RESUMEN
Agricultural management using technologies that help farmers increase productivity and reduce production costs must be promoted to ensure agricultural sustainability. The objective of the study was to achieve the pH effect of growth solution, chemical treatment, use of osmoprotector additive and mineral nitrate presence, on the activity of growth promoting bacteria, Azospirillum brasilense, and its effects on the physiological quality of seeds and wheat seedling growth. The first experiment evaluated the physiological quality of seeds and the second experiment was divided into four, evaluating the growth of wheat seedling in a hydroponic system. The experiments were prolonged in a very randomized design, with four replications. The physiological quality of the seeds was evaluated by germination tests, first germination count, length of the shoot and root and dry mass of the shoot and root. Initial growth was evaluated by quantifying the dry mass of the leaf shoot and root and the root system intervals. The pH of the solution and the presence of nitrogen did not influence the effects of inoculation of the A. brasilense bacteria. With the use of chemical treatment and osmoprotective additive, A. brasilense had no effect on the growth of wheat seedlings.
Asunto(s)
Azospirillum brasilense , Medios de Cultivo , Germinación , Plantones , Triticum , Triticum/microbiología , Triticum/crecimiento & desarrollo , Azospirillum brasilense/fisiología , Plantones/crecimiento & desarrollo , Plantones/microbiología , Germinación/fisiología , Concentración de Iones de HidrógenoRESUMEN
AIMS: To improve RT-qPCR with an internal control and a synthetic standard curve to detect HEV in HIV co-infected patients. METHODS AND RESULTS: A single-stranded RNA (ssRNA) and a double-stranded DNA (dsDNA) synthetic curve were designed, compared to the international reference panel for HEV genotypes, and tested to quantify and detect a reference panel for HEV genotypes. The detection limit of the RNA synthetic curve (50 copies per ml) was better than the DNA synthetic curve (100 copies per ml) and the WHO standard curve (250 copies per ml). Then, 280 serum samples from HIV-positive patients were tested for HEV RNA, which was detected in 3·6% of serum samples. The viral load ranged from 2 × 102 copies per ml to 4·78 × 108 copies per ml. HEV IgM/IgG antibodies were not detected in the RNA-positive patients. Sequencing analysis of HEV showed that the virus belongs to genotype 3 (HEV GT3). CONCLUSIONS: Real-time PCR was a useful tool to estimate co-infection with HEV/HIV, even in patients with low viral loads and undetectable anti-HEV IgG and IgM antibodies. SIGNIFICANCE AND IMPACT OF THE STUDY: Hepatitis E virus genotype 3 (HEV GT3) has been associated with silent chronic hepatitis and cirrhosis in HIV-positive subjects worldwide, but there is a lack of data on this co-infection in Brazil.
Asunto(s)
Infecciones por VIH/sangre , Anticuerpos Antihepatitis/sangre , Virus de la Hepatitis E/aislamiento & purificación , Hepatitis E/virología , Inmunoglobulina G/sangre , Inmunoglobulina M/sangre , Adulto , Brasil , Coinfección/sangre , Coinfección/virología , Femenino , Genotipo , Infecciones por VIH/virología , Hepatitis E/sangre , Virus de la Hepatitis E/genética , Virus de la Hepatitis E/inmunología , Virus de la Hepatitis E/fisiología , Humanos , Masculino , Persona de Mediana Edad , Reacción en Cadena en Tiempo Real de la Polimerasa , Carga ViralRESUMEN
BACKGROUND: Hepatitis E virus (HEV) infection represents an important cause of acute viral hepatitis. Selective waste collection is a widespread activity carried out by the urban poor, and recyclable waste pickers have a lifestyle that makes this group highly vulnerable to unfavorable socio-economic and environmental factors. To date, the epidemiology of HEV infection in this population remains unknown. OBJECTIVES: To assess the seroprevalence of hepatitis E-specific antibodies in a population of recyclable waste pickers in Brazil. STUDY DESIGN: Between April 2010 and May 2011, a cross-sectional study was conducted among recyclable waste pickers from all 15 recycling cooperatives in Goiânia City, Central Brazil. The participants were tested for serological markers indicative of HEV infection. RESULTS: Of 432 individuals asked to participate in the survey, 431 (99.8%) agreed to participate. Twenty-four of 431 participants were anti-HEV IgG positive by ELISA. Of these, 22 were confirmed positive by immunoblot, resulting in an anti-HEV IgG prevalence of 5.1% (95% CI: 3.4-7.6). In addition, four individuals were anti-HEV IgM positive by ELISA. Of these, three (0.7%; 95% CI: 0.4-2.4) were confirmed anti-HEV IgM positive by immunoblot, but were HEV RNA negative. One was concurrently positive for anti-HEV IgG. Only age>40 years was independently associated with the presence of anti-HEV. CONCLUSIONS: These findings demonstrated that the prevalence of HEV antibodies among recyclable waste pickers in Central Brazil is relatively low and increased with age.
