Ticagrelor Loading on ST-Elevation Myocardial Infarction: Interaction With Prodromal Angina on Infarct Size and Clinical Events

Introduction:Ticagrelor might reduce infarct size by exerting a more potent antiplatelet effect or by promoting a potential conditioning stimulus in ST-elevation myocardial infarction (STEMI) patients. Pre-infarction angina (PIA) is an effective preconditioning stimulus that reduces ischemia-reperfusion injury. Because little is known on the interaction of PIA in STEMI-patients loaded with ticagrelor, we sought to determine if patients loaded with ticagrelor had improved clinical outcomes as compared to clopidogrel and to study if it is modulated by the presence of PIA. Methods:From 1272 STEMI patients submitted to primary percutaneous coronary intervention and treated with clopidogrel or ticagrelor from January 2008 to December 2018, 826 were analyzed after propensity score matching. Infarct size was estimated using peak creatine kinase (CK) and troponin T (TnT), and clinical impact was evaluated through cumulative major cardiac and cerebrovascular events (MACCE) at 1-year follow-up. Matched patients and their interaction with PIA were analyzed. Results:Patients loaded with ticagrelor had lower peak CK [1405.50 U/L (730.25-2491.00), P < .001] and TnT [3.58 ng/mL (1.73-6.59), P < .001)], regardless of PIA. The presence of PIA was associated with lower CK (P = .030), but not TnT (P = .097). There was no interaction between ticagrelor loading and PIA (P = .788 for TnT and P = .555 for CK). There was no difference in MACCE incidence between clopidogrel or ticagrelor loading (P = .129). Cumulative survival was also similar between clopidogrel or ticagrelor, regardless of PIA (P = .103). Conclusion:Ticagrelor reduced infarct sizes independently and without a synergic effect with PIA. Despite reducing infarct size, clinical outcomes were similar across both groups.The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The UMIBis funded by the Foundation of Science and Technology (FCT) Portugal (UIDB/00215/2020; UIDP/00215/2020; LA/P/0064/2020)

Simulação da movimentação de agrotóxicos no solo com o uso de geotecnologias, como instrumento para avaliação do potencial de risco de contaminação de águas subterrâneas na Amazônia Oriental.

Pesticides use represents a great environmental risk with high economic cost. The objective of this study is to investigate groundwater contamination risk in a small watershed in northeastern Pará State, Brazil, coupling remote sensing, GIS techniques, and simulations. We have confirmed a high risk exposure to contamination by Dimethoate in 67.76 ha, which represents 1.67% of the total watershed area. According to these analyses, Dimethoate has the potential to reach 12.96 m depth in the soil. The groundwater in the study area has a high risk of exposure to contamination by this pesticide, as the water table depth ranges from 1.5 to 13.0 meters. The shallow water table together with soil and geological characteristics increases the potential risk of contamination of groundwater

Effect of the carbohydrate counting method on glycemic control in patients with type 1 diabetes

<p>Abstract</p> <p>Background</p> <p>The importance of achieving and maintaining an appropriate metabolic control in patients with type 1 diabetes mellitus (DM1) has been established in many studies aiming to prevent the development of chronic complications. The carbohydrate counting method can be recommended as an additional tool in the nutritional treatment of diabetes, allowing patients with DM1 to have more flexible food choices. This study aimed to evaluate the influence of nutrition intervention and the use of multiple short-acting insulin according to the carbohydrate counting method on clinical and metabolic control in patients with DM1.</p> <p>Methods</p> <p>Our sample consisted of 51 patients with DM1, 32 females, aged 25.3 ± 1.55 years. A protocol of nutritional status evaluation was applied and laboratory analysis was performed at baseline and after a three-month intervention. After the analysis of the food records, a balanced diet was prescribed using the carbohydrate counting method, and short-acting insulin was prescribed based on the total amount of carbohydrate per meal (1 unit per 15 g of carbohydrate).</p> <p>Results</p> <p>A significant decrease in A1c levels was observed from baseline to the three-month evaluation after the intervention (10.40 ± 0.33% and 9.52 ± 0.32%, respectively, p = 0.000). It was observed an increase in daily insulin dose after the intervention (0.99 ± 0.65 IU/Kg and 1.05 ± 0.05 IU/Kg, respectively, p = 0.003). No significant differences were found regarding anthropometric evaluation (BMI, waist, hip or abdominal circumferences and waist to hip ratio) after the intervention period.</p> <p>Conclusions</p> <p>The use of short-acting insulin based on the carbohydrate counting method after a short period of time resulted in a significant improvement of the glycemic control in patients with DM1 with no changes in body weight despite increases in the total daily insulin doses.</p

Watershed studies in a region mainly occupied by small holder farms in the eastern Amazon.

Abstract ID: 71