Signal processing and machine learning algorithm to classify anaesthesia depth.

BACKGROUND: Poor assessment of anaesthetic depth (AD) has led to overdosing or underdosing of the anaesthetic agent, which requires continuous monitoring to avoid complications. The evaluation of the central nervous system activity and autonomic nervous system could provide additional information on the monitoring of AD during surgical procedures. METHODS: Observational analytical single-centre study, information on biological signals was collected during a surgical procedure under general anaesthesia for signal preprocessing, processing and postprocessing to feed a pattern classifier and determine AD status of patients. The development of the electroencephalography index was carried out through data processing and algorithm development using MATLAB V.8.1. RESULTS: A total of 25 men and 35 women were included, with a total time of procedure average of 109.62 min. The results show a high Pearson correlation between the Complexity Brainwave Index and the indices of the entropy module. A greater dispersion is observed in the state entropy and response entropy indices, a partial overlap can also be seen in the boxes associated with deep anaesthesia and general anaesthesia in these indices. A high Pearson correlation might be explained by the coinciding values corresponding to the awake and general anaesthesia states. A high Pearson correlation might be explained by the coinciding values corresponding to the awake and general anaesthesia states. CONCLUSION: Biological signal filtering and a machine learning algorithm may be used to classify AD during a surgical procedure. Further studies will be needed to confirm these results and improve the decision-making of anaesthesiologists in general anaesthesia.

Analysis of the quality of prenatal data of pregnant women attended at Healthcare Services in the city of São Paulo between 2012 and 2020 / Análise da qualidade dos dados de pré-natal de gestantes atendidas em Unidades Básicas de Saúde do município de São Paulo entre 2012 e 2020

ABSTRACT Objective: To analyze the quality of data collected during prenatal care recorded in the Integrated Health Care Management System (SIGA) of the Municipal Department of Health of São Paulo from 2012 to 2020. Methods: Descriptive study using SIGA data and the variables: maternal height (cm), weight (kg) measured throughout pregnancy, gestational age at prenatal consultation, systolic (SBP) and diastolic (DBP) blood pressure (in mmHg), and body mass index (BMI) at the beginning of pregnancy (up to 8 weeks). Quality analysis was carried out by calculating the indicators: percentage of incompleteness and zero values of all variables studied, percentage of implausible values for height, weight, BMI; preference for terminal digit of weight and height, and normality of distributions. Results: The database of pregnant women made available for analysis included 8,046,608 records and 1,174,115 women. The percentage of incompleteness and zero values was low (<1%) in all original variables of the system. There are more records at the end of pregnancy. For the four original variables of interest in the database (weight, height, SBP, DBP), there is a clear preference for the terminal digit. The variables of interest did not present an approximately normal distribution during the evaluated period. Conclusion: The quality analysis showed the need for improving the standardization of information collection and recording, the rounding of measurements and the need for encouraging pregnant women to start prenatal care as soon as possible, in such a way that it is important to invest in data quality, through educational resources for professionals who work in health care.

RESUMO Objetivo: Analisar a qualidade dos dados coletados no acompanhamento pré-natal registrados no Sistema Integrado de Gestão da Assistência à Saúde (SIGA) da Secretaria Municipal de Saúde de São Paulo de 2012 a 2020. Métodos: Estudo descritivo utilizando dados do SIGA e as variáveis: altura materna (cm), peso (kg) medido ao longo da gestação, idade gestacional na consulta pré-natal, pressão arterial (em mmHg) sistólica (PAS) e diastólica (PAD), e índice de massa corporal (IMC) no início da gestação (até 8 semanas). A análise da qualidade foi realizada por meio do cálculo dos indicadores: percentual de incompletude e valores zero de todas as variáveis estudadas, percentual de valores implausíveis de estatura, peso, IMC; preferência por dígito terminal do peso e estatura, e normalidade das distribuições. Resultados: Base de dados de gestantes disponibilizada para análise incluía 8.046.608 registros e 1.174.115 mulheres. O percentual de incompletude e valores zeros foi baixo (<1%) em todas as variáveis originais do sistema. Existe maior número de registros ao final da gestação. Para as quatro variáveis de interesse originais do banco de dados (peso, altura, PAS, PAD), existe clara preferência por dígito terminal. As variáveis de interesse não apresentaram distribuição aproximadamente normal durante o período avaliado. Conclusão: A análise da qualidade mostrou necessidade de melhoria na padronização da coleta e do registro das informações, no arredondamento das medidas e na necessidade de incentivar as gestantes a iniciar o pré-natal o quanto antes; por isso, é importante investir na qualidade do dado, por meio de recursos educativos para profissionais que atuam na assistência.

