Real-Time Early Detection of Allergic Reactions based on Heart Rate Variability

La popularización del concepto “Internet de las cosas” ha fomentado el rápido desarrollo de aplicaciones centradas en la obtención de información relativa a personas. Por este motivo, y gracias a la disponibilidad de la capacidad de cálculo de los Smartphones, a lo largo de los últimos años se han comercializado diversos dispositivos económicos y aplicaciones a través de los que analizar la salud de los usuarios. En esta tesis se propone el uso de la señal electrocardiográfica para la detección precoz de reacciones alérgicas. Con este objetivo, se ha diseñado en primer lugar un nuevo algoritmo de detección de latidos cardiacos capaz de trabajar en tiempo real. La precisión de dicho algoritmo es similar a los propuestos en la literatura, sin embargo, su complejidad computacional y consumo de recursos son muy reducidos, lo que lo hace idóneo para ser empleado en plataformas portátiles de recursos limitados. En un estudio previo, se analizó el efecto que las reacciones alérgicas provocaban en la variabilidad del ritmo cardíaco, demostrando que dicho efecto es detectable incluso antes de la aparición de síntomas físicos en la mayoría de los pacientes alérgicos estudiados. Sin embargo, el método propuesto en dicho trabajo no puede emplearse para detectar alergias en pruebas reales, puesto que la complejidad computacional del modelo diseñado necesita horas de análisis para realizar dicha detección. Además, el estudio se centró únicamente en pruebas de provocación de alergias alimentarias en niños menores de 12 años. En este trabajo se continúa el estudio de la variabilidad del ritmo cardíaco en pacientes realizando pruebas de provocación con dos objetivos principales: el diseño de un algoritmo capaz de detectar alergias en tiempo real, y la extensión del estudio para incluir adultos y pruebas de provocación de alergias a medicamentos. El algoritmo resultante de dicho estudio tiene una precisión similar al propuesto en el trabajo previo, así como la reducción de la cantidad de alérgeno que los pacientes alérgicos deben consumir y de la duración de las provocaciones. Sin embargo, la nueva propuesta puede implementarse en un dispositivo autónomo y portátil y, lo que es más importante, es capaz de realizar las detecciones de reacciones alérgicas en tiempo real. A pesar de que los resultados obtenidos son prometedores, este estudio debe interpretarse como el inicio de una investigación mayor, puesto que es necesario emplear más tiempo y esfuerzo en la adquisición de nuevos datos para obtener una muestra representativa de toda la población de pacientes alérgicos a alimentos y medicamentos

European Position Paper on Rhinosinusitis and Nasal Polyps 2020

The European Position Paper on Rhinosinusitis and Nasal Polyps 2020 is the update of similar evidence based position papers published in 2005 and 2007 and 2012. The core objective of the EPOS2020 guideline is to provide revised, up-to-date and clear evidence-based recommendations and integrated care pathways in ARS and CRS. EPOS2020 provides an update on the literature published and studies undertaken in the eight years since the EPOS2012 position paper was published and addresses areas not extensively covered in EPOS2012 such as paediatric CRS and sinus surgery. EPOS2020 also involves new stakeholders, including pharmacists and patients, and addresses new target users who have become more involved in the management and treatment of rhinosinusitis since the publication of the last EPOS document, including pharmacists, nurses, specialised care givers and indeed patients themselves, who employ increasing self-management of their condition using over the counter treatments. The document provides suggestions for future research in this area and offers updated guidance for definitions and outcome measurements in research in different settings. EPOS2020 contains chapters on definitions and classification where we have defined a large number of terms and indicated preferred terms. A new classification of CRS into primary and secondary CRS and further division into localized and diffuse disease, based on anatomic distribution is proposed. There are extensive chapters on epidemiology and predisposing factors, inflammatory mechanisms, (differential) diagnosis of facial pain, allergic rhinitis, genetics, cystic fibrosis, aspirin exacerbated respiratory disease, immunodeficiencies, allergic fungal rhinosinusitis and the relationship between upper and lower airways. The chapters on paediatric acute and chronic rhinosinusitis are totally rewritten. All available evidence for the management of acute rhinosinusitis and chronic rhinosinusitis with or without nasal polyps in adults and children is systematically reviewed and integrated care pathways based on the evidence are proposed. Despite considerable increases in the amount of quality publications in recent years, a large number of practical clinical questions remain. It was agreed that the best way to address these was to conduct a Delphi exercise . The results have been integrated into the respective sections. Last but not least, advice for patients and pharmacists and a new list of research needs are included. The full document can be downloaded for free on the website of this journal: http://www.rhinologyjournal.com

The Largest Unethical Medical Experiment in Human History

This monograph describes the largest unethical medical experiment in human history: the implementation and operation of non-ionizing non-visible EMF radiation (hereafter called wireless radiation) infrastructure for communications, surveillance, weaponry, and other applications. It is unethical because it violates the key ethical medical experiment requirement for “informed consent” by the overwhelming majority of the participants. The monograph provides background on unethical medical research/experimentation, and frames the implementation of wireless radiation within that context. The monograph then identifies a wide spectrum of adverse effects of wireless radiation as reported in the premier biomedical literature for over seven decades. Even though many of these reported adverse effects are extremely severe, the true extent of their severity has been grossly underestimated. Most of the reported laboratory experiments that produced these effects are not reflective of the real-life environment in which wireless radiation operates. Many experiments do not include pulsing and modulation of the carrier signal, and most do not account for synergistic effects of other toxic stimuli acting in concert with the wireless radiation. These two additions greatly exacerbate the severity of the adverse effects from wireless radiation, and their neglect in current (and past) experimentation results in substantial under-estimation of the breadth and severity of adverse effects to be expected in a real-life situation. This lack of credible safety testing, combined with depriving the public of the opportunity to provide informed consent, contextualizes the wireless radiation infrastructure operation as an unethical medical experiment