Diabetes Mellitus and Glucose as Predictors of Mortality in Primary Coronary Percutaneous Intervention

Background: Diabetes mellitus and admission blood glucose are important risk factors for mortality in ST segment elevation myocardial infarction patients, but their relative and individual role remains on debate. Objective: To analyze the influence of diabetes mellitus and admission blood glucose on the mortality of ST segment elevation myocardial infarction patients submitted to primary coronary percutaneous intervention. Methods: Prospective cohort study including every ST segment elevation myocardial infarction patient submitted to primary coronary percutaneous intervention in a tertiary cardiology center from December 2010 to May 2012. We collected clinical, angiographic and laboratory data during hospital stay, and performed a clinical follow-up 30 days after the ST segment elevation myocardial infarction. We adjusted the multivariate analysis of the studied risk factors using the variables from the GRACE score. Results: Among the 740 patients included, reported diabetes mellitus prevalence was 18%. On the univariate analysis, both diabetes mellitus and admission blood glucose were predictors of death in 30 days. However, after adjusting for potential confounders in the multivariate analysis, the diabetes mellitus relative risk was no longer significant (relative risk: 2.41, 95% confidence interval: 0.76 - 7.59; p-value: 0.13), whereas admission blood glucose remained and independent predictor of death in 30 days (relative risk: 1.05, 95% confidence interval: 1.02 - 1.09; p-value ≤ 0.01). Conclusion: In ST segment elevation myocardial infarction patients submitted to primary coronary percutaneous intervention, the admission blood glucose was a more accurate and robust independent predictor of death than the previous diagnosis of diabetes. This reinforces the important role of inflammation on the outcomes of this group of patients.

Electrical Properties of Isolated Cardiomyocytes in a Rat Model of Thiamine Deficiency

In modern society, thiamine deficiency (TD) remains an important medical condition linked to altered cardiac function. There have been contradictory reports about the impact of TD on heart physiology, especially in the context of cardiac excitability. In order to address this particular question, we used a TD rat model and patch-clamp technique to investigate the electrical properties of isolated cardiomyocytes from epicardium and endocardium. Neither cell type showed substantial differences on the action potential waveform and transient outward potassium current. Based on our results we can conclude that TD does not induce major electrical remodeling in isolated cardiac myocytes in either endocardium or epicardium cells.

Testosterone Deficiency Increases Hospital Readmission and Mortality Rates in Male Patients with Heart Failure

Background:Testosterone deficiency in patients with heart failure (HF) is associated with decreased exercise capacity and mortality; however, its impact on hospital readmission rate is uncertain. Furthermore, the relationship between testosterone deficiency and sympathetic activation is unknown.Objective:We investigated the role of testosterone level on hospital readmission and mortality rates as well as sympathetic nerve activity in patients with HF.Methods:Total testosterone (TT) and free testosterone (FT) were measured in 110 hospitalized male patients with a left ventricular ejection fraction < 45% and New York Heart Association classification IV. The patients were placed into low testosterone (LT; n = 66) and normal testosterone (NT; n = 44) groups. Hypogonadism was defined as TT < 300 ng/dL and FT < 131 pmol/L. Muscle sympathetic nerve activity (MSNA) was recorded by microneurography in a subpopulation of 27 patients.Results:Length of hospital stay was longer in the LT group compared to in the NT group (37 ± 4 vs. 25 ± 4 days; p = 0.008). Similarly, the cumulative hazard of readmission within 1 year was greater in the LT group compared to in the NT group (44% vs. 22%, p = 0.001). In the single-predictor analysis, TT (hazard ratio [HR], 2.77; 95% confidence interval [CI], 1.58–4.85; p = 0.02) predicted hospital readmission within 90 days. In addition, TT (HR, 4.65; 95% CI, 2.67–8.10; p = 0.009) and readmission within 90 days (HR, 3.27; 95% CI, 1.23–8.69; p = 0.02) predicted increased mortality. Neurohumoral activation, as estimated by MSNA, was significantly higher in the LT group compared to in the NT group (65 ± 3 vs. 51 ± 4 bursts/100 heart beats; p < 0.001).Conclusion:These results support the concept that LT is an independent risk factor for hospital readmission within 90 days and increased mortality in patients with HF. Furthermore, increased MSNA was observed in patients with LT.

