A Simple Methodology for 2D Reconstruction Using a CNN Model

In recent years, Deep Learning research have demonstrated their effectiveness in digital image processing, mainly in areas with heavy computational load. Such is the case of aerial photogrammetry, where the principal objective is to generate a 2D map or a 3D model from a specific terrain. In these topics, high-efficiency in visual information processing is demanded. In this work we present a simple methodology to build an orthomosaic, our proposal is focused in replacing traditional digital imagen processing using instead a Convolutional Neuronal Network (CNN) model. The dataset of aerial images is generated from drone photographs of our university campus. The method described in this article uses a CNN model to detect matching points and RANSAC algorithm to correct feature’s correlation. Experimental results show that feature maps and matching points obtained between pair of images through a CNN are comparable with those obtained in traditional artificial vision algorithms.

Automatic Estrus Cycle Identification System on Female Dogs Based on Deep Learning

Vaginal cytology is a complementary economic method and of simple realization, an indicative to determine in which stage of the estrous cycle the dog is, to achieve a higher fertility and fertility rate. This method is based on determining the type and quantity of cells of the different stages of the estrous cycle, since the hormonal changes that the vaginal mucosa undergoes during the estrous cycle are shown in the morphology of its epithelial cells. The canine female in her reproductive life goes through different phases of activity and hormonal rest that are repeated cyclically. This is called the estrous cycle and consists of 4 stages: proestrus, estrus, diestrus and anestrus. The interpretation of vaginal cytology’s, is a process to which a considerable amount of time is dedicated by its observation in the microscope and the same interpretation by the doctor which can become subjective and poorly performed, causing economic losses for the owners. Therefore, this work proposes an automatic system that will identify six types of cells and the quantity of them in the glass slide, based on a Faster R-CNN to determine in which stage of the estrous cycle the dog is. Our results show an accuracy of 91.6%. The proposed system will improve the efficiency and speed of cytology’s to decreased from 1 h approximately to just a few seconds.

A Novel Set of Moment Invariants for Pattern Recognition Applications Based on Jacobi Polynomials

A novel set of moment invariants for pattern recognition applications, which are based on Jacobi polynomials, are presented. These moment invariants are constructed for digital images by means of a combination with geometric moments, and are invariant in the face of affine geometric transformations such as rotation, translation and scaling, on the image plane. This invariance is tested on a sample of the MPEG-7 CE-Shape-1 dataset. The results presented show that the low-order moment invariants indeed possess low variance between images that are affected by the mentioned geometric transformations.

RISK FACTORS FOR SEVERE POSTOPERATIVE COMPLICATIONS AFTER GASTRECTOMY FOR GASTRIC AND ESOPHAGOGASTRIC JUNCTION CANCERS

BACKGROUND

Gastrectomy is the main treatment for gastric and Siewert type II-III esophagogastric junction (EGJ) cancer. This surgery is associated with significant morbidity. Total morbidity rates vary across different studies and few have evaluated postoperative morbidity according to complication severity.

AIM

To identify the predictors of severe postoperative morbidity.

METHODS

This was a retrospective cohort study from a prospective database. We included patients treated with gastrectomy for gastric or EGJ cancers between January 2012 and December 2016 at a single center. Severe morbidity was defined as Clavien-Dindo score ≥3. A multivariate analysis was performed to identify predictors of severe morbidity.

RESULTS

Two hundred and eighty-nine gastrectomies were performed (67% males, median age: 65 years). Tumor location was EGJ in 14%, upper third of the stomach in 30%, middle third in 26%, and lower third in 28%. In 196 (67%), a total gastrectomy was performed with a D2 lymph node dissection in 85%. Two hundred and eleven patients (79%) underwent an open gastrectomy. T status was T1 in 23% and T3/T4 in 68%. Postoperative mortality was 2.4% and morbidity rate was 41%. Severe morbidity was 11% and was mainly represented by esophagojejunostomy leak (2.4%), duodenal stump leak (2.1%), and respiratory complications (2%). On multivariate analysis, EGJ location and T3/T4 tumors were associated with a higher rate of severe postoperative morbidity.

CONCLUSION

Severe postoperative morbidity after gastrectomy was 11%. Esophagogastric junction tumor location and T3/T4 status are risk factors for severe postoperative morbidity.

