Pulmonary embolism (PE) prevalence in Mexican-mestizo patients with severe SARS-COV-2 (COVID-19) pneumonia at a tertiary-level hospital: A review

Since the report of the first case of COVID-19 in Wuhan, China, on December 31, 2019, several associated thrombotic complications have been reported, mainly venous thromboembolic events, and myocardial infarctions, in addition to peripheral arterial thrombosis and cerebral vascular events, which have been attributed to a hypercoagulable state. We aimed to know the prevalence and prognostic biomarkers in patients with pulmonary thromboembolism (PE) and SARS Cov-2 pneumonia. Hospitalized patients with SARS Cov-2 pneumonia who have had clinical, biomarker, and imaging data (chest angiography) of pulmonary thromboembolism were included. Descriptive statistics and prevalence rates were calculated. For the analysis between the groups, the paired Student's t and the Wilcoxon test were performed. CT angiography was performed on 26 patients at our institution, with a diagnosis of severe pneumonia secondary to SARS-CoV2. 9 of the patients (34.6%) had a venous thromboembolic disease. Type 2 DM was the most frequent comorbidity up to 55.5% of the total; it was followed by obesity and overweight in 55.5%, and in third place, by systemic arterial hypertension in 33.3% of the cases, 1 (11.1%) patient had chronic kidney disease and 1 (11.1%) patient with a history of cancer, only 1 patient met criteria and was treated with thrombolysis. 6 (66.6%) of the patients had segmental PE, 3 (33.3%) patients had subsegmental PE, and 4 (44.4%) patients presented pulmonary infarction.

Cost analysis of drug treatment in hypertensive patients at social security health care family medicine units

Objective. To estimate the increase of drug treatment costs associated with predictive factors of hypertensive patients in family medicine units. Materials and methods. A generalized linear model was employed to estimate costs with data from a microcosting costing study for a 1-year time horizon. Sources of dada were medical electronic files, phar­macy records and unitary prices updated to 2019. Results. From a total of 864 patients older than 65 years were 67% and women 65%. Factors with most influence on mean drug treatment costs were diabetes, age and complications associ­ated with hypertension. Mean annual cost of antihypertensive treatment was 61 dollars (CI95% 55,67) and median were 32 dollars (IQR 30,35) per patient. Incremental costs for diabetes were 23 dollars (CI95% 13,33) and 10 dollars (CI95% 8.3,12) in the group of ≥ 65 years. Conclusion. Diabetes, age and complications were the factors with largest influence on hypertension pharmacological costs.

A review of the usefulness of catheter-directed thrombolysis for pulmonary embolism

Venous thromboembolic disease (VTE) is a health problem; around 10 million cases occur yearly with substantial morbidity and mortality. Those who survive may be left with long-term sequelae. Those sequelae might include chronic thromboembolic pulmonary hypertension, persistent right ventricular dysfunction, exercise intolerance, and reduced quality of life. Current PE management consists of anticoagulation alone, systemic thrombolysis, catheter-directed thrombolysis, and surgical embolectomy. The severity of patients with pulmonary embolism (PE) depends on the clinic and not exclusively on the extent of radiological or anatomical involvement. In this review, we present the main clinical and functional characteristics of patients in whom thrombotic fragmentation plus catheter-guided thrombolysis is used to manage acute PE of intermediate-high risk and torpid evolution within the first hours of admission.

Is a Non-Caloric Sweetener-Free Diet Good to Treat Functional Gastrointestinal Disorder Symptoms? A Randomized Controlled Trial

Background: A diet containing non-caloric sweeteners (NCS) could reduce calorie intake; conversely, some animal studies suggest that NCS consumption may increase functional gastrointestinal disorder symptoms (FGDs). This study aimed to compare the effect of consuming a diet containing NCS (c-NCS) versus a non-caloric sweetener-free diet (NCS-f) on FGDs. Methods: We conducted a randomized, controlled, parallel-group study using two different diets for five weeks: the c-NCS diet contained 50−100 mg/day NCS, whereas the NCS-f diet had less than 10 mg/day NCS. At the beginning of the study (PreTx) and at the end (PostTx), we assessed FGDs, dietary intake, and NCS consumption. Results: The percentage of participants with diarrhea (PreTx = 19% vs. PstTx = 56%; p = 0.02), post-prandial discomfort (PreTx = 9% vs. PstTx = 39%; p = 0.02), constipation (PreTx = 30% vs. PostTx = 56%; p < 0.01), and burning (PreTx = 13% vs. PostTx = 33%; p < 0.01) increased in the c-NCS diet group. Conversely, abdominal pain (PreTx = 15% vs. PostTx = 3%; p = 0.04), post-prandial discomfort (PreTx = 26% vs. PostTx = 6%; p = 0.02), burning (PreTx = 15% vs. PostTx = 0%; p = 0.02), early satiety (PreTx = 18% vs. PostTx = 3%; p < 0.01), and epigastric pain (PreTx = 38% vs. PostTx = 3%; p < 0.01) decreased in the NCS-f diet group. Conclusion: A c-NCS diet is associated with increased FGDs, including diarrhea, post-prandial discomfort, constipation, and burning or retrosternal pain. The NCS-f diet also decreased FGDs, as well as abdominal pain, post-prandial discomfort, burning or retrosternal pain, early satiety, and epigastric pain.

