La bioestadística: una herramienta fundamental en la elaboración de artículos radiológicos

La bioestadística se ha convertido en una herramienta indispensable en todos los dominios de las Ciencias de la Salud, necesaria para tomar decisiones válidas, por lo que conocer bien sus principios básicos nos permitirá hacer un buen uso de ella. Tras definirla, se plantea el uso de su manejo y su justificación. Se pretende hacer un recorrido por las diferentes etapas que se deben seguir en todo proceso de investigación, empezando por concretar el objetivo del estudio, abordando los diversos diseños de estudios (transversales, longitudinales prospectivos y retrospectivos, ensayos clínicos) y las técnicas estadísticas más usualmente utilizadas en el ámbito de la salud, desde la estadística descriptiva para iniciar todo estudio, pasando por los análisis univariados tanto de variables cualitativas como cuantitativas, así como los análisis multivariados más utilizados en nuestro medio.0.123 SJR (2008) Q4, 191/231 Radiology, nuclear medicine and imagin

The irruption of online clinical simulation in COVID-19 times. An explanatory experience of a course in the Psychology Degree

Introducción. El desafío de la educación superior durante la pandemia de COVID-19 fue transformar las prácticas clínicas a un entorno virtual de manera urgente. La simulación desempeñó un papel relevante, y se hace necesario analizar las consecuencias que acarrea un cambio súbito en su modalidad de impartición. Sujetos y métodos. Manteniendo los procedimientos lo más parecido a como eran en la modalidad original, se comparó la satisfacción de los estudiantes en prácticas en ambos entornos. Sus resultados académicos fueron contrastaron con los de los estudiantes de cursos previos. Resultados. Sin diferencias significativas en la satisfacción global, el material distribuido y la capacidad de concentración se percibieron como más satisfactorios en el modo presencial. Las calificaciones mejoraron significativamente en el modo virtual. Conclusión. En situaciones exigentes de cambio de modelo de enseñanza, se ha demostrado la idoneidad de la simula-ción virtual para el desarrollo de competencias clínicas en psicología.Introduction. The challenge for higher education during COVID-19 was to urgently transform clinical practices into a virtual environment. Simulation played a relevant role and it is necessary to analyze the consequences of a sudden change in its mode of delivery. Subjects and methods. Keeping the procedures as close as possible to what they were in the face-to-face original mode, the degree of satisfaction of the students in clinical practices with simulation was compared in both environments. Their academic results were compared with those of students from previous courses. Results. With no significant differences in overall satisfaction, the material distributed and the ability to concentrate were perceived as more satisfactory for the face-to-face mode. Grades improved significantly in the virtual mode. Conclusion. In demanding situations of change of teaching model, the suitability of virtual simulation for the development of clinical competencies in Psychology has been demonstrated.Sin financiaciónNo data JCR 2020No data SJR 20200,088 IDR (2019) C4, 162 / 230 EducaciónUE

Uricemia y síndrome metabólico en pacientes con hipertensión arterial

Objetivo: Los niveles de uricemia se han asociado con el síndrome metabólico (SM). Sin embargo, la relación entre estas 2 variables en pacientes con hipertensión arterial (HTA) esencial no ha sido estudiada. Pacientes y métodos: Estudio observacional, transversal, de 592 pacientes con HTA esencial. Para la definición de SM se emplearon ≥3 criterios de la ATP-III. Se excluyeron a los pacientes con tratamiento hipouricemiante. Resultados: La prevalencia de SM fue del 52% (IC del 95%: 48-56%) y aumentó gradualmente a medida que se incrementaba la uricemia (uricemia: ≤4,7mg/dl, 36%; uricemia ≥6,8mg/dl, 70%; p<0,001). Los enfermos hipertensos con SM mostraron una uricemia media más elevada que los que no tenían esta comorbilidad (6,1±1,5mg/dl vs 5,4±1,3mg/dl; p<0,0001). La prevalencia de hiperuricemia (varones: ≥7,0mg/dl; mujeres: ≥6,0mg/dl) en los pacientes hipertensos que no recibían tratamiento diurético fue del 24,3% (en aquellos con SM, 40,5% frente a un 11,4% en los que no tenían SM; p<0,001). En el análisis multivariante los triglicéridos (OR: 1,008; IC del 95%: 1,004-1,012; p<0,001) y el índice de masa corporal (IMC) (OR: 1,118; IC del 95%: 1,059-1,181; p<0,001) fueron predictores independientes de la uricemia. Conclusiones: En los pacientes con HTA esencial, aproximadamente la mitad padecen SM y uno de cada 4 presenta hiperuricemia. El determinante más relevante del incremento de la concentración sérica de uratos es el aumento del IMC.0,257 JCR (2012) Q2, posición 786 de 1840 (Medicine (miscellaneous)

