The DNA methyltransferase inhibitor decitabine blunts the response to a high animal fat and protein diet in mice.

Increasing evidence hints that DNA hypermethylation may mediate the pathogenic response to cardiovascular risk factors. Here, we tested a corollary of that hypothesis, i.e., that the DNA methyltransferase inhibitor decitabine (Dec) ameliorates the metabolic profile of mice fed a moderately high-animal fat and protein diet (HAFPD), a proxy of cardiovascular risk-associated Western-type diet. HAFPD-fed mice were exposed to Dec or vehicle for eight weeks (8W set, 4-32/group). To assess any memory of past exposure to Dec, we surveyed a second mice set treated as 8W but HAFPD-fed for further eight weeks without any Dec (16W set, 4-20/group). In 8W, Dec markedly reduced HAFPD-induced body weight gain in females, but marginally in males. Characterization of females revealed that Dec augmented skeletal muscle lipid content, while decreasing liver fat content and increasing plasma non-esterified fatty acids, adipose insulin resistance, and -although marginally- whole blood acylcarnitines, compared to HAFPD alone. Skeletal muscle mitochondrial DNA copy number was higher in 8W mice exposed to HAFPD and Dec, or in 16W mice fed HAFPD only, relative to 8W mice fed HAFPD only, but Dec induced a transcriptional profile indicative of ameliorated mitochondrial function. Memory of past Dec exposure was tissue-specific and sensitive to both duration of exposure to HAFPD and age. In conclusion, Dec redirected HAFPD-induced lipid accumulation towards the skeletal muscle, likely due to augmented mitochondrial functionality and increased lipid demand. As caveat, Dec induced adipose insulin resistance. Our findings may help identifying strategies for prevention and treatment of lipid dysmetabolism.

Reproducibility Analysis of Radiomic Features on T2-weighted MR Images after Processing and Segmentation Alterations in Neuroblastoma Tumors.

Purpose To evaluate the reproducibility of radiomics features extracted from T2-weighted MR images in patients with neuroblastoma. Materials and Methods A retrospective study included 419 patients (mean age, 29 months ± 34 [SD]; 220 male, 199 female) with neuroblastic tumors diagnosed between 2002 and 2023, within the scope of the PRedictive In-silico Multiscale Analytics to support cancer personalized diaGnosis and prognosis, Empowered by imaging biomarkers (ie, PRIMAGE) project, involving 746 T2/T2*-weighted MRI sequences at diagnosis and/or after initial chemotherapy. Images underwent processing steps (denoising, inhomogeneity bias field correction, normalization, and resampling). Tumors were automatically segmented, and 107 shape, first-order, and second-order radiomics features were extracted, considered as the reference standard. Subsequently, the previous image processing settings were modified, and volumetric masks were applied. New radiomics features were extracted and compared with the reference standard. Reproducibility was assessed using the concordance correlation coefficient (CCC); intrasubject repeatability was measured using the coefficient of variation (CoV). Results When normalization was omitted, only 5% of the radiomics features demonstrated high reproducibility. Statistical analysis revealed significant changes in the normalization and resampling processes (P < .001). Inhomogeneities removal had the least impact on radiomics (83% of parameters remained stable). Shape features remained stable after mask modifications, with a CCC greater than 0.90. Mask modifications were the most favorable changes for achieving high CCC values, with a radiomics features stability of 70%. Only 7% of second-order radiomics features showed an excellent CoV of less than 0.10. Conclusion Modifications in the T2-weighted MRI preparation process in patients with neuroblastoma resulted in changes in radiomics features, with normalization identified as the most influential factor for reproducibility. Inhomogeneities removal had the least impact on radiomics features. Keywords: Pediatrics, MR Imaging, Oncology, Radiomics, Reproducibility, Repeatability, Neuroblastic Tumors Supplemental material is available for this article. © RSNA, 2024 See also the commentary by Safdar and Galaria in this issue.

Stabilized Palladium Nanoparticles from Bis-(N-benzoylthiourea) Derived-PdII Complexes as Efficient Catalysts for Sustainable Cross-Coupling Reactions in Water.

