The influence of caregiver attitudes and socioeconomic group on formal and informal mental health service use among youth.

BACKGROUND: Young people can receive mental health care from many sources, from formal and informal sectors. Caregiver characteristics/experiences/beliefs may influence whether young people get help and the type of care or support used by their child. We investigate facilitators/barriers to receiving formal and/or informal care, particularly those related to the caregiver's profile. METHODS: We interviewed 1,400 Brazilian primary caregivers of young people (aged 10-19), participants of a high-risk cohort. Caregivers reported on young people's formal/informal mental health care utilization, and associated barriers and facilitators to care. Data were also collected on youth mental health and its impact on everyday life; and caregiver characteristics-education, socioeconomics, ethnicity, mental health, and stigma. Logistic regression models were used to examine the relationship between caregiver and young people characteristics with formal/informal care utilization. RESULTS: Persistence and greater impact of youth mental health conditions were associated with a higher likelihood of care, more clearly for formal care. Caregiver characteristics, however, also played a key role in whether young people received any care: lower parental stigma was associated with greater formal service use, and lower socioeconomic class showed higher odds of informal care (mainly from religious leaders). CONCLUSIONS: This study highlights the key role of the caregivers as gatekeepers to child treatment access, particularly parental stigma influencing whether young people received any mental health care, even in a low resource setting. These results help to map barriers for treatment access and delivery for young people, aiming to improve intervention efforts and mental health support.

High-dose versus low-dose angiotensin converting enzyme inhibitors in heart failure: systematic review and meta-analysis.

OBJECTIVE: To systematically review evidence comparing the effect of low-dose versus high-dose ACE inhibitors (ACEIs) on all-cause and cardiovascular mortality and hospitalisation, functional capacity and side effects in patients with heart failure (HF). METHODS: We searched PubMed, Embase, Cochrane CENTRAL and LILACS up to January 2019. We included randomised controlled trials (RCTs) comparing low-dose versus high-dose ACEIs in adults with HF with reduced left ventricular ejection fraction (HFrEF). Study selection and data extraction were performed by two independent reviewers. Risk of bias was assessed with RoB 2.0, and quality of evidence with Grading of Recommendations Assessment, Development and Evaluation (GRADE). We conducted random effects meta-analysis and trial sequential analysis. RESULTS: We included eight RCTs (5829 patients with HF). In comparison with low-dose ACEIs, high-dose ACEIs showed a non-significant effect on all-cause mortality (8 RCTs, n=5828, relative risk (RR) 0.95, 95% CI 0.88 to 1.02; moderate quality of evidence), cardiovascular mortality (6 RCTs, n=4048, RR 0.93, 95% CI 0.85 to 1.01; moderate quality of evidence), all-cause hospitalisation (5 RCTs, n=5394, RR 0.95, 95% CI 0.82 to 1.10; moderate quality of evidence) and cardiovascular hospitalisation (4 RCTs, n=5242, RR 0.98, 95% CI 0.83 to 1.17; low quality of evidence). High-dose ACEI increased functional capacity (4 studies, n=555, standardised mean difference 0.38, 95% CI 0.20 to 0.55; low quality of evidence) and the risk of hypotension (4 RCTs, n=3783, RR 1.64, 95% CI 1.30 to 2.05; moderate quality of evidence). High-dose ACEI had no effect on dizziness (3 RCTs, n=4994, RR 1.37, 95% CI 0.97 to 1.93; low quality of evidence), but decreased the risk of cough (4 RCTs, n=5146, RR 0.85, 95% CI 0.73 to 0.98; moderate quality of evidence). CONCLUSIONS: The magnitude of benefit of using high dose versus low to intermediate doses of ACEIs might be less than traditionally suggested in clinical guidelines. These findings might help clinicians address the complex task of HF management in a more rational and timely fashion, saving efforts to implement strategies with the greatest net clinical benefit.

I Brazilian Registry of Heart Failure - Clinical Aspects, Care Quality and Hospitalization Outcomes.