Asunto(s)
Anticuerpos Antihepatitis/sangre , Hepatitis E/epidemiología , Adulto , Brasil/epidemiología , Femenino , Hepatitis E/inmunología , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Profesionales , Pobreza , Estudios Seroepidemiológicos , Instalaciones de Eliminación de Residuos , Adulto JovenRESUMEN
O presente trabalho teve como objetivo avaliar o efeito alelopático do óleo essencial de plantas de carqueja, Baccharis trimera (Less.) DC., sobre a germinação de sementes de feijão Vigna unguiculata (L.) Walp. Foi avaliado o efeito do óleo essencial de B. trimera sobre V. unguiculata nas dosagens 20 μL, 15 μL, 10 μL, 5 μL e testemunha. A qualidade fisiológica das sementes foi determinada pela porcentagem de emergência, velocidade de emergência e índice de velocidade de emergência. O delineamento experimental foi o inteiramente casualizado, em esquema fatorial 5 x 2 com cinco repetições. Não foi observado efeito inibidor do óleo essencial de B. trimera na germinação de sementes de feijão caupi, caracterizando-se como de efeito alelopático benéfico. De acordo com os resultados obtidos, o óleo essencial de B. trimera revelou-se eficiente na manutenção da viabilidade dessas sementes.
This research aimed to evaluate the allellopathic effect of essential oils of the Baccharis trimera (Less.) DC. plants on the seeds germination of cowpea Vigna unguiculata (L.) Walp. The effect of B. trimera essential oil on V. unguiculata was evaluated at levels of 20 μL, 15 μL, 10 μL, 5 μL and control. The physiologic quality of the seeds was determined by percentage emergence, the rate of speed emergence and speed emergence index. The data analysis was carried out using an entirely randomized design, in a 5 x 2 factorial scheme with five repetitions. An inhibitory effect of B. trimera essential oil on bean seeds germination was not observed, which is characterized as a beneficial allelopathic effect. Based on the results, the B. trimera essential oil proved efficient in the viability maintenance of these seeds.
Asunto(s)
Aceites Volátiles/análisis , Baccharis/efectos adversos , Vigna/fisiología , Semillas/clasificación , AlelopatíaRESUMEN
O tratamento de sementes com óleos essenciais é um método alternativo que auxilia o manejo integrado de pragas. O objetivo deste trabalho foi avaliar a influência do tratamento de sementes de feijão Vigna unguiculata (L.) Walp. com o óleo essencial de citronela (Cymbopogon winterianus Jowitt). Foi avaliado o efeito do óleo essencial de C. winterianus sobre V. unguiculata nas dosagens 20 µL, 15 µL, 10 µL, 5 µL e testemunha. A qualidade fisiológica das sementes foi determinada pela porcentagem de emergência, velocidade de emergência e índice de velocidade de emergência. A análise dos dados foi realizada no delineamento inteiramente casualizado, disposto em esquema fatorial 5 x 2 com cinco repetições. As sementes fumigadas apresentaram diferenças estatísticas entre os parâmetros avaliados em relação à testemunha. O óleo essencial de citronela revelou potencialidade alelopática sobre a germinação de sementes de feijão que variou de acordo com a concentração do óleo.