Differential fat accumulation in early adulthood according to adolescent-BMI and heavy metal exposure

INTRODUCTION

Heavy metals such as Lead (Pb) and Mercury (Hg) can affect adipose tissue mass and function. Considering the high prevalence of exposure to heavy metals and obesity in Mexico, we aim to examine if exposure to Pb and Hg in adolescence can modify how fat is accumulated in early adulthood.

METHODS

This study included 100 participants from the ELEMENT cohort in Mexico. Adolescent Pb and Hg blood levels were determined at 14-16 years. Age- and sex-specific adolescent BMI Z-scores were calculated. At early adulthood (21-22 years), fat accumulation measurements were performed (abdominal, subcutaneous, visceral, hepatic, and pancreatic fat). Linear regression models with an interaction between adolescent BMI Z-score and Pb or Hg levels were run for each adulthood fat accumulation outcome with normal BMI as reference.

RESULTS

In adolescents with obesity compared to normal BMI, as Pb exposure increased, subcutaneous (p-interaction = 0.088) and visceral (p-interaction < 0.0001) fat accumulation increases. Meanwhile, Hg was associated with subcutaneous (p-interaction = 0.027) and abdominal (p-interaction = 0.022) fat deposition among adolescents with obesity.

CONCLUSIONS

Heavy metal exposure in adolescence may alter how fat is accumulated in later periods of life.

Chronic thromboembolic pulmonary hypertension (CTEPH): a review of another sequel of severe post-Covid-19 pneumonia

The spectrum of pulmonary parenchymal and vascular pathologies related to the COVID-19 have emerged. There is evidence of a specific susceptibility related to thrombotic microangiopathy in situ and a complex immune-inflammatory cascade, especially in the pulmonary vascular bed. The potential to lead to transient or self-correcting sequelae of pulmonary vascular injury will only become apparent with longer-term follow-up. In this review, we aimed to present the findings in a group of patients with severe pneumonia due to covid-19 complicated by acute pe documented by chest angiography, who during a follow-up of more than 3 months with oral anticoagulant met clinical, hemodynamic, and imaging criteria of chronic thromboembolic pulmonary hypertension. We present a brief review of the epidemiology, pathophysiology, clinical findings, comorbidities, treatment, and imaging findings of chronic thromboembolic pulmonary hypertension as a sequel of severe post-covid-19 pneumonia; and compared and discussed these findings with similar reports from the medical literature.

Review of the myelodysplastic syndrome as a cause of group V pulmonary arterial hypertension: an orphan disease in an orphan pulmonary hypertension group

The coexistence of MDS and pulmonary hypertension (PH) is not a common finding and often goes unnoticed because symptoms such as dyspnea can be confused with the underlying pathology. The annual incidence of idiopathic pulmonary arterial hypertension (PAH) is only around 0.2 cases per 100,000 inhabitants, while MDS is 1 to 8 cases per 100,000 inhabitants. This review summarizes the clinical manifestations, functional respiratory tests, hemodynamic parameters using right heart catheterization, and imaging findings using echocardiography and tomography of pulmonary hypertension in myelodysplastic syndrome. We centered our discussion on the diagnosis of these patients within the hematologic disorders, especially in patients with the detriment of the functional class, as we were not used to looking for this diagnosis as a first choice. Several specialties dealing with patients with hematologic disorders (internists, hematologists, family physicians, geriatrics, oncologists) will find helpful the contents of this review.

MRI Visualization and Distribution Patterns of Foreign Modeling Agents: A Brief Pictorial Review for Clinicians

Since the ancient Egyptians, people have always been worried about their physical appearance. Nowadays, for some cultures like Latin American, physical appearance depends on the context, and the concept of beauty is to have wider hips and more prominent buttocks. One way to achieve these goals is to inject foreign modelants that include some oils to modify certain body regions. Until today, the search continues to find a modelling agent that is nonteratogenic, noncarcinogenic, and not susceptible to infection and can stay at the spot where it was injected (not migration). This review is aimed at providing a brief, comprehensive assessment of the use of modeling agents and summarizes some key imaging features of filler-related complications. The topics of this review are historical data, epidemiology, classification of dermal fillers (xenografts, hyaluronic acid derivatives, autografts, homografts, synthetic materials), adverse reactions, imaging method used in the detection of injectable fillers, MRI patterns observed in complications of injectable fillers, and histological findings of immune response, treatment, and conclusions. We present several classifications of injectable fillers based on composition, degradation, and complications. Additionally, readers will find some representative cases of the most common locations of injectable fillers demonstrating their infiltrative MRI patterns.

Pulmonary Thromboendarterectomy in Klinefelter Syndrome. Literature Review

Klinefelter syndrome  is a form of male hypogonadism due to testicular sclerohyalinosis with atrophy and azoospermia, which is the most common cause of male infertility. The syndrome is usually accompanied by metabolic, morphological, and neurobehavioral manifestations; Venous thromboembolic diseases such as deep vein thrombosis and pulmonary embolism. The existence of chronic thromboembolic pulmonary hypertension in patients with Klinefelter syndrome   is scarce in the literature. We present the imaging and genetic analysis of a 37 -year-old male with a history of deep vein thrombosis who was admitted for exertional dyspnea.

