Search Results (17)

Background/Objectives: Helicobacter pylori is a major risk factor for gastric cancer. The incidence and prevalence of the pathogen are increasing worldwide, urging novel approaches to reduce detection turnaround times. H. pylori diagnosis relies on histological examination of gastric biopsies, but interobserver variability considerably impacts its identification. We present an algorithm combining a feature pyramid network and a ResNet architecture for automatic and rapid H. pylori detection in digitized Warthin–Starry-stained gastric biopsies. Methods: Whole-slide images were segmented into manually annotated smaller patches and segments containing stomach tissue were analyzed for the presence of Gram-negative bacteria. Patches classified as positive were examined to confirm the presence/absence of bacteria in contact with the gastric epithelial surface (H. pylori). Results: The algorithm exhibited 0.923 average precision and 0.982 average recall. The conducted efficiency study demonstrated that algorithm utilization significantly decreased (p < 0.001) diagnostic turnaround times for all participants (two pathologists, a pathology resident, a pathology technician, and a biotechnologist), observing an 88.13–91.76% time reduction. Implementation of the algorithm also improved diagnostic accuracy for the resident, technician, and biotechnologist, indicating that the tool remarkably supports less experienced personnel. Conclusions: We believe that the incorporation of our algorithm into pathology workflows will help standardize diagnostic protocols and drastically reduce H. pylori diagnostic turnaround times. Full article

Heart failure is a disease with an increasingly greater prevalence due to the aging population, the development of new drugs, and the organization of healthcare processes. Malnutrition has been identified as a poor prognostic factor in these patients, very often linked to frailty or to other comorbidities, meaning that early diagnosis and treatment are essential. This paper reviews some important aspects of the pathophysiology, detection, and management of malnutrition in patients with heart failure. Full article

Acid mine drainage events have a negative influence on the water quality of fluvial systems affected by coal mining activities. This research focuses on the analysis of these events, revealing hidden correlations among potential factors that contribute to the occurrence of atypical measures and ultimately proposing the basis of an analytical tool capable of automatically capturing the overall behavior of the fluvial system. For this purpose, the hydrological and water quality data collected by an automated station located in a coal mining region in the NW of Spain (Fabero) were analyzed with advanced mathematical methods: statistical Bayesian machine learning (BML) and functional data analysis (FDA). The Bayesian analysis describes a structure fully dedicated to explaining the behavior of the fluvial system and the characterization of the pH, delving into its statistical association with the rest of the variables in the model. FDA allows the definition of several time-dependent correlations between the functional outliers of different variables, namely, the inverse relationship between pH, rainfall, and flow. The results demonstrate that an analytical tool structured around a Bayesian model and functional analysis automatically captures different patterns of the pH in the fluvial system and identifies the underlying anomalies. Full article

Ustekinumab has shown efficacy in Crohn’s Disease (CD) patients. To identify patient profiles of those who benefit the most from this treatment would help to position this drug in the therapeutic paradigm of CD and generate hypotheses for future trials. The objective of this analysis was to determine whether baseline patient characteristics are predictive of remission and the drug durability of ustekinumab, and whether its positioning with respect to prior use of biologics has a significant effect after correcting for disease severity and phenotype at baseline using interpretable machine learning. Patients’ data from SUSTAIN, a retrospective multicenter single-arm cohort study, were used. Disease phenotype, baseline laboratory data, and prior treatment characteristics were documented. Clinical remission was defined as the Harvey Bradshaw Index ≤ 4 and was tracked longitudinally. Drug durability was defined as the time until a patient discontinued treatment. A total of 439 participants from 60 centers were included and a total of 20 baseline covariates considered. Less exposure to previous biologics had a positive effect on remission, even after controlling for baseline disease severity using a non-linear, additive, multivariable model. Additionally, age, body mass index, and fecal calprotectin at baseline were found to be statistically significant as independent negative risk factors for both remission and drug survival, with further risk factors identified for remission. Full article

