Orientadores: Ilma Aparecida Paschoal, Mônica Corso Pereira, Lilian Tereza Lavras Costallat / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-19T08:01:04Z (GMT). No. of bitstreams: 1 Leite_MarivoneArruda_M.pdf: 553765 bytes, checksum: 523c010d8a4b64d307b61b14f6c9b8d4 (MD5) Previous issue date: 2011 / Resumo: Objetivo: avaliar os pacientes com LES sem sintomas respiratórios significativos, por meio do teste de caminhada de 6 minutos (TC6). Casuística e Métodos: foram selecionados 45 pacientes com LES estáveis. Os pacientes foram avaliados quanto à dispneia (MRC), foram submetidos a testes de função pulmonar (espirometria e manovacuometria) e realizaram TC6 (protocolo da ATS/ERS). Dois parâmetros de TC6 (distância e dessaturação) foram comparados com as outras variáveis estudadas. Resultados: Dos 45 pacientes, 42 eram mulheres com idade média de 39±11.4 anos; a média do tempo de doença foi 121±93.1 meses; valor da média do MRC 2±0; a média da CVF foi 85.9±34.2%; a média do VEF1 67.5±21.6%; média PiMáx 82±58.4%; média PeMáx 78±37.3%; média FC em repouso 75±12.8 bpm; FR em repouso 19±5.3bpm; média da distância caminhada no TC6 foi 478±82m; média SpO2 em repouso foi 98±0.8%; média da queda da SpO2 foi de 4±6 pontos. Quando a população de estudo foi dividida de acordo com o valor da distância caminhada, a FC antes do TC6 foi significantemente menor no grupo que caminhou '> ou =' 400m quando comparados com o grupo que caminhou < 400m (p=0.0043), assim como o valor da Escala de Borg (p=0.0036); de acordo com a presença de dessaturação, a FC ao final do teste foi significantemente maior no grupo que dessaturou (p=0.0170), PeMáx (p=0.0282) e a distância caminhada no TC6 (p=0.0291) foi significativamente menor, enquanto que a PiMáx mostrou uma tendência para também ser menor (p=0.0504). CVF<limite inferior de normal era significativamente associado com o grupo que dessaturou (p=0.0274). Conclusão: comparada com a distância caminhada no TC6, a dessaturação foi melhor parâmetro para identificar os pacientes com comprometimento nos índices dos testes de função respiratória / Abstract: Objective: to evaluate SLE patients without overt respiratory symptoms by means of six-minute walk test (6MWT). Casuistic and Methods: 45 stable SLE patients were enrolled. Patients were evaluated for dyspnoea (MRC), underwent pulmonary function tests (spirometry and manovacuometry ) and performed the 6MWT protocol (ATS / ERS). Two parameters of the 6MWT (distance anddesaturation) were compared with the other variables. Results: Of the 45 patients, 42 were women with mean age 39±11.4 years; mean duration of disease was 121±93.1 months; mean value of MRC was 2±0; mean FVC 85.9±34.2%; mean FEV1 was 67.5±21.6%; mean MIP was 82±58.4%; mean MEP was 78±37.3%; mean heart rate at rest was 75±12.8 bpm; mean respiratory rate at rest was 19±5.3bpm; mean 6MWD was 478±82m; mean SpO2 at rest was 98±0.8%; mean fall in SpO2 was 4±6 points. When the study population was divided according to the cut-off value of 400m of walk distance heart rate immediately before the test was significant smaller in those who walked less than 400m (p=0.0043) as was the value of Borg scale(p=0.0036); according to the presence of desaturation '> or =' 4, heart rate at the end of the test was significant higher in those who desaturate (p=0.0170), MEP (p=0.0282) and 6MWD (p=0.0291) were significantly smaller, MIP showed a tendency towards being smaller(p=0.0504). FVC < inferior limit of normal was significantly associated with the group that desaturates (p=0.0274). Conclusion: compared with 6MWD, desaturation was better suited to find the patients with the most compromised indexes in respiratory function tests / Mestrado / Clinica Medica / Mestre em Clinica Medica

No description available.

