Escore Prognóstico para Síndrome Coronariana Aguda em Hospital Terciário Privado

Fundamento: Os modelos prognósticos disponíveis para Síndrome Coronariana Aguda (SCA) podem ter limitações de performance, por terem sido elaborados há vários anos, ou problemas de aplicabilidade. Objetivos: Elaborar escores para predição de eventos desfavoráveis em 30 dias e 6 meses, em pacientes com SCA, com ou sem Supradesnivelamento de ST (SST), atendida em hospital privado terciário. Métodos: Coorte prospectiva de pacientes consecutivos com SCA admitidos entre agosto/2009 a junho/2012. O desfecho primário composto foi a ocorrência de óbito, infarto ou reinfarto, Acidente Vascular Cerebral (AVC), parada cardiorrespiratória e sangramento maior. As variáveis preditoras foram selecionadas de dados clínicos, laboratoriais, eletrocardiográficos e da terapêutica. O modelo final foi obtido por meio de regressão logística e submetido a validação interna, utilizando-se bootstraping. Resultados: Incluímos 760 pacientes, 132 com SCA com SST e 628 sem SST. A idade média foi 63,2 ± 11,7 anos, sendo 583 homens (76,7%). O modelo final para eventos em 30 dias contém cinco preditores: idade ≥ 70 anos, antecedente de neoplasia, Fração de Ejeção do Ventrículo Esquerdo (FEVE) < 40%, troponinaI > 12,4 ng/mL e trombólise. Na validação interna, o modelo mostrou ter boa performance com área sob a curva de 0,71.Os preditores do modelo para 6 meses são: antecedente de neoplasia, FEVE < 40%, trombólise, troponina I > 14,3 ng/mL, creatinina > 1,2 mg/dL, antecedente de doença pulmonar obstrutiva crônica e hemoglobina < 13,5 g/dL. Na validação interna, o modelo apresentou boa performance com área sob a curva de 0,69. Conclusões: Desenvolvemos escores de fácil utilização e boa performance para predição de eventos adversos em 30 dias e 6 meses em pacientes com SCA.

Impact of Atrial Fibrillation Ablation on Left Ventricular Filling Pressure and Left Atrial Remodeling

Background:Left ventricular (LV) diastolic dysfunction is associated with new-onset atrial fibrillation (AF), and the estimation of elevated LV filling pressures by E/e' ratio is related to worse outcomes in patients with AF. However, it is unknown if restoring sinus rhythm reverses this process.Objective:To evaluate the impact of AF ablation on estimated LV filling pressure.Methods:A total of 141 patients underwent radiofrequency (RF) ablation to treat drug-refractory AF. Transthoracic echocardiography was performed 30 days before and 12 months after ablation. LV functional parameters, left atrial volume index (LAVind), and transmitral pulsed and mitral annulus tissue Doppler (e' and E/e') were assessed. Paroxysmal AF was present in 18 patients, persistent AF was present in 102 patients, and long-standing persistent AF in 21 patients. Follow-up included electrocardiographic examination and 24-h Holter monitoring at 3, 6, and 12 months after ablation.Results:One hundred seventeen patients (82.9%) were free of AF during the follow-up (average, 18 ± 5 months). LAVind reduced in the successful group (30.2 mL/m2 ± 10.6 mL/m2 to 22.6 mL/m2 ± 1.1 mL/m2, p < 0.001) compared to the non-successful group (37.7 mL/m2 ± 14.3 mL/m2 to 37.5 mL/m2 ± 14.5 mL/m2, p = ns). Improvement of LV filling pressure assessed by a reduction in the E/e' ratio was observed only after successful ablation (11.5 ± 4.5 vs. 7.1 ± 3.7, p < 0.001) but not in patients with recurrent AF (12.7 ± 4.4 vs. 12 ± 3.3, p = ns). The success rate was lower in the long-standing persistent AF patient group (57% vs. 87%, p = 0.001).Conclusion:Successful AF ablation is associated with LA reverse remodeling and an improvement in LV filling pressure.

