RESUMO
Cerebral small vessel disease is a major contributor to both brain aging and cognitive decline. This study aimed to determine the prevalence of cerebral small vessel disease in a Colombian population over 40 years of age who attended a Radiology and Diagnostic Imaging service for brain MRI between October 2018 and March 2019. This was an observational, cross-sectional and analytical study of 710 adult patients over 40 years of age who attended the Radiology and Diagnostic Imaging service for a brain MRI. The analysed data were obtained from an anonymized database of the service. We studied 710 MRI scans of patients aged between 40 and 104 years. The most frequent risk factor was hypertension (36.2%). Brain abnormalities associated with cerebral small vessel disease, such as white matter hyperintensities, were seen in 56.20% of the population, and brain atrophy was observed in 12.96%. Brain disease prevalence increased with age (23.18% for those aged 55 years, 54.49% for those aged 55-64 years, 69.8% for those aged 65-74 years and 90.53% for those older than 75 years). The prevalence of cerebral small vessel disease in our population was similar to that reported in the world literature, as were the prevalence of the evaluated cardiovascular risk factors. Additionally, we identified an association between hypertension and advanced age with cerebral small vessel disease, with white matter hyperintensities being the most characteristic finding.
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La uretroplastía se ha convertido en el estándar de manejo de la estrechez uretral, dependiendo de la localización y etiología de esta. Los datos de los resultados a largo plazo varían dependiendo de la definición que se utilice como éxito (subjetiva u objetiva). El objetivo de esta revisión integrativa es mostrar la información disponible sobre los resultados funcionales de pacientes con estrechez uretral manejados quirúrgicamente. El estudio es una revisión integrativa que se realizó mediante una búsqueda de la literatura en PubMed. Incluimos artículos que describían resultados de pacientes sometidos a reconstrucción uretral con uretroplastia, solo hombres, en inglés o español, publicados entre 1999-2022. Incluimos 34 artículos, los cuales mostraron que, según el tipo de procedimiento realizado, las características de la estrechez uretral y las variables definidas como éxito y fracaso, los factores de riesgo asociados a la recurrencia posterior a la reconstrucción con uretroplastia en uretra fueron la presencia de comorbilidades, obesidad y etiología infecciosa. Concluimos entonces que la uretroplastia es un procedimiento que ha aumentado en los últimos años, con pocos estudios que nos comparan resultados dependiendo del tipo de procedimiento utilizado. Nuestra revisión encontró que hay mayor literatura sobre el uso de injertos de mucosa oral comparado con escición primaria y anastomosis (EPA), con unos resultados anatómicos y funcionales comparables entre ambos procedimientos. Los cuestionarios PROMS (Patient Reported Outcome Measures) son herramientas útiles para el seguimiento postoperatorio de estos pacientes.
Urethroplasty has become the standard for managing urethral stricture, depending on its location and etiology. Long-term outcome data varies depending on the definition of success used (subjective or objective). The objective of this integrative review is to show the available information on the functional results of patients with surgically managed urethral stricture. The study is an integrative review that was carried out through a literature search in PubMed, we included articles that described the results of patients undergoing urethral reconstruction with urethroplasty, only men, in English or Spanish, published between 1999-2022. The study included 34 articles, which showed that, depending on the type of procedure performed, the characteristics of the urethral stricture and the variables defined as success and failure, the risk factors associated with recurrence after reconstruction with urethroplasty in the urethra were the presence of comorbidities, obesity, and infectious etiology. In conclusion, urethroplasty is a procedure that has increased in recent years, with few studies that compare results depending on the type of procedure used. Our review found that there is more literature on the use of buccal mucosa graft (BMG) compared to excision and primary anastomotic urethroplasy (EPA), with comparable anatomical and functional results between both procedures.
Assuntos
Humanos , Masculino , Recidiva , Uretra/diagnóstico por imagem , Estreitamento Uretral , Fatores de Risco , Homens , Cirurgia Plástica , Uretra , Urologia , Revisão , Transplantes , Mucosa BucalRESUMO
Existe controversia y escasa literatura sobre las pautas de manejo del ureterocele y sus desenlaces, debido a que el abordaje varía desde procedimientos endoscópicos hasta reconstrucción completa. Nuestro objetivo es evaluar la efectividad y seguridad de los diferentes abordajes terapéuticos del ureterocele y sus desenlaces clínicos en la población pediátrica. Revisión sistemática de la literatura, respondiendo a la pregunta: ¿Cuáles son las diferentes opciones de manejo del ureterocele y sus desenlaces clínicos en la población pediátrica? Se encontraron 220 artículos, seleccionamos 48 artículos, para un total de 2.082 pacientes. Evaluamos la calidad metodológica con la herramienta ROBINS-I. Se realizó un metaanálisis de la mejoría del reflujo en el postoperatorio. Los pacientes con reflujo vesicoureteral (RVU) postoperatorio mostraron una mejoría posterior al tratamiento con una odds ratio de 0,24; se evidenció una gran heterogeneidad entre los estudios (I2: 85%; p < 0,001). La asociación entre los tratamientos practicados y la presencia de RVU pre no mostró una diferencia estadísticamente significativa (p = 0,321), en contraste con el RVU post (p = 0,02). En cuanto a la presencia de IVU pre y post, no se encontró diferencia estadísticamente significativa relacionada (p = 0,428 y p = 0,825). Existe una variación significativa en el abordaje, manejo inicial y seguimiento de los pacientes con ureterocele, posiblemente secundario al modo de presentación y curso clínico. Además, la mejoría del RVU posterior al tratamiento quirúrgico del ureterocele es significativo. La importancia de realizar estudios multiinstitucionales, prospectivos, aleatorizados y controlados es clave para evaluar el tratamiento y los resultados a largo plazo de esta patologí
There is controversy and little literature on the management guidelines for ureterocele and its outcomes since the approach varies from endoscopic procedures to complete reconstruction. Our objective is to evaluate the effectiveness and safety of the different therapeutic approaches for ureterocele and their clinical outcomes in the pediatric population. Systematic review of the literature, answering the question: What are the different management options for ureterocele and its clinical outcomes in the pediatric population? Two hundred and twenty articles were found, we selected 48 articles, for a total of 2,082 patients.We evaluated the methodological quality with the ROBINS-I tool.A meta-analysis of postoperative reflux improvement was performed. Patients with postoperative VUR showed improvement after treatment with an odds ratio 0.24; a great heterogeneity was evidenced among the studies (I2: 85%; p < 0.001].The association between the treatments performed and the presence of pre-VUR did not show a statistically significant difference (p = 0.321), in contrast to post-VUR (p = 0.02). Regarding the presence of pre- and post-UTI, no related statistically significant difference was found (p = 0.428 and p = 0.825). There is a significant variation in the approach, initial management, and follow-up of patients with ureterocele, possibly secondary to the mode of presentation and clinical course. In addition, the improvement in VUR after surgical treatment of the ureterocele is significant. The importance of conducting multi-institutional, prospective, randomized, and controlled studies is key to evaluating the treatment and long-term results of this pathology.