[Development of communicative abilities in infants with Down syndrome after systematized training in gestural communication]

INTRODUCTION

Gestural communication, understood as the use of non-verbal gestures before the word appears, is a strength in children with Down syndrome (DS).

OBJECTIVE

To describe com munication development behaviors in children with DS, before and after gestural communication training, based on the "Signs, words and games" workshops of the Baby Signs® program.

SUBJECTS AND METHOD

Prospective study of children with DS between 18 and 22 months of cognitive age, who were trained in gestural communication according to the "Baby Signs®" methodology, evaluating communication skills through the MacArthur inventory adapted for children with DS (Communica tive Development Inventories, CDI-DS), analyzing the scores before and three months after the in tervention. The evaluated items were: Early comprehension, First sentences comprehension, Starting to speak, Vocabulary list, and Decontextualized language use (part 1) and total, early and late gestures (part 2).

RESULTS

21 children completed the workshops, with an average chronological age of 27.5 months and 19.8 months of cognitive age. 29% of the participants increased their scores in sentence comprehension, 62% in vocabulary production with gestures, 33% improved in vocabulary compre hension, 57% lost early gestures, and 43% increased late gestures production.

CONCLUSIONS

Gestural communication training favors the communication skills development in a group of children with DS, mainly in the initial understanding and gesture production. There is important inter-individual variability, therefore is necessary to consider child to child recommendations.

A Single-Nucleotide Polymorphism of αVβ₃ Integrin Is Associated with the Andes Virus Infection Susceptibility

The AndesOrthohantavirus (ANDV), which causes the hantavirus cardiopulmonary syndrome, enters cells via integrins, and a change from leucine to proline at residue 33 in the PSI domain (L33P), impairs ANDV recognition. We assessed the association between this human polymorphism and ANDV infection. We defined susceptible and protective genotypes as “TT” (coding leucine) and “CC” (coding proline), respectively. TT was present at a rate of 89.2% (66/74) among the first cohort of ANDV cases and at 60% (63/105) among exposed close-household contacts, who remained uninfected (p < 0.05). The protective genotype (CC) was absent in all 85 ANDV cases, in both cohorts, and was present at 11.4% of the exposed close-household contacts who remained uninfected. Logistic regression modeling for risk of infection had an OR of 6.2–12.6 (p < 0.05) in the presence of TT and well-known ANDV risk activities. Moreover, an OR of 7.3 was obtained when the TT condition was analyzed for two groups exposed to the same environmental risk. Host genetic background was found to have an important role in ANDV infection susceptibility, in the studied population.

Clinical profile of children with diabetic ketoacidosis in fifteen years of management in a Critical Care Unit

INTRODUCTION

Diabetic ketoacidosis (DKA) is the main cause of morbidity and mortality in children with type 1 diabetes mellitus (T1DM) due to clinical and biochemical alterations associated, cerebral edema as one of the most critical because of the high mortality rates and long-term neurological se quelae.

OBJECTIVE

To analyze the clinical characteristics and complications of patients with DKA ad mitted to a pediatric intensive care unit.

PATIENTS AND METHODS

Retrospective study of DKA patients treated at the Hospital Clínico, Pontificia Universidad Católica de Chile (UPCPUC) between 2000 and 2015. Demographic characteristics, clinical manifestations, biochemical alterations, treatment, complications, and prognosis were assessed. Patients with T1DM onset were compared with those patients already diagnosed with diabetes, analyzing variables according to distribution.

RESULTS

46 DKA events were identified, 67% of them were the first episode of DKA. 66% of patients already diagnosed with diabetes were admitted due to poor adherence to treatment. The main symptoms described were: 63% polydipsia, 56% polyuria, 48% vomiting, 39% weight loss and 35% abdominal pain, and mean blood sugar levels of 522 mg/dL, pH 7.17, and plasma osmolality of 305 mOsm/L. 89% of patients received insulin infusion, and 37% presented hypokalemia. No episodes of cerebral edema or deaths were registered.

CONCLUSIONS

Most of the DKA admissions were due to T1DM onset. In the group of patients already diagnosed with diabetes, the poor adherence to treatment was the main cause of decompensation. There were no serious complications or deaths associated with DKA management during the studied period. Early diagnosis and proper and standardized treatment contributed to reducing morbidity and mortality in children with DKA.

