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Pneumonia is one of the major causes of child mortality, yet with a timely diagnosis, it is usually curable with antibiotic therapy. In many developing regions, diagnosing pneumonia remains a challenge, due to shortages of medical resources. Lung ultrasound has proved to be a useful tool to detect lung consolidation as evidence of pneumonia. However, diagnosis of pneumonia by ultrasound has limitations: it is operator-dependent, and it needs to be carried out and interpreted by trained personnel. Pattern recognition and image analysis is a potential tool to enable automatic diagnosis of pneumonia consolidation without requiring an expert analyst. This paper presents a method for automatic classification of pneumonia using ultrasound imaging of the lungs and pattern recognition. The approach presented here is based on the analysis of brightness distribution patterns present in rectangular segments (here called "characteristic vectors") from the ultrasound digital images. In a first step we identified and eliminated the skin and subcutaneous tissue (fat and muscle) in lung ultrasound frames, and the "characteristic vectors"were analyzed using standard neural networks using artificial intelligence methods. We analyzed 60 lung ultrasound frames corresponding to 21 children under age 5 years (15 children with confirmed pneumonia by clinical examination and X-rays, and 6 children with no pulmonary disease) from a hospital based population in Lima, Peru. Lung ultrasound images were obtained using an Ultrasonix ultrasound device. A total of 1450 positive (pneumonia) and 1605 negative (normal lung) vectors were analyzed with standard neural networks, and used to create an algorithm to differentiate lung infiltrates from healthy lung. A neural network was trained using the algorithm and it was able to correctly identify pneumonia infiltrates, with 90.9% sensitivity and 100% specificity. This approach may be used to develop operator-independent computer algorithms for pneumonia diagnosis using ultrasound in young children.

Parasitic infections are generally diagnosed by professionals trained to recognize the morphological characteristics of the eggs in microscopic images of fecal smears. However, this laboratory diagnosis requires medical specialists which are lacking in many of the areas where these infections are most prevalent. In response to this public health issue, we developed a software based on pattern recognition analysis from microscopi digital images of fecal smears, capable of automatically recognizing and diagnosing common human intestinal parasites. To this end, we selected 229, 124, 217, and 229 objects from microscopic images of fecal smears positive for Taenia sp., Trichuris trichiura, Diphyllobothrium latum, and Fasciola hepatica, respectively. Representative photographs were selected by a parasitologist. We then implemented our algorithm in the open source program SCILAB. The algorithm processes the image by first converting to gray-scale, then applies a fourteen step filtering process, and produces a skeletonized and tri-colored image. The features extracted fall into two general categories: geometric characteristics and brightness descriptions. Individual characteristics were quantified and evaluated with a logistic regression to model their ability to correctly identify each parasite separately. Subsequently, all algorithms were evaluated for false positive cross reactivity with the other parasites studied, excepting Taenia sp. which shares very few morphological characteristics with the others. The principal result showed that our algorithm reached sensitivities between 99.10%-100% and specificities between 98.13%- 98.38% to detect each parasite separately. We did not find any cross-positivity in the algorithms for the three parasites evaluated. In conclusion, the results demonstrated the capacity of our computer algorithm to automatically recognize and diagnose Taenia sp., Trichuris trichiura, Diphyllobothrium latum, and Fasciola hepatica with a high sensitivity and specificity.

Objectives. To implement a system for remote diagnosis of tuberculosis and multidrug resistance (MDR) using the Microscopic-Observation Drug Susceptibility Assay (MODS) method in the Mycobacteria Laboratory, Trujillo Center of Excellence in Tuberculosis (CENEX-Trujillo). The system included a variant of an algorithm for recognition of Mycobacterium tuberculosis recently reported from digital images of MODS cultures of sputum samples. Materials and methods. The recognition algorithm was optimized using a retraining statistical model based on digital images of MODS cultures from CENEX-Trujillo. Images of 50 positive MODS cultures of patients with suspected multidrug-resistant tuberculosis were obtained between January and October 2012 in the CENEX-Trujillo. Results. The sensitivity and specificity to recognize strings of tuberculosis were 92.04% and 94.93% respectively using objects. The sensitivity and specificity to determine a positive tuberculosis field were 95.4% and 98.07% respectively using pictures. Conclusions. The results demonstrated the feasibility of the implementation of telediagnostics in remote locations, which may contribute to the early detection of multidrug-resistant tuberculosis by MODS method.