High Flow Nasal Cannula Oxygenation Successfully Used as Bridge Therapy for Systemic Thrombolysis in COVID-19 Associated Intermediate-high Risk Pulmonary Embolism

The risk of venous thromboembolism (VTE) in COVID-19 patients is a growing problem. Thromboembolic complications are associated with the infection by SARSCoV-2, with an estimated incidence up to 25%-30% of VTE in patients with severe COVID-19 pneumonia. Here in, we present a case of a patient with severe pneumonia due to COVID-19 who is admitted with mild pneumothorax secondary to COVID-19 and high-intermediate-risk pulmonary embolism (PE), who underwent successfully a highflow nasal cannula (HFNC) oxygenation bridge with subsequent successful half-doses of systemic thrombolysis with intravenous alteplase. Prospective studies are warranted in this subset of patients with intermediate-high and high-risk PE, to further explore HFNC oxygenation with or without diverse reperfusion strategies, with the aim to identify the best individualized therapeutic approach in each patient with significant COVID-19 associated VTE and optimize outcomes.

Global research trends in COVID-19 with MRI and PET/CT: a scoping review with bibliometric and network analyses

Objective

To identify and evaluate the indexed studies that allow us to understand the implications of imaging studies in MRI and PET/CT related to COVID-19 research.

Methods

Scoping review. Articles in PubMed, Scopus, and Web of Science (WoS) were scanned from 2019 to 2021 with COVID-19, MRI, and PET-CT as keywords. EndNote software and manual checking removed the duplicated references. Our assessment includes citation, bibliometric, keyword network, and statistical analyses using descriptive statistics and correlations. Highlighted variables were publication year, country, journals, and authorship.

Results

Only 326 papers were included. The most cited article reached 669 cites; this number represented 21.71% of 3081 citations. The top-15 cited authors received 1787 citations, which represented 58% of the total cites. These authors had affiliations from ten countries (Belgium, China, France, Italy, Japan, Spain, Sweden, Turkey, United Kingdom (UK), and the USA). The top-30 journals were cited 2762 times, representing 89.65% of the total cites. Only five journals were cited more than 100 times; Int J Infect Dis had the most significant number of citations (674). Some of the unexpected keywords were encephalitis, stroke, microbleeds, myocarditis.

Conclusion

COVID-19 pandemic is still spreading worldwide, and the knowledge about its different facets continues advancing. MRI and PET/CT are being used in more than 50% of the selected studies; research trends span seven categories, no only the diagnostic but others like socio-economic impact and pathogenesis Developed countries had an advantage by having hospitals with more resources, including MRI and PET/CT facilities in the same institution to supplement basic assessment in patients with COVID-19.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40336-021-00460-x.

Comparison between Mexican and International Medical Graduates’ scores in the ENARM Competing for Clinical Specialities in Mexico during 2012-2019: Data Visualization, Trends and Forecasting Analyses

Objectives: Because there is heterogeneity in the ENARM scores obtained between Mexicans and International medical graduates (IMG) in the eight clinical specialities with direct-entry (Anesthesiology, and Emergency Medicine. Geriatrics, Internal Medicine, Medical Genetics, Pediatrics, Pneumology, Psychiatry), we aimed to evaluate those scores. We hypothesized that Mexican test-takers achieve higher scores than IMG with significant growth trends in their exam scores. Methods: This study was cross-sectional, used historical data from the annual public report of the ENARM for eight years (2012 to 2019). We compare the minimum (MinSco) and maximum (MaxSco) scores of each speciality using ANOVA. Mexican versus IMG scores were evaluated with an independent student t-test, trends with Spearman’s correlation coefficient, and a 5-years forecasting trend. Results: There was a significant difference among the MinSco for five surgical specialities; F (7, 115) = 26.611, p = < .001; the global mean of MinSco was 69.133; specialities above this mean were Internal Medicine, Anesthesiology, Pediatrics, and Pneumology. The global mean for MaxSco was 79.422; five specialities were above: Internal Medicine, Pneumology, Geriatrics, Psychiatry, and Medical Genetics. We did not find a significant difference in the MinSco between Mexicans and IMG, but a significant difference was found in the MaxSco between both groups. Conclusions: ENARM represents a market of high-performance test-takers across the clinical specialities. Mexicans and IMG achieved similar entrance scores, but Mexicans showed a higher MaxSco over IMG in all clinical specialities.

Imaging Assessment of the Postoperative Spine: An Updated Pictorial Review of Selected Complications

Imaging of the postoperative spine requires the identification of several critical points by the radiologist to be written in the medical report: condition of the underlying cortical and cancellous bone, intervertebral disc, and musculoskeletal tissues; location and integrity of surgical implants; evaluation of the success of decompression procedures; delineation of fusion status; and identification of complications. This article presents a pictorial narrative review of the most common findings observed in noninstrumented and instrumented postoperative spines. Complications in the noninstrumented spine were grouped in early (hematomas, pseudomeningocele, and postoperative spine infection) and late findings (arachnoiditis, radiculitis, recurrent disc herniation, spinal stenosis, and textiloma). Complications in the instrumented spine were also sorted in early (hardware fractures) and late findings (adjacent segment disease, hardware loosening, and implant migration). This review also includes a short description of the most used diagnostic techniques in postoperative spine imaging: plain radiography, ultrasound (US), computed tomography (CT), magnetic resonance (MR), and nuclear medicine. Imaging of the postoperative spine remained a challenging task in the early identification of complications and abnormal healing process. It is crucial to consider the advantages and disadvantages of the imaging modalities to choose those that provide more accurate spinal status information during the follow-up. Our review is directed to all health professionals dealing with the assessment and care of the postoperative spine.