Stable palladium (II) complexes, incorporating a double (N-benzoylthiourea) arrangement bonded to a complex heterocyclic scaffold, are used as precursors of catalytic species able to promote Suzuki-Miyaura, Mizoroki-Heck, Hiyama, Buchwald-Hartwig, Hirao and Sonogashira-Hagihara cross-coupling transformations in water. These sustainable processes are chemoselective and very versatile. The nanoparticles responsible for these catalytic reactions were analyzed and studied. Their usefulness is demonstrated after several tests and analyses. The heterogeneous character of this species in water was also confirmed.

Design and validation of a decision support checklist for efficient resource allocation in research projects during proposal preparation.

PURPOSE: This article presents the design and validation of evaluation criteria checklist aimed at facilitating decision-making processes regarding participation in research projects and allocation of resources before the preparation of research proposals. MATERIALS AND METHODS: A multidisciplinary team developed a comprehensive evaluation focusing on the proposal preparation phase of research projects. A Delphi survey method was used to establish a connection between the relevance of the project and the possible success of research proposals. Assessment criteria were agreed upon, each assigned specific weights. The results of the survey were applied to a database of 62 proposals for which our research group sought funding during 2020-2021. The method was validated using the funding body's outcomes (approval or rejection) of the submitted proposals as the ground truth per project type (national, European and regional). RESULTS: The results of the survey generated a checklist of 8 criteria (excellence, impact, and efficiency aspects) that effectively assess the possibility of success of research proposals during the preparatory phase. For national projects, the tool validation demonstrated a sensitivity of 100% and a specificity of 76.19%; European projects exhibited a sensitivity of 100% and a specificity of 53.84%; and regional projects showed a sensitivity of 80% and a specificity of 30%. CONCLUSIONS: By establishing an agreed set of evaluation criteria, the developed comprehensive index enables a more precise decision support tool for the participation in research proposals and the allocation of necessary resources. This control system saves valuable time and effort for research groups while enhancing the overall efficiency of available resources.

Embryo ranking agreement between embryologists and artificial intelligence algorithms.

OBJECTIVE: To evaluate the degree of agreement of embryo ranking between embryologists and eight artificial intelligence (AI) algorithms. DESIGN: Retrospective study. PATIENT(S): A total of 100 cycles with at least eight embryos were selected from the Weill Cornell Medicine database. For each embryo, the full-length time-lapse (TL) videos, as well as a single embryo image at 120 hours, were given to five embryologists and eight AI algorithms for ranking. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Kendall rank correlation coefficient (Kendall's τ). RESULT(S): Embryologists had a high degree of agreement in the overall ranking of 100 cycles with an average Kendall's tau (K-τ) of 0.70, slightly lower than the interembryologist agreement when using a single image or video (average K-τ = 0.78). Overall agreement between embryologists and the AI algorithms was significantly lower (average K-τ = 0.53) and similar to the observed low inter-AI algorithm agreement (average K-τ = 0.47). Notably, two of the eight algorithms had a very low agreement with other ranking methodologies (average K-τ = 0.05) and between each other (K-τ = 0.01). The average agreement in selecting the best-quality embryo (1/8 in 100 cycles with an expected agreement by random chance of 12.5%; confidence interval [CI]95: 6%-19%) was 59.5% among embryologists and 40.3% for six AI algorithms. The incidence of the agreement for the two algorithms with the low overall agreement was 11.7%. Agreement on selecting the same top two embryos/cycle (expected agreement by random chance corresponds to 25.0%; CI95: 17%-32%) was 73.5% among embryologists and 56.0% among AI methods excluding two discordant algorithms, which had an average agreement of 24.4%, the expected range of agreement by random chance. Intraembryologist ranking agreement (single image vs. video) was 71.7% and 77.8% for single and top two embryos, respectively. Analysis of average raw scores indicated that cycles with low diversity of embryo quality generally resulted in a lower overall agreement between the methods (embryologists and AI models). CONCLUSION(S): To our knowledge, this is the first study that evaluates the level of agreement in ranking embryo quality between different AI algorithms and embryologists. The different concordance methods were consistent and indicated that the highest agreement was intraembryologist agreement, followed by interembryologist agreement. In contrast, the agreement between some of the AI algorithms and embryologists was similar to the inter-AI algorithm agreement, which also showed a wide range of pairwise concordance. Specifically, two AI models showed intra- and interagreement at the level expected from random selection.

Histopathologic findings in ointment pseudo-cheilitis: An alert to dermatopathologists.

