Mesalamine-induced myocarditis following diagnosis of Crohn's disease: a case report

Mesalamine is a common treatment for Crohn's disease, and can be rarely associated with myocarditis through a mechanism of drug hypersensitivity. We present the case of a 19-year-old male who developed chest pain two weeks after beginning mesalamine therapy. The electrocardiogram showed slight ST-segment elevation with upward concavity in the inferolateral leads; blood tests demonstrated elevated troponin I and the echocardiogram revealed moderately depressed left ventricular systolic function with global hypocontractility. Cardiac magnetic resonance imaging confirmed the diagnosis of myocarditis, revealing multiple areas of subepicardial fibrosis. The onset of symptoms after mesalamine, and improvement of chest pain, cardiac biomarkers and left ventricular systolic function after discontinuing the drug, suggest that our patient suffered from a rare drug-hypersensitivity reaction to mesalamine

Conservação ambiental forte alcançada através de sistemas agroflorestais multiestratificados: 1 - agroflorestas e a restauração ecológica de florestas.

O objetivo deste trabalho foi verificar se um sistema agroflorestal multiestratificado (agrofloresta) agroecológico pode ser considerado como tendo uma sustentabilidade ambiental forte, com base em uma análise dos serviços ecossistêmicos de restauração florestal. Para tanto, foi utilizado resultados de pesquisas que compararam agroflorestas e regenerações naturais. Os resultados sugerem que as agroflorestas apresentam uma sustentabilidade ambiental forte e potencial de promover a restauração florestal, no entanto, é um sistema produtivo e não uma metodologia de restauração. Este fato, ao mesmo tempo em que impõe desafios legais e conceituais, aponta para uma alternativa de restauração para as florestas brasileiras.Edição do 1º Seminário de Agroecologia da América do Sul; 5º Seminário de Agroecologia de Mato Grosso do Sul; 4º Encontro de Produtores Agroecológicos de Mato Grosso do Sul; 1º Seminário de Sistemas Agroflorestais em Bases Agroecológicas de Mato Grosso do Sul, 2014, Dourados, MS - AGROECOL

Observational study in Takotsubo cardiomyopathy

INTRODUCTION: Takotsubo cardiomyopathy (TC) is a still rarely diagnosed clinical syndrome, which is characterized by transient cardiac dysfunction with reversible wall motion abnormalities. AIM: Determine the demographic characteristics, clinical presentation and prognosis of patients with TC. METHODS: Retrospective study of 39 patients admitted for TC in a cardiology center during a period of 3 years. RESULTS: In the population studied, the mean age was 67.15±12.01 years and women were predominant.The most frequent comorbidities were hypertension (76.9%), dyslipidemia (51.3%), psychiatric illness (23.1%) and diabetes mellitus (12.8%). The emotional stress was the most common triggering event (n=10), however, in 17 patients we were not able to identify any precipitating factor. Cardinal symptoms which led to admission, were acute chest pain (n=28) and dyspnoea (n=15). The most common ECG findings were ST segment elevation (n=21), inversion of the T wave (n=21) and QTc prolongation (n=22). All patients had typical wall motion abnormalities in the echocardiography and/or ventriculography. The mean ejection fraction was 35.59±5.54%. The most common in-hospital complication was acute heart failure (n=16, 41%), whereas 3 patients developed cardiogenic shock. The presence of moderate to severe LVS dysfunction (p=0.048) and higher levels of C reactive protein (p=0.02) and pBNP (p=0.042) were associated with the development of acute heart failure. Rhythm disturbances occurred in 3 patients and there was only one non-cardiovascular death. At follow-up at 6 months all patients showed recovery of LVS function; there was one recurrence and 3 deaths from non-cardiovascular causes. CONCLUSION: According to the literature, our review shows higher prevalence of TC in women and a clinical and electrocardiographic presentation similar to the picture of an acute coronary syndrome. In the acute phase, the TC is not necessarily a benign entity, because we observed a high prevalence of acute heart failure