Assuntos
Humanos , População , Associação , Terapêutica , Ureterocele , Refluxo Vesicoureteral , Literatura , Pediatria , Cirurgia Geral , Doenças Ureterais , Urologia , Guias como Assunto , Aves CanorasRESUMO
BACKGROUND: Intracameral antibiotics, such as moxifloxacin and cefuroxime, are safe to corneal endothelial cells and effective prophylaxis of endophthalmitis after cataract surgery. Corneal endothelial cells decrease in density after cataract surgery. Any substance used in the anterior chamber may affect corneal endothelial cells and lead to a greater decrease in density. This study wants to determine the percentage of endothelial cell loss after cataract extraction by phacoemulsification with off-label intracameral injection of moxifloxacin and dexamethasone (Vigadexa®). METHODS: An observational retrospective study was performed. The clinical records of patients undergoing cataract surgery by phacoemulsification plus intracameral injection of Vigadexa® were analyzed. Endothelial cell loss (ECL) was calculated using preoperative and postoperative endothelial cell density. The relation of endothelial cell loss with cataract grade using LOCS III classification, total surgery time, total ultrasound time, total longitudinal power time, total torsional amplitude time, total aspiration time, estimated fluid usage, and cumulative dissipated energy (CDE) was studied using univariate linear regression analysis and logistic regression analysis. RESULTS: The median loss of corneal endothelial cells was 4.6%, interquartile range 0 to 10.4%. Nuclear color and CDE were associated with increased ECL. ECL>10% was associated with age and total ultrasound time in seconds. CONCLUSIONS: The endothelial cell loss after the intracameral use of Vigadexa® at the end of cataract surgery was similar to the reported in other studies of cataract surgery without the use of intracameral prophylaxis for postoperative endophthalmitis (POE). This study confirmed the association of CDE and nuclear opalescence grade with postoperative corneal endothelial cell loss.
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Isometric handgrip or (wall) squat exercise performed three times per week produces reductions in systolic blood pressure (SBP) in adults with hypertension. We aimed to compare these interventions and the potential to retain benefits with one exercise session per week. We compared blood pressure changes following handgrip and squat isometric training interventions with controls in a randomized controlled multicentre trial in 77 unmedicated hypertensive (SBP ≥ 130 mmHg) adults. Exercise sessions were performed in the workplace and consisted of four repetitions-three sessions per week for the first 12 weeks (phase 1), and one session per week for the subsequent 12 weeks (phase 2). Office blood pressure (BP) was measured at baseline, post-phase 1 and post-phase 2. Post-phase 1, mean reductions in SBP were significantly greater in handgrip (-11.2 mmHg, n = 28) and squat (-12.9 mmHg, n = 27) groups than in controls (-.4 mmHg; n = 22) but changes in DBP were not. There were no significant within-group changes during phase 2 but SBP was 3.8 mmHg lower in the wall squat than the handgrip group-a small magnitude but clinically important difference. While both interventions produced significant SBP reductions, the wall squat appears to be more effective in maintaining benefits with a minimal training dose. The low time investment to achieve and retain clinically significant SBP reductions-42 and 12 min, respectively-and minimal cost, particularly of the wall squat, make it a promising intervention for delivery in public health settings.
Assuntos
Hipertensão , Adulto , Humanos , Hipertensão/tratamento farmacológico , Pressão Sanguínea , Força da Mão/fisiologia , Exercício Físico/fisiologia , Contração Isométrica/fisiologiaRESUMO
Objective: Group the barriers to knowledge, treatment, and control of hypertension in patients in Latin America through a scoping review. Methods: A scoping review was conducted in accordance with the Arksey and O'Malley methodological framework and the PRISMA guidelines for systematic reviews and meta-analyses. Searches were carried out in the PubMed, Virtual Health Library, and Scopus databases. Blind and independent selection was conducted in the RAYYAN QCRI application. Finally, the results of the selected studies were addressed narratively. Results: Eight qualitative and quantitative studies that fit the research question were included. The most frequently described barriers are systemic barriers that hinder comprehensive and equitable access to health care and medication, as well as a lack of educational programs, personalized interventions to improve adherence to treatments, and lifestyle changes. Economic factors are critical in Latin America, hindering access to the health system and changes to lifestyles due to the costs of transportation, medical appointments, and medicines. Conclusions: The detected barriers affect all dimensions of adherence to treatment; among the most important barriers are decision makers who lack education and positioning with respect to care of hypertension.
Objetivo: Compilar as barreiras ao conhecimento, tratamento e controle da hipertensão arterial em pacientes da América Latina por meio de uma revisão de escopo. Métodos: Foi realizada uma revisão de escopo de acordo com a estrutura metodológica de Arksey e O'Malley e as diretrizes PRISMA para revisões sistemáticas e metanálises. Foi realizada uma busca nas bases de dados PubMed, Biblioteca Virtual em Saúde e Scopus. A seleção foi realizada de forma independente e cega no aplicativo RAYYAN QCRIâ. Por último, os resultados dos estudos selecionados foram abordados de forma narrativa. Resultados: Foram incluídos oito estudos qualitativos e quantitativos que se enquadravam na nossa questão de pesquisa. As barreiras mais frequentemente descritas são aquelas próprias do sistema que dificultam o acesso integral e equitativo a atendimento médico e medicamentos, a ausência de programas educativos e intervenções personalizadas que melhorem a adesão ao tratamento e as mudanças no estilo de vida. O fator econômico é crítico na América Latina e impede o acesso ao sistema de saúde para modificar o estilo de vida devido aos custos de transporte, consultas médicas e medicamentos. Conclusões: As barreiras detectadas afetam todas as dimensões da adesão ao tratamento, entre as quais se destaca a falta de capacitação e posicionamento dos tomadores de decisão sobre o cuidado da hipertensão.