Ointment pseudo-cheilitis is a recently recognized distinctive type of self-induced cheilitis. Lesions consist of a variable amount of crusts adhered to the vermilion. These crusts consist of dried saliva and dead cells mixed with applied medications attached to the lip surface. Patients are typically severely anxious or depressed; the condition impacts quality of life. Ointment pseudo-cheilitis is frequently misdiagnosed as exfoliative cheilitis or cheilitis glandularis. Biopsy reports are often non-revealing because there are no established histopathological criteria for this disease, and clinicians usually do not formulate the correct diagnostic hypothesis. Here, we present the histopathological findings of four cases of ointment pseudo-cheilitis. The most consistent finding was the presence of laminated parakeratotic material detached from the epithelium in biopsies that are devoid of other significant diagnostic changes. This material at the lip surface possibly represents physiologic labial desquamation mixed with dried saliva and applied medication. With this report, we intend to alert dermatopathologists to the diagnosis of ointment pseudo-cheilitis if they receive biopsies from patients who present clinically exuberant labial lesions that show only minimal histopathological changes.

Therapeutic Management and Long-Term Outcome of Hyperthyroidism in Patients with Antithyroid-Induced Agranulocytosis: A Retrospective, Multicenter Study.

BACKGROUND: Antithyroid drug-induced agranulocytosis (AIA) (neutrophils <500/µL) is a rare but serious complication in the treatment of hyperthyroidism. METHODOLOGY: Adult patients with AIA who were followed up at 12 hospitals in Spain were retrospectively studied. A total of 29 patients were studied. The etiology of hyperthyroidism was distributed as follows: Graves' disease (n = 21), amiodarone-induced thyrotoxicosis (n = 7), and hyperfunctioning multinodular goiter (n = 1). Twenty-one patients were treated with methimazole, as well as six patients with carbimazole and two patients with propylthiouracil. RESULTS: The median (IQR) time to development of agranulocytosis was 6.0 (4.0-11.5) weeks. The most common presenting sign was fever accompanied by odynophagia. All of the patients required admission, reverse isolation, and broad-spectrum antibiotics; moreover, G-CSF was administered to 26 patients (89.7%). Twenty-one patients received definitive treatment, thirteen patients received surgery, nine patients received radioiodine, and one of the patients required both treatments. Spontaneous normalization of thyroid hormone values occurred in six patients (four patients with amiodarone-induced thyrotoxicosis and two patients with Graves' disease), and two patients died of septic shock secondary to AIA. CONCLUSIONS: AIA is a potentially lethal complication that usually appears around 6 weeks after the initiation of antithyroid therapy. Multiple drugs are required to control hyperthyroidism before definitive treatment; additionally, in a significant percentage of patients (mainly in those treated with amiodarone), hyperthyroidism resolved spontaneously.

Independent Validation of a Deep Learning nnU-Net Tool for Neuroblastoma Detection and Segmentation in MR Images.

OBJECTIVES: To externally validate and assess the accuracy of a previously trained fully automatic nnU-Net CNN algorithm to identify and segment primary neuroblastoma tumors in MR images in a large children cohort. METHODS: An international multicenter, multivendor imaging repository of patients with neuroblastic tumors was used to validate the performance of a trained Machine Learning (ML) tool to identify and delineate primary neuroblastoma tumors. The dataset was heterogeneous and completely independent from the one used to train and tune the model, consisting of 300 children with neuroblastic tumors having 535 MR T2-weighted sequences (486 sequences at diagnosis and 49 after finalization of the first phase of chemotherapy). The automatic segmentation algorithm was based on a nnU-Net architecture developed within the PRIMAGE project. For comparison, the segmentation masks were manually edited by an expert radiologist, and the time for the manual editing was recorded. Different overlaps and spatial metrics were calculated to compare both masks. RESULTS: The median Dice Similarity Coefficient (DSC) was high 0.997; 0.944-1.000 (median; Q1-Q3). In 18 MR sequences (6%), the net was not able neither to identify nor segment the tumor. No differences were found regarding the MR magnetic field, type of T2 sequence, or tumor location. No significant differences in the performance of the net were found in patients with an MR performed after chemotherapy. The time for visual inspection of the generated masks was 7.9 ± 7.5 (mean ± Standard Deviation (SD)) seconds. Those cases where manual editing was needed (136 masks) required 124 ± 120 s. CONCLUSIONS: The automatic CNN was able to locate and segment the primary tumor on the T2-weighted images in 94% of cases. There was an extremely high agreement between the automatic tool and the manually edited masks. This is the first study to validate an automatic segmentation model for neuroblastic tumor identification and segmentation with body MR images. The semi-automatic approach with minor manual editing of the deep learning segmentation increases the radiologist's confidence in the solution with a minor workload for the radiologist.

