Objetivo: Determinar la asociación de la mala autopercepción de la salud bucal con los síntomas del síndrome de apnea obstructiva del sueño (SAOS) en población adulta de los Estados Unidos de América. Materiales y métodos: Se realizó un estudio observacional transversal retrospectivo analítico, con un total de 2348 personas entre las edades comprendidas de 15 a 55 años tomadas de las encuestas National Health Nutrition Examination Survey (NHANES) durante el periodo 2015-2016 realizadas por el Center Disease Control and Prevention (CDC) de los Estados Unidos de América. Para la evaluación de ambas variables se emplearon preguntas de auto reporte. Asimismo, la comparación de la mala autopercepción de salud bucal con las características de los participantes se realizó mediante la prueba estadística Chi cuadrado. Para asociar la mala autopercepción de salud bucal con los síntomas del síndrome de apnea obstructiva del sueño (SAOS) se usó la regresión de Poisson para asociar la razón de prevalencia cruda y ajustada con un nivel de significancia de p < 0.05 e IC (95%). Resultados: Al asociar la mala autopercepción de salud bucal con los síntomas del síndrome de apnea obstructiva del sueño (SAOS), no se encontró asociación estadísticamente significativa p > 0.05. El 9.5% de participantes del sexo femenino tienen una mayor frecuencia de presentar una mala autopercepción de salud bucal en comparación al sexo opuesto. Conclusiones: En el presente estudio se observó que, la autopercepción de salud bucal no está relacionada con los síntomas tales como la somnolencia y ronquidos del síndrome de apnea obstructiva del sueño (SAOS). / Aim: Determine the association of negative self-perception of oral health with symptoms of obstructive sleep apnea syndrome (OSAS) disorders in the population aged 15 to 55 years of the United States of America. Materials and methods: An analytical retrospective cross-sectional observational study was carried out, with a total of 2348 people between the ages of 15 and 55 years taken from the National Health Nutrition Examination Survey (NHANES) during the period 2015-2016 carried out by the Center Disease Control and Prevention (CDC) of the United States of America. For the evaluation of both variables, self-report questions were used. Likewise, the comparison of the poor self-perception of oral health with the characteristics of the participants was carried out using the Chi square statistical test. To associate poor self-perceived oral health with obstructive sleep apnea syndrome (OSAS) symptoms, Poisson regression was used to associate crude and adjusted prevalence ratios with a significance level of p < 0.05 and CI (95%). Results: When associating poor self-perception of oral health with symptoms of obstructive sleep apnea syndrome (OSAS), no statistically significant association was found p > 0.05. While 9.5% of female participants have a higher frequency of presenting a poor self-perception of oral health compared to the opposite sex. Conclusions: In the present study, it was observed that oral health self-perception is not related to symptoms such as sleepiness and snoring of obstructive sleep apnea syndrome (OSAS) disorders. / Tesis

[pt] Para o diagnóstico de distúrbios do sono, um dos exames mais usado é a polissonografia (PSG), na qual é registrada uma variedade de sinais fisiológicos. O exame de PSG é observado por um especialista do sono, processo que pode levar muito tempo e incorrer em erros de interpretação. O presente trabalho desenvolve e compara o desempenho de quatro sistemas baseados em arquiteturas de redes neurais de aprendizado profundo, mais especificamente, redes convolutivas (CNN) e redes recorrentes Long-Short Term Memory (LSTM), para a identificação de despertares relacionados ao esforço respiratório (Respiratory Effort-Related Arousal-RERA) e a eventos de despertar relacionados à apneia/hipopneia. Para o desenvolvimento desta pesquisa, foram usadas as informações de apenas