The magnitude of the variation in glycemia: a new parameter for risk assessment in acute coronary syndrome?

INTRODUCTION AND OBJECTIVES: The aim was to evaluate the relationship between the magnitude of the variation in the level of glycemia during hospitalization and in-hospital and long-term mortality and postdischarge endpoints in two groups of patients with acute coronary syndrome: those with and those without a previous diagnosis of diabetes. METHODS: The study included 1210 patients admitted for acute coronary syndrome between May 2004 and July 2007. The study population was divided in two subgroups: patients with a previous diagnosis of diabetes (n=386) and nondiabetics (n=824). Each subgroup was further divided into four smaller groups according to the quartile of glycemia variation: diabetics (Q1: or=164 mg/dl) and nondiabetics (Q1: or=60 mg/dl). Patients were followed up for an average of 18 months after the occurrence of the acute coronary syndrome. RESULTS: In diabetic patients, there was no relationship between the magnitude of the glycemia variation and in-hospital or postdischarge endpoints. In nondiabetics, no significant difference was observed in in-hospital mortality or morbidity, but statistically significant clinical differences were found during follow-up. Multivariate regression analysis showed that Q4 versus Q1, age >or=70 years, and previous antiplatelet or angiotensin-converting enzyme inhibitor therapy were independent predictors of postdischarge endpoints in the nondiabetic group. CONCLUSIONS: In nondiabetic acute coronary syndrome patients, the magnitude of the variation in glycemia observed during hospitalization was a strong independent predictor of postdischarge clinical endpoints