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[RESUMEN]. Objetivo. Agrupar las barreras para el conocimiento, tratamiento y control de la hipertensión en pacientes de América Latina mediante una revisión de alcance. Métodos. Se realizó una revisión de alcance de acuerdo con el marco metodológico de Arksey y O'Malley y las directrices para revisiones sistemáticas y metaanálisis (PRISMA). Se efectuó una búsqueda en las bases de datos PubMed, Biblioteca Virtual de Salud y Scopus. La selección se realizó de manera independiente y en ciego en el aplicativo RAYYAN QCRI®. Por último, se abordaron los resultados de los estudios seleccionados de manera narrativa. Resultados. Se incluyeron ocho estudios cualitativos y cuantitativos que se adecuaban a nuestra pregunta de investigación. Las barreras descritas con más frecuencia son las propias del sistema que dificultan el acceso integral y equitativo a la atención médica y los medicamentos, la ausencia de programas educativos e intervenciones personalizadas que mejoren la adherencia a tratamientos y los cambios en el estilo de vida. El factor económico es crítico en América Latina e impide el acceso al sistema de salud y modificar el estilo de vida debido a los costos del transporte, las citas médicas y los medicamentos. Conclusiones. Las barreras detectadas afectan todas las dimensiones para la adherencia al tratamiento; entre ellas se destacan la falta de educación y posicionamiento de los tomadores de decisiones en la atención de la hipertensión.
[ABSTRACT]. Objective. Group the barriers to knowledge, treatment, and control of hypertension in patients in Latin America through a scoping review. Methods. A scoping review was conducted in accordance with the Arksey and O'Malley methodological fra- mework and the PRISMA guidelines for systematic reviews and meta-analyses. Searches were carried out in the PubMed, Virtual Health Library, and Scopus databases. Blind and independent selection was conducted in the RAYYAN QCRI application. Finally, the results of the selected studies were addressed narratively. Results. Eight qualitative and quantitative studies that fit the research question were included. The most fre- quently described barriers are systemic barriers that hinder comprehensive and equitable access to health care and medication, as well as a lack of educational programs, personalized interventions to improve adhe- rence to treatments, and lifestyle changes. Economic factors are critical in Latin America, hindering access to the health system and changes to lifestyles due to the costs of transportation, medical appointments, and medicines. Conclusions. The detected barriers affect all dimensions of adherence to treatment; among the most impor- tant barriers are decision makers who lack education and positioning with respect to care of hypertension.
[RESUMO]. Objetivo. Compilar as barreiras ao conhecimento, tratamento e controle da hipertensão arterial em pacientes da América Latina por meio de uma revisão de escopo. Métodos. Foi realizada uma revisão de escopo de acordo com a estrutura metodológica de Arksey e O’Ma- lley e as diretrizes PRISMA para revisões sistemáticas e metanálises. Foi realizada uma busca nas bases de dados PubMed, Biblioteca Virtual em Saúde e Scopus. A seleção foi realizada de forma independente e cega no aplicativo RAYYAN QCRIâ. Por último, os resultados dos estudos selecionados foram abordados de forma narrativa. Resultados. Foram incluídos oito estudos qualitativos e quantitativos que se enquadravam na nossa questão de pesquisa. As barreiras mais frequentemente descritas são aquelas próprias do sistema que dificultam o acesso integral e equitativo a atendimento médico e medicamentos, a ausência de programas educativos e intervenções personalizadas que melhorem a adesão ao tratamento e as mudanças no estilo de vida. O fator econômico é crítico na América Latina e impede o acesso ao sistema de saúde para modificar o estilo de vida devido aos custos de transporte, consultas médicas e medicamentos. Conclusões. As barreiras detectadas afetam todas as dimensões da adesão ao tratamento, entre as quais se destaca a falta de capacitação e posicionamento dos tomadores de decisão sobre o cuidado da hipertensão.
Assuntos
Hipertensão , Cooperação e Adesão ao Tratamento , América Latina , Hipertensão , Cooperação e Adesão ao Tratamento , Barreiras ao Acesso aos Cuidados de Saúde , América Latina , Hipertensão , Cooperação e Adesão ao Tratamento , Barreiras ao Acesso aos Cuidados de SaúdeRESUMO
Introduction. Non-communicable chronic diseases represent the leading cause of death worldwide, and their prevalence is increasing due to the epidemiological transition. Despite the advances in their management, control rates are deficient, attributed to multiple factors like adherence to pharmacological treatment, one of the most significant and least studied in the Colombian population. Objective. To calculate adherence to treatment in Colombian patients with arterial hypertension, cerebrovascular disease, diabetes mellitus, asthma, chronic obstructive pulmonary disease, and dyslipidemia between 2005 and 2022. Materials and methods. We performed a systematic literature review and a meta-analysis of studies identified through the Medline and LILACS databases to quantitatively synthesize treatment adherence percentage. Results. Fourteen studies met the inclusion criteria, and 5,658 patients were analyzed. The treatment adherence was 59%, with significant heterogeneity among the included studies (95% CI= 46- 71%; I2 = 98.8%, p< 0.001). Higher adherence rates were observed for diabetes mellitus (79%; 95% CI = 65- 90%) and dyslipidemia (70%; 95% CI = 66- 74%). Adherence to arterial hypertension treatment was 51% (95 %; CI = 31- 72%). Conclusions. This systematic review showed low adherence to recommendations regarding pharmacological management in non-communicable chronic diseases, which can have implications for long-term clinical outcomes and disease burden.
