Current status and prospects of automatic sleep stages scoring: Review.

The scoring of sleep stages is one of the essential tasks in sleep analysis. Since a manual procedure requires considerable human and financial resources, and incorporates some subjectivity, an automated approach could result in several advantages. There have been many developments in this area, and in order to provide a comprehensive overview, it is essential to review relevant recent works and summarise the characteristics of the approaches, which is the main aim of this article. To achieve it, we examined articles published between 2018 and 2022 that dealt with the automated scoring of sleep stages. In the final selection for in-depth analysis, 125 articles were included after reviewing a total of 515 publications. The results revealed that automatic scoring demonstrates good quality (with Cohen's kappa up to over 0.80 and accuracy up to over 90%) in analysing EEG/EEG + EOG + EMG signals. At the same time, it should be noted that there has been no breakthrough in the quality of results using these signals in recent years. Systems involving other signals that could potentially be acquired more conveniently for the user (e.g. respiratory, cardiac or movement signals) remain more challenging in the implementation with a high level of reliability but have considerable innovation capability. In general, automatic sleep stage scoring has excellent potential to assist medical professionals while providing an objective assessment.

Obstructive sleep apnea event detection using explainable deep learning models for a portable monitor.

Background: Polysomnography (PSG) is the gold standard for detecting obstructive sleep apnea (OSA). However, this technique has many disadvantages when using it outside the hospital or for daily use. Portable monitors (PMs) aim to streamline the OSA detection process through deep learning (DL). Materials and methods: We studied how to detect OSA events and calculate the apnea-hypopnea index (AHI) by using deep learning models that aim to be implemented on PMs. Several deep learning models are presented after being trained on polysomnography data from the National Sleep Research Resource (NSRR) repository. The best hyperparameters for the DL architecture are presented. In addition, emphasis is focused on model explainability techniques, concretely on Gradient-weighted Class Activation Mapping (Grad-CAM). Results: The results for the best DL model are presented and analyzed. The interpretability of the DL model is also analyzed by studying the regions of the signals that are most relevant for the model to make the decision. The model that yields the best result is a one-dimensional convolutional neural network (1D-CNN) with 84.3% accuracy. Conclusion: The use of PMs using machine learning techniques for detecting OSA events still has a long way to go. However, our method for developing explainable DL models demonstrates that PMs appear to be a promising alternative to PSG in the future for the detection of obstructive apnea events and the automatic calculation of AHI.

A Minimum Set of Physiological Parameters to Diagnose Obstructive Sleep Apnea Syndrome Using Non-Invasive Portable Monitors. A Systematic Review.

Introduction. Despite its high accuracy, polysomnography (PSG) has several drawbacks for diagnosing obstructive sleep apnea (OSA). Consequently, multiple portable monitors (PMs) have been proposed. Objective. This systematic review aims to investigate the current literature to analyze the sets of physiological parameters captured by a PM to select the minimum number of such physiological signals while maintaining accurate results in OSA detection. Methods. Inclusion and exclusion criteria for the selection of publications were established prior to the search. The evaluation of the publications was made based on one central question and several specific questions. Results. The abilities to detect hypopneas, sleep time, or awakenings were some of the features studied to investigate the full functionality of the PMs to select the most relevant set of physiological signals. Based on the physiological parameters collected (one to six), the PMs were classified into sets according to the level of evidence. The advantages and the disadvantages of each possible set of signals were explained by answering the research questions proposed in the methods. Conclusions. The minimum number of physiological signals detected by PMs for the detection of OSA depends mainly on the purpose and context of the sleep study. The set of three physiological signals showed the best results in the detection of OSA.

Bloqueo laparoscópico subcostal del plano transverso abdominal (TAP) como analgesia multimodal postquirúrgica en pacientes con patología biliar / Laparoscopic subcostal block of the transverse abdominal plane (TAP) as postoperative multimodal analgesia in patients with biliary pathology