Tuberculosis control efforts are hampered by a mismatch in diagnostic technology: modern optimal diagnostic tests are least available in poor areas where they are needed most. Lack of adequate early diagnostics and MDR detection is a critical problem in control efforts. The Microscopic Observation Drug Susceptibility (MODS) assay uses visual recognition of cording patterns from Mycobacterium tuberculosis (MTB) to diagnose tuberculosis infection and drug susceptibility directly from a sputum sample in 7-10 days with a low cost. An important limitation that laboratories in the developing world face in MODS implementation is the presence of permanent technical staff with expertise in reading MODS. We developed a pattern recognition algorithm to automatically interpret MODS results from digital images. The algorithm using image processing, feature extraction and pattern recognition determined geometrical and illumination features used in an object-model and a photo-model to classify TB-positive images. 765 MODS digital photos were processed. The single-object model identified MTB (96.9% sensitivity and 96.3% specificity) and was able to discriminate non-tuberculous mycobacteria with a high specificity (97.1% M. avium, 99.1% M. chelonae, and 93.8% M. kansasii). The photo model identified TB-positive samples with 99.1% sensitivity and 99.7% specificity. This algorithm is a valuable tool that will enable automatic remote diagnosis using Internet or cellphone telephony. The use of this algorithm and its further implementation in a telediagnostics platform will contribute to both faster TB detection and MDR TB determination leading to an earlier initiation of appropriate treatment.

Objetivos. Implementar un sistema para el diagnóstico remoto de tuberculosis y multidrogorresistencia (MDR) usando el método Microscopic-Observation Drug Susceptibility Assay (MODS) en el Laboratorio de Micobacterias del Centro de Excelencia en Tuberculosis de Trujillo (CENEX-Trujillo). El sistema incluyó una variante de un algoritmo de reconocimiento de Mycobacterium tuberculosis recientemente reportado a partir de imágenes digitales de cultivos MODS de muestras de esputo. Materiales y métodos. Se optimizó un algoritmo de reconocimiento por medio de un reentrenamiento del modelo estadístico basado en imágenes digitales de cultivos MODS provenientes del Laboratorio de Micobacterias del CENEX-Trujillo. Se obtuvieron imágenes de 50 cultivos MODS positivos de pacientes con sospecha de tuberculosis multidrogorresistente entre enero y octubre de 2012 en el CENEX-Trujillo. Resultados. La sensibilidad y la especificidad en objetos, para reconocer cordones de tuberculosis fueron de 92,04% y de 94,93% respectivamente. La sensibilidad y la especificidad en foto, para determinar un campo positivo a tuberculoisis fueron 95,4% y de 98,07% respectivamente. Conclusiones. Los resultados demostraron la factibilidad de la implementación de telediagnóstico en lugares remotos, el cual puede contribuir con la detección temprana de tuberculosis multidrogorresistente mediante el método MODS

Objetivos. Implementar un sistema para el diagnóstico remoto de tuberculosis y multidrogorresistencia (MDR) usando el método Microscopic-Observation Drug Susceptibility Assay (MODS) en el Laboratorio de Micobacterias del Centro de Excelencia en Tuberculosis de Trujillo (CENEX-Trujillo). El sistema incluyó una variante de un algoritmo de reconocimiento de Mycobacterium tuberculosis recientemente reportado a partir de imágenes digitales de cultivos MODS de muestras de esputo. Materiales y métodos. Se optimizó un algoritmo de reconocimiento por medio de un reentrenamiento del modelo estadístico basado en imágenes digitales de cultivos MODS provenientes del Laboratorio de Micobacterias del CENEX-Trujillo. Se obtuvieron imágenes de 50 cultivos MODS positivos de pacientes con sospecha de tuberculosis multidrogorresistente entre enero y octubre de 2012 en el CENEX-Trujillo. Resultados. La sensibilidad y la especificidad en objetos, para reconocer cordones de tuberculosis fueron de 92,04% y de 94,93% respectivamente. La sensibilidad y la especificidad en foto, para determinar un campo positivo a tuberculoisis fueron 95,4% y de 98,07% respectivamente. Conclusiones. Los resultados demostraron la factibilidad de la implementación de telediagnóstico en lugares remotos, el cual puede contribuir con la detección temprana de tuberculosis multidrogorresistente mediante el método MODS

Abstract The production of Paleolithic art represents one of the most intricate technical and cognitive endeavors of Homo sapiens, marked by its profound antiquity and vast temporal and spatial framework. Despite its significance, there have been no prior studies aimed at understanding the cognitive and motor skills linked to the creation of realistic images characteristic of this artistic cycle. This research integrates archaeology and experimental psychology, premised on the assumption that the neurological basis of Anatomically Modern Humans has not changed substantially since the Upper Paleolithic. This work employs an innovative interdisciplinary approach, utilizing psychometric tests and drawing and engraving tasks monitored by motion-sensing gloves, to compare the performance of experts and non-experts in visual arts when faced with challenges akin to those of Upper Paleolithic artistic production. The results revealed that expertise in visual arts is linked to enhanced spatial abilities and specific patterns in drawing from memory. Additionally, both experts and non-experts displayed similar motor skills when engraving using Paleolithic techniques, suggesting that these techniques required specialized training in the contemporary experts. In conclusion, this research deepens our understanding of the processes involved in Upper Paleolithic artistic production.

