Acute myocardial infarction in progressively elderly patients. A comparative analysis of immediate results in patients who underwent primary percutaneous coronary intervention

OBJECTIVE: Analysis of the in-hospital results, in progressively elderly patients who undergo primary percutaneous coronary intervention (PCI) in the first 24 hours of AMI. METHODS: The patients were divided into three different age groups (60/69, 70/79, and > or = 80 years) and were treated from 7/95 until 12/99. The primary success rate and the occurrence of major clinical events were analyzed at the end of the in-hospital phase. Coronary stent implantation and abciximab use were employed at the intervencionist discretion. RESULTS: We analyzed 201 patients with age ranging from 60 to 93 years, who underwent primary PCI. Patients with ages above 70 were more often female (p=.015). Those with ages above 80 were treated later with PCI (p=.054), and all of them presented with total occlusion of the infarct-related artery. Coronary stents were implanted in 30% of the patients. Procedural success was lower in > or = 80 year old patients (p=.022), and the death rate was higher in > or = 70 years olds (p=.019). Reinfarction and coronary bypass surgery were uncommon events. A trend occurred toward a higher combined incidence of major in-hospital events according to increased age (p=.064). CONCLUSION: Elderly patients ( > or = 70 years) presented with adverse clinical and angiographic profiles and patients > or = 80 years of age obtained reduced TIMI 3 flow success rates after primary PTCA, and those > or = 70 years had a higher death rate.

One-year follow-up after primary coronary intervention for acute myocardial infarction in diabetic patients: a substudy of the STENT PAMI trial

OBJECTIVE - This analysis was undertaken to determine the composite incidence of cumulative adverse events (death, reinfarction, disabling stroke, and target vessel revascularization) at the end of the first year after acute myocardial infarction, in diabetic patients who underwent coronary stenting or primary coronary balloon angioplasty. METHODS - From the STENT PAMI trial, we analyzed the 6-month angiographic and 1-year clinical outcomes of 135 diabetic (112, noninsulin dependent) patients who underwent the randomization process of the trial and compared them with 758 nondiabetic patients. RESULTS - Coronary stenting did not significantly reduce the primary composite clinical end point when compared with PTCA (20 vs. 30%, p=0.2). A significant benefit from stenting was observed in patients with noninsulin dependent diabetes, with a trend toward a lesser need for new revascularization procedures (10 vs. 21%, p<.001), with a significant reduction in the primary composite clinical end point at 1 year (12 vs. 28%, p=. 04). At 6 months, the restenosis rate were significantly reduced only in nondiabetic patients (18 vs. 33%, p<. 001). Diabetic patients had the same restenosis rate (38%) either with stenting or balloon PTCA. CONCLUSIONS - Coronary Stenting in diabetics noninsulin dependent offered a significant reduction in the composite incidence of major clinical adverse events compared with balloon PTCA.

Estudio de la micobiota y sus micotoxinas en ingredientes y raciones de animales domésticos. Estrategias orientadas a la prevención de las micotoxicosis. Studies on mycobiota and incidence of mycotoxins in raw material and feedstuff for domestic animals. Different strategies for mycotoxicosis prevention.

