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Priscilla Sigua-Arce,1 Ramy Mando,1 Lisa Spencer,2 Alexandra Halalau1,2 1Department of Internal Medicine, Beaumont Health System, Royal Oak, MI, USA; 2Oakland University William Beaumont School of Medicine, Rochester Hills, MI, USACorrespondence: Alexandra Halalau Email Alexandra.halalau@beaumont.eduObjective: To assess the treatment options and associated complications in patients with May–Thurner’s syndrome (MTS).Methods: We retrospectively reviewed the charts of patients diagnosed with MTS. Thorough review was completed and data relevant to methods of diagnosis, treatment, complications, hospital readmission, and mortality were extracted from patient charts. The patients were followed for two years after diagnosis.Results: Of the 47 patients identified as having “MTS”, 32 (70%) were diagnosed formally with either magnetic resonance venography, computed tomography venography, or ultrasound. Two patients were excluded for insufficient availability of follow-up records. Mean age of the population included (N = 30) was 50.24 ± 15.33 years and 83% (N = 25) had female gender. The majority (40%) of patients were treated with anticoagulation, thrombolysis, and stent placement, and 13.3% received a combination of anticoagulation, antiplatelet agent, thrombolysis, and stent placement. Overall, we found 28 patients (93%) who underwent endovascular stenting. However, 39.3% (11/28) had stent-related complications that included stent thrombosis, stenosis, and migration. One patient underwent open heart surgery for stent retrieval. Duration of anticoagulation therapy ranged from 6 months to lifelong. Two patients (6.7%) suffered major bleeds requiring transfusion. Fourteen patients (46.6%) developed post-thrombotic syndrome. Seven (23.3%) patients required MTS-related readmission within 30 days. No mortality was noted at two-year follow-up.Conclusion: Although our study only included 30 patients, it was evident to us that there is no consensus in the management of MTS. Furthermore, endovascular stenting, which has a major role in the management of MTS, has complication rates that hover close to 40%. Further research is needed to help develop a standardized evidence-based approach in the management of MTS that ensures a decreased risk of immediate and long-term complications.Keywords: May–Thurner syndrome, treatment, complications, diagnosis, anticoagulation

Knee osteoarthritis (KOA) is one of the main problems of an aging society in terms of incidence, impairment to the quality of daily living (QOL), and economics. The main aim of this study was to verify the usefulness, in practical terms, of applying the existing diagnostic criteria of early knee osteoarthritis (EKOA). The secondary objective of this project was to evaluate the clinical progression of healthy subjects (HS) at risk of osteoarthritis and of patients with diagnosed EKOA. A cross-sectional longitudinal pilot study was carried out, in which 105 participants were classified as EKOA patients or HS according to the diagnostic criteria. Measures of disability, pain, and self-reported variables were assessed. Two follow-ups were performed in order to assess the diagnoses and radiological progression, and the clinical progression was evaluated using self-reported measures. Following the current diagnostic criteria, the participants were divided into EKOA and HS. Most of the participants did not present changes in their classification, although some subjects were reclassified as EKOA or HS in the follow-ups which were performed. The current classification criteria for EKOA based on self-reported measures, radiological findings, and clinical conditions such as pain could lead to a misdiagnosis of this process, as fluctuations in the classifications of patients according to their conditions were found during follow up.

Volatile organic compounds (VOCs) are small molecular mass metabolites which compose the volatilome, whose analysis has been widely employed in different areas. This innovative approach has emerged in research as a diagnostic alternative to different diseases in human and veterinary medicine, which still present constraints regarding analytical and diagnostic sensitivity. Such is the case of the infection by mycobacteria responsible for tuberculosis and paratuberculosis in livestock. Although eradication and control programs have been partly managed with success in many countries worldwide, the often low sensitivity of the current diagnostic techniques against Mycobacterium bovis (as well as other mycobacteria from Mycobacterium tuberculosis complex) and Mycobacterium avium subsp. paratuberculosis together with other hurdles such as low mycobacteria loads in samples, a tedious process of microbiological culture, inhibition by many variables, or intermittent shedding of the mycobacteria highlight the importance of evaluating new techniques that open different options and complement the diagnostic paradigm. In this sense, volatilome analysis stands as a potential option because it fulfills part of the mycobacterial diagnosis requirements. The aim of the present review is to compile the information related to the diagnosis of tuberculosis and paratuberculosis in livestock through the analysis of VOCs by using different biological matrices. The analytical techniques used for the evaluation of VOCs are discussed focusing on the advantages and drawbacks offered compared with the routine diagnostic tools. In addition, the differences described in the literature among in vivo and in vitro assays, natural and experimental infections, and the use of specific VOCs (targeted analysis) and complete VOC pattern (non-targeted analysis) are highlighted. This review emphasizes how this methodology could be useful in the problematic diagnosis of tuberculosis and paratuberculosis in livestock and poses challenges to be addressed in future research.

