Fractal diagnosis of left heart ventriculograms Fractal geometry of ventriculogram during cardiac dynamics

ANTECEDENTES Y OBJETIVOS: la geometría fractal permite describir y caracterizar los objetos irregulares, lo que resulta adecuado para medir estructuras del cuerpo humano. El propósito de este trabajo es caracterizar el ventrículo izquierdo durante la dinámica cardiaca con dimensiones fractales para desarrollar un diagnóstico matemático objetivo y reproducible de la ventriculografía izquierda. MÉTODO: este es un estudio de concordancia diagnóstica donde se calcularon las dimensiones fractales del ventrículo en sístole, en diástole y en un total de 36 ventriculogramas evaluados como normales, y anormales en leves, moderados y severos de acuerdo con la fracción de eyección según el diagnóstico clínico convencional; posteriormente se determinaron los grados de similitud de las dimensiones fractales entre los tres objetos componentes. RESULTADOS: los grados de similitud estuvieron entre 1 y 9.000, y al organizar estos valores en conjuntos, se encontró una progresión a partir de los normales hasta los anormales severos. Se establecieron los grados de similitud característicos que permiten diferenciar normalidad de enfermedad y evolución entre éstas, evidenciando que la clasificación de la clínica convencional presenta dificultades al evaluar de forma precisa y objetiva la evolución de un ventriculograma hacia la normalidad o la enfermedad. CONCLUSIONES: se desarrolló una nueva metodología diagnóstica objetiva y reproducible de aplicación clínica basada en evaluaciones geométricas independiente de la clasificación clínica.BACKGROUND AND OBJECTIVES: fractal geometry allows to describe and characterize irregular objects, which is appropriate for measuring human body structures. The purpose of this study is to characterize the left ventricle during cardiac dynamics by means of fractal dimensions to develop an objective, mathematical and reproducible diagnosis of left ventriculography.METHOD: this is a diagnostic concordance study in which we calculated the fractal dimensions of the ventricle in systole, in diastole and in a total of 36 ventriculograms evaluated as normal, mild, moderate and severe according to the ejection fraction in accordance with the conventional clinical diagnosis ; subsequently, the degree of similarity of the fractal dimensions between the three components were determined. RESULTS: the degrees of similarity were between 1 and 9,000, and when arranging these values into sets, there was a progression from normal to severe. We established the characteristic degrees of similarity that allow to distinguish normality from disease and the evolution between them, showing that the conventional clinical classification presents difficulties to assess accurately and objectively the evolution of a ventriculogram towards normality or disease. CONCLUSIONS: we developed a new objective and reproducible diagnostic methodology of clinical application based on geometric assessments that is independent from the clinical classification

Equity, diversity, and inclusion at the Global Alliance for Genomics and Health

A lack of diversity in genomics for health continues to hinder equitable leadership and access to precision medicine approaches for underrepresented populations. To avoid perpetuating biases within the genomics workforce and genomic data collection practices, equity, diversity, and inclusion (EDI) must be addressed. This paper documents the journey taken by the Global Alliance for Genomics and Health (a genomics-based standard-setting and policy-framing organization) to create a more equitable, diverse, and inclusive environment for its standards and members. Initial steps include the creation of two groups: the Equity, Diversity, and Inclusion Advisory Group and the Regulatory and Ethics Diversity Group. Following a framework that we call "Reflected in our Teams, Reflected in our Standards," both groups address EDI at different stages in their policy development process. [Abstract copyright: © 2023 The Author(s).

Molecular, microbiological and clinical characterization of Clostridium difficile isolates from tertiary care hospitals in Colombia