Numerosas investigaciones han desarrollado estrategias para la remoción de micotoxinas en alimentos por diferentes métodos, aunque muchos de ellos no han llegado a ser utilizados debido a los elevados costos o a las dificultades prácticas involucradas en el proceso de detoxificación. Estos argumentos estimulan a los investigadores a desarrollar nuevas estrategias de decontaminación que eviten el uso de agentes químicos y que reduzcan las pérdidas en el valor nutritivo y la palatabilidad de los alimentos decontaminados. Una de las alternativas promisorias es la detoxificación biológica. Las levaduras capaces de adsorber micotoxinas y con habilidades probióticas o prebióticas son promisorias para reducir la exposición humana a las micotoxinas. En el tracto gastrointestinal se encuentra normalmente un gran número de especies de bacterias comensales y patógenas; sin embargo, cuando se incrementa la cantidad de microorganismos patógenos se pueden producir alteraciones de la salud y muerte. La industria argentina de alimentos destinados a animales necesita reducir los niveles de micotoxinas presentes en ingredientes o en insumos terminados. Si bien los resultados obtenidos en el mundo en la temática son preliminares y promisorios, en nuestro país aún no se han desarrollado estrategias biológicas de decontaminación de micotoxinas aplicadas a estos alimentos. Estudios de incidencia de micoflora y detección de micotoxinas en alimentos balanceados para aves, llevados a cabo por nuestro grupo de investigación en la región del sur de Córdoba demostraron la presencia de los principales géneros toxicogénicos (Aspergillus, Penicillium y Fusarium) y sus micotoxinas asociadas (aflatoxinas, zearalenona y fumonisinas). En relación a porcinotecnia, la zona sur de la provincia de Córdoba es considerada una de las tres zonas de mayor densidad porcina en Argentina. Sin embargo, la contaminación de los granos con micotoxinas representa un serio problema debido a que producen rechazo del alimento, disminución de la tasa de crecimiento y reducción inmunológica. Si consideramos la evolución en la producción lechera en los últimos años ha seguido una línea de intensificación que ha conllevado un cambio en la utilización de los alimentos, evolucionando del simple pastoreo a los sistemas de alimentación única, basados en la formulación de alimentos balanceados que constituyen la clave de la alimentación de los animales. Diferentes estudios epidemiológicos usando técnicas moleculares han demostrado que con frecuencia la infección por A. fumigatus ocurre como consecuencia de la adquisición exógena del hongo. La magnitud del problema se manifiesta en la continua búsqueda de medidas de prevención y control de estas micotoxicosis. Debido a este impacto negativo que ejercen las toxinas fúngicas lo cual, afecta los parámetros productivos como ganancia de peso y conversión alimenticia con graves pérdidas a la industria animal tanto en el mercado interno como externo.

Regímenes Internacionales y Derechos Humanos. La incidencia del sistema interamericano de protección en la legislación y jurisprudencia argentinas. International Regimes and Human Rights. The incidence of inter-American system in Argentine law and jurisprudence.

El nuevo escenario internacional produce lo que se ha dado en caracterizar como la globalización del derecho, especialmente en el ámbito de los derechos humanos. En este contexto se analiza la incidencia del Sistema Interamericano de protección de los Derechos Humanos con especial énfasis en el derecho de la información, desde la optica del derecho interno. Nos preguntamos acerca de cómo se presenta la tensión entre la lógica estatal con su rasgo de afirmación en la soberanía y monopolio en la creación de la jurisdicción doméstica, con la doctrina del derecho internacional de los derechos humanos, que consecuentemente conduce hacia una globalización jurídica de estos temas. Esto refleja un debilitamiento en el monopolio de creación y aplicación del derecho por parte de los Estados. A partir de este dato del escenario internacional buscamos determinar la incidencia de los informes de la Comisión Interamericana de Derechos Humanos y los pronunciamientos de la Corte Interamericana en materia de derecho de la información y su influencia en la jurisprudencia y creación de legislación en nuestro país. The new internacional scenario produces wtah has come to be characterized as the globalization of law, especially in the field of the human rights. In this context we analyze the impact of the Inter-American system of human Rights, whit particular emphasis on media law in domestic law

A comparative study of the physical, chemical and microbiological status of soils, as influenced by conventional and reduced tillage

Historically, shifts to reduced and no-tillage management for production of crops were fostered by needs to decrease soil erosion and loss of organic matter, reduce fuel and labour costs and conserve soil water, as compared with conventional fallow tillage management. Recent interest in maintaining soil quality has been stimulated by a renewed awareness of the importance of soil condition to both the sustainability of agricultural production systems and environmental quality (Doran and Parkin, 1996). The aim of this project was to determine the impact on the physical, chemical and microbiological status of the soil of conventional and reduced tillage. It has been suggested that the reduced soil disturbance associated with the tine cultivator improves soil structure, increases nutrient content in the top 10cm of soil, increases microbial activity and improves physical characteristics. From this study it was determined that the environmental benefits linked to reduced tillage in literature, did not develop in the first two years of this programmes implementation. The results of this study determined that soil nutrients did not increase in concentration in the top 10 cm of soil under reduced cultivation. The only exception was exchangeable potassium. As potassium is not a mobile nutrient its movement is dependent on soil disturbance, therefore under reduced cultivation its concentration was allowed to accumulate in the upper horizon of the soil profile. Microbial activity was greater in the conventionally tilled treatments, as determined by total aerobic bacterial numbers. This could be due to the increased rates of soil aeration in this treatment. Numbers of aerobic bacteria were greater in the conventional tillage treatments at both incubation temperatures of 22 and 32° C. The physical characteristics of the soil determined, indicate that below the depth of soil cultivation, cone penetration resistance increases. Therefore the reduced cultivation treatments would be more prone to soil compaction, higher in the soil profile.