Experience of ECMO in Primary Graft Dysfunction after Orthotopic Heart Transplantation

Background:Primary graft dysfunction is the main cause of early mortality after heart transplantation. Mechanical circulatory support has been used to treat this syndrome.Objective:Describe the experience with extracorporeal membrane oxygenation to treat post-transplant primary cardiac graft dysfunction.Methods:Between January 2007 and December 2013, a total of 71 orthotopic heart transplantations were performed in patients with advanced heart failure. Eleven (15.5%) of these patients who presented primary graft dysfunction constituted the population of this study. Primary graft dysfunction manifested in our population as failure to wean from cardiopulmonary bypass in six (54.5%) patients, severe hemodynamic instability in the immediate postoperative period with severe cardiac dysfunction in three (27.3%), and cardiac arrest (18.2%). The average ischemia time was 151 ± 82 minutes. Once the diagnosis of primary graft dysfunction was established, we installed a mechanical circulatory support to stabilize the severe hemodynamic condition of the patients and followed their progression longitudinally.Results:The average duration of extracorporeal membrane oxygenation support was 76 ± 47.4 hours (range 32 to 144 hours). Weaning with cardiac recovery was successful in nine (81.8%) patients. However, two patients who presented cardiac recovery did not survive to hospital discharge.Conclusion:Mechanical circulatory support with central extracorporeal membrane oxygenation promoted cardiac recovery within a few days in most patients.

Serial High-Sensitivity Troponin T in Post-Primary Angioplasty Exercise Test

Abstract Background: The kinetics of high-sensitivity troponin T (hscTnT) release should be studied in different situations, including functional tests with transient ischemic abnormalities. Objective: To evaluate the release of hscTnT by serial measurements after exercise testing (ET), and to correlate hscTnT elevations with abnormalities suggestive of ischemia. Methods: Patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary angioplasty were referred for ET 3 months after infarction. Blood samples were collected to measure basal hscTnT immediately before (TnT0h), 2 (TnT2h), 5 (TnT5h), and 8 hours (TnT8h) after ET. The outcomes were peak hscTnT, TnT5h/TnT0h ratio, and the area under the blood concentration-time curve (AUC) for hscTnT levels. Log-transformation was performed on hscTnT values, and comparisons were assessed with the geometric mean ratio, along with their 95% confidence intervals. Statistical significance was assessed by analysis of covariance with no adjustment, and then, adjusted for TnT0h, age and sex, followed by additional variables (metabolic equivalents, maximum heart rate achieved, anterior wall STEMI, and creatinine clearance). Results: This study included 95 patients. The highest geometric means were observed at 5 hours (TnT5h). After adjustments, peak hscTnT, TnT5h/TnT0h and AUC were 59% (p = 0.002), 59% (p = 0.003) and 45% (p = 0.003) higher, respectively, in patients with an abnormal ET as compared to those with normal tests. Conclusion: Higher elevations of hscTnT may occur after an abnormal ET as compared to a normal ET in patients with STEMI.

Prevalence of Risk for Obstructive Sleep Apnea Syndrome and Association With Risk Factors in Primary Care

Abstract Background: Obstructive sleep apnea syndrome (OSAS) is a chronic, progressive disease with high morbidity and mortality. It is underdiagnosed, especially among women. Objective: To study the prevalence of high risk for OSAS globally and for the Berlin Questionnaire (BQ) categories, and to evaluate the reliability of the BQ use in the population studied. Methods: Observational, cross-sectional study with individuals from the Niterói Family Doctor Program, randomly selected, aged between 45 and 99 years. The visits occurred between August/2011 and December/2012. Variables associated with each BQ category and with high risk for OSAS (global) were included in logistic regression models (p < 0.05). Results: Of the total (616), 403 individuals (65.4%) reported snoring. The prevalence of high risk for OSA was 42.4%, being 49.7% for category I, 10.2% for category II and 77.6% for category III. Conclusion: BQ showed an acceptable reliability after excluding the questions Has anyone noticed that you stop breathing during your sleep? and Have you ever dozed off or fallen asleep while driving?. This should be tested in further studies with samples mostly comprised of women and low educational level individuals. Given the burden of OSAS-related diseases and risks, studies should be conducted to validate new tools and to adapt BQ to better screen OSAS.