Approaches to the identification of metabolites have progressed from early biochemical pathway evaluation to modern high-dimensional metabolomics, a powerful tool to identify and characterize biomarkers of health and disease. In addition to its relevance to classic metabolic diseases, metabolomics has been key to the emergence of immunometabolism, an important area of study, as leukocytes generate and are impacted by key metabolites important to innate and adaptive immunity. Herein, we discuss the metabolomic signatures and pathways perturbed by the activation of the human immune system during infection and vaccination. For example, infection induces changes in lipid (e.g., free fatty acids, sphingolipids, and lysophosphatidylcholines) and amino acid pathways (e.g., tryptophan, serine, and threonine), while vaccination can trigger changes in carbohydrate and bile acid pathways. Amino acid, carbohydrate, lipid, and nucleotide metabolism is relevant to immunity and is perturbed by both infections and vaccinations. Metabolomics holds substantial promise to provide fresh insight into the molecular mechanisms underlying the host immune response. Its integration with other systems biology platforms will enhance studies of human health and disease.

In the context of updating the Cuban economic model, the management systems and specifically the quality systems have contributed to optimizing the processes with all the advantages that this entails. The article aims to develop a comprehensive diagnosis of Cuban enterprises related to the quality activity they carry out. It is based on the use of tools and techniques such as: documentary review, surveys, interviews with entrepreneurs and the study of the regulatory framework. [ABSTRACT FROM AUTHOR]

Knee osteoarthritis (KOA) is one of the main problems of an aging society in terms of incidence, impairment to the quality of daily living (QOL), and economics. The main aim of this study was to verify the usefulness, in practical terms, of applying the existing diagnostic criteria of early knee osteoarthritis (EKOA). The secondary objective of this project was to evaluate the clinical progression of healthy subjects (HS) at risk of osteoarthritis and of patients with diagnosed EKOA. A cross-sectional longitudinal pilot study was carried out, in which 105 participants were classified as EKOA patients or HS according to the diagnostic criteria. Measures of disability, pain, and self-reported variables were assessed. Two follow-ups were performed in order to assess the diagnoses and radiological progression, and the clinical progression was evaluated using self-reported measures. Following the current diagnostic criteria, the participants were divided into EKOA and HS. Most of the participants did not present changes in their classification, although some subjects were reclassified as EKOA or HS in the follow-ups which were performed. The current classification criteria for EKOA based on self-reported measures, radiological findings, and clinical conditions such as pain could lead to a misdiagnosis of this process, as fluctuations in the classifications of patients according to their conditions were found during follow up. [ABSTRACT FROM AUTHOR]

(1) Background: Chagas disease is the main neglected tropical disease in America. It is estimated that around 6 million people are currently infected with the parasite in Latin America, and 25 million live in endemic areas with active transmission. The disease causes an estimated economic loss of USD 24 billion dollars annually, with a loss of 75,200 working years per year of life; it is responsible for around ~12,000 deaths annually. Although Mexico is an endemic country that recorded 10,186 new cases of Chagas disease during the period of 1990–2017, few studies have evaluated the genetic diversity of genes that could be involved in the prophylaxis and/or diagnosis of the parasite. One of the possible candidates proposed as a vaccine target is the 24 kDa trypomastigote excretory–secretory protein, Tc24, whose protection is linked to the stimulation of T. cruzi-specific CD8+ immune responses. (2) Methods: The aim of the present study was to evaluate the fine-scale genetic diversity and structure of Tc24 in T. cruzi isolates from Mexico, and to compare them with other populations reported in the Americas with the aim to reconsider the potential role of Tc24 as a key candidate for the prophylaxis and improvement of the diagnosis of Chagas disease in Mexico. (3) Results: Of the 25 Mexican isolates analysed, 48% (12) were recovered from humans and 24% (6) recovered from Triatoma barberi and Triatoma dimidiata. Phylogenetic inferences revealed a polytomy in the T. cruzi clade with two defined subgroups, one formed by all sequences of the DTU I and the other formed by DTU II–VI; both subgroups had high branch support. Genetic population analysis detected a single (monomorphic) haplotype of TcI throughout the entire distribution across both Mexico and South America. This information was supported by Nei's pairwise distances, where the sequences of TcI showed no genetic differences. (4) Conclusions: Given that both previous studies and the findings of the present work confirmed that TcI is the only genotype detected from human isolates obtained from various states of Mexico, and that there is no significant genetic variability in any of them, it is possible to propose the development of in silico strategies for the production of antigens that optimise the diagnosis of Chagas disease, such as quantitative ELISA methods that use this region of Tc24. [ABSTRACT FROM AUTHOR]