Aquifers are ubiquitous, and their water is easy to obtain with low extraction costs. On many occasions, these characteristics lead to overexploitation due to important water level declines, reduction of river base flows, enhanced seawater intrusion, and wetland affection. The forecasted increase in water demands and global warming will impact the future availability of water resources. Conjunctive use of surface and subsurface waters can help in mitigating these impacts. There are two main conjunctive use strategies: artificial recharge (AR) and alternate conjunctive use (ACU). AR stores waters that are not to be used directly in aquifers. ACU utilizes groundwater in dry periods, while surface waters are preferred in wet ones; this allows the increase of water supply with lower dam storage, economic gains, and environmental advantages. Efficient conjunctive use can prevent soil salinization and waterlogging problems in semiarid countries due to excessive recharge from irrigation return flows or other origins. Groundwater is a neglected and generally misused resource to maintain environmental conditions. When considering the solution to a water resources problem, groundwater should always be part of the design as an alternative or a complementary resource. Aquifers have large inertia, and changes in their volumes are only noticeable after years of observations. Unfortunately, groundwater observation networks are much poorer than surface ones, something that should be changed if groundwater is to come to the rescue in these times of climate change. Human and material resources should be made available to monitor, control, analyze, and forecast groundwater. Full article

Community-onset bloodstream infections (CO-BSI) caused by gram-negative bacilli are common and associated with significant mortality; those caused by Pseudomonas aeruginosa are associated with worse prognosis and higher rates of inadequateempirical antibiotic treatment. The aims of this study were to describe the characteristics of patients with CO-BSI caused by P. aeruginosa, to identify predictors, and to develop a predictive score for P. aeruginosa CO-BSI. Materials/methods: PROBAC is a prospective cohort including patients >14 years with BSI from 26 Spanish hospitals between October 2016 and May 2017. Patients with monomicrobial P. aeruginosa CO-BSI and monomicrobial Enterobacterales CO-BSI were included. Variables of interest were collected. Independent predictors of Pseudomonas aeruginosa CO-BSI were identified by logistic regression and a prediction score was developed. Results: A total of 78patients with P. aeruginosa CO-BSI and 2572 with Enterobacterales CO-BSI were included. Patients with P. aeruginosa had a median age of 70 years (IQR 60–79), 68.8% were male, median Charlson score was 5 (IQR 3–7), and 30-daymortality was 18.5%. Multivariate analysis identified the following predictors of CO-BSI-PA [adjusted OR (95% CI)]: male gender [1.89 (1.14–3.12)], haematological malignancy [2.45 (1.20–4.99)], obstructive uropathy [2.86 (1.13–3.02)], source of infection other than urinary tract, biliary tract or intra-abdominal [6.69 (4.10–10.92)] and healthcare-associated BSI [1.85 (1.13–3.02)]. Anindex predictive of CO-BSI-PA was developed; scores ≥ 3.5 showed a negative predictive value of 89% and an area under the receiver operator curve (ROC) of 0.66. Conclusions: We did not find a good predictive score of P. aeruginosa CO-BSI due to its relatively low incidence in the overall population. Our model includes variables that are easy to collect in real clinical practice and could be useful to detect patients with very low risk of P. aeruginosa CO-BSI. Full article

Hyperkalaemia is a growing concern in the treatment of patients with heart failure and reduced ejection fraction (HFrEF) as it limits the use of some prognostic-modifying drugs and has a negative impact on prognosis. The objective of the present study was to estimate the prevalence of hyperkalaemia in outpatients with HFrEF and its impact on achieving optimal medical treatment. For this purpose, a multicentre, prospective, and observational study was carried out on consecutive HFrEF patients who were monitored as outpatients in heart failure (HF) units and who, in the opinion of their doctor, received optimal medical treatment. A total of 565 HFrEF patients were included from 16 specialised HF units. The mean age was 66 ± 12 years, 78% were male, 45% had an ischemic cause, 39% had atrial fibrillation, 43% were diabetic, 42% had a glomerular filtration rate < 60 mL/min/1.7 m², and the mean left ventricular ejection fraction was 31 ± 7%. Treatment at the study entry included: 76% on diuretics, 13% on ivabradine, 7% on digoxin, 18.9% on angiotensin-conversing enzyme inhibitors (ACEi), 11.3% on angiotensin receptors blockers (ARBs), 63.8% on angiotensin-neprilysin inhibitors (ARNi), 78.5% on mineralocorticoid receptor antagonists (MRAs), and 92.9% on beta-blockers. Potassium levels in the baseline analysis were: ≤5 mEq/L = 80.5%, 5.1–5.4 mEq/L = 13.8%, 5.5–5.9 mEq/L = 4.6%, and ≥6 mEq/L = 1.06%. Hyperkalaemia was the reason for not prescribing or reaching the target dose of an MRAs in 34.8% and 12.5% of patients, respectively. The impact of hyperkalaemia on not prescribing or dropping below the target dose in relation to ACEi, ARBs, and ARNi was significantly less. In conclusion, hyperkalaemia is a frequent problem in the management of patients with HFrEF and a limiting factor in the optimisation of medical treatment. Full article

