Use of automated external defibrillators in a Brazilian airline. A 1-year experience

After the incorporation of automated external defibrilators by other airlines and the support of the Brazilian Society of cardiology, Varig Airlines Began the onboard defibrilation program with the initial purpose of equiping wide-body aircrafts frequently used in international flights and that airplanes use in the Rio - São Paulo route. With all fight attendants trained, the automated. External defibrilation devides were incorporated to 34 airplanes of a total pleet of 80 aircrats. The devices were intalled in the bagage compartments secured with velero straps and 2 pairs of electrods, one or which pre-conected to the device to minimize application time. Later, a portable monitor was addres to the ressocitation kit in the long flights. The expansion of the knowledge of the basic life support fundamentors and the correted implantation of the survival chain and of the automated external defibrilators will increase the extense of recovery of cardiorespiratory arrest victins in aircrafts.

Short- and midterm follow-up results of valvuloplasty with balloon catheter for congenital aortic stenosis

OBJECTIVE: To report short and midtem follow-up results of balloon aortic valvuloplasty to treat congenital aortic stenosis. METHODS: Seventy-five patients (median age: 8 years) underwent the procedure through the retrograde femoral or carotid route. RESULTS: The procedure was completed in 74 patients (98.6%). The peak-to-peak systolic gradient dropped from 79.6±27.7 to 22.3±17.8 mmHg (P<0.001), the left ventricular systolic pressure dropped from 164±39.1 to 110±24.8 mmHg (P<0.001), and the left ventricular end diastolic pressure dropped from 13.3±5.5 to 8.5±8.3 mmHg (P< 0.01). Four patients (5.3%) died due to the procedure. Aortic regurgitation (AoR) appeared or worsened in 27/71 (38%) patients, and no immediate surgical intervention was required. A mean follow-up of 50±38 months was obtained in 37 patients. Restenosis and significant AoR were observed in 16.6% of the patients. The estimates for being restenosis-free and for having significant AoR in 90 months were 60% and 50%, respectively. CONCLUSION: Aortic valvuloplasty was considered the initial palliative method of choice in managing congenital aortic stenosis, with satisfactory short- and midterm results.

Safety, feasibility, and results of exercise testing for stratifying patients with chest pain in the emergency room

OBJECTIVE: To assess safety, feasibility, and the results of early exercise testing in patients with chest pain admitted to the emergency room of the chest pain unit, in whom acute myocardial infarction and high-risk unstable angina had been ruled out. METHODS: A study including 1060 consecutive patients with chest pain admitted to the emergency room of the chest pain unit was carried out. Of them, 677 (64%) patients were eligible for exercise testing, but only 268 (40%) underwent the test. RESULTS: The mean age of the patients studied was 51.7±12.1 years, and 188 (70%) were males. Twenty-eight (10%) patients had a previous history of coronary artery disease, 244 (91%) had a normal or unspecific electrocardiogram, and 150 (56%) underwent exercise testing within a 12-hour interval. The results of the exercise test in the latter group were as follows: 34 (13%) were positive, 191 (71%) were negative, and 43 (16%) were inconclusive. In the group of patients with a positive exercise test, 21 (62%) underwent coronary angiography, 11 underwent angioplasty, and 2 underwent myocardial revascularization. In a univariate analysis, type A/B chest pain (definitely/probably anginal) (p<0.0001), previous coronary artery disease (p<0.0001), and route 2 (patients at higher risk) correlated with a positive or inconclusive test (p<0.0001). CONCLUSION: In patients with chest pain and in whom acute myocardial infarction and high-risk unstable angina had been ruled out, the exercise test proved to be feasible, safe, and well tolerated.

