OBJETIVO: Avaliar a taxa de remodelamento ventricular (RV) e a importância de variáveis clínico-funcionais em pacientes com função cardíaca normal submetidos à estimulação artificial apical do ...ventrículo direito (VD). MÉTODOS: Dentre 268 pacientes consecutivos com BAVT e marcapasso convencional, foram excluídos os portadores de fração de ejeção do ventrículo esquerdo (FEVE) < 55% e diâmetro diastólico do ventrículo esquerdo (DDVE) > 53 mm ao eco-Doppler. O RV foi definido como o conjunto de modificações ecocardiográficas documentadas pelo menos 6 meses pós-implante: aumento >10% no DDVE e redução > 20% na FEVE. As variáveis analisadas foram: cardiopatia de base, classe funcional de insuficiência cardíaca (IC), tempo de estimulação ventricular e duração do QRS. A análise estatística incluiu os testes da razão de verossimilhança, exato de Fisher e a soma de postos de Wilcoxon. O valor de p foi significante quando < 0,05. RESULTADOS: o estudo incluiu 75 pacientes com idade média de 70,9 ± 14 anos, 22,6% do sexo masculino. O tempo médio entre as avaliações foi de 80,2 meses. A FEVE média pré-implante foi 72% e o DDVE 46 mm e pós-implante, 69,7% (p = 0,0025) e 48,5mm (p < 0,0001), respectivamente. A duração média do QRS pós-implante foi 156 ms. O RV ocorreu em apenas quatro pacientes (5,3%), e nenhuma das variáveis exploratórias discriminou esse comportamento. CONCLUSÃO: Pacientes sem disfunção ventricular submetidos à estimulação cardíaca apical do VD em longo seguimento apresentaram baixa taxa de RV, e não foram definidos fatores associados para sua ocorrência.
A lightning-precipitation relationship (LPR) is studied at high temporal and spatial resolution (5 min and 5 km). As a proof of concept of these methods, precipitation data are retrieved from the ...National Severe Storms Laboratory (NSSL) NMQ product for southern Arizona and western Texas while lightning data are provided by the National Lightning Detection Network (NLDN). A spatial- and time-invariant (STI) linear model that considers spatial neighbors and time lags is proposed. A data denial analysis is performed over Midland, Texas (a region with good sensor coverage), with this STI model. The LPR is unchanged and essentially equal, regardless of the domain (denial or complete) used to obtain the STI model coefficients. It is argued that precipitation can be estimated over regions with poor sensor coverage (i.e., southern Arizona) by calibrating the LPR over well-covered domains that are experiencing similar storm conditions. To obtain a lightning-estimated precipitation that dynamically updates the model coefficients in time, a Kalman filter is applied to the STI model. The correlation between the observed and estimated precipitation is statistically significant for both models, but the Kalman filter provides a better precipitation estimation. The best demonstration of this application is a heavy-precipitation, high-frequency lightning event in southern Arizona over a region with poor radar and rain gauge coverage. By calibrating the Kalman filter over a data-covered domain, the lightning-estimated precipitation is considerably greater than that estimated by radar alone. Therefore, for regions where both rain gauge and radar data are compromised, lightning provides a viable alternative for improving QPE.
To describe an outbreak of Salmonella gastroenteritis among employees of the National Institute of Nutrition (INNSZ) of Mexico City during July, 1994.
Employees who developed diarrhea or fever ...associated with gastrointestinal symptoms starting on July 14th were included for study as well as 50 healthy controls. A questionnaire was applied to all, and they also provided a stool sample, along with other 80 asymptomatic people (included the kitchen workers) in whom only stool culture was done.
Ninety-seven employees that ate regularly at the Hospital's cafeteria were affected by the outbreak, and 67 of them (69%) could be evaluated. Most of them were nurses (34%), and handymen (27%). Most common symptoms were abdominal pain (97%), diarrhea (95%), nausea (91%), and fever (89%). Cultures from suspicious food items were all negative, but stool cultures from 10/70 cases were positive for Salmonella enteritidis vs. 0/133 in the controls. The ten S. enteritidis isolates resulted identical either by serotyping and by rapid amplified polymorphic DNA (RAPD) analysis. Cultures from all kitchen employees were negative for S. enteritidis. Breakfast meal on July 14th was associated with the development of gastroenteritis (61/67 cases vs 26/50 controls, p < 0.001), and particularly with an egg-covered meat plate (61/62 vs 13/26 controls, p < 0.0001).
This outbreak was probably caused by eggs contaminated with Salmonella, since no one of the kitchen personnel was found to be an asymptomatic carrier, and the implicated recipe allows for inappropriate cooking. Recommendations to improve cooking procedures must be added to the usual regulations to diminish the frequency of foodborne disease outbreaks in hospitals.
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