Nota prévia sôbre a meiose de Corizus (Liorhyssus) hyalinus (Fabr.) (Hemiptera-Corizidae)

The main facts presented in this paper may be summarized as follows: 1) Corizus (Liorhyssus) hyalinus (Fabr.) has primary spermatocytes provided with 6 autosomal tetrads, one pair of microchromosomes and one sex chromosome. 2) The two microchromosomes present in this species sometimes appear at the primary metaphase as an unequal pair of minute elements. In the secondary spermatocytes the unique microchromosome present may be in the limit of visibility or entirely invisible. This invisibility may be partly due to a loss of colourability. 3) The sex chromosome divides transversely in the first division of the spermatocyte, passing undivided to one pole in the second one. In the latter it becomes fusiform in the beginning of anaphase revealing in this manner its dicentricity. In late anaphase it finishes by passing to one pole leaving in the other pole one of its kinetochores sometimes accompanied by a chromosomal fragment. 4) All the chromosomes divide transversely in both divisions, a diagram being enclosed to elucidate the question. 5) Spermatogonial chromosomes are provided with one kinetochore at each end, being curved toward the poles since the most beginning anaphase. 6) The following hypothesis is presented as an essay to explain the origin of microchromosomes: Since microchromosomes parallel sex chromosomes in most respects, as for instances in heteropycnosis and pairing modus, it seems highly probable that they originate from sex chromosomes. One may suppose that the ancestral form of a given species had a sex chromosome which used to lose a small centric fragment when it divided during meiosis. This fragment might well be at first an unstable one. Later, to compensate the effects of such a deficiency a mechanism arose through evolution which produced two useful results : a) the establishment of the fragment as a permanent structure of the cell nucleus and b) the acquirement by the sex chromosome of the faculty of passing to one pole without losing any of its ends.

Estudos químico-agrícolas sôbre o enxofre

1. Analyses of soluble sulphates in 2 N ammonium chloride extracts of 24 samples of soils of the state of São Paulo, Brazil, S. A., showed a sulphur content varying from 0,0013 g per 100 g (found in the b layer of a genuine "terra roxa") to 0,007 g per 100 g of soil (b layer of a soil of depression without definite characteristics). (The results are expressed as elemental sulphur). Determinations of total sulphur in 56 samples of soils of the same state using the method of fusion with sodium carbonate and sodium nitrate revealed 0.007 g of elemental S per 100 g of soil as the lowest value (found in several soil types) and 0.096 g as the highest one (found in the b layer of an ar-quean soil). Apparently soluble sulphates accumulate in the upper layers and total sulphur does the opposite. It was found a strong correlation between total S and carbon content. 2. Under laboratory conditions, in a compost of fresh soil, powdered sulphur and apatite, it was verified after a three months period of incubation that the pH value lowered from 6.30 to 3.23; the citric acid solubility of apatite increased to 271.1 per cent of the original one. Lupinus sp. grown in soil manured with sulphur and apatite has showed fresh and dry weights higher than the plants in control pots; the results are significant at 5% level of probability; phosphorus content is also higher in the manured plants. It was observed a net influence of the apatite plus sulphur treatment on the weight of root nodosities that was four times greater than in the control plants. 3. Nearly five hundred determinations of S, N and P were carried out in 35 species of plants cultivated in the state of São Paulo. A great variation in the amounts of these elements was observed. As a general rule, the leaves contain more sulphur than the stems and roots show the lowest percentages. The conjunct roots and stem of guar (Cyamopsis psoraloides) revealed only 0.019 per cent sulphur; the leaves of kale showed the highest sulphur content, i. e., 2.114%. Apparently there is no correlation between the amounts of S, N and P. The ratio S/N increases from 0.006 (guar) to 0.485 (kale). The ratio S/P, always higher than the corresponding S/N, increases from 0.082 (guar) to 6.381 (older leaves of tomato plants). It is interesting to mention that several among the most important crops in the state of São Paulo namely, cotton, rice, coffee and sugar cane contain more sulphur than phosphorus. 4. Tomato plants cultivated in nutrient solution lacking sulphur showed the following visual symptons of deficiency : chlorosis first in the younger leaves and afterwards in all the leaves; anthocyanin pigments in the petioles and stems; absence of fruits; primary roots stunted and secondary ones longer than in the control plants; stems slender, hard, woody. The histological study of petioles suffering from sulphur deficiency revealed anthocyanin in the parenchyme layer instead of clo-rophyll pigments observed in normal petioles; in the chlorotic leaves the large chloroplasts present only the stroma but the small ones have a little amount of green pigments. Chemical analysis revealed in the abnormal plants : less sulphur and an increased proportion of phosphorus; older leaves contain more sulphur and less phosphorus than the younger ones probably due to physiological difficulties in translocation of sulphur bearing material; increased amount of total N attributed to accumulation of nitrates; marked decrease in ash, sugars and starch; increased proportion of crude fiber and dry material. In the plants suffering from sulphur deficiency photosyntetic rate decreased 34 per cent. 5. Tomato plants were succesfully cultivated in nutrient solution in absence of mineral sulphur but in presence of cysteine. The plants absorbed sulphur, under that form and were able to grow up quite well; the fruiting was normal. In this way rested cleary demonstrated the possibility of absorption of organic sulphur without previous mineralization and its utilization in the building up of protein molecules.

