Predictors of in-hospital mortality in patients with ST-segment elevation myocardial infarction undergoing pharmacoinvasive treatment

OBJECTIVES: To identify predictors of in-hospital mortality in patients with acute myocardial infarction undergoing pharmacoinvasive treatment. METHODS: This was an observational, prospective study that included 398 patients admitted to a tertiary center for percutaneous coronary intervention within 3 to 24 hours after thrombolysis with tenecteplase. ClinicalTrials.gov: NCT01791764. RESULTS: The overall in-hospital mortality rate was 5.8%. Compared with patients who survived, patients who died were more likely to be older, have higher rates of diabetes and chronic renal failure, have a lower left ventricular ejection fraction, and demonstrate more evidence of heart failure (Killip class III or IV). Patients who died had significantly lower rates of successful thrombolysis (39% vs. 68%; p = 0.005) and final myocardial blush grade 3 (13.0% vs. 61.9%; p,0.0001). Based on the multivariate analysis, the Global Registry of Acute Coronary Events score (odds ratio 1.05, 95% confidence interval (CI) 1.02-1.09; p = 0.001), left ventricular ejection fraction (odds ratio 0.9, 95% CI 0.89-0.97; p = 0.001), and final myocardial blush grade of 0-2 (odds ratio 8.85, 95% CI 1.34-58.57; p = 0.02) were independent predictors of mortality. CONCLUSIONS: In this prospective study that evaluated patients with ST-segment elevation myocardial infarction treated by a pharmacoinvasive strategy, the in-hospital mortality rate was 5.8%. The Global Registry of Acute Coronary Events score, left ventricular ejection fraction, and myocardial blush were independent predictors of mortality in this high-risk group of acute coronary syndrome patients

GREEN FORAGE FIBROUS FRACTIONS AND THREE PEARL MILLET GENOTYPES SILAGE [Pennisetum glaucum (L). R. BR.] IN DIFFERENT FERMENTATION PERIODS

It was determined the fibrous fraction (NDF, ADF, cellulose, hemicellulose and lignin) in green forage and pearl millet silages (CMS-1, BRS-1501 and BN-2). The genotypes were planted at Embrapa Milho e Sorgo, ensiled in PVC laboratory silos and evaluated after one, three, five, seven, 14, 28 and 56 days. NDF values ranged from 46.96 to 62.43% and ADF from 27.86 to 34.56%. Hemicellulose contents in green forage were significantly lower than in silages after 56 days ensiling. The NDF, ADF, cellulose, hemicellulose and lignin mean values in green forages and silages after 56 days of fermentation were 60.76 and 51.8%, 33.58 and 31.54%, 29.25 and 27.66%, 27.18 and 20.26%; 4.33 and 3.89%, respectively. The NDF and ADF average values found in this work were lower than those reported in other studies. The hemicellulose fraction contributed as an additional subtract source to the fermentation process. BRS-1501 genotype showed the lower NDF and ADF contents

I Diretrizes do Grupo de Estudos em Cardiogeriatria da Sociedade Brasileira de Cardiologia

O idoso apresenta características próprias na manifestação das doenças, na resposta à terapêutica e no efeito colateral dos medicamentos. Constitui um grupo de maior risco para o aparecimento das doenças degenerativas, em geral, e cardiovasculares, em particular, além de apresentar maior número de comorbidades

Vasoplegic syndrome: A new dilemma

ESCOLA PAULISTA MED,DIV CARDIOVASC SURG & CARDIOL,RUA BOTUCATU 740,BR-04023900 SAO PAULO,BRAZILESCOLA PAULISTA MED,DIV CARDIOVASC SURG & CARDIOL,RUA BOTUCATU 740,BR-04023900 SAO PAULO,BRAZILWeb of Scienc

Pharmacological Therapy for Myocardial Infarction in the Elderly: An 8-year Analysis