Seed treatment with essential oils is an alternative method tool in integrated pest management. The objective of this study was to evaluate the effect of treating Vigna unguiculata (L.) Walp. bean seeds with essential oil of Java grass (Cymbopogon winterianus Jowitt). The effect of C. winterianus essential oil on P. vulgaris was evaluated at levels of 20 µL, 15 µL, 10 µL, 5 µL and control. The physiologic quality of the seeds was determined by percentage emergence, speed emergence and speed emergence index. The data analysis was carried out using an entirely randomized design, in a 5 x 2 factorial scheme with five repetitions. The fumigated bean seeds showed the statistics differences among the analyzed parameters when was compared with the no treated check. The essential oil of Java grass revealed allelopathic potentiality on bean seed germination which varied according to the oil concentration.
Asunto(s)
Semillas/metabolismo , Aceites Volátiles/uso terapéutico , Vigna/efectos adversos , Germinación , Cymbopogon/efectos adversos , AlelopatíaRESUMEN
During recent years, vaccination against hepatitis A has been implemented in several countries. It is expected that the increase in mass vaccination against hepatitis A will eventually result in a decreased prevalence of anti-HAV antibodies in the general population. For this reason, a suitable clinical sample for diagnosis of hepatitis A must be sufficiently sensitive to enable detection of lower antibodies titers. In this study, the feasibility of using dried blood spots (DBS) was assessed for the detection of anti-HAV antibodies after a natural infection and vaccination. Seventy-four DBS and paired plasma samples were obtained from a group of college students for a cross-sectional hepatitis A seroepidemiological study. Forty-six students seronegative for anti-HAV were selected randomly and immunized with an inactivated hepatitis A vaccine using an 0-6 month schedule. Seroconversion was monitored in paired plasma and DBS samples 6 months after the first dose followed by a period of 8 and 24 months after the second dose. A strong correlation between OD/CO rates of paired plasma and DBS samples for the detection of anti-HAV was observed. The sensitivity and specificity of the DBS compared with plasma for the detection of anti-HAV antibodies after natural infection was 100%. The sensitivity of DBS in samples collected 24 months after the second dose of hepatitis A vaccine was 95.4%. The results showed that DBS samples can be used for the detection of anti-HAV antibodies both after natural infection or vaccination.
Asunto(s)
Anticuerpos de Hepatitis A/sangre , Vacunas contra la Hepatitis A/inmunología , Virus de la Hepatitis A Humana/inmunología , Hepatitis A/diagnóstico , Técnicas para Inmunoenzimas , Vacunación , Brasil/epidemiología , Femenino , Hepatitis A/sangre , Hepatitis A/epidemiología , Hepatitis A/inmunología , Humanos , Masculino , Sensibilidad y Especificidad , Estudios Seroepidemiológicos , Manejo de Especímenes , Adulto JovenRESUMEN
The replication of hepatitis A virus (HAV) is via a complementary negative-strand RNA. Each negative strand may serve as a template for the synthesis of many positive strands. The aim of this study was to detect the intermediate replicative (negative strand) of HAV in order to monitor its replication in vitro and in vivo. Real-time polymerase chain reaction (PCR) was standardized to detect the intermediate replicative of HAV in cell culture and liver from non-human primates infected experimentally. HAV primers from the 5' non-translated region and VP3 were used in the cDNA synthesis of negative-strand RNA. The negative strand was detected in the infected cell lines and liver by highly strand-specific rTth recombinant Thermus thermophilus DNA polymerase reverse transcription followed by quantitative PCR. The results indicate that the negative-strand HAV RNA can be detected in vivo and in vitro. This model is an approach for assessing the dynamic patterns of replication and should represent a valuable tool for the monitoring of HAV replications in cell cultures and for the evaluation of experimental infections in animal models.