Introducción. Las enfermedades crónicas no transmisibles representan la principal causa de muerte en el mundo y su prevalencia va en aumento debido a la transición epidemiológica. A pesar de los avances en su manejo, las cifras de control son deficientes y esto se atribuye a múltiples factores, como el cumplimiento del tratamiento farmacológico, que es uno de los más representativos y menos estudiados en la población colombiana.Objetivo. Establecer la frecuencia de casos que cumplieron con el tratamiento farmacológico en pacientes colombianos con hipertensión arterial, enfermedad cerebrovascular, diabetes mellitus, asma, enfermedad pulmonar obstructiva crónica y dislipidemia, entre el 2005 y el 2022.Materiales y métodos. Se llevó a cabo una revisión sistemática de la literatura y un metaanálisis de los estudios identificados mediante las bases de datos Medline y LILACS para sintetizar cuantitativamente el porcentaje de cumplimiento del tratamiento.Resultados. Catorce estudios cumplieron los criterios de inclusión y se analizaron 5.658 pacientes. El cumplimiento del tratamiento fue del 59 %, con una heterogeneidad alta entre los estudios incluidos (IC95 % = 46-71 %; I2 = 98,8 %, p<0,001). Se obtuvo un mayor cumplimiento para la diabetes mellitus (79 %; IC95 % = 65-90 %) y la dislipidemia (70 %; IC 95 % = 66-74 %). En los pacientes con hipertensión arterial el cumplimiento fue del 51 % (IC 95 % = 31-72 %).Conclusiones. La revisión sistemática muestra un bajo cumplimiento de las recomendaciones sobre el manejo farmacológico de enfermedades crónicas no transmisibles, lo que puede repercutir en los resultados clínicos y en la carga de la enfermedad a largo plazo.
Assuntos
Doenças não Transmissíveis , Humanos , Doença Crônica , Colômbia/epidemiologia , Diabetes Mellitus/tratamento farmacológico , Diabetes Mellitus/epidemiologia , Dislipidemias/tratamento farmacológico , Dislipidemias/epidemiologia , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia , Doenças não Transmissíveis/tratamento farmacológico , Doenças não Transmissíveis/epidemiologia , Adesão à MedicaçãoRESUMO
RESUMEN Objetivo. Agrupar las barreras para el conocimiento, tratamiento y control de la hipertensión en pacientes de América Latina mediante una revisión de alcance. Métodos. Se realizó una revisión de alcance de acuerdo con el marco metodológico de Arksey y O'Malley y las directrices para revisiones sistemáticas y metaanálisis (PRISMA). Se efectuó una búsqueda en las bases de datos PubMed, Biblioteca Virtual de Salud y Scopus. La selección se realizó de manera independiente y en ciego en el aplicativo RAYYAN QCRI®. Por último, se abordaron los resultados de los estudios seleccionados de manera narrativa. Resultados. Se incluyeron ocho estudios cualitativos y cuantitativos que se adecuaban a nuestra pregunta de investigación. Las barreras descritas con más frecuencia son las propias del sistema que dificultan el acceso integral y equitativo a la atención médica y los medicamentos, la ausencia de programas educativos e intervenciones personalizadas que mejoren la adherencia a tratamientos y los cambios en el estilo de vida. El factor económico es crítico en América Latina e impide el acceso al sistema de salud y modificar el estilo de vida debido a los costos del transporte, las citas médicas y los medicamentos. Conclusiones. Las barreras detectadas afectan todas las dimensiones para la adherencia al tratamiento; entre ellas se destacan la falta de educación y posicionamiento de los tomadores de decisiones en la atención de la hipertensión.
ABSTRACT Objective. Group the barriers to knowledge, treatment, and control of hypertension in patients in Latin America through a scoping review. Methods. A scoping review was conducted in accordance with the Arksey and O'Malley methodological framework and the PRISMA guidelines for systematic reviews and meta-analyses. Searches were carried out in the PubMed, Virtual Health Library, and Scopus databases. Blind and independent selection was conducted in the RAYYAN QCRI application. Finally, the results of the selected studies were addressed narratively. Results. Eight qualitative and quantitative studies that fit the research question were included. The most frequently described barriers are systemic barriers that hinder comprehensive and equitable access to health care and medication, as well as a lack of educational programs, personalized interventions to improve adherence to treatments, and lifestyle changes. Economic factors are critical in Latin America, hindering access to the health system and changes to lifestyles due to the costs of transportation, medical appointments, and medicines. Conclusions. The detected barriers affect all dimensions of adherence to treatment; among the most important barriers are decision makers who lack education and positioning with respect to care of hypertension.
RESUMO Objetivo. Compilar as barreiras ao conhecimento, tratamento e controle da hipertensão arterial em pacientes da América Latina por meio de uma revisão de escopo. Métodos. Foi realizada uma revisão de escopo de acordo com a estrutura metodológica de Arksey e O'Malley e as diretrizes PRISMA para revisões sistemáticas e metanálises. Foi realizada uma busca nas bases de dados PubMed, Biblioteca Virtual em Saúde e Scopus. A seleção foi realizada de forma independente e cega no aplicativo RAYYAN QCRIâ. Por último, os resultados dos estudos selecionados foram abordados de forma narrativa. Resultados. Foram incluídos oito estudos qualitativos e quantitativos que se enquadravam na nossa questão de pesquisa. As barreiras mais frequentemente descritas são aquelas próprias do sistema que dificultam o acesso integral e equitativo a atendimento médico e medicamentos, a ausência de programas educativos e intervenções personalizadas que melhorem a adesão ao tratamento e as mudanças no estilo de vida. O fator econômico é crítico na América Latina e impede o acesso ao sistema de saúde para modificar o estilo de vida devido aos custos de transporte, consultas médicas e medicamentos. Conclusões. As barreiras detectadas afetam todas as dimensões da adesão ao tratamento, entre as quais se destaca a falta de capacitação e posicionamento dos tomadores de decisão sobre o cuidado da hipertensão.
