IOT BASED REAL TIME TELE-HEALTHCARE SYSTEM

Tele-healthcare is need of the hour to bridge the vast healthcare gap in developing country like India. Being the second most populous country, quality healthcare facility is not easily accessible in the rural outskirts of India. In this research work the proposed system has acquired ECG, heart rate, SpO2 and body temperature data for better diagnosis and prognosis. The proposed system has been tested on the different patients belonging to different age groups and the result obtained on the health monitoring dashboard is found to be satisfactory. It also provides enhanced accessibility as multiple healthcare professionals can collaborate on the patient's data. This paper concludes with real time audio/ video connectivity, scope of interest of which is very effective and applicable in healthcare world.

Evaluation of the QTc internal and QT dispersion in patients with newly detected clinical hypothyroidism

Background: Thyroid hormones play an important role in the orchestration of various metabolic functions in the body and thus thyroid dysfunction can produce dramatic cardiovascular effects. Electrocardiographic changes such as bradycardia, low voltage complexes, and varying degrees of heart block are commonly recognized in hypothyroid patients. Hypothyroidism has been found to be associated with increased cardiovascular morbidity and mortality. Hence, it is important to investigate the ECG profile in these patients. The present study was aimed at evaluating the QTc interval and QT dispersion, an indicator of inhomogeneity of ventricular repolarisation and cardiac autonomic modulation in patients with newly detected clinical hypothyroidism.Methods: 50 patients with newly detected clinical hypothyroidism and 50 healthy controls were included in the study. The ECG was recorded and the heart-rate, QTc interval and QT dispersion were calculated.Results: The mean heart-rate was found to be significantly (p <0.05) reduced in hypothyroid patients when compared to healthy controls. The mean QTc interval and QT dispersion were significantly increased in hypothyroid patients when compared to controls. QTmin and QTmax of cases and controls also showed a statistically significant difference.Conclusion: Thus, the present study confirms the role of thyroid hormones on the cardiovascular system, particularly on ventricular repolarisation and cardiac autonomic modulation. Hence, early and prompt therapy with levothyroxine may help to prevent the adverse events resulting from cardiovascular dysfunction.

Sympathetic Overactivity Based on Heart-Rate Variability in Patients with Obstructive Sleep Apnea and Cerebral Small-Vessel Disease

BACKGROUND AND PURPOSE: Obstructive sleep apnea (OSA) is associated with cerebral white-matter changes (WMC), but the underlying mechanisms are not completely understood. Our aim was to identify the cardiovascular autonomic characteristics during sleep that are associated with cerebral WMC in OSA patients. METHODS: We recruited subjects from our sleep-center database who underwent both polysomnography and brain MRI within a 1-year period. Sixty patients who had OSA with WMC (OSA+WMC), 44 patients who had OSA without WMC (OSA−WMC), and 31 control subjects who had neither OSA nor WMC were analyzed. Linear and nonlinear indices of heart-rate variability (HRV) were analyzed in each group according to different sleep stages and also over the entire sleeping period. RESULTS: Among the nonlinear HRV indices, the Poincaré ratio (SD12) during the entire sleep period was significantly increased in the OSA+WMC group, even after age adjustment. Meanwhile, detrended fluctuation analysis 1 during non-rapid-eye-movement sleep tended to be lowest in the OSA+WMC group. These indices were altered regardless of the presence of hypertension or diabetes. In the subgroup analysis of middle-aged OSA patients, approximate entropy during rapid-eye-movement sleep was significantly lower in OSA+WMC patients than in OSA−WMC patients. Overall, the nonlinear HRV indices suggest that sympathetic activity was higher in the OSA+WMC group than in the OSA−WMC and control groups. CONCLUSIONS: Our findings suggest that dysregulation of HRV, especially overactivation of sympathetic tone, could be a pathophysiologic mechanism underlying the development of WMC in OSA patients.

Impaired functional and hemodynamic response to graded exercise testing and its recovery in patients with subclinical hyperthyroidism / Capacidade funcional e hemodinâmica em esforço e na recuperação de pacientes com hipertireoidismo subclínico

OBJECTIVE: To evaluate the functional and hemodynamic responses during exercise and its recovery in patients with subclinical hyperthyroidism (SCH). SUBJECTS AND METHODS: A cross-sectional study was carried out with 29 patients on TSH-suppressive therapy with levothyroxine for thyroid carcinoma and 35 euthyroid subjects. All volunteers underwent a cardiopulmonary exercise testing on a treadmill and functional and hemodynamic variables were measured during exercise and its recovery. RESULTS: SCH patients showed impaired functional response to exercise, marked by lower values for oxygen consumption and exercise duration in addition to premature achievement of the anaerobic threshold. Heart-rate and blood pressure recovery immediately after exercise were slower among SCH patients when compared to euthyroid subjects. CONCLUSION: SCH is associated with impaired functional and hemodynamic responses during exercise and its recovery.