Contexto: el dolor postoperatorio es uno de los principales problemas en la práctica quirúrgica y debe ser tratado de forma adecuada para lograr una evolución favorable en el paciente. Objetivo: evaluar el bloqueo subcostal laparoscópico del plano transverso del abdomen con bupivacaína 0,5%, versus el no bloqueo en pacientes adultos sometidos a cirugía de patología biliar en el hospital San Francisco de Quito. Metodología: estudio epidemiológico de casos y controles de pacientes que ingresaron al hospital San Francisco de Quito. Son 210 pacientes divididos de forma equitativa en dos grupos, en uno de ellos se aplicó bloqueo subcostal, mientras que el otro fue sin intervención. Los dos grupos fueron observados y valorados por 24 horas. Las variables cuantitativas se reportaron como promedios (± DE, desviación estándar) y las cualitativas con sus valores absolutos y relativos (porcentajes). Las comparaciones de variables cuantitativas se realizaron con la prueba t-Student, mientras que para las cualitativas se usaron pruebas de independencia para proporciones x2 y prueba exacta de Fisher. Resultados: comparado con el segundo grupo la tasa de analgesia de rescate fue significativamente menor en los pacientes que recibieron bloqueo laparoscópico con bupivacaína al 0,5% (28,6% vs. 51,4 %, respectivamente). La reducción en el uso de analgésicos fue en promedio del 22,9% (C 95 %:36,7, 9 %; p =0,0012), equivalente a un OR: 0,38 (IC 95 %: 0,21, 0,67; p = 0,004). ORad = 0,38 (IC 95 %: 0,21, 0,67; p <0,01). El uso de opioides fue menor en el grupo con bloqueo, comparado con su control (46,7% vs 59,3 %),mientras que el uso de paracetamol fue mayor (30% vs 18,5 %). Y en el uso de analgésicos no esteroidales (AINES) el resultado fue similar (23,3% vs 22,2 %). Conclusión: el bloqueo subcostal laparoscópico se muestra como una técnica eficaz para control y tratamiento del dolor en pacientes sometidos a cirugía con patología biliar, disminuyendo el uso de analgesia de rescate durante las 6 primeras horas. (AU)

Context: the postoperative pain is one of the main problems in surgical practices; it must be adequately treated to achieve a favorable evolution in the patient. Objective: To evaluate the laparoscopic subcostal block of the transverse plane of the abdomen with 0.5% of bupivacaine, versus the non-block in adult patients that had surgery of biliary pathology at San Francisco de Quito Hospital. Methodology: epidemiological study of cases and controls of patients that were admitted to the San Francisco de Quito Hospital. There are 210 patients equally divided in two groups, in the first group the subcostal block was applied, while in the other group was without intervention. The two groups were observed and assessed for 24 hours. The quantitative variables were reported as averages (± SD, Standard Deviation) and qualitative variables with their absolute and relative values (percentages) were also reported as well. The comparisons of quantitative variables were performed with a t-Student test, while the comparison of qualitative variables was performed with independent tests for proportions x2 and Fisher's exact test. Results: compared with the second group, the rate of analgesia for rescue was significantly lower in patients who received laparoscopic block with 0.5% bupivacaine (28.6% vs. 51.4%, respectively). The reduction in the use of analgesics was of 22.9% on average (95% CI: 36.7, 9%, p = 0.0012), equivalent to an OR: 0.38 (95% CI: 0.21, 0.67, p = 0.004). ORad = 0.38 (95% CI: 0.21, 0.67, p <0.01). The use of opioids was lower in the group with block compared to its control (46.7% vs 59.3%), the use of paracetamol was higher (30% vs 18.5%) and in the use of non-steroidal analgesics (NSAIDs), the result was similar (23.3% vs 22.2%). Conclusion: laparoscopic subcostal block is shown as an effective technique for pain control and treatment in patients that had surgery with biliary pathology, reducing the use of analgesia on average during the first 6 hours. (AU)

Estudio para determinar los niveles de calcio y paratohormona en pacientes con y sin vaciamiento central profiláctico, con diagnóstico de cáncer papilar de tiroides / Study to determine calcium and parathyroid hormone levels in patients with and without prophylactic central emptying, with diagnosis of papillary thyroid cancer