Femoral versus Radial Access in Primary Angioplasty. Analysis of the ACCEPT Registry

Background:The radial access provides a lower risk of bleeding and vascular complications related to the puncture site in comparison to the femoral access. Recent studies have suggested a reduction in mortality associated with the radial access in patients with acute myocardial infarction undergoing percutaneous coronary intervention.Objective:To compare the occurrence of adverse cardiovascular ischemic and hemorrhagic events in patients undergoing primary angioplasty according to the type of arterial access route.Methods:From August 2010 to December 2011, 588 patients undergoing primary percutaneous coronary intervention during acute ST-segment elevation myocardial infarction were assessed; they were recruited from 47 centers participating in the ACCEPT registry. Patients were grouped and compared according to the arterial access used for the procedure.Results:The mean age was 61.8 years; 75% were males and 24% had diabetes mellitus. There was no difference between groups as regards the procedure success rate, as well as regards the occurrence of death, reinfarction, or stroke at six months of follow-up. Severe bleeding was reported in 1.1% of the sample analyzed, with no statistical difference related to the access used.Conclusions:The femoral and radial accesses are equally safe and effective for the performance of primary percutaneous coronary intervention. The low rate of cardiovascular events and of hemorrhagic complications reflects the quality of the participating centers and the operators expertise with the use of both techniques.

Predictors of Conversion from Radial Into Femoral Access in Cardiac Catheterization

Background: Fewer bleeding complications and early ambulation make radial access a privileged route for cardiac catheterization. However, transradial (TR) approach is not always successful, requiring its conversion into femoral access. Objectives: To evaluate the rate of conversion from radial into femoral access in cardiac catheterization and to identify its predictors. Methods: Prospective dual-center registry, including 7632 consecutive patients undergoing catheterization via the radial access between Jan/2009 and Oct/2012. We evaluated the incidence of conversion into femoral access and its predictors by logistic regression analysis. Results: The patients’ mean age was 66 ± 11 years, and 32% were women. A total of 2969 procedures (38.4%) were percutaneous coronary interventions (PCI), and the most used first intention arterial access was the right radial artery (97.6%). Radial access failure rate was 5.8%. Independent predictors of conversion from radial into femoral access were the use of short introducer sheaths (OR 3.047, CI: 2.380-3.902; p < 0.001), PCI (OR 1.729, CI: 1.375-2.173; p < 0.001), female sex (OR 1.569, CI: 1.234-1.996; p < 0.001), multivessel disease (OR 1.457, CI: 1.167-1.819; p = 0.001), body surface area (BSA) ≤ 1.938 (OR 1.448, CI: 1.120-1.871; p = 0.005) and age > 66 years (OR 1.354, CI: 1.088-1.684; p = 0.007). Conclusion: Transradial approach for cardiac catheterization has a high success rate and the need for its conversion into femoral access in this cohort was low. Female sex, older age, smaller BSA, the use of short introducer sheaths, multivessel disease and PCI were independent predictors of conversion into femoral access.

Dous phyllopodos, observados no Rio Grande do Norte

Le 19 juillet 1928 l'auteur trouva près de Natal, capitale de l'État de Rio Grande do Norte, a 5º 47' au sud de l'équateur, un nouveau Dendrocephalus qui portera le nom ornatus, dû a ses appendices caudales teints d'écarlate brillant. La femelle (Pl.1) atteint 12 mm. de longueur e contient des oeufs noirs dans sa cavité d'incubation. Le mâle, beaucoup plus robuste, atteint 16 mm. et montre, outre les caracteres sexuels, une modification extrémement compliquée des deuxièmes antennes (qui dans la planche II sont vues devant les premières). L'espèce est plus petite que les deux autres décrites de l'Amérique du Sud et se distingue facilement par les antennes du mâle. Elle fut trouvée au bord de la route dans une flaque large et profonde d'eau de pluie argileuse. Les exemplares rapportés moururent en quelques jours et la mare, lors d'une seconde visite, fut trouvé sèche. L'autre espèce, observée en 9. 7. 28 dans un étang naturel tout-près de la capitale, avait déjà été observée á Matto Grosso et en Paraguay et déterminée comme Cyclestheria hislopi BAIRD. THIELE pense que les individus de l'Amérique du Sud, pour cause de quelques petites différences, pour-raient nien former une autre espèce qu'il propose d'appeler sarsiana, mais la comparaison des desseins et descriptions avec mes exemplaires ne parait pas soutenir cette idée. Tout-de-mème la répartition connue de cette espèce est extrêmement curieuse et peut-être unique en zoologie. Elle a été signalée à Nagpur (Hindoustan), Ceylon, Queensland (Australie), Célèbes, Afrique orientale et Sansibar; seulement le premier lieu se trouve bien au nord de l'équateur, mais encore dans la zone tropicale, comme toutes les autres localités. L'explication de cette extension sur les deux mondes est tout ce qu'il a de plus difficile, puisque entre les localisations il n'y a pas seulement d'énormes distances sur terre (que l'on pourrait expliquer par un défaut d'observations), mais des espaces tres étendus, occupés par la mer. L'intervention de l'homme ne saurait expliquer ces faits et le transport par les oiseaux aquatiques ne pourrait être qu'un fait tout-a-fait excepcionnel pour les grands trajets océaniques. Le recours aux terres hypothétiques, qui formaient des ponts intercontinentaux dans des périodes géologiques extrêmement reculées, recontre des objections évidentes. En tous les cas on ne peut qu'admirer la constance avec laquelle le type de l'espèce s'est maintenu durant d'innombrales générations et a travers de telles distances quand les autres phyllopodes ont formé non seulement des variétés, mais même un grand nombre de genre et de familles.