OBJETIVO: Avaliar a capacidade funcional e hemodinâmica em esforço e durante a recuperação em pacientes com hipertireoidismo subclínico (SCH). SUJEITOS E MÉTODOS: Foi realizado um estudo seccional em que participaram 29 pacientes em terapia supressiva de TSH com levotiroxina para carcinoma diferenciado de tireoide e 35 indivíduos sem doença tireoidiana. Todos foram submetidos a um teste cardiopulmonar de esforço em esteira, no qual foram medidas variáveis funcionais e hemodinâmicas durante o exercício e a recuperação. RESULTADOS: Os pacientes apresentaram um comprometimento na capacidade funcional, evidenciado por menores valores de consumo de oxigênio e duração de exercício, além do alcance prematuro do limiar anaeróbio. Imediatamente após o exercício, os pacientes apresentaram uma curva mais lenta de recuperação da frequência cardíaca e da pressão arterial. CONCLUSÃO: O SCH está associado ao comprometimento na capacidade funcional e hemodinâmica em esforço e na recuperação.

Association between Autonomic Nervous Activities of Climacteric Patients and Undefined Symptoms / 日本東洋医学雑誌

This study was designed to investigate the association between autonomic nervous activities and clinical symptoms of climacteric women with qi disturbance. Power spectral analysis of heart-rate variability (HRV) was performed in 55 climacteric patients with undefined symptoms (age;51.9±2.8). The total power of HRV in patients with hot flushes was significantly higher (529.6±529.9ms2) than that of patients without this symptom (295.4±260.8 ms2) (P<0.05). The sympathetic nerve system (SNS) index in patients with hot flushes and with jitters (2.81±2.93 and 3.16±2.78), was significantly higher than those of patients without them (1.03±0.78 and 0.87±0.72) (P<0.001 and P<0.0001, respectively). The parasympathetic nerve system (PNS) index of patients with hot flushes and patients with jitters (0.38±0.19 and 0.33±0.16) was significantly lower than those of patients without them (0.55±0.17 and 0.58±0.14) (P<0.001 and P<0.0001, respectively). These findings indicate that HRV-based assessment of the autonomic nervous system activity of climacteric women with hot flushes and jitters, which have been known as symptoms of qi counterflow in the Kampo medicine, is associated with an increase in sympathetic nerve system and a decrease in parasympathetic nerve system activity. It has been suggested that autonomic nervous activities be included in the part of pathological condition of qi in the Kampo medicine, and that evaluation of qi be used as one diagnostic tool in the practical Kampo medicine, or fusion of western and oriental medicine.

Noninvasive measurement of cardiac performance in recovery from exercise in heart failure patients

OBJECTIVE: To examine the association between cardiac performance during recovery and the severity of heart failure, as determined by clinical and cardiopulmonary exercise test responses. METHODS: As part of a retrospective cohort study, 46 heart failure patients and 13 normal subjects underwent cardiopulmonary exercise testing while cardiac output was measured using a noninvasive device. Cardiac output in recovery was expressed as the slope of a single exponential relationship between cardiac output and time; the recovery-time constant was assessed in relation to indices of cardiac function, along with clinical, functional, and cardiopulmonary exercise responses. RESULTS: The recovery time constant was delayed in patients with heart failure compared with normal subjects (296.7 + 238 vs. 110.1 +27 seconds, p <0.01), and the slope of the decline of cardiac output in recovery was steeper in normal subjects compared with heart failure patients (p,0.001). The slope of the decline in cardiac output recovery was inversely related to peak VO2 (r = -0.72, p<0.001) and directly related to the VE/VCO2 slope (r = 0.57, p,0.001). Heart failure patients with abnormal recovery time constants had lower peak VO2, lower VO2 at the ventilatory threshold, lower peak cardiac output, and a heightened VE/VCO2 slope during exercise. CONCLUSIONS: Impaired cardiac output recovery kinetics can identify heart failure patients with more severe disease, lower exercise capacity, and inefficient ventilation. Estimating cardiac output in recovery from exercise may provide added insight into the cardiovascular status of patients with heart failure.

