Prognostic Value of TIMI Score versus GRACE Score in ST-segment Elevation Myocardial Infarction

Background: The TIMI Score for ST-segment elevation myocardial infarction (STEMI) was created and validated specifically for this clinical scenario, while the GRACE score is generic to any type of acute coronary syndrome. Objective: Between TIMI and GRACE scores, identify the one of better prognostic performance in patients with STEMI. Methods: We included 152 individuals consecutively admitted for STEMI. The TIMI and GRACE scores were tested for their discriminatory ability (C-statistics) and calibration (Hosmer-Lemeshow) in relation to hospital death. Results: The TIMI score showed equal distribution of patients in the ranges of low, intermediate and high risk (39 %, 27 % and 34 %, respectively), as opposed to the GRACE Score that showed predominant distribution at low risk (80 %, 13 % and 7%, respectively). Case-fatality was 11%. The C-statistics of the TIMI score was 0.87 (95%CI = 0.76 to 0.98), similar to GRACE (0.87, 95%CI = 0.75 to 0.99) - p = 0.71. The TIMI score showed satisfactory calibration represented by χ2 = 1.4 (p = 0.92), well above the calibration of the GRACE score, which showed χ2 = 14 (p = 0.08). This calibration is reflected in the expected incidence ranges for low, intermediate and high risk, according to the TIMI score (0 %, 4.9 % and 25 %, respectively), differently to GRACE (2.4%, 25% and 73%), which featured middle range incidence inappropriately. Conclusion: Although the scores show similar discriminatory capacity for hospital death, the TIMI score had better calibration than GRACE. These findings need to be validated populations of different risk profiles.

Very Long-Term Prognostic Role of Admission BNP in Non-ST Segment Elevation Acute Coronary Syndrome

Abstract Background: BNP has been extensively evaluated to determine short- and intermediate-term prognosis in patients with acute coronary syndrome, but its role in long-term mortality is not known. Objective: To determine the very long-term prognostic role of B-type natriuretic peptide (BNP) for all-cause mortality in patients with non-ST segment elevation acute coronary syndrome (NSTEACS). Methods: A cohort of 224 consecutive patients with NSTEACS, prospectively seen in the Emergency Department, had BNP measured on arrival to establish prognosis, and underwent a median 9.34-year follow-up for all-cause mortality. Results: Unstable angina was diagnosed in 52.2%, and non-ST segment elevation myocardial infarction, in 47.8%. Median admission BNP was 81.9 pg/mL (IQ range = 22.2; 225) and mortality rate was correlated with increasing BNP quartiles: 14.3; 16.1; 48.2; and 73.2% (p < 0.0001). ROC curve disclosed 100 pg/mL as the best BNP cut-off value for mortality prediction (area under the curve = 0.789, 95% CI= 0.723-0.854), being a strong predictor of late mortality: BNP < 100 = 17.3% vs. BNP ≥ 100 = 65.0%, RR = 3.76 (95% CI = 2.49-5.63, p < 0.001). On logistic regression analysis, age >72 years (OR = 3.79, 95% CI = 1.62-8.86, p = 0.002), BNP ≥ 100 pg/mL (OR = 6.24, 95% CI = 2.95-13.23, p < 0.001) and estimated glomerular filtration rate (OR = 0.98, 95% CI = 0.97-0.99, p = 0.049) were independent late-mortality predictors. Conclusions: BNP measured at hospital admission in patients with NSTEACS is a strong, independent predictor of very long-term all-cause mortality. This study allows raising the hypothesis that BNP should be measured in all patients with NSTEACS at the index event for long-term risk stratification.

When is the Best Time for the Second Antiplatelet Agent in Non-St Elevation Acute Coronary Syndrome?