Histopathology is the gold standard for disease diagnosis. The use of digital histology on fresh samples can reduce processing time and potential image artifacts, as label-free samples do not need to be fixed nor stained. This fact allows for a faster diagnosis, increasing the speed of the process and the impact on patient prognosis. This work proposes, implements, and validates a novel digital diagnosis procedure of fresh label-free histological samples. The procedure is based on advanced phase-imaging microscopy parameters and artificial intelligence. Fresh human histological samples of healthy and tumoral liver, kidney, ganglion, testicle and brain were collected and imaged with phase-imaging microscopy. Advanced phase parameters were calculated from the images. The statistical significance of each parameter for each tissue type was evaluated at different magnifications of 10×, 20× and 40×. Several classification algorithms based on artificial intelligence were applied and evaluated. Artificial Neural Network and Decision Tree approaches provided the best general sensibility and specificity results, with values over 90% for the majority of biological tissues at some magnifications. These results show the potential to provide a label-free automatic significant diagnosis of fresh histological samples with advanced parameters of phase-imaging microscopy. This approach can complement the present clinical procedures. [ABSTRACT FROM AUTHOR]

La enfermedad periodontal se caracteriza por la pérdida del balance que existe entre la relación bacteria-hospedero resultando en un proceso inflamatorio que destruye los tejidos de protección y soporte del diente. Los conocimientos actuales sobre la etiopatogénesis periodontal aceptan que la proliferación de ciertos microorganismos en el ambiente subgingival están asociados con enfermedad periodontal destructiva. La identificación de dichos patógenos periodontales permite un acercamiento más racional al diagnóstico, tratamiento y pronóstico de las enfermedades periodontales. Diferentes técnicas de diagnóstico microbiológico periodontal se han empleado desde los inicios del siglo pasado y van desde la evaluación microscópica de la placa bacteriana dental hasta las modernas técnicas moleculares de detección de genomas virales/bacterianos. Cada una de estos métodos de detección microbiana posee ventajas y desventajas. En general, las técnicas de diagnóstico microbiológico ofrecen información importante acerca de la composición microbiana subgingival y en algunos casos, como el cultivo microbiológico, determinan susceptibilidad de los microorganismos a los antibióticos. Este artículo revisa y discute las diferentes técnicas disponibles para el diagnóstico microbiológico y su importancia en el diagnóstico y tratamiento de la enfermedad periodontal.

Volatilome analysis is growing in attention for the diagnosis of diseases in animals and humans. In particular, volatilome analysis in fecal samples is starting to be proposed as a fast, easy and noninvasive method for disease diagnosis. Volatilome comprises volatile organic compounds (VOCs), which are produced during both physiological and patho-physiological processes. Thus, VOCs from a pathological condition often differ from those of a healthy state and therefore the VOCs profile can be used in the detection of some diseases. Due to their strengths and advantages, feces are currently being used to obtain information related to health status in animals. However, they are complex samples, that can present problems for some analytical techniques and require special consideration in their use and preparation before analysis. This situation demands an effort to clarify which analytic options are currently being used in the research context to analyze the possibilities these offer, with the final objectives of contributing to develop a standardized methodology and to exploit feces potential as a diagnostic matrix. The current work reviews the studies focused on the diagnosis of animal diseases through fecal volatilome in order to evaluate the analytical methods used and their advantages and limitations. The alternatives found in the literature for sampling, storage, sample pretreatment, measurement and data treatment have been summarized, considering all the steps involved in the analytical process. [ABSTRACT FROM AUTHOR]

Objective: parasites are organisms that live inside or on another species for their own benefit, managing to affect plants, animals, and humans. Children are more vulnerable to infection, but the incidence has decreased thanks to the improvement in Costa Rican sanitation. The aim was to evaluate the general knowledge that the Costa Rican population has regarding childhood parasitosis. Methodology: an observational, descriptive, cross-sectional study was carried out on a sample of 196 subjects. A survey was conducted among Costa Ricans over 18 years of age who had a device with internet access. The participants were asked about their knowledge on the clinical picture of childhood parasitosis in Costa Rica. Results: most of the participants were college students (68.3%). 89.9% of them believe that pet parasites can infect humans. The best-known parasites were lice, marked by 173 (88.3%) people. The stomach is the part of the body considered most affected, with 148 (75.5%) responses. The main known preventive measure is washing hands with soap and water, answered by 133 participants (67.9%). Conclusion: Many participants believe that humans can be infected by the same parasites as animals. Lice were the best known and ticks the least. Most of the people consider vomiting and/or diarrhea as one of the main symptoms and believe that the stomach is the most affected part during the infection. In addition, they consider that the main preventive measure to avoid contagion is hand washing. [ABSTRACT FROM AUTHOR]

Communication of diagnosis in chronic disease has been little studied in pediatric oncology. Clinical practices for disclosure are mainly carried out at the end of life, not at the onset of the disease, and there does not seem to be clarity on how to communicate to families. Objective: to understand the current communication practices of diagnosis in children and young people with oncologic disease. Method: systematic review according to PRISMA guidelines. Results: A total of 17 studies were obtained that met the inclusion criteria. Two protocols for communicating the diagnosis were identified and several recommendations were found for disclosure according to the patient's age, the right to be informed, and the importance of involving the family. Discussion: validated communication practices are required that respond to the mental health needs in pediatric oncology, considering the culture and environment of patients and their families, and other barriers to effective communication. [ABSTRACT FROM AUTHOR]

El presente artículo está dirigido a la discusión del estado presente de las técnicas de diagnóstico en el área específica de los transformadores de potencia, comenzando por el nivel mundial [1, 2], para centrarse finalmente en la aplicación de estos métodos y técnicas en Cuba. Se plantean las características y requerimientos técnicos para el diagnóstico, los parámetros fundamentales a monitorear, y los diferentes métodos. This paper describes the present status of diagnosis techniques for power transformers, starting on world level and focusing on methods and techniques applied in Cuba. Characteristics and requirements are presented for diagnostic process, including main monitoring parameters and methods.