Contexto: El cáncer papilar de tiroides representa una patología que va en aumento, y el manejo quirúrgico es complejo. Una disección profiláctica cervical central para los pacientes con cáncer papilar de tiroides es controvertida. Dado que los riesgos de complicaciones transitorias probablemente son altas, y los beneficios parecen ser pequeños, de tal forma, que para realizarlo se utiliza un enfoque selectivo, en función de factores de riesgo del paciente y el nivel de experiencia del cirujano. Objetivo: determinar en el postquirúrgico los niveles de calcio y paratohormona en pacientes adultos, de ambos sexos con sospecha alta de cáncer papilar de tiroides, a los cuales se les realizó o no, vaciamiento central en los hospital Eugenio Espejo de la ciudad de Quito, durante un año. Sujetos y métodos: observacional, analítico, epidemiológico transversal, de cohortes. Se estudiaron todos los pacientes con sospecha citológica de cáncer papilar de tiroides, sometidos a tiroidectomía total, con o sin vaciamiento central profiláctico; se midió a las 24 horas los niveles de calcio y paratohormona. Las variables cuantitativas se reportaron como promedios y las cualitativas con sus valores absolutos y relativos. Las comparaciones de variables cuantitativas se realizaron con la prueba t-Student, mientras que para las cualitativas se usaron pruebas de independencia para proporciones x2 y prueba exacta de Fisher. Se hizo un análisis multivariados con regresión logística reportada como Odds Ratios ajustados (ORadj). Resultados: con respecto al calcio el grupo con vaciamiento central presentó valores significativamente menores que el grupo sin vaciamiento, esta diferencia fue de -0.07 mmol/L (IC 95 %: -0.036, -0.097 mmol/L;p < 0.0001). Los pacientes sometidos a vaciamiento central tuvieron tasas significativamente menores de paratohormona (para valores inferiores a los 10pg/ml) hasta el 53.9%, mientras que en el grupo sin vaciamiento solo el 11.1%(IC 95%: 29.5, 56.2%; p < 0.0001). Conclusión: se observó que en el grupo de tiroidectomía con vaciamiento central profiláctico, hubo una tasa importante de hipocalcemia e hipoparatiroidismo, todos estos pacientes presentaron signos de hipocalcemia durante su periodo postquirúrgico, lo que prolongo su estadía hospitalaria, (AU)

Introduction: Papillary thyroid cancer is on the rise and surgical treatment is complex. Prophylactic central neck dissection for papillary thyroid cancer patients is controversial because of the possibility of higher risk of transient complications and the benefits of the surgery are low. As a result, the surgery is performed based of the risk factors of the patient and the experience of the surgeon. Objective: to determine the levels of calcium and parathyroid hormone post-surgery in adult male and female patients with suspected risk of papillary thyroid cancer, to who prophylactic central drainage, was and was not performed. Subjects and methods: this is an epidemiological, observational, analytic, cross-sectional, of cohorts. The research will be done on all patients suspected of cytological papillary thyroid cancer in Hospital Eugenio Espejo, and who underwent total thyroidectomy with and without prophylactic central drainage. Calcium and parathyroid hormone levels will be checked 24 hours post-surgery. The quantitative variables will be reported as averages and the qualitative variables as absolute and relative data. t-Student test was used to compare qualitative data. Qualitative data was compared using independent test with scales of x2 and the Fisher exact test. A logistic regression analysis was done and reported as Adjusted Odds ratios (AOR). Results: calcium level on the group with central drainage had significant lower levels compare to the group without central drainage, the difference was of -0.07 mmol/L (IC 95 %: -0.036, -0.097 mmol/L; p<0.0001). The patients with central drainage had significantly lower levels of parathyroid hormone (levels lower than 10pg/ml) up to 53.9%; while the group without central drainage only had 11.1% %(IC 95%: 29.5, 56.2%; p < 0.0001). Conclusion: though the study the thyroidectomy with prophylactic central drainage group had a significant rate of hypocalcemia and hypoparathyroidism. These patients had symptoms of hypocalcemia post-surgery, which prolong their hospital stay. (AU)

Niveles séricos de mucoproteínas y de proteínas combinadas con hexosas o con ácido siálico en escolares enfermos residentes en la ciudad de Mérida (Venezuela) / Mucoproteins serum levels and combination proteins with hexoses or with sialic acid the sick student resinding at the Mérida city (Venezuela)

En el presente trabajo se cuantificó el contenido sérico de las mucoproteínas y de las proteínas combinadas con hexosas (PBH) o con ácido siálico (PAS) en 440 escolares portadores de diversas patologías (GRUPO DE CASOS) y se comparó con los hallazgos obtenidos en 160 escolares sanos con características similares a los casos (GRUPO TESTIGO). Los valores de mucoproteínas, PBH y PAS en los escolares sanos fueron 15ñ9, 112ñ20 y 66ñ12 mg/dL, respectivamente, los cuales se utilizaron para comparar con los casos. En los escolares enfermos no tratados los niveles de estas seroglicoproteínas difieren significativamente (p<0.05), dependiendo de la patología en estudio, al comparar con los valores normales y de los escolares tratados. En las piodermitis y en las parasitosis se encuentran valores de PBH inferiores al rango normal, igual fenómeno se detectó con las mucoproteínas en las hepatitis virales e infecciones agudas. Cuando los tratamientos son adecuados, los valores alterados de las glicoproteínas rápidamente retornan a la normalidad. Se concluye que la determinación de estas seroglicoproteínas puede ser un auxiliar útil para evaluar la respuesta de los pacientes al tratamiento (s) y en casos de diagnóstico difícil, tal como sucede en los escolares ictéricos

