick Diagnostic Interview Schedule. After EEG preprocessing, robust exact low-resolution electromagnetic tomography (ReLORETA) computed EEG sources for 82 brain regions. 20 % of all subjects were then set aside for independent testing. Feature selection methods were then used for the remaining subjects to identify brain source regions that are discriminating between diagnostic categories. RESULTS: Pair-wise classification accuracies between 90 % and 100 % were obtained using independent test subjects whose data were not used for training purposes. The most frequently selected features across various pairs are in the postcentral, supramarginal, and fusiform gyri, the hypothalamus, and the left cuneus. Brain sites discriminating SCZ from HC were mainly in the left hemisphere while those separating BD-ME from HC were on the right. LIMITATIONS: The use of superseded DSM-III-R diagnostic system and relatively small sample size in some disorder categories that may increase the risk of overestimation. CONCLUSIONS: DLA of EEG could be trained to autonomously classify psychiatric disorders with over 90 % accuracy compared to an expert clinical team using standardized operational methods.

Sex-Dependent Performance of the Neutrophil-to-Lymphocyte, Monocyte-to-Lymphocyte, Platelet-to-Lymphocyte and Mean Platelet Volume-to-Platelet Ratios in Discriminating COVID-19 Severity.

Background: The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and mean platelet volume-to-platelet ratio (MPR) are combined hematology tests that predict COVID-19 severity, although with different cut-off values. Because sex significantly impacts immune responses and the course of COVID-19, the ratios could be biased by sex. Purpose: This study aims to evaluate sex-dependent differences in the contribution of NLR, PLR, MLR, and MPR to COVID-19 severity and mortality upon hospital admission using a sample of pneumonia patients with SARS-CoV-2 infection. Methods: This single-center observational cross-sectional study included 3,280 confirmed COVID-19 cases (CDC 2019-Novel Coronavirus real-time RT-PCR Diagnostic) from Quito (Ecuador). The receiver operating characteristic (ROC) curve analysis was conducted to identify optimal cut-offs of the above parameters when discriminating severe COVID-19 pneumonia and mortality risks after segregation by sex. Severe COVID-19 pneumonia was defined as having PaO2 < 60 mmHg and SpO2 < 94%, whereas non-severe COVID-19 pneumonia was defined as having PaO2 ≥ 60 mmHg and SpO2 ≥ 94%. Results: The mortality rate of COVID-19 among men was double that in women. Severe COVID-19 pneumonia and non-surviving patients had a higher level of NLR, MLR, PLR, and MPR. The medians of NLR, MLR, and MPR in men were significantly higher, but PLR was not different between men and women. In men, these ratios had lower cut-offs than in women (NLR: 2.42 vs. 3.31, MLR: 0.24 vs. 0.35, and PLR: 83.9 vs. 151.9). The sensitivity of NLR, MLR, and PLR to predict pneumonia severity was better in men (69-77%), whereas their specificity was enhanced in women compared to men (70-76% vs. 23-48%). Conclusion: These ratios may represent widely available biomarkers in COVID-19 since they were significant predictors for disease severity and mortality although with different performances in men and women.

Biomarkers of severe COVID-19 pneumonia on admission using data-mining powered by common laboratory blood tests-datasets.

In the epidemiological COVID-19 research, artificial intelligence is a unique approach to make predictions about disease severity to manage COVID-19 patients. A limitation of artificial intelligence is, however, the high risk of bias. We investigated the skill of data mining and machine learning, two advanced forms of artificial intelligence, to predict severe COVID-19 pneumonia based on routine laboratory tests. A sample of 4009 COVID-19 patients was divided into Severe (PaO2< 60 mmHg, 489 cases) and Non-Severe (PaO2 ≥ 60 mmHg, 3520 cases) groups according to blood hypoxemia on admission and their laboratory datasets analyzed by the R software and WEKA workbench. After curation, data were processed for the selection of the most influential features including hemogram, pCO2, blood acid-base balance, prothrombin time, inflammation biomarkers, and glucose. The best fit of variables was successfully confirmed by either the Multilayer Perceptron, a feedforward neural network algorithm that performed machine recognition of severe COVID-19 with 96.5% precision, or by the C4.5 software, a supervised learning algorithm based on an objective-predefined variable (severity) that generated a decision tree with 89.4% precision. Finally, a complex bivariate Pearson's correlation matrix combined with advanced hierarchical clustering (dendrograms) were conducted for knowledge discovery. The hidden structure of the datasets revealed shift patterns related to the development of COVID-19-induced pneumonia that involved the lymphocyte-to-C-reactive protein and leukocyte-to-C-protein ratios, neutrophil %, pH and pCO2. The data mining approaches to the hematological fluctuations associated with severe COVID-19 pneumonia could not only anticipate adverse clinical outcomes, but also reveal putative therapeutic targets.

