Echocardiographic predictors of early in-hospital heart failure during first ST-elevation acute myocardial infarction: does myocardial performance index and left atrial volume improve diagnosis over conventional parameters of left ventricular function?

<p>Abstract</p> <p>Background</p> <p>Left ventricular ejection fraction (LVEF) has been considered a major determinant of early outcome in acute myocardial infarction (AMI). Myocardial performance index (MPI) has been associated to early evolution in AMI in a heterogeneous population, including non ST-elevation or previous AMI. Left atrial volume has been related with late evolution after AMI. We evaluated the independent role of clinical and echocardiographic variables including LVEF, MPI and left atrial volume in predicting early in-hospital congestive heart failure (CHF) specifically in patients with a first isolated ST-elevation AMI.</p> <p>Methods</p> <p>Echocardiography was performed within 30 hours of chest pain in 95 patients with a first ST-elevation AMI followed during the first week of hospitalization. Several clinical and echocardiographic variables were analyzed. CHF was defined as Killip class ≥ II. Multivariate regression analysis was used to select independent predictor of in-hospital CHF.</p> <p>Results</p> <p>Early in-hospital CHF occurred in 29 (31%) of patients. LVEF ≤ 0.45 was the single independent and highly significant predictor of early CHF among other clinical and echocardiographic variables (odds ratio 17.0; [95% CI 4.1 - 70.8]; p < 0.0001). MPI alone could not predict CHF in first ST-elevation AMI patients. Left atrial volume was not associated with early CHF in such patients.</p> <p>Conclusion</p> <p>For patients with first, isolated ST-elevation AMI, LVEF assessed by echocardiography still constitutes a strong and accurate independent predictor of early in-hospital CHF, superior to isolated MPI and left atrial volume in this particular subset of patients.</p

Neurocognitive Dysfunction in Systemic Lupus Erythematosus: Association with Antiphospholipid Antibodies, Disease Activity and Chronic Damage

Introduction: Systemic lupus erythematosus (SLE) is characterized by frequent neuropsychiatric involvement, which includes cognitive impairment (CI). We aimed at assessing CI in a cohort of Italian SLE patients by using a wide range of neurocognitive tests specifically designed to evaluate the fronto-subcortical dysfunction. Furthermore, we aimed at testing whether CI in SLE is associated with serum autoantibodies, disease activity and chronic damage. Methods: Fifty-eight consecutive patients were enrolled. Study protocol included data collection, evaluation of serum level

European clinical guidelines for Tourette syndrome and other tic disorders. Part II: pharmacological treatment

To develop a European guideline on pharmacologic treatment of Tourette syndrome (TS) the available literature was thoroughly screened and extensively discussed by a working group of the European Society for the Study of Tourette syndrome (ESSTS). Although there are many more studies on pharmacotherapy of TS than on behavioral treatment options, only a limited number of studies meets rigorous quality criteria. Therefore, we have devised a two-stage approach. First, we present the highest level of evidence by reporting the findings of existing Cochrane reviews in this field. Subsequently, we provide the first comprehensive overview of all reports on pharmacological treatment options for TS through a MEDLINE, PubMed, and EMBASE search for all studies that document the effect of pharmacological treatment of TS and other tic disorders between 1970 and November 2010. We present a summary of the current consensus on pharmacological treatment options for TS in Europe to guide the clinician in daily practice. This summary is, however, rather a status quo of a clinically helpful but merely low evidence guideline, mainly driven by expert experience and opinion, since rigorous experimental studies are scarce

Ocorrência de larva migrans na areia de áreas de lazer das escolas municipais de ensino infantil, Araçatuba, SP, Brasil