Glucose series complexity in hypertensive patients

Nonlinear methods have been applied to the analysis of biological signals. Complexity analysis of glucose time series may be a useful tool for the study of the initial phases of glucoregulatory dysfunction. This observational, cross-sectional study was performed in patients with essential hypertension. Glucose complexity was measured with detrended fluctuation analysis (DFA), and glucose variability was measured by the mean amplitudes of glycemic excursion (MAGE). We included 91 patients with a mean age of 59 ± 10 years. We found significant correlations for the number of metabolic syndrome (MS)-defining criteria with DFA (r = 0.233, P = .026) and MAGE (r = 0.396, P < .0001). DFA differed significantly between patients who complied with MS and those who did not (1.44 vs. 1.39, P = .018). The MAGE (f = 5.3, P = .006), diastolic blood pressures (f = 4.1, P = .018), and homeostasis model assessment indices (f = 4.2, P = .018) differed between the DFA tertiles. Multivariate analysis revealed that the only independent determinants of the DFA values were MAGE (β coefficient = 0.002, 95% confidence interval: 0.001-0.004, P = .001) and abdominal circumference (β coefficient = 0.002, 95% confidence interval: 0.000015-0.004, P = .048). In our population, DFA was associated with MS and a number of MS criteria. Complexity analysis seemed to be capable of detecting differences in variables that are arguably related to the risk of the development of type 2 diabetes.Sin financiación2.606 JCR (2014) Q3, 31/60 Peripheral Vascular DiseaseUE

Symptomatic and asymptomatic interphalageal osteoarthritis: An ultrasonographic study

Objetivo: Pocos estudios han examinado si existen diferencias morfológicas detectables con ecografía entre las articulaciones sintomáticas y las que no lo son en pacientes con artrosis. Este estudio describe y compara los hallazgos clínicos, radiológicos y ecográficos de los pacientes con artrosis interfalángica proximal (IFP) y/o distal (IFD) que tienen articulaciones con y sin dolor. Métodos: Prospectivamente, se incluyó a pacientes con artrosis IFP y/o IFD según los criterios ACR. El reumatólogo clínico eligió hasta un máximo de 3 articulaciones dolorosas y 3 articulaciones no dolorosas de localización simétrica en cada paciente para formar 2 cohortes de artrosis: grupo con dolor (GD) y grupo sin dolor (GSD). La radiografía simple postero-anterior de las manos fue leída por un reumatólogo según las recomendaciones del atlas OARSI, ciego a toda información clínica y ecográfica. El estudio ecográfico fue realizado por un reumatólogo en las articulaciones previamente seleccionadas por el clínico ciego a los datos clínicos y radiológicos. Se registraron como ausente o presente: osteofitos, pinzamiento articular, sinovitis, señal Doppler intraarticular, erosiones y visualización del cartílago. Se realizó un estudio de fiabilidad intralector para la radiología y para la ecografía. Resultados: Se estudió un total de 50 articulaciones en cada cohorte de 20 mujeres diestras de 61,85 años de edad (46-73) con artrosis IFP y IFD diagnosticada hace 6,8 años (1-17 años). El 70% de las articulaciones del GD y GSD se localizaron en la mano derecha e izquierda, respectivamente. El GD tenía significativamente más osteofitos, sinovitis y ausencia de cartílago que el GSD. La fiabilidad interlector radiológico y ecográfico fue excelente. Conclusión: La ecografía detecta más daño estructural y sinovitis en las IFP y/o IFD artrósicas que presentan dolor.Objective: To date few studies have examined whether ultrasonography can depict morphologic differences in painful and painless osteoarthritis (OA). This study describes and compares the clinical, radiographic and ultrasonographic findings of patients with both painful and painless proximal interphalgeal (PIP) and/or distal interphalgeal (DIP) OA. Methods: Patients with PIP and/or DIP OA (ACR criteria) were prospectively recruited. The clinical rheumatologist chose up to 3 painful joints and up to 3 painless symmetric joints in each patient to define 2 cohorts of OA: symptomatic (SG) and asymptomatic (ASG). A conventional postero-anterior hand x ray was performed and read by one rheumatologist following the OARSI atlas, blinded to clinical and sonographic data. Ultrasound (US) was performed by an experienced rheumatologist, blinded to both clinical and radiographic data in joints previously selected by the clinical rheumatologist. US-pathology was assessed as present or absent as defined in previous reports: osteophytes, joint space narrowing, synovitis, intra-articular power doppler signal, intra-articular bony erosion, and visualization of cartilage. Radiographic and ultrasonographic intrareader reliability test was performed. Results: A total of 50 joints in the SG and ASG were included from 20 right handed women aged 61.85 (46-73) years with PIP and DIP OA diagnosed 6.8 (1-17) years ago. 70% SG joints and ASG were right and left sided respectively. The SG showed significantly more osteophytes, synovitis and non-visualization of joint cartilage. Intrareader radiographic and ultrasonographic agreement was excellent. Conclusion: This study demonstrates that painful PIP and/or DIP OA have more ultrasonographic structural changes and synovitis.Sin financiación0.409 SJR (2014) Q3, 33/61 RheumatologyUE