La prevención y mitigación de los riesgos de los pasivos ambientales mineros (PAM) en Colombia: una propuesta metodológica

La minería colombiana ha adquirido una gran importancia en la economía del país. No obstante su relevancia, las repercusiones ambientales y sociales no son insignificantes; por el contrario, los alcances del deterioro que genera han exigido la adopción de políticas públicas que los contrarresten. El país está a la zaga en América Latina en política ambiental, particularmente en lo referente a la gestión de los llamados pasivos ambientales mineros y al cierre de minas abandonadas, inactivas, paralizadas o huérfanas, que requieren medidas de mitigación o remediación; además del manejo del riesgo de sus efectos negativos actuales y futuros. Para una adecuada gestión de estos pasivos es conveniente el diseño y aplicación de una matriz de riesgo que incorpore las buenas prácticas mineras, para así mitigar y prevenir mayores daños en el entorno socio-ambiental.

The Colombian mining has acquired an important role in the economy of the country. Despite its relevancy, environmental and social impacts are not insignificant, on the contrary the scope of this deterioration has demanded the adoption of public policies to counteract it. The country is lagging behind in Latin America in environmental policy particularly as regards manage of so called mining environmental liabilities and abandoned, inactive, paralyzed or orphaned mine closure requiring measures to mitigate them or remedy them, in addition to the management of risks of effects both current and future. For a suitable management of these liabilities, it is convenient the design and application of a risk matrix incorporating good mining practices in order to mitigate and prevent further damage to socio-environmental surroundings.

Mineração colombiana tornou-se cada vez mais importante na economia do país. Apesar de sua relevância, impactos ambientais e sociais não são insignificantes; pelo contrário, o alcance da deterioração que gera exigiram a adoção de políticas públicas que neutralizam. O país está ficando para trás na América Latina na política ambiental, particularmente em relação à gestão de passivos ambientais de mineração e fechamento de minas abandonadas, inativos ou órfão paralisadas, exigindo mitigação ou remediação conhecido; além da gestão de riscos de efeitos negativos atuais e futuras. Para uma gestão adequada desses passivos é conveniente para a concepção e implementação de uma matriz de risco para incorporar as boas práticas de mineração, a fim de mitigar e evitar mais danos ao ambiente sócio-ambientais.

Planning and Executing the Neurosurgery Boot Camp: The Bolivia Experience.

BACKGROUND: The neurosurgical boot camp has been fully incorporated into U.S. postgraduate education. This is the first implementation of the neurosurgical boot in a developing country. To advance neurosurgical education, we developed a similar boot camp program, in collaboration with Bolivian neurosurgeons, to determine its feasibility and effectiveness in an international setting. METHODS: In a collective effort, the Bolivian Society for Neurosurgery, Foundation for International Education in Neurological Surgery, Solidarity Bridge, and University of Massachusetts organized and executed the first South American neurosurgical boot camp in Bolivia in 2015. Both U.S. and Bolivian faculty led didactic lectures followed by a practicum day using mannequins and simulators. South American residents and faculty were surveyed after the course to determine levels of enthusiasm and their perceived improvement in fund of knowledge and course effectiveness. RESULTS: Twenty-four neurosurgery residents from 5 South American countries participated. Average survey scores ranged between 4.2 and 4.9 out of 5. Five Bolivian neurosurgeons completed the survey with average scores of 4.5-5. This event allowed for Bolivian leaders in the field to unify around education, resulting in the formation of an institute to continue similar initiatives. Total cost was estimated at $40 000 USD; however, significant faculty, industry, and donor support helped offset this amount. CONCLUSION: The first South American neurosurgical boot camp had significant value and was well received in Bolivia. This humanitarian model provides a sustainable solution to education needs and should be expanded to other regions as a means for standardizing the core competencies in neurosurgery.

