Fonocardiograma : construcción y evaluación

Este artículo presenta la construcción de un instrumento para monitorizar la frecuencia cardíaca (FC), caracterizado por el bajo coste material de su producción. Para verificar la aplicabilidad del Fonocardiograma (FCG) se tomó la FC de nueve (9) sujetos experimentales con a través de dos sistemas: el FCG y el monitor de FC de la marca Polar inc. (Finlandia) modelo RS 800 Cx HR. A continuación, se compraron los resultados. A las nueve (9) personas (4 hombres y 5 mujeres) investigadas se les midió la FC en posición sentada y en posición supina (Zuttin, R. S., Moreno, M. A., César, M. C., Martins, L. E. B., Catai, A. M., & Silva, E., 2008) durante 5 minutos (Vanderlei, L.C.M., Silva, R.A., Pastre, C.M., Azevedo, F.M. & Godoy, M.F., 2008). Se obtuvo una correlación de r = 0,982 para la posición supina y de r = 0,794 para la posición sentada, ambas con p <0,05. Se conseja la construcción de este instrumento para la enseñanza y el aprendizaje de la monitorización de la FC, así como su importancia como método didáctico para la comprensión de la auto-regulación de los ritmos internos.

Fonocardiograma : construcción y evaluación

Este artículo presenta la construcción de un instrumento para monitorizar la frecuencia cardíaca (FC), caracterizado por el bajo coste material de su producción. Para verificar la aplicabilidad del Fonocardiograma (FCG) se tomó la FC de nueve (9) sujetos experimentales con a través de dos sistemas: el FCG y el monitor de FC de la marca Polar inc. (Finlandia) modelo RS 800 Cx HR. A continuación, se compraron los resultados. A las nueve (9) personas (4 hombres y 5 mujeres) investigadas se les midió la FC en posición sentada y en posición supina (Zuttin, R. S., Moreno, M. A., César, M. C., Martins, L. E. B., Catai, A. M., & Silva, E., 2008) durante 5 minutos (Vanderlei, L.C.M., Silva, R.A., Pastre, C.M., Azevedo, F.M. & Godoy, M.F., 2008). Se obtuvo una correlación de r = 0,982 para la posición supina y de r = 0,794 para la posición sentada, ambas con p <0,05. Se conseja la construcción de este instrumento para la enseñanza y el aprendizaje de la monitorización de la FC, así como su importancia como método didáctico para la comprensión de la auto-regulación de los ritmos internos.

Feasibility of MR-Based Body Composition Analysis in Large Scale Population Studies

Introduction Quantitative and accurate measurements of fat and muscle in the body are important for prevention and diagnosis of diseases related to obesity and muscle degeneration. Manually segmenting muscle and fat compartments in MR body-images is laborious and time-consuming, hindering implementation in large cohorts. In the present study, the feasibility and success-rate of a Dixon-based MR scan followed by an intensity-normalised, non-rigid, multi-atlas based segmentation was investigated in a cohort of 3,000 subjects. Materials and Methods 3,000 participants in the in-depth phenotyping arm of the UK Biobank imaging study underwent a comprehensive MR examination. All subjects were scanned using a 1.5 T MR-scanner with the dual-echo Dixon Vibe protocol, covering neck to knees. Subjects were scanned with six slabs in supine position, without localizer. Automated body composition analysis was performed using the AMRA Profiler™ system, to segment and quantify visceral adipose tissue (VAT), abdominal subcutaneous adipose tissue (ASAT) and thigh muscles. Technical quality assurance was performed and a standard set of acceptance/rejection criteria was established. Descriptive statistics were calculated for all volume measurements and quality assurance metrics. Results Of the 3,000 subjects, 2,995 (99.83%) were analysable for body fat, 2,828 (94.27%) were analysable when body fat and one thigh was included, and 2,775 (92.50%) were fully analysable for body fat and both thigh muscles. Reasons for not being able to analyse datasets were mainly due to missing slabs in the acquisition, or patient positioned so that large parts of the volume was outside of the field-of-view. Discussion and Conclusions In conclusion, this study showed that the rapid UK Biobank MR-protocol was well tolerated by most subjects and sufficiently robust to achieve very high success-rate for body composition analysis. This research has been conducted using the UK Biobank Resource.