Association Between Hemodynamic Profile, Physical Capacity and Quality of Life in Pulmonary Hypertension

Background: No studies have described and evaluated the association between hemodynamics, physical limitations and quality of life in patients with pulmonary hypertension (PH) without concomitant cardiovascular or respiratory disease. Objective: To describe the hemodynamic profile, quality of life and physical capacity of patients with PH from groups I and IV and to study the association between these outcomes. Methods: Cross-sectional study of patients with PH from clinical groups I and IV and functional classes II and III undergoing the following assessments: hemodynamics, exercise tolerance and quality of life. Results: This study assessed 20 patients with a mean age of 46.8 ± 14.3 years. They had pulmonary capillary wedge pressure of 10.5 ± 3.7 mm Hg, 6-minute walk distance test (6MWDT) of 463 ± 78 m, oxygen consumption at peak exercise of 12.9 ± 4.3 mLO2.kg-1.min-1 and scores of quality of life domains < 60%. There were associations between cardiac index (CI) and ventilatory equivalent for CO2 (r=-0.59, p <0.01), IC and ventilatory equivalent for oxygen (r=-0.49, p<0.05), right atrial pressure (RAP) and 'general health perception' domain (r=-0.61, p<0.01), RAP and 6MWTD (r=-0.49, p<0.05), pulmonary vascular resistance (PVR) and 'physical functioning' domain (r=-0.56, p<0.01), PVR and 6MWTD (r=-0.49, p<0.05) and PVR index and physical capacity (r=-0.51, p<0.01). Conclusion: Patients with PH from groups I and IV and functional classes II and III exhibit a reduction in physical capacity and in the physical and mental components of quality of life. The hemodynamic variables CI, diastolic pulmonary arterial pressure, RAP, PVR and PVR index are associated with exercise tolerance and quality of life domains.

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.

Estudos sôbre a Alimentação Mineral do Abacaxí (Ananas sativus) Sch

Pineapple plants when grown in the greenhouse by the sand culture technique in order to study the effects of deficiencies of macronutrients in growth, yield, leaf and fruit composition, the main results were the following. As a result of the several treatments, yield decreased in the order: Complete Minus Mg Minus S Minus Ca Minus K; nitrogen and phosphorus deficiente plants did not bear fruit. Leaf analyses (see Table 5-1) showed that the ommission of given element from the nutrient solution always caused a decrease in its level in the green tissue. As seen in Table 5-2 the lack of macronutrients had certain effects on fruit composition: acidity increased in all cases excet in the minus Mg fruits; ash usually decreased reaching its lowest valued in fruits from the minus K plants; when compared to fruits picked in the "normal" plants, those lacking K showed a marked decrease both in brix and in total sugars as well; sulfur deficiency also brought a net reduction in the sugar content. Table 5-1. Levels of macronutrients found in pinapple leaves. Elements Treatment Percent of dry matter Nitrogen (N) Complete 1.29 Minus N 0.78 Phosphorus (P) Complete 0.12 Minus P .05 Potassium (K) Complete 2.28 Minus K 0.16 Calcium (Ca) Complete 1.19 Minus Ca 1.10 Magnesium (Mg) Complete 0.41 Minus Mg .29 Sulfur (S) Complete 1.00 Minus S .65 Table 5-2. Effects of macronutrients deficiency in yield and fruit characteristics. Treatment Ave. weight of Acidity As per Brix Total sugars fruits (gm) per cent cent per cent Complete 1.031 1.16 0.40 14.7 10.8 Minus N no fruit was produced Minus P no fruit was produced Minus K 246 1.44 0.26 11.9 8.3 Minus Ca 513 1.40 0.35 17.8 14.3 Minus Mg 957 0.97 0.38 15.4 13.0 Minus S 576 1.42 0.46 17.1 6.5