Thesis (MScIng)--Stellenbosch University, 2008. / ENGLISH ABSTRACT: Conventional pulse oximetry has limited accuracy in measuring blood oxygen saturation in low saturation and perfusion scenarios. This limits the application of pulse oximetry in patients su ering from peripheral vascular a ictions. A novel pulse oximetry system is presented in this study which proposes solutions to these low saturation and perfusion issues. The presented system was designed to overcome the low perfusion issues by inducing an arti cial pulse in the detected photoplethysmograph. A novel arterio-venous hypothesis was formulated to extract arterial and venous saturation data from this arti cial photoplethysmograph using arterial-to-venous compliance ratios. Sensor wavelengths were selected to provide high and low saturation accuracy, followed by an in vitro sensor calibration procedure. System performance was validated by means of in vivo human studies. In vivo results indicate good accuracy for high saturation, with limited accuracy in low saturation scenarios. The arterio-venous hypothesis was validated, indicating that venous saturation information can be extracted from the arti cial PPG. Although inconclusive, results indicate that the proposed system might be able to accurately monitor arterial and venous saturation in severe hypoperfusion scenarios with recommended hardware and calibration modi cations. It is recommended that further studies into the presented system's performance are conducted. / AFRIKAANSE OPSOMMING: Konvensionele 'pulse oximetry' sisteme het beperkte akkuraatheid tydens die meting van bloed suurstof saturasie in lae saturasie en perfusie gevalle. Dit beperk die bruikbaarheid van 'pulse oximetry' in pasiënte wat ly aan perifere vaskulêre siektes. 'n Nuwe 'pulse oximetry' sisteem, wat oplossings vir hierdie lae saturasie en perfusie beperkings voorstel, word in hierdie studie aangebied. Die voorgestelde sisteem is ontwerp om die lae perfusie beperkings te oorkom deur 'n kunsmatige polsslag in die 'photoplethysmograph' te induseer. 'n Nuwe arterio-veneuse hipotese is geformuleer om arteriële en veneuse saturasie inligting uit hierdie kunsmatige polsslag te onttrek deur middel van 'n arteriële-teenoor-veneuse styfheids verhouding. Die gol engtes wat gebruik is in die sensors, is spesi ek gekies om hoë en lae saturasie akkuraatheid te verskaf. 'n In vitro kalibrasie prosedure is gevolg om die sensors vir hoë en lae saturasie te kalibreer, waarna die werkverrigting van die sisteem getoets is deur middel van 'n in vivo validasie prosedure. Die in vivo resultate toon goeie akkuraatheid vir hoë saturasie, met beperkte akkuraatheid vir lae saturasie. Die arterio-veneuse hipotese is gevalideer, wat aandui dat veneuse saturasie wel uit die kunsmatige 'photoplethysmograph' onttrek kan word. Alhoewel die resultate wat in hierdie studie aangebied word nie omvattend of beslissend is nie, dui dit egter aan dat die voorgestelde sisteem dalk in staat kan wees om arteriële en veneuse saturasie in uiters lae perfusie gevalle te meet. Verbeteringe sal egter aan die sisteem aangebring moet word in terme van hardeware en kalibrasie, om 'n meer gestandardiseerde metings metode te verseker. Verdere navorsing oor die werkverrigting van die voorgestelde sisteem word ook voorgestel.

I rapporten presenteras en lågkostnads, portabel och bärbar design av ett nytt system med reflekterande teknik för pulsoximetri. Arbetet har utförts som ett projekt, inkluderande elektronikkonstruktion, mjukvaruutveckling, design av inkapsling för prototypen samt fortlöpande tester av både hård- och mjukvara under arbetets gång. Resultatet av arbetet är ett egenkonstruerat system för pulsoximetri. Med hjälp av bluetooth-teknik kan systemet kommunicera trådlöst med en PC, laptop eller mobiltelefon som stöder bluetooth 4.0. Mätvärden visas i realtid på PC/laptop/mobiltelefon. Programvaran är skriven i mbed med programspråket C++ för mikroprocessorn. Projektet kräver olika tekniska färdigheter såsom signalbehandling, programmering, kretskortskonstruktion och mikroprocessorer. Totalt sett är projektet en bra introduktion till medicintekniska enheter och en grund för elektronikingenjörer. Syftet och målet med examensarbetet har till större delen uppnåtts och vidare tester samt utveckling av produkten är möjlig. / In this report a low-cost, portable and wearable design of a new system with reflective technologyfor pulse oximetry is presented. The work has been executed as a project, including electronics construction, software development, a design of the embedding for the prototype and continuous tests of both the hardware and software during the work in progress. The result of this work is a prototype system for pulse oximetry. The system can communicate through Bluetooth wireless interface with a PC, laptop or smartphone which supports Bluetooth 4.0. The measurements are shown in real time on a PC/laptop/smartphone. The software is written in mbed with the language C++ for the microprocessor. The project demands different technical skills like signal processing, programming, electronic design and microprocessors. Over all the project is a good introduction for medical technology and a basis for electronic engineers. The purpose and goal with the thesis is considered to be reached for the most part and further testing and development of the product is possible.

