Cardiovascular magnetic resonance findings in a pediatric population with isolated left ventricular non-compaction

<p>Abstract</p> <p>Background</p> <p>Isolated Left Ventricular Non-compaction (LVNC) is an uncommon disorder characterized by the presence of increased trabeculations and deep intertrabecular recesses. In adults, it has been found that Ejection Fraction (EF) decreases significantly as non-compaction severity increases. In children however, there are a few data describing the relation between anatomical characteristics of LVNC and ventricular function. We aimed to find correlations between morphological features and ventricular performance in children and young adolescents with LVNC using Cardiovascular Magnetic Resonance (CMR).</p> <p>Methods</p> <p>15 children with LVNC (10 males, mean age 9.7 y.o., range 0.6 - 17 y.o.), underwent a CMR scan. Different morphological measures such as the Compacted Myocardial Mass (CMM), Non-Compaction (NC) to the Compaction (C) distance ratio, Compacted Myocardial Area (CMA) and Non-Compacted Myocardial Area (NCMA), distribution of NC, and the assessment of ventricular wall motion abnormalities were performed to investigate correlations with ventricular performance. EF was considered normal over 53%.</p> <p>Results</p> <p>The distribution of non-compaction in children was similar to published adult data with a predilection for apical, mid-inferior and mid-lateral segments. Five patients had systolic dysfunction with decreased EF. The number of affected segments was the strongest predictor of systolic dysfunction, all five patients had greater than 9 affected segments. Basal segments were less commonly affected but they were affected only in these five severe cases.</p> <p>Conclusion</p> <p>The segmental pattern of involvement of non-compaction in children is similar to that seen in adults. Systolic dysfunction in children is closely related to the number of affected segments.</p

Naproxen chemoprevention induces proliferation of cytotoxic lymphocytes in Lynch Syndrome colorectal mucosa

BackgroundRecent clinical trial data from Lynch Syndrome (LS) carriers demonstrated that naproxen administered for 6-months is a safe primary chemoprevention that promotes activation of different resident immune cell types without increasing lymphoid cellularity. While intriguing, the precise immune cell types enriched by naproxen remained unanswered. Here, we have utilized cutting-edge technology to elucidate the immune cell types activated by naproxen in mucosal tissue of LS patients.MethodsNormal colorectal mucosa samples (pre- and post-treatment) from a subset of patients enrolled in the randomized and placebo-controlled ‘Naproxen Study’ were obtained and subjected to a tissue microarray for image mass cytometry (IMC) analysis. IMC data was processed using tissue segmentation and functional markers to ascertain cell type abundance. Computational outputs were then used to quantitatively compare immune cell abundance in pre- and post-naproxen specimens.ResultsUsing data-driven exploration, unsupervised clustering identified four populations of immune cell types with statistically significant changes between treatment and control groups. These four populations collectively describe a unique cell population of proliferating lymphocytes within mucosal samples from LS patients exposed to naproxen.ConclusionsOur findings show that daily exposure of naproxen promotes T-cell proliferation in the colonic mucosa, which paves way for developing combination of immunoprevention strategies including naproxen for LS patients

Prediction of Opioid-Induced Respiratory Depression on Inpatient Wards Using Continuous Capnography and Oximetry: An International Prospective, Observational Trial.