BACKGROUND: Heart failure (HF) is one of the leading causes of hospitalization in adults in Brazil. However, most of the available data is limited to unicenter registries. The BREATHE registry is the first to include a large sample of hospitalized patients with decompensated HF from different regions in Brazil. OBJECTIVE: Describe the clinical characteristics, treatment and prognosis of hospitalized patients admitted with acute HF. METHODS: Observational registry study with longitudinal follow-up. The eligibility criteria included patients older than 18 years with a definitive diagnosis of HF, admitted to public or private hospitals. Assessed outcomes included the causes of decompensation, use of medications, care quality indicators, hemodynamic profile and intrahospital events. RESULTS: A total of 1,263 patients (64±16 years, 60% women) were included from 51 centers from different regions in Brazil. The most common comorbidities were hypertension (70.8%), dyslipidemia (36.7%) and diabetes (34%). Around 40% of the patients had normal left ventricular systolic function and most were admitted with a wet-warm clinical-hemodynamic profile. Vasodilators and intravenous inotropes were used in less than 15% of the studied cohort. Care quality indicators based on hospital discharge recommendations were reached in less than 65% of the patients. Intrahospital mortality affected 12.6% of all patients included. CONCLUSION: The BREATHE study demonstrated the high intrahospital mortality of patients admitted with acute HF in Brazil, in addition to the low rate of prescription of drugs based on evidence.

I Brazilian Registry of Heart Failure - Clinical Aspects, Care Quality and Hospitalization Outcomes / I Registro Brasileiro de Insuficiência Cardíaca – Aspectos Clínicos, Qualidade Assistencial e Desfechos Hospitalares

Background: Heart failure (HF) is one of the leading causes of hospitalization in adults in Brazil. However, most of the available data is limited to unicenter registries. The BREATHE registry is the first to include a large sample of hospitalized patients with decompensated HF from different regions in Brazil. Objective: Describe the clinical characteristics, treatment and prognosis of hospitalized patients admitted with acute HF. Methods: Observational registry study with longitudinal follow-up. The eligibility criteria included patients older than 18 years with a definitive diagnosis of HF, admitted to public or private hospitals. Assessed outcomes included the causes of decompensation, use of medications, care quality indicators, hemodynamic profile and intrahospital events. Results: A total of 1,263 patients (64±16 years, 60% women) were included from 51 centers from different regions in Brazil. The most common comorbidities were hypertension (70.8%), dyslipidemia (36.7%) and diabetes (34%). Around 40% of the patients had normal left ventricular systolic function and most were admitted with a wet-warm clinical-hemodynamic profile. Vasodilators and intravenous inotropes were used in less than 15% of the studied cohort. Care quality indicators based on hospital discharge recommendations were reached in less than 65% of the patients. Intrahospital mortality affected 12.6% of all patients included. Conclusion: The BREATHE study demonstrated the high intrahospital mortality of patients admitted with acute HF in Brazil, in addition to the low rate of prescription of drugs based on evidence. .

Fundamento: A insuficiência cardíaca (IC) é uma das principais causas de hospitalização em adultos no Brasil, no entanto a maioria dos dados disponíveis é limitada a registros unicêntricos. O registro BREATHE é o primeiro a incluir uma ampla amostra de pacientes hospitalizados com IC descompensada de diferentes regiões do Brasil. Objetivo: Descrever as características clínicas, tratamento e prognóstico intra-hospitalar de pacientes admitidos com IC aguda. Métodos: Estudo observacional tipo registro, com seguimento longitudinal. Os critérios de elegibilidade incluíram pacientes acima de 18 anos com diagnóstico definitivo de IC, admitidos em hospitais públicos ou privados. Os desfechos avaliados incluíram causas de descompensação, uso de medicações, indicadores de qualidade assistencial, perfil hemodinâmico e eventos intra-hospitalares. Resultados: O total de 1.263 pacientes (64 ± 16 anos, 60% mulheres) foi incluído a partir de 51 centros de diferentes regiões do Brasil. As comorbidades mais comuns foram hipertensão arterial (70,8%), dislipidemia (36,7%) e diabetes (34%). Em torno de 40% dos pacientes apresentavam função sistólica do ventrículo esquerdo normal e a maioria foi admitida com perfil clínico-hemodinâmico quente-úmido. Vasodilatadores e inotrópicos endovenosos foram administrados a menos de 15% da amostra estudada. Indicadores de qualidade assistencial baseados nas orientações de alta hospitalar foram atingidos em menos de 65% dos pacientes. A mortalidade intra-hospitalar afetou 12,6% do total dos pacientes incluídos. Conclusão: O estudo BREATHE demonstrou a alta mortalidade intra-hospitalar dos pacientes admitidos com IC aguda no Brasil, somada à baixa taxa de prescrição de medicamentos baseados em evidências. .

