RESUMEN
INTRODUCTION: Vaccination is a key strategy to control the coronavirus disease 2019 (COVID-19) pandemic. Safety concerns strongly influence vaccine hesitancy. Disease transmission during pregnancy could exacerbate risks of preterm birth and perinatal mortality. This study examined patterns of vaccination and transmission among pregnant and postnatal women during the fifth wave of COVID-19 in Hong Kong. METHODS: The Antenatal Record System and Clinical Management System of the Hospital Authority was used to retrieve information concerning the demographic characteristics, vaccination history, COVID-19 status, and obstetric outcomes of women who were booked for delivery at Queen Mary Hospital in Hong Kong and had attended the booking antenatal visit from 1 July 2021 to 30 June 2022. RESULTS: Among 2396 women in the cohort, 2006 (83.7%), 1843 (76.9%), and 831 (34.7%) had received the first, second, and third doses of COVID-19 vaccine, respectively. Among 1012 women who had received the second dose, 684 (67.6%) women were overdue for their third dose. There were 265 (11.1%) reported COVID-19 cases. Women aged 20 to 29 years had a low vaccination rate but the highest disease rate (19.1%). The disease rate was more than tenfold higher in women who had no (20.3%) or incomplete (18.8%) vaccination, compared with women who had complete vaccination (2.1%; P<0.001). CONCLUSION: Acceptance of COVID-19 vaccination was low in pregnant women. Urgent measures are needed to promote vaccination among pregnant women before the next wave of COVID-19.
Asunto(s)
COVID-19 , Nacimiento Prematuro , Recién Nacido , Embarazo , Femenino , Humanos , Centros de Atención Terciaria , COVID-19/epidemiología , COVID-19/prevención & control , Vacunas contra la COVID-19 , Hong Kong/epidemiología , VacunaciónRESUMEN
INTRODUCTION: This study evaluated behavioural adaptations and responses to obstetric care among pregnant women during an early stage of the coronavirus disease 2019 (COVID-19) pandemic. METHODS: This cross-sectional survey included pregnant women who received obstetric care from 27 May 2020 to 16 June 2020 in a university-affiliated hospital in Hong Kong. Responses were collected with respect to obstetric appointment scheduling, workplace changes, mask-wearing practices, travel and quarantine experiences, obstetric service adjustments, and visiting arrangements. Regression analysis was used to compare the effects of patient characteristics on their responses. RESULTS: In total, 1000 surveys were distributed; 733 pregnant women provided complete survey responses. Among obstetric-related appointments in public hospitals, 16% were postponed or cancelled by pregnant women; such changes were most frequent among women beyond 24 weeks of gestation, women who had previous deliveries, and women who had a history of mental illness. The practice of working from home imposed psychological stress and negatively impacted the pregnancy experience in 4.5% of women. Childbirth companionship was regarded as an important service by 88.1% of women; only 4.2% agreed with its suspension. Obstetric service adjustments had the greatest impact on Chinese women and nulliparous women. CONCLUSIONS: The findings provide an overview of how pregnant women adapted during an early stage of the COVID-19 pandemic. Women adjusted obstetric service attendance, began working from home, and wore masks. Women's expectations did not match changes in childbirth companionship and peripartum services. Hospital administrators should consider psychological impacts on pregnant women when implementing service adjustments.
RESUMEN
INTRODUCTION: Owing to the coronavirus disease 2019 outbreak Hong Kong hospitals have suspended visiting periods and made mask wearing mandatory. In obstetrics, companionship during childbirth has been suspended and prenatal exercises, antenatal talks, hospital tours, and postnatal classes have been cancelled. The aim of the present study was to investigate the effects of these restrictive measures on delivery plans and risks of postpartum depression. METHODS: We compared pregnancy data and the Edinburgh Postpartum Depression Scale (EPDS) scores of women who delivered between the pre-alert period (1 Jan 2019 to 4 Jan 2020) and post-alert period (5 Jan 2020 to 30 Apr 2020) in a tertiary university public hospital in Hong Kong. Screening for postpartum depression was performed routinely using the EPDS questionnaire 1 day and within 1 week after delivery. RESULTS: There was a 13.1% reduction in the number of deliveries between 1 January and 30 April from 1144 in 2019 to 994 in 2020. The EPDS scores were available for 4357 out of 4531 deliveries (96.2%). A significantly higher proportion of women had EPDS scores of ≥10 1 day after delivery in the post-alert group than the pre-alert group (14.4% vs 11.9%; P<0.05). More women used pethidine (6.2% vs 4.6%) and fewer used a birthing ball (8.5% vs 12.4%) for pain relief during labour in the post-alert group. CONCLUSIONS: Pregnant women reported more depressive symptoms in the postpartum period following the alert announcement regarding coronavirus infection in Hong Kong. This was coupled with a drop in the delivery rate at our public hospital. Suspension of childbirth companionship might have altered the methods of intrapartum pain relief and the overall pregnancy experience.