Asunto(s)
ADN Complementario/biosíntesis , Virus de la Hepatitis A/fisiología , Hepatitis A/virología , Reacción en Cadena de la Polimerasa/métodos , ARN Viral/genética , Replicación Viral/fisiología , Regiones no Traducidas 5' , Animales , Proteínas de la Cápside , Células Cultivadas , Modelos Animales de Enfermedad , Amplificación de Genes , Virus de la Hepatitis A Humana/fisiología , Humanos , Cinética , Hígado/virología , Fragmentos de Péptidos , Reacción en Cadena de la Polimerasa/normas , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa/métodos , Sensibilidad y EspecificidadRESUMEN
Visceral leishmaniasis (VL) was experimentally induced in rhesus macaques (Macaca mulatta) by intravenously inoculating 2 x 10(7)amastigotes/kg of body weight of Leishmania infantum. The macaques developed a systemic disease showing characteristic features of human VL such as fever, diarrhoea, body weight loss, anaemia, hypergammaglobulinaemia and transient lymphocytosis, as well as lymph node, liver and/or spleen enlargement. Nine weeks after infection, one primate showed pronounced weight loss, became moribund and was euthanized. The necropsy findings included granulomas composed of parasite-containing macrophages, lymphocytes and plasma cells in the liver, spleen and lymph nodes. The remaining macaques had a sustained course of infection but developed a mild-to-moderate illness that subsequently showed evidence of self-cure. Of note, pathological findings included a typical cell-mediated immunity-induced granulomatous reaction that had an effect on the control of parasite replication. All infected monkeys responded with increased production of anti-Leishmania-specific IgG antibodies. Despite the fact that clinical resistance to L. infantum was not consistently associated with a parasite-specific cell-mediated immune response, drug-cured macaques from the primary infection acquired immunity to homologous re-infection. These findings point to the feasibility of using the L. infantum macaque model for pre-clinical evaluation of novel chemotherapeutics or vaccine candidates for human VL.
Asunto(s)
Modelos Animales de Enfermedad , Leishmania infantum/inmunología , Leishmaniasis Visceral/inmunología , Animales , Anticuerpos Antiprotozoarios/sangre , Formación de Anticuerpos , Antígenos de Protozoos/sangre , ADN Protozoario/análisis , Ensayo de Inmunoadsorción Enzimática , Enfermedades Hematológicas/parasitología , Inmunidad Celular , Inmunohistoquímica , Leishmaniasis Visceral/sangre , Leishmaniasis Visceral/diagnóstico , Macaca mulatta , MasculinoRESUMEN
Fourteen hepatitis C virus (HCV) chronically infected patients were submitted to routine liver biopsy for histological evaluation. Liver samples were assayed to HCV-RNA by in situ hybridization, using digoxigenin labeled probe. HCV genotypes were found to be predominantly type 1 (71.4%), followed by genotype 3 (21.4%), and genotype 2 (7.2%). Alanine-aminotransferase levels were raised in 10 patients. The histopathological scores were minimal (21.4%), mild (57.2%), and moderate (21.4%). Viral RNA was detected in liver cells from nine patients (64.3%). ISH method provides localization and poor confirmation of HCV RNA in the liver tissue of HCV chronic patients.
Asunto(s)
Hepacivirus/genética , Hepatitis C Crónica/virología , Hibridación in Situ/métodos , Hígado/virología , ARN Viral/aislamiento & purificación , Adulto , Anciano , Alanina Transaminasa/sangre , Biopsia , Digoxigenina , Femenino , Formaldehído , Genotipo , Hepacivirus/aislamiento & purificación , Hepatitis C Crónica/patología , Humanos , Hígado/patología , Masculino , Persona de Mediana Edad , Adhesión en Parafina , Polimorfismo de Longitud del Fragmento de Restricción , ARN Viral/genética , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Índice de Severidad de la EnfermedadRESUMEN
Fourteen hepatitis C virus (HCV) chronically infected patients were submitted to routine liver biopsy for histological evaluation. Liver samples were assayed to HCV-RNA by in situ hybridization, using digoxigenin labeled probe. HCV genotypes were found to be predominantly type 1 (71.4 percent), followed by genotype 3 (21.4 percent), and genotype 2 (7.2 percent). Alanine-aminotransferase levels were raised in 10 patients. The histopathological scores were minimal (21.4 percent), mild (57.2 percent), and moderate (21.4 percent). Viral RNA was detected in liver cells from nine patients (64.3 percent). ISH method provides localization and poor confirmation of HCV RNA in the liver tissue of HCV chronic patients.