BACKGROUND: Opioid-related adverse events are a serious problem in hospitalized patients. Little is known about patients who are likely to experience opioid-induced respiratory depression events on the general care floor and may benefit from improved monitoring and early intervention. The trial objective was to derive and validate a risk prediction tool for respiratory depression in patients receiving opioids, as detected by continuous pulse oximetry and capnography monitoring. METHODS: PRediction of Opioid-induced respiratory Depression In patients monitored by capnoGraphY (PRODIGY) was a prospective, observational trial of blinded continuous capnography and oximetry conducted at 16 sites in the United States, Europe, and Asia. Vital signs were intermittently monitored per standard of care. A total of 1335 patients receiving parenteral opioids and continuously monitored on the general care floor were included in the analysis. A respiratory depression episode was defined as respiratory rate ≤5 breaths/min (bpm), oxygen saturation ≤85%, or end-tidal carbon dioxide ≤15 or ≥60 mm Hg for ≥3 minutes; apnea episode lasting \u3e30 seconds; or any respiratory opioid-related adverse event. A risk prediction tool was derived using a multivariable logistic regression model of 46 a priori defined risk factors with stepwise selection and was internally validated by bootstrapping. RESULTS: One or more respiratory depression episodes were detected in 614 (46%) of 1335 general care floor patients (43% male; mean age, 58 ± 14 years) continuously monitored for a median of 24 hours (interquartile range [IQR], 17-26). A multivariable respiratory depression prediction model with area under the curve of 0.740 was developed using 5 independent variables: age ≥60 (in decades), sex, opioid naivety, sleep disorders, and chronic heart failure. The PRODIGY risk prediction tool showed significant separation between patients with and without respiratory depression (P \u3c .001) and an odds ratio of 6.07 (95% confidence interval [CI], 4.44-8.30; P \u3c .001) between the high- and low-risk groups. Compared to patients without respiratory depression episodes, mean hospital length of stay was 3 days longer in patients with ≥1 respiratory depression episode (10.5 ± 10.8 vs 7.7 ± 7.8 days; P \u3c .0001) identified using continuous oximetry and capnography monitoring. CONCLUSIONS: A PRODIGY risk prediction model, derived from continuous oximetry and capnography, accurately predicts respiratory depression episodes in patients receiving opioids on the general care floor. Implementation of the PRODIGY score to determine the need for continuous monitoring may be a first step to reduce the incidence and consequences of respiratory compromise in patients receiving opioids on the general care floor

APPROACH AND TREATMENT OF SUICIDAL BEHAVIOR IN THE CLINICAL PRACTICE OF DIFFERENT GROUPS OF HEALTH PROFESSIONALS IN SPAIN: RESULTS OF THE PROJECT EUREGENA.

According to the WHO (World Health Organization) and the European Union, suicide is considered to be a health problem of prime importance and to be one of the principal causes of unnatural death. In Spain, the number of suicides has increased 12% since 2005 . The Research Project “European Regions Enforcing Actions against Suicide (EUREGENAS), funded by the Health Program 2008-2013, has as main objective the description of an integrated model of Mental Health orientated to the prevention of suicide. The differences that allow distinguishing the meaning of prevention in suicide behavior are described and explained through a qualitative methodological strategy and through the creation of discussion groups formed by different groups of health professionals. The results highlight the existing differences between the diverse health professionals who come more in contact with this problem and it shows as well the coincidence of meaning that suicide has to be considered as a priority in the field of health

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

4to. Congreso Internacional de Ciencia, Tecnología e Innovación para la Sociedad. Memoria académica

Este volumen acoge la memoria académica de la Cuarta edición del Congreso Internacional de Ciencia, Tecnología e Innovación para la Sociedad, CITIS 2017, desarrollado entre el 29 de noviembre y el 1 de diciembre de 2017 y organizado por la Universidad Politécnica Salesiana (UPS) en su sede de Guayaquil. El Congreso ofreció un espacio para la presentación, difusión e intercambio de importantes investigaciones nacionales e internacionales ante la comunidad universitaria que se dio cita en el encuentro. El uso de herramientas tecnológicas para la gestión de los trabajos de investigación como la plataforma Open Conference Systems y la web de presentación del Congreso http://citis.blog.ups.edu.ec/, hicieron de CITIS 2017 un verdadero referente entre los congresos que se desarrollaron en el país. La preocupación de nuestra Universidad, de presentar espacios que ayuden a generar nuevos y mejores cambios en la dimensión humana y social de nuestro entorno, hace que se persiga en cada edición del evento la presentación de trabajos con calidad creciente en cuanto a su producción científica. Quienes estuvimos al frente de la organización, dejamos plasmado en estas memorias académicas el intenso y prolífico trabajo de los días de realización del Congreso Internacional de Ciencia, Tecnología e Innovación para la Sociedad al alcance de todos y todas

