Prognostic value of systolic mitral annular velocity measured with Doppler tissue imaging in patients with chronic heart failure caused by left ventricular systolic dysfunction.

OBJECTIVE: To assess the prognostic value of various conventional and novel echocardiographic indices in patients with chronic heart failure (CHF) caused by left ventricular (LV) systolic dysfunction. METHODS: 185 patients with a mean (SD) age of 67 (11) years with CHF and LV ejection fraction < 45% despite optimal pharmacological treatment were prospectively enrolled. The patients underwent two dimensional echocardiography with tissue harmonic imaging to assess global LV systolic function and obtain volumetric data. Transmitral flow was assessed with conventional pulse wave Doppler. Systolic (Sm), early, and late diastolic mitral annular velocities were measured with the use of colour coded Doppler tissue imaging. RESULTS: During a median follow up of 32 months (range 24-38 months in survivors), 34 patients died and one underwent heart transplantation. Sm velocity (hazard ratio (HR) 0.648, 95% confidence interval (CI) 0.463 to 0.907, p = 0.011), diastolic arterial pressure (HR 0.965, 95% CI 0.938 to 0.993, p = 0.015), serum creatinine (HR 1.006, 95% CI 1.001 to 1.011, p = 0.023), LV ejection fraction (HR 0.945, 95% CI 0.899 to 0.992, p = 0.024), age (HR 1.035, 95% CI 1.000 to 1.071, p = 0.052), LV end systolic volume index (HR 1.009, 95% CI 0.999 to 1.019, p = 0.067), and restrictive pattern of transmitral flow (HR 0.543, 95% CI 0.278 to 1.061, p = 0.074) predicted the outcome of death or transplantation on univariate analysis. On multivariate analysis, only Sm velocity (HR 0.648, 95% CI 0.460 to 0.912, p = 0.013) and diastolic arterial pressure (HR 0.966, 95% CI 0.938 to 0.994, p = 0.016) emerged as independent predictors of outcome. CONCLUSIONS: In patients with CHF and LV systolic dysfunction despite optimal pharmacological treatment, the strongest independent echocardiographic predictor of prognosis was Sm velocity measured with quantitative colour coded Doppler tissue imaging.

Use of automated external defibrillators in a Brazilian airline. A 1-year experience.

After the incorporation of automated external defibrillators by other airlines and the support of the Brazilian Society of Cardiology, Varig Airlines began the onboard defibrillation program with the initial purpose of equipping wide-body aircrafts frequently used in international flights and that airplanes use in the Rio - São Paulo route. With all flight attendants trained, the automated external defibrillation devices were incorporated to 34 airplanes of a total fleet of 80 aircrafts. The devices were installed in the baggage compartments secured with velcro straps and 2 pairs of electrodes, one or which pre-connected to the device to minimize application time. Later, a portable monitor was address to the resuscitation kit in the long flights. The expansion of the knowledge of the basic life support fundamentors and the corrected implantation of the survival chain and of the automated external defibrillators will increase the extense of recovery of cardiorespiratory arrest victims in aircrafts.

[Lactose malabsorption diagnosis with H2 breath test]. / Medida do H2 expirado no diagnóstico da má absorção de lactose.

One hundred and five healthy subjects under investigation for lactose malabsorption were enrolled in this prospective study. After an overnight fast, breath was collected immediately before and every 15 minutes for three hours after an oral administration of 50 g lactose dissolved in 200 mL of water (lactose overload). Blood samples were also collected before and 20, 40 and 60 minutes after the lactose overload for blood glucose determination. Expired H2 was measured by gas chromatography using a Quintron Microlyser and the maximum increase in H2 (delta-H2) was calculated. The area under the curve (ASC-H2) was also calculated using the trapezoid model. Lactose malabsorption was defined as a maximum increase in blood glucose (delta-G) under 18 mg%. The sensibility (S), specificity (E) and accuracy (A) of the H2 determination was analyzed using (a) linear regression [log (ASC-H2) = 4.034-0.029. delta-G], (b) receiver operating curve (ROC) and by (c) Q-Q plot of the cubit root transformation of the ASC-H2 values. Our results demonstrate that ASC-H2, but not delta-H2, correlates with delta-G, suggesting that the measurement of maximum increase in H2 expired following a lactose overload is not reliable for the diagnosis of lactose malabsorption. The cutoff value for the ASC-H2 using linear regression was 3260 (S = 89.3%, E = 80% and A = 86.7%), while using ROC it was 3353 (S = 88.0%, E = 80.0% and A = 85.7%) and while using Q-Q plot method it was 2936 (S = 92.0%, E = 80.0% and A = 88.6%). When the cutoff value was set to 3000, the sensibility, specificity and accuracy were 90.7%, 80.0% and 88.6%, respectively. We conclude that the calculation of the ASC-H2, but not delta-H2, following a lactose overload is reliable in detecting lactose malabsorption and can be used in the clinical practice.