Asunto(s)
COVID-19 , Salas de Parto/organización & administración , Depresión Posparto , Amigos/psicología , Control de Infecciones , Planificación de Atención al Paciente/organización & administración , Adulto , COVID-19/epidemiología , COVID-19/prevención & control , COVID-19/psicología , Depresión Posparto/diagnóstico , Depresión Posparto/epidemiología , Depresión Posparto/prevención & control , Depresión Posparto/psicología , Femenino , Hong Kong/epidemiología , Humanos , Control de Infecciones/instrumentación , Control de Infecciones/métodos , Control de Infecciones/organización & administración , Tamizaje Masivo/métodos , Tamizaje Masivo/estadística & datos numéricos , Innovación Organizacional , Embarazo , Atención Prenatal/organización & administración , Atención Prenatal/psicología , Educación Prenatal/organización & administración , Prevalencia , SARS-CoV-2RESUMEN
OBJECTIVE: To compare a couple-based cognitive behavioural intervention (CBI) for postnatal depression with CBI delivered to women alone and control (standard perinatal care). DESIGN: Multisite randomised controlled trial. SETTING: Antenatal clinics at three regional public hospitals in Hong Kong. SAMPLE: 388 low-risk childbearing couples. METHODS: Childbearing couples were randomly allocated to couple-based CBI (n = 134), women-alone CBI (n = 124) or control (n = 130). The CBI consists of a 3-hour antenatal group session and two 30-minute postnatal telephone follow-up sessions. MAIN OUTCOME MEASURES: The primary outcome was depressive symptoms, measured on the Edinburgh Postnatal Depression Scale (EPDS). Assessments were collected at baseline (during pregnancy), 6 weeks, 6 months, and 12 months postpartum. RESULTS: Depressive symptoms were significantly more improved at 6 weeks postpartum for mothers in couple-based CBI than in women-alone CBI (difference 1.46, 95% CI 0.11-2.81) or control groups (difference 1.71, 95% CI 0.29-3.13). The proportion of mothers with postnatal depression (EPDS score ≥ 10) was significantly lower at 6 weeks postpartum in couple-based CBI than in control (difference 17.8%, 95% CI 3.6-32.0). However, the treatment effect was not maintained at 6 and 12 months. There was no significant intervention effect among fathers. CONCLUSIONS: Couple-based CBI is more effective than CBI delivered to mothers alone and standard perinatal care in reducing the incidence of postnatal depression among Chinese mothers in the early postpartum period. TWEETABLE ABSTRACT: Couple-based cognitive behavioural intervention is effective in reducing postnatal depression among Chinese mothers in the early postpartum period.
Asunto(s)
Terapia Cognitivo-Conductual/métodos , Depresión Posparto/prevención & control , Parejas Sexuales/psicología , Adulto , Depresión Posparto/psicología , Femenino , Hong Kong , Humanos , Masculino , Atención Prenatal/métodos , Atención Prenatal/psicologíaRESUMEN
INTRODUCTION: A service model was established for pregnant women with positive screening results for hepatitis B surface antigen (HBsAg) at Queen Mary Hospital in Hong Kong. All women were offered a blood test for hepatitis B virus (HBV) DNA level during the first antenatal visit. Women with HBV DNA levels of ≥200 000 IU/mL received counselling from hepatologists regarding treatment with antenatal tenofovir disoproxil fumarate (TDF) 300 mg daily. METHODS: This retrospective review included women attending our antenatal clinic who exhibited positive HBsAg screening results from 15 May 2017 to 31 December 2019. The proportions of women with positive HBsAg, DNA test acceptance, hepatological review, and TDF acceptance during pregnancy were reviewed. RESULTS: In total, 375 (2.9%) of 13 082 pregnant women had positive HBsAg screening results. Blood tests for HBV DNA and hepatological reviews were offered to 273 women who had not undergone hepatological review prior to pregnancy; the acceptance rate was 97.8%. Sixty (22.6%) pregnant women were hepatitis B carriers with high viral loads of ≥200 000 IU/mL. Among 58 women with high viral loads, 57 received antenatal counselling regarding TDF and 56 (96.6%) agreed to take the drug; 92.9% of these 56 women had commenced TDF at or before 32 weeks of gestation. CONCLUSIONS: This study indicated broad acceptance of HBV DNA tests by pregnant women. Triage allowed early review and commencement of antiviral medication. This service model serves as a framework for enhanced antenatal service to prevent mother-to-child-transmission in public maternity units.