La matriz de falla es una novedosa herramienta creada que constituye el único modo para la aplicacióndel diagnóstico integral y tomar las decisiones adecuadas en las instalaciones industriales y suequipamiento. En el presente trabajo se muestra el camino seguido para la obtención de la matriz defallas correspondiente a los motores de inducción de gran potencia (MIGP). Los resultados obtenidosestán soportados en un diagrama de Ishikawa caracterizado por 11 causas principales, 31 subcausas y36 motivos de falla. Los resultados del presente trabajo constituyen el punto a partir del cual se obtienela matriz de ensayos de diagnóstico para los MIGP The matrix of failures is a new tool created. It means the only way to take the proper decision andapplication of integral diagnosis in industrial utilities and equipments. This paper presents the process toobtaining the matrix of failures of big induction rotating machines. In this case results are supported by anishikawa diagram characterized by 11 main causes, 31 sub-causes and 36 failure roots causes. Resultsare the starting point to define the matrix of diagnosis test.

Introduction: Intranasal esketamine has been approved as a treatment for patients with treatment-resistant depression. We analyzed the results of its efficacy in 15 patients. Objectives: To evaluate the efficacy of intranasal Esketamine as a treatment in patients with treatment-resistant depression Methods: Case series Results: For the last 8 months, since the treatment with intranasal esketamine was approved for resistant depression, we have treated 14 patients with this drug. Through this process, we followed a standardized method consisting in the following steps: On the first esketamine session (DAY 1) the patient has to fill a CGI and a MADRS scale. On the second esketamine session (DAY 7) the patient has to fill a CGI, a MADRS scale, a form about the level of satisfaction with the drug and a last form in which they can include the secondary effects. On week 6 since the start of the treatment, the patient has to fill again a CGI, a MADRS scale, a form about the level of satisfaction with the drug and a last form in which they can include the secondary effects. In the 6th month since the start of the treatment, the patient has to fill again a CGI, a MADRS scale, a form about the level of satisfaction with the drug and a last form in which they can include the secondary effects they have perceived. We analyzed and compared all of the previous data and obtained the following results: At day 7: 64% of the patients had a response in the form of improvement, of which 66% were feeling "slightly better" and 33% were feeling "better". At week 6: 71% of the patients had a response in the form of improvement, of which 50% were feeling "slightly better" and the other 50% were feeling "better". At month 6: only 28% of the patients completed the treatment; of which 100% had a response in the form of improvement: 50% were feeling "slightly better", 25% were feeling "better" and 25% were feeling "far better". Conclusions: Although our data suggests that intranasal esketamine has been effective in short term depressive symptoms, we have yet no information about its medium and long-term efficacy or secondary effects. Nevertheless, other potential factors should be evaluated as they could affect the results in the long-term such as the difficulty in maintaining the treatment for more than 6 weeks. In addition, the patients who experienced the most improvement according to our data were patients with a TAB diagnosis, so this could be an interesting research focus. Disclosure of Interest: None Declared [ABSTRACT FROM AUTHOR]

Objective The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) is a brief neuropsychological battery that has been validated in the assessment of dementia and other clinical populations. The current study examines the utility of the RBANS in patients with epilepsy. Methods Ninety-eight patients with epilepsy completed the RBANS as part of a more comprehensive neuropsychological evaluation. Performance on the RBANS was evaluated for patients with a diagnosis of temporal lobe epilepsy (TLE; n  = 51) and other epilepsy patients (non-TLE, n  = 47) in comparison to published norms. Multivariate analysis of variance compared group performances on RBANS indices. Rates of impairment were also compared across groups using cutoff scores of ≤1.0 and ≤1.5 standard deviation s below the normative mean. Exploratory hierarchical regressions were used to examine the relations between epilepsy severity factors (i.e. age of onset, disease duration, and number of antiepileptic drugs [AEDs]) and RBANS performance. Results TLE and non-TLE patients performed below the normative sample across all RBANS indices. Those with TLE performed worse than non-TLE patients on the Immediate and Delayed Memory indices and exhibited higher rates of general cognitive impairment. Number of AEDs was the only epilepsy severity factor that significantly predicted RBANS total performance, accounting for 14% of the variance. Conclusions These findings suggest that the RBANS has utility in evaluating cognition in patients with epilepsy and can differentiate TLE and non-TLE patients. Additionally, number of AEDs appears to be associated with global cognitive performance in adults with epilepsy. [ABSTRACT FROM AUTHOR]