Integridade da pele em idosos: revisão da literatura segundo as cartas de promoção da saúde

Trata-se de uma revisão bibliográfica que objetivou relacionar as medidas educativas para a promoção da integridade da pele em idosos com as Cartas de Promoção da Saúde. Realizou-se a busca nas bases de dados CINAHL, SCOPUS, LILACS e COCHRANE, nos portais CAPES e BVS e na biblioteca PUBMED, mediante a aplicação dos descritores Health Education; Skin e Aged. Os resultados dos 7 artigos analisados apontaram como principais medidas educativas: inspeção diária da pele, cuidados com calçados e com os pés, uso regular de protetor solar e mudanças de decúbito. Essas medidas estavam relacionadas com as seguintes Cartas de Promoção da Saúde: Ottawa, Declaração de Santafé de Bogotá e Declaração de Jacarta. Conclui-se que as medidas educativas, baseadas nas Cartas, são de grande relevância para a criação de uma cultura de saúde, com enfoque na população e no indivíduo como agentes executores imprescindíveis para o alcance da promoção da saúde

Role of emergency thoracic ultrasonography in spontaneous pneumomediastinum. Two case report

Early identification of spontaneous pneumomediastinum in an Emergency Department is possible with thoracic ultrasound. We report two cases of spontaneous pneumomediastinum, diagnosed in a 26-year old man with chronic asthma and a 19-year old athlete, and discuss the role of thoracic US alongside conventional X-ray and thoracic CT in emergency medicine. The patients were transferred to an Emergency Department, where conservative treatment produced a good outcome. The greater sensitivity and specificity of thoracic US over conventional supine X-ray in the detection of occult pneumothorax is ever more appreciated. However, training in the diagnosis of pneumomediastinum is required.

Volatile Blood Pressure Due To Baroreflex and Autonomic Failure

An 85-year-old male was hospitalized because of deterioration of his general condition and infection of the tracheostoma. He had had laryngectomy, bilateral neck dissection and radiation therapy for a laryngeal carcinoma 5 years earlier. Despite a good recovery, he could not get up because of a new onset of postural symptoms (dizziness, lightheadedness, collapse). Late onset of baroreflex failure and autonomic nervous system failure were diagnosed. Volatility of blood pressure (supine hypertension, upright hypotension) was treated with NaCl supplement during the day and a short-acting antihypertensive (clonidine) at night. With this regimen, the patient could walk without support.

Il «Castellazzo» di Monte Iato in Sicilia occidentale (PA) Quinta e sesta campagna di scavo. Aggiornamenti dal territorio

From May 15th to 30th and 15th to 30th September 2015 took place the fifth and sixth excavation campaign at the Castellazzo of Monte Iato. The presence of 15 participants made it possible to deepen the research significantly and ex-pand the surface area of investigation. It is completely emptied a room already identified in previous campaigns and provided new information about the relationship with the existing cemetery. Part of a burial in a supine position was destroyed by the installation of wall 20. Traces of another turret projecting from the walls have been discovered in the east and another section of the inner walls (15) was fully exposed. A gate, between two towers, is the first entry traced so far, on the north-eastern side of the plateau. The archaeological materials found confirm the characteristics and type of construction. Being a military camp of ephemeral nature, although active at least 30 years, objects such as arrowheads and crossbow quarrels, knives, buckles and harnesses for horses have been found. One of the environments has been interpreted as an area where gaming took place because of the presence of four dice in ivory, glasses and different coins, in addition to the greater extent than the other environments found. Among the findings are reported a glass weight with a cufic inscription dated to the mid-twelfth century and two bronze coins dated in 15th centu-ry.