Estudos sôbre a excitação química da córtex cerebral (Ação da acetilcolina)

The author has studied the influence of acetylcholine solutions directly applied on the motor cortex of dogs, cats monkeys and rabbits. For this purpose small squares of filter paper were soaked in the acetylcholine solution and soon afterwards laid on the motor cortex. Solutions varying from 0,2 to 10 per cent have been experimented. It has been shown that local application of the solutions on the motor points, previously localized by induction coil, produced motor reactions. It has been found, in the dogs that 10 per cent acetylcholine solutions cause localized muscular twitchings (clonus) in almost all the animals experimented. Generalised epileptiform convulsions were obtained in44,4% of the dogs. Convulsions were also obtained by employing 1 per cent solution of acetylcholine. Definite response has been obtained with 0,2 per cent solution. Failure of motor action, pointed out by other authors, has been related to the use of anesthetics. Convulsions were easily produced by rapid light mechanical stimulations of the skin covering the muscles in conection with the excited motor point, and the application on the motor point of acetylcholine. The results on monkeys can be summarized as follows. Two species of monkeys were experimented: Cebus capucinus and Macaca mulata. In the monkeys C. capucinus generalised convulsive reactions were induced with actylcholine solutions in a concentration as low as 0,5 per cent. Motor reaction or convulsive seizeres were obtained in seven of the eight monkeys used. Three monkeys M. mulata were stimulated with 10 per cent acetylcholine solution but only localized muscular contraction hae been observed. Similar results has been obtained on the motor cortex of cats and rabbits. One of the three cats employed has shown epileptiform convulsions and the remaining only localized muscular contractions. In the rabbits muscular twitchings have been also induced. The sensitizing power of eserine on the action of acetylcholine has been also searched. The results indicate that a previous application of eserine solution on the motor center, potentiates the action of acetylcholine. The intensity of the muscular twitchings is greater than the obtained before the application of the eserine solution. Generalised epileptiform convulsions sometimes appeared following the use of lower concentrations of acetylcholine than those previously employed. Experiments have been carried out by injecting eserine and prostigmine by parenteral route. A dosis dufficient for induce small muscular tremors did not enhance obviously the motor effects produced by the application of the acetylcholine solutions on the motor cortex. From seven dogs experimented, all previously tested for convulsive seiruzes by application of 1 and 10 per cent acetylcholine solution with negative results, only one has shown epileptiform convulsions after the injection of prostigmine. Morphine has also been tested as facilitating substance for convulsions induced by acetylcholine. Six from the nine dogs submitted to the experiments, developed epileptiform seizures after injection of morphine and stimulation of the motor cortex with acetylcholine. (Table IV). In another series of experiments atropine and nicotine have been studied as for to their action on the motor effects of acetylcholine. Nicotine has a strong convulsant action, even when employed in very high concentration. Since a depressant effect has not appeared even by the applications of high concentrations of nicotine in the motor corteõ of dogs, unlike the classical observations for the autonomus nervous system, it was not possible to verify the action of acetylcholine on a motor center paralised by nicotine. It is important to not that the motor phenomena observed after the first aplication of acetylcholine, can desappear by the renewal of the pieces of filter paper soaked in the acetylcholine solution. Atropine, either applied on the motor point in low concentration, or injected in sufficient amount for inhibiting the “muscarinic effects” of acetylcholine on the autonomous nervous system, did not prevent the motor reactions of acetylcholine on the cerebral cortex.

