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Cardiovascular Assessment Tool for Breast Cancer Survivors and Oncology Providers: Usability Study
(2021)
Kathryn E Weaver
;
Heidi D Klepin
;
Brian J Wells
;
Emily V Dressler
;
Karen M Winkfield
<jats:sec> <jats:title>Background</jats:title> <jats:p>Cardiovascular health is of increasing concern to breast cancer survivors and their health care providers, as many survivors are more likely to die from cardiovascular disease than cancer. Implementing clinical decision support tools to address cardiovascular risk factor awareness in the oncology setting may enhance survivors’ attainment or maintenance of cardiovascular health.</jats:p> </jats:sec> <jats:sec> <jats:title>Objective</jats:title> <jats:p>We sought to evaluate survivors’ awareness of cardiovascular risk factors and examine the usability of a novel electronic health record enabled cardiovascular health tool from the perspective of both breast cancer survivors and oncology providers.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Breast cancer survivors (n=49) recruited from a survivorship clinic interacted with the cardiovascular health tool and completed pre and posttool assessments about cardiovascular health knowledge and perceptions of the tool. Oncologists, physician assistants, and nurse practitioners (n=20) who provide care to survivors also viewed the cardiovascular health tool and completed assessments of perceived usability and acceptability.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Enrolled breast cancer survivors (84% White race, 4% Hispanic ethnicity) had been diagnosed 10.8 years ago (SD 6.0) with American Joint Committee on Cancer stage 0, I, or II (45/49, 92%). Prior to viewing the tool, 65% of survivors (32/49) reported not knowing their level for one or more cardiovascular health factors (range 0-4). On average, only 45% (range 0%-86%) of survivors’ known cardiovascular health factors were at an ideal level. More than 50% of survivors had ideal smoking status (45/48, 94%) or blood glucose level (29/45, 64%); meanwhile, less than 50% had ideal blood pressure (12/49, 24%), body mass index (12/49, 24%), cholesterol level (17/35, 49%), diet (7/49, 14%), and physical activity (10/49. 20%). More than 90% of survivors thought the tool was easy to understand (46/47, 98%), improved their understanding (43/47, 91%), and was helpful (45/47, 96%); overall, 94% (44/47 survivors) liked the tool. A majority of survivors (44/47, 94%) thought oncologists should discuss cardiovascular health during survivorship care. Most (12/20, 60%) oncology providers (female: 12/20, 60%; physicians: 14/20, 70%) had been practicing for more than 5 years. Most providers agreed the tool provided useful information (18/20, 90%), would help their effectiveness (18/20, 90%), was easy to use (20/20, 100%), and presented information in a useful format (19/20, 95%); and 85% of providers (17/20) reported they would use the tool most or all of the time when providing survivorship care.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>These usability data demonstrate acceptability of a cardiovascular health clinical decision support tool in oncology practices. Oncology providers and breast cancer survivors would likely value the integration of such apps in survivorship care. By increasing awareness and communication regarding cardiovascular health, electronic health record–enabled tools may improve survivorship care delivery for breast cancer and ultimately patient outcomes.</jats:p> </jats:sec>
10Scopus© Citations 10
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Parámetros hematológicos y biomarcadores predictores de gravedad en Síndrome Inflamatorio Pediátrico Multisistémico asociado a SARS-CoV-2
(2021)
Patricia Verdugo
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Patricia Álvarez
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Patricia Aroca
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Vicente Enrique Montes-nogales
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POLI HARLOWE, MARIA CECILIA BERTA
<jats:p>El síndrome inflamatorio multisistémico pediátrico asociado a SARS-CoV-2 (MIS-C) se caracteriza por un estado hiperinflamatorio producto de una tormenta de citoquinas, evidenciado en alteraciones del laboratorio hematológico y proteínas de fase aguda.Objetivo: Describir las características clínicas y de laboratorio de pacientes hospitalizados por MIS-C e identificar marcadores predictores de gravedad.Pacientes y Método: Estudio retrospectivo de 32 pacientes. El grupo se dividió en crítico y no crítico según presentación clínica y tipo de terapia utilizada. En ellos se estudiaron aspectos clínicos y de laboratorio que incluyeron hemograma completo, pruebas de coagulación y biomarcadores. Resultados: 18/32 hombres, mediana de edad 6,8 años. Las manifestaciones más frecuentes fueron cardiovasculares (84,3%), digestivas (84%) y mucocutáneas (59%). El grupo de los críticos incluyó 15 pacientes, 12 hombres con mediana de edad de 8,9 años y los no críticos 17 pacientes; 6 hombres, con mediana de edad de 5,4 años. Los parámetros de laboratorio al ingreso en el grupo global mostraron aumento de la proteína C reactiva, dímero-D, leucocitos, neutrófilos, ferritina y fibrinógeno. La albúmina y la natremia en cambio se encontraban disminuidas. El grupo crítico se caracterizó por tener al ingreso: trombocitopenia, hipoalbuminemia, prolongación del tiempo de protrombina y elevación de la ferritina. Al deterioro hubo acentuación de la trombocitopenia, ascenso mayor de la proteína C reactiva junto a elevación de los neutrófilos.Conclusión: El hemograma, la proteína C reactiva y la albuminemia al ingreso resultaron ser de alto valor en la identificación de pacientes con riesgo de agravamiento clínico.</jats:p>
20Scopus© Citations 10
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Increase in Beta Power Reflects Attentional Top-Down Modulation After Psychosocial Stress Induction
(2021)
Ismael Palacios-García
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SILVA CONCHA, JAIME
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Mario Villena-González
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Germán Campos-Arteaga
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Claudio Artigas-Vergara
<jats:p>Selective attention depends on goal-directed and stimulus-driven modulatory factors, each relayed by different brain rhythms. Under certain circumstances, stress-related states can change the balance between goal-directed and stimulus-driven factors. However, the neuronal mechanisms underlying these changes remain unclear. In this study, we explored how psychosocial stress can modulate brain rhythms during an attentional task and a task-free period. We recorded the EEG and ECG activity of 42 healthy participants subjected to either the Trier Social Stress Test (TSST), a controlled procedure to induce stress, or a comparable control protocol (same physical and cognitive effort but without the stress component), flanked by an attentional task, a 90 s of task-free period and a state of anxiety questionnaire. We observed that psychosocial stress induced an increase in heart rate (HR), self-reported anxiety, and alpha power synchronization. Also, psychosocial stress evoked a relative beta power increase during correct trials of the attentional task, which correlates positively with anxiety and heart rate increase, and inversely with attentional accuracy. These results suggest that psychosocial stress affects performance by redirecting attentional resources toward internal threat-related thoughts. An increment of endogenous top-down modulation reflected an increased beta-band activity that may serve as a compensatory mechanism to redirect attentional resources toward the ongoing task. The data obtained here may contribute to designing new ways of clinical management of the human stress response in the future and could help to minimize the damaging effects of persistent stressful experiences.</jats:p>
13 1Scopus© Citations 48
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Atovaquone/Proguanil Resistance in an Imported Malaria Case in Chile
(2021)
Stella M. Chenet
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Alan Oyarce
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Jorge Fernandez
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Rafael Tapia-Limonchi
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WEITZEL, THOMAS
<jats:title>ABSTRACT</jats:title><jats:p>In November 2018, we diagnosed a cluster of falciparum malaria cases in three Chilean travelers returning from Nigeria. Two patients were treated with sequential intravenous artesunate plus oral atovaquone/proguanil (AP) and one with oral AP. The third patient, a 23-year-old man, presented with fever on day 29 after oral AP treatment and was diagnosed with recrudescent falciparum malaria. The patient was then treated with oral mefloquine, followed by clinical recovery and resolution of parasitemia. Analysis of day 0 and follow-up blood samples, collected on days 9, 29, 34, 64, and 83, revealed that parasitemia had initially decreased but then increased on day 29. Sequencing confirmed Tyr268Cys mutation in the <jats:italic>cytochrome b</jats:italic> gene, associated with atovaquone resistance, in isolates collected on days 29 and 34 and <jats:italic>P. falciparum dihydrofolate reductase</jats:italic> mutation Asn51Ile, associated with proguanil resistance in all successfully sequenced samples. Molecular characterization of imported malaria contributes to clinical management in non-endemic countries, helps ascertain the appropriateness of antimalarial treatment policies, and contributes to the reporting of drug resistance patterns from endemic regions.</jats:p>
4Scopus© Citations 5