Some patients in the community receive a high burden of antibiotics. We aimed at describing the characteristics of these patients, antibiotics used, and conditions for which they received antibiotics. We carried out a cross-sectional study. Setting: Thirty Health Primary Care Areas from 12 regions in Spain, covering 5,960,191 inhabitants. Patients having at least 30 packages of antibacterials for systemic use dispensed in 2017 were considered. Main outcome measures: Prevalence of antibiotic use, conditions for which antibiotics were prescribed, clinical characteristics of patients, comorbidities, concomitant treatments, and microbiological isolates. Patient's average age was 70 years; 52% were men; 60% smokers/ex-smokers; 54% obese. Overall, 93% of patients had, at least, one chronic condition, and four comorbidities on average. Most common comorbidities were cardiovascular and/or hypertension (67%), respiratory diseases (62%), neurological/ mental conditions (32%), diabetes (23%), and urological diseases (21%); 29% were immunosuppressed, 10% were dead at the time of data collection. Patients received three antibiotic treatments per year, mainly fluoroquinolones (28%), macrolides (21%), penicillins (19%), or cephalosporins (12%). Most frequently treated conditions were lower respiratory tract (infections or prophylaxis) (48%), urinary (27%), and skin/soft tissue infections (11%). Thirty-five percent have been guided by a microbiological diagnosis, being Pseudomonas aeruginosa (30%) and Escherichia coli (16%) the most frequent isolates. In conclusion, high antibiotic consumers in the community were basically elder, with multimorbidity and polymedication. They frequently received broad-spectrum antibiotics for long periods of time. The approach to infections in high consumers should be differentiated from healthy patients receiving antibiotics occasionally. [ABSTRACT FROM AUTHOR]

Introduction: Cutaneous Leishmaniasis is a neglected tropical disease caused by a parasite. The most common presumptive diagnostic tool for this disease is the visual examination of the associated skin lesions by medical experts. Here, a mobile application was developed to aid this pre-diagnosis using an automatic image recognition software based on a convolutional neural network model. Material and Methods: A total of 2022 images of cutaneous diseases taken from 2012 to 2018 were used for training. Then, in 2019, machine learning techniques were tested to develop an automatic classification model. Also, a mobile application was developed and tested against specialized human experts to compare its performance. Results: Transfer learning using the VGG19 model resulted in a 93% accuracy of the classification model. Moreover, on average, the automatic model performance on a randomly selected skin image sample revealed a 99% accuracy while, the ensemble prediction of seven human medical expert’s accuracy was 83%. Conclusion: Mobile skin monitoring applications are crucial developments for democratizing health access, especially for neglected tropical diseases. Our results revealed that the image recognition software outperforms human medical experts and can alert possible patients. Future developments of the mobile application will focus on health monitoring of Cutaneous Leishmaniasis patients via community leaders and aiming at the promotion of treatment adherence. [ABSTRACT FROM AUTHOR]

Neglected tropical diseases (NTDs) share certain traits: they are parasitic infections, prevailing in tropical environments and affecting marginalized sectors of the population. Six NTDs – ascariasis, cysticercosis, echinococcosis, hookworm infection, onchocerciasis and trichuriasis – all of them endemic in Latin America and the Caribbean (LAC), are analysed in this work. This review aims to discuss key information on the function of excretory/secretory (E/S) proteins from these parasites in their infectivity, pathogeny and diagnosis. The modulation of the host immune system to favour the permanence and survival of the parasite is also discussed. An updated knowledge on the function of E/S molecules in endemic parasitoses in LAC may lead to new approaches for the clinical management and diagnosis of these diseases. In turn, this could allow us to optimize their treatment and make it more affordable – a relevant goal given the economic constraints that the region is facing. [ABSTRACT FROM AUTHOR]

Objectives: Vitamin D deficiency/insufficiency is a worldwide public health issue that has been linked to numerous inflammatory disorders, including periodontitis. There is increasing support for a role for adequate vitamin D levels in overall health. Populations with darker skin color have a higher prevalence of vitamin D deficiency/insufficiency and periodontitis. The purpose of this small pilot study was to investigate the influence of 12 weeks of 25(OH)D vitamin D supplementation (VDS) on mediators of systemic inflammation in dark‐skinned, periodontitis patients. Materials and Methods: A total of 23 patients with moderate to severe periodontitis were randomly assigned to the vitamin D group or placebo group and received intensive single visit scaling and root planning to elicit a systemic inflammatory response. Results: Vitamin D supplementation increased serum 25(OH)D levels approximately 2‐fold over baseline levels; moreover, VDS group had reduced peripheral blood CD3 and CD3+CD8+ cytotoxic T lymphocyte (CTLs) counts and reduced pro‐inflammatory salivary cytokines. In contrast, VDS group had higher levels of the autophagy‐related proteins and other proteins crucial for anti‐microbial autophagy in whole blood PBMCs. Conclusion: In conclusion, VDS has multiple benefits for reducing systemic inflammation and promoting induction of autophagy‐related proteins related to anti‐microbial functions. [ABSTRACT FROM AUTHOR]

