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Introducción: El estrés psíquico en los estudiantes universitarios de Licenciatura en Turismo puede provocar manifestaciones negativas en el orden psíquico, físico y social. Objetivo: Exponer la validez de un procedimiento de masaje terapéutico que contribuya a disminuir el estrés psíquico en los estudiantes de Licenciatura en Turismo en la Universidad de Holguín. Método: Se realizó una investigación cuantitativa, se utilizaron métodos teóricos y empíricos; para el procesamiento de los datos se utilizó la estadística matemática. Se seleccionaron 17 expertos para la valoración del procedimiento empleado, con una experiencia promedio de 17 años, la investigación fue de septiembre 2019 a julio 2022. Se seleccionó una muestra de 82 estudiantes, a la cual se le aplicó un test antes y después de concluir el tratamiento con masaje terapéutico. Resultados: Mediante la observación a los estudiantes en los diferentes contextos de actuación y la revisión de las fuentes de información se evidenció resultados indicadores de estrés psíquico. En encuesta aplicada a los profesores, se demostró pocos conocimientos teóricos y metodológicos para la aplicación del masaje terapéutico para estudiantes universitarios con estrés psíquico. Conclusiones: El procedimiento elaborado para disminuir el estrés se aplicó y demuestra su efectividad en la salud y el bienestar de la muestra seleccionada.(AU)
Introduction: Psychological stress in university students studying Bachelor of Tourism can cause negative manifestations in the psychological, physical and social order. Objective: To present the validity of a therapeutic massage procedure that contributes to reducing psychological stress in Bachelor of Tourism students at the University of Holguín. Method: A quantitative research was carried out, theoretical and empirical methods were used.Mathematical statistics were used to process the data.17 experts were selected to evaluate the procedure used, with an average experience of 17 years. The research was from September 2019 to July 2022. A sample of 82 students was selected, to whom a pre-test was applied before treatment,with therapeutic massage, and a post-test at the end. Results: By observing the students in the different contexts of action and reviewing the sources of information, results indicative of psychological stress were evident.In a survey administered to teachers, little theoretical and methodological knowledge was demonstrated for the application of therapeutic massage for university students with psychological stress. Conclusions: The procedure developed to reduce stress was applied and demonstrate its effectiveness on the health and well-being of the selected sample.(AU)
Introdução: O estresse psicológico em estudantes universitários do Bacharelado em Turismo pode causar manifestações negativas de ordem psicológica, física e social. Objetivo: Apresentar a validade de um procedimento de massagem terapêutica que contribui para a redução do estresse psicológico em estudantes do Bacharelado em Turismo da Universidade de Holguín. Método: Foi realizada uma pesquisa quantitativa, foram utilizados métodos teóricos e empíricos.Estatística matemática foi usada para processar os dados.Para avaliar o procedimento utilizado foram selecionados 17 especialistas, com experiência média de 17 anos. A pesquisa ocorreu de setembro de 2019 a julho de 2022. Foi selecionada uma amostra de 82 estudantes, aos quais foi aplicado um pré-teste antes do tratamento com massagem terapêutica, e um pós-teste no final. Resultados: Ao observar os estudantes nos diferentes contextos de atuação e revisar as fontes de informação, ficaram evidentes resultados indicativos de estresse psicológico.Em pesquisa realizada com professores, foi demonstrado pouco conhecimento teórico e metodológico para a aplicação da massagem terapêutica em estudantes universitários com estresse psicológico. Conclusões: O procedimento desenvolvido para reduzir o estresse foi aplicado e demonstrou sua eficácia na saúde e no bem-estar da amostra selecionada.(AU)
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Promover la estimulación del desarrollo motriz para niños de tres a cuatro años y aprovechar las potencialidades del Programa Educa a Tu Hijo mediante el papel de las familias, la comunidad y los docentes se consideran premisas para el desarrollo del pensamiento creativo que incluye el papel de los juegos en la formación integral, a partir de la ejecución de acciones motrices básicas. Por lo que, se propuso como objetivo de la investigación diseñar un sistema de juegos psicomotrices para los niños de tres a cuatro años del Programa Educa tu Hijo que favorezcan su desarrollo psicomotor. Esto, dio la posibilidad de capacitar a familiares, comunidad y docentes con un enfoque formativo integrador para la motivación del aprendizaje de la motricidad. Los juegos creados dieron muestra de buenas prácticas creativas, incluyeron acciones para expresar el sentir y el deseo de la muestra seleccionada. Para evaluar la temática fueron empleados los métodos teóricos análisis-síntesis, inductivo-deductivo y sistémico-estructural-funcional, empíricos análisis documental, observación, entrevista a los profesores, encuesta a la familia, así como métodos matemático-estadísticos. Por lo que, se ha llegado a la conclusión que los juegos psicomotrices, si se planifican de manera adecuada tienen un impacto positivo en las relaciones sociales, en lo cognitivo, el lenguaje, los sentimientos y las formas en que familiares, comunidad y docentes se preparan para potenciar la formación integral de sus hijos.