Asunto(s)
Antivirales/administración & dosificación , Hepatitis B/tratamiento farmacológico , Aceptación de la Atención de Salud/estadística & datos numéricos , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Atención Prenatal/métodos , Adenina/administración & dosificación , Adenina/análogos & derivados , Adulto , ADN Viral/sangre , Femenino , Hepatitis B/diagnóstico , Antígenos de Superficie de la Hepatitis B/sangre , Virus de la Hepatitis B/genética , Hong Kong , Humanos , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Pruebas de Detección del Suero Materno , Ácidos Fosforosos/administración & dosificación , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Estudios RetrospectivosAsunto(s)
Terapia por Láser , Placenta , Anastomosis Quirúrgica , Cauterización , Femenino , Humanos , Rayos Láser , Embarazo , Gemelos MonocigóticosRESUMEN
In this prospective study, 27 consecutive neonates suspected to be suffering from pulmonary atresia and intact ventricular septum underwent detailed two-dimensional echocardiographic examination before cardiac catheterization. Of the 27 neonates 25 had pulmonary atresia and intact ventricular septum and the remaining 2 had "functional pulmonary atresia" secondary to severe Ebstein's anomaly of the tricuspid valve. In all 25 neonates with pulmonary atresia and intact ventricular septum, the diagnosis and right ventricular morphology based on the tripartite approach were correctly established by echocardiography. The associated Ebstein's anomaly in two babies with pulmonary atresia and intact ventricular septum was also correctly identified by echocardiography. Among the five babies who had a sinusoidal-coronary artery communication, echocardiography demonstrated the fistula in one and provided clues for its diagnosis in two others. In the 25 neonates with pulmonary atresia and intact ventricular septum, the echocardiographic dimensions of their tricuspid anulus, right ventricular infundibulum and main pulmonary artery correlated well with the angiocardiographic measurements (r greater than 0.8). The results of this study suggest that, in the management of neonates with pulmonary atresia and intact ventricular septum, preoperative evaluation by echocardiography is usually sufficient and cardiac catheterization should be reserved for selected cases.
Asunto(s)
Ecocardiografía , Tabiques Cardíacos/patología , Arteria Pulmonar/anomalías , Cateterismo Cardíaco , Anomalía de Ebstein/patología , Ventrículos Cardíacos/patología , Humanos , Recién Nacido , Estudios Prospectivos , Arteria Pulmonar/patología , Válvula Pulmonar/anomalíasRESUMEN
The atrioventricular junction of 52 consecutive patients with univentricular atrioventricular connexion was examined by cross-sectional and pulsed Doppler echocardiography. The echocardiographic features were then compared with catheterisation and cineangiographic findings. In the diagnosis of the mode of atrioventricular connexion, cross-sectional echocardiography was superior to cineangiography in differentiating single inlet with absence of one atrioventricular connexion from double inlet with a common atrioventricular valve. Straddling atrioventricular valves were diagnosed by echocardiography alone. Using pulsed Doppler echocardiography, the diagnostic sensitivity of atrioventricular valvar regurgitation was 92.6% and the specificity 100%. By mapping the regurgitant jet with pulsed Doppler echocardiography, an index was derived to evaluate the severity of atrioventricular valvar regurgitation. The indices obtained correlated well with cineangiographic grading on a three-point scale (Spearman rank correlation coefficient: rs = 0.9). Thus, cross-sectional echocardiography coupled with a range-gated Doppler system provide accurate anatomical details of the atrioventricular junction and reliable assessment of atrioventricular valvar regurgitation in patients with univentricular atrioventricular connexion.