Low-density lipoprotein cholesterol (LDL-C) levels below 50 mg/dL may suggest familial hypobetalipoproteinemia, particularly in patients with hepatic steatosis. The prevalence of hypobetalipoproteinemia in cohorts with nonalcoholic fatty liver disease (NAFLD) is not known, and it is not clear whether the severity of liver disease of these patients is different. The objective of this study was to address these questions in a large pediatric NAFLD cohort. Retrospective study of children followed at the Steatohepatitis Center of a tertiary care center from August 2010 to October 2017. Patients with secondary causes of hepatic steatosis and those on statins were excluded. Of the 740 patients included, 58 (8%) had hypobetalipoproteinemia. These patients were younger (P =.04), had a lower body mass index (P <.01) and waist circumference (P =.01), and were less likely to be on metformin (P =.01). In spite of that, serum aminotransferase levels were not different between those with low, normal, and high LDL-C levels. Of the 222 patients who had both lipid and histology data available, the steatosis score was higher in those with low LDL-C compared to those with normal or elevated LDL-C, a result that trended toward significance (P =.06). The severity of inflammation and fibrosis did not differ between the groups. When all patients with hypertriglyceridemia were excluded, steatosis severity was higher in those with low LDL-C (P =.04). Hypobetalipoproteinemia is common among patients with NAFLD and is associated with similar liver disease severity in spite of a leaner phenotype and a more favorable metabolic profile. • Almost 10% of children with NAFLD have extremely low LDL-C levels. • Patients with low LDL-C levels have more severe steatosis. • These patients are younger and less likely to have metabolic comorbidities. [ABSTRACT FROM AUTHOR]

Introduction: Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) is an inherited cardiomyopathy characterized by ventricular arrhythmias and heart failure. The variable phenotype suggesting that determined environmental factors may have an influence. The aim of our study was to discover the impact of the dynamic physical activity on patients with high‐risk definite ARVC/D. Methods and Results: Collection of data on physical activity at the time of diagnosis was conducted at an in‐person clinical interview. The intensity of the activity was classified in accordance with the mean frequency of weekly physical exercise sessions in the 10 years before diagnosis and into the following three groups of dynamic activity: high/competitive (>3 h/wk), moderate (1 to 3 h) and minimal/inactive (<1 h). Seventeen patients practiced high dynamic physical activities. The intensity of dynamic activity was classified into three groups: 8 of high intensity, 9 moderate, and 19 inactive. The first major arrhythmic event and occurrence of severe right ventricular dysfunction were earlier in the high‐intensity exercise group, followed by the moderate intensity group and at a later age in the low‐intensity/inactive group. Conclusions: Dynamic exercise could be directly associated with the severity of the phenotype in relation to the precocity of major ventricular arrhythmic events and right ventricular systolic dysfunction in patients with high‐risk definite ARVC/D. [ABSTRACT FROM AUTHOR]

Background: The risk of recurrent stroke among patients with symptomatic carotid near-occlusion is not well established, and management of the condition remains controversial. Symptomatic carotid near-occlusion with full collapse has been identified as a strong predictor of early recurrence. We aimed to analyze the 90-day risk of recurrent ipsilateral ischemic stroke in medically treated patients with symptomatic carotid near-occlusion. Methods: We performed a multicenter, nationwide, prospective study from January 2010 to May 2016. Patients with angiography-confirmed symptomatic carotid near-occlusion were included. The primary endpoint was ipsilateral ischemic stroke or transient ischemic attack (TIA) within 90 days after the presenting event. For this analysis, patients who underwent revascularization within 90 days after stroke were excluded. Results: The study population comprised 141 patients from 17 Spanish centers; 83 patients were treated medically. Primary endpoint occurred in eight patients, resulting in a cumulative rate of 10.6% (95% CI, 3.7-17.5). Previous history of stroke or transient ischemic attack was identified as an independent predictor for recurrence in the multivariate Cox regression analysis (HR, 4.37 [95% CI, 1.05-18.18]; p=0.043), while the presence of full collapse was not associated with an increased risk (HR, 0.81 [95% CI, 0.17-3.92]; p=0.793). The risk of recurrence was also not affected by the presence of significant stenosis or occlusion of the contralateral carotid artery, or by the collateral circulation. Conclusions: Patients with symptomatic carotid near-occlusion seem to have an increased risk of early ipsilateral recurrent stroke. Our results contrast with the low risk of symptomatic carotid near-occlusion reported to date. Full collapse did not increase the risk of recurrent stroke in our study. [ABSTRACT FROM AUTHOR]

Episodic memory in the 7 Minute Screen is assessed by the Enhanced Cued Recall (ECR) test. The ECR test is composed of three phases, Identification, Immediate Recall, and Free and Cued Recall. However, just the last phase is considered for the total score. We believe that collecting the performance data of the Identification and Immediate Recall phases could provide information regarding possible difficulties or impairments in the different aspects involved in the temporal mnesic process of acquisition of new information, such as in working memory or visual identification. The objective was to assess the goodness of fit for the three phases of the ECR test using a Confirmatory Factor Analysis (CFA) to show if each phase is separated from each other as a different aspect that participates in the mnesic process. A total of 311 participants greater than 65 years were included in this study. Confirmatory factor analyses were conducted for each individual phase. The analyses show that the ECR test consists of three separate phases that identify different steps of the mnesic process. Individual scores for each phase could allow for investigation of patient performance in different aspects of the memory process and could help in further neuropsychological assessment. [ABSTRACT FROM AUTHOR]