Estudos sôbre a alimentação mineral do cafeeiro, X: extração de macronutrientes na colheita pelas variedades "Mundo Novo", "Caturra" e "Bourbon Amarelo"

This paper deals with the determination of the content of macronutrients in pulp and beans of three coffee varieties, namely 'Mundo Novo', 'Caturra Amarelo' and 'Bourbon Amarelo'. Samples were collected in plantations located in the three types of soils herein most of S. Paulo, Brazil, coffee is grown, that is, "terra roxa legítima" (Ribeirão Preto), "massapé-salmourão" (Mocóca), and "arenito de Bauru" (Pindorama). The following main conclusions were drawn after statistical analysis of data obtained hereby. There is no statistical difference among the three varieties . Average contents of macronutrients, as per cent of the dry matter, are the following: N P K Ca Mg S bean 1,71 0,10 1,53 0,27 0,15 0,12 pulps 1.78 0,14 3,75 0,41 0,13 0,15 Samples collected in Mocóca ("massapé-salmourão") had lower N and K contents, probably due to lack of availability of these elements in the soil, as suggested by its analysis. Results obtained in this work are in good agreement with data described elsewhere. Out of the total of elements contained in the whole fruit the following proportions are exported as clean coffee: N - 2/3, P and K - 1/2, Ca, Mg and S - 1/3. It is clear therefore that a substantial amount of elements absorbed from the soil remains in the pulp or in the dry hulls which result from processing. From this fact raises the interest of using these residues as fertilizer in the coffee plantations.

Propagação da uvaieira (Eugenia uvalha camb.) através da enxertia por garfagem

Ensaiou-se a enxertia por garfagem da uvaieira (Eugenia uvalha Camb.) sobre seedlings de mesma espécie através dos processos em inglês-complicado, meia-fenda e fenda-inteira e constatou-se pegamentos da ordem de 56,6; 45,5 e 52,2%, respectivamente. Os processos não diferiram entre si e a média geral foi de 51,4% de sucesso. A retirada da cobertura piástica que recobria os garfos, foi realizada 90 dias após a operação e resultou em perda de cerca de 14,3% dos enxertos dados como pegos naquela data. Considerou-se, pois, prematura essa retirada.

Nutrição mineral de hortaliças: LXXVII. demanda de nutrientes por uma cultura de rúcula

De uma bem conduzida plantação de rúcula (Euruca sativa var. Cultivada) foram coletadas plantas aos 20, 27, 34 e 41 dias de idade. As plantas foram lavadas e divididas em folhas e raízes. Postas a secar a 80°C e analisadas para N, P, K, Ca, Mg, S, B, Cu, Fe , Mn e Zn pelos métodos convencionais de laboratório. Observou-se que o crescimento, expresso em produção de matéria seca, é crescente até os 34 dias, estabilizando-se após este período. A análise química mostrou que a concentração de K e Ca é elevada atingindo 2,19% para este último elemento aos 41 dias de idade da planta. Para os micronutrientes chama atenção a elevada concentração de zinco nas folhas atingindo 229 ppm aos 41 dias de idade. Uma área cultivada de 10 m² extrai pelas folhas , que é parte exportada as seguintes quantidades de elementos: 20 g de N, 1,86 g de P, 22,1 g de K, 7,56 g de Ca , 1,77 g de Mg, 1,99 g de S, 17,7 mg de B, 7,8 mg de Cu , 475,6 mg de Fe, 14,3 mg de Mn e 37,7 mg de Zn.