Correlation between Chest X-Ray Severity in COVID-19 and Age in Mexican-Mestizo Patients: An Observational Cross-Sectional Study

Introduction

Chest X-ray (CXR) is used for the initial triage of patients with suspected COVID-19. Studies of CXR scoring in the European population found a higher score in males than in females and significantly correlated with age. Because there have not been studies in the Mexican-mestizo community, we aimed to compare the differences in CXR scores between males and females and their correlation with age after controlling comorbidities like diabetes and hypertension.

Materials and Methods

A retrospective study of 1000 CXR of Mexican-mestizo patients with SARS-CoV-2 infection, confirmed by RT-PCR. Significant differences between age, age groups, symptoms, comorbidities, and CXR scores between males and females used the Mann-Whitney U, Chi-square tests (χ ²), and Kruskal-Wallis tests. The relationship between the total CXR score and age was measured with the Spearman rank correlation coefficient (Rs); partial correlation analysis controlled the effect of symptoms, risk factors, and comorbidities.

Results

The total CXR score did not show a difference between males and females grouped by age. There was a positive, low correlation between the total CXR score and age in males, Rs = 0.260, p < 0.001 (N = 616), and in females, Rs = 0.170, p = 0.001 (N = 384). Age only explained a <9% variance of CXR severity. Rs decreased its magnitude (from Rs = 0.152 to Rs = 0.046) and lost its significance (change in p value from p < 0.001 to p = 0.145) after controlling the effect of hypertension.

Conclusions

There is no significant difference in CXR score between males and females in the Mexican-mestizo population grouped by age. Hypertension cancels the significance of CXR severity with age pointing to its role in the pathophysiology of COVID-19. Further research using stratified groups by age and gender in other populations needs to be published.

Free Area of the Spinal Canal and Torg's Ratio in Acute Cervical Trauma and Degenerative Disease: MANCOVA and Correlational Analyses

BACKGROUND

The two of the most common indications for magnetic resonance (MR) imaging of the cervical spine include acute spine trauma and degenerative disease.

OBJECTIVE

We aimed to correlate the measurements of the free area of the spinal canal (FASC), a new approach to the cervical spinal canal compromise, with the Torg´s ratio quantification of the cervical spine.

METHODS

A cross-sectional study including 50 cervical-spine MR evaluations of patients with acute cervical trauma or degenerative disease was performed. We used multivariate analysis of covariance (MANCOVA) to identify the type of lesion, intervertebral level and gender differences between FASC and Torg´s ratio quantification of the cervical spine; age was the controlled covariate. Correlates between FASC and Torg´s ratio were obtained at each intervertebral level.

RESULTS

There was a non-significant interaction between the type of lesion, gender and intervertebral levels between FASC and Torg´s ratio measurements, F (8, 456) 0.260, p = .978; Wilks' Lambda 0.991; with a small effect size (partial η² = .005). Among the main effects, only the gender was statistically significant: F (2, 228) = 3.682, p = .027. The age (controlled covariate) was non-significantly related to FASC and Torg´s ratio quantification: F (2, 228) = .098, p = .907. The Pearson´s correlation coefficient depicted a poor, non-significant agreement between FASC and Torg´s ratio.

CONCLUSION

FASC provides an integrative evaluation of the cervical spinal canal compromise in acute, cervical spine trauma and degenerative disease. Further observations and correlation with specific neurological symptoms, surgical findings and clinical outcomes are necessary to assess the usefulness of FASC in clinical settings.

Radial diffusivity is the best global biomarker able to discriminate healthy elders, mild cognitive impairment, and Alzheimer's disease: A diagnostic study of DTI-derived data

Introduction

For the past two decades, diffusion tensor imaging (DTI)-derived metrics allowed the characterization of Alzheimer's disease (AzD). Previous studies reported only a few parameters (most commonly fractional anisotropy, mean diffusivity, and axial and radial diffusivities measured at selected regions). We aimed to assess the diagnostic performance of 11 DTI-derived tensor metrics by using a global approach.

Materials and Methods

A prospective study performed in 34 subjects: 12 healthy elders, 11 mild cognitive impairment (MCI) patients, and 11 patients with AzD. Postprocessing of DTI magnetic resonance imaging allowed the calculation of 11 tensor metrics. Anisotropies included fractional (FA), and relative (RA). Diffusivities considered simple isotropic diffusion (p), simple anisotropic diffusion (q), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD). Tensors included the diffusion tensor total magnitude (L); and the linear (Cl), planar (Cp), and spherical tensors (Cs). We performed a multivariate discriminant analysis and diagnostic tests assessment.

Results

RD was the only variable selected to assemble a predictive model: Wilks' λ = 0.581, χ² (2) = 14.673, P = 0.001. The model's overall accuracy was 64.5%, with areas under the curve of 0.81, 0.73 and 0.66 to diagnose AzD, MCI, and healthy brains, respectively.

Conclusions

Global DTI-derived RD alone can discriminate between healthy elders, MCI, and AzD patients. Although this study proves evidence of a potential biomarker, it does not provide clinical guidance yet. Additional studies comparing DTI metrics might determine their usefulness to monitor disease progression, measure outcome in drug trials, and even perform the screening of pre-AzD subjects.