The petrographic and petrophysical characteristics of three varieties of ignimbrites used in the architectural heritage of Arequipa (southwest Peru) are analyzed. The modal classification QAFP and TAS diagram discriminate their dacitic nature. Mercury injection porometry revealed very high porosity: 46.5% for white and beige ignimbrites, and 35.5% for the pink variety. Ignimbrites contain intrusions of vulcanodetrital fragments and vacuoles that influence their predominantly non-linear mechanical behavior. The results of water absorption by capillarity (C) and ultrasound pulse velocity (UPV) demonstrate a slight anisotropy for the beige variety and near isotropy for white and pink ignimbrites, which justify the randomness of the application of the ashlars in the masonry and in the selection of the faces to carve. Surfaces with hollows in the white and beige ignimbrites are the result of the erosion of the acicular pumice that fills the vacuoles. Full article

The biomonitoring methods implemented by water authorities are mostly developed for perennial rivers, and do not apply to temporary rivers (TRs). We propose a new classification for TRs to better assess their ecological status. It arises from the LIFE+ TRivers project, which was conducted in the Catalan and the Júcar Mediterranean river basin districts (RBD). The European Water Framework Directive (WFD) provided two systems to set river types (systems A or B from Annex II), which have been officially used by water authorities across Europe to set “national river types” (NRTs). However, essential hydrological variables for TRs are largely omitted. NRTs established according to the WFD were compared with TR categories obtained by using a rainfall-runoff model, “natural flows prescribed regimes” (NFPRs), and with “aquatic phases regimes” (APRs) calculated by using TREHS software. The biological quality indices currently used in Spain, based on macroinvertebrates and diatoms (IBMWP, IMMI-T, and IPS), were compared with a “general degradation” gradient in order to analyze the two TR river classification procedures (NFPR and APR). The results showed that NRTs did not properly classify TRs, and that the APR classification identified ecologically meaningful categories, especially those related to stagnant phases. Four “management temporary river categories” based on APRs are proposed to be used for water managers to properly assess the ecological status of TRs. Full article

Around two percent of asymptomatic women in labor test positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Spain. Families and care providers face childbirth with uncertainty. We determined if SARS-CoV-2 infection at delivery among asymptomatic mothers had different obstetric outcomes compared to negative patients. This was a multicenter prospective study based on universal antenatal screening for SARS-CoV-2 infection. A total of 42 hospitals tested women admitted for delivery using polymerase chain reaction, from March to May 2020. We included positive mothers and a sample of negative mothers asymptomatic throughout the antenatal period, with 6-week postpartum follow-up. Association between SARS-CoV-2 and obstetric outcomes was evaluated by multivariate logistic regression analyses. In total, 174 asymptomatic SARS-CoV-2 positive pregnancies were compared with 430 asymptomatic negative pregnancies. No differences were observed between both groups in key maternal and neonatal outcomes at delivery and follow-up, with the exception of prelabor rupture of membranes at term (adjusted odds ratio 1.88, 95% confidence interval 1.13–3.11; p = 0.015). Asymptomatic SARS-CoV-2 positive mothers have higher odds of prelabor rupture of membranes at term, without an increase in perinatal complications, compared to negative mothers. Pregnant women testing positive for SARS-CoV-2 at admission for delivery should be reassured by their healthcare workers in the absence of symptoms. Full article

