Left Ventricular Function in Patients with Pulmonary Arterial Hypertension: The Role of Two-Dimensional Speckle Tracking Strain.

BACKGROUND: Pulmonary arterial hypertension (PAH) is characterized by elevated mean pulmonary arterial pressure with abnormal right ventricular (RV) pressure overload that may alter left ventricular (LV) function. The aim of this study was to assess the impact of RV pressure overload on LV function in PAH patients using two-dimensional (2D) speckle tracking strain. METHODS: The study enrolled 37 group 1 PAH patients and 38 age- and gender-matched healthy controls. LV longitudinal and radial 2D strains were measured with and without including the ventricular septum. Six-minute walk test (6MWT) and brain natriuretic peptide (BNP) levels were also obtained in patients with PAH. RESULTS: The mean age of patients was 46.4 ± 14.8 years, 76% women, and 16 patients (43%) had schistosomiasis. Sixteen patients (43%) were in WHO class III or IV under specific treatment for PAH. The overall 6MWT distance was 441 meters, and the BNP levels were 80 pg/mL. Patients with PAH more commonly presented with LV diastolic dysfunction and impairment of RV function when compared to controls. LV global longitudinal and radial strains were lower in patients than in controls (-17.9 ± 2.8 vs. -20.5 ± 1.9; P < 0.001 and 30.8 ± 10.5 vs. 49.8 ± 15.4; P < 0.001, respectively). After excluding septal values, LV longitudinal and radial strains remained lower in patients than in controls. The independent factors associated with global LV longitudinal strain were LV ejection fraction, RV fractional area change, and tricuspid annular systolic motion. CONCLUSIONS: This study showed impaired LV contractility in patients with PAH assessed by speckle tracking strain, irrespective of ventricular septal involvement. Global LV longitudinal strain was associated independently with RV fractional area change and tricuspid annular systolic motion, after adjustment for LV ejection fraction.

Simulation in Pediatric Video Surgery: Training with Simple and Reproducible Exercises Elaborated by Residents.

Background: Most residents do not have a defined program for simulation training in video surgery in Brazil. The training takes place for the most part in vivo or in short courses. The goal of this article is to describe and evaluate a set of exercises using low-cost materials, created by the residents themselves, to enable basic skills training in video surgery. Materials and Methods: Seven exercises were elaborated aiming to simulate main maneuvers performed in video surgery. The residents were guided by a written and video description showing the execution of the exercises, performed the exercises, and answered a questionnaire. After 3 weeks of free training, the residents performed the exercises and answered the questionnaire again. Results: Seven residents started the study; however, 6 completed the two steps. Among the participants, 83% received in vivo video surgery training, and only 2 (33%) received some supervised simulation training in minimally invasive surgery before this time. All participants considered the set of seven exercises representative of the actual skills in video surgery. There was no difficulty in acquiring the materials or in assembling them to carry out the training. All the participants had a shorter training time than initially proposed, on average 1 day/week for 20 minutes. Conclusions: A simple set of exercises can be elaborated by the residents themselves and make feasible the simulated training in video surgery even without the availability of sophisticated and expensive materials. The presence of a tutor and the scheduling of exclusive training seem necessary for more satisfactory results.

Conduta nos prolapsos genitais / Management of genital prolapse

O prolapso genital constitui afecção de grande importância social e econômica dada sua prevalência estimada em até 40% das mulheres, cujo aumento gradual coincide com o envelhecimento populacional. Estima-se que 30% das pacientes submetidas ao tratamento cirúrgico já foram operadas previamente pelo mesmo motivo. Fatos como esses e outras situações conflitantes, como a escolha entre tratamento conservador ou cirúrgico, a melhor técnica operatória para tratar as alterações anatômicas e funcionais do assoalho pélvico e o uso ou não de uma grande complexidade de materiais sintéticos e biológicos, têm sido objeto de constante investigação. O presente estudo teve por objetivo realizar uma revisão sistemática da literatura em relação ao manejo das pacientes portadoras de prolapso genital, considerando as evidências atuais referentes à utilização dos pessários vaginais, ao papel da fisioterapia, à melhor abordagem cirúrgica, às indicações do uso de telas e a concomitância, na vigência do prolapso, do tratamento cirúrgico da incontinência urinária

The pelvic organ prolapse is an important social and economic problem with the estimated prevalence at up to 40% of women, increasing with the aging population. It is estimated that 30% of patients undergoing surgical treatment, have been operated previously for the same reason. Facts such as these and other situations of conflict as the choice between conservative or surgical treatment, the best surgical technique to treat the anatomical and functional changes of the pelvic floor and use or not of a great complexity of biological and synthetic materials, have been under constant investigation. This study aims to realize a systematical review regarding the management of patients with genital prolapse, considering the current evidence regarding the use of vaginal pessaries, the role of physiotherapy, the best surgical approach, the indications for the meshes use and the concomitant surgical treatment of urinary incontinence, in the presence of prolapse