Identificação dos procedimentos de contagem e dos processos de memória em crianças com TDAH / Identification of counting procedures and memory processes predominantly used by children with ADHD

O armazenamento e/ou o acesso automático dos fatos aritméticos da memória de longo prazo têm sido apontados como habilidades prejudicadas em crianças com Transtorno de Déficit de Atenção/Hiperatividade (TDAH). Em vista disso, esses estudantes acabam por utilizar procedimentos de contagem mais imaturos do que seus pares sem dificuldades. O objetivo principal deste estudo foi identificar os procedimentos de contagem e os processos de memória utilizados por um grupo de 28 estudantes com diagnóstico de TDAH do tipo com predomínio de desatenção (TDAH-D) ou do tipo combinado (TDAH-C). Os resultados indicaram que os estudantes continuam usando procedimentos de contagem considerados imaturos além da série esperada e que, dentre os processos de memória, a decomposição foi o mais usado.(AU)

The storage and/or automatic and accurate access of basic facts of addition from the long term memory seem to be impaired in children with Attention Deficit/Hyperactivity Disorder (ADHD). As a result, such group of students ultimately uses more immature counting procedures than their peers without the disorder. The aim of this study is to identify and describe the counting procedures and memory processes used by a group of 28 students, aged between 8 and 14 years old, with ADHD predominantly inattentive type (ADHD-PI) or combined type (ADHD-C). The results indicated that students with ADHD were still using counting procedures considered immature for the expected grade and that, among the memory processes, the decomposition was the most used one.(AU)

Identificação dos procedimentos de contagem e dos processos de memória em crianças com TDAH / Identification of counting procedures and memory processes predominantly used by children with ADHD

O armazenamento e/ou o acesso automático dos fatos aritméticos da memória de longo prazo têm sido apontados como habilidades prejudicadas em crianças com Transtorno de Déficit de Atenção/Hiperatividade (TDAH). Em vista disso, esses estudantes acabam por utilizar procedimentos de contagem mais imaturos do que seus pares sem dificuldades. O objetivo principal deste estudo foi identificar os procedimentos de contagem e os processos de memória utilizados por um grupo de 28 estudantes com diagnóstico de TDAH do tipo com predomínio de desatenção (TDAH-D) ou do tipo combinado (TDAH-C). Os resultados indicaram que os estudantes continuam usando procedimentos de contagem considerados imaturos além da série esperada e que, dentre os processos de memória, a decomposição foi o mais usado...

The storage and/or automatic and accurate access of basic facts of addition from the long term memory seem to be impaired in children with Attention Deficit/Hyperactivity Disorder (ADHD). As a result, such group of students ultimately uses more immature counting procedures than their peers without the disorder. The aim of this study is to identify and describe the counting procedures and memory processes used by a group of 28 students, aged between 8 and 14 years old, with ADHD predominantly inattentive type (ADHD-PI) or combined type (ADHD-C). The results indicated that students with ADHD were still using counting procedures considered immature for the expected grade and that, among the memory processes, the decomposition was the most used one...

Effect of nicotine and cigarette smoke on an experimental model of intraepithelial lesions and pancreatic adenocarcinoma induced by 7,12-dimethylbenzanthracene in mice.

OBJECTIVES: To evaluate the effects of nicotine and cigarette smoke exposure on mice submitted to 7,12-dimethylbenzanthracene (DMBA) model of pancreatic carcinogenesis. METHODS: One hundred fourteen male mice were divided into the DMBA-n and DMBA-s groups: the DMBA-n group was given 2 mg/kg per dose of nicotine ([3-(1-methyl-2-pyrrolidinyl)pyridine]) subcutaneously for 45 days, and the DMBA-s group was exposed to 100 mg/m of cigarette smoke. At day 16, 1 mg of DMBA crystals was implanted in the pancreatic head of both groups. Euthanasia was performed in all mice 30 days after the surgery. The specimens were evaluated according to the following criteria: normal ducts, reactive hyperplasia, pancreatic intraepithelial neoplasm 3 (PanIN-3), and carcinoma. For statistical analysis, DMBA-exclusive ([DMBA-e] historical control group) was included. RESULTS: The frequency of PanIN in the 3 groups was almost the same when considering the higher-grade lesions: DMBA-e (16 [66.7%]), DMBA-s (20 [66.7%]), and DMBA-n (12 [44.4%]). Pancreatic adenocarcinoma has a higher frequency in the DMBA-n group (14 [51.9%]) than in the DMBA-e (4 [16.7%]) and DMBA-s (4, 13.3%) groups. The DMBA-s group has the highest score of PanIN-3 (40%). The differences among the groups were statistically significant (P = 0.05, Fisher exact test). CONCLUSIONS: Nicotine but not cigarette smoke promotes pancreatic DMBA carcinogenesis in mice. Pancreatic adenocarcinomas and PanINs have the same phenotypic appearance as those that occur in humans.