CT FINDINGS OF AN ENDO-ORBITAL OSTEOMA PRODUCING PROPTOSIS AND THE OPTIC NERVE’S COMPRESSION

Osteoma is a benign bone tumour, with an incidence of 2% of all orbital tumours. Osteomas located in orbit remain asymptomatic until they reach a size that originates mass effect signs such as exophthalmos, diplopia, and unilateral blindness. Materials and methods. In this case, a male patient presented to the emergency room with progressive proptosis, worsening headaches, and swelling of the left anterior periorbital and frontal sinus region one year after the beginning of the symptoms. Results. Imaging studies revealed a hyperdense mass in the left orbital floor displacing the left globe superiorly and anteriorly with the optic nerve’s compression. Conclusion. Osteoma may represent an emergency in the long term when left untreated; it may destruct the eye due to direct pressure on the optic nerve and disturbance of the ocular blood supply.

Portopulmonary Hypertension: Prevalence, Clinical and Hemodynamic Features

Portopulmonary hypertension (PoPH) is a vascular complication of portal hypertension. This study aims to identify the prevalence and analyzing the clinical and hemodynamic features of patients with PoPH from a cohort of pulmonary arterial hypertension (PAH) patients. A retrospective transversal descriptive and analytical study. Patients with PoPH taken from a PAH cohort. We compare with those reported in the literature. We found prevalence of 6.1% of 244 consecutive patients with PAH, 11 females and 4 males. The mean age was 62 years and the main etiology of portal hypertension was primary biliary cirrhosis. Statistical differences were found in mean pulmonary arterial pressure, pulmonary vascular resistance, right atrial pressure; we found levels lower than reported. We found significant differences in clinical and hemodynamic characteristics such as older age and hemodynamic parameters of less severity in the group of patients analyzed compared with reported data.

Comparison between Mexican and International Medical Graduates' scores obtained in the ENARM competing for surgical specialties in Mexico during 2012-2019: data visualization, trend and forecasting analyses

Introduction

We aimed to compare the performance at the Examen Nacional de Aspirantes a Residencias Médicas (ENARM) of the five direct-entry surgical specialties, and between Mexicans and International medical graduates (IMG).

Methods

This study was cross-sectional, used historical data from the annual public report of the ENARM during 8 years (2012-2019). We compare the minimum (MinSco) and maximum (MaxSco) scores of each specialty using ANOVA. Mexican versus IMG scores were evaluated with independent student t-test, trends with Spearman's correlation coefficient and a 5-years forecasting trend.

Results

There was a significant difference among the MinSco for five surgical specialties; F (4, 78) = 24.586, p ≤ 0.001; the global mean of MinSco was 72.572; specialties above this mean were ophthalmology, otorhinolaryngology, and general surgery. The global mean for MaxSco was 81.559, two specialties were above: ophthalmology, and general surgery. We did not find a significant difference in the MinSco between Mexicans and IMG, but significance was found in the MaxSco between both groups.

Conclusions

ENARM represents a market of high-performance test-takers across the surgical specialties. Mexicans and IMG achieved similar entrance scores, but Mexicans showed a higher MaxSco over IMG in all surgical specialties.

Quantitative systematic review: Methods used for the in vivo measurement of body composition in pregnancy

AIMS

Because of the increased overall prevalence of pre-pregnancy obesity among racial-ethnic groups, we conducted a review of published methods for body composition measurement during pregnancy considering at present there is no consensus on the best practices and type of study design that researchers should use for this purpose.

DESIGN

Quantitative systematic review.

DATA SOURCES

PubMed, EMBASE, Scopus, Web of Science, and Virtual Library of Health. Search dates from 1997-2016.

REVIEW METHODS

Search of articles indexed in selected databases from 1997-2016. Studies were published in English, Spanish, and Portuguese. Graphs were carried out using data visualization software.

RESULTS

From the 112 included studies, 70 were prospective cohorts, 30 cross-sectional studies, 10 randomized controlled trial, and two retrospective studies. Cross-sectional studies and randomized controlled trial depicted a positive correlation with significant trend.

CONCLUSIONS

Although several methods for body composition measurement exist, only bioelectrical impedance analysis, displacement plethysmography, and displacement plethysmography show a significant growing trend. Use of data visualization allows understanding various associations among categorical variables, with a graphical display of their multidimensional behaviour.

IMPACT

Public and private health-care institution evaluating pregnancy women. Health-care personnel, including nursing professional, dealing with measurements of body composition during pregnancy will find reading this manuscript beneficial.

Breast Prosthesis Syndrome: Pathophysiology and Management Algorithm

The cosmetic use of devices like prostheses to increase breast volume is nothing new. It is calculated that millions of people have been exposed to silicone in several ways, including breast implants, and since 1964 there has been uncertainty regarding their safety. We did not find in the literature any studies that reported the appearance of a specific immunological disease in patients with silicone breast implants. Furthermore, there are also neither case-control studies nor reports of patients proving that symptoms of autoimmune/inflammatory syndrome induced by adjuvants (ASIA) occurred after the placement of silicone implants nor that the patients had pre-existing symptoms. Several studies link silicone to allergic reactions and the development of systemic autoimmune diseases; however, other studies deny this association. There are currently several theories about the effect of silicone on the body. One theory with greater acceptance proposes an adjuvant effect of silicone on the development of autoimmune diseases in genetically predisposed patients. However, the variety of symptoms occurring in patients who develop these pathologies leads to doubts about the relationship between the adjuvant effects of a silicone prosthesis may have with a specific autoimmune disease or a mix of these diseases. The lack of consensus on this topic obliges a full review of what has already been reported in the literature to integrate the knowledge and propose a focus for new research on this matter. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Correlations between DTI-derived metrics and MRS metabolites in tumour regions of glioblastoma: a pilot study

Introduction

Specific correlations among diffusion tensor imaging (DTI)-derived metrics and magnetic resonance spectroscopy (MRS) metabolite ratios in brains with glioblastoma are still not completely understood.

