RESUMO
OBJECTIVES: To assess whether spatiotemporal image correlation (STIC) volumes from fetuses at 11 + 0 to 13 + 6 weeks' gestation can be obtained by a non-expert and whether fetal echocardiography can be performed via a telemedicine link, providing a remote and reproducible diagnosis of the fetal heart condition. METHODS: STIC volume datasets from 35 fetuses at 11 + 0 to 13 + 6 weeks were obtained prospectively by a general obstetrician, transmitted via the Internet and subsequently analyzed systematically by two different reviewers. Forty-nine pregnancies were initially enrolled into the study, but adequate volumes were not obtained for 14. Thirty-four datasets were obtained on transabdominal and one on transvaginal ultrasound examination. A checklist was used that included 18 structures and views relating to the fetal heart evaluation, and each reviewer assigned the variables as normal, abnormal or unsure. Cohen's kappa analysis was used to evaluate the agreement between reviewers and the reported findings were compared with the outcome where available. RESULTS: The mean gestational age was 12 + 3 weeks and the mean (range) crown-rump length was 68 (47-84) mm. The mean maternal age was 33 (range, 26-41) years; 12/35 (34%) were older than 35 years. The four-chamber view obtained was apical in 22/35 (63%) cases and lateral in 13 (37%). Volume datasets were obtained after 12 weeks' gestation in 30/35 fetuses. Three cases had nuchal translucency thickness above the 99(th) percentile, and two of these had an abnormal heart. Five cases had abnormal outcomes. A mean of 3 (range, 1-6) STIC datasets per patient were acquired. The kappa index obtained confirmed interobserver reliability, with good or very good concordance (kappa > 0.6) in 14/18 structures and views related to the heart. CONCLUSIONS: STIC volumes acquired between 11 + 0 and 13 + 6 weeks' gestation could be sent over the Internet and their analysis enabled recognition of most of the structures and views necessary to assess the small fetal cardiac anatomy, with a high degree of interobserver concordance.
Assuntos
Ecocardiografia Quadridimensional/métodos , Cardiopatias Congênitas/diagnóstico por imagem , Interpretação de Imagem Assistida por Computador/normas , Internet , Telerradiologia/métodos , Ultrassonografia Pré-Natal/normas , Adulto , Volume Cardíaco , Feminino , Coração Fetal/diagnóstico por imagem , Cardiopatias Congênitas/embriologia , Humanos , Interpretação de Imagem Assistida por Computador/métodos , Variações Dependentes do Observador , Projetos Piloto , Gravidez , Primeiro Trimestre da Gravidez , Segundo Trimestre da Gravidez , Estudos Prospectivos , Ultrassonografia Pré-Natal/métodosRESUMO
OBJECTIVE: To compare sonographic visualization of midline cerebral structures obtained by two-dimensional (2D) imaging and three-dimensional (3D) multiplanar and volume contrast imaging in the coronal plane (VCI-C), with transfrontal 3D acquisition. METHODS: Sixty consecutive healthy fetuses in vertex presentation at a mean gestational age of 24 (range, 20-33) weeks underwent 2D and 3D ultrasound examination. Sagittal cerebral planes were reconstructed using 3D acquisition from axial planes by multiplanar analysis and by VCI-C. The reconstructed midline images of both these techniques were compared with the midline structures visualized directly in the A-plane by transfrontal 3D acquisition using a sweep angle of 30 degrees . Measurement of the corpus callosum and cerebellar vermis and visualization of the fourth ventricle and the main vermian fissures were compared. The sharpness of the images was also assessed qualitatively. Mid-sagittal tomographic ultrasound imaging (TUI) was also performed. 3D planes were compared with 2D transfontanelle median planes obtained by transabdominal or, when required, transvaginal sonography. RESULTS: The midline plane could be obtained in 88% of multiplanar, 82% of VCI-C and 87% of transfrontal analyses. Measurements of the corpus callosum and cerebellar vermis obtained by 3D median planes were highly correlated. The clearest and sharpest definition of midline structures was obtained with transfrontal acquisition. Primary and secondary fissures of the cerebellar vermis could be detected in 13-26% of multiplanar, 18-35% of VCI-C and 52-79% of transfrontal analyses. 2D visualization was superior or equal to the 3D transfrontal approach in all the parameters compared. CONCLUSION: 3D planes obtained from axial acquisitions are simpler and easier to display than are transfrontal ones. However, artifacts and acoustic shadowing are frequent in 3D axial acquisition and spatial resolution is better in the direct visualization transfrontal technique. If the standard examination includes a view of the fetal facial profile, a quick 3D acquisition through the frontal sutures provides direct visualization for assessment of the midline structures. We believe that this volumetric methodology could represent a step towards incorporating a comprehensive fetal neuroscan into routine targeted organ evaluation.