Evidence of natural selection and dominance of SARS-CoV-2 variant Lambda (C.37) over variants of concern in Cusco, Peru.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) lineage C.37 (Lambda) has spread rapidly in Peru and other Latin American countries. However, most studies in Peru have focused on Lima, the capital city, without knowing the dynamics of the spread of the variant in other departments. Cusco, Peru, is one of the most popular departments in the country for tourists, so the introduction of new variants of SARS-CoV-2 might occur despite closure of the borders. Therefore, in this work, we analyzed the variants circulating in Cusco. The aim of this work was to better understand the distribution of SARS-CoV-2 lineages circulating in Cusco and to characterize the genomes of these strains. To this end, 46 SARS-CoV-2 genomes from vaccinated and unvaccinated patients were sequenced in the first half of 2021. The genomes were analyzed using phylogenetic and natural selection methods. Phylogenetic trees from Cusco showed dominance of the Lambda lineage over the variants of concern (VOCs), and there was no clustering of variants by district. Natural selection analysis revealed mutations, mainly in the spike protein, at positions 75, 246, 247, 707, 769, and 1020. In addition, we found that unvaccinated patients accumulated more new mutations than did vaccinated patients, and these included the F101Y mutation in ORF7a, E419A in NSP3, a deletion in S (21,618-22,501), and a deletion in ORF3a (25,437-26,122).

Accuracy of anterior denture tooth arrangements of CAD-CAM complete removable dental prostheses made with a tooth mold template.

STATEMENT OF PROBLEM: Research evaluating the accuracy of anterior tooth mold templates to computer-aided design and computer-aided manufacture (CAD-CAM) fabricated complete removable dental prostheses (CRDPs) is limited. PURPOSE: The purpose of this in vitro study was to investigate the accuracy of the anterior denture tooth arrangement on CAD-CAM complete removable dental prostheses made with the anterior tooth mold template. MATERIAL AND METHODS: A maxillary and mandibular edentulous model was mounted on a semiadjustable articulator to simulate a patient's maxillary arch. Definitive impressions and jaw relation records were made as per the manufacturer's protocol. A maxillary and mandibular anatomic measuring device was completely seated onto the edentulous models, centered on the edentulous model midline, and horizontally positioned parallel to the mandibular ridge. A medium-size anterior tooth mold template sticker was attached on the anatomic measuring device to identify the maxillary dental midline and incisal edge position and was sent to the manufacturer as the proposed tooth arrangement reference for the definitive complete removable dental prostheses. A total of 10 milled complete removable dental prostheses were generated for 2 groups by using 2 different tooth arrangement techniques. One group (n=5) used the monobloc milling technique without bonding of denture teeth, while the other group (n=5) used the bonding system for denture teeth on the milled denture base. For comparison, a camera mounted on a tripod was used for photographic documentation. Reference markers placed on the edentulous model were used to orient and measure the difference of 4 aspects of the anterior tooth arrangement: average incisal edge position, intercanine distance, midline, and clinical crown length of the left central incisor. The difference values between the tooth mold template and definitive complete removable dental prostheses were statistically analyzed by multivariate ANOVA (α=.05) and 1-sample t tests (adjusted α=.0125). RESULTS: Overall, statistically significant differences were found between the tooth mold template (control) and definitive complete removable dental prostheses at all measuring aspects except for the midline of the midline of the milled arrangement technique (P<.0125). In terms of the midline value, the value of the milled group did not show a significant difference compared with tooth mold template (-0.19 mm). However, the value of the bonded group indicated a significant difference of midline (0.44 mm toward to the left of the tooth mold template midline). When the complete removable dental prosthesis milled denture tooth and complete removable dental prosthesis bonded denture tooth techniques were compared, there was no difference in the tested variables between the milled and the bonded groups (P>.0125). CONCLUSIONS: The tooth mold template did not represent an accurate position for definitive complete removable dental prostheses for either the milled or bonded techniques. The largest differences were found at the average incisal edge of the anterior teeth and the intercanine distance for both groups. However, there was overall no clinical difference between the 2 groups (milled and bonded) of CAD-CAM complete removable dental prostheses.