Factors influencing the development of Plasmodium gallinaceum in Aedes fluviatilis

Aedes fluviatilis is susceptible to infection by Plasmodium gallinaceum and is a convenient insect host for the malaria parasite in countries where Aedees aegypti cannot be maintained in laboratories. In South America, for instance, the rearing of A. aegypti the main vector of urban yellow fever, is not advaisable because of the potential health hazard it represents. Our results of the comparative studies carried out between the sporogonic cycle produced with two lines of P. gallinaceum parasites into A. fuviatilis were as follows. As proved for A. aegypti, mosquito infection rates were variable when A. fluviatilis blood-fed on chicks infected with and old syringe-passaged strain of P. gallinaceum. Oocysts developed in 41% of those mosquitos and the mean peak of oocyst production was 56 per stomach. Salivary gland infections developed in about 6% of the mosquitos. The course of sporogony was unrelated to the size of the inoculum administered to chicks or to the route by which the birds were infected. The development of infected salivary glands was unrelated to oocyst production. Sporogony of P. gallinaceum was more uniform when mosquitos blood-fed on chicks infected with a sporozoite-passaged strain. Oocysts developed in about 50% of those mosquitoes and the mean peak of oocyst production was 138 per stomach, with some individuals having as many as 600-800 oocysts. Infected salivary glands developed in a mean of 27% of the mosquitos but, in some batches, was a high as 50%. Patterns of salivary gland parasitism were similar to those of oocyst production. The course of sporogony of P. gallinaceum in A. fluviatilis is analized in relation to degree of parasitemia and gametocytemia in the vertebrate host.

Studies on Trypanosoma rangeli Tejera, 1920: V - Developmental pattern in the alimentary canal of Rhodnius prolixus

The morphological sequence of Trypanosoma rangeli development in the alimentary canal of Rhodnius prolixus, is described, with observation made in dissected guts from 6 hours to 45 days post-infection. No metacyclic-forms are produced in the digestive tract at any time, and transmission by the contaminative route must be considered atypical. Amastigotes appear to be an essential stage in the development of T. rangeli in the gut of R. prolixus. The epidemiological importance of the developmental pattern of T. rangeli in the vector´s gut is discussed, and its usefulness for aging infection is considered.

Evolution of sarcoma 180 in mice treated with hyperchlorinated water

Mice treated with hyperchlorinated water (50 ppm of chlorine) and control mice, drinking tap water (1-3 ppm of chlorine) were inoculated with 2.5 x 10 [raised to the power of 6] sarcoma 180 cells, by intraperitoneal route. Tumor evolution was measured by enumeration of tumor cells in peritoneal cavity and by evaluation of weight gain at different time intervals after tumor implantation. In mice treated with excessive amounts of chlorine there was enhancement of tumor growth demonstrated by: (a) shorter incubation period and increased weight gain (ascites formation) after tumor implantation; (b) increased number of tumor cells in the peritoneal cavity 2, 3 and 4 days after tumor challenge. The number of peritoneal cells exsudated after tumor implantation was lower in mice treated with hyperchlorinated water than in controls. The tumor enhancement observed after excessive chlorine ingestion would be due to: (a) reduction of the number of peritoneal macrophages that migrate to the peritoneal cavity and (b) reduction of the tumoricidal capacity of peritonela macrophages induced by the direct effect of chlorine or by the reduction of the amount of endogenous endotoxins due to the bactericidal effect of chlorine.

Evolution of sarcoma 180 in mice infected with Trypanosoma cruzi

Mice infected with Trypanosoma cruzi were challenged with 2x10[raised to the power of 6] cells of sarcoma 180 (ascite tumor) by i.p. route, on day seven post infection. Tumor development was followed by evaluation of weight gain, by measurement of ascitic fluid produced and enumeration of tumor cells in ascitic fluid. Infected mice were more resitant to tumor development as demonstrated by reduction in ascites formation and by reduction in the number of tumor cells in ascitic fluid, at different time intervals after tumor challenge. The number of peritoneal cells exsudated after tumor inoculation was greater in infected mice than in controls. This increased resitance of mice infected with T. cruzi to tumor development could be due to the action of macrophages activated by the infection and by the action of endotoxins absorbed from the gut or produced by the own parasite.