Deep breathing heart rate variability is associated with respiratory muscle weakness in patients with chronic obstructive pulmonary disease

BACKGROUND: A synchronism exists between the respiratory and cardiac cycles. However, the influence of the inspiratory muscle weakness in chronic obstructive pulmonary disease (COPD) on cardiac autonomic control is unknown. The purpose of the present investigation was to evaluate the influence of respiratory muscle strength on autonomic control in these patients. METHODS: Ten chronic obstructive pulmonary disease patients (69±9 years; FEV1/FVC 59±12 percent and FEV1 41±11 percent predicted) and nine age-matched healthy volunteers (64±5 years) participated in this study. Heart-rate variability (HRV) was obtained at rest and during respiratory sinusal arrhythmia maneuver (RSA-M) by electrocardiograph. RESULTS: Chronic obstructive pulmonary disease patients demonstrated impaired cardiac autonomic modulation at rest and during RSA-M when compared with healthy subjects (p<0.05). Moreover, significant and positive correlations between maximal inspiratory pressure (MIP) and the inspiratory-expiratory difference (ΔIE) (r = 0.60, p<0.01) were found. CONCLUSION: Patients with chronic obstructive pulmonary disease presented impaired sympathetic-vagal balance at rest. In addition, cardiac autonomic control of heart rate was associated with inspiratory muscle weakness in chronic obstructive pulmonary disease. Based on this evidence, future research applications of respiratory muscle training may bring to light a potentially valuable target for rehabilitation.

Efeito da imersão sobre o comportamento do consumo de oxigênio de repouso / Effect of immersion over oxigen consumption behavior during rest

O objetivo deste estudo foi analisar o efeito da imersão sobre VO2 de repouso (ml/kg/min). A amostra foi composta por 6 mulheres praticantes de hidroginástica (idade: 21,3 ± 1,03 anos, massa corporal: 57 ± 4,29 kg, estatura: 164,5 ± 4,09 cm), avaliadas em diferentes situações experimentais (SE) na seguinte ordem: 20 minutos em repouso em decúbito dorsal fora da água (DD); 5 minutos na posição ortostática fora da água (OF) e 3 minutos em repouso na posição ortostática com imersão ao nível do processo xifóide (OI). Cada SE foi realizada em três dias diferentes, com intervalo de 48 horas, a fim de avaliar o efeito da variação metabólica dos indivíduos. A temperatura da água variou entre 32 e 33 °C. Para a coleta de VO2 foi utilizado o analisador de gases Aerosport KB1- C. Utilizou-se ANOVA para medidas repetidas e ANOVA One Way (Bonferroni) (p<0,05). Não foram encontradas diferenças estatisticamente significativas entre as mesmas SE nos três dias de coleta. Dessa forma, os dados das SE semelhantes foram somadas e suas médias utilizadas para comparação entre diferentes SEs. Encontramos um aumento no VO2 de DD (3,17 ± 0,34) para OF (3,62 ± 0,36) e dessa para a OI (3,98 ± 0,44), entretanto foram encontradas diferenças significativas somente entre a DD e OI. A imersão no processo xifóide na temperatura avaliada provocou aumento significativo do VO2 em repouso nos 3 primeiros minutos de imersão somente com a associação da mudança de posição corporal.

The aim of this study was to analyse the effect of immersion over rest VO2. The sample complised of six women that practice water exercise, aging 21.3 ± 1.03 years, body mass 57 ± 4.29 kg, height 164 ± 4.09 cm, which were evaluated in the following experimental situations: 20 minutes of rest in dorsal decumbant outside the water (DD); 5 minutes of orthostatic position outside the water (OO); and 3 minutes of rest in orthostatic position under immersion at the xyphoid process level (OI). Each experimental situation was procceeded in three days, with intervals of 48 hours, to evaluate the effect of metabolic variation of the individuals. The water temperature varied between 32 and 33oC. The VO2 analyses were done through a KB1-C Aerosport gás analyser. Repeted measurements and One Way ANOVA (Bonferroni) (p<0.05) were used for statistical analysis. There were no statistically significant differences among the same experimental situations. These datas were added and your means used for comparison among different experimental situations. There was a raise of VO2 in DD (3.17 ± 0.36) when compared to OO (3.62 ± 0.34), which was different than the OI (3.98 ± 0.44), but the differences were significant only for the first and third experimental situations. Water immersion of xyphoid process in the temperature used caused a significant raise of VO2 under rest during the three firts minutes of immersion only with the association of a change in body position.

Method to transfer physiological data through carrier-current communication / 医疗卫生装备

This article describes a method totransfer physiological data through carrier-current communication.The microcontroller measures the data of heartrate and body temperature and sends them through the serial port tothe carrier-current module implementing carrier-current communication.This method can be used totransfer physiological data through short distance less than200meters.