Made available in DSpace on 2014-06-11T19:32:13Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-11-23Bitstream added on 2014-06-13T20:23:13Z : No. of bitstreams: 1 rosa_dmc_dr_botfm.pdf: 3233881 bytes, checksum: 5694e4fedd14157940872a22ed833acc (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Diferentemente do que em países desenvolvidos nos quais tem havido redução do número, da morbidade e da mortalidade dos casos de queimadura, nos países em desenvolvimento estas taxas ainda são muito elevadas. Embora a queimadura seja um problema muito freqüente no Brasil, existem poucos estudos e dados epidemiológicos disponíveis. O presente trabalho teve como objetivos descrever a epidemiologia, identificar variáveis epidemiológicas e clínicas que influenciam no prognóstico de adultos queimados e fatores prognósticos. Estudo observacional, prospectivo, casos consecutivos de pacientes queimados com idade igual ou superior a 18 anos, internados na Unidade de Tratamento de Queimados (UTQ) de um hospital geral universitário de nível terciário, localizado na região centro-oeste do Estado de São Paulo, sudeste do Brasil, que atende exclusivamente pacientes do Sistema Único de Saúde, no período de maio de 2006 a julho de 2007. Dos prontuários e do exame clínico dos pacientes foram extraídos os seguintes dados: sexo, idade, características da queimadura (agente, causa, extensão e profundidade), intervalo de tempo entre a queimadura e a internação, presença de lesão inalatória, complicações e tempo de permanência. Em um grupo de 25 pacientes foi possível a dosagem sérica de dímero D e de proteína C reativa nas primeiras 48 horas e no 7º dia após a queimadura. O desfecho final considerado foi alta hospitalar ou óbito. Foi realizada comparação entre os grupos de acordo com o desfecho, sendo as variáveis quantitativas analisadas pelos testes t de Student, teste de Wilcoxon ou das medianas para amostras independentes, dependendo da normalidade dos dados, e as variáveis qualitativas pelo teste de diferença de proporções. Considerando o desfecho como variável resposta, foi ajustada uma regressão logística em função das variáveis clínicas... / Differently from developed countries in which there have been a reduction in the numbers of deaths in burn cases, in third world countries these numbers still very high. Even thou burns are a very frequent problem in Brazil, there are few studies and even fewer epidemiological data available. To describe the epidemiology and identify epidemiological variables and clinics that influence in the prognostic of adult burn patients. Observational, prospective study and series of adult burn cases, of which all are of 18 years of age or above, admitted in the Burn Care Unit of a tertiary referral University Hospital, in the central-west region of the state of São Paulo, southeast Brazil, that treats exclusively public health system, from May of 2006 to July of 2007. From the patients file and physical examination the following data has been extracted: sex, age, characteristics of the burn (cause, agent, extension and depth), time between the time of the burn and the admittance into the hospital, presence of inhalation injury, complications and duration of the hospital stay. The endpoint was considered release from the hospital or death. A comparison was made between the groups according to the endpoint, variables being quantized analyzed by the t Student and Wilcoxon tests or median by independent sampling, depending of the normality of the data and qualities variables by which were shown differences in the test. Considering the endpoint with a variable answer, the formula was readjusted by logistical regression due to the variable clinics. For the lenght stay there were calculated the survival curves by the Kaplan-Meier method, considering the endpoint as a censorship variable of all the patients, stratified by age, inhalation injury, depth, agent, cause and extension of the burn. In cases of curves obtained by stratification there was applied... (Complete abstract click electronic access below)

Orientador: Thais Helena Abrahão Thomaz Queluz / Banca: Ana Lúcia Gut / Banca: Lydia M. Terruira / Banca: Pedro Caruzo / Banca: Luis Cuadrado Martin / Acompanha 1 CD-Rom / Resumo: Diferentemente do que em países desenvolvidos nos quais tem havido redução do número, da morbidade e da mortalidade dos casos de queimadura, nos países em desenvolvimento estas taxas ainda são muito elevadas. Embora a queimadura seja um problema muito freqüente no Brasil, existem poucos estudos e dados epidemiológicos disponíveis. O presente trabalho teve como objetivos descrever a epidemiologia, identificar variáveis epidemiológicas e clínicas que influenciam no prognóstico de adultos queimados e fatores prognósticos. Estudo observacional, prospectivo, casos consecutivos de pacientes queimados com idade igual ou superior a 18 anos, internados na Unidade de Tratamento de Queimados (UTQ) de um hospital geral universitário de nível terciário, localizado na região centro-oeste do Estado de São Paulo, sudeste