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.

Estudos sôbre Ascia monuste orseis (GODART, 1818) (Lep., Pierididae)

A biologia de Ascia monuste orseis (Godart, 1818) (Lep., Pierididae) foi estudada. O material utilizado foi coligido em Campinas e Piracicaba (Estado de São Paulo), durante os meses de dezembro de 1951 e janeiro de 1952 e constituiu-se principalmente de posturas do inseto. O número máximo de ovos, obtido de uma fêmea, em condições de laboratório, foi de 202, sendo registradas algumas observações sobre o comportamento da borboleta durante a oviposição na natureza. Os ovos e as posturas são descritos. A incubação exigiu cerca de 4 dias. Durante a vida larvária, a espécie passa por 5 estádios, sofrendo, portanto, 4 ecdises. São descritas as lagartas em tôdas essas idades. O ciclo completo, de ôvo a imago, andou ao redor de 22 dias. O 5º. estádio larval mostrou-se, de todos, o mais longo, consumindo 3 até 6 dias. O período de crisálida abrangeu 6 a 7 dias. Os adultos viveram, em insetário, 5 a 9 dias, quer em presença ou em ausência de uma mecha de algodão hidrófilo em-bebida de uma mistura de água e mel. Unicamente um caso de parasitismo foi verificado, os Autores concluindo que, nestas regiões de São Paulo, na época em que as observações foram feitas, a espécie é muito pouco perseguida por agentes naturais de controle. O parasito foi identificado pelo Professor Luis De Santis, da Universidade de La Plata (Rep. Argentina), como Pteromalus caridei Brèthes, 1913, interessante Hymenoptera da família Pteromalidae. Os Autores procuraram esclarecer a ação do pardal - Passer domesticus domesticus (L.) - com relação às lagartas de A. m. orseis, uma vez que há, entre olericultures, a crença de que o referido Ploceidae constitui inimigo do Lepidoptera em estudo. As observações colhidas não permitiram uma conclusão, sendo, contudo, de molde a negar a ação do pássaro como devorador das lagartas.

Microsatellite genotyping from faeces of Lontra longicaudis from southern Brazil

A genetic study of the neotropical river otter Lontra longicaudis (Olfers, 1818), which has an unknown conservation status, was carried out at the Taim Ecological Station and the margins of the Vargas stream, Rio Grande do Sul, southern Brazil. Faecal samples were collected, and DNA was extracted using a silica-guanidine method. Five microsatellite loci were amplified using PCR with heterologous primers previously described for Lutra lutra (Linnaeus, 1758). Sixteen faecal samples out of 29 from Taim and 11 out of 14 from Vargas stream margins contained enough DNA for genetic analysis. A total of 49 different alleles were found at both localities, from which 18 were exclusively found in individuals from Taim and 17 were exclusives from Vargas individuals. The most common allele was the same at both locations for three loci (Lut715, Lut733, and Lut818). A high level of genetic diversity was found at both sites (NeTaim=4.1, HoTaim=0.299, HeTaim=0.681; NeVargas=4.9, HoVargas=0.355, HeVargas=0.724), being higher at the Vargas stream site. A high and significant level of heterozygote deficiency was observed at most loci according to the χ2 test. The homogeneity χ2 test (P<0.001) showed that there were significant differences in the allele frequencies between the two locations. Genotyping for more than one locus was possible in 81.5% of samples, from which only 37% were possible to genotype for more than three loci. A low degree of relatedness was found among individuals from Taim (R=0.055±0.310), but an even lower value of relatedness was found at the Vargas site (R= -0.285±0.440). The significant degree of differentiation (I=0.890; F ST=0.059) found between Taim and Vargas individuals suggests that there is more than one population of otters in the southern extreme of Brazil, which probably are associated with the water body systems found in this region, the Mirim and the Caiuvá/Flores/Mangueira Lagoons. The high genetic diversity and low relatedness found at the Vargas stream, lead us to believe that the Vargas stream may be acting as a corridor between these water bodies for otter dispersion.

Estudos sobre o comportamento dos planorbídeos: II - enterramento de Biomphalaria glabrata (Say, 1818) como meio de proteção contra a dessecação

Os a.a confirmaram em laboratório a ocorrência de enterramento no repertório comportamental de Biomphalaria glabrata. Verificaram que os indivíduos enterrados se recuperaram com maior rapidez, depois de um período de 20 dias de dessecação, do que os outros que permaneceram sobre o solo. Estudos mais detalhados a respeito são necessários para avaliar a importância epidemiológica desse comportamento.

Comportamento de Biomphalaria glabrata (Say, 1818) como critério de toxicidade em ensaios biológicos com moluscicidas