A non-invasive artificial intelligence approach for the prediction of human blastocyst ploidy: a retrospective model development and validation study.

BACKGROUND: One challenge in the field of in-vitro fertilisation is the selection of the most viable embryos for transfer. Morphological quality assessment and morphokinetic analysis both have the disadvantage of intra-observer and inter-observer variability. A third method, preimplantation genetic testing for aneuploidy (PGT-A), has limitations too, including its invasiveness and cost. We hypothesised that differences in aneuploid and euploid embryos that allow for model-based classification are reflected in morphology, morphokinetics, and associated clinical information. METHODS: In this retrospective study, we used machine-learning and deep-learning approaches to develop STORK-A, a non-invasive and automated method of embryo evaluation that uses artificial intelligence to predict embryo ploidy status. Our method used a dataset of 10 378 embryos that consisted of static images captured at 110 h after intracytoplasmic sperm injection, morphokinetic parameters, blastocyst morphological assessments, maternal age, and ploidy status. Independent and external datasets, Weill Cornell Medicine EmbryoScope+ (WCM-ES+; Weill Cornell Medicine Center of Reproductive Medicine, NY, USA) and IVI Valencia (IVI Valencia, Health Research Institute la Fe, Valencia, Spain) were used to test the generalisability of STORK-A and were compared measuring accuracy and area under the receiver operating characteristic curve (AUC). FINDINGS: Analysis and model development included the use of 10 378 embryos, all with PGT-A results, from 1385 patients (maternal age range 21-48 years; mean age 36·98 years [SD 4·62]). STORK-A predicted aneuploid versus euploid embryos with an accuracy of 69·3% (95% CI 66·9-71·5; AUC 0·761; positive predictive value [PPV] 76·1%; negative predictive value [NPV] 62·1%) when using images, maternal age, morphokinetics, and blastocyst score. A second classification task trained to predict complex aneuploidy versus euploidy and single aneuploidy produced an accuracy of 74·0% (95% CI 71·7-76·1; AUC 0·760; PPV 54·9%; NPV 87·6%) using an image, maternal age, morphokinetic parameters, and blastocyst grade. A third classification task trained to predict complex aneuploidy versus euploidy had an accuracy of 77·6% (95% CI 75·0-80·0; AUC 0·847; PPV 76·7%; NPV 78·0%). STORK-A reported accuracies of 63·4% (AUC 0·702) on the WCM-ES+ dataset and 65·7% (AUC 0·715) on the IVI Valencia dataset, when using an image, maternal age, and morphokinetic parameters, similar to the STORK-A test dataset accuracy of 67·8% (AUC 0·737), showing generalisability. INTERPRETATION: As a proof of concept, STORK-A shows an ability to predict embryo ploidy in a non-invasive manner and shows future potential as a standardised supplementation to traditional methods of embryo selection and prioritisation for implantation or recommendation for PGT-A. FUNDING: US National Institutes of Health.

Patient experience in automated peritoneal dialysis with telemedicine monitoring during the COVID-19 pandemic in Mexico: Qualitative study.

AIM: The aim of the study was to understand the experiences of patients on automated peritoneal dialysis (APD) during the period of confinement due to the COVID-19 pandemic. DESIGN: Qualitative exploratory study, phenomenological through semi-structured telephone interview. METHOD: A priori sampling was carried out with patients on APD with remote monitoring and telephone follow-up, in 13 hospitals in Mexico. RESULTS: Twenty-nine informants, mean age 45.41 ± 16.93; 15 women and 14 men. The analysis revealed four categories of analysis: home isolation, clinical follow-up, socioeconomic challenges and infodemic. The experiences of these patients led them to somatize emotions, presenting symptoms such as anxiety, sadness, loneliness, sleep, eating and digestive disorders, situation that sets the tone for future research on telemedicine care models, coping styles, emotional support strategies and socioeconomic impact on patients with chronic home treatments during the pandemic.