Abstract Dual antiplatelet therapy is a well-established treatment in patients with non-ST elevation acute coronary syndrome (NSTE-ACS), with class I of recommendation (level of evidence A) in current national and international guidelines. Nonetheless, these guidelines are not precise or consensual regarding the best time to start the second antiplatelet agent. The evidences are conflicting, and after more than a decade using clopidogrel in this scenario, benefits from the routine pretreatment, i.e. without knowing the coronary anatomy, with dual antiplatelet therapy remain uncertain. The recommendation for the upfront treatment with clopidogrel in NSTE-ACS is based on the reduction of non-fatal events in studies that used the conservative strategy with eventual invasive stratification, after many days of the acute event. This approach is different from the current management of these patients, considering the established benefits from the early invasive strategy, especially in moderate to high-risk patients. The only randomized study to date that specifically tested the pretreatment in NSTE-ACS in the context of early invasive strategy, used prasugrel, and it did not show any benefit in reducing ischemic events with pretreatment. On the contrary, its administration increased the risk of bleeding events. This study has brought the pretreatment again into discussion, and led to changes in recent guidelines of the American and European cardiology societies. In this paper, the authors review the main evidence of the pretreatment with dual antiplatelet therapy in NSTE-ACS.

Genetic characterization of St. Louis encephalitis virus isolated from human in São Paulo, Brazil

The molecular characterization of SPH253157, a new strain of St. Louis encephalitis virus (SLEV), isolated in 2004 from the first case of human infection recognized in the state of São Paulo, Brazil, is reported. The patient, presenting a febrile illness without neurological involvement, was hospitalized as a probable case of dengue fever. Genomic RNA was isolated from the supernatant of C6/36 cells infected with acute phase-serum specimen of the patient and the envelope gene was amplified by reverse-transcription-polymerase chain reaction. The complete nucleotide sequence of the envelope gene of this isolate was directly sequenced from the amplified products and compared with other Brazilian and American SLEV strains. Phylogenetic analyses were carried out under maximum likelihood criterion with outgroups both included and excluded. Outgroups comprised four flavivirus of the Japanese encephalitis group. Phylogeny also included Bayesian analysis. The results indicated that the new SLEV isolate belongs to lineage III, being closely related to an Argentinean strain recovered from Culex sp. in 1979. It is concluded that there are at least 3 lineages of SLEV in Brazil.

Immunological and microbiological activity of Davilla elliptica St. Hill. (Dilleniaceae) against Mycobacterium tuberculosis

Mycobacterium tuberculosis is responsible for over 8 million cases of tuberculosis (TB) annually. Natural products may play important roles in the chemotherapy of TB. The immunological activity of Davilla elliptica chloroform extract (DECE) was evaluated in vitro by the determination of hydrogen peroxide (H2O2), nitric oxide (NO), and tumor necrosis factor-alpha (TNF-alpha) release in peritoneal macrophages cultures. DECE was also tested for its antimycobacterial activity against M. tuberculosis using the microplate alamar blue assay. DECE (50, 150, 250 µg/ml) stimulated the production of H2O2 (from 1,79 ± 0,23 to 7,27 ± 2,54; 15,02 ± 2,86; 20,5 ± 2,1 nmols) (means ± SD), NO (from 2,64 ± 1,02 to 25,59 ± 2,29; 26,68 ± 2,41; 29,45 ± 5,87 µmols) (means ± SD) and TNF-alpha (from 2,44 ± 1,46 to 30,37 ± 8,13; 38,68 ± 1,59; 41,6 ± 0,90 units/ml) (means ± SD) in a dose-dependent manner and also showed a promising antimycobacterial activity with a minimum inhibitory concentration of 62,5 µg/ml. This plant may have therapeutic potential in the immunological and microbiological control of TB.

