Left atrial shortening fraction in fetuses with and without myocardial hypertrophy in diabetic pregnancies.

OBJECTIVE: To test the hypothesis that, in diabetic pregnancies, left atrial shortening fraction (LASF) is decreased in fetuses with myocardial hypertrophy, compared to those without hypertrophy and to fetuses of non-diabetic mothers. METHODS: Fetal echocardiography was performed in women with pre-existing or gestational diabetes and in non-diabetic controls between 25 weeks' gestation and term. LASF was calculated using the formula: (end-systolic diameter-end-diastolic diameter)/end-systolic diameter, and data were compared between diabetic women with and without fetal myocardial hypertrophy and controls. RESULTS: The study population comprised 53 diabetic women and 45 controls. Out of the 53 fetuses of diabetic women, 14 had myocardial hypertrophy and 39 had normal septal thickness. Gestational age at the time of examination did not differ significantly between the control group and the two diabetic subgroups (P = 0.57). Fetuses with myocardial hypertrophy presented a mean ( +/- SD) LASF of 0.32 +/- 0.11, those without myocardial hypertrophy 0.46 +/- 0.12, and those of normal mothers 0.53 +/- 0.09 (P < 0.001). A significant inverse linear correlation was observed between LASF and septal thickness (r = - 0.51, P < 0.001). CONCLUSIONS: In diabetic pregnancies, LASF is lower in fetuses with myocardial hypertrophy than it is in those without hypertrophy and in fetuses of non-diabetic women, suggesting that LASF could be a useful alternative parameter in the assessment of fetal diastolic function.

[Accidental extubation in a pediatric intensive care unit]. / Extubação acidental em uma Unidade de Terapia Intensiva.

It is an on-going practice in the pediatric ICUs to obtain and to maintain a working artificial airway. Nevertheless this procedure bears not infrequent risks of accidental extubation (AE) which ranges in several services from 0.9 to 3.3 for each 100 days of intubation. The risk factors that are involved in AE are related to: sedation level, age-group, intubation path, and others. The purpose of the authors in this article was to observe the incidence of AE in their service and to compare the relative risk in the rate of AE among orotracheal and nasotracheal intubation population. A prospective study was taken during six months, in which every patients with artificial airway admitted at the PICU of the Santo Antonio Hospital in Porto Alegre (Brazil) was included except those with tracheostomy. The total number of cases were 673 patients-day with artificial airway, with an average of 3.7 patients with tracheal tube per day. In the period there were 18 AE, with a rate of 2.7 AE/ 100 days. The incidence rate of AE in the orotracheal group was 3.1% and 1.6% in the nasotracheal group with no statistically significant difference (p=0.6). The authors concluded that the pathway of intubation in their study does not carry any additional risk in the incidence of accidental extubation.