Asunto(s)
Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Hepacivirus/genética , Hepatitis C Crónica/virología , Hibridación in Situ/métodos , Hígado/virología , ARN Viral/aislamiento & purificación , Alanina Transaminasa/sangre , Biopsia , Digoxigenina , Formaldehído , Genotipo , Hepacivirus/aislamiento & purificación , Hepatitis C Crónica/patología , Hígado/patología , Adhesión en Parafina , Polimorfismo de Longitud del Fragmento de Restricción , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , ARN Viral/genética , Índice de Severidad de la EnfermedadRESUMEN
The purpose of this paper is to present an alternative method of achieving a synostosis between tibia and fibula in trans-tibial amputations by means of a fibular segment in place of tibial osteoperiosteal flaps as described by Ertl, in 1949. From May 1997 through to February 2003, 15 patients were submitted to the proposed procedure. As a result, all patients produced a solid synostosis between tibia and fibula and were rehabilitated with the use of prostheses. The capacity of these patients for distal weight-bearing on the stump was remarkable when compared to patients submitted to the conventional trans-tibial amputation technique.
Asunto(s)
Amputación Quirúrgica/métodos , Oseointegración , Tibia/cirugía , Adulto , Anciano , Amputación Quirúrgica/rehabilitación , Muñones de Amputación , Trasplante Óseo/métodos , Femenino , Fémur/cirugía , Peroné/trasplante , Humanos , Masculino , Persona de Mediana Edad , Músculo Esquelético/cirugía , Colgajos Quirúrgicos , Sinostosis/cirugía , Resultado del TratamientoRESUMEN
Common marmosets (Callithrixjacchus) were orally inoculated with a Brazilian strain (HAF-203) of hepatitis A virus (HAy). Three monkeys were euthanized at postinoculation hours 6, 12 and 24 to investigate the early events of HAV infection. Following others three inoculated and one control marmosets remained throughout the 46 day to evaluation of viral excretion. Different samples were collected to detect sequential presence of HAV RNA by nested reverse transcription-polymerase chain reaction (RT-PCR) in liver, saliva, bile and stools at 6 hours to 461h days postinoculation. Liver tissues were examined by immunofluorescence assay in a confocal laser-scanning microscope for the presence of HAV antigen. HAV RNA was detected in saliva during the course of the study, in bile from 24 hours to 46 days. in stools from 7 to 46 days and liver at 12 hours postinfection. In immunofluorescence of liver stained preparations, viral antigen was present at six hours after inoculation throughout the remainder of the 46-day study. The animals developed histological and biochemical acute hepatitis after second week postinoculation. Spleen, duodenum, and mesenteric lymph nodes specimens were negative for HAV antigens. This study supports the possibility that in Callithrixjacchus orally inoculated with hepatitis A virus the saliva route may be additional way of viral elimination. The viral replication in the liver was responsible for biliary HAV presence and latter HAV detection in fecal samples.
Asunto(s)
Antígenos Virales/análisis , Callithrix , Virus de la Hepatitis A/inmunología , Hepatitis A/inmunología , Enfermedades de los Monos/inmunología , Replicación Viral/inmunología , Animales , Modelos Animales de Enfermedad , Hepatitis A/patología , Hepatitis A/transmisión , Antígenos de Hepatitis A , Virus de la Hepatitis A/crecimiento & desarrollo , Virus de la Hepatitis A/aislamiento & purificación , Hígado/inmunología , Hígado/patología , Hígado/virología , Enfermedades de los Monos/transmisión , ARN Viral/análisis , Reacción en Cadena de la Polimerasa de Transcriptasa InversaRESUMEN
Thrombolytic efficacy of lonomin V (LV), a protein isolated from Lonomia achelous caterpillars haemolymph, administered either as a single intravenous bolus or as a continuous infusion, was evaluated in a rabbit jugular vein thrombosis model, and compared with those of single-chain tissue-type plasminogen activator (sct-PA) and two-chain urokinase-type plasminogen activator (tcu-PA). As a bolus LV, at doses of 100 000 IU/kg body weight (bw) produced an activator-induced thrombolysis (AIL) of 50.94% +/- 12.4 compared with 14.4% +/- 10.8 for tcu-PA at the same dose. As a continuous infusion at doses of 200 000 IU/kg bw LV produced an AIL of 45.8%, whereas sct-PA and tcu-PA produced an AIL of 69.9 and 33.7%, respectively. Fibrinogen, plasminogen and alpha-2-antiplasmin levels decreased significantly with the higher doses of LV, sct-PA, and tcu-PA. Factor XIII levels were significantly reduced in a dose-dependent manner only with LV. In conclusion, LV produces a dose-dependent thrombolysis in combination with a decrease in factor XIII activity.