seis canais eletroencefalográficos (EEG) provenientes de 994 registros de PSG noturna da base de dados PhysioNet CinC Challenge2018, além disso, foi considerado o uso de class weight e Focal Loss para lidar com o desbalanceamento de classes. Para a avaliação de cada um dos sistemas foram usadas a Accuracy, AUROC e AUPRC como métricas de desempenho. Os melhores resultados para o conjunto de teste foram obtidos com os modelos CNN1 obtendo-se uma Accuracy, AUROC e AUPRC de 0,8404, 0,8885 e 0,8141 respetivamente, e CNN2 obtendo-se uma Accuracy, AUROC e AUPRC de 0,8214, 0,8915 e 0,8097 respetivamente. Os resultados restantes confirmaram que as redes neurais de aprendizado profundo permitem lidar com dados temporais de EEG melhor que os algoritmos de aprendizado de máquina tradicional, e o uso de técnicas como class weight e Focal Loss melhoram o desempenho dos sistemas. / [en] For the diagnosis of sleep disorders, one of the most commonly used tests is polysomnography (PSG), in which a variety of physiological signs are recorded. The study of PSG is observed by a sleep therapist, This process may take a long time and may incur misinterpretation. This work develops and compares the performance of four classification systems based on deep learning neural networks, more specifically, convolutional neural networks (CNN) and recurrent networks Long-Short Term Memory (LSTM), for the identification of Respiratory Effort-Related Arousal (RERA) and to events related to apnea/hypopnea. For the development of this research, it was used the Electroencephalogram (EEG) data of six channels from 994 night polysomnography records from the database PhysioNet CinC Challenge2018, the use of class weight and Focal Loss was considered to deal with class unbalance. Accuracy, AUROC, and AUPRC were used as performance metrics for evaluating each system. The best results for the test set were obtained with the CNN1 models obtaining an accuracy, AUROC and AUPRC of 0.8404, 0.8885 and 0.8141 respectively, and RCNN2 obtaining an accuracy, AUROC and AUPRC of 0.8214, 0.8915 and 0.8097 respectively. The remaining results confirmed that deep learning neural networks allow dealing with EEG time data better than traditional machine learning algorithms, and the use of techniques such as class weight and Focal Loss improve system performance.

Made available in DSpace on 2016-01-26T12:51:26Z (GMT). No. of bitstreams: 1 joaobatistasalomaojunior_tese.pdf: 726701 bytes, checksum: be09a3fcaa3d491c8ac2601eb72d7961 (MD5) Previous issue date: 2008-02-08 / Acute lower respiratory tract disease (ALRTD) accounts for high infantile mortality and morbidity rate worldwidely. Respiratory syncytial virus (RSV) is frequently found among pathogens. Objectives: The objectives were: 1) to evaluate the RSV frequency in children from 0 to 6 years hospitalized due to acute lower respiratory disease in São José do Rio Preto, SP; 2) to characterize the virus seasoning in this city and 3) to verify possible association among epidemiologic, clinical and diagnostic data with this viral agent. Casuistic and Method: From May 2004 to September 2005, 278 children aged from 0 to 6 years with ALRTD were studied. They have contracted the disease in the community, hospitalized in the children s ward, emergency room and Pediatric Intensive Care Unit of Hospital de Base, São José do Rio Preto. They were asymptomatic in a 7-day period before the beginning of the disease. Questionnaires were used for the children's characterization and their clinical presentation. Samples of nasopharyngeal secretion were collected to identify RSV, using reverse transcription polymerase chain reaction (RT-PCR). Results: The results showed that in the 290 hospitalizations of ALRTD, RSV was positive in 29.3%. ALRTD was more frequent in infants (average = 13.5 months) and male (57.6%). RSV was more frequent in bronchiolitis cases (64%). RSV+ infections were more frequent in the first year of life (35%). In RSV + infections, pneumonia frequency varied from 19.5 to 26.2% in the studied age groups; acute wheezing was observed in 31.8% of children aged over 2 years; bronchiolitis was registered in 62.5% of the children younger than 1 year; pneumonia with pleural effusion was noticed in 18.7% of the children aged over 2 years. Conclusions: The frequency of RSV in children from 0 to 6 years hospitalized due to ALRTD was 29.3% in São José do Rio Preto, SP. The ALRTD were more frequent between June and November 2004. In 2005, the hospitalizations occurred mainly starting from March decreasing in September. There was RSV prevalence in children younger than 2 years, male and with bronchiolitis. The RSV frequency in the hospitalizations was higher in 2004 than in 2005. In the RSV+ infections, the cases of pneumonia had similar occurrence in the studied age groups. There was reduction of the RSV frequency as age increases in the cases of pneumonia with pleural effusion and increase in the cases of acute wheezing; in bronchiolitis most of the RSV+ cases occurred in children younger than1 year. The clinical and radiological data obtained did not allow the proper identification of the infection by RSV. Laboratory examination by means of RT-PCR was necessary to identify it. / As doenças agudas do aparelho respiratório inferior (DARI) são responsáveis por altos índices de mortalidade e morbidade infantil em todo mundo. Dentre os patógenos predominantes encontra-se o vírus sincicial respiratório (VSR). Objetivos: Os objetivos foram: 1) avaliar a freqüência do VSR em crianças de 0 a 6 anos hospitalizadas por DARI em São José do Rio Preto, SP; 2) caracterizar a sazonalidade do vírus nessa cidade e 3) evidenciar possível associação de dados epidemiológicos, clínicos e diagnósticos e este agente viral. Casuística e Método: No período de maio de 2004 a setembro de 2005 foram estudadas 278 crianças de 0 a 6 anos com DARI adquirida na comunidade, internadas na enfermaria, emergência e Unidade de Terapia Intensiva Pediátrica do Hospital de Base de São José do Rio Preto, que estavam assintomáticas por um período de 7 dias antes do início da doença. Foram utilizados questionários para caracterização das crianças e do quadro clínico. Para identificação do VSR foram coletadas amostras de secreção de nasofaringe, utilizando-se a técnica de Reverse Transcription Polymerase Chain Reaction (RT-PCR). Resultados: Os resultados mostraram que nas 290 internações por DARI, o VSR foi positivo em 29,3%. DARI foi mais freqüente em lactentes (mediana = 13,5 meses) e do gênero masculino (57,6%). O VSR foi mais freqüente nos casos de bronquiolite (64%). As infecções VSR+ foram mais freqüentes no primeiro ano de vida (35%). Nas infecções VSR+, a freqüência de pneumonia variou de 19,5 a 26,2% nas faixas etárias estudadas; em 31,8% das crianças maiores de 2 anos observou-se sibilância aguda; bronquiolite foi registrada em 62,5% das crianças menores de 1 ano; pneumonia com derrame pleural foi notada em 18,7% das crianças maiores de 2 anos. Conclusões: A freqüência do VSR em crianças de 0 a 6 anos hospitalizadas por DARI em São José do Rio Preto, SP, foi 29,3%. As DARI foram mais freqüentes entre junho e novembro de 2004. Em 2005, as internações ocorreram principalmente a partir de março, com queda em setembro. Houve predomínio do VSR em crianças de 0 a 2 anos, do gênero masculino e com bronquiolite. A freqüência do VSR nas internações foi maior em 2004 que em 2005. Nas infecções VSR+ os casos de pneumonia tiveram ocorrência semelhante nas faixas etárias estudadas. Houve redução da freqüência do VSR com aumento da idade nos casos de pneumonia com derrame pleural e aumento nos casos de sibilância aguda; na bronquiolite a maioria dos casos VSR+ ocorreu em crianças menores de 1 ano. Os dados clínicos e radiológicos encontrados não permitiram a identificação correta da infecção pelo VSR, havendo necessidade do exame laboratorial pela técnica RT-PCR para sua identificação.