Visando à aplicação sistemática de parâmetros comportamentais como indicadores da ação tóxica de moluscicidas empregados no combate aos hospedeiros intermediários do Schistosoma mansoni, um procedimento para avaliação quantitativa do efeito de dose sobre o comprotamento de Biomphalaria glabrata foi desenvolvido, com base no paradigma recomendado pela O.M.S. para ensaios biológicos e envolvendo registro comportamental por cenematografia ocm lapso de tempo: caramujos com 5 7/8 ± 1/8 giros eram subemtidos a diferentes concentrações subletais de sulfato de cobre durante 24 horas e em seguida transferidos para recuperação em água destilada desionizada; a partir da análise dos registros foram computados (a) a freqüência total de subidas à superfície por indivíduo, (b) a frqüência total de saídas da água por indivíduo e (c) a proporção média de indivíduos no terço superior do recipiente de teste. O método Litchfield-Wilcoxon foi empregaod para determinação de índices de referência (denominados "concentrações de efieto comportamental de 50%" ou CEC50) em relação a cada parâmetro, e os valores obtidos - (a) 0,010, (b) 0,006 e (c) 0,029 ppm de cobre - não só evidenciaram a exeqüibilidade da aplicação sistemática de critérios comportamentais de toxidade, como se revelaram capazes de detectar o efieto tóxico do produto em concentrações muito infereiores às obtidas nas determinações convencionais de letalidade. Os dados também mostraram alterações na atividade dos caramujos em decorrência do ciclo de iluminação dia-noite. Embora o esclarecimento dos aspectos etológicos envolvidos no problema do controle químico do vetor dependa da análise das relações entre o indivíduo e seu ambiente natural, estudos de laboratório com mensurações acuradas de parâmetros relacionados a comportamentos de proteção podem fornecer subsídios relevantes a respeito.

Orientation to light of juvenile and adult forms of melanic and albino populations of Biomphalaria glabrata (Say, 1818)

The process of light orientation by the snail Biomphalaria glabrata was studied using the selection technique in a Y-shaped aquarium under vertical or horizontal lighting schemes. Snail behavior was measured on the basis of distance (cm) covered per hour, direction of locomotion, and localization of the animal in the aquarium. A comparison was made of the action of the light stimulus on young and adult animals of albino populations from Santa Luzia (State of Minas Gerais, Brazil) and of a melanic population from Touros (State of Rio Grande do Norte) studied in groups and separately. All groups studied were attracted to light. Analysis of the data suggests the exitence of two orientation mechanisms with respect to light in these animals, i.e. high photo-orthokinesia and positive phototaxis, which influence their motion in the environment. This evidence permitted us to discuss features of the distribution dynamics of these mollusks in the environment and their relationship with the larval phases of Schistosoma mansoni, for which they act as intermediated hosts.

Effects of Laurus nobilis (Lauraceae) on Biomphalaria glabrata (Say, 1818)

Experiments were carried out using aqueous extracts from leaves and flowers of Laurus nobilis on Biomphalaria glabrata. Treatments were performed on blastula stage (± 15 h after first cleavage) and on adult snails (11-18 mm). In both instances they were exposed for 24 h to different concentrations of the extracts on snails (200 to 2500 ppm) and embryos (20 to 300 ppm) at 25 ± 1ºC. The embryos were observed for a period of 20 days after treatment and the snails for 10 days. Results obtained with leaf aqueous extracts have shown a degree of toxicity on embryos starting at a concentration of 125 ppm, the flower extract being effective at 35 ppm. The malformation obtained with the different concentrations falls into the unespecific type category, however some cephalic and shell malformations were found in embryos treated with concentrations over 50 ppm (leaves) and 25 ppm (flowers). The LD90 on adult snails obtained by treatments with flower and leaf extract was observed at concentrations of 340 ppm and 1900 ppm respectively.

Biphally in Biomphalaria glabrata (Say, 1818) (Pulmonata, Planorbidae)

We describe a biphallic specimen of Biomphalaria glabrata (Say, 1818) from the municipality of Caeté, State of Minas Gerais, Brazil. The conformation of the two penial complexes, with a common genital pore on the left side. suggests that both have copulatory capacity. Based on a review of literature type of biphally appears to be reported for the first time in planorbids.

Effect of Niclosamide (Bayluscide WP 70 (R)), Anacardium occidentale hexane extract and Euphorbia splendens latex on behavior of Biomphalaria glabrata (Say, 1818), under laboratory conditions

The repellent effect of the molluscicides Niclosamide (Bayluscide WP 70 (R)), Anacardium occidentale and the latex of Euphorbia splendens on Biomphalaria glabrata was observed through the investigation of the occurrence of escape behavior among molluscs that were exposed to dosages lower than the LD 50. The total number of individuals out of water among the surviving snails in the control group provided a "Natural Escape Index". The comparison between this total and the total number of surviving snails in each group exposed to the different dosages of the molluscicides after 24 hr provided the "Molluscicide Escape Index" and the detection of a "Repellency Range" to these snails. The escape indexes for Niclosamide, A. occidentale and E. splendens were 10, 6.22 and 6.44 respectively. Repellency occurred at the following concentration ranges: 0.01, 0.02 and 0.03 ppm Bayluscide, 0.1, 0.2 and 0.3 ppm A. occidentale and 0.05, 0.10, 0.15 and 0.20 ppm E. splendens. The Natural Escape Index obtained in the control group was zero.

Behavior of Biomphalaria glabrata Say, 1818 (Gastropoda: Planorbidae): I. Morphophysiology of the Mantle Cavity

Using longitudinal and transverse anatomical sections, we observed that the three cristae of the mantle of Biomphalaria glabrata (renal, rectal and dorsolateral cristae) divide the mantle cavity into three chambers which we designated air or pulmonary chamber, water inflow chamber and water outflow chamber. Using videotape filming, we observed the inflow and outflow of air and water into and from the mantle cavity and we related their probable functions such as flotation, oxygen reservoir and transport, excreta circulation and elimination, water skeleton, and modification of specific weight. To determine whether the air bubble may function as a physical gill in this species we submitted three groups of snails to different systems in which water contained the same level of dissolved oxygen whereas the gas phases were atmospheric air, pure nitrogen or pure oxygen. We observed the following parameters: time of permanence on the surface, time of immersion, and frequency at which the snails reached the surface. These results did not demonstrate a physical gill function; morphological analysis of the mantle cavity indicates this possibility