Risk factors for acute myocardial infarction during the postoperative period of myocardial revascularization

OBJECTIVE: To identify risk factors for acute myocardial infarction during the postoperative period after myocardial revascularization. METHODS: This was a case-control study paired for sex, age, number, type of graft used, coronary endarterectomy, type of myocardial protection, and use of extracorporeal circulation. We assessed 178 patients (89 patients in each group) undergoing myocardial revascularization, and the following variables were considered: dyslipidemia, systemic hypertension, smoking, diabetes mellitus, previous myocardial revascularization surgery, previous coronary angioplasty, and acute myocardial infarction. RESULTS: Baseline clinical characteristics did not differ in the groups, except for previous myocardial revascularization surgery, prevalent in the case group (34 patients vs. 12 patients; p = 0.0002). This was the only independent predictor of risk for acute myocardial infarction in the postoperative period, based on a multivariate logistic regression analysis (p=0.0001). Mortality and the time of hospital stay of the case group were significantly higher (19.1% vs. 1.1%; p<0.001 and 15.7 days vs. 10.6 days; p<0.05 respectively) than those of the control. CONCLUSION: Only previous myocardial revascularization was an independent predictor of acute myocardial infarction in the postoperative period, based on multivariate logistic regression analysis.

Surgical myocardial revascularization without extracorporeal circulation

OBJECTIVE: To assess the immediate postoperative period of patients undergoing myocardial revascularization without extracorporeal circulation with different types of grafts. METHODS: One hundred and twelve patients, 89 (79.5%) of whom were males, were revascularized without extracorporeal circulation. Their ages ranged from 39 to 85 years. The criteria for indicating myocardial revascularization without extracorporeal circulation were as follows: revascularized coronary artery caliber > 1.5 mm, lack of intramyocardial trajectory on coronary angiography, noncalcified coronary arteries, and tolerance of the heart to the different rotation maneuvers. RESULTS: Myocardial revascularization without extracorporeal circulation was performed in 112 patients. Three were converted to extracorporeal circulation, which required a longer hospital stay but did not impact mortality. During the procedure, the following events were observed: atrial fibrillation in 10 patients, ventricular fibrillation in 4, total transient atrioventricular block in 2, ventricular extrasystoles in 58, use of a device to retrieve red blood cells in 53, blood transfusion in 8, and arterial hypotension in 89 patients. Coronary angiography was performed in 20 patients on the seventh postoperative day when the grafts were patent. CONCLUSION: Myocardial revascularization without extracorporeal circulation is a reproducible technique that is an alternative for treating ischemic heart disease.

Colchicine to Reduce Atrial Fibrillation in the Postoperative Period of Myocardial Revascularization

Abstract Background: The high prevalence of atrial fibrillation (AF) in the postoperative period of myocardial revascularization surgery increases morbidity and mortality. Objective: To assess the efficacy of colchicine to prevent AF in the postoperative period of myocardial revascularization surgery, the impact of AF on hospital length of stay and death, and to identify its risk factors. Methods: Between May 2012 and November 2013, 140 patients submitted to myocardial revascularization surgery were randomized, 69 to the control group and 71 to the colchicine group. Colchicine was used at the dose of 1 mg orally, twice daily, preoperatively, and of 0.5 mg, twice daily, until hospital discharge. A single dose of 1 mg was administered to those admitted 12 hours or less before surgery. Results: The primary endpoint was AF rate in the postoperative period of myocardial revascularization surgery. Colchicine group patients showed no reduction in AF incidence as compared to control group patients (7.04% versus 13.04%, respectively; p = 0.271). There was no statistically significant difference between the groups regarding death from any cause rate (5.6% versus 10.1%; p = 0,363) and hospital length of stay (14.5 ± 11.5 versus 13.3 ± 9.4 days; p = 0.490). However, colchicine group patients had a higher infection rate (26.8% versus 8.7%; p = 0.007). Conclusion: The use of colchicine to prevent AF after myocardial revascularization surgery was not effective in the present study. Brazilian Registry of Clinical Trials number RBR-556dhr.