INTRODUÇÃO: Uma alta prevalência de apnéia obstrutiva do sono (AOS) tem sido relatada em paciente com doença arterial coronária (DAC). Vários mecanismos relacionados à AOS, incluindo dessaturação da oxi-hemoglobina e aumento da demanda de oxigênio, aumento da atividade simpática bem como estado pro trombótico, podem ser perigosos nos pacientes com DAC. Entretanto, a AOS é pouco reconhecida e não é rotineiramente pesquisada nos pacientes admitidos em unidade de cuidados coronários (UCC) com DAC. O padrão ouro para o diagnóstico de AOS é a polissonografia noturna (PSG), método impraticável na UCC, pois implica no deslocamento do paciente para o laboratório de sono. OBJETIVOS: Construir e validar um monitor de oximetria para diagnóstico de AOS em pacientes admitidos na UCC com diagnóstico de DAC aguda. MÉTODOS: Foi inicialmente desenvolvido monitor de oximetria continua que registra os dados derivados dos monitores da UCC e permite a determinação do índice de dessaturação da oxi-hemoglobina (IDO) através de análise visual da curva de oximetria. O monitor foi então utilizado em pacientes consecutivos admitidos na UCC com diagnóstico de DAC aguda. Uma amostra desta população foi também estudada através de PSG, num período máximo de três meses após a alta. RESULTADOS: Trinta e sete pacientes foram estudados através de monitorização de oximetria durante a noite na UCC. PSG foi também realizada em vinte pacientes. AOS, diagnosticada pelo monitor de oximetria contínua (IDO > 5/hora), estava presente em 43% dos pacientes. AOS foi diagnosticada em 45% dos pacientes estudados com PSG (índice de apnéia e hipopnéia > 15 eventos por hora). Houve um bom nível de concordância entre o diagnóstico de AOS pelo monitor de oximetria na UCC e pela polissonografia - kappa = 0.898; p < 0.0001. O IDO determinado pelo monitor se correlacionou de forma significativa com o índice de apnéia e hipopnéia (r = 0.737; p < 0.0001). O diagnóstico de AOS através do monitor demonstrou sensibilidade de 88,9% e especificidade de 100%. CONCLUSÃO: O monitor desenvolvido no presente trabalho, que permite o registro da oximetria contínua a partir de dados que já são habitualmente coletados na UCC, é um método simples e preciso para o diagnóstico de AOS na UCC. / BACKGROND: A high prevalence of Obstructive sleep apnea (OSA) has been reported in patients with coronary artery disease (CAD). Several OSA related mechanisms, such as oxygen desaturation, high sympathetic activity, increased cardiac oxygen demand and a prothrombotic state, may be particularly dangerous in acute CAD patients. Nevertheless, OSA is frequently underdiagnosed and patients with CAD are not routinely screened for OSA when admitted to the Coronary Care Unit (CCU). OBJECTIVES: To build and validate a continuous overnight oximetry, by recording oximetry data derived from the CCU monitor, for the detection of OSA in acute CAD patients. DESIGN: We studied consecutive patients recruited on the basis of the presence of acute CAD requiring CCU, analyzed overnight continuous oximetry data and further compared it with full overnight polysomnography (PSG). RESULTS: Thirty-seven patients underwent overnight oxygen saturation monitoring in the CCU and 20 of these patients were submitted to PSG, performed within 3 months after hospital discharge. OSA was present in 43% and 45% of the patients studied by overnight oxygen saturation monitoring and PSG, respectively. The oxymetry derived oxygen desaturation index and the PSG derived apnea hypopnea index were strongly correlated (r = 0,737; p < 0,0001). There was a good level of agreement between abnormal oxymetric results and abnormal PSG results (kappa = 0.898; p < 0,0001). Overnight oximetry had a sensitivity of 88.9% and a specificity of 100% for OSA diagnosis. CONCLUSIONS: Continuous overnight oximetry derived from monitors that are already present in the CCU is a simple and accurate method for the diagnosis of OSA in the CCU.