Assuntos
Cérebro/diagnóstico por imagem , Cérebro/embriologia , Ecoencefalografia/métodos , Ultrassonografia Pré-Natal/métodos , Feminino , Idade Gestacional , Humanos , Processamento de Imagem Assistida por Computador , Imageamento Tridimensional , Gravidez , Segundo Trimestre da GravidezRESUMO
OBJECTIVES: To describe the normal appearance and study the biometry of the fetal cerebellar vermis by three-dimensional (3D) volume contrast imaging in the coronal (C-) plane (VCI-C). METHODS: A total of 203 normally developed fetuses were examined prospectively at 18-33 weeks' gestation. At the level of the view used to measure the transverse cerebellar diameter (TCD), a VCI-C plane was displayed to examine, using a transabdominal probe, the fetal mid-saggital vermis. The volumes acquired were stored for later review and measurement of the anteroposterior (AP) diameter, craniocaudal (CC) diameter and surface area of the cerebellar vermis. Each dataset was evaluated by two independent observers. Measurements as a function of gestational age (GA), biparietal diameter (BPD), head circumference (HC) and TCD were expressed by regression equations. Interobserver variability was evaluated. Nomograms were produced. In order to validate the use of VCI in fetal biometry, datasets from 57 patients were selected arbitrarily for comparison of their VCI-C measurements with those from mid-sagittal sections of a stored 3D multiplanar examination. Intraclass correlation was used to evaluate the agreement between these measurements. RESULTS: The mean maternal age was 32 years. We were able to measure mid-sagittal CC diameter, mid-sagittal AP diameter and cerebellar vermis surface area in all fetuses. Interobserver variability analysis showed no significant differences between the two observers (P > 0.05). Measurements of the cerebellar vermis (AP diameter, CC diameter and surface area) correlated linearly with GA, BPD, HC and TCD (r > or = 0.82, P < 0.0001). CC and AP diameters estimated from the mid-sagittal section of the multiplanar measurements were significantly correlated with VCI-C measurements (r = 0.96, P < 0.00001 and r = 0.95, P < 0.00001, respectively). CONCLUSIONS: VCI-C is a valuable tool, allowing intrauterine assessment of the normal appearance of the fetal cerebellar vermis. The nomograms developed in this study should enable accurate evaluation of the cerebellar vermis.
Assuntos
Cerebelo/embriologia , Feto/anatomia & histologia , Ultrassonografia Pré-Natal/métodos , Adolescente , Adulto , Biometria , Cerebelo/diagnóstico por imagem , Meios de Contraste , Feminino , Humanos , Gravidez , Segundo Trimestre da Gravidez , Estudos ProspectivosRESUMO
BACKGROUND: In Chile, 10% of deaths in adults are directly attributed to smoking. AIM: To identify intrinsic and extrinsic motivations to quit smoking among a group of subjects that quitted without external help. MATERIAL AND METHODS: The motivations to quit smoking were measured using the 20 items Reasons for Quitting Scale (RFQ), in 145 ex smokers (80 students and 65 workers at The University of Conception). The scale identifies intrinsic motivations in the categories health and self control and extrinsic motivations in the categories immediate reinforcement and social pressure. RESULTS: Factorial analysis with orthogonal rotation of the 20 items of the scale, suggested an optimal solution with five factors, that had a maximal impact of 0.43 and explained the motivations in up to a 66% of workers and 65% of students. The factors with the greater impact were the items of immediate reinforcement, social pressure and self control. The category health had only a 6% influence in the modification of smoking habits. CONCLUSIONS: The most important motivations to quit smoking in this sample were an immediate reinforcement, social pressure and self control. The analysis of motivations will help to orient smoking cessation programs.
Assuntos
Motivação , Abandono do Hábito de Fumar/psicologia , Fumar/psicologia , Adolescente , Adulto , Chile , Estudos Transversais , Feminino , Humanos , Masculino , Fumar/epidemiologia , Ajustamento SocialRESUMO
BACKGROUND: Not all the techniques for the correct use of metered dose inhalers are used by patients and health care professionals. AIM: To assess the techniques and errors in the use of metered dose inhalers among patients and health care professionals. MATERIAL AND METHODS: Evaluation of the inhaling technique, using a validated questionnaire, used by 68 patients, 30 physicians and 30 nurses working in a hospital at Concepción, Chile. RESULTS: The "closed mouth" technique is used by 84% of patients, 40% of physicians and 73% of nurses. The rest uses the "open mouth" technique. The aerochamber is used by 12% of patients, 37% of physicians and 27% of nurses. The most frequent inhaling errors detected were not shaking the inhaler (26% of patients, 30% of physicians and 7% of nurses), not applying the puff at the start of inspiration (28% of patients, 7% of physicians and 13% of nurses), and not maintaining an apnea after the inhalation (41% of patients, 7% of physicians and 10% of nurses). Sixty percent of patients, 67% of physicians and 40% of nurses have not received instructions about the inhaler use. CONCLUSIONS: There is a high frequency of errors in the use of inhalers and most users have not been trained in its use.