A retrospective study of reducing unnecessary thyroid biopsy for American College of Radiology Thyroid Imaging Reporting and Data Systems 4 assessment through applying shear wave elastography

ABSTRACT Objective The purpose of the study is to quantitatively assess shear-wave elastography (SWE) value in American College of Radiology Thyroid Imaging Reporting and Data Systems (ACR TI-RADS) 4. Materials and methods One hundred and fifty-two ACR TI-RADS 4 thyroid nodules undergoing SWE were included in the study. The mean (EMean), minimum (EMin) and maximum (EMax) of SWE elasticity were measured. Results The areas under the receiver operating characteristic (ROC) curves for SWE EMean, EMin and EMax in detecting benign and malignant nodules were 0.95, 0.83 and 0.84, respectively. Cut-off value of EMean ≤ 23.30 kPa is able to downgrade the lesion category to ACR TI-RADS 3 and cut-off value of EMean ≥ 52.14 kPa is able to upgrade the lesion category to ACR TI-RADS 5. Conclusions The EMean of SWE will probably identify nodules that have a high potential for benignity in ACR TI-RADS 4. It may help identify and select benign nodules while reducing unnecessary biopsy of benign thyroid nodules.

Diagnostic accuracy of retrospective application of the Vesical Imaging-Reporting and Data System: preliminary results.

OBJECTIVE: To evaluate the retrospective accuracy of the Vesical Imaging-Reporting and Data System (VI-RADS) in detecting muscle invasion in bladder cancer. MATERIALS AND METHODS: We investigated patients who underwent pelvic magnetic resonance imaging and were submitted to transurethral resection of a bladder tumor between 2015 and 2018. Thirty cases were reviewed by radiologists blinded to the final clinical stage. The VI-RADS score was applied and compared with the histopathological findings in the surgical specimen. RESULTS: Of the 30 patients with suspicious bladder lesions, 5 (16.6%) had benign histopathological findings, 17 (56.6%) had non-muscle-invasive bladder cancer, and 8 (26.6%) had muscle-invasive bladder cancer. The optimal criterion to detect muscle-invasive bladder cancer was a final VI-RADS score > 3, for which the sensitivity and specificity were 100% (95% CI: 56.0-100%) and 90.9% (95% CI: 69.3-98.4%), respectively. CONCLUSION: The VI-RADS appears to estimate correctly the degree of muscle invasion in suspicious bladder lesions. However, prospective studies evaluating larger samples are needed in order to validate the method.

Diagnostic accuracy of retrospective application of the Vesical Imaging-Reporting and Data System: preliminary results / Resultados preliminares da aplicação retrospectiva do Vesical Imaging-Reporting and Data System

Abstract Objective: To evaluate the retrospective accuracy of the Vesical Imaging-Reporting and Data System (VI-RADS) in detecting muscle invasion in bladder cancer. Materials and Methods: We investigated patients who underwent pelvic magnetic resonance imaging and were submitted to transurethral resection of a bladder tumor between 2015 and 2018. Thirty cases were reviewed by radiologists blinded to the final clinical stage. The VI-RADS score was applied and compared with the histopathological findings in the surgical specimen. Results: Of the 30 patients with suspicious bladder lesions, 5 (16.6%) had benign histopathological findings, 17 (56.6%) had non-muscle-invasive bladder cancer, and 8 (26.6%) had muscle-invasive bladder cancer. The optimal criterion to detect muscle-invasive bladder cancer was a final VI-RADS score > 3, for which the sensitivity and specificity were 100% (95% CI: 56.0-100%) and 90.9% (95% CI: 69.3-98.4%), respectively. Conclusion: The VI-RADS appears to estimate correctly the degree of muscle invasion in suspicious bladder lesions. However, prospective studies evaluating larger samples are needed in order to validate the method.