Asunto(s)
Venenos de Artrópodos/uso terapéutico , Fibrinolíticos/uso terapéutico , Venas Yugulares , Terapia Trombolítica , Trombosis de la Vena/tratamiento farmacológico , Animales , Anticoagulantes/administración & dosificación , Anticoagulantes/uso terapéutico , Venenos de Artrópodos/administración & dosificación , Modelos Animales de Enfermedad , Factor XIII/análisis , Femenino , Fibrinógeno/análisis , Fibrinolíticos/administración & dosificación , Infusiones Intravenosas , Inyecciones Intravenosas , Masculino , Plasminógeno/análisis , Conejos , Activador de Tejido Plasminógeno/uso terapéutico , Activador de Plasminógeno de Tipo Uroquinasa/uso terapéutico , Trombosis de la Vena/sangre , alfa 2-Antiplasmina/análisisRESUMEN
Callithrix jacchus is considered a reliable animal model for hepatitis A virus (HAV) infection. All three HAV orally inoculated marmosets developed hepatitis - the infection was monitored by continuous virus shedding, high levels of serum enzyme alanine aminotransferase, specific antibody and seroconversion 3-6 weeks after HAV inoculation. HAV antigen was detected in liver by immunofluorescence 4 days post inoculation (PI) and onwards. To gain insight into the biological role of inducible nitric oxide synthase (iNOS) during immune-related acute liver injury the enzyme was searched in frozen biopsies: immunofluorescent labeling was found in the cytoplasm of liver cells mainly Kupffer's cells and spleen macrophages (CD68+) starting 11 days PI with maximum intensity on the fifth to sixth week PI. Necroinflammatory liver lesions characteristic of viral hepatitis were also observed at 10 days PI with maximum severity at 4 to 6 weeks PI. Furthermore, T lymphocytes (CD2+) were raised at this time point. No difference was evident in the frequency of B lymphocytes (CD20+). Therefore, iNOS expression preceded necroinflammatory liver lesion and maximal immunofluorescence reaction was coincident with tissue injury, supporting the hypothesis that NO contributes to hepatic cytotoxic mechanism but also to virus clearance. The concomitant rise in T-lymphocyte population may suggest a role for these cells in this and/or other independent HAV-induced pathological changes.
Asunto(s)
Hepatitis A/enzimología , Hepatovirus , Hígado/patología , Óxido Nítrico Sintasa/biosíntesis , Linfocitos T/inmunología , Animales , Callithrix , Modelos Animales de Enfermedad , Inducción Enzimática , Técnica del Anticuerpo Fluorescente , Hepatitis A/patología , Inmunofenotipificación , Hígado/enzimología , Hígado/virología , Necrosis , Óxido Nítrico Sintasa de Tipo II , Bazo/virología , Linfocitos T/virologíaRESUMEN
The lack of well established dosimetry protocols for HDR sources is a point of great concern regarding the uniformity of procedures within a particular country and worldwide. The main objective of this paper is to report the results from ten institutions of an intercomparison of calibration procedures for 192Ir HDR sources currently in use in Brazil. The treatment irradiator of one institution was calibrated by a reference system and used by all participants with their own measuring electrometers and ionization chambers under the same experimental conditions. Two methods were used: the calibration jig and the well-type ionization chamber. Each participant was allowed to use their own method and formalism. The results of this exercise were very positive since this was the first time in Brazil that a group of users gathered to share their experience and openly discuss the physical concepts behind the calibration procedures. The results were all within +/-3.0%, except one case where -4.6% was observed and later identified as a problem with the Nk value for x-rays. Though the magnitude of the deviations found was generally acceptable considering the diversity of formalisms currently in use, a proposal is now being prepared to be adopted as a national protocol. The identification of the institutions was left out for the sake of confidentiality.