There are sandboxes in public elementary school playground areas in Brazil, which can be harmful to children. They are at risk of cutaneous and visceral larva migrans infection caused by Ancylostoma spp. and Toxocara spp., respectively. The study was designed to investigate contamination by Toxocara spp. and/or their eggs and Ancylostoma spp. larvae in sand samples collected from the schools' sandboxes. Five hundred and thirty-five sand samples from 28 public elementary schools were collected during summer and winter and analyzed by both Baermann´s method and centrifugal flotation technique. Ancylostoma spp. larvae were found in 35.7% (10/28) schools in summer time and in 46.4% (13/28) schools in the winter time. Eggs of Toxocara spp. could not be recovered from the samples analyzed and eggs from Ancylostoma spp. were seen in 0.56% (3/535) of the samples.A areia das áreas de lazer de escolas podem constituir vias de transmissão para várias zoonoses parasitárias, representando risco potencial para as crianças que brincam nesses locais. Foi avaliada a ocorrência de agentes de larva migrans em 28 escolas municipais de ensino infantil de Araçatuba, SP. Foram colhidas 535 amostras de areia das áreas de lazer dessas escolas nos meses de janeiro (verão) e julho (inverno) de 1997 para estabelecimento da freqüência de isolamento de larvas e/ou ovos de Ancylostoma spp. e de ovos de Toxocara spp., pelos métodos de centrífugo-flutuação e de Baermann, respectivamente. A presença de larvas de Ancylostoma spp. foi observada, em pelo menos uma das amostras, em 35,7% (10/28) das amostras da primeira colheita (verão) e em 46,4% (13/28) quando da segunda colheita (inverno). Ovos de Toxocara spp. não foram encontrados e a presença de ovos de Ancylostoma spp. foi observada em 0,56% (3/535) das amostras

Ocorrência de larva migrans na areia de áreas de lazer das escolas municipais de ensino infantil, Araçatuba, SP, Brasil

A areia das áreas de lazer de escolas podem constituir vias de transmissão para várias zoonoses parasitárias, representando risco potencial para as crianças que brincam nesses locais. Foi avaliada a ocorrência de agentes de larva migrans em 28 escolas municipais de ensino infantil de Araçatuba, SP. Foram colhidas 535 amostras de areia das áreas de lazer dessas escolas nos meses de janeiro (verão) e julho (inverno) de 1997 para estabelecimento da freqüência de isolamento de larvas e/ou ovos de Ancylostoma spp. e de ovos de Toxocara spp., pelos métodos de centrífugo-flutuação e de Baermann, respectivamente. A presença de larvas de Ancylostoma spp. foi observada, em pelo menos uma das amostras, em 35,7% (10/28) das amostras da primeira colheita (verão) e em 46,4% (13/28) quando da segunda colheita (inverno). Ovos de Toxocara spp. não foram encontrados e a presença de ovos de Ancylostoma spp. foi observada em 0,56% (3/535) das amostras

Ocorrência de larva migrans na areia de áreas de lazer das escolas municipais de ensino infantil, Araçatuba, SP, Brasil Presence of larva migrans in sand boxes of public elementary schools, Brazil

A areia das áreas de lazer de escolas podem constituir vias de transmissão para várias zoonoses parasitárias, representando risco potencial para as crianças que brincam nesses locais. Foi avaliada a ocorrência de agentes de larva migrans em 28 escolas municipais de ensino infantil de Araçatuba, SP. Foram colhidas 535 amostras de areia das áreas de lazer dessas escolas nos meses de janeiro (verão) e julho (inverno) de 1997 para estabelecimento da freqüência de isolamento de larvas e/ou ovos de Ancylostoma spp. e de ovos de Toxocara spp., pelos métodos de centrífugo-flutuação e de Baermann, respectivamente. A presença de larvas de Ancylostoma spp. foi observada, em pelo menos uma das amostras, em 35,7% (10/28) das amostras da primeira colheita (verão) e em 46,4% (13/28) quando da segunda colheita (inverno). Ovos de Toxocara spp. não foram encontrados e a presença de ovos de Ancylostoma spp. foi observada em 0,56% (3/535) das amostras.<br>There are sandboxes in public elementary school playground areas in Brazil, which can be harmful to children. They are at risk of cutaneous and visceral larva migrans infection caused by Ancylostoma spp. and Toxocara spp., respectively. The study was designed to investigate contamination by Toxocara spp. and/or their eggs and Ancylostoma spp. larvae in sand samples collected from the schools' sandboxes. Five hundred and thirty-five sand samples from 28 public elementary schools were collected during summer and winter and analyzed by both Baermann´s method and centrifugal flotation technique. Ancylostoma spp. larvae were found in 35.7% (10/28) schools in summer time and in 46.4% (13/28) schools in the winter time. Eggs of Toxocara spp. could not be recovered from the samples analyzed and eggs from Ancylostoma spp. were seen in 0.56% (3/535) of the samples