Resumo Objetivo: O objetivo deste estudo foi avaliar retrospectivamente a acurácia do Vesical Imaging-Reporting and Data System (VI-RADS) para detectar invasão muscular em câncer de bexiga. Materiais e Métodos: Foram inseridos pacientes submetidos a ressonância magnética pélvica e a ressecção transuretral de bexiga entre 2015 e 2018. Trinta casos foram revisados, sem o conhecimento do estágio clínico final. O escore do VI-RADS foi aplicado e comparado aos achados histopatológicos da ressecção transuretral de bexiga. Resultados: Entre os 30 pacientes com lesões vesicais suspeitas, 5 (16,6%) tinham achados histopatológicos benignos, 17 (56,6%) tinham câncer de bexiga não músculo invasivo e 8 (26,6%) tinham câncer de bexiga músculo invasor. O critério ideal para detectar câncer de bexiga músculo invasor foi o escore final do VI-RADS > 3, em que sensibilidade e especificidade foram, respectivamente, 100% (IC 95%: 56,0-100%) e 90,9% (IC 95%: 69,3-98,4%). Conclusão: O VI-RADS parece estimar corretamente o grau de invasão muscular em lesões suspeitas da bexiga; no entanto, estudos maiores e prospectivos são necessários para validar o método.

Consumo de frutas, legumes e verduras na Região Centro-Oeste do Brasil: prevalência e fatores associados / Consumption of fruit, greens and vegetables in the Midwest region of Brazil: prevalence and associated factors

Resumo Estudo transversal, baseado em dados do sistema de monitoramento por inquérito telefônico - VIGITEL, com o objetivo de estimar a prevalência e os fatores associados ao consumo recomendado de frutas, legumes e verduras (FLV) em 6696 indivíduos com idade ≥ 18 anos, de ambos os sexos, residentes na Região Centro-Oeste do Brasil, em 2012. O consumo recomendado foi a variável dependente e variáveis sociodemográficas, comportamentais e relacionadas à saúde foram as independentes. A prevalência do consumo recomendado de FLV foi de 26,3%, sendo maior entre as mulheres (RPaj = 1,44; IC95% = 1,29-1,62). A regressão de Poisson entre o desfecho e as variáveis independentes mostrou maior prevalência do consumo recomendado entre as mulheres residentes no Distrito Federal, casadas e que consideravam seu estado de saúde como bom/muito bom. Em ambos os sexos, observou-se associação direta do desfecho com a escolaridade, idade e prática de atividade física e associação inversa com o consumo de alimentos não saudáveis. Devido à baixa prevalência do consumo recomendado de FLV na população da Região Centro-Oeste do Brasil no ano de 2012, propõe-se que as estratégias de intervenção para melhorar o consumo desses alimentos sejam feitas de forma globalizada.

Abstract This is a cross-sectional study based on data from the VIGITEL telephone health monitoring survey, aiming to describe the prevalence of adequate fruit, greens and vegetable intake and to identify associated factors. This population-based study included 6696 individuals aged ≥ 18 years, living in the Midwest of Brazil, in 2012. The adequate consumption of fruit, greens and vegetables (FGV) was the dependent variable and sociodemographic, behavioral and health factors were the independent variables. The prevalence of adequate FGV consumption was 26.3%, being higher among women (RPaj = 1.44; CI95% = 1.29-1.62). The Poisson regression showed that the adequate consumption of FGV was higher among women resident in the Federal District, married and who considered their own health as good/very good. In both genders there was a direct association with education, age and physical activity and inversely associated with the consumption of unhealthy foods. Due to the low prevalence of adequate fruit, greens and vegetable intake in the population of Brazil's Midwest region in 2012, it is proposed that the intervention strategies to increase the consumption of these foods should be encouraged in a global manner.

Trauma Registry of the Pan-American Trauma Society: One year of experience in two hospitals in southwest Colombia.