Overweight And Obesity Repercussion In The Postoperative Of Myocardial Revascularization Surgery

This is a descriptive, retrospective study with cross-sectional quantitative approach, which aimed to relate the body mass index with events in the postoperative period of the myocardial revascularization surgery with use of extracorporeal circulation. The data collection period was between April and June/2012. Patients were divided according to the body mass index and classified as without excess of weight, overweight or obese. The data analysis was based on the descriptive statistics. The patients without excess of weight had more complications, especially those related to the lungs. Among overweight and obese individuals, the cardiovascular complications stood out. The obese subjects had the worse prognostic. Obesity and overweight did not have statistically significant association with a higher frequency of postoperative complications, in spite of the occurrence of cardiovascular complications in this group. The patients without excess of weight had higher risks of developing neurological events.


Arterial hypertension and associated factors in patients submitted to myocardial revascularization

OBJECTIVE To identify the prevalence of arterial hypertension and associated factors in patients submitted to myocardial revascularization. METHOD Cross-sectional study using the database of a hospital in São Paulo (SP, Brazil) containing 3010 patients with coronary artery disease submitted to myocardial revascularization. A multiple logistic regression was performed to identify variables independently associated with hypertension (statistical significance: p<0.05). RESULTS Prevalence of hypertension was 82.8%. After the variables were adjusted, the associated factors were as follows: age, odds ratio (OR): OR=1.01; 95% confidence interval (CI): CI:1.00-1.02; female gender: (OR=1.77;CI:1.39-2.25); brown-skin race: (OR=1.53;CI:1.07-2.19); obesity: (OR=1.53;CI:1.13-2.06); diabetes: (OR=1.90;CI:1.52-2.39); dyslipidemia: (OR=1.51;CI:1.23-1.85); and creatinine>1.3: (OR=1.37;CI:1.09-1.72). CONCLUSION A high prevalence of arterial hypertension and association with both non-modifiable and modifiable factors was observed.

Application of alkaline waste from pulp industry to acid soil with pine

In Brazil extensive areas are covered with pine forests, planted for pulp and paper production. This industry generates solid alkaline waste, such as dregs. The application of this dregs to forest soils is an alternative for soil acidity correction and plant nutrient supply, as well as a solution for its proper disposal. The purpose of this study was to compare the residual effect of surface application of dregs and dolomitic lime on (a) changes in the physical and chemical properties of an acidic soil and (b) pine tree development. The experiment was carried out in 2004 in Bocaina do Sul, Santa Catarina, consisting of the application of increasing dreg and lime rates to a Pinus taeda L. production area, on a Humic Cambisol, in a randomized block design with four replications and 10 x 10 m plots. The treatments consisted of levels of soil acidity amendments corresponding to the recommendations by the SMP method to reach pH 5.5 in the 0-20 cm layer, as follows: no soil amendment; dregs at 5.08 (1/4 SMP), 10.15 (1/2 SMP) and 20.3 Mg ha-1 (1 SMP); and lime at 8.35 (1/2 SMP) and 16.7 Mg ha-1 (1 SMP). Soil layers were sampled in 2010 for analyses of soil chemical and physical properties. The diameter at breast height of the 6.5 year old pine trees was also evaluated. Surface application of dregs improved soil chemical fertility by reducing acidity and increasing base saturation, similar to liming, especially in surface layers. Dregs, comparable to lime, reduced the degree of clay flocculation, but did not affect the soil physical quality. There was no effect of the amendments on increase in pine tree diameter. Thus, the alternative to raise the pH in forest soils to 5.5 with dregs is promising for the forestry sector with a view to dispose of the waste and increase soil fertility.

