Diagnostic and prognostic value of QRS duration and QTc interval in patients with suspected myocardial infarction

Background: While prolongation of QRS duration and QTc interval during acute myocardial infarction (AMI) has been reported in animals, limited data is available for these readily available electrocardiography (ECG) markers in humans. Methods: Diagnostic and prognostic value of QRS duration and QTc interval in patients with suspected AMI in a prospective diagnostic multicentre study were prospectively assessed. Digital 12-lead ECGs were recorded at presentation. QRS duration and QTc interval were automatically calculated in a blinded fashion. Final diagnosis was adjudicated by two independent cardiologists. The prognostic endpoint was all-cause mortality during 24 months of follow-up. Results: Among 4042 patients, AMI was the final diagnosis in 19% of patients. Median QRS duration and median QTc interval were significantly greater in patients with AMI compared to those with other final diagnoses (98 ms [IQR 88–108] vs. 94 ms [IQR 86–102] and 436 ms [IQR 414–462] vs. 425 ms [IQR 407–445], p < 0.001 for both comparisons). The diagnostic value of both ECG signatures however was only modest (AUC 0.56 and 0.60). Cumulative mortality rates after 2 years were 15.9% vs. 5.6% in patients with a QRS > 120 ms compared to a QRS duration ≤ 120 ms (p < 0.001), and 11.4% vs. 4.3% in patients with a QTc > 440 ms compared to a QRS duration ≤ 440 ms (p < 0.001). After adjustment for age and important ECG and clinical parameters, the QTc interval but not QRS duration remained an independent predictor of mortality. Conclusions: Prolongation of QRS duration > 120 ms and QTc interval > 440 ms predict mortality in patients with suspected AMI, but do not add diagnostic value

PENGELOLAAN RETRIBUSI PASAR KOTA TERNATE TAHUN 2006-2010

This research was conducted in Ternate city, the objectives to be achieved in this study were to unveil the contribution of market levy towards local levies and Locally Derived Revenue (PAD), the target growth and the realization of market levy, the target growth and the realization of local levies, the effectiveness and efficiency in the collection of market levy, also to indentify the weak factor, the strength factor, the opportunity and threat factor in the market levy management. This research used the contribution formulation, the growth, the effectiveness and efficiency, and the SWOT analysis. The results of this research showed that the contribution of market levy to the local levies in 2006 till 2010 was average at 30.24 percent, while the contribution of market levy to the Locally Derived Revenue (PAD) was average at 11,35 percent. The target change of market levy was average at 22,29 percent and the target change of local levies was average at 19,46 percent, whereas the change of market levy realization was average at 22,19 percent and the change of local levies realization was average at 17,23 percent. The effectiveness during the study period was average at 98,97 percent, while the average efficiency was average at 21,29 percent. The SWOT analysis result on the market levy management of Ternate city located in the fourth quadrant, that was the strategic diversification, i.e in the quadrant that Municipal Government of Ternate should create some strategies which uses its power to address the existing threats

The Value of Ultrasonography in Hand Surgery

The quality of ultrasound imaging to examine anatomical structures in the wrist and hand has improved highly over the last years. The value of ultrasonography (US) performed by hand surgeons on treatment decisions was investigated in this study. One hundred and ninety-five patients with an unclear clinical hand problem were evaluated by high-definition ultrasonography from January 2005 until June 2007. In 21% of cases, the procedure and therapy were influenced by the ultrasonographic findings. In 26 patients examined by ultrasound, surgery was avoided, while 14 patients had unexpected ultrasound results that led to surgery. In 22 of the 84 performed operations, ultrasound had a direct impact on the surgical procedure itself. The agreement of the ultrasonographic diagnosis and the post-operative diagnosis (n = 80) was better, though not statistically significant compared to the agreement between clinical diagnosis and diagnosis after operation (n = 84). Ultrasound imaging performed by the hand surgeon improves quality in the evaluation of hand problems. Ultrasonography is a cost-effective high-resolution investigation with the possibility of dynamic imaging