Nobel Prizes: Contributions to Cardiology

The Nobel Prize was created by Alfred Nobel. The first prize was awarded in 1901 and Emil Adolf von Behring was the first laureate in medicine due to his research in diphtheria serum. Regarding cardiology, Nobel Prize’s history permits a global comprehension of progress in pathophysiology, diagnosis and therapeutics of various cardiac diseases in last 120 years. The objective of this study was to review the major scientific discoveries contemplated by Nobel Prizes that contributed to cardiology. In addition, we also hypothesized why Carlos Chagas, one of our most important scientists, did not win the prize in two occasions. We carried out a non-systematic review of Nobel Prize winners, selecting the main studies relevant to heart diseaseamong the laureates. In the period between 1901 and 2013, 204 researches and 104 prizes were awarded in Nobel Prize, of which 16 (15%) studies were important for cardiovascular area. There were 33 (16%) laureates, and two (6%) were women. Fourteen (42%) were American, 15 (45%) Europeans and four (13%) were from other countries. There was only one winner born in Brazil, Peter Medawar, whose career was all in England. Reviewing the history of the Nobel Prize in physiology or medicine area made possible to identify which researchers and studies had contributed to advances in the diagnosis, prevention and treatment of cardiovascular diseases. Most winners were North Americans and Europeans, and male.

Post-Hospital Syndrome: A New Challenge in Cardiovascular Practice

AbstractThe image of the hospital representing the modern medicine and its diagnostic and therapeutic advances becomes more evident in the face of an aging population and patients with multiple comorbidities requiring highly complex care. However, recent studies have shown a growing number of hospital readmissions within 30 days after discharge. The post-hospital syndrome is a new clinical entity associated with multiple vulnerabilities that contribute to hospital readmissions. During hospitalization, the patient is exposed to different stressors of physical, environmental, and psychosocial natures that trigger pathophysiological and multisystemic responses and increase the risk of complications after hospital discharge. Patients with a cardiac disease have high rates of readmission within 30 days. Therefore, it is important for cardiologists to recognize the post-hospital syndrome since it may impact their daily practice. This review aims at discussing the current scientific evidence regarding predictors and stressors involved in the post-hospital syndrome and the measures that are currently being taken to minimize their effects.

Transcatheter Aortic Valve Implantation and Morbidity and Mortality-Related Factors: a 5-Year Experience in Brazil

Abstract Background: Transcatheter aortic valve implantation has become an option for high-surgical-risk patients with aortic valve disease. Objective: To evaluate the in-hospital and one-year follow-up outcomes of transcatheter aortic valve implantation. Methods: Prospective cohort study of transcatheter aortic valve implantation cases from July 2009 to February 2015. Analysis of clinical and procedural variables, correlating them with in-hospital and one-year mortality. Results: A total of 136 patients with a mean age of 83 years (80-87) underwent heart valve implantation; of these, 49% were women, 131 (96.3%) had aortic stenosis, one (0.7%) had aortic regurgitation and four (2.9%) had prosthetic valve dysfunction. NYHA functional class was III or IV in 129 cases (94.8%). The baseline orifice area was 0.67 ± 0.17 cm2 and the mean left ventricular-aortic pressure gradient was 47.3±18.2 mmHg, with an STS score of 9.3% (4.8%-22.3%). The prostheses implanted were self-expanding in 97% of cases. Perioperative mortality was 1.5%; 30-day mortality, 5.9%; in-hospital mortality, 8.1%; and one-year mortality, 15.5%. Blood transfusion (relative risk of 54; p = 0.0003) and pulmonary arterial hypertension (relative risk of 5.3; p = 0.036) were predictive of in-hospital mortality. Peak C-reactive protein (relative risk of 1.8; p = 0.013) and blood transfusion (relative risk of 8.3; p = 0.0009) were predictive of 1-year mortality. At 30 days, 97% of patients were in NYHA functional class I/II; at one year, this figure reached 96%. Conclusion: Transcatheter aortic valve implantation was performed with a high success rate and low mortality. Blood transfusion was associated with higher in-hospital and one-year mortality. Peak C-reactive protein was associated with one-year mortality.