Bloqueo de nervios del tobillo guiado por ultrasonido como tratamiento adyuvante en dolor crónico posterior a lesiones por accidente laboral / Ultrasound-guided ankle nerve block as adjuvant therapy in chronic pain after occupational injury

Introducción: Los traumatismos de tobillo y pie pueden generar dolor crónico, causar limitación funcional e incapacidad laboral prolongada. El bloqueo de nervios periféricos guiado por imagen es una alternativa de tratamiento en pacientes con dolor crónico con baja respuesta a otras estrategias terapéuticas. Objetivo: Evaluar los efectos del bloqueo de nervios del tobillo guiado por ultrasonido (US), en pacientes con dolor crónico posterior a lesiones de tobillo y pie ocasionadas por accidente de trabajo.Métodos: Estudio pre y post intervención de temporalidad retrospectiva, que incluyó las historias clínicas de pacientes con dolor crónico posterior a trauma de tobillo y pie, a quienes se les había practicado bloqueo de nervios del tobillo guiado por ultrasonido . Para la valoración del dolor se utilizó la escala numérica (EN) y el Índice de Lattinen (IL). El dolor y el uso de medicamentos se evaluó un mes después del procedimiento. Resultados: Se analizaron los registros clínicos de 41 pacientes; 24 (58,5%) hombres y 17 (41,5%) mujeres, con edad media de 42,5 años (±12,2). Todos los pacientes presentaban dolor crónico posterior a lesiones de tobillo y pie, con tiempo promedio de evolución de 16,8 (±12,1) meses. Un mes después del procedimiento, se evidencia disminución significativa de la intensidad del dolor en el grupo de pacientes según EN (p = 0,000) y en la puntuación global del IL (p = 0,000). En la evaluación de seguimiento, 26 (63,4%) pacientes registran disminución en el número de medicamentos para el dolor. Conclusión: El bloqueo de nervios del tobillo guiado por US, puede considerarse como adyuvante analgésico en dolor crónico posterior a trauma de tobillo-pie y contribuir a disminuir el uso de medicamentos.(AU)

Introduction: Ankle and foot injuries can generate chronic pain, lead to functional limitation and long-term work disability. Image-guided peripheral nerve block is an alternative treatment in patients with chronic pain and poor response to other therapeutic strategies. Objective: To evaluate the effects of ultrasound-guided ankle nerve block in patients with chronic pain after ankle and foot injuries caused by an occupational accident. Methods: Pre- and post-intervention retrospective study, which included the medical records of patients with chronic pain after ankle and foot trauma, who had undergone peripheral nerve block of the ankle using ultrasound guidance. The numerical scale (NS) and the Lattinen Index (LI) were used to assess pain. Pain and medication use were assessed one month after the procedure. Results: The clinical records of 41 patients were analyzed. 24 (58.5%) men and 17 (41.5%) women, with a mean age of 42.5 years (±12.2). All patients had chronic pain after ankle and foot injuries, with an average evolution time of 16.8 (±12.1) months. One month after the procedure, there is evidence of a significant decrease in pain intensity in the group of patients according to the NS (p = 0.000) and in the total LI score (p = 0.000). In the follow-up assessment, 26 (63.4%) patients recorded a decrease in the number of pain medications. Conclusion: Ultrasound-guided ankle nerve block can be considered as an analgesic adjuvant in chronic pain after ankle-foot trauma and help reduce the use of medications.(AU)

Alta prevalencia de discapacidad intelectual y de comportamiento en niños de 2-17 años, Honduras 2017 / High prevalence of intellectual and behavioral disability in children aged 2-17 years, Honduras 2017