Patients and methods

We made retrospective cohort study. MRS ratios (choline-to-N-acetyl aspartate [Cho/NAA], lipids and lactate to creatine [LL/Cr], and myo-inositol/creatine [mI/Cr]) were correlated with eleven DTI biomarkers: mean diffusivity (MD), fractional anisotropy (FA), pure isotropic diffusion (p), pure anisotropic diffusion (q), the total magnitude of the diffusion tensor (L), linear tensor (Cl), planar tensor (Cp), spherical tensor (Cs), relative anisotropy (RA), axial diffusivity (AD) and radial diffusivity (RD) at the same regions: enhanced rim, peritumoral oedema and normal-appearing white matter. Correlational analyses of 546 MRS and DTI measurements used Spearman coefficient.

Results

At the enhancing rim we found four significant correlations: FA ⇔ LL/Cr, Rs = -.364, p = .034; Cp ⇔ LL/Cr, Rs = .362, p = .035; q ⇔ LL/Cr, Rs = -.349, p = .035; RA ⇔ LL/Cr, Rs = -.357, p = .038. Another ten pairs of significant correlations were found in the peritumoral edema: AD ⇔ LL/Cr, AD ⇔ mI/Cr, MD ⇔ LL/Cr, MD ⇔ mI/Cr, p ⇔ LL/Cr, p ⇔ mI/ Cr, RD ⇔ mI/Cr, RD ⇔ mI/Cr, L ⇔ LL/Cr, L ⇔ mI/Cr.

Conclusions

DTI and MRS biomarkers answer different questions; peritumoral oedema represents the biggest challenge with at least ten significant correlations between DTI and MRS that need additional studies. The fact that DTI and MRS measures are not specific of one histologic type of tumour broadens their application to a wider variety of intracranial pathologies.

Reference Percentiles and Changes over Time for Total Thyroxine in Preterm Infants: A Retrospective Cohort Study

Hypothyroxinemia of prematurity increases the rate of false-positive results in total thyroxine (tT4)-based screening programs for congenital hypothyroidism. The use of specific cutoff values for preterm infants has been proposed, but data on tT4 reference ranges in this population are limited. The primary aim was to establish reference percentiles for tT4 in dried blood spots among Mexican preterm infants. Secondary aims included a comparison of the change of tT4 concentrations over time according to gestational age and to discuss its impact on tT4-based screening programs. This was a retrospective cohort study; 1561 preterm infants were included. Percentile 10th for tT4 concentration at 24-27, 28-30, 31-34, and 35-36 weeks of gestational age, measured in the first week of life was: 47.6, 56.6, 82.3, and 117.1 nmol/L, respectively. tT4 concentrations were compared in three different time points: first week of life, 2-3 weeks of life, and term-corrected gestational age (38 weeks of gestation), progressively increased in infants below 30 weeks, remained stable in infants from 31 to 34 weeks, and decreased in late preterm newborns (35-36 weeks). This study suggests that preterm infants may require the use of lower tT4 cutoff values in newborn screening.

Overweight and obesity status from the prenatal period to adolescence and its association with non-alcoholic fatty liver disease in young adults: cohort study

OBJECTIVE

To examine the associations of maternal and child overweight status across multiple time-points with liver fat content in the offspring during young adulthood.

DESIGN

Cohort study.

SETTING

ELEMENT Cohort in Mexico City.

POPULATION

Pregnant women with singleton births (n = 97).

METHODS

We quantified hepatic triglyceride content (liver fat content) by proton magnetic resonance spectroscopy (1H MRS) and conventional T2-weighted MRIs (3T scanner) in 97 young adults from the ELEMENT birth cohort in Mexico City. Historical records of the cohort were used as a source of pregnancy, and childhood and adolescence anthropometric information, overweight and obesity (OWOB) were defined. Adjusted structural equation models were run to identify the association between OWOB in different life stages with liver fat content (log-transformed) in young adulthood.

MAIN OUTCOME

Maternal OWOB at the time of delivery was directly and indirectly associated with the liver fat content in the offspring at young adulthood.

RESULTS

Seventeen percent of the participants were classified as having NAFLD. We found a strong association of OWOB between all periods assessed. Maternal OWOB at time of delivery (β = 1.97, 95% CI 1.28-3.05), and OWOB status in the offspring at young adulthood (β = 3.17, 95% CI 2.10-4.77) were directly associated with the liver fat content in the offspring. Also, maternal OWOB was indirectly associated with liver fat content through offspring OWOB status.

CONCLUSION

We found that maternal OWOB status is related to fatty liver content in the offspring as young adults, even after taking into account OWOB status and lifestyle factors in the offspring.

TWEETABLE ABSTRACT

There was an association between pre-pregnancy overweight and the development of NAFLD in adult offspring.