In order to increase the quality of life of patients with epilepsy, it is essential to develop tools that facilitate early disease diagnosis and encourage the use of individualized therapies. The association between seizures and other neurological pathologies is well known but incompletely explained, with multiple sclerosis (MS)-seizures correlation being a relevant example. In this context, the present review aimed to highlight the most important facts related to the association between the heterogeneous group of epileptic pathology and MS, in order to provide initial directions for establishing a diagnostic and therapeutic protocol. The first part reviewed the most relevant epidemiological and clinical data on seizures; MS association. Subsequently, it highlighted the most common and actually accepted pathophysiological mechanisms that try to explain the association between the two pathologies. Finally, the importance of paraclinical investigations and the optimal choice of antiseizure-based therapies with respect to seizures associated with MS are presented, also revealing several directions that should be explored in the near future. [ABSTRACT FROM AUTHOR]

Copyright of NOVA: Publicación Científica en Ciencias Biomédicas is the property of Universidad Colegio Mayor de Cundinamarca and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Compendium of Veterinary Sciences / Compendio de Ciencias Veterinarias is the property of Facultad de Ciencias Veterinarias de la Universidad Nacional de Asuncion and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background ICDs have been demonstrated to be highly effective in the primary prevention of sudden death, but inappropriate shocks (IS) occur frequently and represent one of the most important adverse effects of ICDs. The aim of this study was to analyze IS and identify the clinical predictors and prognostic implications of ISs in a real-world primary prevention ICD population. Methods This multicenter retrospective study was performed in 13 centers with experience in the field of ICD implantation (at least 30 per year) and ICD follow-up in Spain. All consecutive patients who underwent ICD implantation for primary prevention between January 2008 and May 2014 were included. Results One-thousand-sixteen patients were included, and 4 (0.39%) were lost to follow-up. Two-hundred-seventeen (21.4%) patients suffered from shock; 69 (6.8%) of these patients experienced IS, and 154 (15.4%) experienced appropriate shocks (AS). Age (< 65 years, hazard ratio (HR) 2.588 [95% CI 1.282-5.225]; p = 0.008), history of atrial fibrillation (HR 2.252 [95% CI 1.230-4.115]; p = 0.009), non-ischemic myocardiopathy (HR 2.258 [95% CI 1.090-4.479]; p = 0.028), and cardiac resynchronization therapy (HR 0.385 [95% CI 0.200-0.740]; p = 0.004) were identified as IS predictors in a multivariate analysis. IS was not associated with rehospitalization due to heart failure, myocardial infarction, cardiovascular mortality or all-cause mortality. Conclusions This analysis of our national registry identified the independent IS predictors of age, atrial fibrillation history and cardiac resynchronization therapy and suggests that ISs are not linked to poorer clinical endpoints. [ABSTRACT FROM AUTHOR]

Copyright of Ginecología y Obstetricia de México is the property of Federacion Mexicana de Ginecologia y Obstetricia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The protein-energy wasting syndrome (PEW) is a condition of malnutrition, inflammation, anorexia and wasting of body reserves resulting from inflammatory and non-inflammatory conditions in patients with chronic kidney disease (CKD).One way of assessing PEW, extensively described in the literature, is using the Malnutrition Inflammation Score (MIS). Objective: To assess the reliability and consistency of MIS for diagnosis of PEW in Mexican adults with CKD on hemodialysis (HD). Methods: Study of diagnostic tests. A sample of 45 adults with CKD on HD were analyzed during the period June-July 2014.The instrument was applied on 2 occasions; the test-retest reliability was calculated using the Intraclass Correlation Coefficient (ICC); the internal consistency of the questionnaire was analyzed using Cronbach's α coefficient. A weighted Kappa test was used to estimate the validity of the instrument; the result was subsequently compared with the Bilbrey nutritional index (BNI). Results: The reliability of the questionnaires, evaluated in the patient sample, was ICC=0.829.The agreement between MIS observations was considered adequate, κ = 0.585 (p <0.001); when comparing it with BNI, a value of κ = 0.114 was obtained (p <0.001).In order to estimate the tendency, a correlation test was performed. The r2 correlation coefficient was 0.488 (P <0.001). Conclusion: MIS has adequate reliability and validity for diagnosing PEW in the population with chronic kidney disease on HD. [ABSTRACT FROM AUTHOR]