En Honduras el último registro de discapacidad en niños fue en el 2002 y se considera que su valor pudo ser subestimado. Objetivo: Determinar la prevalencia de discapacidad en niños de 2-17 años, Honduras 2017. Métodos: Estudio descriptivo transversal. Estudiantes del último año de la Carrera de Medicina, Universidad Nacional Autónoma de Honduras (UNAH), visitaron 50 casas de las comunidades asignadas mediante muestreo polietápico. Se encuestaron cuidadores adultos de niños de 2-17 años aplicando Instrumento del Grupo de Washington, previo consentimiento/asentimiento informado. Se realizó análisis univariado (frecuencias, porcentajes, prevalencias, IC95%) y bivariado (diferencia de proporciones, p<0.05 se consideró significativo). Resultados: Prevalencia de discapacidad en niños fue 8.96% (IC95% 8.5-9.4), departamentos con prevalencia ≥10%: El Paraíso, Francisco Morazán, Santa Bárbara, Cortés y Comayagua. Se identificó mayor prevalencia en sexo masculino, edad 5-17 años, nivel de escolaridad medio y secundaria y relación inversa entre discapacidad con escolaridad del cuidador y nivel de ingresos del hogar (p<0.01). El tipo de discapacidad encontrado fue intelectual y conductual: comportamiento (1.9%) y comunicación (2.4%) en edad 2-4 años, y comportamiento, aprendizaje, atención y comunicación en edad 5-17 años (prevalencia≥2%). El 80% no había recibido atención alguna. Discusión: La discapacidad en los niños de Honduras es mayor de lo reportado, y estos niños están desatendidos por lo que podrían ser adultos dependientes a futuro. Debe educarse a quienes atienden la primera infancia en identificar la discapacidad en niños y crear políticas públicas que generen mayor atención e inclusión...(AU)

Severity of protein-energy wasting and obesity are independently related with poor quality of life in peritoneal dialysis patients.

Protein-energy wasting (PEW) and poor health-related quality of life (HRQoL) are independently associated with morbi-mortality in continuous ambulatory peritoneal dialysis (CAPD). PEW may reduce HRQoL; however, we hypothesized HRQoL is affected differentially by PEW degrees or by individual criteria of nutritional status. AIM: To evaluate HRQoL according to PEW severity and nutritional status indicators in CAPD. This is a cross-sectional study in 151 patients. Subjective global assessment (SGA) was employed, and nutritional status classified as normal, mild-moderate PEW, and severe PEW. HRQoL was evaluated using Kidney Disease Quality of Life Short Form™, including physical (PCS), mental (MCS) and kidney disease (KDCS) components, and their subscales. Dietary intake, anthropometric and biochemical variables were measured. Forty-six percent of patients were well-nourished, 44% had mild-moderate PEW, and 10% severe PEW. Compared with well-nourished patients, those with mild-moderate (p=0.06) and severe (p=0.005) PEW had lower HRQoL score [68 (52-75), 55 (45-72), 46 (43-58), respectively]. PCS, MCS, and KDCS and their subscales had lower values as PEW was more severe. Patients with obesity and hypoalbuminemia had significantly lower HRQoL overall and component scores than their counterparts. Dietary intake was not associated with quality of life. In multivariate analysis obesity, PEW (by SGA), hypoalbuminemia, and low educational level predicted poor HRQoL (χ2 58.2, p<0.0001). As conclusion, PEW severity was related with worse HRQoL, either as overall score or in every component or subscale in CAPD patients. Poor HRQoL was predicted independently by PEW severity and obesity; additional predictors were hypoalbuminemia and low education.

Mortality Due to COVID-19 in Renal Transplant Recipients, Related to Variants of SARS-CoV-2 and Vaccination in Mexico.

BACKGROUND: SARS-CoV-2 infection in transplant patients has shown greater lethality and vaccination in this group of patients has shown less information. The objective of this study is to show the statistics in Mexico of lethality in kidney recipients infected with COVID-19 in relation to vaccination and variants of the coronavirus. METHODS: This is a bibliographic search of kidney transplant recipient patients since the start of the pandemic in Mexico to determine lethality after SARS-CoV-2 compared to the general population and in relation to patients, the 4 most important infectious peaks in the country due to identified variants, and also before and after vaccination. RESULTS: The global lethality is 26.91% from the beginning of the pandemic to April 9, 2022 in kidney recipients in Mexico (130 deaths of 483 infected kidney transplant recipients) compared to the national lethality of 5.60%. Variant B. 1.1.220 represented the highest lethality with 30.43% and the lowest lethality was Omicron with 16.41%. The lethality prior to vaccination was 30.94% and 23.46% after it. CONCLUSION: Both some variants and vaccination have influenced a lower lethality due to COVID-19 in Mexico in kidney transplant patients; It is important to consider global recommendations, such as a third or fourth dose, a combination of mRNA vaccines and vectors in order to reduce lethality in this group of patients.