High-grade atrioventricular block in ST-segment elevation myocardial infarction patients: insights of a terciary centre

Background: High-grade atrioventricular block (HABV) is associated with poorer outcomes in the setting of acute coronary syndromes. Limited information is available on the incidence and death associated with HABV in STEMI patients (pts) receiving contemporary treatment. Aim: To evaluate the incidence of HABV and its impact on outcome of STEMI patients, in primary percutaneous coronary intervention era. Methods: We analysed retrospectively 1149 STEMI pts admitted, consecutively, in our coronary care unit, from July of 2009 to June 2014. They were divided in two groups: group 1 – pts without HABV, n=1057, 92%); group 2 – pts with HABV (n=92, 8%). For each group we compared clinical features and adverse events. Primary endpoint was the occurrence of death at 6 months; follow-up was completed in 99,8% of patients. Results: Patients of group 2 were older (62±13 vs 69±15;p1 (18.0 % vs 42.4%;p1 (71.4% vs 37,2%;p<0.001), left ventricular dysfunction (100% vs 34.8%;p<0.001), but less right ventricular dysfunction (7.1% vs 28.4%;p<0.001). Compared with IMI pts, AMI pts had higher risk of in hospital [OR 9.04, 95% CI (2.87-28.50);p<0.001] and 6-month mortality [OR 10.88; 95% CI (3.33 – 35.53);p<0.001]. After adjusting for different baseline characteristics in multivariate analysis, HABV patients had higher risk of overall 6-month mortality compared to those without HABV [OR 2.18, 95% CI (1.25-3.79),p=0.006]. Conclusion: Besides low incidence of HABV, this complication continues to have a high risk of in-hospital and 6-month mortality and occurring with AMI the risk increases significantly

Cardiogenic shock complicating acute coronary syndromes

INTRODUCTION: Despite advances in the treatment of patients with acute coronary syndromes (ACS), cardiogenic shock (CS) remains the leading cause of death in these patients. PURPOSE: Determine characteristics and management of patients with an ACS complicated by CS. Determine predictors of development of CS during hospitalization and predictors of in-hospital mortality. METHODS: Retrospective study of 2064 patients consecutively admitted for ACS in a Coronary Unit over a period of 4 years. RESULTS: During the years under study, 111 patients (5.4%) developed CS. Patients with CS were more likely to be older (69.8 ± 13.2 vs 63.5 ± 13.1 years, p<0.001); there were no significant differences in other clinical characteristics. Myocardial Infarction with ST segment elevation (STEMI) was more frequent in patients with CS (p<0.001). Patients with CS underwent less often coronary angiography (p<0.001), revascularization (p = 0.004) and were less treated with β-blocker (p <0.001) and ACE inhibitors therapy (p <0.001). In multivariate analysis, predictors of occurrence of CS during hospitalization were: tachycardia (OR 3.2, 95% CI 1.6-6.3), systolic blood pressure 1 (OR 3.5, 95% CI 1.8-6.8) at admission. The in-hospital mortality of patients with CS was 45%, compared with 1.7% in those who did not develop CS. Factors associated with an increased mortality in patients with CS included absence of coronary revascularization (OR 4.9, 95% CI 1.5-16.0), GFR <60ml/min (OR 4.4, 95% CI 1.3-15.6), advanced age (OR 6.4, 95% CI 1.6-26.2) and LVEF ≤ 35 % (OR 3.9, 95% CI 1.3-12.4). CONCLUSION: According to the literature, our review showed that CS in the context of ACS is associated with a high mortality. We identified clinical markers that are associated with the development of CS and may spot patients at risk earlier. Absence of coronary revascularization remains an independent predictor of mortality in CS

Temporal trends of risk profile among patients admitted with acute coronary syndrome