1264. Healthcare-Acquired Influenza in Critical Ill Patients

Background

Healthcare-associated infections (HAIs) increases morbidity and mortality. During 2014, at Hospital Clínico Red de Salud UC CHRISTUS (RS-UCCH), was estimated that 15% of viral respiratory infections were acquired during hospitalization, and influenza was the main etiologic agent. The aim of this study was to obtain clinical characterization of HAIs due to influenza virus in patients hospitalized in critical care units (CCU) and special care units (chronic patients who need hospitalized nurse care).

Methods

Descriptive study of CCU and special care patients with hospital acquired influenza during 2014–2017. HAI due to influenza was defined as: symptoms onset and/or positive influenza PCR ≥48 hours after hospital admission, without previous respiratory symptoms or with negative PCR.

Results

22 patients with median age of 74 years old were identified, only three pediatric cases. The average time of acquired influenza was at 13th day of hospitalization. In 77% Influenza A was the only agent detected and 27% had respiratory co-infection. Thirteen (59%) were previously hospitalized in CCU, but only 2 (15%) due to respiratory problems. Nineteen patients (86%) presented comorbidity such as arterial hypertension (59%), chronic kidney disease (18%), and immunosuppression (18%). Half of them had a decompensation, mainly respiratory, associated to influenza infection. The observed lethality was 18%. Among all the influenza HAI, 59% occurred in unvaccinated patients, although 46% of them met criteria for vaccination recommendation.

Conclusion

HAI due to influenza occurred in chronic, older, and unvaccinated patients. Education about HAIs and continuing high vaccination coverage must be a priority.

Disclosures

All authors: No reported disclosures.

[High frequency of dyslipidemia in children and adolescents with Down Syndrome]

Down Syndrome (DS) shows an increased risk of chronic diseases, associated to higher morbidity and mortality for cardiovascular disease. Some studies have shown a worse lipid profile in children with DS, however, until now there is no recommendation for screening for dyslipidemia in these subjects.

OBJECTIVE

To describe the frequency of dyslipidemia in a population of Chilean children and adolescents with DS.

PATIENTS AND METHOD

Retrospective study, including patients with DS, aged 2 to 18 years, who participated in a special health care program for people with DS in Health Net UC CHRISTUS, between 2007 and 2015. Patients who had a lipid profile between their routine laboratory tests were included. Clinical characteristics, relevant comorbidities, malformations, medications, nutritional status and pubertal development were obtained from medical records. Diagnosis of dyslipidemia was considered according to the criteria of the NHLBI 2011.

RESULTS

The medical records of 218 children with DS were revised, 58,3% had some type of dyslipidemia. The most frequent single dyslipidemias were low HDL Chol (15,1%) and hypertriglyceridemia (12,8%). Atherogenic dyslipidemia (low HDL plus hypertriglyceridemia) was the most frequent combined dyslipidemia (13,3%). The occurrence of atherogenic dyslipidemia was not associated with overnutrition and obesity.

CONCLUSIONS

A high frequency of dyslipidemia was found in Chilean children and adolescents with DS. Our results make us suggest that lipid profile should be performed early in all patients with DS, independent of the presence of risk factors for dyslipidemia.

[Heavy menstrual bleeding affects quality of life in adolescents]

INTRODUCTION

Heavy menstrual bleeding (HMB) occurs in 37% of adolescents and compromise their quality of life.

OBJECTIVE

To measure the magnitude of the impact of the SME on the quality of life in adolescents.

PATIENTS AND METHOD

We interviewed adolescents diagnosed with HMB between 10 and 18 years old and one of their guardians. PedsQL 4.0 generic core scale was applied to measure quality of life, its Proxy PedsQL 4.0 version was applied to the guardian and 3 more questions to adolescents about limitation of daily activities. The concordance between the guardian's perception of the adolescent quality of life and the adolescent's perception was evaluated with the Bland and Altman graph.

RESULTS

46 adolescents and guardians were evaluated. The total average PedsQL 4.0 score for adolescents was 64.48 (SD 14.54), with a range of 18.48 to 88.04 with a greater involvement in the emotional dimension. 50% of adolescents missed school, 80.4% physical education and 65.2% outdoor activities or parties. There was no agreement between the perception of the girls and guar dians.

