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 &#8805; 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 &#8805; 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.

Efeitos de giberelinas e auxina na frutifica����o da videira 'Niagara Rosada'

Estudou-se a influ��ncia da aplica����o, por imers��o, de giberelinas e auxina (��cido 2-hidroximetil 4-clorofenoxiac��tico), 11 dias ap��s o florescimento, nas caracter��sticas morfol��gicas da pan��cula da videira Vitis (labrusca x vinifera) 'Niagara Rosada'. Neste experimento verificou-se que, aplica����o de giberelinas na concentra����o de 100 ppm em p��s-florescimento, promoveu aumento no peso da pan��cula, n��mero e peso das bagas, al��m de alongamento da r��quila, o que contribue para a forma����o de pan��culas com distribui����o das bagas mais adequada. Tratamento com giberelinas 60 ppm + ��cido 2-hidroximetil 4-clorofenoxiac��tico 50 ppm provocou aumento no peso da pan��cula, n��mero e peso das bagas, sem contudo promover uma melhor distribui����o das mesmas. Giberelinas na concentra����o de 500 ppm causou aumento na elonga����o das bagas com rela����o ao di��metro, por��m n��o apresentou nenhuma outra caracter��stica superior ao controle. Aplica����o do ��cido 2-hidroximetil 4-clorofenoxiac��tico em p��s-fiorescimento, nas concentra����es utilizadas, n��o apresentou resultados favor��veis na frutifica����o da 'Niagara Rosada', nas condi����es de estudo.

Efeitos de retardadores de crescimento na frutifica����o da videira 'Niagara Rosada'

Estudou-se a influ��ncia da aplica����o por imers��o, de retardadores de crescimento (CCC e SADH), 5 dias antes do florescimento, nas caracter��sticas morfol��gicas da pan��cuia da videira Vitis (labrusca x vinifera) 'Niagara Rosada'. Neste ensaio verificou-se que as concentra����es de CCC aplicadas em pr��-florescimento, n��o afetaram favoravelmente a morfologia das pan��culas da cultivar estudada, nas condi����es do ensaio. SADH na dosagem de 1000 ppm provocou, na primeira colheita, aumento no peso e comprimento da pan��cula, no peso das bagas, e no comprimento da r��quis, proporcionando a forma����o desejada de uma pan��cula mais alongada, nas condi����es estudadas. Aplica����o de SADH na concentra����o de 250 ppm em pr��-florescimento, promoveu aumento no peso e comprimento da pan��cula, n��mero e peso das bagas, al��m do inconveniente de elevar o n��mero de sementes.

A����o do cepa e do ��cido giber��lico na frutifica����o da videira 'niagara rosada'

Estudou-se o efeito da aplica����o, por imers��o, do CEPA (��cido 2-cloroetil fosf��nico) e do ��cido giber��lico, 14 dias antes do florescimento, nas caracter��sticas morfol��gicas da pan��cula da videira Vitis (labrus-ca x vinifera) "Niagara Rosada". Alguns tratamentos com ��cido giber��lico foram conclu��dos com nova aplica����o 10 dias ap��s o florescimento. Neste experimento verificou-se que, aplica����o do CEPA na concentra����o de 250 ppm resultou na forma����o de pan��culas com a maioria de caracter��sticas indesej��veis. o tratamento misto CEPA 100 ppm + ��cido giber��lico 100 ppm tamb��m promoveu o aparecimento de pan��culas subdesenvolvidas. Aplica����o de ��cido giber��lico na concentra����o de 100 ppm em pr�� e p��s-��lorescimento, resultou m��dias mais elevadas, com rela����o ao peso da pan��cula, comprimento da pan��cula, peso das bagas e comprimento da r��quis. ��cido giber��lico na concentra����o de 100 ppm aplicado em p��s-��lorescimento, promoveu uma tend��ncia de aumento nas m��dias do tratamento quanto ao comprimento m��dio das bagas, largura m��dia das bagas, largura do enga��o e comprimento da r��quila. Devemos considerar por��m, que os resultados obtidos n��o apresentaram diferen��as significativas com rela����o ao controle, quanto ��s caracter��sticas das frutifica����es, nas condi����es de estudo.

Ac��mulo de boro, cobre, ferro, mangan��s e zinco pela videira (Vitis labrusca L. X Vitis vinifera L.) CV.'niagara rosada' durante um ciclo vegetativo

Ensaio foi conduzido com viderias da cultivar 'Niagara Rosada' (Vitis labrusca L. X Vitis vinifera L.) com 7 anos de idade, no munic��pio de Jundia��, SP, (23��12' de latitude sul e 46��33' de longitude oeste e 715 m de altitude), situadas sobre um Regossolo unidade Currupira, com os objetivos de: (1) determinar as quantidades de nutrientes absorvidos pela videira nos diferentes est��dios de desenvolvimento; (2) avaliar a exporta����o de nutrientes pela cultura durante um ciclo vegetativo. Ap��s a brota����o da videira, foram realizadas 17 coletas quinzenais de material. Foram coletadas e separadas as folhas das partes terminal e basal, sarmentos das partes terminal e basal e cachos. No material coletado foram determinados os teores de micronutrientes, com exce����o do molibd��nio e cloro. Curvas representativas das concentra��oes dos nutrientes nas partes da planta, em fun����o da idade, foram obtidas a partir dos dados calculados atrav��s de equa����es de regress��o. Pelos pontos de m��ximo estimaram-se as quantidades m��ximas de nutrientes extra��dos. Concluiu-se que: - A concentra����o dos nutrientes �� sempre maior nas folhas do que nos sarmentos e existem diferen��as nas concentra����es de nutrientes das folhas, sarmentos e cachos, em fun����o da idade. - Os ac��mulos m��ximos de nutrientes nas folhas, sarmentos e cachos ocorrem nas seguintes idades: - A exporta����o de nutrientes em mg por planta pelos cachos e sarmentos removidos pelas colheitas e poda �� a seguinte.

A����o de calciocianamida e alzodef na ��poca de brota����o e produtividade da videira 'Niagara Rosada'

Este ensaio foi realizado com o objetivo de determinar o efeito de calciocianamida e Alzodef na quebra de dorm��ncia das gemas da videira 'Niagara Rosada'. O controle da brota����o da videira pode possibilitar a produ����o de uvas nas diferentes ��pocas do ano. Em 28 de outubro, na regi��ode Jundia��, duas horas depois da poda, aplicou-se calciocianamida 20% atrav��s de pincelamento da regi��o apical do ramo, calciocianamida 20% pincelada sobre o corte da poda, pulveriza����o com Alzodef 2% e com Alzodef 5% sobre a regi��o apical do ramo , al��m do controle. Verificou-se que Alzodef 2% promoveu maior precocidade na emerg��ncia das gemas da videira 'Niagara Rosada'. Pincelamento do ramo ou do corte da poda com calciocianamida 20% e pulveriza����o com Alzodef 2% e 5%promoveram quebra da dorm��ncia das gemas. Os produtos qu��micos aplicados n��o afetaram significati v��mente o n��mero de pan��culas nem o peso das pan��culas na colheita.

Genetic characterization of St. Louis encephalitis virus isolated from human in S��o 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 S��o 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 ��g/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 ��mols) (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 ��g/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-na��ve 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.

Esp��cies de cigarrinhas (Hemiptera, Cicadellidae, Cicadellinae) em pomares de citros da regi��o de Bebedouro, SP, com descri����o de uma esp��cie 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 &amp; 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 Turv��nia. 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.