Seroconversion for west Nile and St. Louis encephalitis viruses among sentinel horses in Colombia

We prospectively sampled flavivirus-naïve horses in northern Colombia to detect West Nile virus (WNV) and St. Louis encephalitis virus (SLEV) seroconversion events, which would indicate the current circulation of these viruses. Overall, 331 (34.1%) of the 971 horses screened were positive for past infection with flaviviruses upon initial sampling in July 2006. During the 12-month study from July 2006-June 2007, 33 WNV seroconversions and 14 SLEV seroconversions were detected, most of which occurred in the department of Bolivar. The seroconversion rates of horses in Bolivar for the period of March-June 2007 reached 12.4% for WNV and 6.7% for SLEV. These results comprise the first serologic evidence of SLEV circulation in Colombia. None of the horses sampled developed symptoms of encephalitis within three years of initial sampling. Using seroconversions in sentinel horses, we demonstrated an active circulation of WNV and SLEV in northern Colombia, particularly in the department of Bolivar. The absence of WNV-attributed equine or human disease in Colombia and elsewhere in the Caribbean Basin remains a topic of debate and speculation.

Serological detection of St. Louis encephalitis virus and West Nile virus in equines from Santa Fe, Argentina

St. Louis encephalitis virus (SLEV) and West Nile virus (WNV) present ecological and antigenic similarities and are responsible for serious human diseases. In addition, WNV is a significant pathogen in terms of equine health. The purpose of our study was to analyse the seroprevalence of SLEV and WNV in equine sera collected in Santa Fe Province, Argentina. The seroprevalence determined using the plaque reduction neutralisation test was 12.2% for SLEV, 16.2% for WNV and 48.6% for a combination of both viruses. These results provide evidence of the co-circulation of SLEV and WNV in equines in Santa Fe.

Espécies de cigarrinhas (Hemiptera, Cicadellidae, Cicadellinae) em pomares de citros da região de Bebedouro, SP, com descrição de uma espécie nova de Acrogonia St&#229;l

Sharpshooter leafhoppers (Hemiptera, Cicadellidae, Cicadellinae) in citrus groves of the area of Bebedouro, SP, with description of a new species of Acrogonia St&#229;l. Sixteen species of Cicadellidae, subfamily Cicadellinae, were collected and identified: 11 of the tribe Cicadellini and five of the tribe Proconiini. The ten most common species, together with a new species, are characterized based on external morphology and male genitalia: Acrogonia citrina Marucci & Cavichioli sp. nov.; Bucephalogonia xanthophis (Berg, 1879); Dilobopterus costalimai Young, 1977; Ferrariana trivittata (Signoret, 1854); Hortensia similis (Walker, 1851); Macugonalia cavifrons (St&#229;l, 1862); M. leucomelas (Walker, 1851); Oncometopia facialis (Signoret, 1854); Plesiommata corniculata Young, 1977 and P. mollicella (Fowler, 1900). The leafhopper samples were collected in citrus groves and in adjacent habitats (woods, swamp, cultivable plain, spontaneous vegetation of the grove, coffee crop and sugarcane) at the counties of Bebedouro and Monte Azul Paulista and in the district of Turvínia. The collecting methods were: insect net, yellow sticky cards, portable suction trap and Malaise trap. Identification keys were elaborated for the 16 species. There is a great diversity of Cicadellinae species in the citric groves. In the three areas sampled, it was collected a larger number of species of the tribe Cicadellini than of the tribe Proconiini. In the Bebedouro area, the vector species of Xylella fastidiosa, A. citrina sp. nov., B. xanthophis, D. costalimai and O. facialis, were collected in the citrus groves and in all adjacent habitats.

Nomenclatural notes in Membracidae (Homoptera): new combination and new synonymies in Amastris St&#229;l, 1862

The following nomenclatural changes are made: Amastris convoluta (Fabricius, 1781) comb. nov. (formerly Darnis; Hebetica); Amastris maculata Funkhouser, 1922 = Amastris fasciata Broomfield, 1976 syn. nov. = Amastris pseudomaculata Broomfield, 1976 syn. nov. = Amastris inermis Broomfield, 1976 syn. nov. = Amastris sakakibarai Broomfield, 1976 syn. nov.; Amastris elevata Funkhouser, 1922 = Amastris vismiae Haviland, 1925 syn. nov. = Amastris flavifolia Funkhouser, 1927 syn. nov.