Microspines in the pylorus of Pseudonannolene tricolor and Rhinocricus padbergi (Arthropoda, Diplopoda)

The aim of this paper is to report the morphology and distribution of microspines in diplopods pylorus, as these are important structures present along the alimentary tract of arthropods. The morphology of the internal surface of the pylorus of Pseudonannolene tricolor Brolemann, 1901 and Rhinocricus padbergi Verhoeff, 1938 was analyzed by SEM. Pseudonannolene tricolor presents two morphologically distinct pyloric regions: anterior and posterior. The first region is characterized by the presence of thin microspines that increase in number and size towards the posterior portion; the second region presents smaller and triangular-shaped microspines distributed throughout small plates. The pylorus of R. padbergi does not present differentiated regions; the anterior portion is characterized by microspines grouped in plates that decrease in number and increase in size towards the ileum.

Influência da temperatura na mortalidade de imaturos de Centris (Heterocentris) analis (Hymenoptera, Apidae, Centridini)

Os ninhos de Centris (Heterocentris) analis (Fabricius, 1804) foram estudados no Campus de Ribeirão Preto da Universidade de São Paulo, de janeiro a dezembro de 2003. As fêmeas nidificaram em ninhos-armadilha confeccionados com cartolina preta, os quais foram introduzidos em placas de madeira colocadas em duas áreas distintas: sombreada e ensolarada. Nas duas áreas, a mortalidade de imaturos ocorreu principalmente no estágio de ovo; área sombreada: estágio de ovo (76,7%), estágio de larva (10,0%) e estágio de pupa (13,3%); área ensolarada: estágio de ovo (80,0%), estágio de larva (6,6%) e estágio de pupa (13,3%). A diferença de mortalidade entre as duas áreas (chi2 = 1,0, gl:1, p>0,05) não foi estatisticamente significativa, entretanto, a diferença de temperatura entre os meses nas duas áreas estudadas foi estatisticamente significativa (t-student, p<0,05). Os resultados mostraram também que a temperatura entre 26ºC e 27ºC foi ideal para o desenvolvimento de Centris analis.

Estudos sobre condução nuclear: I - aspectos qualitativos observados em systemas impolarizaveis

As experiencias demonstram que a conducção nuclear tambem se processa nos systemas praticamente impolizaveis, (metal/sol. do mesmo metal), onde é bem determinada e caracteristica. O estudo destes systemas pode fornecer dados seguros para a analyse do phenomeno da polarização, assim como do electrotonus physico do nervo. Na proxima nota analizaremos o phenomeno quantitativamente e esboçaremos sua theoria. Desejamos deixar expresso os nossos agradecimentos aos Professores Miguel Osorio de Almeida e José Felippe, pela attenção com que acompanham nossos trabalhos, assim como pelas suggestões que nos foram feitas, e ao Professor Evandro Chagas o nos ter facilitado o uso do Electrocardiographo.

Ensaios terapêuticos com penicilina: II - Sífilis: (Nota prévia)

Seis sifiliticos foram tratados com penicilina em doses baixas, no Hospital Evandro Chagas, do Instituto Oswaldo Cruz. Protossifilomas foram bacterioscópicamente negativos entre 3 e 6 dias e cicatrizaram completamente entre 10 e 13 idas, com a aplicação de 1.200 a 2.400 unidades Oxford por 24 horas. Condilomas sifiliticos e placas mucosas hipertróficos tiveram bacterioscopia negativa entre 6 e 8 dias, cicatrizaram completamente entre 10 e 20 dias, com a aplicação de 1.200 unidades por 24 horas. Porém, doses de 4.800 unidades, no mesmo espaço de tempo, forma insuficientes para controlar outras manifestações luéticas secundárias (roséolas, placas mucosas). Em 3 casos sob contrõle sorológico, verificou-se que a negatividade das reações não acompanha imediatamente a cura clínica. Além disso, conforme já foi observado também com a bouba, os resultados dos testes sorológicos oscilam mezes a fio, negativando e voltando à positividade.

Ensaios terapêuticos com penicilina: IV - Bouba - (Framboesia, pian, yaws): tratamento das ulcerações gomosas, periostites, osteites áreas de rarefação óssea e gangoza (Rhinopharyngitis mutilans)

Six patients of terciary yaws, were treated with Penicillin in small dosis at Evandro Chagas Hospital of the Oswaldo Cruz Institute. The lesions presented by the patients were: gummatous ulcerations, periostitis, osteitis, osteoporosis and gangoza (rhinopharyngitis mutilans). In all cases, clinic recovery were obtained, the time of treatment varying from 2 to 8 months. The total amount of oxford units 'per" subject varied from 48.000 to 586.800 Patients with bone lesions, ever after the treatment, has not showed complete recomposition of the bone structure, ever so aparently healing and with negative sorologics tests. Identical results has been observed in patient showing the same lesions and treated with neo-arsphenamine. The patients are still under observations at the Hospital.