Asunto(s)
Ecocardiografía/métodos , Cardiopatías Congénitas/fisiopatología , Corazón/fisiopatología , Adolescente , Angiografía , Cateterismo Cardíaco , Niño , Preescolar , Atrios Cardíacos , Cardiopatías Congénitas/diagnóstico , Cardiopatías Congénitas/diagnóstico por imagen , Cardiopatías Congénitas/patología , Válvulas Cardíacas/anomalías , Ventrículos Cardíacos , Humanos , Lactante , Recién Nacido , Películas CinematográficasRESUMEN
The aim of this study is to test the hypothesis that the fluid conductance of cancellous bone graft is a deciding factor in graft-host union. Cylindrical cancellous bone specimens were trephined from fresh porcine femoral heads in a direction either parallel or perpendicular to the femoral neck axes. The graft after a defatting and freeze-drying process was placed in a perfusion apparatus. The pressure drop across the bone graft and the induced flow were measured and the conductance to fluid flow was calculated as the slope of the flow-pressure relation. Grafts of different flow conductance were transplanted into 35 rabbits to replace segments of tibiae. Nine weeks after grafting, 29 rabbits which had completed the follow-up without incidents were sacrificed. The decalcified sections of the grafts and the adjacent tibiae were examined microscopically for histological events during graft-host interface healing. Perfusion data indicated that fluid conductance ranged from 0.05 x 10(-10) to 13.4 x 10(-10) m3 s-1 Pa-1 and was higher in the direction parallel to the femoral neck axis, inversely proportional to the length of the graft and directly proportional to the square of porosity. Data from rabbit model supported the hypothesis stated above. A threshold conductance was found to be 1.5 x 10(-10) m3 s-1 Pa-1, below which revascularisation and the formations of osteoblasts and fibrous tissues could not be attained. How the low conductance led to non-union at the graft-host interface was briefly discussed.
Asunto(s)
Trasplante Óseo/fisiología , Huesos/fisiología , Animales , Trasplante Óseo/patología , Huesos/anatomía & histología , Huesos/cirugía , Exudados y Transudados/fisiología , Cabeza Femoral , Cuello Femoral , Estudios de Seguimiento , Predicción , Liofilización , Neovascularización Fisiológica/fisiología , Osteoblastos/fisiología , Perfusión , Permeabilidad , Porosidad , Presión , Conejos , Reología , Porcinos , Tibia , Conservación de Tejido , Trasplante Heterólogo , Cicatrización de HeridasRESUMEN
We conducted a retrospective analysis of 94 children with fractures of the distal third of the radius, with or without ulnar fractures, treated by primary closed reduction and plaster. The overall failure rate of 29% was due mainly to irreducibility, inability to maintain reduction and eventual limitation of forearm rotation. Age, sex and severity of angulation were not significant, but the direction of angulation and the degree of translation at either the radial or the ulnar fracture sites were significant risk factors. Translation of the radius was the single most reliable predictor of outcome (83% correct). The risk of failure in fractures with translation of the radius of more than half the diameter of the bone was 60%, compared with 8% for fractures with less translation.
Asunto(s)
Fracturas del Radio/terapia , Moldes Quirúrgicos , Niño , Femenino , Estudios de Seguimiento , Humanos , Masculino , Manipulación Ortopédica , Valor Predictivo de las Pruebas , Fracturas del Radio/clasificación , Estudios Retrospectivos , Factores de Riesgo , Sensibilidad y Especificidad , Resultado del TratamientoRESUMEN
The Gamma nail was introduced for the treatment of peritrochanteric fractures with the theoretical advantage of a load-sharing femoral component which could be implanted by a closed procedure. We report a randomised prospective study of 186 fractures treated by either the Gamma nail or a dynamic hip screw. Gamma nails were implanted with significantly shorter screening times, smaller incisions, and less intraoperative bleeding. The Gamma nail group had a shorter convalescence and earlier full weight-bearing, but there was no significant difference in mortality within six months, postoperative mobility, or hip function at review. More intra-operative complications were recorded in the Gamma nail group, mainly due to the mismatching of the femoral component of the nail to the small femurs of Chinese people. Use of a smaller modified nail reduced these complications. We conclude that with careful surgical technique and the modified femoral component, the Gamma nail is an advance in the treatment of peritrochanteric fractures.