Nível crítico de fósforo em cultivares de algodão: III. concentração de fósforo no limbo e pecíolo de acordo com a época da coleta e concentração de fósforo nas soluções nutritivas

Com o intuito de se estudar a melhor época de coleta de folhas e pecíolos para a diagnose foliar do algodoeiro, ensaios foram conduzidos em casa-de-vegetação com solução nutritiva, com os cultivares de ciclo anual, IAC-17, IAC-19, IAC-20 e CNPA 78/SME4 e para as do ciclo perene CNPA 2M e CNPA 3M. As plantas foram cultivadas nos seguintes níveis de fósforo, em ppm: 0,38; 1,14; 3,42; 10,26; 30,78. Em plantas com 44 dias, 59 dias e 74 dias de idade foi coletada a 5ª folha situada na haste principal, a partir do ápice, e dividida em limbo e pecíolo para a determinação de fósforo. Os autores concluiram que a época mais adequada para a coleta das folhas nos cultivares de ciclo anual é aos 44 dias após a semeadura e para os cultivares perenes a melhor época corresponde aos 59 dias após a semeadura.

Anomalia em Coscinodiscus oculus-iridis ehrenberg, 1839 (Diatomácea)

The author describes an anomalous specimen in diatom Coscinodiscus oculus-iridis Ehr., 1839, caught from Guanabara Bat, (22º 51' 8" Lat. S. - 43º 14' 3" Long. W. G.); its dorsal face (fig. 1), is different from the ventral one, (fig. 2).

Morbidade da doença de Chagas: I - Estudo de casos procedentes de vários estados do Brasil, observados no Rio de Janeiro

Um estudo da morbidade através de exames clínicos, eletrocardiográficos, radiológicos, sorológicos, xenodiagnósticos e outros exames laboratoriais seriados, foi feito em 510 pacientes com sorologia positiva para doença de Chagas, procedentes de vários Estados do Brasil e observados no Rio de Janeiro a partir de 1960. Os pacientes foram classificados, de acordo com a forma clínica, em assintomáticos (forma indeterminada), cardíacos, portadores de "megas" ou com formas clínicas associadas. Foi observada uma prevalência de cardiopatia em 52,1% dos pacientes, de "megas" em 14,3% e de associação entre cardiopatia e "megas" em 10,7% e entre megaesôfago e megacolon em 10,9% dos casos. A forma indeterminada (assintomática) foi observada em 39% dos pacientes. A proporção de casos de cardiopatia aumentou progressivamente da 1ª a 5ª décadas de vida, enquanto a dos "megas" continuou aumentando até a 7ª década. Entretanto, em número de casos o pico de ambas as formas ocorreu na 4ª década. Não houve diferenças significativas de formas clínicas com relação ao sexo, apesar de uma discreta predominância de cardiopatia no sexo masculino e de "megas" no sexo feminino. Com relação à raça, entre os pacientes classificados como brancos, pretos e mestiços, não foi possível determinar a significância entre as diversas formas clínicas, por desconhecimento da constituição do universo da procedência de cada paciente. Embora o reduzido número de casos não possa ser considerado como representativo da prevalência das fomas clínicas nas regiões de origem dos pacientes, tomando-se os quatro Estados representados com maior número de casos, verificou-se que as proporções de cardiopatia e "megas" foram respectivamente de 65,7 e 20,1% nos casos procedentes da Bahia, de 55,7 e 14,7% nos de Minas Gerais, de 50,9 e 15% nos de Pernambuco e de 23,3 e 0% nos procedentes da Paraíba. O reduzido número de casos procedentes dos demais Estados não permitiu qualquer inferência de proporção entre as formas...

Eimeria vitellini n. sp. (Apicomplexa: eimeriidae) from the brazilian toucan Rhamphastos vitellinus vitellinus Lichtenstein (Aves: Picicformes: Rhamplastidae)

Eimeria vitellini n. sp. is described from the faeces of the Rhamphastos v. vitellinus. Oocysts broadly ellipsoidal to oval (egg-shaped), 22,6 x 18.3 (20.0-25.0 x 16.3-22.5) micronm, shapeindex (length/width) 1.2 (1.1-1.1). Oocyst wall a single colourless layer about 0.5 micronm thick, becoming thinner at one ectremity, at which point the oocyst usually ruptures. No oocyst residuum, but 1 or 2 small polr bodies of about 1.0-1.5 x 0.5-1.0 micronm. Sporocysts ellongated ellipsoid (pearshaped), 14.3 x 7.5 (13.8-15.0 x 6.9-7.5) micronm, shape-index (1.9 (1.8-2.0), with a thin colourless wall bearing a very delicate Stieda body: a conspicuous sub-Stieda body is present. Sporozoites with anterior and posterior regractile bodies and strongly recurved around a bulky, compact sporocyst residuum composed of relatively fine granules and spherules.

