Effects of cobalt-chromium everolimus eluting stents or bare metal stent on fatal and non-fatal cardiovascular events: patient level meta-analysis

Objectives: To examine the safety and effectiveness of cobalt-chromium everolimus eluting stents compared with bare metal stents. Design: Individual patient data meta-analysis of randomised controlled trials. Cox proportional regression models stratified by trial, containing random effects, were used to assess the impact of stent type on outcomes. Hazard ratios with 95% confidence interval for outcomes were reported. Data sources and study selection: Medline, Embase, the Cochrane Central Register of Controlled Trials. Randomised controlled trials that compared cobalt-chromium everolimus eluting stents with bare metal stents were selected. The principal investigators whose trials met the inclusion criteria provided data for individual patients. Primary outcomes: The primary outcome was cardiac mortality. Secondary endpoints were myocardial infarction, definite stent thrombosis, definite or probable stent thrombosis, target vessel revascularisation, and all cause death. Results: The search yielded five randomised controlled trials, comprising 4896 participants. Compared with patients receiving bare metal stents, participants receiving cobalt-chromium everolimus eluting stents had a significant reduction of cardiac mortality (hazard ratio 0.67, 95% confidence interval 0.49 to 0.91; P=0.01), myocardial infarction (0.71, 0.55 to 0.92; P=0.01), definite stent thrombosis (0.41, 0.22 to 0.76; P=0.005), definite or probable stent thrombosis (0.48, 0.31 to 0.73; P<0.001), and target vessel revascularisation (0.29, 0.20 to 0.41; P<0.001) at a median follow-up of 720 days. There was no significant difference in all cause death between groups (0.83, 0.65 to 1.06; P=0.14). Findings remained unchanged at multivariable regression after adjustment for the acuity of clinical syndrome (for instance, acute coronary syndrome v stable coronary artery disease), diabetes mellitus, female sex, use of glycoprotein IIb/IIIa inhibitors, and up to one year v longer duration treatment with dual antiplatelets. Conclusions: This meta-analysis offers evidence that compared with bare metal stents the use of cobalt-chromium everolimus eluting stents improves global cardiovascular outcomes including cardiac survival, myocardial infarction, and overall stent thrombosis.

Micronutrientes no sistema solo-Pinus caribaea Morelet em plantios apresentando amarelecimento das acículas e morte de plantas

Com o objetivo de contribuir no diagnóstico de causas que têm levado à morte precoce de pinheiros, verificada após amarelecimento e necrose progressiva das acículas, foi desenvolvido este estudo em áreas de cerrado, no oeste de Minas Gerais. Foram comparadas árvores de Pinus caribaea Morelet das variedades caribaea e hondurensis, plantadas entre 1977-82. Em cada local de amostragem coletou-se material de 20 árvores, sendo 10 com acículas amarelecidas e 10 normais. Foram coletados acículas e tecidos do xilema e floema de raízes, nos quais foram analisados os teores de Fe, Mn, Zn, Cu e B. A classe de solo dos sítios de estudo é Latossolo Amarelo ácrico típico. As amostras foram coletadas nas profundidades: 0-5, 5-10, 10-20, 20-40, 40-60, 60-80, 80-100, 100-150, 150-200, 200-250 e 250-300 cm, nas quais foram analisados os teores trocáveis de Fe, Mn, Zn, Cu e B. Os teores de Fe, Zn, Cu e B não diferiram significativamente entre acículas verdes e amarelecidas, enquanto os teores de Mn foram significativamente inferiores nestas. Observou-se também que os teores de Mn foram maiores no xilema e menores nas acículas das plantas anormais, ocorrendo o inverso nas plantas normais. Os sintomas visuais, confirmados pelos resultados analíticos, revelam haver deficiência de manganês no sistema solo-planta estudado.