PURPOSETo better understand immigration disparities among a Spanish Early-Onset Colorectal Cancer (SECOC) subset, according to the country of origin.PATIENTS AND METHODSWe selected 250 consecutive participants from the SECOC consortium. Data on baseline patient and tumor characteristics, family history of colorectal cancer (CRC), and follow-up were collected. The presence of mismatch repair deficiency was also assessed. Special data regarding country of origin, time of stay in Spain in case of other different country, and a 10-year cutoff that specifies the obtaining of Spanish nationality defined the variables of interest for comparison.RESULTSSeventy-five percent of patients with early-onset CRC (EOCRC) (188) were born in Spain, whereas the other 25% were born outside of Spain. The mean time of living in Spain until the EOCRC diagnosis was 16.5 years. Comparatively, most of the analyzed features showed equivalent proportions between cohorts. Only Spanish patients appeared to have more familial cancer component in first degree in general (32.3%; P = .01), compared with non-Spaniards, which showed a predominant sporadic component (56.4%; P < .001). Among immigrants, those patients living in Spain before CRC diagnosis ≤10 years were younger at diagnosis (39.1 v 42.5), more frequently male (77.8 v 47.7), were in more advanced stages (88.8% diagnosed at stage III and IV [P = .01]), and had a worse prognosis regarding recurrence rates (29.4% v 6.3%).CONCLUSIONAlthough there were few differences between Spanish and non-Spanish EOCRC, the most remarkable difference was that linked with the situation of those immigrants who have recently arrived in Spain, in relation to their lower health coverage, which could be associated with the delay in the diagnosis and their subsequent worse prognosis.

Introducción: El consumo de alcohol es considerado uno de los transcendentales factores de riesgo de discapacidad y muerte prematura. Develar el sentido de la experiencia de la persona consumidora de alcohol en cuanto a las necesidades de cuidado en el contexto hospitalario e incentiva que enfermería brinde un cuidado humano. Objetivo: Comprender las necesidades de cuidado de una persona consumidora de alcohol durante la estancia hospitalaria. Método: Investigación cualitativa fenomenológica. Muestreo por conveniencia, participaron 07 hombres y 02 mujeres que consumen alcohol e ingresaron al hospital. Para recolectar los datos se utilizó una entrevista fenomenológica, previo consentimiento informado. El análisis se realizó mediante el círculo hermenéutico de Martin Heidegger. Resultados: Fueron develadas cinco categorías: 1) Necesidades físicas ante deterioro corporal, 2) Necesidades emocionales y de apoyo con traspaso de energía para vivir, 3) Necesidades de confort humano dentro de la hospitalización, 4) Agradecimiento verbalizado y escrito ante acompañamiento y preocupación, 5) Anhelos de ser cuidado como persona. Conclusiones: Enfermería se encuentra con un ser vulnerable que muestra necesidades físicas debilitadas, necesidades emocionales que requieren apoyo y confort humano, un ser que anhela y agradece al ser enfermera.

Abstract Cereblon/CRBN is a substrate-recognition component of the Cullin4A-DDB1-Roc1 E3 ubiquitin ligase complex. Destabilizing mutations in the human CRBN gene cause a form of autosomal recessive non-syndromic intellectual disability (ARNSID) that is modelled by knocking-out the mouse Crbn gene. A reduction in excitatory neurotransmission has been proposed as an underlying mechanism of the disease. However, the precise factors eliciting this impairment remain mostly unknown. Here we report that CRBN molecules selectively located on glutamatergic neurons are necessary for proper memory function. Combining various in vivo approaches, we show that the cannabinoid CB1 receptor (CB1R), a key suppressor of synaptic transmission, is overactivated in CRBN deficiency-linked ARNSID mouse models, and that the memory deficits observed in these animals can be rescued by acute CB1R-selective pharmacological antagonism. Molecular studies demonstrated that CRBN interacts physically with CB1R and impairs the CB1R-Gi/o-cAMP-PKA pathway in a ubiquitin ligase-independent manner. Taken together, these findings unveil that CB1R overactivation is a driving mechanism of CRBN deficiency-linked ARNSID and anticipate that the antagonism of CB1R could constitute a new therapy for this orphan disease.