Promover a estimulação do desenvolvimento motor de crianças de três a quatro anos e aproveitar as potencialidades do Programa Eduque Seu Filho por meio do papel das famílias, da comunidade e dos professores são considerados premissas para o desenvolvimento do pensamento criativo que inclui o papel dos jogos no treinamento integral, baseado na execução de ações motoras básicas. Portanto, o objetivo da pesquisa foi propor um sistema de jogos psicomotores para crianças de três a quatro anos do Programa Educa tu Hijo que promovam seu desenvolvimento psicomotor. Isto deu a possibilidade de treinar familiares, comunidade e professores com uma abordagem de formação integrativa para motivar a aprendizagem motora. Os jogos criados apresentaram boas práticas criativas, incluíram ações para expressar os sentimentos e desejos da amostra selecionada. Para avaliar o tema foram utilizados os métodos teóricos de análise-síntese, indutivo-dedutivo e sistêmico-estrutural-funcional, análise documental empírica, observação, entrevista com professores, inquérito familiar, além de métodos matemático-estatísticos. Portanto, concluiu-se que os jogos psicomotores, se planejados de forma adequada, têm impacto positivo nas relações sociais, cognitivas, na linguagem, nos sentimentos e nas formas como os familiares, a comunidade e os professores interagem.
Promoting the stimulation of motor development for children aged three to four years and taking advantage of the potential of the Educa tu Hijo Program through the role of families, the community and teachers are considered premises for the development of creative thinking that includes the role of games in comprehensive training, based on the execution of basic motor actions. Therefore, it was proposed as the objective of the research design a system of psychomotor games for children aged three to four years of the Educa tu Hijo Program that promote their psychomotor development. This gave the possibility of training family members, the community and teachers with an integrative training approach to motivate motor learning. The games created showed good creative practices, they included actions to express the feelings and desires of the selected sample. The theoretical methods used to evaluate the topic were analysis-synthesis, inductive-deductive and systemic-structural-functional, the empirical ones were documentary analysis, observation, interview with teachers, family survey, as well as mathematical-statistical methods. Therefore, it has been concluded that psychomotor games, if planned appropriately, have a positive impact on social relationships, cognitive, language, feelings and the ways in which family members, the community and teachers interact. prepare to enhance the comprehensive education of their children.
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La discapacidad intelectual leve provoca un lento aprendizaje de las habilidades motrices, en particular de la coordinación, y se considera que esta problemática precisa de atención. En las clases de Educación Física se observó que los educandos con discapacidad intelectual leve presentaron alteraciones en las capacidades coordinativas motoras, posturales, sensoriales y en las conductas de adaptación a los diferentes contextos como la casa, la institución educativa y la comunidad; por lo que se planteó como objetivo desarrollar la coordinación en los educandos de siete a ocho años, mediante juegos motrices en las clases de Educación Física. El estudio que se presenta, se sustentó en la complementariedad metodológica al combinarse los enfoques cualitativo y cuantitativo; se emplearon métodos teóricos como el analítico-sintético, el sistémico-estructural-funcional, el histórico-lógico y el inductivo-deductivo y métodos empíricos como la observación, la entrevista, la encuesta y el experimento. Como resultado, se realizó la sistematización teórica, el diagnóstico y la propuesta de juegos motrices acorde con la edad y la discapacidad intelectual leve que se manifiesta en el desarrollo de la conducta motriz y en las relaciones de actuación de los educandos. De manera general, se constató una mejor coordinación y desarrollo de las habilidades para realizar los diferentes ejercicios y juegos motrices en las clases de Educación Física.