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Humanos , Conhecimentos, Atitudes e Prática em Saúde , Cooperação e Adesão ao Tratamento , Hipertensão/prevenção & controle , Hipertensão/tratamento farmacológico , Fatores Sociodemográficos , América LatinaRESUMO
INTRODUCTION: The coronavirus disease 2019 (COVID-19) has become a significant public health problem worldwide. In this context, CT-scan automatic analysis has emerged as a COVID-19 complementary diagnosis tool allowing for radiological finding characterization, patient categorization, and disease follow-up. However, this analysis depends on the radiologist's expertise, which may result in subjective evaluations. OBJECTIVE: To explore deep learning representations, trained from thoracic CT-slices, to automatically distinguish COVID-19 disease from control samples. MATERIALS AND METHODS: Two datasets were used: SARS-CoV-2 CT Scan (Set-1) and FOSCAL clinic's dataset (Set-2). The deep representations took advantage of supervised learning models previously trained on the natural image domain, which were adjusted following a transfer learning scheme. The deep classification was carried out: (a) via an end-to-end deep learning approach and (b) via random forest and support vector machine classifiers by feeding the deep representation embedding vectors into these classifiers. RESULTS: The end-to-end classification achieved an average accuracy of 92.33% (89.70% precision) for Set-1 and 96.99% (96.62% precision) for Set-2. The deep feature embedding with a support vector machine achieved an average accuracy of 91.40% (95.77% precision) and 96.00% (94.74% precision) for Set-1 and Set-2, respectively. CONCLUSION: Deep representations have achieved outstanding performance in the identification of COVID-19 cases on CT scans demonstrating good characterization of the COVID-19 radiological patterns. These representations could potentially support the COVID-19 diagnosis in clinical settings.
Introducción. La enfermedad por coronavirus (COVID-19) es actualmente el principal problema de salud pública en el mundo. En este contexto, el análisis automático de tomografías computarizadas (TC) surge como una herramienta diagnóstica complementaria que permite caracterizar hallazgos radiológicos, y categorizar y hacer el seguimiento de pacientes con COVID-19. Sin embargo, este análisis depende de la experiencia de los radiólogos, por lo que las valoraciones pueden ser subjetivas. Objetivo. Explorar representaciones de aprendizaje profundo entrenadas con cortes de TC torácica para diferenciar automáticamente entre los casos de COVID-19 y personas no infectadas. Materiales y métodos. Se usaron dos conjuntos de datos de TC: de SARS-CoV-2 CT (conjunto 1) y de la clínica FOSCAL (conjunto 2). Los modelos de aprendizaje supervisados y previamente entrenados en imágenes naturales, se ajustaron usando aprendizaje por transferencia. La clasificación se llevó a cabo mediante aprendizaje de extremo a extremo y clasificadores tales como los árboles de decisiones y las máquinas de soporte vectorial, alimentados por la representación profunda previamente aprendida. Resultados. El enfoque de extremo a extremo alcanzó una exactitud promedio de 92,33 % (89,70 % de precisión) para el conjunto 1 y de 96,99 % (96,62 % de precisión) para el conjunto-2. La máquina de soporte vectorial alcanzó una exactitud promedio de 91,40 % (precisión del 95,77 %) para el conjunto-1 y del 96,00 % (precisión del 94,74 %) para el conjunto 2. Conclusión. Las representaciones profundas lograron resultados sobresalientes al caracterizar patrones radiológicos usados en la detección de casos de COVID-19 a partir de estudios de TC y demostraron ser una potencial herramienta de apoyo del diagnóstico.
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COVID-19 , Aprendizado Profundo , Teste para COVID-19 , Humanos , Redes Neurais de Computação , SARS-CoV-2 , Tomografia Computadorizada por Raios XRESUMO
AIMS: In a multinational South American cohort, we examined variations in CVD incidence and mortality rates between subpopulations stratified by country, by sex and by urban or rural location. We also examined the contributions of 12 modifiable risk factors to CVD development and to death. METHODS AND RESULTS: This prospective cohort study included 24 718 participants from 51 urban and 49 rural communities in Argentina, Brazil, Chile, and Colombia. The mean follow-up was 10.3 years. The incidence of CVD and mortality rates were calculated for the overall cohort and in subpopulations. Hazard ratios and population attributable fractions (PAFs) for CVD and for death were examined for 12 common modifiable risk factors, grouped as metabolic (hypertension, diabetes, abdominal obesity, and high non-HDL cholesterol), behavioural (tobacco, alcohol, diet quality, and physical activity), and others (education, household air pollution, strength, and depression). Leading causes of death were CVD (31.1%), cancer (30.6%), and respiratory diseases (8.6%). The incidence of CVD (per 1000 person-years) only modestly varied between countries, with the highest incidence in Brazil (3.86) and the lowest in Argentina (3.07). There was a greater variation in mortality rates (per 1000 person-years) between countries, with the highest in Argentina (5.98) and the lowest in Chile (4.07). Men had a higher incidence of CVD (4.48 vs. 2.60 per 1000 person-years) and a higher mortality rate (6.33 vs. 3.96 per 1000 person-years) compared with women. Deaths were higher in rural compared to urban areas. Approximately 72% of the PAF for CVD and 69% of the PAF for deaths were attributable to 12 modifiable risk factors. For CVD, largest PAFs were due to hypertension (18.7%), abdominal obesity (15.4%), tobacco use (13.5%), low strength (5.6%), and diabetes (5.3%). For death, the largest PAFs were from tobacco use (14.4%), hypertension (12.0%), low education (10.5%), abdominal obesity (9.7%), and diabetes (5.5%). CONCLUSIONS: Cardiovascular disease, cancer, and respiratory diseases account for over two-thirds of deaths in South America. Men have consistently higher CVD and mortality rates than women. A large proportion of CVD and premature deaths could be averted by controlling metabolic risk factors and tobacco use, which are common leading risk factors for both outcomes in the region.