Clinical Significance of Fractional Anisotropy Measured in Peritumoral Edema as a Biomarker of Overall Survival in Glioblastoma: Evidence Using Correspondence Analysis

Introduction

Fractional anisotropy (FA), a diffusion tensor image (DTI) derived biomarker is related to invasion, infiltration, and extension of glioblastoma (GB). We aimed to evaluate FA values and their association with intervals of overall survival (OS).

Materials and Methods

Retrospective study conducted in 36 patients with GB included 23 (63.9%) males, 46 ± 14 y; and 13 (36.1%) females, 53 ± 13; followed up for 36 months. We measured FA at edema, enhancing rim, and necrosis. We created two categorical variables using levels of FA and intervals of OS to evaluate their relationships. Kaplan-Meier method and correspondence analysis evaluated the association between OS (grouped in 7 six-month intervals) and FA measurements.

Results

Median FA values were higher in healthy brain regions (0.351), followed by peritumoral edema (0.190), enhancing ring (0.116), and necrosis (0.071). Pair-wise comparisons among tumor regions showed a significant difference, P < 0.001. The median OS for all patients was 19.3 months; variations in the OS curves among subgroups was significant χ² (3) = 8.48, P = 0.037. Correspondence analysis showed a significant association between FA values in the edema region and the survival intervals χ² (18) = 30.996, P = 0.029.

Conclusions

Alternative multivariate assessment using correspondence analysis might supplement the traditional survival analysis in patients with GB. A close follow-up of the variability of FA in the peritumoral edema region is predictive of the OS within specific six-month interval subgroup. Further studies should focus on predictive models combining surgical and DTI biomarkers.

Imaging methods used in the assessment of environmental disease networks: a brief review for clinicians

Background

Across the globe, diseases secondary to environmental exposures have been described, and it was also found that existing diseases have been modified by exposure to environmental chemicals or an environmental factor that has been found in their pathogenesis. The Institute of Medicine has shared a permanent concern related to the nations environmental health capacity since 1988.

Main body

Contemporary imaging methods in the last 15 years started reporting alterations in different human systems such as the central nervous system, cardiovascular system and pulmonary system among others; evidence suggests the existence of a human environmental disease network. The primary anatomic regions, affected by environmental diseases, recently assessed with imaging methods include Brain (lead exposure, cerebral stroke, pesticide neurotoxicity), uses MRI, DTI, carotid ultrasonography and MRS; Lungs (smoke inhalation, organophosphates poisoning) are mainly assessed with radiography; Gastrointestinal system (chronic inflammatory bowel disease), recent studies have reported the use of aortic ultrasound; Heart (myocardial infarction), its link to environmental diseased has been proved with carotid ultrasound; and Arteries (artery hypertension), the impairment of aortic mechanical properties has been revealed with the use of aortic and brachial ultrasound.

Conclusions

Environmental epidemiology has revealed that several organs and systems in the human body are targets of air pollutants. Current imaging methods that can assess the deleterious effects of pollutants includes a whole spectrum: radiography, US, CT and MRI. Future studies will help to reveal additional links among environmental disease networks.

Mexican ENARM: performance comparison of public vs. private medical schools, geographic and socioeconomic regions

OBJECTIVE

This study aimed to compare the performance in the National Assessment for Applicants for Medical Resi- dency (ENARM in spanish) of private versus public medical schools, geographic regions and socioeconomic levels by using three different statistical methods (summary measurements, the rate of change and the area under the receiver operator characteristics [AUROC]). These methods have not been previously used for the ENARM; however, some variations of the summary measurements have been reported in some USA assessments of medical school graduates.

MATERIALS AND METHODS

Cross-sectional study based on historical data (2001-2017). We use summary measures and colourfilled map. The statistical analysis included Mann-Whitney U, Kruskal-Wallis, Spearman correlation coefficient (Rs), and linear regression.

RESULTS

A total of 113 medical schools were included in our analysis; 60 were public and 53 private. We found difference in the median of total scores for type of schools, MD= 54.07 vs. MD= 57.36, p= 0.011. There were also significant differences among geographic and socioeconomic regions (p<0.05).

CONCLUSIONS

Differences exist in the total scores and percentage of selected test-takers between type of schools, geographic and socioeconomic regions. Higher scores are prevalent in the Northeast and Norwest regions. Additional research is required to identify factors that contribute to these differences. Unsuspected differences in examination scores can be unveiled using summary measures.

Alternative bibliometrics from the web of knowledge surpasses the impact factor in a 2-year ahead annual citation calculation: Linear mixed-design models' analysis of neuroscience journals

CONTEXT

The decision about which journal to choose for the publication of research deserves further investigation.

AIMS

In this study, we evaluate the predictive ability of seven bibliometrics in the Web of Knowledge to calculate total cites over a 7-year period in neuroscience journals.

SETTINGS AND DESIGN

Coincidental bibliometrics appearing during 2007, 2008, 2009, 2010, and 2011, along with their corresponding cites in 2009, 2010, 2011, 2012, and 2013, were recorded from the journal citation reports (JCR) Science Edition. This was a retrospective study.

MATERIALS AND METHODS

This was a bibliographic research using data from the Web of Knowledge in the neuroscience category.

STATISTICAL ANALYSIS USED

A linear-mixed effects design using random slopes and intercepts was performed on 275 journals in the neuroscience category.

RESULTS

We found that Eigenfactor score, cited half-life, immediacy index, and number of articles are significant predictors of 2-year-ahead total cites (P ≤ 0.010 for all variables). The impact factor, 5-year impact factor, and article influence score were not significant predictors; the global effect size was significant (R2= 0.999; P < 0.001) with a total variance of 99.9%.

