Drug-induced angioedema: experience of Italian emergency departments

Acute angioedema represents a cause of admission to the emergency department requiring rapid diagnosis and appropriate management to prevent airway obstruction. Several drugs, including angiotensin-converting enzyme inhibitors (ACE-I), nonsteroidal anti-inflammatory drugs (NSAIDs) and oral antidiabetics, have been reported to induce angioedema. The aim of this prospective observational study conducted in a setting of routine emergency care was to evaluate the incidence and extent of drug-induced non-histaminergic angioedema in this specific clinical setting, and to identify the class of drugs possibly associated with angioedema. Patients admitted to seven different emergency departments (EDs) in Rome with the diagnosis of angioedema and urticaria were enrolled during a 6-month period. Of the 120,000 patients admitted at the EDs, 447 (0.37 %) were coded as having angioedema and 655 (0.5 %) as having urticaria. After accurate clinical review, 62 cases were defined as drug-induced, non-histaminergic angioedema. NSAIDs were the most frequent drugs (taken by 22 out of 62 patients) associated with the angioedema attack. Of the remaining patients, 15 received antibiotic treatment and 10 antihypertensive treatment. In addition, we observed in our series some cases of angioedema associated with drugs (such as antiasthmatics, antidiarrheal and antiepileptics) of which there are few descriptions in the literature. The present data, which add much needed information to the existing limited literature on drug-induced angioedema in the clinical emergency department setting, will provide more appropriate diagnosis and management of this potentially life-threatening adverse event

Rendimento, composição e análise sensorial do queijo minas frescal fabricado com leite de vacas mestiças alimentadas com diferentes volumosos Yield, composition and sensory analysis of Minas cheese made with milk from crossbred cows fed different roughages

Objetivou-se com este trabalho avaliar a qualidade físico-química e sensorial e o perfil de ácidos graxos do queijo minas frescal produzido com o leite de vacas mestiças alimentadas com dietas contendo quatro volumosos: canade-açúcar, silagem de sorgo, silagem de girassol e pastagem de Panicum maximum cv. Tanzânia. Foram avaliados o rendimento, a composição físico-química e o perfil de ácidos graxos. Também foi realizada a análise sensorial do queijo minas frescal e da composição físico-química do leite. Utilizaram-se oito vacas mestiças 1/2 Holandês/Gir, com período de lactação de 180 ± 12 dias, distribuídas em dois quadrados latinos 4 × 4, com quatro animais, quatro dietas e quatro períodos. Os períodos foram de 18 dias, sendo 15 dias de adaptação e três dias de coletas de dados. Após o processamento do queijo, foi feita análise microbiológica, físico-química e posteriormente análise sensorial. Amostras do queijo foram congeladas e analisadas quanto ao perfil de ácidos graxos. O teor de gordura do queijo foi maior para as dietas com cana-de-açúcar e silagem de girassol em relação à silagem de sorgo e ao pasto de Panicum maximum cv. Tanzânia, que não diferiram entre si. O queijo produzido a partir do leite de vacas alimentadas com silagem de girassol apresentou melhor perfil de ácidos graxos e índices de qualidade nutricional, maior proporção e melhor perfil de ácidos graxos insaturados. O rendimento do queijo foi igual para todas as dietas, independentemente do volumoso utilizado em sua composição. O queijo produzido com o leite de vacas alimentadas com silagem de girassol tem maior preferência pelos julgadores no teste de análise sensorial, especialmente quanto ao atributo aparência.<br>The objective of this study was to evaluate the physical-chemical and sensory quality and fatty acid profile of Minas cheese produced from milk from crossbred cows fed diets with four roughages (sugar cane, sorghum silage, sunflower silage and pasture of Panicum maximum cv. Tanzania). Yield, physical-chemical composition, fatty acid profile and sensory analysis of Minas cheese, as well as the physical-chemical composition of milk were analyzed. For the experiment, eight 1/2 Holstein/Gir crossbred cows, with lactation period of 180 ± 12 days were distributed in two 4 × 4 latin squares (four animals, four diets and four periods). The experimental periods had a duration of 18 days: 15 days of adaptation and three days of data collection. After cheese processing microbiological, physical-chemical and sensory analysis were done. Cheese samples were frozen and analyzed for fatty acid profile. The fat content of cheese was higher for diets with sugar cane and sunflower silage compared with sorghum silage and pasture of Panicum maximum cv. Tanzania. Cheese produced from milk from cows fed sunflower silage had superior fatty acid composition and nutritional quality indexes, and better profile and higher proportion of unsaturated fatty acids. Cheese yield did not differ between diets containing different roughages. Cheese produced from milk from cows fed a diet with sunflower silage presents higher preference at the sensory analysis test, especially regarding the attribute appearance

Implementation of a Brazilian Cardioprotective Nutritional (BALANCE) Program for improvement on quality of diet and secondary prevention of cardiovascular events: A randomized, multicenter trial

Background: Appropriate dietary recommendations represent a key part of secondary prevention in cardiovascular disease (CVD). We evaluated the effectiveness of the implementation of a nutritional program on quality of diet, cardiovascular events, and death in patients with established CVD. Methods: In this open-label, multicenter trial conducted in 35 sites in Brazil, we randomly assigned (1:1) patients aged 45 years or older to receive either the BALANCE Program (experimental group) or conventional nutrition advice (control group). The BALANCE Program included a unique nutritional education strategy to implement recommendations from guidelines, adapted to the use of affordable and regional foods. Adherence to diet was evaluated by the modified Alternative Healthy Eating Index. The primary end point was a composite of all-cause mortality, cardiovascular death, cardiac arrest, myocardial infarction, stroke, myocardial revascularization, amputation, or hospitalization for unstable angina. Secondary end points included biochemical and anthropometric data, and blood pressure levels. Results: From March 5, 2013, to Abril 7, 2015, a total of 2534 eligible patients were randomly assigned to either the BALANCE Program group (n = 1,266) or the control group (n = 1,268) and were followed up for a median of 3.5 years. In total, 235 (9.3%) participants had been lost to follow-up. After 3 years of follow-up, mean modified Alternative Healthy Eating Index (scale 0-70) was only slightly higher in the BALANCE group versus the control group (26.2 ± 8.4 vs 24.7 ± 8.6, P <.01), mainly due to a 0.5-serving/d greater intake of fruits and of vegetables in the BALANCE group. Primary end point events occurred in 236 participants (18.8%) in the BALANCE group and in 207 participants (16.4%) in the control group (hazard ratio, 1.15; 95% CI 0.95-1.38; P =.15). Secondary end points did not differ between groups after follow-up. Conclusions: The BALANCE Program only slightly improved adherence to a healthy diet in patients with established CVD and had no significant effect on the incidence of cardiovascular events or death. © 2019 The Author