BACKGROUND: Trauma information systems are needed to improve decision making and to identify potential areas of intervention. OBJECTIVE: To describe the first year of experience with a trauma registry in two referral centers in southwest Colombia. METHODS: The study was performed in two referral centers in Cali. Patients with traumatic injuries seen between January 1 and December 31, 2012, were included. The collected information included demographics, mechanism of trauma, injury severity score (ISS), and mortality. A descriptive analysis was carried out. RESULTS: A total of 17,431 patients were registered, of which 67.8% were male with an average age of 30 (±20) years. Workplace injuries were the cause of emergency consultations in 28.2% of cases, and falls were the most common mechanism of trauma (37.3%). Patients with an ISS ≥15 were mostly found in the 18-35-year age range (6.4%). Most patients who suffered a gunshot wound presented an ISS ≥15. A total of 2.5% of all patients died, whereas the mortality rate was 54% among patients with an ISS ≥15 and a gunshot wound. CONCLUSION: Once the trauma registry was successfully implemented in two institutions in Cali, the primary causes of admission were identified as falls and workplace injuries. The most severely compromised patients were in the population range between 18 and 35 years of age. The highest mortality was caused by gunshot wounds. INTRODUCCIÓN: Los sistemas de información en trauma son requeridos para mejorar la toma de decisiones e identificar potenciales áreas de intervención. OBJETIVO: Describir el primer año de experiencia del registro de trauma en dos centros de referencia de trauma del suroccidente Colombiano. MÉTODOS: Estudio realizado en dos centros de referencia de Cali. Se incluyeron pacientes con trauma o lesiones externas entre el 1-Ene y el 31-Dic-2012. Se recolectó información demográfica, relacionada con mecanismos de trauma, severidad (ISS) y mortalidad. Se presenta un análisis descriptivo. RESULTADOS: Se registraron 17,431 pacientes. El 67.8% de los pacientes eran de género masculino con edad promedio de 30 (±20) años. Las lesiones laborales fueron causa de consulta a urgencias en un 28.2%, y las caídas el mecanismo de trauma más frecuente (37.3%). Los pacientes con ISS ≥15 en su mayoría se encontraban en el rango de edad de 18-35 años (6.4%). El 28% de los pacientes que sufrieron lesión por arma de fuego presentaron un ISS ≥15. El 2.5% de los pacientes murieron y aquellos pacientes con ISS ≥15 y lesión por arma de fuego presentaron mortalidad del 54%. CONCLUSIÓN: una vez se logró implementar el registro de trauma en dos instituciones en Cali, se identificó que la principal causa de ingreso fue secundaria a caídas y las lesiones laborales. Los pacientes más severamente comprometidos están en el rango de población entre 18 a 35 años. La mayor mortalidad se presentó secundario a lesiones de causa externa por arma de fuego.

La gestión de los datos, un proceso esencial para el desarrollo del Biobanco / Data management, an essential process for the development of Biobanks

El proceso de recolección de material biológico humano, necesita cada vez más la organización de la información para la gestión de las muestras y la integración de los datos relacionados con el participante o donante, provenientes de diferentes fuentes. Con el avance de la computación, esto permitirá identificar posibles interacciones sociodemográficas, genéticas, ambientales, entre otras con determinada enfermedad. Las estructuras de datos, los sistemas de codificación y los sistemas de metadatos, se han convertido en un desafío para la organización de los biobancos. La gestión, integración, seguridad, privacidad y análisis de los datos, son retos importantes para los investigadores y la informática. La normalización de los datos, la armonización e interoperabilidad de sistemas informáticos de biobancos permitirán el óptimo uso del material biológico, convirtiéndose en no solo un gran recurso para estudios epidemiológicos y clínicos a gran escala, sino también en bases para nuevas pruebas de diagnóstico e intervenciones terapéuticas personalizadas.

The collection, processing and storage of biological samples need a system for not only organizing and managing the patient samples but also integrating data records from different sources related to these patients. Along with computer advancement, these integration processes will allow to identify possible relationships between sociodemographic, genetic and environmental factors with specific diseases. Therefore, data structures, coding and metadata systems, have become essential elements for controlling biobanks. In fact, management, integration, security, privacy and data analysis are current challenges for scientists and computer administrators. The standardization of data, harmonization and interoperability of biobank computer systems will help to have an optimum use of biological material. As a result, these advances will turn into a great resource for large-scale epidemiological and clinical studies as well as the basis for new diagnostic tests and personalized therapies.

Trauma Registry of the Pan-American Trauma Society: One year of experience in two hospitals in southwest Colombia / Registro de Trauma de la Sociedad Panamericana de Trauma: Un año de experiencia en dos hospitales en el suroccidente colombiano

Abstract Background: Trauma information systems are needed to improve decision making and to identify potential areas of intervention. Objective: To describe the first year of experience with a trauma registry in two referral centers in southwest Colombia. Methods: The study was performed in two referral centers in Cali. Patients with traumatic injuries seen between January 1 and December 31, 2012, were included. The collected information included demographics, mechanism of trauma, injury severity score (ISS), and mortality. A descriptive analysis was carried out. Results: A total of 17,431 patients were registered, of which 67.8% were male with an average age of 30 (±20) years. Workplace injuries were the cause of emergency consultations in 28.2% of cases, and falls were the most common mechanism of trauma (37.3%). Patients with an ISS ≥15 were mostly found in the 18-35-year age range (6.4%). Most patients who suffered a gunshot wound presented an ISS ≥15. A total of 2.5% of all patients died, whereas the mortality rate was 54% among patients with an ISS ≥15 and a gunshot wound. Conclusion: Once the trauma registry was successfully implemented in two institutions in Cali, the primary causes of admission were identified as falls and workplace injuries. The most severely compromised patients were in the population range between 18 and 35 years of age. The highest mortality was caused by gunshot wounds.