CONCLUSIONS

An integrative model using a set of several metrics could represent a new standard to assess the influence and importance of scientific journals, and may simultaneously help researchers to rank journals in their decision-making during the manuscript submission phase.

Metabolic Score for Visceral Fat (METS-VF), a novel estimator of intra-abdominal fat content and cardio-metabolic health

BACKGROUND & AIMS

Intra-abdominal and visceral fat (VAT) are risk factors for the development of cardio-metabolic comorbidities; however its clinical assessment is limited by technology and required expertise for its assessment. We aimed to develop a novel score (METS-VF) to estimate VAT by combining the non-insulin-based METS-IR index, waist-height ratio (WHtr), age and sex.

METHODS

We developed METS-VF in a sample of 366 individuals with Dual X-ray absorptiometry (DXA). METS-VF was modeled using non-linear regression and validated in two replication cohorts with DXA (n = 184, with n = 118 who also had MRI) and bio-electrical impedance (n = 991). We also assessed METS-VF to predict incident type 2 diabetes (T2D) and arterial hypertension independent of body-mass index (BMI) in our Metabolic Syndrome Cohort (n = 6144).

RESULTS

We defined METS-VF as: 4.466 + 0.011*(Ln(METS-IR))³ + 3.239*(Ln(WHtr))³ + 0.319*(Sex) + 0.594*(Ln(Age)). METS-VF showed better performance compared to other VAT surrogates using either DXA (AUC 0.896 95% CI 0.847-0.945) or MRI (AUC 0.842 95% CI 0.771-0.913) as gold standards. We identified a METS-VF cut-off point >7.18 in healthy patients which has 100% sensitivity (95% CI 76.8-100) and 87.2% specificity (95% CI 79.1-93.0) to identify increased VAT (>100 cm²). METS-VF also had adequate performance in subjects with metabolically-healthy obesity. Finally, in our metabolic syndrome cohort, subjects in the upper quintiles of METS-VF (>7.2) had 3.8 and 2.0-fold higher risk of incident T2D and hypertension, respectively (p < 0.001). This effect was independent of BMI for both outcomes.

CONCLUSION

METS-VF is a novel surrogate to estimate VAT, which has better performance compared to other surrogate VAT indexes and is predictive of incident T2D and hypertension. METS-VF could be a useful tool to assess cardio-metabolic risk in primary care practice and research settings.

Pre-operative apparent diffusion coefficient values and tumour region volumes as prognostic biomarkers in glioblastoma: correlation and progression-free survival analyses

Objectives

Glioblastoma (GB) contains diverse histologic regions. Apparent diffusion coefficient (ADC) values are surrogates for the degree of number of cells within the tumour regions. Because an assessment of ADC values and volumes within tumour sub-compartments of GB is missing in the literature, we aimed to evaluate these associations.

Methods

A retrospective cohort of 48 patients with GB underwent segmentation to calculate tumour region volumes (in cubic centimetre) and ADC values in tumour regions: normal tissue, enhancing tumour, proximal oedema, distal oedema, and necrosis. Correlation, Kaplan-Meier, and Cox hazard regression analyses were performed.

Results

We found a statistically significant difference among ADC values for tumour regions: F (4, 220) = 166.71 and p ≤ .001 and tumour region volumes (necrosis, enhancing tumour, peritumoural oedema): F (2, 141) = 136.3 and p ≤ .001. Post hoc comparisons indicated that the only significantly different mean score was the peritumoural volume in oedema region (p < .001). We observed a positive significant correlation between ADC of distal oedema and peritumoural volume, r = .418, df = 34, and p = .011. Cox proportional hazards regression analysis considering only tumour region volumes provided an almost significant model: − 2 log-likelihood = 146.066, χ² (4) = 9.303, and p = .054 with a trend towards significance of the hazard function: p = .067 and HR = 1.077 for the non-enhancing tumour volume.

Conclusions

ADC values together with volumes of oedema region might have a role as predictors of progression-free survival (PFS) in patients with GB; we recommend a routine MRI assessment with the calculation of these biomarkers in GB.

Dietary Sources of Fructose and Its Association with Fatty Liver in Mexican Young Adults

Fructose intake has been associated with non-alcoholic fatty liver disease (NAFLD). The objective of this study was to assess the consumption of dietary fructose according to: 1) classification of hepatic steatosis by two indexes and 2) diagnosis of NAFLD by MRI. We conducted a cross-sectional analysis among 100 young adults from Mexico City. The Hepatic Steatosis Index (HSI) and the Fatty Liver Index (FLI) were estimated using Body Mass Index (BMI), waist circumference, and fasting concentrations of glucose, triglycerides, and hepatic enzymes (ALT, AST, GGT). A semi-quantitative food frequency questionnaire was administered to obtain dietary sources of fructose. We estimated the concordance between the hepatic indices and NAFLD and the correlation between the index scores and the percentage of liver fat. Eighteen percent presented NAFLD; 44% and 46% were classified with hepatic steatosis according to HSI and FLI, respectively. We compared dietary intake of fructose by each outcome: HSI, FLI, and NAFLD. Sugar-sweetened beverages (SSB) and juices were consumed significantly more by those with steatosis by FLI and NAFLD suggesting that SSB intake is linked to metabolic alterations that predict the risk of having NAFLD at a young age.