Basic density and pulp yield relationship with some chemical parameters in eucalyptus trees

The objective of this work was to evaluate the use of basic density and pulp yield correlations with some chemical parameters, in order to differentiate an homogeneous eucalyptus tree population, in terms of its potential for pulp production or some other technological applications. Basic density and kraft pulp yield were determined for 120 Eucalyptus globulus trees, and the values were plotted as frequency distributions. Homogenized samples from the first and fourth density quartiles and first and fourth yield quartiles were submitted to total phenols, total sugars and methoxyl group analysis. Syringyl/guaiacyl (S/G) and syringaldehyde/vanillin (S/V) ratios were determined on the kraft lignins from wood of the same quartiles. The results show the similarity between samples from high density and low yield quartiles, both with lower S/G (3.88-4.12) and S/V (3.99-4.09) ratios and higher total phenols (13.3-14.3 g gallic acid kg-1 ). Woods from the high yield quartile are statistically distinguished from all the others because of their higher S/G (5.15) and S/V (4.98) ratios and lower total phenols (8.7 g gallic acid kg-1 ). Methoxyl group and total sugars parameters are more adequate to distinguish wood samples with lower density.

Determination of thermal diffusivity in papaya pulp as a function of maturation stage

In order to determine the penetration of the thermal wave in the papaya fruit pulp (Carica papaya L.), cv. Golden, thermal diffusivity of the pulp was obtained measuring temperature at four different depths. Measurements were carried out initially with the fruit on the first stage of maturity. The changes of the thermal diffusivity were expressed as a function of ripening. A temporal decrease of the thermal diffusivity was observed. Chemical (pH, soluble solids and total titratable acidity) and physical (pulp firmness) properties were measured as well and the results were compared to the thermal diffusivity change.

Enzymatic technology to improve oil extraction from Caryocar brasiliense camb. (Pequi) Pulp.

The present study aims to compare yield and quality of pequi pulp oil when applying two distinct processes: in the first, pulp drying in a tray dryer at 60ºC was combined with enzymatic treatment and pressing to oil extraction; in the second, a simple process was carried out by combining sun-drying pulp and pressing. In this study, raw pequi fruits were collected in Mato Grosso State, Brazil. The fruits were autoclaved at 121ºC and stored under refrigeration. An enzymatic extract with pectinase and CMCase activities was used for hydrolysis of pequi pulp, prior to oil extraction. The oil extractions were carried out by hydraulic pressing, with or without enzymatic incubation. The oil content in the pequi pulp (45% w/w) and the physicochemical characteristic of the oil was determined according to standard analytical methods. Free fatty acids, peroxide values, iodine and saponification indices were respectively 1.46 mgKOH/g, 2.98 meq/kg, 49.13 and 189.40. The acidity and peroxide values were lower than the obtained values in commercial oil samples, respectively 2.48 mgKOH/g and 5.22 meq/kg. Aqueous extraction has presented lower efficiency and higher oxidation of unsaturated fatty acids. On the other hand, pequi pulp pressing at room temperature has produced better quality oil. However its efficiency is still smaller than the combined enzymatic treatment and pressing process. This combined process promotes cellular wall hydrolysis and pulp viscosity reduction, contributing to at least 20% of oil yield increase by pressing.

An ethanol-based process to simultaneously extract and fractionate carotenoids from Mauritia flexuosa L. Pulp

Mauritia vinifera (buriti) is a palm tree that grows wild in different areas of Brazil, particularly in the Amazonian region. The buriti oil is rich in carotenoids, especially in β-carotene. The growing interest in other natural sources of β-carotene has stimulated the industrial use of buriti as a raw material for pulp oil extraction. Most processes are based on the conventional technologies, involving drying and pressing the pulp for oil recovery and further separation of carotenoids in a liquid phase using organics solvents. In the present work, the ethanol-based process was evaluated for simultaneous carotenoids recovering and fractionating from buriti pulp. The raw material and ethanol, 1:4 ratio, were placed in an erlenmeyer flask and maintained at 30rpm for 1 hour in a temperature-controlled bath at 65ºC. The mixture was filtered under vacuum and cooling at 10ºC to allow for the separation of the solvent in two phases. Carotenoids composition, determined by HPLC, has indicated a β-carotene concentration about 12 times greater in the lower phase than in the upper phase. The profile of the carotenoids in the denser phase is quite similar to that of raw buriti oil, and the concentration of total carotenoids is 40% higher than that of the original raw oil, making the ethanol-based process particularly attractive for industrial applications.