A deficiência intelectual leve causa uma aprendizagem lenta das habilidades motoras, particularmente da coordenação, e considera-se que esse problema precisa de atenção. Nas aulas de Educação Física, observou-se que os alunos com deficiência intelectual leve apresentavam alterações nas habilidades de coordenação motora, postural e sensorial e no comportamento de adaptação a diferentes contextos, como a casa, a instituição de ensino e a comunidade; portanto, o objetivo foi desenvolver a coordenação em alunos de sete a oito anos de idade, por meio de jogos motores nas aulas de Educação Física. O estudo aqui apresentado baseou-se na complementaridade metodológica, combinando abordagens qualitativas e quantitativas; foram utilizados métodos teóricos como o analítico-sintético, o sistêmico-estrutural-funcional, o histórico-lógico e o indutivo-dedutivo, bem como métodos empíricos como observação, entrevista, pesquisa e experimento. Como resultado, foram realizados a sistematização teórica, o diagnóstico e a proposta de jogos motores de acordo com a idade e a deficiência intelectual leve que se manifesta no desenvolvimento do comportamento motor e nas relações de desempenho dos alunos. Em geral, observou-se uma melhor coordenação e desenvolvimento de habilidades para realizar os diferentes exercícios e jogos motores nas aulas de Educação Física.
Mild intellectual disability causes slow learning of motor skills, particularly coordination, and this problem is considered to require attention. In Physical Education classes, it was observed that students with mild intellectual disabilities presented alterations in motor, postural, sensory coordinative capacities and in adaptation behaviors to different contexts such as home, the educational institution and the community; for this reason, the objective was to develop coordination in students from seven to eight years of age, through motor games in Physical Education classes. The study presented was based on methodological complementarity by combining the qualitative and quantitative approaches; theoretical methods such as the analytical-synthetic, the systemic-structural-functional, the historical-logical and the inductive-deductive and empirical methods such as observation, interview, survey and experiment were used. As a result, the theoretical systematization, the diagnosis and the proposal of motor games according to age and mild intellectual disability that manifests itself in the development of motor behavior and in the relations of action of the students were carried out. In general, there was a better coordination and development of skills to perform the different exercises and motor games in Physical Education classes.
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PURPOSE: To analyze the evolution post-cardiac resynchronization therapy (CRT) in left ventricular non-compaction (LVNC) cardiomyopathy (CM) patients compared to other types of CM, according to clinical and functional variables, by using gated-SPECT myocardial perfusion imaging (MPI). METHODS: Ninety-three patients (60 ± 11 years, 28% women) referred for pre-CRT assessment were studied and divided into three groups: 1 (non-ischemic CM with LVNC, 11 patients), 2 (ischemic CM, 28 patients), and 3 (non-ischemic CM, 53 patients). All were studied by a 99mTc-MIBI gated-SPECT MPI at rest pre-CRT implantation and 6 ± 1 months after, including intraventricular dyssynchrony assessment by phase analysis. Quality of life was measured by the Minnesota Living with Heart Failure Questionnaire (MLHFQ). RESULTS: No differences in sex, atherosclerotic risk factors other than smoking habit, and MLHFQ results were found among groups. LVNC CM patients were younger, with greater QRS width and lower left ventricular ejection fraction (LVEF) at baseline, but the differences were not significant. No significant differences were found at baseline regarding ventricular function, although end-systolic volume was slightly higher in LVNC CM patients. Mean SRS was significantly higher (p < 0.0001) in ischemic patients (14.9) versus non-ischemic ones (8.7 in group 1 and 9 in group 2). At baseline, LVNC CM patients were significantly more dyssynchronous: Their phase standard deviation (PSD) was higher (89.5° ± 14.2°) versus groups 2 (65.2° ± 23.3°) and 3 (69.7° ± 21.7°), p = 0.007. Although the quality of life significantly improved in all groups, non-ischemic patients (with or without LVNC) showed a higher LVEF increase and volumes reduction at 6 months post-CRT. Dyssynchrony reduced post-CRT in all groups. Nevertheless, those more dyssynchronous at baseline (LVNC CM) exhibited the most significant intraventricular synchronism improvement: PSD was reduced from 89.5° ± 14.2° at baseline to 63.7° ± 20.5° post-CRT (p = 0.028). Six months post-CRT, 89% of patients were responders: 11 (100%) of those with LVNC CM, 25 (86%) of those with ischemic CM, and 47 (89%) of patients with non-ischemic CM. No patient with LVNC CM had adverse events during the follow-up. CONCLUSION: CRT contributes to a marked improvement in non-ischemic CM patients with non-compaction myocardium. Phase analysis in gated-SPECT MPI is a valuable tool to assess the response to CRT.