Cohort study of intracameral moxifloxacin in postoperative endophthalmitis prophylaxis.

We conducted a cohort study to evaluate post-cataract surgery endophthalmitis rates in relation to prophylactic intracameral moxifloxacin administration. A total of 2332 patients (2674 eyes) who underwent phacoemulsification by a single surgeon from January 2007 through December 2012 were included in the study. A total of 1056 eyes did not receive intracameral prophylactic moxifloxacin and the antibiotic was injected in 1618 eyes. The incidence of presumed postoperative endophthalmitis in the 2 groups was calculated. The rate of presumed infectious endophthalmitis after cataract surgery between January 2007 and June 2009 (without intracameral moxifloxacin) was 0.094%. The rate in the second period, from July 2009 to December 2012 (with prophylactic intracameral moxifloxacin), was 0%. In our patients, a decline in the incidence of presumed infectious postoperative endophthalmitis appeared to be associated with the application of intracameral moxifloxacin.

Especies y concentración bacterianas en bilis de colecistectomías realizadas en la Clínica "Cobija", segundo semestre 2009 / Bacterial species and concentration in bile of cholecystectomy realized at the Clinic "Cobija" for second semester 2009

El objetivo del presente trabajo es determinar las especies bacterianas más prevalentes en muestras biliares de pacientes colecistectomizados en la clínica Cobija durante el segundo semestre de la gestión 2009, diferenciando entre aquellas que se presentan en el cuadro agudo y el cuadro crónico; además identificar el tipo de colecistitis más frecuente y si existe relación entre las mismas y la concentración bacteriana de aquellas muestras que resultaron positivas; también demostrar su relación con los factores de riesgo sexo y edad. El presente trabajo es una investigación de tipo descriptivo, analítico y transversal. La muestra fue 52 pacientes, que representa el 100% de aquellos sometidos a colecistectomía abierta en la clínica Cobija en los últimos seis meses del año 2009, de los cuales se recolectó la bilis durante el intraoperatorio y se procedió a su cultivo en Agar Sangre, caldo de tioglicolato; 24 horas después se verificó el crecimiento de colonias y se procede a su recuento y observación al microscopio, una vez identificados bacilos Gram negativos, se los cultivó en Agar Mc Conkey y posteriormente en kits bioquímicos de determinación de enterobacterias. Todo el procedimiento se realizó en el laboratorio de Bacteriología de la Facultad de Medicina Aurelio Meleán. Los resultados obtenidos indican que las bacterias más frecuentes en cuadros agudos son los bacilos Gram positivos y de los cuadros crónicos, los estreptococos. El sexo más susceptible es el femenino con la edad comprendida entre 30-34 y 50-54 años. Por último, se observó una relación directa entre concentraciones bacterianas mayores a 10000/ml con la colecistitis aguda. Concluimos que existe una relación entre el tipo de cuadro clínico de colecistitis y la concentración bacteriana. Además que el cuadro agudo puede desencadenarse con mayor frecuencia por bacilos Gram positivos y el crónico se relaciona con Streptococcus.