Papaya pulp gelling: is it premature ripening or problems of water accumulation in the apoplast?

Gelled aspect in papaya fruit is typically confused with premature ripening. This research reports the characterization of this physiological disorder in the pulp of papaya fruit by measuring electrolyte leakage, Pi content, lipid peroxidation, pulp firmness, mineral contents (Ca, Mg and K - in pulp and seed tissues), and histological analysis of pulp tissue. The results showed that the gelled aspect of the papaya fruit pulp is not associated with tissue premature ripening. Data indicate a reduction of the vacuole water intake as the principal cause of the loss of cellular turgor; while the waterlogged aspect of the tissue may be due to water accumulation in the apoplast.

The role of bound chlorine in the brightness reversion of bleached hardwood kraft pulp

Our previous paper showed fragmentary evidence that pulp brightness reversion may be negatively affected by its organically bound chlorine (OX) content. A thorough investigation on eucalyptus kraft pulp led to the conclusion that OX increases reversion of certain pulps but this trend is not universal. Alkaline bleaching stages decrease reversion regardless of pulp OX content. Pulps bleached with high temperature chlorine dioxide revert less than those bleached with conventional chlorine dioxide in sequences ending with a chlorine dioxide stage but similarly in sequences ending with a final peroxide stage. The use of secondary condensate for pulp washing decreases reversion.

Characterization of the major nutritional components of Caryocar brasiliense fruit pulp by nmr spectroscopy

Pequi (Caryocar brasiliense Camb.), a typical fruit of Brazilian Cerrado, is well known in regional cookery and used in folk medicine to treat various illnesses. Mass spectrometry and chromatographic methods have identified the organic composition of pequi fruit pulp; however, NMR spectroscopy is used for the first time to characterize the nutritional components of organic and aqueous-ethanolic extracts. This spectroscopic technique determined the triacylglycerols in the pequi organic fraction, which is constituted mainly by oleate and palmitate esters, and detected the carbohydrate mixtures as the major components of aqueous and ethanolic fractions, respectively. In this study, presence of phenolic compounds was only evidenced in the ethanolic fraction.

Final chlorine dioxide stage at near-neutral pH for bleaching eucalypt pulp

It is well known that pH is an important parameter for controlling the eucalyptus pulp bleaching when using the final chlorine dioxide stage, since it affects the effectiveness of the process. Recommendations found in the literature for operating are in the 3.5 to 4.0 range. However, in this paper it was shown that final chlorine dioxide has better performance, with significant brightness gain while also preserving pulp quality, when it is operated at near neutral pH. This result can be explained by the generation of sodium bicarbonate in situ upon adding carbon dioxide at this stage.

Bleached kraft pulp production from Pinus tecunumanii (Eguiluz e Perry)

The use of 12-year-old Pinus tecunumanii (Eguiluz e Perry) grown in Colombia was evaluated for bleached kraft pulp production. Kraft pulps of kappa number 30 ± 1 were produced, and oxygen delignified and bleached to 90% ISO with ECF processes. The bleached pulps produced under optimum conditions were evaluated with regard to their strength properties. Pinus tecunumanii wood required low effective alkali charge to reach the desired kappa number and the unbleached pulp showed high oxygen delignification efficiency and bleachability when a OD(EO)DED sequence was used. The bleached pulps presented good physical-mechanical properties, which are comparable to those obtained with more traditional pines such as Pinus taeda and Pinus radiata. The results demonstrate that this tropical pine species is a suitable raw material for bleached kraft pulp production