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BACKGROUND: Left ventricular contraction dyssynchrony (LVCD) has been related to induced ischemia and transmural scar but the interplay of myocardial viability and dyssynchrony is unknown. The aim of the present study was to establish the role of dyssynchrony in the context of a viability study performed with nitrate augmentation gated single photon emission computed tomography (GSPECT) myocardial perfusion imaging (MPI). METHODS: Fifty-four consecutive patients with ischemic dilated cardiomyopathy (IDC) and depressed left ventricular ejection fraction (LVEF) were included. They underwent a two-day rest/nitroglycerine (NTG) study GSPECT MPI to determine the myocardial viability. Patients with a nitrate-induced uptake increase of > 10% vs baseline, in at least, two consecutive dysfunctional segments were considered viable as well as those who showed no improvement in the uptake but the uptake was > 50% on post NTG study. Patients with no nitrate-induced uptake increase of > 10% and the uptake of < 50% were considered non-viable. Perfusion, function and LVCD were compared in 25 viable patients vs 29 non-viable patients at baseline and after NTG administration. RESULTS: After NTG administration, in the viable group, the LVEF increased (36.44 ± 6.64% vs 39.84 ± 6.39%) and the end-systolic volume decreased significantly (119.28 ± 31.77 mL vs 109.08 ± 33.17 mL) (P < 0.01). These patients also experienced a significant reduction in the LVCD variables: phase standard deviation was reduced in the post NTG study (57.77° ± 19.47° vs 52.02° ± 17.09°) as well as the phase histogram bandwidth (190.20° ± 78.83° vs 178.0° ± 76.14°) (P < 0.05). Functional and LVCD variables remained similar in the non-viable patients (P > 0.05). CONCLUSION: In patients with IDC and depressed LVEF, the myocardial viability detected by rest/ NTG GSPECT MPI, might determine LVCD improvement.
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Tomografia Computadorizada por Emissão de Fóton Único de Sincronização Cardíaca/métodos , Cardiomiopatia Dilatada/fisiopatologia , Contração Miocárdica/fisiologia , Isquemia Miocárdica/fisiopatologia , Imagem de Perfusão do Miocárdio/métodos , Função Ventricular Esquerda/fisiologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Combined assessment of perfusion and function improves diagnostic and prognostic power of gated-SPECT in patients with coronary artery disease. The aim of this study was to investigate whether the presence of stress-induced ischemia is associated with abnormal resting left ventricular (LV) function and intraventricular dyssynchrony. METHODS AND RESULTS: Gated-SPECT myocardial perfusion imaging (MPI) at rest and 15 min post-stress was performed in 101 patients, who were divided into three groups: those with stress-induced ischemia (Group 1, n = 58), those with normal scans (Group 2, n = 28), and those with scar but no ischemia (Group 3, n = 15). More extensive perfusion defects were found in patients of Groups 1 and 3 [Summed stress score (SSS): 13 ± 8 and 21 ± 9, respectively]. In Group 2, the mean SSS was 1.5. The mean change in LV ejection fraction (LVEF at stress - LVEF at rest) was higher in Group 1 v. Group 2 patients: -5.54% ± 6.24% vs -2.46% ± 5.56%, p = 0.02. Group 3 patients also had higher values, similar to Group 1: -6.47% ± 8.82%. Patients with ischemia had almost 50% higher end-diastolic volumes than patients with normal MPI. Similarly, end-systolic volumes were almost twice as high in this group (p < 0.0001). In addition, the histogram bandwidth, a measure of intraventricular dyssynchrony, was greater in Group 1. CONCLUSIONS: Baseline differences in left ventricular volumes and degree of dyssynchrony are associated with inducible ischemia on stress testing in a gated-SPECT MPI. Stress-induced ischemia increases the degree of intraventricular dyssynchrony.