Asunto(s)
Clavos Ortopédicos , Fracturas de Cadera/cirugía , Anciano , Anciano de 80 o más Años , Tornillos Óseos , Interpretación Estadística de Datos , Femenino , Fracturas de Cadera/diagnóstico por imagen , Humanos , Complicaciones Intraoperatorias/etiología , Masculino , Complicaciones Posoperatorias/mortalidad , Estudios Prospectivos , Diseño de Prótesis , RadiografíaAsunto(s)
Huesos del Carpo/lesiones , Luxaciones Articulares/cirugía , Adulto , Clavos Ortopédicos , Huesos del Carpo/diagnóstico por imagen , Huesos del Carpo/cirugía , Humanos , Luxaciones Articulares/diagnóstico por imagen , Ligamentos Articulares/lesiones , Masculino , Persona de Mediana Edad , RadiografíaRESUMEN
OBJECTIVE: To examine the applicability of hysterofetoscopy and cord blood collection at first trimester termination of pregnancy for fetal abnormalities. METHODS: From 2004 to 2007, transcervical hysterofetoscopy was performed in seven patients at the same operation setting of surgical termination of pregnancy. The findings were compared with prenatal diagnosis. Feasibility of cord blood collection was also examined. RESULTS: Out of these seven patients, six of them had prenatal ultrasound diagnosis of cystic hygroma. All of them had chromosomal abnormalities. Subcutaneous oedema was confirmed by hysterofetoscopy with good view. Another pregnancy was complicated by homozygous alpha thalassaemia and the diagnosis was confirmed by electrophoresis of fetal haemoglobin collected from umbilical cord vessel. Cord blood collection was also attempted in two other patients yielding fetal blood with minimal maternal contamination. CONCLUSION: Transcervical hysterofetoscopy is a feasible tool in confirming external fetal structural abnormalities before surgical termination of pregnancy. It can be performed under either general anaesthesia or conscious sedation. Umbilical cord blood collection can facilitate confirmation of genetic diseases. It may also allow the potential of isolating fetal mesenchymal stem cell in first trimester.
Asunto(s)
Recolección de Muestras de Sangre/métodos , Sangre Fetal , Fetoscopía/métodos , Feto/anomalías , Histeroscopía/métodos , Aborto Inducido , Aberraciones Cromosómicas , Femenino , Edad Gestacional , Humanos , Linfangioma Quístico/diagnóstico , Linfangioma Quístico/embriología , Embarazo , Primer Trimestre del Embarazo , Diagnóstico Prenatal/métodos , Ultrasonografía PrenatalRESUMEN
OBJECTIVES: As opposed to biochemical markers of Down syndrome, nuchal translucency (NT) was once thought to be a more reliable screening marker for high order multiple pregnancies and pregnancies conceived after assisted conception. Recent data suggested that NT in singleton fetuses from assisted reproduction technology (ART) was thicker than those from singleton pregnancies. The present study compared the thickness of NT in dichorionic twins from natural conception and assisted reproduction. METHODS: A retrospective analysis for comparison of NT thickness on 3319 spontaneous singletons, 19 pairs of spontaneous twins and 27 pairs of assisted reproduction twins was performed. RESULTS: The median NT multiple of median (MoM) of spontaneous singletons was 1.00. For twins, the median NT MoM for pregnancies after assisted reproduction and natural conception were 1.02 and 1.07 respectively. There was no statistical difference in the NT thickness among the three pregnancy groups. CONCLUSION: Contrary to the observed increase in NT in singleton pregnancies from assisted reproduction, the NT in dichorionic twins was comparable to the spontaneous ones. The mode of conception appears to impose differential influence on singletons and twins.
Asunto(s)
Medida de Translucencia Nucal/métodos , Técnicas Reproductivas Asistidas , Gemelos Dicigóticos , Femenino , Fertilización/fisiología , Humanos , Edad Materna , Embarazo , Resultado del Embarazo , Embarazo Múltiple , Técnicas Reproductivas Asistidas/efectos adversos , Estudios Retrospectivos , Ultrasonografía PrenatalRESUMEN
OBJECTIVES: Levels of maternal serum markers of fetal Down syndrome in pregnancies conceived after assisted reproduction are different from those of normal spontaneous pregnancies. The present study examined the effects of conventional in-vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI) and embryo cryopreservation on nuchal translucency (NT) thickness. METHODS: A retrospective analysis on 16 673 spontaneous pregnancies, 119 pregnancies with fresh embryos from IVF, 62 pregnancies with frozen-thawed embryos from IVF, 81 pregnancies with fresh embryos from ICSI and 39 frozen-thawed embryos from ICSI was performed. All were singletons with known normal outcomes. Multiples of the median (MoM) of NT were compared. RESULTS: The median NT MoM of spontaneous pregnancies was 1.01. In the assisted reproduction pregnancies, the median NT MoM were significantly increased to 1.07 (P = 0.003), 1.09 (P = 0.009) and 1.09 (P = 0.001) in pregnancies conceived with fresh embryos from IVF, frozen-thawed embryos from IVF and fresh embryos from ICSI, respectively. A non-significant increase in median NT MoM (1.04; P = 0.489) was also observed in pregnancies with frozen-thawed embryos from ICSI. CONCLUSIONS: Increased NT in assisted reproduction pregnancies is postulated to be due to some delay in fetal development. Another possible reason might be related to adverse antenatal course in these pregnancies.