In Colombia, the epidemiology and circulating genotypes of Clostridium difficile have not yet been described. Therefore, we molecularly characterized clinical isolates of C.difficile from patients with suspicion of C.difficile infection (CDI) in three tertiary care hospitals. C.difficile was isolated from stool samples by culture, the presence of A/B toxins were detected by enzyme immunoassay, cytotoxicity was tested by cell culture and the antimicrobial susceptibility determined. After DNA extraction, tcdA, tcdB and binary toxin (CDTa/CDTb) genes were detected by PCR, and PCR-ribotyping performed. From a total of 913 stool samples collected during 2013–2014, 775 were included in the study. The frequency of A/B toxins-positive samples was 9.7% (75/775). A total of 143 isolates of C.difficile were recovered from culture, 110 (76.9%) produced cytotoxic effect in cell culture, 100 (69.9%) were tcdA+/tcdB+, 11 (7.7%) tcdA-/tcdB+, 32 (22.4%) tcdA-/tcdB- and 25 (17.5%) CDTa+/CDTb+. From 37 ribotypes identified, ribotypes 591 (20%), 106 (9%) and 002 (7.9%) were the most prevalent; only one isolate corresponded to ribotype 027, four to ribotype 078 and four were new ribotypes (794,795, 804,805). All isolates were susceptible to vancomycin and metronidazole, while 85% and 7.7% were resistant to clindamycin and moxifloxacin, respectively. By multivariate analysis, significant risk factors associated to CDI were, staying in orthopedic service, exposure to third-generation cephalosporins and staying in an ICU before CDI symptoms; moreover, steroids showed to be a protector factor. These results revealed new C. difficile ribotypes and a high diversity profile circulating in Colombia different from those reported in America and European countries

Croton schiedeanus Schltd prevents experimental hypertension in rats induced by nitric oxide deficit

Croton schiedeanus Schltd (N.V.: "almizclillo") is a plant used in traditional medicine as an antihypertensive in Colombia. It contains flavonoid, diterpenoid and fenilbutanoid metabolites that have vasodilatation effects linked to the NO/cGMP pathway. This work aimed to assess the capacity of a 96% EtOH extract to prevent the hypertension induced by nitric oxide (NO) deficiency in rats. The NO synthase inhibitor L-NAME (10 mg/kg/d, i.p) was administered during five weeks to three groups of rats (6-7 animals): C. Schiedeanus (200 mg/kg/d, p.o), enalapril (reference, 10 mg/kg/d, p.o) and vehicle (control: olive oil 1 ml/kg/d, p.o). In addition, the blank group received only vehicle. The arterial blood pressure (BP) and heart rate (HR) were measured daily for six weeks. After sacrificing the animals, the aortic rings were isolated, contraction was triggered with phenylephrine (PE 10-6 M) and relaxant responses were achieved with cumulative concentrations of acetylcholine (ACh, 10-10 - 10-4 M). L-NAME increased the systolic arterial pressure in the control group, attaining mean values of 131 mm Hg at week 5, whereas the C. schiedeanus, enalapril and blank groups maintained blood pressure under 100 mm Hg. The capacity of PE to contract aortic rings was greater in the C. schiedeanus, enalapril and blank groups than in the control group (2157, 2005, 1910 and 1646 mg, respectively). The pEC50 values for ACh were as follows: C. Schiedeanus (6.89) >enalapril (6.39) > blank (5.68) > control (5.09). These results give support to C. Schiedeanus as a natural antihypertensive source

RICORS2040 : The need for collaborative research in chronic kidney disease

Chronic kidney disease (CKD) is a silent and poorly known killer. The current concept of CKD is relatively young and uptake by the public, physicians and health authorities is not widespread. Physicians still confuse CKD with chronic kidney insufficiency or failure. For the wider public and health authorities, CKD evokes kidney replacement therapy (KRT). In Spain, the prevalence of KRT is 0.13%. Thus health authorities may consider CKD a non-issue: very few persons eventually need KRT and, for those in whom kidneys fail, the problem is 'solved' by dialysis or kidney transplantation. However, KRT is the tip of the iceberg in the burden of CKD. The main burden of CKD is accelerated ageing and premature death. The cut-off points for kidney function and kidney damage indexes that define CKD also mark an increased risk for all-cause premature death. CKD is the most prevalent risk factor for lethal coronavirus disease 2019 (COVID-19) and the factor that most increases the risk of death in COVID-19, after old age. Men and women undergoing KRT still have an annual mortality that is 10- to 100-fold higher than similar-age peers, and life expectancy is shortened by ~40 years for young persons on dialysis and by 15 years for young persons with a functioning kidney graft. CKD is expected to become the fifth greatest global cause of death by 2040 and the second greatest cause of death in Spain before the end of the century, a time when one in four Spaniards will have CKD. However, by 2022, CKD will become the only top-15 global predicted cause of death that is not supported by a dedicated well-funded Centres for Biomedical Research (CIBER) network structure in Spain. Realizing the underestimation of the CKD burden of disease by health authorities, the Decade of the Kidney initiative for 2020-2030 was launched by the American Association of Kidney Patients and the European Kidney Health Alliance. Leading Spanish kidney researchers grouped in the kidney collaborative research network Red de Investigación Renal have now applied for the Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS) call for collaborative research in Spain with the support of the Spanish Society of Nephrology, Federación Nacional de Asociaciones para la Lucha Contra las Enfermedades del Riñón and ONT: RICORS2040 aims to prevent the dire predictions for the global 2040 burden of CKD from becoming true