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Doença da Artéria Coronariana/diagnóstico por imagem , Imagem de Perfusão do Miocárdio , Tomografia Computadorizada de Emissão de Fóton Único , Idoso , Cicatriz/diagnóstico por imagem , Estudos Transversais , Teste de Esforço , Feminino , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/diagnóstico por imagem , Volume Sistólico , Disfunção Ventricular Esquerda/fisiopatologia , Função Ventricular EsquerdaRESUMO
INTRODUCTION: Heart failure, primarily in the elderly, is a growing epidemic in today's world. It leads to high rates of disability and mortality, as well as significant health care expenditures, making it important to assess possible predictors of adverse cardiac events. In Cuba, heart failure mortality is 19.1/100,000 population. OBJECTIVES: Assess the value of stress-rest protocol gated-SPECT for identifying patients with symptomatic heart failure likely to suffer adverse cardiac events. METHODS: A study was conducted of 52 patients (mean age 59 years, SD 9; 62% women) with functional capacity II/III (New York Heart Association scale) and left ventricular ejection fraction <40%. Patients were divided into two groups based on coronary heart disease diagnosis: those with coronary heart disease (41), labeled ischemic; and those without (11), labeled nonischemic. All underwent gated SPECT myocardial perfusion scintigraphy with technetium-99m-labeled methoxyisobutyl isonitrile, using a two-day stress-rest protocol, including evaluation of intraventricular synchrony by phase analysis. Patients were followed over 36 months for adverse cardiac effects. RESULTS: No significant differences were observed between the two groups during the stress test with regard to exercise time, metabolic equivalents or percentage of maximal heart rate during maximal stress. Summed stress, rest and difference scores, however, were significantly different between the ischemic and nonischemic groups: 16.82 (SD 6.37) vs. 7.54 (SD 5.8), p <0.001; 14.43 (SD 6.28) vs. 6.45 (SD 3.77), p = 0.001; and 2.39 (SD 4.89) vs. 1.09 (SD 3.7), p = 0.034. No differences were found in ventricular function, although stress-minus-rest left ventricular ejection fraction was slightly lower in patients with ischemic heart disease (-1.29, SD 5.8) than in patients without ischemic heart disease (1.27, SD 4.31). Dyssynchrony was greater in patients with ischemic heart disease than in those without, primarily during stress (p <0.01). The only variable that showed a possible association with the occurrence of adverse events was <5 metabolic equivalents on the stress test (p = 0.03), while resting phase SD showed only a tendency toward association (p = 0.05). CONCLUSIONS: Information on myocardial perfusion, functional capacity and intraventricular synchrony obtained from stress-rest gated SPECT may help identify patients with symptomatic heart failure who are likely to develop adverse cardiac events, enabling better management of higher-risk cases and improved allocation of resources.
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Doença das Coronárias/epidemiologia , Insuficiência Cardíaca/diagnóstico , Efeitos Adversos de Longa Duração/epidemiologia , Função Ventricular Esquerda/fisiologia , Comorbidade , Cuba/epidemiologia , Teste de Esforço , Feminino , Seguimentos , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Imagem de Perfusão , Prognóstico , Medição de Risco/métodos , Índice de Gravidade de Doença , Tomografia Computadorizada de Emissão de Fóton Único/métodosRESUMO
OBJECTIVE: The aim of the study was to identify the possible association among myocardial perfusion imaging (MPI) variables, coronary calcium score (CCS), and adverse events at medium term in type 2 asymptomatic diabetes mellitus patients. MATERIALS AND METHODS: Patients who participated in a first study that included a stress-rest MPI and a CCS assessment were asked to take part in this study. The present study protocol required a control single-photon emission computerized tomography after 3 years. Forty-one patients gave their informed consent. RESULTS: Of the 41 patients, 13 (32%) showed perfusion defects at the initial MPI. Of them, at 3 years, five continued showing perfusion defects, whereas another two had new defects (incidence of ischemia of 17%). Thus, 61% of the initial positive MPIs were normal at 3 years (P=0.04). In these cases the therapy was modified between the two studies. Left ventricular ejection fraction at stress showed a slight increase at 3 years (P=NS). Ventricular volumes significantly decreased at 3 years (P<0.01). Three patients (7.3%) developed an event during the follow-up (FU): two noncardiac deaths and one non-ST elevation myocardial infarction. The only variables that showed a possible association with the occurrence of events at FU were a CCS higher than 100 and less than 5 metabolic equivalents (METS) reached during the stress test (P=0.01). CONCLUSION: A CCS higher than 100 and a low functional capacity (<5 METS), but not an abnormal MPI, can be associated with cardiac events at 3-year FU in asymptomatic type 2 diabetic patients.