Integridade da pele em idosos: revisão da literatura segundo as cartas de promoção da saúde

Trata-se de uma revisão bibliográfica que objetivou relacionar as medidas educativas para a promoção da integridade da pele em idosos com as Cartas de Promoção da Saúde. Realizou-se a busca nas bases de dados CINAHL, SCOPUS, LILACS e COCHRANE, nos portais CAPES e BVS e na biblioteca PUBMED, mediante a aplicação dos descritores Health Education; Skin e Aged. Os resultados dos 7 artigos analisados apontaram como principais medidas educativas: inspeção diária da pele, cuidados com calçados e com os pés, uso regular de protetor solar e mudanças de decúbito. Essas medidas estavam relacionadas com as seguintes Cartas de Promoção da Saúde: Ottawa, Declaração de Santafé de Bogotá e Declaração de Jacarta. Conclui-se que as medidas educativas, baseadas nas Cartas, são de grande relevância para a criação de uma cultura de saúde, com enfoque na população e no indivíduo como agentes executores imprescindíveis para o alcance da promoção da saúde

Motion artefact separation in single channel doppler radar respiration measurement

Direct conversion Doppler radar has the capability to remotely monitor human respiratory activity in a non-contact form. However, the motion or movement from the subject will degrade the acquired respiration signal. As the respiration pattern is one of the essential parameters in respiratory medicine intrinsically containing more information about the respiratory function, it is particularly important to suppress or to separate these motion artefacts in order to reconstruct the corresponding patterns. Experiment results show that EMD-ICA algorithm is capable of separating the mixed respiration signal by recovering the useful information of the breathing pattern as well as the motion signatures using only a single channel measurement when using the source separation algorithm. This reduces the complexity and the cost of the sensing system while removing the undesirable artefacts. A high correlation was also observed from the recovered respiration pattern in comparison to the standard respiration strap for both experiments setup (a seated and a supine position).

Analyzing systolic-diastolic interval interaction characteristics in diabetic cardiac autonomic neuropathy progression

Cardiac autonomic neuropathy (CAN), one of the major complications in diabetes, if detected at the subclinical stage allows for effective treatment and avoiding further complication including cardiovascular pathology. Surface ECG (Electrocardiogram)-based diagnosis of CAN is useful to overcome the limitation of existing cardiovascular autonomic reflex tests traditionally used for CAN identification in clinical settings. The aim of this paper is to analyze the changes in the mechanical function of the ventricles in terms of systolic-diastolic interval interaction (SDI) from a surface ECG to assess the severity of CAN progression [no CAN, early CAN (ECAN) or subclinical CAN, and definite CAN (DCAN) or clinical CAN]. ECG signals recorded in supine resting condition from 72 diabetic subjects without CAN (CAN-) and 70 diabetic subjects with CAN were analyzed in this paper. The severity of CAN was determined by Ewing's Cardiovascular autonomic reflex tests. Fifty-five subjects of the CAN group had ECAN and 15 subjects had DCAN. In this paper, we propose an improved version of the SDI parameter (i.e., TQ/RR interval ratio) measured from the electrical diastolic interval (i.e., TQ interval) and the heart rate interval (i.e., RR interval). The performance of the proposed SDI measure was compared with the performance of the existing SDI measure (i.e., QT/TQ interval ratio). The proposed SDI parameter showed significant differences among three groups (no CAN, ECAN, and DCAN). In addition, the proposed SDI parameter was found to be more sensitive in detecting CAN progression than other ECG interval-based features traditionally used for CAN diagnosis. The modified SDI parameter might be used as an alternative measure for the Ewing autonomic reflex tests to identify CAN progression for those subjects who are unable to perform the traditional tests. These findings could also complement the echocardiographic findings of the left ventricular diastolic dysfunction by providing additional information about alteration in systolic and diastolic intervals in heart failure.