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

A multi-country test of brief reappraisal interventions on emotions during the COVID-19 pandemic.

The COVID-19 pandemic has increased negative emotions and decreased positive emotions globally. Left unchecked, these emotional changes might have a wide array of adverse impacts. To reduce negative emotions and increase positive emotions, we tested the effectiveness of reappraisal, an emotion-regulation strategy that modifies how one thinks about a situation. Participants from 87 countries and regions (n = 21,644) were randomly assigned to one of two brief reappraisal interventions (reconstrual or repurposing) or one of two control conditions (active or passive). Results revealed that both reappraisal interventions (vesus both control conditions) consistently reduced negative emotions and increased positive emotions across different measures. Reconstrual and repurposing interventions had similar effects. Importantly, planned exploratory analyses indicated that reappraisal interventions did not reduce intentions to practice preventive health behaviours. The findings demonstrate the viability of creating scalable, low-cost interventions for use around the world

Theoretic-Information Entropies Analysis of Nanostructures: Ab Initio Study of PAMAM Precursors and Dendrimers G0 to G3

International audienceInformation Theory (IT) in conjugated and in Hilbert spaces is employed to analyze the growing behavior of nanostructures. Shannon entropies in position and momentum spaces require costly and time-consuming computations as the size of the molecules increases in contrast with information entropies in Hilbert space, which are shown to be highly advantageous for analyzing large molecules. In this work, ab initio electronic structure calculations at the HF, MP2 and B3LYP levels of theory were performed to analyse the initial steps towards growing nanostructured molecules of Polyamidoamine (PAMAM) dendrimers, starting from the monomers, dimers, trimers, tetramers up to generations G0 (with 84 atoms), G1 (228 atoms), G2 (516 atoms), and G3 (1092 atoms). This is achieved by using selected physical descriptors such as the radius of gyration, the asphericity factor, the moments of inertia, the dipole moments, the total energies and chemical reactivity indices such as the hardness, softness and the electrophilicity index at the HF/3-21G* level of theory. For the chemical indices, higher level calculations at the B3LYP/6-311++G** and MP2/6-311+G* levels were also performed in order to account for the effects of electron correlation. Information-theoretic measures of the Shannon type in conjugated space are employed to characterize the G0-PAMAM precursors and G0. Hilbert space entropies of the Shannon and Kullback type are employed to provide theoretic-information evidence of the validity of the dense-core model of PAMAM precursors and dendrimers G0 through G3

Application of the theory of probability and dynamic systems in the evaluation of cardiac dynamics: Study of diagnostic agreement

In the present work a new methodology was applied, to evaluate the cardiac status in 16 hours, in continuous electrocardiographic records and Holter, this by means of the theory of probability, and the occupation of spaces from attractors in the general space of Box-Counting, of recent development. 20 normal and 80 pathological records were analyzed, according to the conventional diagnosis. A simulation of the totality of the dynamics was made, taking into account the number of beats, and their maximum and minimum frequencies per hour, during 21 hours. With these data the attractors were built in a phase space. The calculation of the fractal dimension of the attractors was made from the evaluation of the spatial occupation of each one of them and through probability of occupation in the Box-Counting space, establishing its diagnosis with previous mathematical results. Finally, taking the conventional diagnosis as Goldstandard, this and the mathematical result were compared. In the states of normality, the probability of occupation values of the attractors was between 0.157 and 0.286, while for the pathological states, it was 0.019 and 0.141, thereby differentiating the normal and pathological states.Introducción. -- Metodología. -- Aspectos éticos. -- Resultados. -- Discusión. -- Conclusiones. -- Agradecimientos. -- Referencias.https://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0000343870https://orcid.org/[email protected]