OBJECTIVE:To assess the changes in the medicamentous treatment of elderly patients hospitalized with acute myocardial infarction occurring over an 8-year period. METHODS:We retrospectively analyzed 379 patients above the age of 65 years with acute myocardial infarction who were admitted to the coronary unit of a university-affiliated hospital from 1990 to 1997. The patients were divided into 2 groups, according to the period of time of hospital admission as follows: group 1 - from 1990 to 1993; and group 2 - from 1994 to 1997. RESULTS:The use of beta-blockers (40.8%chi 75.2%, p<0.0001) and angiotensin-converting enzyme inhibitors (42% chi59.5%, p=0.001) was significantly greater in group 2, while the use of calcium antagonists (42% chi 18.5%, p<0.0001) and general antiarrhythmic drugs (19.1% chi 10.8%, p=0.03) was significantly lower. No significant difference was observed in regard to the use of acetylsalicylic acid, thrombolytic agents, nitrate, and digitalis in the period studied. The length of hospitalization was shorter in group 2 (13.4&plusmn;8.9 days chi 10.5&plusmn;7.5 days, p<0.001). The in-hospital mortality was 35.7% in group 1 and 26.6% in group 2 (p=0.07). CONCLUSION: Significant changes were observed in the treatment of elderly patients with acute myocardial infarction, with a greater use of beta-blockers and angiotensin-converting enzyme inhibitors and a lower use of calcium antagonists and antiarrhythmic drugs in group 2. The length of hospitalization and the mortality rate were also lower in group 2, even though the reduction in mortality was not statistically significant

QUALITY AND NUTRITIONAL VALUE OF SILAGES OF THREE SORGHUM (Sorghum bicolor L.) HYBRIDS HARVESTED IN DIFFERENT MATURATION STAGES

Two dry stem intermediate height sorghum hybrids and a moist stem high height hybrid were ensiled in eight growing stages after bloom. Twenty four treatments were made with three repetitions each, being the three hybrids (AG2006 and BR700 – dry stem, and BR601 moist stem) ensiled in eight growing stages. Silages were evaluated for dry matter (DM), crude protein (CP), DM losses, silage density, pH, ammoniacal nitrogen (N-NH3), neutral detergent fiber (NDF), hemicellulose, cellulose and lignin, IVDMD and total phenols percentages. SNK test was used with a 3 x 8 random factorial design. DM production increased until fifth stage. DM values increased with growth and the best level occurred between 21st and 28th days after bloom. CP and fibrous fractions were reduced with growth. pH, N-NH3 and DM losses were low for all silages. Hybrids lignin and IVDMD varied in erratic ways. Silages were evaluated by Prussian blue assay to total phenols and tannins were detected in all of them. There were no negative correlations between tannins and IVDMD. AG2006 was better than the others two hybrids for some features, and IVDM of BR601, a forage sorghum, was better than BR700, an intermediate height sorghum

CHEMICAL COMPOSITION AND PROFILE OF FERMENTATION OF THE SILAGES OF FIVE SORGHUM HYBRIDS (Sorghum bicolor x Sorghum sudanense)

Five hybrids of Sorghum bicolor x Sorghum sudanense were analyzed asgreen forage (P0) and silage with 7 (P1), 14 (P2), 28 (P3) and 56 (P4) days after ensiling. The hybrids were cultivated at CNPMS/EMBRAPA and ensiled 60 days after planting, in PVC silos, with four repetitions per period. There were determinations of dry matter (DM), pH values and contents of alcohol soluble carbohydrates (CHO’s), crude protein (CP), amoniacal nitrogen (N-NH3/NT), coefficients of IVDMD and cell wall components. A randomized sample design was used in a 5 x 5 factorial arrangement. The analyzed materials showed low DM and CP contents and IVDDM coefficients. All hybrids had similar values for fiber ration. An increase of total phenol contents with ensiling was observed, and those showed negative correlation with IVDDM. It was concluded that DM contents of the studied ensilages were unsatisfactory but, despite the high humidity, the ensilages presented good fermentative standards. As for the quality of the voluminous one, the ensilages were considered of average quality due to the low CP content

Cancer patients, emergencies service and provision of palliative care

SUMMARY Objective: To describe the clinical and sociodemographic profile of cancer patients admitted to the Emergency Center for High Complexity Oncologic Assistance, observing the coverage of palliative and home care. Method: Cross sectional study including adult cancer patients admitted to the emergency service (September-December/2011) with a minimum length of hospital stay of two hours. Student&#8217;s t-test and Pearson chi-square test were used to compare the means. Results: 191 patients were enrolled, 47.6% elderly, 64.4% women, 75.4% from the city of Recife and greater area. The symptom prevalent at admission was pain (46.6%). 4.2% of patients were linked to palliative care and 2.1% to home care. The most prevalent cancers: cervix (18.3%), breast (13.6%) and prostate (10.5%); 70.7% were in advanced stages (IV, 47.1%); 39.4% without any cancer therapy. Conclusion: Patients sought the emergency service on account of pain, probably due to the incipient coverage of palliative and home care. These actions should be included to oncologic therapy as soon as possible to minimize the suffering of the patient/family and integrate the skills of oncologists and emergency professionals