Comparative Multicentric Evaluation of Inter-Observer Variability in Manual and Automatic Segmentation of Neuroblastic Tumors in Magnetic Resonance Images.

Tumor segmentation is one of the key steps in imaging processing. The goals of this study were to assess the inter-observer variability in manual segmentation of neuroblastic tumors and to analyze whether the state-of-the-art deep learning architecture nnU-Net can provide a robust solution to detect and segment tumors on MR images. A retrospective multicenter study of 132 patients with neuroblastic tumors was performed. Dice Similarity Coefficient (DSC) and Area Under the Receiver Operating Characteristic Curve (AUC ROC) were used to compare segmentation sets. Two more metrics were elaborated to understand the direction of the errors: the modified version of False Positive (FPRm) and False Negative (FNR) rates. Two radiologists manually segmented 46 tumors and a comparative study was performed. nnU-Net was trained-tuned with 106 cases divided into five balanced folds to perform cross-validation. The five resulting models were used as an ensemble solution to measure training (n = 106) and validation (n = 26) performance, independently. The time needed by the model to automatically segment 20 cases was compared to the time required for manual segmentation. The median DSC for manual segmentation sets was 0.969 (±0.032 IQR). The median DSC for the automatic tool was 0.965 (±0.018 IQR). The automatic segmentation model achieved a better performance regarding the FPRm. MR images segmentation variability is similar between radiologists and nnU-Net. Time leverage when using the automatic model with posterior visual validation and manual adjustment corresponds to 92.8%.

Frecuencia de hiponatremia posoperatoria en pacientes sometidos a cirugía mayor en un centro de tercer nivel

Contexto la hiponatremia posoperatoria es una complicación frecuente que se encuentra hasta en el 4 % de los pacientes sometidos a cirugía y que además es un factor independiente de mortalidad intrahospitalaria. Hasta ahora, los estudios se enfocan en las primeras horas posteriores a la cirugía, existiendo poca literatura que abarque hasta el periodo posoperatorio tardío. Objetivo evaluar la frecuencia y las características de hiponatremia en la primera semana posoperatoria. Metodología se incluyeron pacientes sometidos a cirugía mayor durante un periodo de 18 meses. Se determinó el nivel de sodio a las 24 horas, al tercer, quinto y séptimo día del procedimiento. Se clasificó de acuerdo con el tipo de cirugía realizada y se documentó la presencia de datos clínicos y desenlaces de los pacientes. Resultados 280 pacientes fueron estudiados, de los cuales 20 (7,1 %) desarrollaron hiponatremia durante el primer día posoperatorio, 34 (12,1 %) en el tercero, 30 (10,7 %) en el quinto día y 31 (11 %) en el séptimo día. En el primer día posoperatorio, los pacientes sometidos a cirugías urológicas y gastrointestinales desarrollaron hiponatremia con mayor frecuencia. Ninguno de los pacientes desarrolló complicaciones graves y no hubo relación entre la edad, el género o el tipo de soluciones y el desarrollo de hiponatremia. Conclusiones la hiponatremia es una complicación frecuente de varios tipos de procedimientos quirúrgicos que puede desarrollarse en los primeros siete días posoperatorios.

Background Postoperative hyponatremia is a frequent complication that is found in more than 4% of patients undergoing surgery. It is also an independent factor of in-hospital mortality. Until now, previous studies have focused on the first hours after surgery, so there is little information regarding hyponatremia in the late postoperative period. Purpose evaluate the frequency and characteristics of hyponatremia in the first postsurgical week. Methodology Patients undergoing major surgery over a period of 18 months were included. Sodium level was determined at 24 hours, third, fifth and seventh day of the procedure. Hyponatremia was classified according to surgery type and presence of clinical symptoms and outcomes were documented. Results 280 patients were studied. 20 (7.1%) developed hyponatremia on the first postoperative day, 34 (12.1%) on the third, 30 (10.7%) on the fifth day, and 31 (11%) on the seventh day. On the first postoperative day, patients undergoing urological and gastrointestinal surgeries developed hyponatremia more frequently. None of the patients developed serious complications. There was no relationship between age, gender or type of solutions and the development of hyponatremia. Conclusions hyponatremia is a frequent complication of surgical procedures that can develop in the first seven postoperative days.