Hyperbaric oxygen therapy effects on tissue lesions in acute pancreatitis. Experimental study in rats.

OBJECTIVE: To study the effects of hyperbaric oxygen therapy on tissue lesions in an experimental model of acute pancreatitis induced by pancreatic duct ligation. ANIMALS: Forty-eight adult female Wistar rats were randomized into two groups (n=24): control group and hyperbaric oxygen therapy group. INTERVENTION: The second group was treated with a two-hour daily session of hyperbaric oxygen therapy at 2.5 ATA started 6 hours after pancreatic duct ligation. SETTING: The two groups were divided into 3 subgroups of 8 rats each undergoing euthanasia on days 1, 3, and 7 after the acute pancreatitis induction. MAIN OUTCOME MEASURES: The pancreas was evaluated according to the following histopathologic criteria: edema, hemorrhage, acinar necrosis and leukocyte infiltration. RESULTS: Hyperbaric oxygen therapy was efficient in significantly reducing acinar necrosis on the first day (P=0.049) and the foci of hemorrhage on the seventh day (P=0.050). The edema and leukocyte infiltration did not show the expected reduction. CONCLUSION: The utilization of a daily session of hyperbaric oxygen therapy at 2.5 ATA is efficient in reducing the hemorrhage and acinar necrosis but is not sufficient to reduce edema and leukocyte infiltration.

Intestinal obstruction caused by a foramen of Winslow hernia.

Hernias occurring through the foramen of Winslow are extremely rare (accounting for only 8% of all internal hernias and 0.08% of all hernias) and are seldom diagnosed preoperatively. A delay in treatment is responsible for high mortality rates of around 36% to 49%. Successful management requires prompt diagnosis and surgical treatment.

Pancreatic intraepithelial neoplasia and ductal adenocarcinoma induced by DMBA in mice: effects of alcohol and caffeine.

PURPOSE: To evaluate the effects of alcohol and caffeine in a pancreatic carcinogenesis mouse model induced by 7,12-dimethylbenzantracene (DMBA), according to the PanIN classification system. METHODS: 120 male, Mus musculus, CF-1 mice were divided into four groups. Animals received either water or caffeine or alcohol or alcohol + caffeine in their drinking water. In all animals, 1 mg of DMBA was implanted into the head of the pancreas. After 30 days, euthanasia was performed; excised pancreata were then fixed in formalin, stained with hematoxylin-eosin and categorized as follows: normal ducts, reactive hyperplasia, PanIN-1A, PanIN-1B, PanIN-2, PanIN-3 or adenocarcinoma. RESULTS: PanIN lesions were verified in all groups. Adenocarcinoma was detected in 15% of animals in the caffeine group, 16.6% in the water group, 23.8% in the alcohol + caffeine group and 52.9% in the alcohol group (P<0.05). CONCLUSIONS: The experimental pancreatic carcinogenesis mouse model using DMBA effectively induces PanIN lesions and pancreatic adenocarcinoma. This study verified the association between alcohol use and pancreatic adenocarcinoma; caffeine did not present the same effect.