O objetivo deste trabalho foi avaliar a taxa de oxigenação (%SpO2) do tecido pulpar em pacientes com tumores malignos intraoral e de orofaringe, tratados através de radioterapia (RT). As mensurações da %SpO2 foram realizadas com o oxímetro de pulso (OP), o qual gera valores relativos à quantidade de oxigênio viável circulante no tecido pulpar, o que o caracteriza como um método fisiométrico de avaliação do status da polpa dental. Foram selecionados 20 pacientes, sendo avaliados dois dentes de cada um (n=40), independente do quadrante e da área de irradiação, em quatro tempos distintos: I- antes da RT; II- no início da RT com dose de radiação entre (30Gy 35Gy); III- ao final da RT (60Gy 70Gy) e IV- depois de 4 5 meses do início do tratamento oncológico. As médias obtidas nos quatro tempos avaliados foram de 93%, 83%, 77% e 85% de SpO2, respectivamente. Através do teste t de Student (p0.01) foram encontradas diferenças estatisticamente significantes entre o Tempo I e todos os outros três tempos, o Tempo III também mostrou diferença quando comparado ao Tempo II e, não houve diferença estatística entre os Tempos II e IV. É possível concluir que as taxas de %SpO2 antes da RT são maiores do que aquelas obtidas trans e pós RT e, como os valores no Tempo IV ficam próximos aos obtidos no Tempo II, pode haver uma recondutibilidade sanguínea normal posterior a radiação ionizante. / The aim of this study was to evaluate pulp oxygenation level (%SpO2) in patients with malignant intraoral and oropharyngeal tumors treated by radiotherapy (RT). Pulp oxygenation level was measured by pulse oximetry, which shows the amount of oxygen circulating in viable pulp tissue and is a physiometric method for assessment of dental pulp status. Twenty patients were selected and two teeth of each of them (n = 40) were analyzed, regardless of the quadrant and the area irradiated, at four different times: I- before RT; IIat the beginning of RT with radiation doses between 30Gy 35Gy; III- at the end of RT (60Gy 70Gy) and IV- after 4-5 months of the beginning of the cancer treatment. Mean %SpO2 in the different times was 93%, 83%, 77% and 85%, respectively. Students t test (p0.01) showed statistically significant differences between Time I and the other three times. Time III was also different when compared to Time II, and there was no statistical difference between Times II and IV. It was concluded that %SpO2 before RT was greater than that observed during and after therapy and, as values obtained in Time IV were close to those of Time II, pulp tissue may show normal blood flow after radiation therapy.

"A wireless wearable battery-operated pulse oximeter has been developed in our laboratory for field triage applications. The wearable pulse oximeter, which uses a forehead-mounted sensor to provide arterial oxygen saturation (SpO2) and heart rate (HR) information, would enable field medics to monitor vital physiological information following critical injuries, thereby helping to prioritize life saving medical interventions. This study was undertaken to investigate if accelerometry (ACC)-based adaptive noise cancellation (ANC) is effective in minimizing SpO2 and HR errors induced during jogging to simulate certain motion artifacts expected to occur in the field. Preliminary tests confirmed that processing the motion corrupted photoplethysmographic (PPG) signals by simple Least-Mean-Square (LMS) and Recursive Least-Squares (RLS) ANC algorithms can help to improve the signal-to-noise ratio of motion-corrupted PPG signals, thereby reducing SpO2 and HR errors during jogging. The study showed also that the degree of improvement depends on filter order. In addition, we found that it would be more feasible to implement an LMS adaptive filter within an embedded microcontroller environment since the LMS algorithm requires significantly less operations."