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Doenças Assintomáticas , Cálcio/metabolismo , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico por imagem , Diabetes Mellitus Tipo 2/complicações , Coração/fisiopatologia , Imagem de Perfusão do Miocárdio , Técnicas de Imagem de Sincronização Cardíaca , Doença da Artéria Coronariana/metabolismo , Doença da Artéria Coronariana/fisiopatologia , Feminino , Seguimentos , Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Estresse FisiológicoRESUMO
PURPOSE: The purpose of this study was to evaluate the ability of rest gated SPECT myocardial perfusion imaging (MPI) and intraventricular synchronism, to identify heart failure (HF) patients most likely to experience cardiac events. METHODS: We studied 165 patients with left ventricular ejection fraction of less than 40%, who were divided in 2 groups according to the diagnosis of coronary artery disease (group 1: 136 patients) or not (group 2: 29 patients). All underwent a rest gated SPECT MPI. RESULTS: In 160 patients, the MPI was abnormal. Mean summed rest score was 17 ± 6 (group 1) versus 10 ± 6 (group 2), P < 0.0001. Mean volumes showed a marked ventricular dilation, slightly higher among nonischemic. The mean value of the phase-derived SD was 70 ± 19 (group 1) versus 59 ± 21 degrees (group 2), P = 0.016. The histogram bandwidth showed no significant differences. Forty-four (39%) of 114 patients showed some kind of event during the follow-up. The more frequent events were HF progression (13%) and acute coronary syndrome (11%). The highest odds ratios for prediction of events were 1.91 (phase SD), 1.66 (etiology), and 1.55 (summed rest score), although the association was not significant. CONCLUSIONS: A rest gated SPECT is a valid approach to identify HF patients most likely to experience cardiac events.
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Tomografia Computadorizada por Emissão de Fóton Único de Sincronização Cardíaca , Insuficiência Cardíaca/fisiopatologia , Ventrículos do Coração/fisiopatologia , Imagem de Perfusão do Miocárdio , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Função VentricularRESUMO
INTRODUCTION: Myocardial reperfusion during the course of an acute myocardial infarction improves patients' short- and long-term prognosis; coronary blood flow is successfully re-established while preserving a large amount of at-risk muscle. Clinical evolution, however, varies. Presence of residual ischemia or viable myocardial tissue affects a patient's prognosis. Assessment by noninvasive methods allows better prognostic stratification. Cardiac-gated SPECT provides appropriate parameters to support treatment selection and monitoring of these patients. OBJECTIVES: Assess the prognostic value--ability to predict occurrence of major cardiac events--of perfusion and cardiac function obtained by myocardial perfusion scintigraphy in myocardial infarction patients treated by any myocardial reperfusion method, whether pharmacological or surgical. METHODS: Forty patients were included, mean age 58.8 ± 9 years, diagnosed with myocardial infarction. Participants were divided into two groups: primary percutaneous transluminal coronary angioplasty (15) or thrombolysis (25). All received myocardial perfusion scintigraphy with cardiac-gated SPECT to assess perfusion and left ventricular function, and were followed for six months with telephone interviews and review of clinical records. RESULTS: In the 11 patients who had major cardiac events within six months of followup, a nonsignificant increase in perfusion defect extent was seen post reperfusion. Six (54.5%) of those with major cardiac events had anterior perfusion defects. In functional parameters, a significant increase in end-diastolic and end-systolic volumes and decrease in left ventricular ejection fraction were observed post stress (p = 0.006) and at rest (p = 0.001). Post-stress end-diastolic volume of ≥70 mL had a higher prognostic value for major cardiac events [sensitivity 100%; specificity 89%, area under ROC curve 0.835 (CI 0.702-0.969), p = 0.001]. CONCLUSIONS: Cardiac-gated SPECT is useful to identify variables (including left ventricular systolic dysfunction and dilation of left cavities, particularly left end-systolic volume of >70 mL) predictive of major cardiac events in reperfused patients, independent of treatment modality.
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Tomografia Computadorizada por Emissão de Fóton Único de Sincronização Cardíaca , Infarto do Miocárdio/diagnóstico por imagem , Reperfusão Miocárdica , Feminino , Cardiopatias/diagnóstico , Cardiopatias/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Infarto do Miocárdio/tratamento farmacológico , Infarto do Miocárdio/cirurgia , Intervenção Coronária Percutânea , Prognóstico , Terapia Trombolítica , Função VentricularRESUMO
OBJECTIVE: To assess the ability of rest myocardial perfusion imaging (MPI) to rule out an acute coronary syndrome (ACS) in emergency department patients, as well as to investigate whether there exists a concordance between MPI and coronary calcium. MATERIALS AND METHODS: Fifty-five patients with chest pain and a normal or nondiagnostic ECG were included. Clinical follow-up was carried out within 1 year. RESULTS: Sixteen patients (29%) showed an abnormal rest MPI, and in 11 (20%) the MPI was equivocal. There was a weak concordance between MPI and coronary arteries calcium score (CACS) (κ: 0.25). Coronary angiogram driven by a positive MPI was performed in 12 patients (23%), resulting in percutaneous coronary intervention in nine cases (75%). A positive MPI (abnormal or equivocal results) was associated with the occurrence of events in the follow-up (χ(2)=19.961, P<0.0001). For a patient presenting to the emergency department with acute chest pain and a normal or nondiagnostic ECG, with a positive MPI, the relative risk of having events during the first year was 7.5 (95% confidence interval: 2.8-19.2), P<0.05, but with a positive CACS this was 1.77 (95% confidence interval: 0.69-4.56), P=NS. At 1 year 68.6% of patients were free of events. CONCLUSION: Patients presenting with acute chest pain and a low-to-intermediate likelihood of coronary artery disease with a normal rest MPI have a very low probability of cardiac events during the first year. Coronary calcium score was not helpful in risk-stratifying these patients.