Long-term Outcomes of Drug-eluting versus Bare-metal stent for ST-elevation Myocardial Infarction

Background:Long-term outcomes of drug-eluting stents (DES) versus bare-metal stents (BMS) in patients with ST-segment elevation myocardial infarction (STEMI) remain uncertain.Objective:To investigate long-term outcomes of drug-eluting stents (DES) versus bare-metal stents (BMS) in patients with ST-segment elevation myocardial infarction (STEMI).Methods:We performed search of MEDLINE, EMBASE, the Cochrane library, and ISI Web of Science (until February 2013) for randomized trials comparing more than 12-month efficacy or safety of DES with BMS in patients with STEMI. Pooled estimate was presented with risk ratio (RR) and its 95% confidence interval (CI) using random-effects model.Results:Ten trials with 7,592 participants with STEMI were included. The overall results showed that there was no significant difference in the incidence of all-cause death and definite/probable stent thrombosis between DES and BMS at long-term follow-up. Patients receiving DES implantation appeared to have a lower 1-year incidence of recurrent myocardial infarction than those receiving BMS (RR = 0.75, 95% CI 0.56 to 1.00, p= 0.05). Moreover, the risk of target vessel revascularization (TVR) after receiving DES was consistently lowered during long-term observation (all p< 0.01). In subgroup analysis, the use of everolimus-eluting stents (EES) was associated with reduced risk of stent thrombosis in STEMI patients (RR = 0.37, p=0.02).Conclusions:DES did not increase the risk of stent thrombosis in patients with STEMI compared with BMS. Moreover, the use of DES did lower long-term risk of repeat revascularization and might decrease the occurrence of reinfarction.

Effects of One Resistance Exercise Session on Vascular Smooth Muscle of Hypertensive Rats

AbstractBackground:Hypertension is a public health problem and increases the incidence of cardiovascular diseases.Objective:To evaluate the effects of a resistance exercise session on the contractile and relaxing mechanisms of vascular smooth muscle in mesenteric arteries of NG-nitro L-arginine methyl ester (L-NAME)-induced hypertensive rats.Methods:Wistar rats were divided into three groups: control (C), hypertensive (H), and exercised hypertensive (EH). Hypertension was induced by administration of 20 mg/kg of L-NAME for 7 days prior to experimental protocols. The resistance exercise protocol consisted of 10 sets of 10 repetitions and intensity of 40% of one repetition maximum. The reactivity of vascular smooth muscle was evaluated by concentration‑response curves to phenylephrine (PHEN), potassium chloride (KCl) and sodium nitroprusside (SNP).Results:Rats treated with L-NAME showed an increase (p < 0.001) in systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) compared to the initial period of induction. No difference in PHEN sensitivity was observed between groups H and EH. Acute resistance exercise reduced (p < 0.001) the contractile response induced by KCl at concentrations of 40 and 60 mM in group EH. Greater (p < 0.01) smooth muscle sensitivity to NPS was observed in group EH as compared to group H.Conclusion:One resistance exercise session reduces the contractile response induced by KCl in addition to increasing the sensitivity of smooth muscle to NO in mesenteric arteries of hypertensive rats.