It is unclear to which extent the higher mortality associated with hypertension in the coronavirus disease (COVID-19) is due to its increased prevalence among older patients or to specific mechanisms. Cross-sectional, observational, retrospective multicenter study, analyzing 12226 patients who required hospital admission in 150 Spanish centers included in the nationwide SEMI-COVID-19 Network. We compared the clinical characteristics of survivors versus non-survivors. The mean age of the study population was 67.5 ± 16.1 years, 42.6% were women. Overall, 2630 (21.5%) subjects died. The most common comorbidity was hypertension (50.9%) followed by diabetes (19.1%), and atrial fibrillation (11.2%). Multivariate analysis showed that after adjusting for gender (males, OR: 1.5, p = 0.0001), age tertiles (second and third tertiles, OR: 2.0 and 4.7, p = 0.0001), and Charlson Comorbidity Index scores (second and third tertiles, OR: 4.7 and 8.1, p = 0.0001), hypertension was significantly predictive of all-cause mortality when this comorbidity was treated with angiotensin-converting enzyme inhibitors (ACEIs) (OR: 1.6, p = 0.002) or other than renin-angiotensin-aldosterone blockers (OR: 1.3, p = 0.001) or angiotensin II receptor blockers (ARBs) (OR: 1.2, p = 0.035). The preexisting condition of hypertension had an independent prognostic value for all-cause mortality in patients with COVID-19 who required hospitalization. ARBs showed a lower risk of lethality in hypertensive patients than other antihypertensive drugs. Full article

In order to achieve significant improvements in quality, cost, and accessibility (the health “iron triangle”), innovation in organizational and service delivery models is necessary to increase the value of healthcare. The aim of this study is to evaluate the efficiency of a model of organizational innovation based on advanced practice nurse in the care of people with ostomies (APN-O) versus usual care. An observational, exploratory, analytical, prospective study with a six-month follow-up was carried out at 12 hospitals that implemented this model in Andalusia. A total of 75 patients who had undergone a digestive elimination ostomy and/or a urinary ostomy were followed for six months. Clinical outcomes, healthcare resources, health-related quality of life, and willingness to pay (WTP) were analyzed. The economic evaluation was conducted from a societal perspective, including healthcare costs and indirect costs. The cost difference between the two models was €136.99 and the quality-adjusted life year (QALY) gained was 0.05965 (€2297 per QALY gained). At six months, the mean of WTP was €69 per APN-O consultation. This model contributes to increasing the value-based healthcare in ostomies. Results of this study suggested that APN-O is an effective patient management model for improving their health status and is highly efficient. Full article

This study assessed the effect of maternal age on satisfaction at each stage of pregnancy, childbirth and puerperium, and globally. An observational study was carried out in five hospitals of the Andalusian public health system with older primiparous women, from May 2016 to May 2018. Using a pre-piloted questionnaire, information was collected on pregnancy, childbirth, puerperium, newborn variables and degree of satisfaction with the care received. Crude and adjusted mean differences and the standard error of the mean were calculated. A total of 373 women participated. In total, 43.0% of the sample were very satisfied with the care received during pregnancy, and 74.2% with the care received during childbirth. During the puerperium, the highest percentage (60.4%) was found among the women who reported being quite satisfied, although the results were not significant in any of these stages (p > 0.05). No significant differences were established between women’s different age strata and maternal satisfaction. However, the average given by women regarding their satisfaction with the process, on a scale from 0 to 4, was: 3.5 ± 0.5 in general, 3.2 ± 0.8 regarding pregnancy, 3.7 ± 0.5 in childbirth and 3.1 ± 0.6 in the postpartum period. The woman’s satisfaction with the follow up and health care received during pregnancy, childbirth and puerperium is independent of the mother’s age. Full article

Delaying motherhood is becoming increasingly common, raising questions of the possible influence that maternal age may have on newborn health. Therefore, the objective of this study was to determine the association between maternal age and different newborn health parameters. An observational study was conducted in Spain on primiparous women and their infants. Data were collected on newborn health variables, breastfeeding, and different clinical practices that are beneficial for child health and development. Crude and adjusted mean differences were calculated along with the standard error of the mean. A total of 373 women and their children participated. In terms of early commencement skin-to-skin contact, the mean age of women that did skin-to-skin contact was 29.95 ± 0.31 years compared to 31.49 ± 0.66 years in those that did not (p = 0.042). In terms of other newborn parameters, such as preterm birth, health problems or complications, or the need for hospital admission, these were more frequent in the oldest group of mothers, but the differences found were not significant (p > 0.05). Hence, indicators of newborn morbidity were not found to be significantly associated with maternal age; however, beneficial practices such as early commencement skin-to-skin contact were found to be significantly associated with maternal age. Full article