Cystatin C is Associated with Serum Uric Acid in a Hypertensive Population

Hyperuricemia has been related with the development of arterial hypertension Cystatin C, a marker of renal function has been proposed recently as a marker of cardiovascular risk, independently of renal function. We investigate if serum uric acid is related with serum cystatin C in patients with essential hypertension. We included 885 patients (50.7% males), aged 57,8 +/- 14,9 y., diagnosed of essential hypertension and attended in our Hypertension Unit during a 12 month. We performed in all of them a clinical history, a physical examination and routine analysis, including cystatin C (Nephelometry, Behring). Hyperuricemia was defined as serum uric acid > 7 mg/dl (males) or >6 mg/dl (females) or being on treatment with allopurinol. The result was that 272 patients had hyperuricemia (30,7%) with male predominance (36.1%) vs. females (25.5%), [p < 0.0001]. Serum cystatin C did not shown gender differences (males 0.87 +/- 0.269 mg/L and females (0.90 +/- 0.47 mg/L), [p: 0.061]. After adjusting for age, gender, estimated glomerular filtration rate (e-GFR) and diuretic (38.2%) and allopurinol treatment (8.1%), serum uric acid showed a positive correlation with abdominal circumference(r:0.277, p< 0,0001), triglycerides(r:0.195, p < 0.0001), body mass index (r:0,274, p< 0.0001), total cholesterol (r:0.136, p =0.009, LDL-cholesterol (r:0.104; p= 0.049), microalbuminuria (r:0.163, p =0.002), serum ferritin (r.0.108, p= 0.041) and cystatin C (r:0.302, p < 0.0001). Others partial correlations analysed (HDL-cholesterol, glucose, CRP, fibrinogen and systolic and diastolic blood pressure) did not shown significant differences. Multivariate analysis, adjusted for age, gender, MDRD-GFR, and diuretic and allopurinol treatment, showed that triglycerides (B = 0.004, IC 95%:0.002–0.005; p< 0.0001), BMI (B = 0.038, IC 95%: 0.012–0.065; p = 0.005), abdominal circumference (B = 0.013, IC 95%: 0.002–0.25; p = 0.023 and cystatin C (B= 0.875, IC 95%: 0.509–1.241; p < 0.0001) as independent determinants of uric acid levels (model R2= 0.36). In conclusion, in our hypertensive patients serum cystatin C was the main independent predictor of serum uric acid levels. This association, independent of renal function and diuretic and allopurinol treatment, support the relationship of both parameters as cardiovascular risk factors in hypertensive patients.3.980 JCR (2010) Q1, 13/68 Peripheral vascular diseas

Comparison of machine learning algorithms for clinical event prediction (risk of coronary heart disease)

The aim of this study is to compare the utility of several supervised machine learning (ML) algorithms for predicting clinical events in terms of their internal validity and accuracy. The results, which were obtained using two statistical software platforms, were also compared. The data used in this research come from the open database of the Framingham Heart Study, which originated in 1948 in Framingham, Massachusetts as a prospective study of risk factors for cardiovascular disease. Through data mining processes, three data models were elaborated and a comparative methodological study between the different ML algorithms – decision tree, random forest, support vector machines, neural networks, and logistic regression – was carried out. The global selection criterium for choosing the right set of hyperparameters and the type of data manipulation was the area under a curve (AUC). The software tools used to analyze the data were R-Studio® and RapidMiner®. The Framingham study open database contains 4240 observations. The algorithm that yielded the greatest AUC when analyzing the data in R-Studio was neural network applied to a model that excluded all observations in which there was at least one missing value (AUC = 0.71); when analyzing the data in RapidMiner and applying the same model, the best algorithm was support vector machines (AUC = 0.75). ML algorithms can reinforce the diagnostic and prognostic capacity of traditional regression techniques. Differences between the applicability of those algorithms and the results obtained with them were a function of the software platforms used in the data analysis.2019/UEM113.526 JCR (2019) Q2, 32/109 Computer Science, Interdisciplinary Applications, 7/27 Medical Informatics1.140 SJR (2019) Q1, 115/1377 Computer Science Applications, 10/141 Health InformaticsNo data IDR 2019UE