Caracterização morfológica de espécies de Hemerobius Linnaeus, 1758 (Neuroptera, Hemerobiidae) associadas a cultivos de café (Coffea arabica L.), milho (Zea mays L.) e erva-mate (Ilex paraguariensis St. Hill.)

The predators were collected in mate crop in Cascavel and São Mateus do Sul, Paraná, Brazil and some other additional specimens in coffee and maize crops in Ribeirão Preto, São Paulo, Brazil. Illustrations obtained by SEM are given by the first time to the principal structures. Three species of Hemerobius were identified: H. bolivari Banks, 1910; H. domingensis Banks, 1941 and H. gaitoi Monserrat, 1996. H. domingensis is recorded for the first time to Brazil.

Comparação dos sistemas de cultivo nativo e adensado de erva mate, Ilex paraguariensis St. Hil., quanto à ocorrência e flutuação populacional de insetos

This research was carried out in order to compare the occurrence of insects in two maté cultivation systems, native and high tree density. It was performed from August/2000 to September/2001, in a private property in São Mateus do Sul county, in Paraná State, Brazil. Visual inspections of trees and light traps were used to evaluate insect populations in both areas. For Hedypathes betulinus (Klug) (Coleoptera, Cerambycidae), only six adults were observed in the dense area. Based on presence of sawdust at the basis of the trunk, it was obtained that the number of attacked trees did not surpass 11% in either area. For Gyropsylla spegazziniana (Lizer y Trelles) (Hemiptera, Psyllidae), the number of galls per tree was counted and it was observed that the population peak occurred from November to January. For Hylesia spp. (Lepidoptera, Saturniidae) and Thelosia camina Schaus (Lepidoptera, Eupterotidae), the presence of caterpillars on the trees was noticed from September to February, with the population peak in November and December. Adults of Hylesia spp. were more numerous in February and March. Two species that were not previously recorded for Brazil on maté were identified: Hylesia paulex Dognin (83%) and Hylesia remex Dyer (17%), collected with light traps. The maté caterpillar, T. camina was not collected with these traps. Nymphs and adults of Ceroplastes grandis Hempel (Hemiptera, Coccidae) were observed along the year on the branches, with population peak between April and June for the nymphs and from September to November for the adults. It should be considered that despite higher insect incidence in the dense area compared to the native area, the first presents higher yield, and that with a good pest management program the insect problems can be minimized.

Larvas de Geometridae (Lepidoptera) e seus parasitóides, associadas a Erythroxylum microphyllum St.- Hilaire (Erythroxylaceae)

O trabalho foi realizado em área de cerrado, em São Carlos, São Paulo, Brasil. Foram realizadas amostragens quinzenais de junho/1999 a junho/2000, por meio de guarda-chuva-entomológico. Foram registradas 22 espécies de Geometridae pertencentes a 14 gêneros; quanto aos parasitóides, 11 gêneros de Hymenoptera e dois de Diptera, Tachinidae. A ocorrência de Cyclomia mopsaria (Geometridae) foi de 83%. Outros Geometridae registrados foram: Glena unipennaria, G. bipennaria, G. demissaria, G. brachia, Physocleora junctilinea, P. cariaria, Physocleora sp., Iridopsis fulvitincta, I. nigraria, Hymenomima amberia, Macaria regulata, Ischnopteris inornata., Prochoerodes onustaria, Prochoerodes sp., Thyrinteina arnobia, Nematocampa sp., Melanolophia sp., Isochromodes sp., Semaeopus lunifera, S. vizaria. Os Hymenoptera foram: Microcharops peronata, Charops sp., Metopius sp., Hyposoter sp., Mesochorus sp.(Ichneumonidae); Aleiodes sp., Meteorus sp., Glyptapanteles sp., Protapanteles sp. (Braconidae); Euplectrus sp. (Eulophidae). Os Diptera, Tachinidae foram: Winthemia sp.(Winthemiini) e uma espécie de Blondeliini. O período de maior ocorrência de larvas de Geometridae e baixa taxa de parasitismo foi ao final da estação chuvosa e início da estação seca.