INTRODUÇÃO: Uma alta prevalência de apnéia obstrutiva do sono (AOS) tem sido relatada em paciente com doença arterial coronária (DAC). Vários mecanismos relacionados à AOS, incluindo dessaturação da oxi-hemoglobina e aumento da demanda de oxigênio, aumento da atividade simpática bem como estado pro trombótico, podem ser perigosos nos pacientes com DAC. Entretanto, a AOS é pouco reconhecida e não é rotineiramente pesquisada nos pacientes admitidos em unidade de cuidados coronários (UCC) com DAC. O padrão ouro para o diagnóstico de AOS é a polissonografia noturna (PSG), método impraticável na UCC, pois implica no deslocamento do paciente para o laboratório de sono. OBJETIVOS: Construir e validar um monitor de oximetria para diagnóstico de AOS em pacientes admitidos na UCC com diagnóstico de DAC aguda. MÉTODOS: Foi inicialmente desenvolvido monitor de oximetria continua que registra os dados derivados dos monitores da UCC e permite a determinação do índice de dessaturação da oxi-hemoglobina (IDO) através de análise visual da curva de oximetria. O monitor foi então utilizado em pacientes consecutivos admitidos na UCC com diagnóstico de DAC aguda. Uma amostra desta população foi também estudada através de PSG, num período máximo de três meses após a alta. RESULTADOS: Trinta e sete pacientes foram estudados através de monitorização de oximetria durante a noite na UCC. PSG foi também realizada em vinte pacientes. AOS, diagnosticada pelo monitor de oximetria contínua (IDO > 5/hora), estava presente em 43% dos pacientes. AOS foi diagnosticada em 45% dos pacientes estudados com PSG (índice de apnéia e hipopnéia > 15 eventos por hora). Houve um bom nível de concordância entre o diagnóstico de AOS pelo monitor de oximetria na UCC e pela polissonografia - kappa = 0.898; p < 0.0001. O IDO determinado pelo monitor se correlacionou de forma significativa com o índice de apnéia e hipopnéia (r = 0.737; p < 0.0001). O diagnóstico de AOS através do monitor demonstrou sensibilidade de 88,9% e especificidade de 100%. CONCLUSÃO: O monitor desenvolvido no presente trabalho, que permite o registro da oximetria contínua a partir de dados que já são habitualmente coletados na UCC, é um método simples e preciso para o diagnóstico de AOS na UCC. / BACKGROND: A high prevalence of Obstructive sleep apnea (OSA) has been reported in patients with coronary artery disease (CAD). Several OSA related mechanisms, such as oxygen desaturation, high sympathetic activity, increased cardiac oxygen demand and a prothrombotic state, may be particularly dangerous in acute CAD patients. Nevertheless, OSA is frequently underdiagnosed and patients with CAD are not routinely screened for OSA when admitted to the Coronary Care Unit (CCU). OBJECTIVES: To build and validate a continuous overnight oximetry, by recording oximetry data derived from the CCU monitor, for the detection of OSA in acute CAD patients. DESIGN: We studied consecutive patients recruited on the basis of the presence of acute CAD requiring CCU, analyzed overnight continuous oximetry data and further compared it with full overnight polysomnography (PSG). RESULTS: Thirty-seven patients underwent overnight oxygen saturation monitoring in the CCU and 20 of these patients were submitted to PSG, performed within 3 months after hospital discharge. OSA was present in 43% and 45% of the patients studied by overnight oxygen saturation monitoring and PSG, respectively. The oxymetry derived oxygen desaturation index and the PSG derived apnea hypopnea index were strongly correlated (r = 0,737; p < 0,0001). There was a good level of agreement between abnormal oxymetric results and abnormal PSG results (kappa = 0.898; p < 0,0001). Overnight oximetry had a sensitivity of 88.9% and a specificity of 100% for OSA diagnosis. CONCLUSIONS: Continuous overnight oximetry derived from monitors that are already present in the CCU is a simple and accurate method for the diagnosis of OSA in the CCU.