The aim of this study is to determine the most prevalent bacterial species in samples from patients cholecystectomized bile clinic Blanket fort he second half of 2009 management, differentiating between those that oceur in the acute and chronic table, also identify the type cholecystitis more frequently and whether a relationship exists between them and the bacterial concentration of those samples were positive, also showed their relationship to the risk factors age and sex. This study is a descriptive research, analytical and longitudinal. Sample 52 patients undergoing cholecystectomy at the clinic shelter in the last six months of 2009, of which the bile was collected during surgery and proceeded to its cultivation on blood agar, thioglycollate broth, 24 hours after the growth was checked colony and proceeds to count and microscopic observation, once identified Gram negative, the Me Conkey agar and then in kit's biochemical determination of Enterobacteriaceae.The entire procedure was performed in the laboratory of Bacteriology, Faculty of Medicine Melean Aurelio. The results obtained indicate that the most common bacteria in acute cases are Gram positive and chronic conditions, the streptococci. Sex is more susceptible to female aged between 30-34 and 50-54 years. Finally, we observed a direct relationship between bacterial concentrations greater than 10000/ml with acute cholecystitis. We conclude that there is a relationship between the type of clinical picture of cholecystitis and bacterial concentration. In addition to the acute condition may be triggered more often by Gram-positive bacilli and Streptococcus related to chronic.

Early intensive care unit mobility therapy in the treatment of acute respiratory failure.

OBJECTIVE: Immobilization and subsequent weakness are consequences of critical illness. Despite the theoretical advantages of physical therapy to address this problem, it has not been shown that physical therapy initiated in the intensive care unit offers benefit. DESIGN AND SETTING: Prospective cohort study in a university medical intensive care unit that assessed whether a mobility protocol increased the proportion of intensive care unit patients receiving physical therapy vs. usual care. PATIENTS: Medical intensive care unit patients with acute respiratory failure requiring mechanical ventilation on admission: Protocol, n = 165; Usual Care, n = 165. INTERVENTIONS: An intensive care unit Mobility Team (critical care nurse, nursing assistant, physical therapist) initiated the protocol within 48 hrs of mechanical ventilation. MEASUREMENTS AND MAIN RESULTS: The primary outcome was the proportion of patients receiving physical therapy in patients surviving to hospital discharge. Baseline characteristics were similar between groups. Outcome data are reflective of survivors. More Protocol patients received at least one physical therapy session than did Usual Care (80% vs. 47%, p < or = .001). Protocol patients were out of bed earlier (5 vs. 11 days, p < or = .001), had therapy initiated more frequently in the intensive care unit (91% vs. 13%, p < or = .001), and had similar low complication rates compared with Usual Care. For Protocol patients, intensive care unit length of stay was 5.5 vs. 6.9 days for Usual Care (p = .025); hospital length of stay for Protocol patients was 11.2 vs. 14.5 days for Usual Care (p = .006) (intensive care unit/hospital length of stay adjusted for body mass index, Acute Physiology and Chronic Health Evaluation II, vasopressor). There were no untoward events during an intensive care unit Mobility session and no cost difference (survivors + nonsurvivors) between the two arms, including Mobility Team costs. CONCLUSIONS: A Mobility Team using a mobility protocol initiated earlier physical therapy that was feasible, safe, did not increase costs, and was associated with decreased intensive care unit and hospital length of stay in survivors who received physical therapy during intensive care unit treatment compared with patients who received usual care.

Hidatidosis peritoneal y gestación: presentación de 3 casos clínicos / hydatidosis and pregnancr: presentation of 3 cases

Se presenta tres casos de gestantes con hidatidosis peritoneal, que llegaron a término; de ellas, dos tuvieron parto vía vaginal, sin complicación alguna. Se hace una revisión de la literatura sobre las potenciales complicaciones relacionadas con la vía del parto.

Three pregnant women with peritoneal hydatidosis are presented, who delivered at term, two of them vaginally without complications. We review current literature on potential complications associated with birth mode.

Valoración de la sensibilidad de los gérmenes aeróbicos en cuidados intensivos / Valoration of the sensitivity of the aerobic germs in intensive care