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Case Report: Acute Onset Fear of Falling and Treatment With “Cognitive Physical Therapy”
(2021)
CASTRO ABARCA, PATRICIA BERNARDITA
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Shree Vadera
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Matthew James Bancroft
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Joseph Buttell
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Diego Kaski
<jats:p>Fear of falling (FoF) is prevalent in older adults, especially those with previous falls, and typically starts insidiously. We present a 78-year-old woman with an abrupt onset FoF and no history of falls, balance problems, vertigo, oscillopsia, psychiatric or psychological issues to account for this. These cognitive changes led to a behavioural alteration of her gait that became slow and wide-based, with her gaze fixed on the floor. She began a tailored program of “Cognitive Physical Therapy (CPT)” combining cognitive behavioural therapy (CBT) and physical rehabilitation. 1 month later her 6 m walk time and steps were reduced by a 25 and 35%, respectively, and the stride length increased by 34%, with further improvement 2 months later. We postulate that the abrupt onset of symptoms triggered a central shift toward postural hypervigilance and anxiety, suppression of anticipatory (feed forward) postural adjustments (APA) leading to FoF. CPT improved objective gait parameters related to FoF and reduced postural anxiety suggesting that early diagnosis and prompt treatment may avoid chronic symptoms and social isolation.</jats:p>
Scopus© Citations 11 1
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Multidimensional inhibitory signatures of sentential negation in behavioral variant frontotemporal dementia
(2022)
Mariano N Díaz-Rivera
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Agustina Birba
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Sol Fittipaldi
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Débora Mola
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Yurena Morera
<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background</jats:title> <jats:p>Processing of linguistic negation has been associated to inhibitory brain mechanisms. However, no study has tapped this link via multimodal measures in patients with core inhibitory alterations, a critical approach to reveal direct neural correlates and potential disease markers.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Here we examined oscillatory, neuroanatomical, and functional connectivity signatures of a recently reported Go/No-go negation task in healthy controls and behavioral variant frontotemporal dementia (bvFTD) patients, typified by primary and generalized inhibitory disruptions. To test for specificity, we also recruited persons with Alzheimer's disease (AD), a disease involving frequent but nonprimary inhibitory deficits.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>In controls, negative sentences in the No-go condition distinctly involved frontocentral delta (2–3 Hz) suppression, a canonical inhibitory marker. In bvFTD patients, this modulation was selectively abolished and significantly correlated with the volume and functional connectivity of regions supporting inhibition (e.g. precentral gyrus, caudate nucleus, and cerebellum). Such canonical delta suppression was preserved in the AD group and associated with widespread anatomo-functional patterns across non-inhibitory regions.</jats:p> </jats:sec> <jats:sec> <jats:title>Discussion</jats:title> <jats:p>These findings suggest that negation hinges on the integrity and interaction of spatiotemporal inhibitory mechanisms. Moreover, our results reveal potential neurocognitive markers of bvFTD, opening a new agenda at the crossing of cognitive neuroscience and behavioral neurology.</jats:p> </jats:sec>
Scopus© Citations 18 4
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Visual-spatial processing impairment in the occipital-frontal connectivity network at early stages of Alzheimer’s disease
(2023)
Iván Plaza-Rosales
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Enzo Brunetti
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Rodrigo Montefusco-Siegmund
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Samuel Madariaga
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Rodrigo Hafelin