Assuntos
Sistemas de Liberação de Medicamentos/métodos , Nebulizadores e Vaporizadores , Administração por Inalação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Sistemas de Liberação de Medicamentos/instrumentação , Falha de Equipamento , Feminino , Pessoal de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes , Estudos Prospectivos , Inquéritos e QuestionáriosRESUMO
BACKGROUND: High density lipoproteins are an heterogeneous population of particles. Two main subpopulations have been identified, one contains Apo A-I and Apo A-II and is denominated LpA-I:A-II and another one contains only Apo A-I and is denominated LpA-I. AIM: To measure the concentrations of these particles in patients with stable coronary artery disease. PATIENTS AND METHODS: Serum lipids, A-I and B apolipoproteins, LpA-I, LpA-I:A-II and LpB particles were measured in 73 men aged 33 to 82 years with angiographically documented coronary artery disease (CAD) and 33 control subjects aged 39 to 76 years. LpA-I, LpA-I:A-II and LpB were measured by a noncompetitive enzyme linked immunoassay using previously characterized monoclonal antibodies against ApoA-I, ApoA-II and apoB. RESULTS: Patients with CAD had significantly higher mean levels of LDL cholesterol than the control group (p = 0.038). The mean concentration of LpA-I particles in patients with CAD was significantly lower (p = 0.031) than in control subjects, while the concentration of LpA-I:A-II particles was significantly higher (p = 0.016). The percentage of coronary stenosis correlated negatively with LpA-I and positively with LpA-I:A-II. The best relative risk (RR) indicator in these patients was LDL-cholesterol. The relative risk increases 2.5 fold when LpA-I falls below the cut-off level. Likewise, the relative risk increases 3-fold when LpA-I:A-II raises over the cut-off level. CONCLUSIONS: Our findings indicate that the quantification of LpA-I and LpA-I:A-II particles might allow a more accurate evaluation of the CAD risk than HDL cholesterol. LpA-I might represent the antiatherogenic fraction of HDL.
Assuntos
Apolipoproteínas A/sangue , Apolipoproteínas B/sangue , Doença das Coronárias/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Doença das Coronárias/etiologia , Ensaio de Imunoadsorção Enzimática/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Fatores de Risco , Estatísticas não ParamétricasRESUMO
BACKGROUND: Effective smoking cessation campaigns require as baseline, precise estimations of smoking habits in different populations. AIM: To assess the prevalence of smoking in academic, non-academics workers and student of the University of Concepción. MATERIAL AND METHODS: In a random and stratified sample of 272 workers (including academics) and 1146 students, a previously validated, self administered questionnaire about smoking was applied. Daily smoking was defined as smoking seven or more cigarettes per week and occasional smoking as smoking less than seven cigarettes per week. RESULTS: The prevalence of smoking was 23% among academics, 34% among non-academic workers and 44% among students. Nineteen percent of men and 16% of women were occasional smokers; 23% of men and 25% of women were daily smokers. Students started smoking at 15 +/- 2 years old and workers did so at 18 +/- 3 years old. The greater influence about smoking came from parents. Workers from the administrative services and from the natural sciences faculty had the higher prevalence of the habit. The total annual cost of smoking was $33,000,000 (US$62,000). CONCLUSIONS: The prevalence of smoking at the University of Concepción is higher among students than workers. Quitting programs are urgently needed.
Assuntos
Docentes/estatística & dados numéricos , Fumar/epidemiologia , Estudantes/estatística & dados numéricos , Adolescente , Adulto , Chile/epidemiologia , Custos e Análise de Custo , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Universidades/estatística & dados numéricosRESUMO
The aim of the study was to assess the short-term effect of estrogen-progestin therapy on the plasma level of lecithin: cholesterol acyltransferase ([LCAT] EC 2.3.1.43), a key enzyme in the cholesterol reverse-transport process. The trial included 21 women with at least 6 months of menopause, which was confirmed by anamnesis, physical evaluation, and follicle-stimulating hormone (FSH) determination. Women receiving pharmacological treatment or who had any kind of endocrine disorder were excluded. In addition, we evaluated and confirmed normal Papanicolaou and mammography tests in all 21 women included in the trial. They received conjugated equine estrogen 0.625 mg daily, plus cyclic medroxyprogesterone acetate (5 mg daily) for 12 days each month. Plasma levels of LCAT, cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides, apoB, and apoAI were evaluated before and after 1 and 3 months of therapy. Pretherapy and posttherapy results were analyzed statistically by Wilcoxon's rank-sum test for paired samples. No significant changes were observed either for body mass index or for blood pressure. A significant increase in plasma LCAT activity was found at the first and third month posttherapy (P < .005). In addition, after 3 months of therapy, HDL-C significantly increased (P < .005), in contrast to the significant decrease detected in total cholesterol (P < .025), LDL-C (P < .005), cholesterol to HDL-C and LDL-C/HDL-C ratios (P < .005). Triglyceride levels did not show significant modification. In conclusion, our results indicate that short-term estrogen-progestin therapy produces a significant increase in plasma LCAT activity, as well as beneficial changes in the lipid profile, in postmenopausal women.