Estudio de seguimiento a 5 años de las tentativas autolíticas atendidas en el área sanitaria del Vallés Occidental este : comparación de las características psicopatológicas con los suicidios consumados /

Premi Extraordinari de Doctorat concedit pels programes de doctorat de la UAB per curs acadèmic 2016-2017Introducción: A menudo se asume que las tentativas de suicidio y los suicidios consumados representan el mismo grupo de individuos pero evaluados en diferentes momentos de la "carrera" suicida. Sin embargo, existen indicios de que se trata de dos poblaciones diferenciadas. Esto implica que las estrategias preventivas más centradas en los intentos de suicidio, podrían no ser suficientes para prevenir el suicidio consumado. Por otro lado, sabemos que solo una proporción pequeña de aquellas personas que presentan tentativas acabaran consumando el suicidio. El tipificar mejor la población de personas que presentan riesgo de suicidio permitiría iniciar estrategias preventivas más eficaces. Objetivos: Comparar las características sociodemográficas y clínicas entre una población que ha realizado intentos de suicidio y otra de suicidios consumados, y el seguimiento de las conductas suicidas durante un periodo de 5 años para identificar mejor a la población con mayor riesgo de reintentar o consumar el suicidio. Metodología: Se seleccionaron todos los casos de tentativas autolíticas atendidas en el servicio de urgencias del Hospital Parc Taulí de Sabadell durante un año natural. La información se obtuvo a partir de la información registrada en la historia clínica hospitalaria, de primaria y de los informes clínicos de urgencias. También, se evaluaron todos los suicidios consumados durante un periodo de 3 años, recabando la información facilitada por el forense. Para la realización de la segunda parte del proyecto se mantuvo el registro de todas las tentativas autolíticas atendidas en el servicio de urgencias y de todos los suicidios consumados cometidos desde el 1 de enero de 2008 hasta el 31 de diciembre de 2012. Dentro del programa E17D (European Alliance Against Depression) del que nuestro hospital forma parte, y como medida preventiva para evitar los reintentos, se realizó un seguimiento telefónico durante 1 año a todas las personas atendidas en urgencias tras realizar una tentativa autolítica, con la finalidad de mejorar la atención a esta población de riesgo y reducir la probabilidad de recurrencia. Resultados: Los factores de riesgo para el suicidio consumado fueron el sexo masculino, una mayor edad, la inactividad laboral, estar viudo y vivir solo, el diagnóstico de trastorno depresivo mayor, y el consumo de alcohol. A pesar de presentar un perfil de mayor gravedad social y clínica, los sujetos que consumaron el suicidio no recibieron tan frecuentemente seguimiento por los servicios de Salud Mental. En cuanto el seguimiento a 5 años, se observó que una menor edad, los trastornos de personalidad y por abuso o dependencia a alcohol son factores de riesgo para repetir la tentativa, mientras que los problemas de alcohol y una mayor edad lo son para acabar consumando el suicidio. Además el programa de seguimiento telefónico fue útil para reducir los reintentos el primer año y el riesgo de consumar el suicidio, aunque la mayoría de los casos de suicidio consumado no pudieron incluirse en el programa. Es decir, la mayoría de los suicidios se produjeron al primer intento, limitando así la función preventiva del programa para el suicidio consumado. Conclusiones: Los suicidios consumados y los intentos de suicidio parecen ser dos poblaciones suicidas diferentes. Las personas que mueren por suicidio tienen un contacto mayor con los servicios de atención primaria, lo que debe ser considerado a la hora de poner en marcha medidas preventivas. La atención de los trastornos depresivos y por consumo de alcohol deben ser una prioridad para reducir las tasas de suicidio consumado. La actuación sobre las personas que han realizado tentativas es una importante estrategia preventiva que reduce los reintentos pero las estrategias preventivas no deben limitarse únicamente a esta población de riesgo.Introduction: Suicide attempts and completed suicides are often assumed to represent the same group of individuals but are assessed at different points in the suicidal "career". However, there are indications that these are two distinct populations. This implies that preventive strategies more focused on attempted suicides may not be sufficient to prevent completed suicide. On the other hand, we know that only a small proportion of those who have attempted will complete suicide. Better characterization of the population of persons at risk of suicide would allow more effective preventive strategies to be initiated. Objectives: To compare sociodemographic and clinical characteristics between a population of suicide attempts and another of completed suicides, and to follow up the suicide attempts during a period of 5 years to better identify the population at greater risk of re-attempting or consuming suicide. Methodology: All suicide attempts attended at the emergency unit of the Parc Taulí Hospital in Sabadell during a calendar year were selected. The information was obtained from the information recorded in the hospital history, primary and emergency clinical reports. We also evaluated all completed suicides over a period of 3 years, and also obtained information provided by the coroner. In order to carry out the second part of the project, all the suicide attempts attended in the emergency department and all completed suicides committed until December 31, 2012, were registered. In the context of the EAAD (European Alliance Against Depression) program, that our hospital is part of, and as a preventive measure to avoid reattempts, a telephone follow-up is carried out for 1 year to all persons attended in the emergency room after making a suicide attempt. Results: The risk factors for consummate suicide were male sex, older age, job inactivity, being widowed and living alone, diagnosis of major depressive disorder, and alcohol consumption. Despite presenting a profile of greater social and clinical severity, subjects who completed suicide were not as frequently followed up by Mental Health services. As for the 5-year follow-up, it was observed that lower age, personality disorders and alcohol abuse or dependence are risk factors to repeat the attempt, while alcohol problems and an older age are risk factors to complete suicide. In addition, the telephone follow-up program was useful in reducing the risk of suicide, but most suicides were not part of the program. That is, most of the suicides occurred on the first attempt, thus limiting the preventive function of the programme. Conclusions: Consummate suicides and suicide attempts appear to be two different suicidal populations. People who die from suicide have greater contact with primary care services, which should be considered when implementing preventive measures. Attention to depressive disorders and alcohol consumption should be a priority to reduce rates of consummate suicide. Action on people who have attempted suicide is an important preventive strategy but these strategies should not be limited to this population at risk