Asunto(s)
Síndrome de Down/diagnóstico por imagen , Medida de Translucencia Nucal , Técnicas Reproductivas Asistidas , Estudios de Casos y Controles , Criopreservación , Transferencia de Embrión , Femenino , Fertilización In Vitro , Humanos , Edad Materna , Embarazo , Primer Trimestre del Embarazo , Estudios Retrospectivos , Inyecciones de Esperma Intracitoplasmáticas , Estadísticas no ParamétricasRESUMEN
The flow velocity pattern in the descending aorta, renal arteries, and celiac and superior mesenteric arteries was studied with pulsed Doppler in eight premature babies with symptomatic ductus arteriosus before and after ductal closure, as compared to nine premature babies without ductus arteriosus. There was a decrease or reversal of flow in diastole in the above arteries in babies with ductus and diastolic flow reappeared after ductal closure. This diastolic steal phenomenon has not been previously demonstrated in the abdominal arteries. It may contribute to proneness to ischemic damage of abdominal organs in premature babies.
Asunto(s)
Conducto Arterioso Permeable/fisiopatología , Enfermedades del Prematuro/fisiopatología , Arteria Renal/fisiopatología , Circulación Esplácnica/fisiología , Ultrasonografía , Aorta Torácica/fisiopatología , Velocidad del Flujo Sanguíneo , Conducto Arterioso Permeable/terapia , Ecocardiografía , Femenino , Hemodinámica , Humanos , Recién Nacido , Enfermedades del Prematuro/terapia , MasculinoRESUMEN
Joint laxity was measured clinically in 2,360 normal Chinese children aged 3-13 years with equal sex distribution using the Carter Wilkinson five tests and scoring system. Results showed minimal differences due to gender. The degree of joint laxity diminished with age. The knee extension and ankle extension tests were more sensitive than other tests. Chinese children were far more lax throughout the age range, with 100% "laxity" at age 3, 67% laxity at age 6, and 28% laxity at age 12, in contrast to 50, 5, and 1% laxity in the same age group respectively, in large series of Caucasian children.
Asunto(s)
Pueblo Asiatico , Inestabilidad de la Articulación/fisiopatología , Rango del Movimiento Articular , Adolescente , Envejecimiento/fisiología , Antropometría/métodos , Niño , Preescolar , Femenino , Hong Kong , Humanos , Masculino , Valores de Referencia , Sensibilidad y Especificidad , Población BlancaRESUMEN
The left ventricular dimension and posterior wall dynamics were studied by computer assisted analysis of M mode echocardiography in 25 normal children (group 1) and 32 transfusion dependent children with beta thalassaemia major who had no evidence of heart failure (group 2). Twenty seven of those in group 2 remained well but five died of cardiac decompensation within 12 months. Compared with group 1, the left ventricular fractional shortening and ejection fraction were normal in those in group 2 who survived but diminished in those who died. Evaluation of left ventricular dimension and posterior wall dynamics during systole (peak shortening rate, peak velocity of circumferential fibre shortening, and peak posterior wall thickening rate) showed similar findings in that only the group who died had abnormal values. The left ventricular dimension and posterior wall diastolic dynamics (peak relaxation rate, normalised peak relaxation, peak wall thinning, and normalised peak wall thinning rate), however, showed progressively slower rates in all the children in group 2. The findings suggest that left ventricular diastolic dysfunction occurs early in myocardial impairment in patients with beta thalassaemia major. When there are abnormalities in both diastole and systole, the myocardial impairment is advanced and the prognosis is poor.