CONCLUSIONS

We evidence a deterioration in the quality of life of the surveyed adolescents, being the emotional dimension most affected. The performance in the questionnaire was also lower than in samples of chronic diseases published with this same tool.

Ambulatory blood pressure monitoring in school children with a history of extreme prematurity

INTRODUCTION

Extremely premature children have a higher incidence of High Blood Pressure (HBP) and risk of renal damage due to decreased glomerular count with consequent hyperfiltration of the remnants.

OBJECTIVES

To assess the prevalence of altered blood pressure values in outpatient measurement and ambulatory blood pressure monitoring (ABPM) in preterm infants ≤ 32 weeks and/ or ≤ 1,500 g birth weight between 5 and 7 years of age, as well as the presence of early renal damage markers.

PATIENTS AND METHODS

An isolated measurement of blood pressure, ABPM and laboratory tests (microalbuminuria/creatininuria ratio in an isolated urine sample, serum creatinine, blood urea nitrogen and urinalysis) were performed.

RESULTS

30 patients were recruited, of whom valid measu rements of ABPM were obtained in 19 cases, of which nine (47,4%) presented some abnormalities, principally nocturnal day/night difference or DIP absent. No abnormal laboratory tests were found.

DISCUSSION

Our study detected a high prevalence of abnormalities in ABPM principally DIP absence, which has been related to an increased risk of progression to hypertension. The importance of per forming ABPM in the study is emphasized in patients with risk factors for developing hypertension in order to detect early alterations and close management and follow-up.

[Statement of the Advisory Committee on Immunizations of Sociedad Chilena de Infectología about outbreaks of hepatitis A in Chile]

This document represents the position of the Chilean Infectious Diseases Society Advisory Committee on Immunization Practices regarding hepatitis A epidemiological situation in Chile. The recommendations are based on local epidemiological data, the hepatitis A virus infection characteristics and the global experience with the available vaccines. In relation to hepatitis A, Chile is no longer a highly endemic area but actually an intermediate one, currently concentrating cases in individuals over 15 years of age, with frequent outbreaks. In 2017 we have seen an important outbreak of genotype 1A in men who have sex with men (MSM). The current endemic, the presence of regular outbreaks, the frequency of natural disasters in Chile, together with the availability of safe, effective vaccines and local cost-effectiveness studies led us to propose measures for outbreak control for high risk groups protection and mid and long term, including a more definitive solution which is universal vaccination against this disease in small children.

Volume Management by Renal Replacement Therapy in Acute Kidney Injury

Management of fluid balance is one of the basic but vital tasks in the care of critically ill patients. Hypovolemia results in a decrease in cardiac output and tissue perfusion and may lead to progressive multiple organ dysfunction, including the development of acute renal injury (AKI). However, in an effort to reverse pre-renal oliguria, it is not uncommon for patients with established oliguric acute renal failure, particularly when associated with sepsis, to receive excessive fluid resuscitation, leading to fluid overload. In patients with established oliguria, renal replacement therapy may be required to treat hypervolemia. Safe prescription of fluid loss during RRT requires intimate knowledge of the patient's underlying condition, understanding of the process of ultrafiltration and close monitoring of the patient's cardiovascular response to fluid removal. To preserve tissue perfusion in patients with AKI, it is important that RRT be prescribed in a way that optimizes fluid balance by removing fluid without compromising the effective circulating fluid volume. In patients who are clinically fluid overloaded, it is equally important that the amount of fluid removed be as exact as possible. Fluid balance errors can occur as a result of inappropriate prescription, operator error or machine error. Some CRRT machines have potential for significant fluid errors if alarms can be overridden. Threshold values for fluid balance error have been developed which can be used to predict the severity of harm. It is important that RRT education programs emphasize the risk associated with fluid balance errors and with overriding machine alarms.

Fluids for Prevention and Management of Acute Kidney Injury

Fluids are the only known method of attenuating renal injury. Furthermore, whether for hydration, resuscitation or renal replacement therapy, fluid prescriptions must be tailored to the fluid and electrolyte, cardiovascular status and residual renal function of the patient. Different fluids have significantly different effects both on volume expansion as well as on the electrolyte and acid-base balance; while controversial, different fluids may even influence renal function differently. This systematic review focuses on fluids for prevention and management of acute kidney injury. We have reviewed the available evidence and have made recommendations for clinical practice and future studies.