En la Unidad de Cuidados Intensivos (UCI) se evaluó de manera prospectiva la sensibilidad de los gérmenes aeróbicos a los antibióticos usados en UCI. Para ello se admitieron 266 pacientes desde enero de 1998 a enero de 1999. A 79 pacientes con diagnóstico de sepsis se les realizó 166 cultivos en condiciones aeróbicas. De las muestras tomadas, 101 resultaron positivas; 81,18 por ciento a gram (-), 12,87 por ciento a gram (+) y 5,94 por ciento a Candida albicans. Los gérmenes más encontrados fueron Klebsiella, Pseudomonas, Enterobacter sp, y E.colí. Las muestras cultivadas con mayor frecuencia fueron; secreción bronquial, orina, sangre, piel y tejidos blandos. Se obtuvo un mayor porcentaje de positividad en los cultivos de secreción bronquial, piel-tejidos blandos, punta de catéter y secreción uretral. La sensibilidad general reportada para gérmenes aeróbicos fue mayor para sulperazona, imipenem/cilastatina y ciprofloxacina. La selección empírica de los antimicrobianos incluyó datos epidemiológicos de los pacientes con infección grave en UCI, utilizándose como apoyo en la prevención de complicaciones y para mejorar los procedimientos en UCI

Programa de Ciencias de la Educacion Sanitaria en Chagas / sss

El programa propuesto de educacion sanitaria para el mal de chagas, integra en forma dialectica, holistica y holografica los componentes del proceso: la comunicacion audiovisual como metodo, atraves de los dibujos animados con un lenguaje de estructura racional simple y una imagen identificada con su cultura para el logro de la recepcion de mensajes cuyos contenidos contribuyen en la adquisicion de habitos de higiene y uso de los centros de salud para someterse al diagnostico y tratamiento...

Hacia una consulta integral: análisis teórico / Toward an integral consult: theorical analysis

Se procura analizar aspectos teóricos de una medicina pediátrica integral dentro del contexto clasico de la fusión Bio-Psico-Social; recordando permanentemente el concepto de una diferencia evolutiva dinámica en las diferentes etapas de la vida de un niño. Cada una de las etapas de la vida del niño tiene características particulares relacionadas principalmente aunque no exclusivamente con los procesos de crecimiento y desarrollo. En la literatura médica, sea nacional o foránea, se encuentran diversas proposiciones para sistematizar la evaluación periódica del niño en cada una de las etapas, reportándose lo más destacado para la edad

Evaluación del examen físico en la consulta de niños sanos / Evaluation of physic examination in the healthy children consultan

Se trata de un seguimiento retrospectivo de 200 expedientes clínicos dela consulta de niños sanos, del Hospital de niños J. M. de los Ríos, período Agosto 1981- Octubre 1984; muestreo simple. Entre las conclusiones: los datos obtenidos en la evaluación, permite inferir que no se realiza una verdadera consulta integral, por falta de algunas variables determinantes. Para la exploración física, en conjunto, se obtuvo el mejor porcentaje de registro. Se obtuvo un pocentaje relativamente similar de reporte "exámen físico normal" entre las diferentes edades, sin que haya registro de las áreas exploradas y consignadas en los expedientes. El estudio demuestra que no se cumplen con regularidad las normas de las variables a ser consideradas según la etapa de vida (patrón de referencia del servicio). Se sugiere el uso de un esquema de examen fisico tabulado para las diferentes edades que garantice el registro real de las exploraciones efectuadas

Consulta pediátrica control vs edad: informe y análisis servicio de niños sanos / Pediatrician consult: control vs age: analysis and formless children healthy service

Se procede al estudio y análisis de diferentes aspectos que caracterizan una consulta pediátrica de control, en particular lo referente a grupos etarios; para ello se obtuvo una muestra de 200 expedientes clínicos de la Consulta de Niños Sanos del Hospital de Niños "J.M. de los Ríos", en el período comprendido entre agosto de 1981 y octubre de 1984; historias escogidas por muestreo simple. Entre las conclusiones: el grupo etario de mayor asistencia, entre las primeras y sucesivas, correapomdió a los lactantes menores. En la mayoría de los grupos, la asistencia fue inferior a las requeridas, lo que dificulta un seguimiento óptimo del crecimiento y desarrollo. A medida que el niño adquiere más edad, disminuye la asistencia a las consultas programadas, alcanzando mayor relevancia entre los escolares. Las variables más estudiadas fueron: crecimiento y desarrollo psicomotor, alimentación y aspectos psicoemocionales