Macronutrientes no sistema solo-Pinus caribaea Morelet em palntios apresentando amarelecimento das acículas e morte de plantas

Este estudo foi desenvolvido em áreas de Cerrado, no oeste de Minas Gerais, visando contribuir para o diagnóstico de causas que têm levado à morte precoce de pinheiros, verificada após amarelecimento e necrose progressiva das acículas. Foram comparadas árvores de Pinus caribaea Morelet das variedades caribaea e hondurensis, plantadas entre 1977-82. Em cada local de amostragem, coletou-se material de 20 árvores, sendo 10 com amarelecimento das acículas e 10 normais. Foram coletadas acículas e tecidos do xilema e floema de raízes nos quais foram analisados os teores de N, P, K, Ca, Mg e S. A classe de solo dos sítios de estudo é Latossolo Amarelo ácrico típico. As amostras foram coletadas nas profundidades: 0-5, 5-10, 10-20, 20-40, 40-60, 60-80, 80-100, 100-150, 150-200, 200-250 e 250-300 cm, nas quais se analisaram os teores trocáveis de Ca, Mg, P e K, bem como o pH em água e em KCl, a acidez extraível (H+Al) e o teor de matéria orgânica. Os teores de N, P, K e S não diferiram significativamente entre acículas verdes e amarelecidas, enquanto os teores de Ca e Mg foram significativamente inferiores nelas. Os sintomas visuais, confirmados pelos resultados analíticos, revelaram um quadro complexo de deficiências no sistema solo-planta estudado, envolvendo principalmente os macronutrientes Ca e Mg.

Fatal Human herpesvirus 1 (HHV-1) infection in captive marmosets (Callithrix jacchus and Callithrix penicillata) in Brazil: clinical and pathological characterization

Fatal Human herpesvirus 1 (HHV-1) was diagnosed in 12 captive marmosets (Callithrix jacchus and Callithrix penicillata) from metropolitan region of São Paulo, São Paulo State. Clinical signs were variable among the cases, but most affected marmosets presented signs associated with viral epithelial replication: oral, lingual and facial skin ulcers and hypersalivation, and viral replication in the central nervous system: prostration, seizure and aggressive behavior. Consistent microscopic findings were diffuse mild to severe nonsuppurative necrotizing meningoencephalitis with gliosis, vasculitis and neuronal necrosis. Additionally, in the brain, oral cavity, skin, adrenal gland and myoenteric plexus intranuclear inclusion bodies were present. Immunohistochemistry confirmed the presence of the HHV-1 antigen in association with lesions in the brain, oral and lingual mucosa, facial skin, adrenal gland and myoenteric plexus. HHV-1-specific polymerase chain reaction (PCR) analysis of the brain was carried out and the virus was detected in 7/8 infected marmosets. It is concluded that HHV-1 causes widespread fatal infection in marmosets.

La pedagogía hospitalaria frente a un niño con pronóstico fatal : reflexiones en torno a la necesidad de una formación profesional específica.

Resumen basado en el del autor

As origens históricas do Zaratustra nietzcheano: o espelho de Zaratustra, a correção do mais fatal dos erros e a superação da morte de Deus

Through a careful examination of the relationship between Zoroastrianism and the Western tradition, and a detailed and critical reading of the writings of Nietzsche, this work aims at showing to what extent the character Zarathustra , his discourses and poetical-philosophical thoughts, and related passages from many distinct Nietzschean works, directly or undirectly reflect a philosophy that harvests contributions from the Zoroastrian tradition or its headways (in the Judeo-Greco-Christian tradition, and furthermore in the whole Western philosophical tradition). Supplied with this provisions, and with the interpretation cast upon them, Nietzschean philosophy questions the entire Western tradition of thought, and proposes its replacement by a new attitude towards life. This work also intends to show the way the Nietzschean Zarathustra was built up, in the writings of the German philosopher, together with the idea of making, out of the namesake character of the ancient Iranian prophet (Zarathushtra or Zoroaster, the founder of Zoroastrianism), the herald of that important text that intended to bring the German language to its highest perfection , clumping together, and leading to a prophetic-poetic climax consonant with the meaning of the Earth , Nietzsche s key ideas about the rectification of the most fatal of errors and about the death of God . An elaborate investigation has been pursued after the reasons and manners of the building up of Nietzsche s Zarathustra mirroring its Iranian namesake (sections 1.1 to 1.6), and a survey of the works of Nietzsche has suggested unquestionable relations with the Zoroastrian tradition, mostly through the Jewish, Greek or Christian repercussions of this tradition. These relations have been put in context, in many framings (sections 2.1 to 2.3.2), in the ambit of the most fatal of errors - the - creation of morals in the very occasion of its transposition to metaphysics (Ecce Homo, Why I am a destiny , 3). Through an evaluation of the possible circumstances and repercussions of the death of God , the relations between Nietzsche s writings and Zoroastrian tradition have been investigated (sections 3.1 to 3.7), allowing the understanding of this event as an essential component, and tragic outcome, of the rectification of the most fatal of errors