Evaluation of the rabbit as a model for chagas' disease: I. Parasitological studies

In order to investigate the value of the rabbit as an experimental model for Chagas' disease, 72 animals have been inoculated by intraperitoneal and conjunctival route with bloodstream forms, vector-derived metacyclic trypomastigotes and tissue culture trypomastigotes of Trypanosoma cruzi strains Y, CL and Ernane. In 95.6% of the animals trypomastigotes had been detected at the early stages of infection by fresh blood examination. The course of parasitemia at the acute phase was strongly influenced by the parasite strain and route of inoculation. At the chronic phase parasites had been recovered by xenodiagnosis and/or hemoculture in 40% of the examined animals. The xenodiagnosis studies have shown selective interactions between the T. cruzi strains and the four species of vectors used, inducing significant variability in the results. The data herein present are consistent with the parasitological requirements established for a suitable model for chronic Chagas' disease.

Prospects for a nonliving vaccine against Schistosomiasis based on cell-mediated immune resistance mechanisms

We have designed a vaccine model based on induction of cell-mediated immunity and shown that it protects mice against Schistosoma mansoni infection. Mice are immunized by intradermal injection with schistosome antigens plus BCG. Resistance is dependent on the route of antigen presentation and the adjuvant chosen. The pattern of resistance correlates with sensitization of T lymphocytes for production of gamma interferon, a macrophage activating lymphokine that stimulates the cellular effector mechanism of protection. Purified schistosome paramyosin, a muscle cell component present in soluble parasite antigenic preparations, is immunogenic for T lymphocytes and induces resistance when given intradermally with BCG. It is likely that this protein, and possibly other soluble molecules that are released by the parasites of a challenge infection, induce a cellular inflammatory response resulting in larval trapping and/or killing by activated macrophages. These results verify the feasibility of a vaccine against schistosomiasis based on induction of cell-mediated immune resistance mechanisms.

Pharmacokinetic aspects of Tert-Butylaminoethyl disulfide, an experimental drug against schistosomiasis in mice

A preliminary study of the pharmacokinetic parameters of t-Butylaminoethyl disulfide was performed after administration of two different single doses (35 and 300 mg/kg) of either the cold or labelled drug. Plasma or blood samples were treated with dithiothreitol, perchloric acid, and, after filtration, submitted to further purification with anionic resein. In the final step, the drug was retained on a cationic resin column, eluted with NaCl 1M and detected according to the method of Ellman (1958). Alternatively, radioactive drug was detected by liquid scintillation counting. The results corresponding to the smaller dose of total drug suggested a pharmacokinetic behavior related to a one open compartment model with the following parameters: area under the intravenous curve (AUC i.v.):671 ± 14; AUC oral: 150 ± 40 µg.min. ml [raised to the power of -1]; elimination rate constant: 0.071 min [raised to the power of -1]; biological half life: 9.8 min; distribution volume: 0.74 ml/g. For the higher dose, the results seemed to obey a more complex undertermined model. Combining the results, the occurence of a dose-dependent pharmacokinetic behavior is suggested, the drug being rapidly absorbed and rapidly eliminated; the elimination process being related mainly to metabolization. The drug seems to be more toxic when administered I.V. because by this route it escapes first pass metabolism, while being quickly distributed to tissues. The maximum tolerated blood level seems to be around 16 µg/ml.

Activity of the artemether in experimental schistosomiasis mansoni

The action of the ether artemisinin (artemether) on Shistosoma mansoni in mice and the hansters experimentally infected with the LE strain was studied. In mice, the drugs showed high schistosomicidal activity using a single intramuscular dose of 100 mg/Kg/day. By the oral route, this dose showed a low activity. Mice treated with a single intramuscular dose of 200 mg/Kg/day, and examined 15 days after treatment, presented 100% alteration of the oogram; when examined 45 days after treatment, the oogram was normal. With doses of 100 mg/Kg/day, i.m., during 3 or 5 consecutive days, the death rate of mice was very high. Morphologic analysis of the worms collected by perfusion of mice treated with a single dose of 100 mg/Kg/day, i.m., detected a marked decrease in the length of male and female forms, degenerative alterations in the parenchyma and in the reproductive system of the females, with reduction of vitellinic material and in ovary volume; the intestinal contents presented a marked despigmentation. In the male worms signifcant alteration was not apparent by optical microscopy.