An Exploratory Analysis on the 2D:4D Digit Ratio and Its Relationship with Social Responsiveness in Adults with Prader-Willi Syndrome

Prader-Willi syndrome (PWS) is a genetic disorder produced by a lack of expression of paternally derived genes in the 15q11-13 region. Research has generally focused on its genetic and behavioral expression, but only a few studies have examined epigenetic influences. Prenatal testosterone or the maternal testosterone-to-estradiol ratio (MaTtEr) has been suggested to play an important role in the development of the 'social brain' during pregnancy. Some studies propose the 2D:4D digit ratio of the hand as an indirect MaTtEr measure. The relationship between social performance and MaTtEr has been studied in other neurodevelopmental conditions such as Autism Spectrum Disorder (ASD), but to our best knowledge, it has never been studied in PWS. Therefore, our study aims to clarify the possible existence of a relationship between social performance-as measured using the Social Responsiveness Scale (SRS)-and MaTtEr levels using the 2D:4D ratio. We found that, as a group, PWS individuals have shorter index and ring fingers than the control group, but no significant difference in the 2D:4D ratios. The 2D:4D ratio showed a correlation only with Restricted Interests and Repetitive Behavior Subscale, where a positive correlation only for male individuals with PWS was found. Considering only PWS with previous GH treatment during childhood/adolescence (PWS-GH), index and ring fingers did not show differences in length with the control group, but the 2D:4D ratio was significantly higher in the right or dominant hand compared to controls