Fatal outcome in bronchus-associated lymphoid tissue lymphoma

Linfomas primários do pulmão são raros. O tipo histológico mais freqüente é o linfoma do tecido linfóide associado ao brônquio. Este tipo de linfoma tem curso indolente e excelente resposta à terapia. Um terço dos casos é descoberto incidentalmente. Devido à raridade desta doença, no entanto, pouco se conhece sobre sua história natural em termos de disseminação e evolução. Neste relato, descrevemos o caso incomum de um homem de 61 anos que recusou o tratamento após diagnóstico de linfoma do tecido linfóide associado ao brônquio e, 2 anos após o diagnóstico, morreu por infiltração pulmonar maciça sem disseminação para outros órgãos.

Envenenamento fatal por baiacu (Tetrodontidae): relato de um caso em criança

É descrito um envenenamento pela ingestão de vísceras de um baiacu-pintado (Sphoeroides testudineus) por uma criança de dois anos, que apresentou sudorese fria, fraqueza muscular progressiva, parada cardiorrespiratória e morte. São discutidos os riscos do consumo da carne e vísceras de baiacus, fato comum em certas regiões do Brasil.

A fatal attack caused by a lowland tapir (Tapirus terrestris) in Southeastern Brazil

A 55-year-old man was attacked by a Brazilian tapir (Tapirus terrestris) after surprising and stabbing the animal in his corn plantation. The victim received deep bites in the thighs, neck, and cervical areas, resulting in severe hemorrhage and death. This is the first report of a tapir incident resulting in death and is of interest because of the severity of the contusions and lacerations caused by the provoked animal.

Marine catfish sting causing fatal heart perforation in a fisherman

Many marine catfish have serrated bony stings (spines), which are used in defense against predators, on the dorsal and pectoral fins. While catfish-induced injuries are generally characterized by the pain associated with envenomation, the stings in some species are sufficiently long and sharp to cause severe penetrating trauma. Most injuries are to the hands of victims, commonly fishermen. We report the death of a fisherman caused by myocardial perforation from a catfish sting. To our knowledge, this is the first such description in the medical literature.

A fatal attack on a child by a black caiman (Melanosuchus niger)

We describe a fatal attack by a black caiman (Melanosuchus niger) on an 11-year-old child with comments on the reptile's aggression mechanisms and the conditions under which this kind of incident takes place in the Amazon region. © 2011 Wilderness Medical Society.

Fatal bothropic snakebite in a horse: a case report

The present study reports a snakebite in a horse in the state of Pará, Brazil. At initial evaluation the animal was reluctant to walk and had tachycardia, tachypnea, severe lameness, bleeding on the pastern and swelling around the left hind leg. Blood samples from the bleeding sites, took on the first day, showed leukocytosis and neutrophilia, whereas biochemical values of urea and creatinine were significantly increased. The chosen treatment was snake antivenom, fluid therapy, antibiotics, anti-inflammatory agents and diuretic drugs. On the fourth day of therapy, the hematological values were within normal parameters. There was improvement related to the clinical lameness and swelling of the limb. However, a decrease in water intake and oliguria were observed. On the seventh day the animal died. Necropsy revealed areas of hemorrhagic edema in the left hind limb and ventral abdomen; the kidneys presented equimosis in the capsule, and when cut they were wet. Moreover, the cortex was pale, slightly yellow and the medullary striae had the same aspect. Based on these data, we concluded that the snakebite in the present study was caused by Bothrops spp. and that renal failure contributed to death.