Longitudinal study of patients with chronic Chagas cardiomyopathy in Brazil (SaMi-Trop project): a cohort profile.

PurposeWe have established a prospective cohort of 1959 patients with chronic Chagas cardiomyopathy to evaluate if a clinical prediction rule based on ECG, brain natriuretic peptide (BNP) levels, and other biomarkers can be useful in clinical practice. This paper outlines the study and baseline characteristics of the participants.ParticipantsThe study is being conducted in 21 municipalities of the northern part of Minas Gerais State in Brazil, and includes a follow-up of 2 years. The baseline evaluation included collection of sociodemographic information, social determinants of health, health-related behaviours, comorbidities, medicines in use, history of previous treatment for Chagas disease, functional class, quality of life, blood sample collection, and ECG. Patients were mostly female, aged 50-74 years, with low family income and educational level, with known Chagas disease for >10 years; 46% presented with functional class >II. Previous use of benznidazole was reported by 25.2% and permanent use of pacemaker by 6.2%. Almost half of the patients presented with high blood cholesterol and hypertension, and one-third of them had diabetes mellitus. N-terminal of the prohormone BNP (NT-ProBNP) level was >300 pg/mL in 30% of the sample.Findings to dateClinical and laboratory markers predictive of severe and progressive Chagas disease were identified as high NT-ProBNP levels, as well as symptoms of advanced heart failure. These results confirm the important residual morbidity of Chagas disease in the remote areas, thus supporting political decisions that should prioritise in addition to epidemiological surveillance the medical treatment of chronic Chagas cardiomyopathy in the coming years. The São Paulo-Minas Gerais Tropical Medicine Research Center (SaMi-Trop) represents a major challenge for focused research in neglected diseases, with knowledge that can be applied in primary healthcare.Future plansWe will continue following this patients' cohort to provide relevant information about the development and progression of Chagas disease in remotes areas, with social and economic inequalities.Trial registration numberNCT02646943; Pre-results

On the Use of XML in Medical Imaging Web-Based Applications

The rapid growth of digital technology in medical fields over recent years has increased the need for applications able to manage patient medical records, imaging data, and chart information. Web-based applications are implemented with the purpose to link digital databases, storage and transmission protocols, management of large volumes of data and security concepts, allowing the possibility to read, analyze, and even diagnose remotely from the medical center where the information was acquired. The objective of this paper is to analyze the use of the Extensible Markup Language (XML) language in web-based applications that aid in diagnosis or treatment of patients, considering how this protocol allows indexing and exchanging the huge amount of information associated with each medical case. The purpose of this paper is to point out the main advantages and drawbacks of the XML technology in order to provide key ideas for future web-based applicationsPeer ReviewedPostprint (author's final draft

Evaluation of international standards for ECG-recording and storage for use in tele-medical services

This report is written to clarify which of the international standards for ECG recordings that can be used in tele-medical services, where the recordings should be transmitted by wireless telecommunication facilities and finally stored as information integrated into the patients Electronic Health Record (EHR). Some principals for recording, transmission and storage of digital vital signs parameters are highlighted and important aspects of wireless communication of recorded signals from biomedical sensors are described, in order to understand the significance and differences in the storing formats to be used. Even if most of the relevant standards are not yet ratified (the last meeting in ISO TC 251 WH6 was held in October 2005), the actual international standards SCP-ECG, MFER, FDAXML and DICIOM are defined and already widely adopted. In this report, these standards are briefly described and evaluated with respect to possible use in tele-medical services, and recommendations are given in order to obtain a reliable and secure communication solution. Requirements for integration of the ECG file formats into the EHR are briefly described, and it is given some recommendations for actual standards to be used in future solutions

System Integration for Medical Data Dissemination and Multimedia Communication in the Implementation of Tele-ECG and Teleconsultation

One of the options to extend medical services coverage is deploying a telemedicine system, where medical personnel make use of ICT (Information and Communication Technology) to overcome distance and time constraints. The implementation of telemedicine systems in Indonesia faces challenges posed by the lack of ICT infrastructure availability, such as communication networks, data centres, and other computing resources. To deal with these challenges, a telemedicine innovation needs to produce a modular and flexible system that is adaptive to medical services needed and the available ICT infrastructure. This paper presents research and development of a telemedicine system prototype for tele-electrocardiography (tele-ECG) and teleconsultation. The contributions offered are integrating system from various open-source modules and the system operational feasibility based on its function and performance. The research is conducted on a testbed which represents various components involved in the telemedicine system operation. Experiments are carried out to assess the system functionality and observe whether tele-ECG and teleconsultation reach their expected performance. Experiment results show that the system works properly and recommend several multimedia communication modes to achieve the target quality based on the available network bandwidth