do Brasil, que atende exclusivamente pacientes do Sistema Único de Saúde, no período de maio de 2006 a julho de 2007. Dos prontuários e do exame clínico dos pacientes foram extraídos os seguintes dados: sexo, idade, características da queimadura (agente, causa, extensão e profundidade), intervalo de tempo entre a queimadura e a internação, presença de lesão inalatória, complicações e tempo de permanência. Em um grupo de 25 pacientes foi possível a dosagem sérica de dímero D e de proteína C reativa nas primeiras 48 horas e no 7º dia após a queimadura. O desfecho final considerado foi alta hospitalar ou óbito. Foi realizada comparação entre os grupos de acordo com o desfecho, sendo as variáveis quantitativas analisadas pelos testes t de Student, teste de Wilcoxon ou das medianas para amostras independentes, dependendo da normalidade dos dados, e as variáveis qualitativas pelo teste de diferença de proporções. Considerando o desfecho como variável resposta, foi ajustada uma regressão logística em função das variáveis clínicas... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Differently from developed countries in which there have been a reduction in the numbers of deaths in burn cases, in third world countries these numbers still very high. Even thou burns are a very frequent problem in Brazil, there are few studies and even fewer epidemiological data available. To describe the epidemiology and identify epidemiological variables and clinics that influence in the prognostic of adult burn patients. Observational, prospective study and series of adult burn cases, of which all are of 18 years of age or above, admitted in the Burn Care Unit of a tertiary referral University Hospital, in the central-west region of the state of São Paulo, southeast Brazil, that treats exclusively public health system, from May of 2006 to July of 2007. From the patients file and physical examination the following data has been extracted: sex, age, characteristics of the burn (cause, agent, extension and depth), time between the time of the burn and the admittance into the hospital, presence of inhalation injury, complications and duration of the hospital stay. The endpoint was considered release from the hospital or death. A comparison was made between the groups according to the endpoint, variables being quantized analyzed by the t Student and Wilcoxon tests or median by independent sampling, depending of the normality of the data and qualities variables by which were shown differences in the test. Considering the endpoint with a variable answer, the formula was readjusted by logistical regression due to the variable clinics. For the lenght stay there were calculated the survival curves by the Kaplan-Meier method, considering the endpoint as a censorship variable of all the patients, stratified by age, inhalation injury, depth, agent, cause and extension of the burn. In cases of curves obtained by stratification there was applied... (Complete abstract click electronic access below) / Doutor

Sepsis remains the second largest killer in the Intensive Care Unit (ICU), giving rise to a significant economic burden ($17b per annum in the US, 0.3% of the gross domestic product). The aim of the work described in this thesis is to improve the estimation of severity in this population, with a view to improving the allocation of resources. A cohort of 2,143 adult patients with sepsis and hypotension was identified from the MIMIC-II database (v2.26). The implementation of state-of-the-art models confirms the superiority of the APACHE-IV model (AUC=73.3%) for mortality prediction using ICU admission data. Using the same subset of features, state-of-the art machine learning techniques (Support Vector Machines and Random Forests) give equivalent results. More recent mortality prediction models are also implemented and offer an improvement in discriminatory power (AUC=76.16%). A shift from expert-driven selection of variables to objective feature selection techniques using all available covariates leads to a major gain in performance (AUC=80.4%). A framework allowing simultaneous feature selection and parameter pruning is developed, using a genetic algorithm, and this offers similar performance. The model derived from the first 24 hours in the ICU is then compared with a “dynamic” model derived over the same time period, and this leads to a significant improvement in performance (AUC=82.7%). The study is then repeated using data surrounding the hypotensive episode in an attempt to capture the physiological response to hypotension and the effects of treatment. A significant increase in performance (AUC=85.3%) is obtained with the static model incorporating data both before and after the hypotensive episode. The equivalent dynamic model does not demonstrate a statistically significant improvement (AUC=85.6%). Testing on other ICU populations with sepsis is needed to validate the findings of this thesis, but the results presented in it highlight the role that data mining will increasingly play in clinical knowledge generation.