Pancreatic intraepithelial neoplasia and ductal adenocarcinoma induced by DMBA in mice: effects of alcohol and caffeine

PURPOSE: To evaluate the effects of alcohol and caffeine in a pancreatic carcinogenesis mouse model induced by 7,12-dimethylbenzantracene (DMBA), according to the PanIN classification system. METHODS: 120 male, Mus musculus, CF-1 mice were divided into four groups. Animals received either water or caffeine or alcohol or alcohol + caffeine in their drinking water. In all animals, 1 mg of DMBA was implanted into the head of the pancreas. After 30 days, euthanasia was performed; excised pancreata were then fixed in formalin, stained with hematoxylin-eosin and categorized as follows: normal ducts, reactive hyperplasia, PanIN-1A, PanIN-1B, PanIN-2, PanIN-3 or adenocarcinoma. RESULTS: PanIN lesions were verified in all groups. Adenocarcinoma was detected in 15 percent of animals in the caffeine group, 16.6 percent in the water group, 23.8 percent in the alcohol + caffeine group and 52.9 percent in the alcohol group (P<0.05). CONCLUSIONS: The experimental pancreatic carcinogenesis mouse model using DMBA effectively induces PanIN lesions and pancreatic adenocarcinoma. This study verified the association between alcohol use and pancreatic adenocarcinoma; caffeine did not present the same effect.

OBJETIVO: Avaliar os efeitos do álcool e da cafeína na carcinogênese pancreática induzida pelo 7,12-dimetilbenzantraceno (DMBA) em camundongos, descrevendo as lesões de acordo com a classificação das neoplasias pacreáticas intraepiteliais (PanIN). MÉTODOS: 120 camundogos machos, Mus musculus, CF-1 foram divididos em quatro grupos. Animais receberam água ou cafeína ou álcool ou álcool + cafeína para beber. Em todos animais, 1 mg de DMBA foi implantado na cabeça do pâncreas. Após 30 dias, eutanásia foi realizada, o pâncreas foi removido, fixado em formalina e corado com hematoxilina e eosina sendo classificado em: ductos normais, hiperplasia reativa, PanIN-1A, PanIN-1B, PanIN-2, PanIN-3 ou adenocarcinoma. RESULTADOS: Neoplasias pancreáticas intraepiteliais foram encontradas em todos grupos. Adenocarcinoma foi detectado em 15 por cento dos animais do grupo cafeína, 16,6 por cento do grupo água, 23,8 por cento do grupo álcool + cafeína e 52,9 por cento do grupo álcool (P<0,05). CONCLUSÕES: O modelo experimental de carcinogênese pancreática em camundongos utilizando DMBA induz neoplasias pancreáticas intraepiteliais (PanIN) e adenocarcinoma pancreático. Este estudoverificou associação entre álcool e adenocarcinoma pancreático, enquanto a cafeína não demonstrou este efeito.

Pancreatic intraepithelial neoplasia and ductal adenocarcinoma induced by DMBA in mice.

BACKGROUND: Pancreatic ductal adenocarcinoma has a poor long-term prognosis. Experimental models are necessary to understand not only its biologic behavior, but also the early pancreatic lesions known as pancreatic intraepithelial neoplasia (PanIN) and to develop new treatments. The aim of this study was to evaluate pancreatic carcinogenesis induced by 7,12-dimethyl-1,2-benzanthracene (DMBA) implantation in mice according to the PanIN classification system. METHODS: Ninety male, Mus musculus, CF-1 mice underwent a median laparotomy and 1 mg of DMBA was implanted into the proximal pancreas held in place by a purse-string suture. Mice were killed after 30 and 60 days after which the excised pancreata were fixed in formalin, embedded in paraffin, and stained with hematoxylin-eosin for histologic analysis. The specimens were evaluated blind by 2 pathologists for the presence of the following histology: normal ducts, reactive hyperplasia, PanIN-1A, PanIN-1B, PanIN-2, and PanIN-3, and adenocarcinoma. RESULTS: In the 30-day group, pathologic evaluation showed 4 (17%) reactive hyperplasia, 16 (67%) PanIN lesions, and 4 (17%) adenocarcinomas. In the 60-day group, there were 10 (27%) specimens with reactive hyperplasia, 13 (35%) with PanIN lesions, and 14 (38%) with adenocarcinomas. The difference between groups was statistically significant (P<.05). All pancreata with adenocarcinoma had concomitant PanIN lesions. CONCLUSIONS: The DMBA experimental model in mice induces PanIN lesions and ductal adenocarcinoma that have similar histology to that of human pancreatic cancer. This model may be useful for study of pancreatic carcinogenesis, particularly the molecular progression of early pancreatic ductal lesions.