Alteraciones enzimáticas séricas en ratas tratadas con bisulfito de sodio / Changes in serum enzymes in rats treated with sodium bisulfite

Inorganic sulphites are chemical compounds with antioxidative, antibacterial and antimycotic properties diffusely employed in agro-food and pharmaceutical industries. In spite of their continuous use there still are many questions regarding their safety, and their possible influence in several nutrients and enzymatic systems, as according to reports in the literature cited. In this study it is determined the effect of increasing doses of sodium bisulphite, 10 to 50 mg/kg/day, injected intramuscularly during seven days on the activity of the following serum enzymes: phosphohexoseisomerase (PHI), gamma-glutamyltranspeptidase (gamma-GT), cholinesterase (CHE), arginase, acid maltase (AM), alkaline phosphatase (AIP), lactic dehydrogenase (LDH), transaminases (GOT and GPT) and 5'-nucleotidase (5'-N) on male Wistar rats (treated groups). The results indicate that in rats treated with sodium bisulphite there is a significant increase (p < 0.05) in the activity of PHI, gamma-GT, arginase, AIP, GOT, GPT and 5'-N as well as an equally significant decrease (p < 0.05) in the activity of LDH, AM and CHE; these variations are proportional to the doses of the compound applied. These findings indicate there is cellular damage to rat liver, kidney orothers organs as a result of bisulphite injected or by its metabolic derivatives. It is suggested that measurements of serum levels of LDH, AM and CHE are particularly helpful in the clinical assessment of pathologies caused by sulfites in allergology.

Modificaciones del contenido de fosforo hepatico y renal en cobayos tratados con dosis elevadas de vitamina A alcohol (retinol) / Alterations in the liver and kidney phosphorus in guinea pigs exposed to high doses of vitamin A (retinol)

In this study, the serum, urinary, hepatic and renal levels of total inorganic phosphorus (Pi) were determined in guinea pigs treated with 100,000 U.I. of vitamin A, dissolved in Tween Span, given each day by intramuscular injections during seven days (treated group), and compared with the levels in healthy guinea pigs which were given the same feed as the treated group, and received the same amount of Tween Span (control group). The activity of the enzymes alkaline phosphatase and acid phosphatase was simultaneously determined in liver and kidneys of both groups, and the phospholipid content in serum and tissue was also determined. The treated group did not show changes in serum and urinary phosphorus as compared with the control group. Liver and kidney of the treated group showed an increase in total Pi (p <0.05). In this group a definite increase (p < 0.05) was also observed both in serum and tissue levels of phospholipids, as well as in the activity of the liver and kidney enzymes studied. These results suggest that phosphorus enters the blood stream in the form of lipid complexes (phospholipids) that are involved in certain characteristic functions

Esofagitis por reflujo: criterios clinicos quirurgicos

Presentamos una revisión bibliográfica sobre esofgitis por reflujo a la que se designa todos aquellos procesos inflamatorios agudos o crónicos que afectan la mucosa esofágica de etiología multifactorial, fundamentalmente por fallas de la barrera antirreflujo, aclaramiento esofágico, etc. Se analiza los múltiples test diagnosticos destacando la endoscopia, la monitorización ph en 24h. Discutimos el tratamiento que va, desde, medidas generales, bloqueadores H2, Omeprazol. Se hace hincapie en las diferentes opciones quirurgicas utilizadas fundamentalmente para sus complicaciones.

Cáncer de esofago: Tratamiento quirúrgico esofaguectomia transmediatinal o toracotomía

El cáncer de esófago es una de las patologías difíciles de tratar, básicamente por razones que involucran tardanza en el diagnóstico debido a que cuando el paciente presenta los síntomas iniciales como disfagia, el cáncer se encuentra ya en un estadio avanzado, frente a lo cual las alternativas de tratamiento quirúrgico en la gran mayoría son de carácter paliativo, y deben er analizadas correctamente, guiadas a obtener un adecuado tránsito digestivo para de esta manera ayudar a que los pacientes con esta enfermedad tengan una vida digna y puedan llegar hasta sus útlimos días, con la satisfacción de cunmlplir con una de las funciones básicas del ser humano que es el poder comer...