OCORRÊNCIA DE CIANOBACTÉRIAS PRODUTORAS DE TOXINAS NO RIO DOS SINOS (RS) ENTRE OS ANOS DE 2005 E 2008

revista vol 13 nº 2.indd Cyanobacteria are widely distributed autotrophic prokaryotic microorganisms, whose blooms depend on ideal amounts of nitrogen and phosphorous as well optimal temperature and pH conditions. Cyanobacterial blooms in the Sinos River, Rio Grande do Sul state, Brazil, are triggered by the influx of household and industrial wastes. The present study aimed at monitoring the occurrence of cyanobacteria in the Sinos River and tracking the water quality for human consumption. Water samples were taken from February 2005 to March 2008 at the Alberto Pasqualine Oil Refinery in the municipality of Esteio, Rio Grande do Sul state, totaling 64 samples. The different genera of cyanobacteria found were identified and counted in the laboratory in Sedgewick-Rafter chambers. The genera Planktothrix and Cylindrospermopsis, as well as an unidentified unicelular cyanobacterium were the most frequently found in the samples. Planktothrix sp. achieved 87,009 cells.mL-1 in March 2005, Cylindrospermopsis sp. achieved 65,100 cells.ml-1 in August 2006, and the unidentified unicellular cyanobacterium achieved 20,000 cells.mL-1 in January 2006. Only six samples contained no cyanobacteria. Planktothrix and Cylindrospermopsis are potentially toxic, but cyanotoxins could not be detected in the samples containing more than 20,000 cells.mL-1. Cylindrospermopsis sp, were most numerous during seasonal floods of the Sinos River (over March, June and August) whereas Planktothrix sp. were most numerous during the drought periods (January, February and March). The presence of each predominant cyanobacterium may be correlated with direction of the water flow in Lake Guaíba--Sinos River system.revista vol 13 nº 2.indd Las cianobacterias son microorganismos procariotes y autotróficos que viven en distintos hábitats. El nitrógeno y el fósforo, así como condiciones adecuadas de temperatura y pH en el agua, pueden dar lugar a la formación de floraciones. En el río dos Sinos (RS), la contaminación por efluentes domésticos e industriales estimula la ocurrencia de floraciones. Este trabajo tiene como objetivo monitorear la ocurrencia de cianobacterias en el río dos Sinos, siguiendo las normas de potabilidad de agua para consumo humano. Las colectas fueron realizadas desde febrero del 2005 hasta marzo del 2008, en la zona de captación de la refinería Alberto Pasqualine S/A en Esteio (RS), haciendo un total de 64 muestreos. En laboratorio, los géneros de cianobacterias fueron identificados y luego cuantificados en una cámara Sedgewick-Rafter. Los géneros Planktothrix, Cylindrospermopsis y una cianobacteria unicelular fueron los de mayor ocurrencia. Planktothrix sp. presentó el valor más alto de 87.009 células mL-1 en marzo del 2005; Cylindrospermopsis sp. llegó a 65.100 células mL-1 en agosto del 2006 y una cianobacteria unicelular 20.000 células mL-1 en enero del 2006. Sólo en 6 muestreos no se hallaron células de cianobacterias en el agua del río dos Sinos. Los dos géneros predominantes Planktothrix y Cylindrospermopsis son potencialmente tóxicos, pero no se encontraron cianotoxinas en el agua tratada cuando los conteos de células sobrepasaron las 20.000 células mL-1 en el agua sin potabilizar. Se constató una mayor concentración de células de Cylindrospermopsis sp. durante las crecidas del río dos Sinos (mayo, junio y agosto) y de Planktothrix sp durante el estiaje (enero, febrero y marzo). Habría la posibilidad de que este relacionada la presencia predominante de una u otra cianobacteria con el sentido de flujo en el sistema que forman el lago Guaiba y el río dos Sinos.Cianobactérias são microorganismos procariontes e autotróficos encontrados em diversos habitats. A disponibilidade de nitrogênio e fósforo e de condições ideais de temperatura e de pH nas águas favorecem as florações. No rio dos Sinos (RS), a contaminação por efluentes domésticos e industriais estimulam as florações. Este trabalho teve como objetivo o monitoramento da ocorrência de cianobactérias no rio dos Sinos, seguindo normas de potabilidade de água para consumo humano. As coletas foram realizadas de fevereiro de 2005 a março de 2008, na captação da Refinaria Alberto Pasqualine S/A em Esteio (RS), totalizando 64 amostragens. Em laboratório, foram identificados os gêneros de cianobactérias e quantificados em câmara de Sedgewick-Rafter. Os gêneros Planktothrix, Cylindrospermopsis e uma cianobactéria unicelular foram os de maior ocorrência. Planktothrix sp. apresentou o valor mais alto de 87.009 células mL-1 em março de 2005, enquanto Cylindrospermopsis sp. alcançou 65.100 células mL-1 em agosto de 2006 e uma cianobactéria unicelular, 20.000 células mL-1 em janeiro de 2006. Somente em seis amostragens não foram encontradas células de cianobactérias nas águas do rio dos Sinos. Os dois gêneros predominantes Planktothrix e Cylindrospermopsis, são potencialmente tóxicos, mas não foram encontradas cianotoxinas na água tratada quando as contagens ultrapassaram a 20.000 células mL-1 na água bruta. Constatou-se uma maior concentração de células de Cylindrospermopsis sp. durante a cheia do rio dos Sinos (maio, junho e agosto) e de Planktothrix sp. durante a estiagem (janeiro, fevereiro e março). Há possibilidade de relacionar-se a presença de uma ou outra cianobactéria predominante com o sentido do fluxo no sistema lago Guaíba -- rio dos Sinos

Impacto da insulinoterapia prévia no prognóstico dos pacientes diabéticos com síndromes coronárias agudas

Impact of previous insulin therapy on the prognosis of diabetic patients with acute coronary syndrome

Left ventricular end diastolic pressure and acute coronary syndromes

BACKGROUND: Data is lacking in the literature regarding the prognostic impact of left ventricular-end diastolic pressure (LVEDP) across acute coronary syndromes (ACS). OBJECTIVE: To assess LVEDP and its prognostic implications in ACS patients. METHODS: Prospective, longitudinal and continuous study of 1329 ACS patients from a single center between 2004 and 2006. Diastolic function was determined by LVEDP. Population was divided in two groups: A - LVEDP 26.5 mmHg (n = 226). RESULTS: There were no significant differences between groups with respect to risk factors for cardiovascular disease, medical history and medical therapy during admission. In group A, patients with non-ST elevation ACS were more frequent, as well as normal coronary angiograms. In-hospital mortality was similar between groups, but one-year survival was higher in group A patients (96.9 vs 91.2%, log rank p = 0.002). On a multivariate Cox regression model, a LVEDP > 26.5 mmHg (HR 2.45, 95%CI 1.05 - 5.74) remained an independent predictor for one-year mortality, when adjusted for age, LV systolic ejection fraction, ST elevation ACS, peak troponin, admission glycemia, and diuretics at 24 hours. Also, a LVEDP > 26.5 mmHg was an independent predictor for a future readmission due to congestive HF (HR 6.65 95%CI 1.74 - 25.5). CONCLUSION: In our selected population, LVEDP had a significant prognostic influence