Reduced Progression of Cardiac Allograft Vasculopathy with Routine Use of Induction Therapy with Basiliximab

AbstractIntroduction:Cardiac allograft vasculopathy (CAV) is a major limitation for long-term survival of patients undergoing heart transplantation (HT). Some immunosuppressants can reduce the risk of CAV.Objectives:The primary objective was to evaluate the variation in the volumetric growth of the intimal layer measured by intracoronary ultrasound (IVUS) after 1 year in patients who received basiliximab compared with that in a control group.Methods:Thirteen patients treated at a single center between 2007 and 2009 were analyzed retrospectively. Evaluations were performed with IVUS, measuring the volume of a coronary segment within the first 30 days and 1 year after HT. Vasculopathy was characterized by the volume of the intima of the vessel.Results:Thirteen patients included (7 in the basiliximab group and 6 in the control group). On IVUS assessment, the control group was found to have greater vessel volume (120–185.43 mm3 vs. 127.77–131.32 mm3; p = 0.051). Intimal layer growth (i.e., CAV) was also higher in the control group (27.30–49.15 mm3 [∆80%] vs. 20.23–26.69 mm3[∆33%]; p = 0.015). Univariate regression analysis revealed that plaque volume and prior atherosclerosis of the donor were not related to intima growth (r = 0.15, p = 0.96), whereas positive remodeling was directly proportional to the volumetric growth of the intima (r = 0.85, p < 0.001).Conclusion:Routine induction therapy with basiliximab was associated with reduced growth of the intima of the vessel during the first year after HT.

Palliative Senning in the Treatment of Congenital Heart Disease with Severe Pulmonary Hypertension

Background:Transposition of the great arteries (TGA) is the most common cyanotic cardiopathy, with an incidence ranging between 0.2 and 0.4 per 1000 live births. Many patients not treated in the first few months of life may progress with severe pulmonary vascular disease. Treatment of these patients may include palliative surgery to redirect the flow at the atrial level.Objective:Report our institutional experience with the palliative Senning procedure in children diagnosed with TGA and double outlet right ventricle with severe pulmonary vascular disease, and to evaluate the early and late clinical progression of the palliative Senning procedure.Methods:Retrospective study based on the evaluation of medical records in the period of 1991 to 2014. Only patients without an indication for definitive surgical treatment of the cardiopathy due to elevated pulmonary pressure were included.Results:After one year of follow-up there was a mean increase in arterial oxygen saturation from 62.1% to 92.5% and a mean decrease in hematocrit from 49.4% to 36.3%. Lung histological analysis was feasible in 16 patients. In 8 patients, pulmonary biopsy grades 3 and 4 were evidenced.Conclusion:The palliative Senning procedure improved arterial oxygen saturation, reduced polycythemia, and provided a better quality of life for patients with TGA with ventricular septal defect, severe pulmonary hypertension, and poor prognosis.

Incidence and Predictors of Cardiovascular Complications and Death after Vascular Surgery

AbstractBackground:Patients undergoing arterial vascular surgery are considered at increased risk for post-operative complications.Objective:To assess the incidence and predictors of complications and death, as well as the performance of two models of risk stratification, in vascular surgery.Methods:This study determined the incidence of cardiovascular complications and deaths within 30 days from surgery in adults. Univariate comparison and logistic regression assessed the risk factors associated with the outcomes, and the receiver operating characteristic (ROC) curve assessed the discriminatory capacity of the revised cardiac risk index (RCRI) and vascular study group of New England cardiac risk index (VSG-CRI).Results:141 patients (mean age, 66 years; 65% men) underwent the following surgeries: carotid (15); lower limbs (65); abdominal aorta (56); and others (5). Cardiovascular complications and death occurred within 30 days in 28 (19.9%) and 20 (14.2%) patients, respectively. The risk predictors were: age, obesity, stroke, poor functional capacity, altered scintigraphy, surgery of the aorta, and troponin change. The scores RCRI and VSG-CRI had area under the curve of 0.635 and 0.639 for early cardiovascular complications, and 0.562 and 0.610 for death in 30 days.Conclusion:In this small and selected group of patients undergoing arterial vascular surgery, the incidence of adverse events was elevated. The risk assessment indices RCRI and VSG-CRI did not perform well for complications within 30 days.

Reduced model for flow simulation in the burner region of lime shaft kilns

Magdeburg, Univ., Fak. für Verfahrens- und Systemtechnik, Diss., 2010

Simulation of interacting populations in inhomogeneous flows using reduced models

Magdeburg, Univ., Fak. für Verfahrens- und Systemtechnik, Diss., 2010