Assuntos
Angina Pectoris/diagnóstico , Tomografia Computadorizada por Emissão de Fóton Único de Sincronização Cardíaca , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico , Eletrocardiografia , Tomografia Computadorizada Multidetectores , Imagem de Perfusão do Miocárdio/métodos , Calcificação Vascular/diagnóstico , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/diagnóstico por imagem , Síndrome Coronariana Aguda/etiologia , Adulto , Angina Pectoris/diagnóstico por imagem , Angina Pectoris/etiologia , Distribuição de Qui-Quadrado , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico por imagem , Serviço Hospitalar de Emergência , Estudos de Viabilidade , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Razão de Chances , Valor Preditivo dos Testes , Prognóstico , Medição de Risco , Fatores de Risco , Fatores de Tempo , Calcificação Vascular/complicações , Calcificação Vascular/diagnóstico por imagemRESUMO
La medicina regenerativa ha abierto una posibilidad más para la consolidación efectiva y la recuperación rápida de los pacientes con lesiones traumáticas. Se presenta un paciente masculino, blanco, de 46 años de edad con antecedentes de accidente de tránsito. Se diagnosticó fractura del tercio medio del fémur izquierdo y las radiografías simples evidenciaron conminución Grado IV. Egresó después de 20 días de internamiento con persistencia del dolor a pesar de habérsele administrado analgésicos cada 4-6 horas. Se indicó terapia celular que se realizó en régimen ambulatorio. A partir de las primeras 48 horas la mejoría se incrementó progresivamente, logró estabilidad y desapareció el dolor en el foco de fractura, síntoma que mantenía desde el accidente. A las 8 semanas después de la terapia celular se observó mejoría radiológica. En general, su evolución se consideró satisfactoria por la pronta mejoría y su incorporación a la vida social. Este es el primer paciente en la provincia de Artemisa en que se ha realizado este nuevo tipo de terapia y hasta donde conocemos en el momento de la redacción de este trabajo, también el primero informado en la literatura científica en Cuba
Regenerative medicine has opened another opportunity for effective consolidation and rapid recovery of patients with traumatic injuries. We present a 46 year- old white male patient with a history of traffic accident. A middle third left femur fracture was diagnosed and plain radiographs showed IV grade comminution. He was released after 20 days of hospitalization with persistent pain despite of pain medication every 4-6 hours. Cell therapy was prescribed and it was performed on outpatient basis. After 48 hours the improvement was increased progressively, stability was achieved and pain disappeared in the fracture site, this was a symptom present since the accident. 8 weeks after cell therapy, radiological improvement was observed. In general, his eveolution was considered satisfactory for the fast recovery and its incorporation into social life. This is the first patient in Artemisa province who underwent this new type of therapy and as far as we know at the time of this writing, it is also the first reported in the scientific literature in Cuba
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Fraturas do Fêmur/terapia , Transplante de Células/métodos , Medicina Regenerativa/métodosRESUMO
BACKGROUND: Coronary artery disease is a leading cause of death among diabetics, and silent ischemia is a major concern in patients with diabetes mellitus (DM). METHODS: To detect the prevalence of ischemia in diabetics by myocardial perfusion imaging (MPI), and compare it to a control group without DM but with coronary risk factors, as well as to explore the relationship between silent ischemia, endothelial dysfunction, and coronary calcium, 59 patients (Group I) and 42 controls (Group II) were included. All underwent clinical and laboratory evaluations, gated MPI, brachial artery vasodilation measured by ultrasonography, and coronary calcium score (CCS). RESULTS: Twenty diabetics showed perfusion defects, vs seven controls (P = .04). There was no significant difference between both groups regarding the brachial artery vasodilator responsiveness: 4.49% ± 4.26% (diabetics) vs 4.70% ± 4.98% (controls). Mean CCS was 74 in diabetics vs five in controls (P = .01). The only risk factor significantly associated with an abnormal MPI was the presence of diabetes (P = .03). In the whole population of patients and in diabetics, the abnormal endothelium-dependent vasodilation, the CCS >100, and the cholesterol/HDL ratio >4, showed an OR >1. CCS exhibited the higher OR among the whole population: OR 2.15 [95% CI 0.42-10.99]; while for diabetics it was the cholesterol/HDL ratio: OR 3.95 [95% CI 0.71-21.84]. CONCLUSIONS: Reversible perfusion defects and coronary calcium are more frequent in diabetics. CCS, abnormal endothelium-dependent vasodilation, and cholesterol/HDL ratio higher than 4, showed an association with perfusion abnormalities in asymptomatic diabetics.