Background: Clinical practice focuses on the primary prevention of cardiovascular (CVD) disease through the modification and pharmacological treatment of elevated risk factors, in order to minimize long-term CVD risk. Aim: To determine if there are differences in risk profile of patients admitted with acute coronary syndrome over time. Methods: We analysed 4871 patients admitted consecutively in our coronary care unit with a diagnosis of ACS and included in a prospective registry, from January 2002 to October 2013. Patients were divided in 3 groups of 4 consecutive years: group 1 – from 2002 to 2005 (n=1245, 25.6%); group 2 – from 2006 to 2009 (n=1562, 32%); group 3 - from 2010 to 2013 (n=2064, 42.4%). For each group we studied the prevalence of conventional risk factors (CRF) including diabetes, hypertension, smoking and dyslipidaemia over time and compared findings according to sex and type of acute coronary syndrome: Results: Women were less prevalent in group 3 (26.2% vs 26.9% vs 22.6%, p=0.006). Temporal trends of age and diabetes didn’t show statistic signify. Group 2 and 3 evidenced higher body mass index (26.48±4.0 vs 27.13±5.8 vs 27.15±4.67 kg/m2; p<0.001), had higher prevalence of dyslipidaemia (43.1% vs 49.2% vs 56.3%; p<0.001), smoking (39.4% vs 65.0% vs 64.4%; p<0.001) and hypertension (55.7% vs 65.0% vs 64.4%; p<0.001). We found at least 1 CRF in 92,4% of patients. The first temporal period had higher prevalence of 1 or 2 CRF, on the contrary two thirds of patients in group 3 had 2 or 3 CRF. Over time, hypertension was more prevalent in women (69.3% vs 77,4% vs 78.6%; p=0,007), on the other hand, smoking and dyslipidaemia occurred more often in men. It was observed an increasing tendency of smoking (44% vs 41.6% vs 54%; p100 mg/dl more often (66% vs 57% vs 68.8%; p=0.022), but higher control of systolic blood pressure below 140mmHg (54.2% vs 59.6% vs 65.7%, p<0.001. Conclusion: We found that the risk profile of patients presenting with acute coronary syndrome worsened over the years. In recent time, patients had more CRF, being smoking and hypertension the leaders

Área e índice de área foliar de bananeiras prata-anã e BRS platina submetidas à adubação orgânica.

A 'Prata-Anã é a principal variedade cultivada nos Perímetros Públicos de Irrigação do 7 Sudoeste da Bahia e do Norte de Minas Gerais, mas apesar da boa aceitação comercial é susceptível 8 às sigatokas e ao mal-do-Panamá. A ?BRS Platina? (AAAB), um híbrido recentemente 9 recomendado (BORGES et al., 2014), é indicado como alternativa à 'Prata-Anã', em ambientes onde 10 o mal-do-Panamá é fator limitante ao cultivo, além de frutos com melhor classificação comercial

Floating formulation for Bacillus thuringiensis var. israelensis obtained from semi-solid rice medium.

A loopful of Bti mantained on Luria-Bertani agar medium was transferred to Bacto-Peptona agar medium. After 3 days at 30oC, the petri-disheswere washed with sterilized water (100ml/petri-dish). The suspension obtained represented the inoculum for the semi-solid rice-based fermentation medium. The growth units were incubated until complete sporulation of Bti. The resulting biomass was dried at 60oC in an oven for 24h, sieved through 60 tyler. The retained powder did not show any larvicidal activity. In parallel, colloidal bentonite was treated with organic macromolecules dissolved in toluene, after sedimentation, the botton phase was dried at 120oC for 4h. This treatment led to a spreading and floating clay which resulted in a good carrier for Bti. Then, the the two powders were mixed in the proportion of 1(Bti):150(clay). The bioassays were performed under laboratory conditions utilizing 2nd instar Culex sp. larvae, with 3 repetitions (20 larvae each) being observed during 96 hours. The data were treated with Abbott method. A complete methodology was developed to get floating units of Bti with 143 mg/m2 of biological activity