Painel brasileiro de especialistas sobre diagnóstico do transtorno de déficit de atenção/hiperatividade (TDAH) em adultos / Brazilian consensus of specialists on the diagnosis of attention-deficit/hyperactivity disorder in adults

Considerando-se as dificuldades atuais do diagnóstico do transtorno do déficit de atenção/hiperatividade em adultos, foram reunidos especialistas brasileiros que fazem pesquisas nesta área, de modo a produzir diretrizes de consenso para uso no país. Foi realizada uma revisão não-sistemática preliminar e concebido um texto inicial, que foi repetidamente avaliado e editado pelos autores, com acréscimos e correções ao longo de 6 meses, através de correio eletrônico e de uma reunião posterior, patrocinada pela Associação Brasileira do Déficit de Atenção. A versão preliminar foi apresentada publicamente durante o congresso anual da Associação Brasileira de Psiquiatria, com comentários e sugestões dos participantes, para a redação da versão final.

Endomyocardial biopsy foretells ventricular function recovery after coronary artery bypass grafting.

OBJECTIVE: Patients with ischemic heart failure may benefit from coronary artery bypass grafting. The histopathological variables associated with improvement in ejection fraction 6 months after surgery were assessed. METHODS: This study comprised 24 patients indicated for coronary artery bypass grafting, ejection fraction < 35%, functional class II-IV heart failure, and mean age 59 +/- 9 years. Endomyocardial biopsies were performed during and 6 months after surgery. Extension of the fibrosis, number of cells with myocytolysis, and hypertrophy of the muscle fiber were quantified by using a system of image analysis. Clinical and functional review was repeated within 6 months. RESULTS: A significant improvement in heart failure functional class was observed in 16 patients after 6 months of follow-up (from NYHA functional class 2.8 +/- 0.7 to 1.7 +/- 0.6; P < 0.001), but the ejection fraction did not change (25 +/- 6 % vs. 26 +/- 10%). Hypertrophy of the muscle fiber was similar in the specimens biopsied in the pre- and postoperative periods (21 +/- 4 vs. 22 +/- 4 microm), but the extension of fibrosis (8 +/- 8 vs. 21 +/- 15% area) and the number of cells with myocytolysis (9 +/- 11 vs. 21 +/- 15% cell) significantly increased. However, the composition of a histological score combining those 3 variables indicated a greater increase in the ventricular function of those with a lower degree of preoperative histopathological alterations. CONCLUSION: Patients with ischemic cardiomyopathy undergoing coronary artery bypass grafting improved their ventricular function when the preoperative adverse histopathological alterations were of a lower degree.

Biópsia endomiocárdica prediz a recuperação da função ventricular após cirurgia de revascularização do miocárdio

OBJETIVO: Pacientes com insuficiência cardíaca isquêmica podem ser beneficiados com a cirurgia de revascularização do miocárdio. Foram estudadas as variáveis histopatológicas que estariam associadas à melhora da fração de ejeção seis meses após a cirurgia. MÉTODOS: Em 24 pacientes estudados com indicação de cirurgia de revascularização do miocárdio, fração de ejeção < 35 por cento, classe funcional de insuficiência cardíaca II-IV e idades entre 59 ± 9 anos, foram realizadas biópsias endomiocárdicas no transoperatório e seis meses após. Extensão de fibrose, número de células apresentando miocitólise e hipertrofia da fibra muscular foram quantificados por um sistema analisador de imagem. Revisão clínica e funcional foi repetida em seis meses. RESULTADOS: Houve melhora significativa da classe funcional de insuficiência cardíaca em 16 pacientes após os seis meses de acompanhamento (classe NYHA 2,8± 0,7 para 1,7±0,6; p <0,001), enquanto a fração de ejeção não se alterou (25 ± 6 por cento vs. 26 ± 10 por cento). Hipertrofia da fibra muscular foi similar nos espécimes biopsiados no pré e no pós operatório (21±4 vs. 22±4 µm), enquanto que a extensão de fibrose (8±8 vs. 21±15 por cento área) e células apresentando miocitólise (9±11 vs. 21±15 por cento cel) aumentaram significativamente. No entanto, a composição de um escore histológico, combinando as três variáveis, indicou maior incremento na função ventricular naqueles que apresentavam menor grau de alterações histopatológicas no pré-operatório. CONCLUSAO: Portadores de miocardiopatia isquêmica, submetidos à revascularização do miocárdio, apresentaram melhora da função ventricular quando as alterações histopatológicas adversas do pré-operatório foram de menor grau.