A verificação da vitalidade pulpar depende de recursos semiotécnicos específicos, e, entre eles, os mais comumente empregados são os testes térmicos e elétrico. Tais testes apresentam limitações clínicas que interferem na análise e interpretação dos dados obtidos pelos mesmos. Os testes de sensibilidade são estímulos de origem térmica, elétrica ou mecânica aplicáveis ao dente e que são transmitidos às fibras nervosas sensitivas pulpares. Portanto, não leva em consideração a atividade circulatória do tecido pulpar e as condições de oxigenação, que são os reais indicadores da vitalidade do tecido. Nos casos de traumatismos dentários, por diversos fatores, a resposta pulpar se torna ainda mais difícil de obter. Assim, faz-se necessário avaliar o comportamento fisiológico pulpar através de testes denominados fisiométricos, destacando-se nesta área a oximetria de pulso, que é um método não invasivo e objetivo para determinação da saturação de oxigênio e taxa de pulso de um determinado tecido. Este estudo procurou estabelecer parâmetros para a utilização do oxímetro de pulso como teste de vitalidade pulpar, avaliando, comparativamente, os níveis de saturação de oxigênio obtidos do dedo indicador, de dentes controle positivo e de dentes permanentes traumatizados dos mesmos pacientes. Os dentes traumatizados apresentavam resposta negativa ao teste de sensibilidade pulpar com gás refrigerante e ausência de outro sinal ou sintoma indicativo de necrose pulpar. Os resultados mostraram que não houve diferença estatisticamente significante comparando-se as taxas de oxigenação dos dentes traumatizados nos três tempos (inicial, 30 e 60 dias) e que houve correlação entre as taxas de oxigenação do dedo indicador e dos dentes traumatizados e entre os dentes controle e os dentes traumatizados. Comparando-se as leituras obtidas neste estudo pode-se afirmar que taxas de oxigenação obtidas nos dentes traumatizados são confiáveis, permitindo ainda um monitoramento da condição pulpar ao longo do tempo. / The evaluation of pulp vitality depends on diagnosis methods. The most widely used are thermal and electric stimulation. However, thermal and electric testing has limitations in providing accurate diagnosis. These tests are subjective and depend upon perceived response of the patient to a stimulus, as well as the interpretation of that response by the dentist. The limitations with present pulp testing methods are that they only indirectly monitor pulp vitality by measuring neural responses and not circulation. For traumatized teeth, the pulp can be affected in a variety of ways as a function of the severity of the injury therefore, that teeth may not respond to vitality test and establishing an accurate and expedient diagnosis is even more complicated. Pulse oximetry is a completely objective test, requiring no sub jective response from the patient and directly measures the blood oxygen levels. This present study purpose was to evaluate the efficiency of pulse oximetry for testing pulp vitality by establishing correlation parameters between blood oxygen levels from the patient’s index finger, positive control teeth and traumatized permanent teeth which do not respond positively to thermal test with refrigerant spray and do not show any other sign or symptom of mortification. The results showed that there was no statistical significance between blood oxygen levels from traumatized teeth at the three different measure times (initial, 30 and 60 days) and there was a correlation between blood oxygen levels from index finger and the traumatized teeth and control teeth and traumatized teeth.

Background: Physiological studies have shown that many preterm infants and infants with chronic lung disease may suffer chronic hypoxaemia, which possibly leads to poor growth and development. Anecdotal reports indicate that there is a drive to increase the oxygen saturation target range to a higher level in these infants due primarily to perceived benefits derived from clinical experience and from uncontrolled observational studies of babies discharged on home oxygen. Objective The BOOST (Benefits Of Oxygen Saturation Targeting) trial is the first randomised trial to assess the long-term benefits and harms of two different oxygen saturation target ranges. Methods: BOOST was a multicentre, double blinded, randomised controlled trial that enrolled 358 infants born at less than 30 weeks� gestation who remained oxygen-dependent at 32 weeks postmenstrual age. They were randomly assigned to target either a functional oxygen saturation range of 91-94% (standard or control group) or 95-98% (higher or treatment group). The primary outcomes were growth and neurodevelopmental measures at 12 months corrected age. Secondary outcomes included length of hospital stay, retinopathy of prematurity, health service utilisation, parental stress, and infant temperament. Results: Prognostic baseline characteristics did not differ between the two groups. Mean birth weight and gestational age of enrolled infants was 917g and 26.5 weeks respectively. The rate of antenatal corticosteroid use was 83%.