Impact of renal function on mortality and incidence of major adverse cardiovascular events following acute coronary syndromes

BACKGROUND: Renal failure patients have a dismal prognosis in the setting of acute coronary syndromes (ACS). Several studies have shown that this population is undertreated, benefiting less frequently from cardiovascular agents and interventions. The aim of our study was to evaluate patients hospitalized for ACS who also presented renal dysfunction, identifying baseline clinical characteristics, treatment options and prognosis. We also assessed whether renal failure was an independent predictor of mortality and cardiovascular events. METHODS: We performed an observational, longitudinal, prospective and continuous study, including 1039 consecutive patients hospitalized in a single center for ACS. Two groups were compared according to estimated glomerular filtration rate (eGFR): eGFR > or = 60 ml/min (group A) and eGFR < 60 ml/min (group B). The mean follow-up was twelve months after discharge. Multivariate analysis was used to identify predictors of mortality and major adverse cardiovascular events (MACE) in this population. RESULTS: Group B patients were older and more frequently female, and presented a higher prevalence of cardiovascular risk factors and previous cardiovascular disease, and more severe coronary artery disease. Group B also had more cases of non-ST-elevation acute myocardial infarction, as well as higher blood glucose, higher heart rate on admission, and lower left ventricular ejection fraction. Patients in group B were less frequently treated with the main cardiovascular drugs or by an invasive strategy; this group also presented higher in-hospital mortality (9.1 vs. 2.5%, p < 0.001). During clinical follow-up, survival and MACE-free rates were significantly lower in group B patients (86.6 vs. 93.6%, p < 0.001, and 76.2 vs. 86.2%, p < 0.001, respectively). Multivariate analysis showed that eGFR of < 30 ml/min was an independent predictor of in-hospital mortality (OR 6.92; C statistic = 0.87) and that eGFR of < 60 ml/min was an independent predictor of MACE during follow-up (OR 2.19; C statistic = 0.71). CONCLUSION: We found that moderate to severe renal dysfunction is common in ACS patients, and this variable was an independent predictor of mortality and MACE. However, we also found that these patients are undertreated, which may contribute to their poor prognosis. Early identification of these high-risk patients is important so that the procedures recommended in the international guidelines can be more consistently implemented

Valorization of Rice Straw into Cellulose Microfibers for the Reinforcement of Thermoplastic Corn Starch Films

[EN] In the present study, agro-food waste derived rice straw (RS) was valorized into cellulose microfi-bers (CMFs) using a green process of combined ultrasound and heating treatments and were, thereafter, used to improve the physical properties of thermoplastic starch films (TPS). Mechanical defibrillation of the fibers gave rise to CMFs with cumulative frequencies of length and diameters below 200 and 5¿15 µm, respectively. The resultant CMFs were successfully incorporated by melt mixing into TPS and also starch subjected to dry heating (DH) modification to yield TPS modified by dry heating (TPSDH) by thermo-compression and characterized. It was observed that both DH modification and fiber incorporation at 3 and 5 wt% loadings interfered with the starch gelatini-zation, leading to non-gelatinized starch granules in the biopolymer matrix. Thermo-compressed films prepared with both types of starches that wereand reinforced with 3 wt% CMF were more rigid (percentages increases of ~215% for TPS and ~207% for the TPSDH), more resistant to break (~100% for TPS and ~60% for TPSDH), but also less extensible (~53% for TPS and ~78% for TPSDH). The incorporation of CMFs into the TPS matrix at both contents also promoted a de-crease in water vapor (~15%) and oxygen permeabilities (~30%). Finally, the TPS composite films showed low changes in terms of optical properties and equilibrium moisture, being less soluble in water than the TPSDH films.This research was funded by Spanish Ministry of Science and Innovation (MICI), grant number PID2019-105207RB-I00.Vieira-De Freitas, PA.; La Fuente Arias, CI.; Torres-Giner, S.; González Martínez, MC.; Chiralt Boix, MA. (2021). Valorization of Rice Straw into Cellulose Microfibers for the Reinforcement of Thermoplastic Corn Starch Films. Applied Sciences. 11(18):1-20. https://doi.org/10.3390/app11188433S120111