Abstract Background The utility of neutrophil‐to‐lymphocyte ratio (NLR), platelet to‐lymphocyte ratio (PLR) and monocyte‐to‐lymphocyte ratio (MLR) as prognostic indicators has not been investigated in canine parvovirosis (CPV). Hypothesis To evaluate whether these hematological ratios obtained at hospital admission in CPV are associated with outcome or duration of hospitalization. Animals. Four hundred one client‐owned dogs presented with CPV. Methods‐Retrospective multicenter cohort study. Medical records were reviewed to identify dogs with CPV. Data regarding signalment, complete blood count at admission, duration of hospitalization and outcome were collected. Results Of the 401 dogs included in the study, 336 (83.8%) survived to discharge. The median (25th and 75th percentiles) PLR in nonsurvivors (336.56 [159.84‐635.77]) was significantly higher than in survivors (217.65 [117.67‐389.65]) (P = .003). The area under the receiver‐operating characteristic curve for nonsurvival was 0.615 (95% CI [0.593‐0.691], P = .003). A cut off of 700 showed a 21.5% sensitivity and 90% specificity for nonsurvival. No association was observed between hospitalization duration and either hematological ratios or total WBC counts. The median (25th and 75th percentiles) lymphocyte count was below reference interval in all dogs and was significantly lower in the dogs which died (0.82 × 109/L [0.5‐1.87]) than in survivors (1.27 × 109/L [0.73‐2.22]) (P = .005). The median (25th and 75th percentiles) monocyte count however was lower in survivors (0.38 × 109/L [0.29‐1.59]), than in nonsurvivors (0.73 × 109/L [0.1‐2]) (P = .002). Conclusions Evaluation of PLR at hospital admission might be a useful marker of disease severity and could have prognostic value in dogs with CPV.

Introducción: el consumo de alcohol es una práctica social compleja que desempeña un papel en la construcción y consolidación de amistades, así como en la formación de identidades de género. Este último determina los límites de los comportamientos y define lo que se considera apropiado o inapropiado en nuestra rutina diaria; por lo tanto, los patrones de consumo de alcohol no son independientes del género. Objetivo: identificar y describir la evidencia disponible sobre la influencia del género en el consumo de alcohol de los jóvenes. Materiales y método: se realizó una revisión bajo las pautas del Instituto Joanna Briggs (JBI) y los lineamientos del Preferred Reporting Items for Systematic reviews and Meta-Analyses, Extension for Scoping Reviews (PRISMA-ScR). Se analizaron artículos originales a texto completo, publicados entre 2018 y 2023 en las bases BVS, PubMed, EBSCOhost, Web of Sciences, Epistemonikos, ScienceDirect, y ProQuest, sin limitación de idioma; las categorías de búsqueda fueron “Alcohol Drinking” AND “Young Adult” AND “Gender Identity” OR “Gender role”. Resultados: se identificaron 403 registros, pero solo se incluyeron 12 estudios en la síntesis. Los resultados principales de estos estudios mostraron que tanto la identidad de género como los roles de género influyen en el consumo de alcohol en adultos jóvenes. Las normas sociales de género pueden presionar a las mujeres jóvenes a mantener una imagen física y a los hombres jóvenes a mantener una imagen pública normativa. Conclusiones: las normas sociales de género influyen en los comportamientos de consumo de alcohol, por ello, es necesario tener en cuenta estas diferencias de género en las intervenciones de enfermería y estrategias de prevención.

Distinctive encoding usually increases correct recognition while also producing a reduction in false recognition. In the Deese-Roediger-McDermott (DRM) illusion this phenomenon, called the mirror effect, occurs when participants focus on unique features of each of the words in the study list. In previous studies, the pleasantness rating task, used to foster distinctive encoding, generated different patterns of results. The main aim of our research is to examine under what circumstances this task can produce the mirror effect in the DRM paradigm, based on evidence from recognition accuracy and subjective retrieval experience. In Experiment 1, a standard version (word pleasantness rating on a 5-point Likert-type scale) was used for comparison with two other encoding conditions: shallow processing (vowel identification) and a read-only control. The standard task, compared to the other conditions, increased correct recognition, but did not reduce false recognition, and this result may be affected by the number of lists presented for study. Therefore, in experiment 2, to minimize the possible effect of the so-called retention size, the number of studied lists was reduced. In addition, the standard version was compared with a supposedly more item-specific version (participants rated the pleasantness of words while thinking of a single reason for this), also including the read-only control condition. In both versions of the pleasantness rating task, more correct recognition is achieved compared to the control condition, with no differences between the two versions. In the false recognition observed here, only the specific pleasantness rating task achieved a reduction relative to the control condition. On the other hand, the subjective retrieval experience accompanied correct and false recognition in the various study conditions. Although the standard pleasantness rating task has been considered to perform item-specific processing, our results challenge that claim. Furthermore, we propose a possible boundary condition of the standard task for the reduction of false recognition in the DRM paradigm.