Resumen Introducción: Los sistemas de información en trauma son requeridos para mejorar la toma de decisiones e identificar potenciales áreas de intervención. Objetivo: Describir el primer año de experiencia del registro de trauma en dos centros de referencia de trauma del suroccidente Colombiano. Métodos: Estudio realizado en dos centros de referencia de Cali. Se incluyeron pacientes con trauma o lesiones externas entre el 1-Ene y el 31-Dic-2012. Se recolectó información demográfica, relacionada con mecanismos de trauma, severidad (ISS) y mortalidad. Se presenta un análisis descriptivo. Resultados: Se registraron 17,431 pacientes. El 67.8% de los pacientes eran de género masculino con edad promedio de 30 (±20) años. Las lesiones laborales fueron causa de consulta a urgencias en un 28.2%, y las caídas el mecanismo de trauma más frecuente (37.3%). Los pacientes con ISS ≥15 en su mayoría se encontraban en el rango de edad de 18-35 años (6.4%). El 28% de los pacientes que sufrieron lesión por arma de fuego presentaron un ISS ≥15. El 2.5% de los pacientes murieron y aquellos pacientes con ISS ≥15 y lesión por arma de fuego presentaron mortalidad del 54%. Conclusión: una vez se logró implementar el registro de trauma en dos instituciones en Cali, se identificó que la principal causa de ingreso fue secundaria a caídas y las lesiones laborales. Los pacientes más severamente comprometidos están en el rango de población entre 18 a 35 años. La mayor mortalidad se presentó secundario a lesiones de causa externa por arma de fuego.

Estudo da subnotificação dos casos de Aids em Alagoas (Brasil), 1999-2005 / Study of the under-reporting of Aids cases in Alagoas (Brazil), 1999-2005

A subnotificação dos casos de Aids dificulta e até mesmo impossibilita o planejamento de ações para o controle da epidemia. Este estudo foi realizado com o objetivo de verificar a subnotificação dos casos de Aids no período de 1999 a 2005 em Alagoas. Analisaram-se as declarações de óbito (DO) por Aids, registradas no Sistema de Informação sobre Mortalidade (SIM) comparando-as com o Sistema de Informação de agravos de notificação (Sinan), utilizando a técnica de relacionamento entre bancos de dados em Alagoas. O percentual de subnotificação no período foi de 12,4 por cento. Entre os 49 óbitos estudados, 67 por cento (33) ocorreram no sexo masculino e 33 por cento (16) no feminino, observando-se uma razão entre os sexos de 2:1. Com relação à escolaridade, 4,08 por cento (2) e 6,12 por cento (3) estavam relacionadas às faixas de 1 a 3 e de 4 a 7 anos de estudo, respectivamente. A faixa etária que apresentou o maior número de óbitos foi entre 20 e 49 anos, tanto no sexo feminino (11; 68,7 por cento) como no masculino (23; 69,6 por cento). A subnotificação revelada pela diferença entre óbitos por Aids registrados no SIM e ausentes no Sinan como casos da doença alerta para a necessidade de serem implementadas políticas públicas dirigidas ao problema.

The under-reporting of Aids (Acquired Immune Deficiency Syndrome) cases makes it difficult and even impossible to plan means to control the epidemic. This study aims to check out the under-reporting of Aids cases from 1999 to 2005 in Alagoas (Brazil). The deaths certificates causes by Aids stored at the Mortality Data System (SIM) in comparison to the Data System of Notification Diseases (Sinan), has been analyzed using the technique of relationship between these two data systems in Alagoas. According to the study, the proportion of under-reporting of Aids cases during this period was of 12.4 percent. Among the 49 deaths studied, 67 percent (33) were men and 33 percent (16) were women configuring a gender rate of 2:1. As to education level, 4,08 percent (2) and 6,12 percent (3) of the deaths by Aids were of people having 1 to 3 and from 4 to 7 years of study, respectively. The age group that presented the largest number of deaths was from 20 to 49 years old, either female (11; 68,7 percent) or male gender (23; 69,6 percent). The comparison between the Mortality Data System and Data System for Disease Notification revealed a high proportion of under-reporting of deaths by Aids, stressing the need for a specific public policy on the matter.