Infant morbidity and mortality attributable to prenatal smoking in Chile

OBJECTIVE

To estimate annual infant morbidity and mortality attributable to prenatal smoking in Chile during 2008-2012.

METHODS

Population-attributable fractions (PAFs) for several infant outcomes were calculated based on previous study estimates of prenatal smoking prevalence and odds ratios associated with exposure (prenatal smoking relative to non-prenatal smoking). Prenatal smoking-attributable infant morbidity and mortality cases were calculated by multiplying the average annual number of morbidity and mortality cases registered in Chile during 2008-2012 by the corresponding PAF.

RESULTS

PAFs for 1) births ≤ 27 weeks; 2) births at 28-33 weeks; 3) births at 34-36 weeks; and 4) full-term low-birth-weight infants were 12.3%, 10.6%, 5.5%, and 27.4% respectively. PAFs for deaths caused by preterm-related causes and deaths caused by sudden infant death syndrome were 11.9% and 40.0% respectively. Annually, 2 054 cases of preterm-birth and full-term low-birth-weight (1 in 9 cases), 68 deaths caused by preterm-related causes (1 in 8 cases), and 26 deaths caused by sudden infant death syndrome (1 in 3 cases) were attributable to prenatal smoking.

CONCLUSIONS

In Chile, infant morbidity and mortality attributable to prenatal smoking are unacceptably high. Comprehensive individual and population-based interventions for tobacco control should be a public health priority in the country, particularly among female adolescents and young women who will be the mothers of future generations.

[Strategies to protect the newborn and infants under 6 months of age against pertussis: Statement of the Advisory Committee for Immunizations of the Chilean Infectious Diseases Society]

In recent years there have been Pertussis outbreaks not seen in the last 50 years affecting adults, adolescents and children and causing deaths in young unvaccinated infants. In Chile an outbreak of Pertussis started in year 2011, leaving 16 infants less than 3 months dead during this year, twice the number seen in a non epidemic year. These children were infected before receiving the programmatic vaccines indicated at 2, 4 and 6 months of age, usually from close contacts, especially their mothers. Pertussis control has not been possible for several reasons, such as limited immunity duration of available vaccines and their poor impact on nasopharyngeal carriage, situation that keeps the agent's circulation and transmission, condition often asymptomatic or unrecognized. Additionally, the use of acellular vaccines appears to be a determining factor because they induce an immune response with poor immune memory and consequently a short time duration. The acellular vaccines with reduced antigen content, available for adolescents and adults, has allowed the evaluation of various strategies but none has succeeded in reducing infant mortality. Recently a new strategy of vaccinating pregnant women against Pertussis in the second or third semester has shown remarkable results reducing up to 90% infant deaths due to Pertussis infection. This strategy prevents mother's infection avoiding child infection through respiratory droplets and also provides the child with antibodies from placental transmission. Improved pertussis vaccines are required, in the meantime the Committee considers that the pregnant immunization strategy, between the 27 and 36 weeks, with acellular pertussis vaccine should be included in our national vaccine program.

[Morbidity profile among adolescents with Down syndrome]

BACKGROUND

There is a paucity of information about morbidity and mortality of adolescents with Down syndrome (DS).

AIM

To describe morbidity and mortality of a cohort of Chilean adolescents with DS.

MATERIAL AND METHODS

Review of electronic clinical records of 67 ambulatory patients with DS aged 10 to 20 years (37 women), seen between the years 2007 and 2014 in outpatient clinics of a University hospital.

RESULTS

The mean age at the last consultation was 13 ± 3 years. Ninety-eight percent of patients had a chronic condition: 37.1% where overweight or obese, 58.2% had a congenital heart disease, 11.9% where being evaluated or had the diagnosis of autism and 44.8% had hypothyroidism. Pubertal development was consistent with chronologic age in 93.7% of patients. In three patients puberty had been suppressed. In women, average age of menarche was 12.2 ± 1.1 years. There were no deaths reported.

CONCLUSIONS

There was a high rate of comorbidities in this group of adolescents with DS, most of them with frequencies comparable to those reported in literature.