Prognostic Value of Coronary Flow Reserve Obtained on Dobutamine Stress Echocardiography and its Correlation with Target Heart Rate / Valor Prognóstico da Reserva de Fluxo Coronariano Obtida Durante o Ecocardiograma sob Estresse com Dobutamina e sua Correlação com a Frequência Cardíaca Alvo

Abstract Background: Normal coronary flow velocity reserve (CFVR) (≥ 2) obtained in the left anterior descending coronary artery (LAD) from transthoracic echocardiography is associated with a good prognosis, but there is no study correlating CFVR with submaximal target heart rate (HR). Objective: To evaluate the prognostic value of CFVR obtained in the LAD of patients with preserved (>50%) left ventricular ejection fraction (LVEF) who completed a dobutamine stress echocardiography (DSE), considering target HR. Methods: Prospective study of patients with preserved LVEF and CFVR obtained in the LAD who completed DSE. In Group I (GI = 31), normal CFVR was obtained before achieving target HR, and, in Group II (GII = 28), after that. Group III (G III=24) reached target HR, but CFVR was abnormal. Death, acute coronary insufficiency, coronary intervention, coronary angiography without further intervention, and hospitalization were considered events. Results: In 28 ± 4 months, there were 18 (21.6%) events: 6% (2/31) in GI, 18% (5/28) in GII, and 46% (11/24) in GIII. There were 4 (4.8%) deaths, 6 (7.2%) coronary interventions and 8 (9.6%) coronary angiographies without further intervention. In event-free survival by regression analysis, GIII had more events than GI (p < 0.001) and GII (p < 0.045), with no difference between GI and GII (p = 0.160). After adjustment, the only difference was between GIII and GI (p = 0.012). Conclusion: In patients with preserved LVEF and who completed their DSE, normal CFVR obtained before achieving target HR was associated with better prognosis.

Resumo Fundamento: A reserva de velocidade de fluxo coronariano (RVFC) adequada (≥ 2) obtida na artéria descendente anterior (ADA) através do ecocardiograma transtorácico associa-se a bom prognóstico, mas não há estudo correlacionando-a com a frequência cardíaca (FC) alvo (submáxima). Objetivo: Avaliar o valor prognóstico da RVFC obtida na ADA de pacientes com fração de ejeção do ventrículo esquerdo (FEVE) preservada (>50%) e ecocardiograma sob estresse com dobutamina (EED) concluído, considerando a FC alvo submáxima. Métodos: studo prospectivo de pacientes com FEVE preservada e RVFC obtida na ADA durante EED concluído. No Grupo I (GI=31), a RVFC adequada foi obtida antes de se atingir a FC alvo, e no Grupo II (G II=28), após. O Grupo III (G III=24) atingiu a FC alvo, mas a RVFC foi inadequada. Foram considerados eventos: óbito, insuficiência coronariana aguda, intervenção coronariana, coronariografia sem intervenção subsequente e internamento hospitalar. Resultados: Em 28 ± 4 meses, ocorreram 18 (21,6%) eventos, sendo 6% (2/31) no GI, 18% (5/28) no GII e 46% (11/24) no GIII. Foram 4 (4,8%) óbitos, 6 (7,2%) intervenções coronarianas e 8 (9,6%) coronariografias sem intervenção subsequente. Na sobrevida livre de eventos pela análise de regressão, GIII apresentou mais eventos do que GI (p < 0,001) ou GII (p < 0,045), não havendo diferença entre GI e GII (p = 0,160). Após o ajustamento, foi mantida a diferença apenas entre GIII e GI (p = 0,012). Conclusão: Em pacientes com FEVE preservada e EED concluído, a RVFC adequada obtida antes da FC alvo associou-se ao melhor prognóstico.

New suture techniques for best esthetic skin healing / Novas técnicas de suturas para melhor cicatrização estética da pele

PURPOSE: To report two new suture techniques for best esthetic skin healing. METHODS: Using the pig skin slices routinely employed for surgical technique training two new types of skin sutures were performed. One defined as inverted or hidden X point suture and other as totally hidden intradermal running suture. The first were performed using 4-0 polypropilene stitch and the intradermal with 4-0 poliglicolic stitch. RESULTS: It was confirmed good skin layers union and contention with best esthetic result than observed with the traditional X and intradermal suture techniques. CONCLUSION: Macroscopic examination of the hidden X point and totally hidden intra-dermal sutures and centrifuge skin traction confirmed good skin layers union and contention with best esthetic result than observed with the traditional X and intradermal sutures techniques.

OBJETIVO: Apresentar dois novos tipos de suturas para melhor resultado estético na cicatrização da pele. METODOS: Utilizando fragmentos de pele de porco rotineiramente empregados no ensino e treinamento de técnica operatória, dois novos tipos de suturas da pele foram desenvolvidos. Um deles definido como sutura com pontos em X invertidos ou ocultos e outro como sutura intradérmica totalmente oculta. A primeira foi realizada com fio de polipropileno 4-0, e a intradérmica oculta com fio poliglicólico 4-0. RESULTADOS: Foram confirmados contenção e união adequada das camadas da pele com melhores resultados estético do que observados com as suturas tradicionais em X e intradémica. CONCLUSÃO: A análise macroscópica das suturas com pontos em X oculto e intradermica totalmente oculta e a tração centrífuga da bordas suturadas confirmaram boa união das camadas da pele com melhor resultado estético do que observado com as suturas em X e intradérmicas tradicionais.

rapid community based health evaluation of pregnant women in low socioeconomic settlements of Karachi

A rapid nutritional and health evaluation of a random sample of 163 pregnant women was conducted in low socioeconomic settlements of Karachi, with the objective of determining the morbidity and nutritional status of pregnant women. These data are expected to be used in an ongoing community-based antenatal care programme. Twenty-nine percent of women reported fever, 14% diarrhoea and 33% respiratory infections in the previous week. Mean weight was 54.8 [ +/- 10.6] kg, mean height was 151.6 [ +/- 6.0] cm and mean midarm circumference was 25.6 [ +/- 3.2] cm. The mean uterine height at gestational ages 8 months and over was 32.1 [ +/- 10.2] cm which is below the 10th%ile. These results suggest a chronic, mildly malnourished population with a high rate of infections. Specifically, we suggest that maternal height and uterine height be used to assess women at high risk for low birthweight