BACKGROUND:Physical activity alleviates menopausal symptoms in women whose menopause occurs after the age of 45; however, its effect in primary ovarian insufficiency, which occurs before the age of 40, remains unknown. OBJECTIVE:To examine the association between physical activity, menopausal symptoms, and the use of menopausal hormone therapy in women with primary ovarian insufficiency. METHODS:We analysed data from 4708 participants from two studies conducted in 12 Latin American countries. After applying eligibility criteria, 564 women with primary ovarian insufficiency (351 idiopathic and 213 surgical) were included. Menopausal symptoms were assessed using a validated scale, and severe symptoms were defined according to established cut-offs. Physical activity was classified according to international recommendations for moderate-intensity activity. Logistic regression models were adjusted for sociodemographic, clinical, and lifestyle variables. RESULTS:The prevalence of severe menopausal symptoms was 39.2%, with no significant difference between idiopathic and surgical primary ovarian insufficiency. Women with severe symptoms were less likely to meet recommended levels of physical activity or to be current users of menopausal hormone therapy. In adjusted models, regular physical activity (OR 0.65; 95% CI 0.45-0.94) and current use of menopausal hormone therapy (OR 0.27; 0.17-0.42) were associated with a lower likelihood of severe symptoms, whereas obesity and use of psychotropic medication were associated with a higher likelihood. CONCLUSIONS:Women with primary ovarian insufficiency who engage in regular physical activity or currently use menopausal hormone therapy report less severe menopausal symptoms. Regular exercise may be an important non-hormonal option for women who cannot or prefer not to use hormone therapy.
Pleural effusion cytology is critical for diagnosing benign and malignant conditions, yet manual interpretation remains time-consuming and prone to subjectivity. The increasing burden of malignant pleural effusion in resource-constrained settings highlights the need for automated diagnostic solutions. This study presents an ensemble deep learning framework combining ResNet50V2, DenseNet121, and InceptionV3 architectures with transfer learning for classifying pleural cytology images into negative for malignancy (NFM) and malignant (MAL) categories. Three scenarios were evaluated: no data augmentation, 50% augmentation, and 300% augmentation. A local dataset of 1,292 images from Hospital Nacional Cayetano Heredia and an external Kaggle dataset (693 images) were used for training, validation, and independent testing. Performance was measured using accuracy, precision, recall, and F1-score across individual models and ensemble voting strategies (hard and soft voting). The ResNet + DenseNet ensemble with soft voting and 300% data augmentation achieved the highest accuracy (96.2% on the local dataset; 89.6% on the external dataset), outperforming individual models across all scenarios. Increasing the dataset through data augmentation significantly improved generalization and robustness. The proposed ensemble-based approach supports cytological diagnosis, potentially reducing diagnostic uncertainty in pleural carcinoma detection. Our findings demonstrate that ensemble deep learning models, optimized with data augmentation, can provide accurate and reproducible diagnostic support for pleural cytology, offering practical potential for deployment in low-resource healthcare settings and contributing to improved cancer diagnosis accessibility.
Antecedentes: la enteropatía hipertensiva portal es una condición poco común caracterizada por anormalidades en la mucosa del intestino delgado en pacientes con hipertensión portal. Algunos factores de riesgo incluyen la presencia de várices esofágicas grandes, gastropatía y colopatía hipertensiva portal, clasificación Child-Pugh B o C e historia de tratamiento de várices. El diagnóstico se realiza mediante videocápsula endoscópica o enteroscopia profunda. No existen guías claras de manejo, por lo que este se basa en reportes de caso. Resumen del caso: presentamos el caso de un varón de 35 años con hipertensión portal no cirrótica debido por trombosis de vena porta crónica, quien acudió a emergencias por hemorragia digestiva, con resultado de endoscopia alta y baja no concluyentes y hallazgos sugerentes de enteropatía hipertensiva portal en la videocápsula endoscópica. El paciente fue tratado con bloqueantes β y no presentó recurrencias hemorrágicas. Conclusión: la enteropatía hipertensiva portal debe incluirse en el diagnóstico diferencial de pacientes con hipertensión portal con o sin cirrosis y hemorragia digestiva o anemia. En estos pacientes, el uso de la videocápsula endoscópica no debe retrasarse.
Introduction Fluid overload in critically ill patients with acute kidney injury (AKI) is independently associated with increased mortality, prolonged mechanical ventilation and impaired renal recovery. Net ultrafiltration (UFNET) during continuous renal replacement therapy (CRRT) is a cornerstone de-resuscitation strategy; however, tolerance to fluid removal is highly variable and difficult to predict. Ultrafiltration intolerance, encompassing haemodynamic instability, peripheral perfusion deterioration and tissue hypoperfusion during UFNET, lacks a standardised definition and has not been prospectively evaluated using a comprehensive multiparametric monitoring strategy. The Volume removal Intolerance during Net ultrafiltration in acute Kidney injury patients, an Observational study (VINKO) aims to identify clinical, haemodynamic, ultrasound-based, perfusion-related and biochemical factors associated with the development of ultrafiltration intolerance in critically ill patients with AKI undergoing CRRT.Methods and analysis VINKO is a prospective, multicentre, observational analytical case–control study enrolling adult intensive care unit patients with AKI requiring CRRT with prescribed UFNET. Cases are defined as patients who develop ultrafiltration intolerance during the 24-hour observation period, whereas controls are patients who tolerate UFNET without meeting intolerance criteria. Serial assessments include macrohaemodynamic variables, dynamic functional tests (passive leg raising and sitting manoeuvre), focused echocardiography, venous congestion assessment using the Venous Excess Ultrasound protocol, peripheral perfusion markers (capillary refill time, mottling score and peripheral perfusion index) and biochemical markers including lactate, albumin, ionised calcium and B-type natriuretic peptide/N-terminal pro-B-type natriuretic peptide when available. Measurements are obtained at predefined time points from UFNET initiation through 24 hours, with additional off-schedule assessments triggered by intolerance events. The primary objective is to identify independent predictors of ultrafiltration intolerance. A total of 128 patients (64 cases and 64 controls) will be enrolled based on a predefined sample size calculation.Ethics and dissemination The study has been approved by the Scientific Ethics Committee of the Talcahuano Health Service (Act No. 15, 14 April 2026) and will be conducted in accordance with the Declaration of Helsinki, Council for International Organizations of Medical Sciences (CIOMS) guidelines and current Chilean regulations. Results will be disseminated through presentations at scientific meetings and publication in peer-reviewed journals.Trial registration number NCT07643597.
Upper gastrointestinal bleeding (UGIB) remains one of the most common emergencies in gastroenterology, with mortality rates reaching 14