Giardia survey in live-trapped small domestic and wild mammals in four regions in the southwest region of the State of São Paulo, Brazil

For the first time, a survey on Giardia in the live-trapped small domestic and wild mammals was perfomed in four regions of state of the São Paulo, Brazil, with special attention to the parasitism of Rattus rattus rattus by Giardia. This species was found infected in all studied sites: Botucatu (15.4%), Conchas (28.5%), Itaporanga (38.7%) and São Roque (100 %). Two new hosts and their frequency of infection were described for Giardia in Nectomys squamipes, an aquatic rodent and in Bolomys lasiurus, a forest rodent (100 % and 14.3 %, respectively). Both G. muris and G. duodenalis groups were found in scrapings of intestinal mucosa of those rodents. Mixed infection was observed in some animals. It is important to emphasize the infection by G. duodenalis in the black rat as this species lives as a comensal with man and in N. squamipes as it may contaminate small streams used for domestic consumption. Therefore, further investigation will be necessary to elucidate the potential of these rodents to act as reservoirs of Giardia for man.

Serodiagnosis of chronic Chagas infection by using EIE-Recombinant-Chagas-Biomanguinhos kit

A kit based on an enzyme immunoassay, EIE-Recombinant-Chagas-Biomanguinhos, developed by the Oswaldo Cruz Foundation, was evaluated for the serodiagnosis of chronic Chagas disease. Evaluation was performed with 368 serum samples collected from individuals living in an endemic area for Chagas disease: 131 patients in the chronic phase with confirmed clinical, epidemiological, and serological diagnosis (indirect immunofluorescence, indirect hemagglutination or enzyme-linked immunosorbent assay) and 237 nonchagasic seronegative individuals were considered negative control. The EIE-Recombinant-Chagas-Biomanguinhos kit showed high sensitivity, 100% (CI 95%: 96.4-100%) and high specificity, 100% (CI 95%: 98-100%). The data obtained were in full agreement with clinical and conventional serology data. In addition, no cross-reaction was observed with sera from patients with cutaneous (n=14) and visceral (n=3) leishmaniasis. However, when these sera were tested by conventional serological assays for Chagas disease, cross-reactions were detected in 14.3% and 33.3% of the patients with cutaneous and visceral leishmaniasis, respectively. No cross-reactions were observed when sera from nonchagasic seronegative patients bearing other infectious disease (syphilis, n=8; HTLV, n=8; HCV, n=7 and HBV, n=12) were tested. In addition, sera of patients with inconclusive results for Chagas disease by conventional serology showed results in agreement with clinical evaluation, when tested by the kit. These results are relevant and indicate that the refered kit provides a safe immunodiagnosis of Chagas disease and could be used in blood bank screening.

Replacing oxamniquine by praziquantel against Schistosoma mansoni infection in a rural community from the sugar-cane zone of Northeast Brazil: an epidemiological follow-up

A group of 52 villagers was followed-up for three years regarding Schistosoma mansoni infection. All villagers were periodically surveyed by the Kato-Katz method. In March 1997 and March 1998 the positives were treated with oxamniquine (15-20 mg/kg), and in March 1999, with praziquantel (60 mg/kg). All infection indices decreased substantially between March 1999 and March 2000: prevalence of infection (from 32.7% to 21.2%), prevalence of moderate/heavy infection (from 7.7% to 1.9%), intensity of infection (from 23.1 epg to 7.4 epg) and reinfection (from 35.7% to 14.3%). Negativation increased from 53.8 to 82.4. An optimistic prognostic is assumed in the short term for the introduction of praziquantel in the study area.