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Doenças Cardiovasculares , Diabetes Mellitus , Hipertensão , Neoplasias , Brasil , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Hipertensão/epidemiologia , Masculino , Obesidade Abdominal/complicações , Estudos Prospectivos , Fatores de RiscoRESUMO
Introduction: The coronavirus disease 2019 (COVID-19) has become a significant public health problem worldwide. In this context, CT-scan automatic analysis has emerged as a COVID-19 complementary diagnosis tool allowing for radiological finding characterization, patient categorization, and disease follow-up. However, this analysis depends on the radiologist's expertise, which may result in subjective evaluations. Objective: To explore deep learning representations, trained from thoracic CT-slices, to automatically distinguish COVID-19 disease from control samples. Materials and methods: Two datasets were used: SARS-CoV-2 CT Scan (Set-1) and FOSCAL clinic's dataset (Set-2). The deep representations took advantage of supervised learning models previously trained on the natural image domain, which were adjusted following a transfer learning scheme. The deep classification was carried out: (a) via an end-to-end deep learning approach and (b) via random forest and support vector machine classifiers by feeding the deep representation embedding vectors into these classifiers. Results: The end-to-end classification achieved an average accuracy of 92.33% (89.70% precision) for Set-1 and 96.99% (96.62% precision) for Set-2. The deep feature embedding with a support vector machine achieved an average accuracy of 91.40% (95.77% precision) and 96.00% (94.74% precision) for Set-1 and Set-2, respectively. Conclusion: Deep representations have achieved outstanding performance in the identification of COVID-19 cases on CT scans demonstrating good characterization of the COVID-19 radiological patterns. These representations could potentially support the COVID-19 diagnosis in clinical settings.
Introducción. La enfermedad por coronavirus (COVID-19) es actualmente el principal problema de salud pública en el mundo. En este contexto, el análisis automático de tomografías computarizadas (TC) surge como una herramienta diagnóstica complementaria que permite caracterizar hallazgos radiológicos, y categorizar y hacer el seguimiento de pacientes con COVID-19. Sin embargo, este análisis depende de la experiencia de los radiólogos, por lo que las valoraciones pueden ser subjetivas. Objetivo. Explorar representaciones de aprendizaje profundo entrenadas con cortes de TC torácica para diferenciar automáticamente entre los casos de COVID-19 y personas no infectadas. Materiales y métodos. Se usaron dos conjuntos de datos de TC: de SARS-CoV-2 CT (conjunto 1) y de la clínica FOSCAL (conjunto 2). Los modelos de aprendizaje supervisados y previamente entrenados en imágenes naturales, se ajustaron usando aprendizaje por transferencia. La clasificación se llevó a cabo mediante aprendizaje de extremo a extremo y clasificadores tales como los árboles de decisiones y las máquinas de soporte vectorial, alimentados por la representación profunda previamente aprendida. Resultados. El enfoque de extremo a extremo alcanzó una exactitud promedio de 92,33 % (89,70 % de precisión) para el conjunto 1 y de 96,99 % (96,62 % de precisión) para el conjunto-2. La máquina de soporte vectorial alcanzó una exactitud promedio de 91,40 % (precisión del 95,77 %) para el conjunto-1 y del 96,00 % (precisión del 94,74 %) para el conjunto 2. Conclusión. Las representaciones profundas lograron resultados sobresalientes al caracterizar patrones radiológicos usados en la detección de casos de COVID-19 a partir de estudios de TC y demostraron ser una potencial herramienta de apoyo del diagnóstico.
Assuntos
Infecções por Coronavirus/diagnóstico , Aprendizado Profundo , Tomografia Computadorizada por Raios XRESUMO
PURPOSE: To assess visual results (including the Lapid-Kushlin defocus coefficient), and satisfaction, following the implantation of PanOptix® a trifocal intraocular lens. METHODS: Observational, retrospective cohort study. 130 eyes of 65 subjects with bilateral implantation were included. Binocular uncorrected visual acuities [distance (Binocular UDVA), intermediate (Binocular UIVA) and near (Binocular UNVA)] were measured. Also, the manifest refraction, binocular defocus curve and binocular contrast sensitivity were determined. The Lapid-Kushlin defocus coefficient, a new single numerical parameter based on the area under the curve of the defocus curve, was calculated. The validated Spanish CATQUEST-9SF satisfaction survey was applied. RESULTS: Postoperative visual acuity ranges were: binocular UDVA 0.18 to 0.0 LogMAR, binocular UIVA 0.30 to 0.0 LogMAR and Binocular UNVA 0.18 to 0.0 LogMAR. The levels of contrast sensitivity both in bright light conditions (with and without glare) and low light conditions with glare, remained within the limits of normality. Under scotopic conditions without glare values below normality were found at lower spatial frequencies. The binocular defocus curve showed a plateau without a clearly evident peak. The Lapid-Kushlin defocus coefficient was 0.199. Two patients (3.1%) needed glasses after the procedure for near and intermediate vision. No patient manifested great visual difficulties or was dissatisfied with the results. CONCLUSIONS: The trifocal platform showed very good results in this series of patients. 96.9% of the patients achieved independence of the glasses and expressed a high degree of satisfaction. The Lapid-Kushlin defocus coefficient was better than those calculated from literature, for other multifocal intraocular lenses.
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Catarata , Lentes Intraoculares , Humanos , Implante de Lente Intraocular/métodos , Satisfação do Paciente , Satisfação Pessoal , Estudos Prospectivos , Desenho de Prótese , Refração Ocular , Estudos Retrospectivos , Visão BinocularRESUMO
Hypertension awareness and control is poor in low- and middle-income countries. Thus, implementing strategies to increase hypertension detection is needed. Colombia participated as one of the 92 countries involved in the third campaign of the May Measurement Month in 2019. Blood pressure (BP) was measured in 48 324 volunteers from 13 departments in Colombia. In total, 27.9% individuals were identified with hypertension. Of those with hypertension, 63.7% were aware of their condition, 60.0% were on antihypertensive medication, and 38.4% had controlled BP. These results showed low levels of awareness, treatment, and control of hypertension in this sample of subjects volunteered to participate, suggest the urgent necessity of implementing programmes to improve the diagnosis and management of hypertension in Colombia.