Detecting subclinical diabetic cardiac autonomic neuropathy by analyzing ventricular repolarization dynamics

In this study, a linear parametric modeling technique was applied to model ventricular repolarization (VR) dynamics. Three features were selected from the surface ECG recordings to investigate the changes in VR dynamics in healthy and cardiac autonomic neuropathy (CAN) participants with diabetes including heart rate variability (calculated from RR intervals), repolarization variability (calculated from QT intervals), and respiration [calculated by ECG-derived respiration (EDR)]. Surface ECGs were recorded in a supine resting position from 80 age-matched participants (40 with no cardiac autonomic neuropathy (NCAN) and 40 with CAN). In the CAN group, 25 participants had early/subclinical CAN (ECAN) and 15 participants were identified with definite/clinical CAN (DCAN). Detecting subclinical CAN is crucial for designing an effective treatment plan to prevent further cardiovascular complications. For CAN diagnosis, VR dynamics was analyzed using linear parametric autoregressive bivariate (ARXAR) and trivariate (ARXXAR) models, which were estimated using 250 beats of derived QT, RR, and EDR time series extracted from the first 5 min of the recorded ECG signal. Results showed that the EDR-based models gave a significantly higher fitting value (p < 0.0001) than models without EDR, which indicates that QT-RR dynamics is better explained by respiratory-information-based models. Moreover, the QT-RR-EDR model fitting values gradually decreased from the NCAN group to ECAN and DCAN groups, which indicate a decoupling of QT from RR and the respiration signal with the increase in severity of CAN. In this study, only the EDR-based model significantly distinguished ECAN and DCAN groups from the NCAN group (p < 0.05) with large effect sizes (Cohen's d > 0.75) showing the effectiveness of this modeling technique in detecting subclinical CAN. In conclusion, the EDR-based trivariate QT-RR-EDR model was found to be better in detecting the presence and severity of CAN than the bivariate QT-RR model. This finding also establishes the importance of adding respiratory information for analyzing the gradual deterioration of normal VR dynamics in pathological conditions, such as diabetic CAN.

The effects of prone position ventilation on experimental mild acute lung injury induced by intraperitoneal lipopolysaccharide injection in rats

The benefits of prone position ventilation are well demonstrated in the severe forms of acute respiratory distress syndrome, but not in the milder forms. We investigated the effects of prone position on arterial blood gases, lung inflammation, and histology in an experimental mild acute lung injury (ALI) model. ALI was induced in Wistar rats by intraperitoneal Escherichia coli lipopolysaccharide (LPS, 5 mg/kg). After 24 h, the animals with PaO2/FIO2 between 200 and 300 mmHg were randomized into 2 groups: prone position (n = 6) and supine position (n = 6). Both groups were compared with a control group (n = 5) that was ventilated in the supine position. All of the groups were ventilated for 1 h with volume-controlled ventilation mode (tidal volume = 6 ml/kg, respiratory rate = 80 breaths/min, positive end-expiratory pressure = 5 cmH2O, inspired oxygen fraction = 1). Significantly higher lung injury scores were observed in the LPS-supine group compared to the LPS-prone and control groups (0.32 ± 0.03; 0.17 ± 0.03 and 0.13 ± 0.04, respectively) (p < 0.001), mainly due to a higher neutrophil infiltration level in the interstitial space and more proteinaceous debris that filled the airspaces. Similar differences were observed when the gravity-dependent lung regions and non-dependent lung regions were analyzed separately (p < 0.05). The BAL neutrophil content was also higher in the LPS-supine group compared to the LPS-prone and control groups (p < 0.05). There were no significant differences in the wet/dry ratio and gas exchange levels. In this experimental extrapulmonary mild ALI model, prone position ventilation for 1 h, when compared with supine position ventilation, was associated with lower lung inflammation and injury.