Assuntos
Calcinose/diagnóstico por imagem , Calcinose/epidemiologia , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/epidemiologia , Diabetes Mellitus/diagnóstico por imagem , Diabetes Mellitus/epidemiologia , Endotélio Vascular/diagnóstico por imagem , Adulto , Comorbidade , Cuba/epidemiologia , Feminino , Humanos , Masculino , Imagem de Perfusão do Miocárdio/estatística & dados numéricos , Prevalência , Tomografia Computadorizada de Emissão de Fóton Único/estatística & dados numéricosRESUMO
Fundamento: las fracturas de clavículas son lesiones bastante frecuentes que producen pérdida de la continuidad ósea, de origen traumático entre las articulaciones acromioclavicular y esternoclavicular. Caso Clínico: se presenta una paciente puérpera de diecisiete años de edad y once días de parida con fractura del tercio medio de la clavícula derecha, debido a un accidente automovilístico, tratada en el hospital integral comunitario Aymara, La Paz, Bolivia. La misma necesitó como tratamiento, fijación interna con lámina y tornillos. Se presentó el proceder realizado, así como la evolución del mismo y se demostró que este método permite una movilidad y rehabilitación mediata del hombro, garantizando la reincorporación temprana de la madre a las actividades hogareñas y a la atención directa de su hijo.
Background: clavicle fractures are quite frequent lesions that produce loss of the bony continuity, of traumatic origin between the acromioclavicular and sternoclavicular joints. Clinical case: a puerperal patient of seventeen year-old and eleven days after given birth was presented with fracture of medial third of the right clavicle, due to an automobile accident, treated at the integral community hospital Aymara, La Paz, Bolivia. She needed as treatment, internal fixation with laminae and screws. The procedure carried out was described, as well as its evolution and it was demonstrated that this method allows a mobility and mediate rehabilitation of the shoulder, guaranteeing an early reincorporation of the mother to homelike activities and her son's direct attention.
Assuntos
Humanos , Feminino , Adolescente , Acidentes de Trânsito , Clavícula/lesões , Fixação de Fratura/métodos , Fraturas Ósseas/terapia , Fixadores Internos , Período Pós-PartoRESUMO
Para evaluar la efectividad del transplante de células madre en pacientes con infarto del miocardio e insuficiencia cardíaca crónica severa mediante técnicas de cardiología nuclear, se estudiaron 15 pacientes revascularizados: nueve (grupo I) recibieron células madre autólogas de médula ósea. Los 6 restantes correspondieron al grupo II (controles). Se les realizó evaluación clínica, ventriculografía radioisotópica y gammagrafía de perfusión con SPECT-gatillado (tecnecio-99m MIBI; protocolo de dos días: dipiridamol reposo), antes y tres meses después del proceder. A los tres meses hubo mejoría clínica en el 89 por ciento de los pacientes del grupo I. La fracción de eyección de ventrículo izquierdo aumentó: de 32±9 por ciento a 44±13 por ciento (p=0.03; grupo I) y de 38±2 por ciento a 48±14 por ciento (p NS; grupo II). La velocidad máxima de llenado se incrementó de 120±11 a 196±45 VTD/seg (p=0.03; grupo I). El score sumado del dipiridamol disminuyó significativamente sólo en el grupo I (de 35±5 a 23±14; p=0.02). La mejoría de la perfusión estuvo relacionada con el sitio de implante en el 60 por ciento de los casos. Concluimos que el transplante de células madre de médula ósea es efectivo en pacientes con insuficiencia cardíaca crónica severa de etiología isquémica.