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The aim of this study was to evaluate the impact on muscle strength, aerobic fitness and body composition, of replacing the physical education (PE) class of Colombian adolescents with resistance or aerobic training. 120 tanner stage 3 adolescents attending a state school were randomized to resistance training, aerobic training, or a control group who continued to attend a weekly 2- hour PE class for 16 weeks. The resistance training and aerobic training groups participated in twice weekly supervised after-school exercise sessions of < 1 hour instead of their PE class. Sum of skinfolds, lean body mass (bioelectrical impedance analysis), muscular strength (6 repetition maximum (RM)) bench press, lateral pulldown and leg press) and estimated cardiorespiratory fitness (multistage 20 meter shuttle run) were assessed at pre and post intervention. Complete data were available for n = 40 of the resistance training group, n = 40 of the aerobic training group and n = 30 PE (controls). Resistance training attenuated increases in sum of skinfolds compared with controls (d = 0.27, [0.09-0.36]). We found no significant effect on lean body mass. Resistance training produced a positive effect on muscle strength compared with both controls (d = 0.66 [.49-.86]) and aerobic training (d = 0.55[0.28-0.67]). There was a positive effect of resistance training on cardiorespiratory fitness compared with controls (d = 0.04 [-0.10-0.12]) but not compared with aerobic training (d = 0.24 [0.10-0.36]). Replacing a 2-hour PE class with two 1 hour resistance training sessions attenuated gains in subcutaneous adiposity, and enhanced muscle strength and aerobic fitness development in Colombian youth, based on a median attendance of approximately 1 session a week. Further research to assess whether adequate stimuli for the development of muscular fitness exists within current physical education provision is warranted.
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Composição Corporal/fisiologia , Exercício Físico/fisiologia , Aptidão Física/fisiologia , Adolescente , Aptidão Cardiorrespiratória , Colômbia/epidemiologia , Teste de Esforço/métodos , Terapia por Exercício , Feminino , Humanos , Masculino , Força Muscular/fisiologia , Músculo Esquelético/fisiologia , Obesidade/metabolismo , Obesidade/fisiopatologia , Treinamento Resistido/métodos , Levantamento de PesoRESUMO
BACKGROUND: Adiposity is a major component of the metabolic syndrome (MetS), low muscle strength has also been identified as a risk factor for MetS and for cardiovascular disease. We describe the prevalence of MetS and evaluate the relationship between muscle strength, anthropometric measures of adiposity, and associations with the cluster of the components of MetS, in a middle-income country. METHODS: MetS was defined by the International Diabetes Federation criteria. To assess the association between anthropometric variables (waist circumference (WC), waist-to-hip ratio (W/H), body mass index (BMI)), strength (handgrip/kg bodyweight (HGS/BW)) and the cluster of MetS, we created a MetS score. For each alteration (high triglycerides, low HDLc, dysglycemia, or high blood pressure) one point was conferred. To evaluate the association an index of fat:muscle and MetS score, participants were divided into 9 groups based on combinations of sex-specific tertiles of WC and HGS/BW. RESULTS: The overall prevalence of MetS in the 5,026 participants (64% women; mean age 51.2 years) was 42%. Lower HGS/BW, and higher WC, BMI, and W/H were associated with a higher MetS score. Amongst the 9 HGS/BW:WC groups, participants in the lowest tertile of HGS/BW and the highest tertile of WC had a higher MetS score (OR = 4.69 in women and OR = 8.25 in men;p < 0.01) compared to those in the highest tertile of HGS/BW and in the lowest tertile of WC. CONCLUSION: WC was the principal risk factor for a high MetS score and an inverse association between HGS/BW and MetS score was found. Combining these anthropometric measures improved the prediction of metabolic alterations over either alone.
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Adiposidade , Força da Mão , Síndrome Metabólica/diagnóstico , Músculo Esquelético/fisiopatologia , Obesidade Abdominal/diagnóstico , Circunferência da Cintura , Adulto , Fatores de Risco Cardiometabólico , Colômbia/epidemiologia , Estudos Transversais , Bases de Dados Factuais , Feminino , Nível de Saúde , Humanos , Masculino , Síndrome Metabólica/epidemiologia , Síndrome Metabólica/fisiopatologia , Pessoa de Meia-Idade , Obesidade Abdominal/epidemiologia , Obesidade Abdominal/fisiopatologia , Valor Preditivo dos Testes , Prevalência , Medição de RiscoRESUMO
OBJECTIVE: To evaluate presence of risk factors for cardiovascular diseases (CVD) and type 2 diabetes mellitus (DM2) in a group of health care workers. METHODS: During the X Latin American Congress of Internal Medicine held in August 2017, in Cartagena, Colombia, attendees were invited to participate in the study that included a survey on medical, pharmacological and family history, lifestyle habits, blood pressure measurement, anthropometry, muscle strength and laboratory studies. The INTERHEART and FINDRISC scales were used to calculate the risk of CVD and diabetes, respectively. RESULTS: Among 186 participants with an average age of 37.9 years, 94% physicians (52.7% specialists), the prevalence of hypertension was 20.4%, overweight 40.3%, obesity 19.9%, and dyslipidemia 67.3%. 20.9% were current smokers or had smoked, and 60.8% were sedentary. Hypertensive patients were found to be older, had higher Body Mass Index (BMI), higher waist circumference, higher waist-to-hip ratio, higher of body fat and visceral fat, smoked more and had lower muscle strength (high jump: 0.38 vs. 0.42Ìcm; pÌ=Ì0.01). In 44.3% of participants was observed a high-risk score for CVD. The prevalence of diabetes was 6.59% and 27.7% were at risk. CONCLUSION: The prevalence of risk factors for CVD among the Latin American physicians studied was similar to that reported in the general population. The prevalence of high-risk scores for CVD and DM2 was high and healthy lifestyle habits were low. It is necessary to improve adherence to healthy lifestyles among these physicians in charge of controlling these factors in the general population.