XML-BSPM: an XML format for storing Body Surface Potential Map recordings

<p>Abstract</p> <p>Background</p> <p>The Body Surface Potential Map (BSPM) is an electrocardiographic method, for recording and displaying the electrical activity of the heart, from a spatial perspective. The BSPM has been deemed more accurate for assessing certain cardiac pathologies when compared to the 12-lead ECG. Nevertheless, the 12-lead ECG remains the most popular ECG acquisition method for non-invasively assessing the electrical activity of the heart. Although data from the 12-lead ECG can be stored and shared using open formats such as SCP-ECG, no open formats currently exist for storing and sharing the BSPM. As a result, an innovative format for storing BSPM datasets has been developed within this study.</p> <p>Methods</p> <p>The XML vocabulary was chosen for implementation, as opposed to binary for the purpose of human readability. There are currently no standards to dictate the number of electrodes and electrode positions for recording a BSPM. In fact, there are at least 11 different BSPM electrode configurations in use today. Therefore, in order to support these BSPM variants, the XML-BSPM format was made versatile. Hence, the format supports the storage of custom torso diagrams using SVG graphics. This diagram can then be used in a 2D coordinate system for retaining electrode positions.</p> <p>Results</p> <p>This XML-BSPM format has been successfully used to store the Kornreich-117 BSPM dataset and the Lux-192 BSPM dataset. The resulting file sizes were in the region of 277 kilobytes for each BSPM recording and can be deemed suitable for example, for use with any telemonitoring application. Moreover, there is potential for file sizes to be further reduced using basic compression algorithms, i.e. the deflate algorithm. Finally, these BSPM files have been parsed and visualised within a convenient time period using a web based BSPM viewer.</p> <p>Conclusions</p> <p>This format, if widely adopted could promote BSPM interoperability, knowledge sharing and data mining. This work could also be used to provide conceptual solutions and inspire existing formats such as DICOM, SCP-ECG and aECG to support the storage of BSPMs. In summary, this research provides initial ground work for creating a complete BSPM management system.</p

Extraction of ECGs for twin pregnancies

The wellbeing of a fetus or fetuses can be monitored by the fetal heart rate (fHR). There are several proposed methods for fHR monitoring; these include fetal phonocardiography (fPCG), fetal cardiography (fCTG) and fetal magnetocardiogram (fMCG). Although, according to the research reviewed, none of these methods are ideal for monitoring or estimating fHR. The fPCG method is highly sensitive to noise and can only be used late in the pregnancy. With fCTG, the ultrasound transducer used for measuring the fHR needs to be properly aligned, otherwise the maternal heart rate (mHR) can be recorded instead of the fHR. In addition, the ultrasound high frequency exposure is not completely proven to be safe for the fetus. fMCG can detect fHR very accurately in comparison to the other methods but the method is unwieldy and expensive; thus not widely used in a clinical environment. Therefore, there is a need for technology which would be able to provide more information about the cardiac health of a fetus, delivered in a cost-effective, streamlined manner. Based on the research reviewed and captured within this dissertation, non-invasive fetal electrocardiography (fECG) has been identified as a promising fetal cardiac monitoring method and if researched further, has the potential to become the next mainstream approach for monitoring fetal health. Within this dissertation, the fECG extraction methods have been explored and the findings captured. The research revealed that the fECG method can be used from early stages of pregnancy (20 weeks gestational age onwards). It is relatively low cost and does not necessarily require a highly skilled user. Continuous monitoring is also possible. The main challenge identified when using the non-invasive fECG extraction method is poor Signal-to-Noise Ratio (SNR) of the fECG signal on the abdominal signal which consists of fECG, maternal ECG (mECG) and noise. Eleven different fECG extraction methods were tested as part of this dissertation. The extraction methods were based on Adaptive Methods (AM), Template Subtraction (TS)or Blind Source Separation (BSS). Synthetic test signals were used for the testing the methods. The test signals included five different noise levels across seven different single pregnancy physiological cases and one twin pregnancy case. Each recording included 34 channels (32 abdominal and two maternal reference channels). For single pregnancy cases all of the extraction methods were able to extract the fECG from the test signals with varying degrees of success. Overall, the BSS-JADE method was the top performing method for single pregnancy cases getting a median F1 score of 99.85%. Furthermore, the twin pregnancy case was tested using BSS methods. The BSS FastICA algorithm using symmetric approach was the top performing method for the twin pregnancy case receiving a median F1 score of 99.93%

TSDF: A simple yet comprehensive, unified data storage and exchange format standard for digital biosensor data in health applications

Digital sensors are increasingly being used to monitor the change over time of physiological processes in biological health and disease, often using wearable devices. This generates very large amounts of digital sensor data, for which, a consensus on a common storage, exchange and archival data format standard, has yet to be reached. To address this gap, we propose Time Series Data Format (TSDF): a unified, standardized format for storing all types of physiological sensor data, across diverse disease areas. We pose a series of format design criteria and review in detail current storage and exchange formats. When judged against these criteria, we find these current formats lacking, and propose a very simple, intuitive standard for both numerical sensor data and metadata, based on raw binary data and JSON-format text files, for sensor measurements/timestamps and metadata, respectively. By focusing on the common characteristics of diverse biosensor data, we define a set of necessary and sufficient metadata fields for storing, processing, exchanging, archiving and reliably interpreting, multi-channel biological time series data. Our aim is for this standardized format to increase the interpretability and exchangeability of data, thereby contributing to scientific reproducibility in studies where digital biosensor data forms a key evidence base