<jats:sec><jats:title>Introduction</jats:title><jats:p>Alzheimer’s disease (AD) is the leading cause of dementia worldwide, but its pathophysiological phenomena are not fully elucidated. Many neurophysiological markers have been suggested to identify early cognitive impairments of AD. However, the diagnosis of this disease remains a challenge for specialists. In the present cross-sectional study, our objective was to evaluate the manifestations and mechanisms underlying visual-spatial deficits at the early stages of AD.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We combined behavioral, electroencephalography (EEG), and eye movement recordings during the performance of a spatial navigation task (a virtual version of the Morris Water Maze adapted to humans). Participants (69–88 years old) with amnesic mild cognitive impairment–Clinical Dementia Rating scale (aMCI–CDR 0.5) were selected as probable early AD (eAD) by a neurologist specialized in dementia. All patients included in this study were evaluated at the CDR 0.5 stage but progressed to probable AD during clinical follow-up. An equal number of matching healthy controls (HCs) were evaluated while performing the navigation task. Data were collected at the Department of Neurology of the Clinical Hospital of the Universidad de Chile and the Department of Neuroscience of the Faculty of Universidad de Chile.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Participants with aMCI preceding AD (eAD) showed impaired spatial learning and their visual exploration differed from the control group. eAD group did not clearly prefer regions of interest that could guide solving the task, while controls did. The eAD group showed decreased visual occipital evoked potentials associated with eye fixations, recorded at occipital electrodes. They also showed an alteration of the spatial spread of activity to parietal and frontal regions at the end of the task. The control group presented marked occipital activity in the beta band (15–20 Hz) at early visual processing time. The eAD group showed a reduction in beta band functional connectivity in the prefrontal cortices reflecting poor planning of navigation strategies.</jats:p></jats:sec><jats:sec><jats:title>Discussion</jats:title><jats:p>We found that EEG signals combined with visual-spatial navigation analysis, yielded early and specific features that may underlie the basis for understanding the loss of functional connectivity in AD. Still, our results are clinically promising for early diagnosis required to improve quality of life and decrease healthcare costs.</jats:p></jats:sec>
Scopus© Citations 16 1
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A nodular lesion on a finger: an unusual site for a cyst
(2022)
Pablo Vargas-Mora
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Daniela González-Godoy
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Nelson Lobos-Guede
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Sebastián Andreani
;
Laura Carreño
<jats:p>We report a greyish nodule on the pad of the second finger of the right hand. High-resolution ultrasound showed a predominantly cystic lesion with an intralesional peripheral solid component with a mamelonated pseudonodular appearance.</jats:p>
1
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Cancer History Avoids the Increase of Senescence Markers in Peripheral Cells of Amnestic Mild Cognitive Impaired Patients
(2023)
Carol D. SanMartín
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Felipe Salech
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Daniela Paz Ponce
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Jorge Concha-Cerda
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Esteban Romero-Hernández
<jats:p>Epidemiological studies show that having a history of cancer protects from the development of Alzheimer’s Disease (AD), and vice versa, AD protects from cancer. The mechanism of this mutual protection is unknown. We have reported that the peripheral blood mononuclear cells (PBMC) of amnestic cognitive impairment (aMCI) and Alzheimer’s Disease (AD) patients have increased susceptibility to oxidative cell death compared to control subjects, and from the opposite standpoint a cancer history is associated with increased resistance to oxidative stress cell death in PBMCs, even in those subjects who have cancer history and aMCI (Ca + aMCI). Cellular senescence is a regulator of susceptibility to cell death and has been related to the pathophysiology of AD and cancer. Recently, we showed that cellular senescence markers can be tracked in PBMCs of aMCI patients, so we here investigated whether these senescence markers are dependent on having a history of cancer. Senescence-associated βeta-galactosidase (SA-β-Gal) activity, G0-G1 phase cell-cycle arrest, p16 and p53 were analyzed by flow cytometry; phosphorylated H2A histone family member X (γH2AX) by immunofluorescence; IL-6 and IL-8 mRNA by qPCR; and plasmatic levels by ELISA. Senescence markers that were elevated in PBMCs of aMCI patients, such as SA-β-Gal, Go-G1 arrested cells, IL-6 and IL-8 mRNA expression, and IL-8 plasmatic levels, were decreased in PBMCs of Ca + aMCI patients to levels similar to those of controls or of cancer survivors without cognitive impairment, suggesting that cancer in the past leaves a fingerprint that can be peripherally traceable in PBMC samples. These results support the hypothesis that the senescence process might be involved in the inverse association between cancer and AD.</jats:p>
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