Possible association between hemoglobin types and reproductive disorders in Brazilian Mangalarga mares

Foram estudadas as hemoglobinas de 100 éguas da raça Mangalarga, em idade de reproduçäo, provenientes da Fazenda Santa Fé, situada na regiäo de Botucatu. Esses animais foram divididos em 2 grupos, de acordo com o histórico reprodutivo de cada animal, sendo um formado por éguas reprodutivamente normais e o segundo por éguas portadoras de problemas reprodutivos. Foram colhidas amostras de 15 ml de sangue com anticoagulante. As hemoglobinas foram identificadas por meio de eletroforese em gel de poliacrilamida em placa vertical, a 7 por cento em pH 8.6, segundo Davis11 (1964). Quanto ao sistema de hemoglobinas, foram encontrados os seguinte fenótipos para o grupo de éguas reprodutivamente normais: A1--- (2,0 por cento), A1A2m+m+ (21,0 por cento) e A1A2m+m- (27,0 por cento); para o grupo de éguas com problemas reprodutivos: A1--- (10,0 por cento), A1A2m+m+ (12,0 por cento) e A1A2m+m- (28,0 por cento). A diferença na frequência do fenótipo A1--- entre os grupos pode ter ocorrido devido à existência da ligaçäo do loco hemoglobina a outro que controlaria características de produçäo. Além disso, pode estar ocorrendo influência do tipo de clima existente nos trópicos

[The practice of breast feeding in rural communities of a semi-arid area of Bahia]. / Prática do aleitamento materno em comunidades rurals do semi-árido baiano.

A Research project in the establishment and duration of total and exclusive breast-feeding in rural communities of Cansação, BA, Brazil, is presented. It included 226 children, from zero to two years old, of families of peasants living on small-holdings in one of the driest and poorest regions of the Brazilian Northeast. The data were collected through questionnaires answered by mothers or any adult responsible for the child during 1988 and 1989. It relates to all children from these families who were two years of age at the time of the study. The survival time was the statistical method used to calculate the median duration of breast-feeding; 91.6% of the 226 children started to be breast-fed. This finding shows that the establishment of the breast-feeding was high. The median duration of total breast-feeding was of 90.28 days and exclusive breast-feeding presented a median duration of 0.1 day. Through the establishment of breast-feeding can be considered high, the median duration of total breast-feeding is extremely short and that of exclusive breast-feeding insignificant.

[Levels of lead and mercury in the hair of children living in Cubatão, in the southeast region of Brazil]. / Teores de chumbo e mercúrio em cabelo de crianças residentes em Cubatão, na região sudeste do Brasil.

A study was carried out in 6 districts of Cubatão county, S. Paulo State, Brazil on a sample of 251 children aged between 1 and 10. The concentration of heavy metals (lead and mercury) in hair was tested. The lead concentration in the hair of 229 children was tested, and in 189 (82.5%) levels varying from 2.5 to 71.4 micrograms/g were detected. The average concentration of the lead found in hair was of 7.25 +/- 8.51 micrograms/g. The concentration of mercury in the hair of 217 children was checked and all of them were found to have levels varying from 0.2 to 3.0 micrograms/g. The average concentration of mercury was of 0.82 +/- 0.48 microgram/g. No statistical difference (p > 0.05) was observed between the averages found for lead and mercury in the hair of those who consumed and those who did not consume aquatic organisms.