La Enfermedad Pulmonar Obstructiva Crónica (EPOC), presenta signos y síntomas sistémicos que se han venido explorando desde hace algún tiempo. La presente Tesis Doctoral estudia la disfunción que presentan los músculos respiratorios y periféricos, específicamente el cuádriceps de los pacientes con EPOC. Esta disfunción muscular afecta las actividades de la vida diaria, la tolerancia al ejercicio, limita la calidad de vida y disminuye la expectativa de vida de estos pacientes. Una de las posibles causas de disfunción muscular en los pacientes con EPOC puede ser la pérdida de masa muscular; por eso nos dedicamos a evaluar, los datos antropométricos de los pacientes con EPOC que asistieron durante 2 años a nuestro Laboratorio de Función Respiratoria del Hospital del Mar de Barcelona. La prevalencia de bajo peso en pacientes con EPOC en un hospital con predominante población mediterránea con, índice de masa corporal (IMC) por debajo de 20 Kg/m2, fue de tan sólo 6,6%, cifra que se reducía al 3,1% si el dintel escogido era de 18 Kg/m2. Estas cifras van claramente en oposición a la prevalencia referida en el mundo anglosajón y del norte-centro europeo, que muestra una prevalencia de bajo peso en pacientes con EPOC que oscila entre el 25 y el 35%. Teniendo en cuentas estos datos de baja prevalencia de bajo peso en nuestros pacientes con EPOC, no se explica la alta prevalencia de disfunción muscular en ellos. Por ello evaluamos variables de función muscular en pacientes con EPOC grave, específicamente del músculo cuádriceps y encontramos que los pacientes con EPOC tenían una disminución tanto de la fuerza muscular (43%), como de la resistencia muscular (77%), al compararlos con controles del mismo grupo etáreo.Tratando de profundizar en la causa de la disfunción muscular periférica en los pacientes con EPOC, hicimos a continuación otro estudio donde evaluamos el daño sarcoplásmico y sarcomérico mediante inmunohistoquímica y microscopía electrónica. Este trabajo demostró por primera vez que los pacientes con EPOC presentan mayor daño a nivel del músculo cuádriceps que los controles sanos.Debido a que en la EPOC los músculos periféricos, específicamente los de las extremidades inferiores, pudieran estar afectados por el sedentarismo, decidimos estudiar otras causas de disfunción muscular en un grupo de músculos en que este factor se hallara ausente, como son los músculos respiratorios. Estos mantienen su nivel de actividad normal o incluso aumentada. Para ello tomamos un músculo como el intercostal externo, que es fácilmente accesible a la biopsia, siguiendo un modelo mínimamente invasivo descrito por nuestro grupo. Como en trabajos precedentes ya habíamos valorado el daño sarcomérico, el estrés oxidativo o la actividad enzimática, en esta ocasión el trabajo se centró en la evaluación de la actividad inflamatoria. En él se ha demostrado que las citocinas proinflamatorias TNF-&#945; e IL-6 se encuentran aumentadas en los músculos intercostales externos de los pacientes con EPOC al compararlo con los controles sanos. / Chronic Obstructive Pulmonary Disease (COPD), shows systemic sign and symptoms that have been studied for some time. The present Doctoral Thesis studies the dysfunction shown by the respiratory and peripheral muscles, specifically the quadriceps muscle of patients with COPD. This muscle dysfunction affects the activities of daily living, tolerance to exercise, limits quality of life and diminishes life expectancy of these patients. One of the possible causes of muscle dysfunction in the patients with COPD could be the loss of muscle mass; for that reason we evaluated, the anthropometrics data of the patients with COPD that attended during 2 years our Respiratory Function Laboratory, Hospital del Mar of Barcelona. The prevalence of low weight in patients with COPD in a hospital with a predominantly Mediterranean population with an Body Mass Index (BMI) below 20 Kg/m2, was only 6.6%, a figure that was reduced to 3.1% if the chosen threshold was 18 Kg/m2. These numbers starkly contrast to the prevalence in Northern Europe, with a low weight in patients with COPD raging from 25 to 35%. Considering these data of low prevalence of low weight in our patients with COPD, the high prevalence of muscle dysfunction is not explained. We evaluated variables of muscle function in patients with severe COPD, specifically the quadriceps muscle and we found that the patients with COPD had a decreased muscle strength (43%), and muscle endurance (77%), when comparing with healthy age matched. To study the cause of the peripheral muscle dysfunction in patients with COPD, we began another study where we assessed sarcoplasmic and sarcomeric damage by immunohystochemical methods and electronic microscopy. This work demonstrated for the first time that patients with COPD show greater muscle injury at the quadriceps muscle level that healthy age matched controls.Because in COPD, peripheral muscles, specifically those of the lower limbs, could be affected by sedentarism, we decided to study other causes of muscle dysfunction in a muscle group in which this factor was absent, as they are the respiratory muscles. These maintain their level of normal activity or activity is even increased. For this we chose a respiratory muscle like the external intercostal muscle, that is easily accessible by biopsy, following a minumum invasive model described by our group. As in preceding works of our group we evaluated the sarcomeric damage, oxidative stress or the enzymatic activity, the present work was focused in the inflammatory activity evaluation. We demonstrated that proinflammatory cytokines such as TNF-&#945; and IL-6 are increased in the external intercostal muscles of patients with COPD when comparing with healthy age matched controls.