Trypanosoma cruzi: antigen-receptor mediated endocytosis of antibody

Trypanomastigote forms of Trypanosoma cruzi were derived from tissue culture and incubated with immune and non-immune human sera. All immune sera showed high titers of specific humoral antibodies of the IgM or the IgG type. Agglutination and swelling of parasites were observed after incubation at 37ºC, but many trypomastigotes remained free-swimming in the sera for two to three days. The quantitiy of immune serum capable of lysing a maximum of 10 x 10 [raised to the power of 6] sensitized red cells was not capable of lysing 4 x 10 [raised to the power of 3] tripomastigotes. Typically, the parasites underwent cyclical changes with the formation of clumps of amastigotes and the appearance of epimastigote forms. Multiplication of the parasites was observed in immune sera. Further, the infectivity of the parasites to susceptible mice was not lost. All sera used produced similar general effects on the growth of the parasite. The antibody bound to T. cruzi appeard to enter cells by antigen-receptor mediated endocytosis. The ferritin-conjugated antibody was internalized and delivered to phagolysosomes where they might be completely degraded to amino-acids. This seemed to be a coupled process by which the immunoglobulin is first bound to specific parasite surface receptor and then rapidly endocytosed by the cell.

Evaluation of a monoclonal antibody affinity purified antigen for zymodeme specific serological diagnosis of Trypanosoma cruzi infection

Theoretically, serological assays with affinity purified marker antigens can allow strain-specific diagnosis even when parasites cannot be retrieved from and infected host. A Trypanosoma cruzi antigen was purified by affinity chromatography using a zymodeme (Z) 2 specific monoclonal antibody (2E2C11). An indirect enzyme-linked immunosorbent assay (ELISA) based on the purified antigen could discriminate between sera from rabbits immunized with T. cruzi zymodeme clones but could not discriminate between sera from mice infected with different zymodemes.

Prevention of bone marrow graft failure by an anti LFA-1 monoclonal antibody

Graft rejection is the major cause of failure of HLA mismatched bone marrow transplantation because of residual host immunity. we have proposed to use a monoclonal murine antibody specific for the LFA-1 molecule (25-3) to prevent graft failure in HLA mismatched bone marrow transplantation (BMT). The rationale for this approach is three fold: LFA-1 deficient patients (3/3) do not reject HLA mismatched BMT; anti LFA-1 blocka in vitro the induction of T cell responses and T/ non T cytotoxic functions; LFA-1 is not expressed by other cells than leucocytes. We have accordingly treated twenty two patients with inherited diseases and 8 with leikemia. The bone marrow was T cells depled by E rosetting of Campath antibody. The antibody was given at days -3, -1, +1, +3, +5 at dose of .1 mg/kg/d for the first 9 and then .2mg/kg/d from day -3 to +6. Engraftment occured in 23/30 patients as shown by at least HLA typing. Hematological recovery was rapid, GVH was limited. Side effects of antibody infusion included fever and possibly an increased incidence of early bacteral infection (sepsis, 1 death). Immunological reconstitution occured slowly leading in six cases to EBV-induced B cell poliferation (1 death and in two others to transient auto immune hemolytic anemia. There has been only one secondary graft rejection. Sisteen patients are alive 3 to 26 months post transplant with functional grafts. Although the number of patients treated is still low the absence of late rejection so far, gives hope for long term maintenance of the graft using anti LFA-1. Since the antibody is an IgG 1 unable to bind human complement, and since it is known to inhibit phagocytosis, there is a good suggestion that 25-3 act through functional blocking of host T and non T luymphocytes at both induction and effector levels.