Abstract: The appropriate handling of chemical substances is an initiative in the environmental agenda of the North America region countries. Thanks to the efforts promoted by this initiative, Mexico knows the identity and dangerousness of the chemical substances that are in the market but still does not know what processes and products are involved in their use. To this day the efforts continue and are focused on identifying opportunities and challenges of chemical substances handling by productive sector. The Healthcare sector has been involved in the efforts carried out for the rational management of chemical substances, given their use during its activities. Furthermore, this sector has a dual responsibility given its involvement in the diagnosis and treatment of illnesses related to exposure to chemicals that are dangerous to health and environment, the later contradicting the principle of “first do no harm” in carrying out their profession. Given the aforementioned, the objective of this work was to characterize the supplies/goods/services so the chemical substances sources in use in the health sector can be identified, using a public hospital in Sonora, Mexico, as a study case. The results show that during the evaluated period entries of 774 data of supplies/goods/services were identified as chemical substances sources, of which only 664 data were used. The characterization of the latter ones allowing their classification in 76 different product lines (92% of which are patented products), including: medical gases, hemodialysis supplies, detergents, cleaners and antiseptics/disinfectants which stand out because of the volume in which they are used. Moreover, it was found that some lines of products in use contain active ingredients that are actually considered of priority interest, because of their toxic characteristics, by several international organizations, like mercury, ethylene oxide, formaldehyde, 2-butoxyethanol, 2-metoxyethanol, monoethanolamine, among others. This investigation shows, for the first time, an overview of the wide range of chemical substances sources, that is to say, products that are or contain chemical substances, used in a Mexican hospital, that pose a potential threat to the health and safety of workers, patients, visitors, and the environment. In the same way, the study results and methodology could be reproducible to all the establishments of healthcare in the state as the data obtained is linked to the law that controls the federal budget. [Copyright &y& Elsevier]

Background: Intracranial amyloid and hypertensive angiopathy have been related to impaired blood vessel function and the etiology of intracerebral hemorrhage (ICH). Microbleeds (MBs) are surrogate radiological markers that are associated with these underlying angiopathies. We assessed the hypothesis that MBs are associated with hematoma expansion (HE) in patients with hyperacute ICH. Methods: We studied patients with spontaneous supratentorial ICH within the first 6 h after onset. HE was defined as an increase ≥33% in the volume of hematoma on the follow-up CT in comparison with the admission CT. The volume was calculated using the ABC/2 formula. MBs were detected by specific magnetic resonance sequences (gradient-echo). The presence, number and distribution of MBs were analyzed. Results: Our study included 44 patients. Their mean age was 68.9 ± 11.1 years, and 70.5% of them were men. HE was observed in 14 of the patients (31.8%). HE was more prevalent in patients with more than 10 MBs compared with patients with 1-10 MBs (60 vs 12.5%; p = 0.03). Conclusion: A high burden of MBs is associated with an increased risk of HE in patients with ICH. This is probably a marker of a more severe underlying angiopathy. Copyright © 2013 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Posterior reversible encephalopathy syndrome is commonly associated with hypertension and hypertensive crisis. Clinical characteristics are headache, visual changes, altered mental status and seizures. There is a strong association with cytotoxic edema, which in most cases involve posterior areas of the brain. This syndrome usually resolves with prompt recognition and standard treatment of the triggering condition. We present the case of a 17-year-old man who developed posterior reversible encephalopathy syndrome associated with hypertensive crisis due to fibromuscular dysplasia of renal arteries. [ABSTRACT FROM AUTHOR]

Copyright of Revista Oral is the property of Benemerita Universidad Autonoma de Puebla and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Avian influenza virus causes infection, disease and death on different bird species and has also acquired the capability of transmitting from avian species to humans and other mammals causing severe diseases. For that reason, there is a great international concern on avian influenza virus detection and diagnostic strategies. Although conventional laboratory methods used for isolation and identification of the virus and for detection of specific antibodies continued to be widely applied, new technologies have been rapidly developed. With the use of molecular tools detection, pathotyping, and phylogenetic characterization of influenza A viruses obtained from clinical specimens can be done on the some day. [ABSTRACT FROM AUTHOR]

Porcine circovirus 2 is nowadays accepted as the essential infectious agent of postweaning multisystemic wasting syndrome which causes severe economic losses in porcine production worldwide. The diagnosis of PMWS is a difficult task and must follow three criteria: (i) the presence of compatible clinical signs, (ii) the presence of characteristic microscopic histopathological lesions, and (iii) the presence of PCV2 within these lesions in moderate or high. The presence of PCV2 in lymphoid tissues must be demonstrated by in situ hybridization or immunohistochemical methods. The in situ hybridization is a more complex and expense compared to other diagnostic tools, on the other hand, one problem concerning the immunohistochemical methods for PMWS diagnostic is the lack of a commercial anti- PCV2 peroxidase conjugate; therefore, the aim of this work was to obtain a polyclonal-antibody- immunoperoxidase-conjugate for the PCV2 specific detection. An anti-PCV2-peroxidase conjugated for the PCV2 specific detection was obtained based on the use of the available commercial vaccine against PCV2 as immunogenic inoculation for producing a polyclonal antibody in rabbits. The conjugate obtained was able to discriminate between PCV2 and PCV1 infections and a high sensitivity and specificity of the conjugate were observed. [ABSTRACT FROM AUTHOR]