Introducción: México presenta una tasa elevada de embarazo adolescente lo que simboliza un riesgo a la salud y desarrollo socioeconómico de este grupo. La prevención de un segundo embarazo en esta etapa es relevante para mejorar su calidad de vida. Objetivo: Explorar las representaciones sociales de la consejería anticonceptiva prenatal a partir de las experiencias y expectativas de adolescentes gestantes y proveedores de salud en un hospital de segundo nivel de atención. Metodología: Estudio cualitativo basado en la Teoría de las Representaciones Sociales de Serge Moscovici con diez adolescentes primíparas en cualquier trimestre de embarazo y siete proveedores de salud, se excluyeron adolescentes sin condición de embarazo. Se utilizó entrevista semiestructurada grabadas y analizadas en su integridad mediante lectura fluctuante realizada por dos investigadores, se contrastó el discurso de los ejes temáticos propuesto. Se respetó la integridad, confidencialidad y autonomía. Resultados: Las realidades representadas por las adolescentes mostraron necesidad de conocimientos, valores, respeto, amabilidad y paciencia. Los proveedores evocaron una consejería paternalista, pero con reconocimiento de una consejería focalizada y derechos reproductivos. Conclusión: Las experiencias similares de los participantes fueron que el momento ideal para recibir la consejería es durante el embarazo, en virtud de que las adolescentes embarazadas manifestaron necesidad de recibir información y espaciar sus embarazos. Las expectativas de la consejería anticonceptiva prenatal difirieron en los valores para dar lugar a una actitud paternalista por parte del proveedor de salud y la preferencia de las adolescentes por una consejería basada en el respeto, honestidad, confianza, entre otros.

Amyotrophic Lateral Sclerosis (ALS) is a progressive neurodegenerative disease that affects motor neurons, resulting in muscle weakness, paralysis, and eventually patient mortality. In recent years, neuromodulation techniques have emerged as promising potential therapeutic approaches to slow disease progression and improve the quality of life of ALS patients. A systematic review was conducted until August 8, 2023, to evaluate the neuromodulation methods used and their potential in the treatment of ALS. The search strategy was applied in the Cochrane Central database, incorporating results from other databases such as PubMed, Embase, CTgov, CINAHL, and ICTRP. Following the exclusion of papers that did not fulfil the inclusion criteria, a total of 2090 records were found, leaving a total of 10 studies. R software was used to conduct meta-analyses based on the effect sizes between the experimental and control groups. This revealed differences in muscle stretch measures with manual muscle testing (p = 0.012) and resting motor threshold (p = 0.0457), but not with voluntary isometric contraction (p = 0.1883). The functionality of ALS was also different (p = 0.007), but not the quality of life. Although intracortical facilitation was not seen in motor cortex 1 (M1) (p = 0.1338), short-interval intracortical inhibition of M1 was significant (p = 0.0001). BDNF showed no differences that were statistically significant (p = 0.2297). Neuromodulation-based treatments are proposed as a promising therapeutic approach for ALS that can produce effects on muscle function, spasticity, and intracortical connections through electrical, magnetic, and photonic stimulation. Photobiomodulation stands out as an innovative approach that uses specific wavelengths to influence mitochondria, with the aim of improving mitochondrial function and reducing excitotoxicity. The lack of reliable placebo controls and the variation in stimulation frequency are some of the drawbacks of neuromodulation.

A lo largo del siguiente texto se expone un breve análisis sobre el manual Procesos y contextos educativos en Educación Secundaria. La lectura de sus diez capítulos acercará a todos los futuros docentes a las realidades actuales dentro y fuera de nuestras aulas de Secundaria y los preparará para el devenir de sus tareas como profesionales de la educación, conociendo de primera mano el funcionamiento del sistema educativo y de qué forma trabajar en otros planos para poder hacer frente de manera personalizada al desarrollo integral de los estudiantes. Su lectura, por tanto, se hace imprescindible para los docentes cuya responsabilidad en esta etapa educativa va mucho más allá de enseñar únicamente los contenidos curriculares, pues permite conocer la caracterización cultural de los jóvenes y entender cómo enseñar a través de ellos para llevar a cabo un exitoso proceso de enseñanza-aprendizaje en Educación Secundaria.