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Doenças Cardiovasculares , Diabetes Mellitus Tipo 2 , Pessoal de Saúde/estatística & dados numéricos , Hipertensão , Adulto , Índice de Massa Corporal , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Diabetes Mellitus Tipo 2/epidemiologia , Humanos , Hipertensão/epidemiologia , América Latina/epidemiologia , Prevalência , Fatores de RiscoRESUMO
Introducción: La gonioscopía es la técnica utilizada para diagnosticar la sospecha de cierre angular primario (SCAP). Sin embargo, es una medida subjetiva, a diferencia de la tomografía óptica coherente de segmento anterior (OCT-SA). Se realizó un estudio midiendo los parámetros estereoscópicos por OCT-SA y su correlación con la gonioscopía. Objetivo: Comparar la gonioscopía y los parámetros por OCT-SA en ojos con ángulo estrecho y abierto, y evaluar la reproducibilidad intraobservador de estos parámetros. Método: Estudio observacional, analítico, descriptivo y longitudinal. Se recolectó la información de los pacientes valorados en la consulta de glaucoma entre marzo y junio de 2019 sin antecedente de cirugía ni láser ocular a quienes se solicitó OCT-SA. Resultados: De 131 ojos, el 28.25% tenían ángulos estrechos y el 68.7% abiertos. La distancia de apertura del ángulo 500 (AOD) promedio nasal fue de 210 µm (rango intercuartílico [RIQ]: 98-275.5) y el temporal fue de 214 µm (RIQ: 130.5-289). El área del espacio del iris trabecular área 500 (TISA) promedio nasal fue de 0.070 mm2 (RIQ: 0.034-0.093) y el temporal fue de 0.068 mm2 (RIQ: 0.038-0.093). El ángulo del iris trabecular (TIA) nasal fue de 23.77° (RIQ: 12.11-29.92) y el temporal fue de 23.46° (RIQ: 14.37-30.45). Cuanto más abiertos están los ángulos por gonioscopía, mayor área de TISA, TIA y AOD. Existe una buena reproducibilidad intraobservador respecto al AOD nasal, con un coeficiente de concordancia de 0.956 (intervalo de confianza del 95% [IC95%]: 0.94- 0.97), y para el AOD temporal de 0.940 (IC95%: 0.92-0.96). Respecto al TISA nasal, el coeficiente de concordancia fue de 0.956 (IC95%: 0.9-0.97), y para el temporal de 0.946 (IC95%: 0.93-0.96). Conclusiones: La OCT-SA tiene una buena correlación con la gonioscopía y una buena reproducibilidad intraobservador. Sin embargo, sigue siendo una ayuda diagnóstica que no reemplaza la evaluación clínicaIntroducción: La gonioscopía es la técnica utilizada para diagnosticar la sospecha de cierre angular primario (SCAP). Sin embargo, es una medida subjetiva, a diferencia de la tomografía óptica coherente de segmento anterior (OCT-SA). Se realizó un estudio midiendo los parámetros estereoscópicos por OCT-SA y su correlación con la gonioscopía. Objetivo: Comparar la gonioscopía y los parámetros por OCT-SA en ojos con ángulo estrecho y abierto, y evaluar la reproducibilidad intraobservador de estos parámetros. Método: Estudio observacional, analítico, descriptivo y longitudinal. Se recolectó la información de los pacientes valorados en la consulta de glaucoma entre marzo y junio de 2019 sin antecedente de cirugía ni láser ocular a quienes se solicitó OCT-SA. Resultados: De 131 ojos, el 28.25% tenían ángulos estrechos y el 68.7% abiertos. La distancia de apertura del ángulo 500 (AOD) promedio nasal fue de 210 µm (rango intercuartílico [RIQ]: 98-275.5) y el temporal fue de 214 µm (RIQ: 130.5-289). El área del espacio del iris trabecular área 500 (TISA) promedio nasal fue de 0.070 mm2 (RIQ: 0.034-0.093) y el temporal fue de 0.068 mm2 (RIQ: 0.038-0.093). El ángulo del iris trabecular (TIA) nasal fue de 23.77° (RIQ: 12.11-29.92) y el temporal fue de 23.46° (RIQ: 14.37-30.45). Cuanto más abiertos están los ángulos por gonioscopía, mayor área de TISA, TIA y AOD. Existe una buena reproducibilidad intraobservador respecto al AOD nasal, con un coeficiente de concordancia de 0.956 (intervalo de confianza del 95% [IC95%]: 0.94- 0.97), y para el AOD temporal de 0.940 (IC95%: 0.92-0.96). Respecto al TISA nasal, el coeficiente de concordancia fue de 0.956 (IC95%: 0.9-0.97), y para el temporal de 0.946 (IC95%: 0.93-0.96). Conclusiones: La OCT-SA tiene una buena correlación con la gonioscopía y una buena reproducibilidad intraobservador. Sin embargo, sigue siendo una ayuda diagnóstica que no reemplaza la evaluación clínica
Introduction: Gonioscopy is the technique used to diagnose primary angle closure suspect (PACS). Nevertheless, it is a subjective measure compared to anterior segment coherent optical tomography (AS-OCT). A study was performed by measuring the stereoscopic parameters with AS-OCT and correlating them with gonioscopy. Objective: To compare gonioscopy and AS-OCT parameters in eyes with closed and open angle. Moreover, to evaluate intraobserver reproducibility of those parameters. Method: Observational, analytical descriptive longitudinal study. Data was collected from patients who attended glaucoma service between March and June 2019 and had an AS-OOCT done. Patients were excluded if they had history of laser or intraocular surgery. Results: Out of 131 eyes, 28.25% had closed angles and 68.7% open angles. The average nasal angle opening distance 500 (AOD) was 210 µm ICR (98 275.5) and the temporal was 214 µm ICR (130.5 289). The average nasal trabecular iris space area 500 (TISA) was 0.070 mm2 ICR (0.034 0.093) and the temporal was 0.068 mm2 ICR (0.038 0.093). The nasal trabecular iris angle (TIA) was 23.77º ICR (12.11 29.92) and the temporal was 23.46º ICR (14.37 30.45). The wider the angles by gonioscopy, the greater the area of TISA, TIA and AOD. A good nasal AOD intraobserver reproducibility was observed with a concordance coefficient of 0.956 (IC 95%: 0.94 0.97) and temporal AOD of 0.940 (0.92 0.96). Regarding the nasal TISA, the concordance coefficient was 0.956 (IC 95%: 0.9 0.97) and temporal TISA was 0.946 (IC 95: 0.93 0.96). Conclusions: AS-OCT has a strong correlation with gonioscopy and a good intraobserver reproducibility. However, it remains as a diagnostic aid that does not substitute clinical evaluation.