Asunto(s)
Radioisótopos de Iridio/análisis , Radiometría , Braquiterapia , Brasil , Calibración , Rayos gammaRESUMEN
It is known that acutely developed collaterals can prevent the onset of acute myocardial infarction (AMI) in the presence of a total coronary occlusion. However, there still is controversy concerning long-term follow-up of coronary collateral circulation to the infarct-related artery. In this study we analyze the prognostic role of collateral flow (degrees 0 to 3) as well as anterograde flow (degrees 0 to 3) in patients with AMI treated with thrombolytic therapy. Four hundred twenty-two patients (median age 57 years, 355 men) with AMI were treated with intravenous streptokinase and followed prospectively for up to 8 years. At the end of the study period, patients with collateral coronary flow 3 (n = 30) and those with flow <3 (n = 392) at in-hospital coronary arteriography had survival rates of 66% and 85%, respectively (p <0.12). Meanwhile, patients with coronary anterograde flow 3 (n = 189) and those with flow <3 (n = 233) had survival rates of 89% and 80%, respectively (p <0.04). By censored regression analysis, a negative correlation was found between coronary collateral flow degree and survival (p = 0.0498) and, inversely, a positive correlation was found between coronary anterograde flow degree and survival (p = 0.0053). By Cox multivariate analysis, the following variables showed significant correlations with long-term survival: global left ventricular ejection fraction (p = 0.0003), anterograde flow degree (p = 0.0006), collateral flow degree (negative correlation, p = 0.0179), and medical treatment (negative correlation, p = 0.0464). Thus, patients treated with intravenous streptokinase during AMI and with adequate coronary collateral circulation had a worse prognosis than those who developed adequate anterograde flow, probably because of residual myocardial ischemia. Such patients may benefit from coronary revascularization (angioplasty or surgery) to restore anterograde blood flow and minimize myocardium at risk.
Asunto(s)
Circulación Colateral , Circulación Coronaria , Fibrinolíticos/uso terapéutico , Infarto del Miocardio/fisiopatología , Activadores Plasminogénicos/uso terapéutico , Estreptoquinasa/uso terapéutico , Terapia Trombolítica , Cateterismo Cardíaco , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/tratamiento farmacológico , Pronóstico , Estudios Prospectivos , Análisis de Regresión , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
UNLABELLED: The aim of the study was to analyze the relationship between antegrade and collateral flow degree to the "culprit" coronary artery, and between both variables and left ventricular systolic function. We analyzed five hundred patients with acute myocardial infarction, treated prospectively and consecutively within 6 h of evolution with intravenous streptokinase. The degree of antegrade (0-3) and collateral blood flow (0-3) were correlated with 18 other variables. RESULTS: (a) By simple regression analysis, antegrade flow degree correlated positively (p < 0.0001), and collateral flow degree negatively (p = 0.0073) with left ventricular ejection fraction; (b) By multiple regression analysis, antegrade flow degree (p = 0.0032), but not collateral flow degree (p > 0.1), correlated independently with left ventricular ejection fraction; (c) In the subgroup of patients with occluded "culprit" coronary artery, the mean ejection fraction was significantly higher for those with collateral flow 3 (60.2% +/- 13.3 in relation to those with collateral flow < 3 (53.9% +/- 13.1, p = 0.032, 95% CI. 11.96 to (0.53%). In conclusion, antegrade coronary flow degree, but not collateral flow degree, correlated significantly and independently with left ventricular ejection fraction. However, in the subgroup of patients with occluded "culprit" coronary artery, collateral flow 3 led to better left ventricular systolic function, in relation to collateral flow < 3.
Asunto(s)
Circulación Colateral/fisiología , Circulación Coronaria/fisiología , Infarto del Miocardio/fisiopatología , Función Ventricular Izquierda/fisiología , Femenino , Fibrinolíticos/uso terapéutico , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/tratamiento farmacológico , Estudios Prospectivos , Análisis de Regresión , Estreptoquinasa/uso terapéutico , Volumen Sistólico , Terapia TrombolíticaRESUMEN
The role of diltiazem on left ventricular systolic function was analyzed in 101 patients with acute myocardial infarction treated with streptokinase, being obtained, for the total of the population, higher LV global ejection fraction (p = 0.022), LV regional shortening (p = 0.046) and LV global shortening (p = 0.064) for the treated group, relative to the placebo group; the p values were, respectively, 0.005, 0.009, and 0.012, for patients that achieved TIMI-3 antegrade coronary flow. It is concluded that diltiazem is useful as adjuvant to streptokinase, especially when antegrade coronary blood flow TIMI-3 is obtained.
Asunto(s)
Bloqueadores de los Canales de Calcio/uso terapéutico , Diltiazem/uso terapéutico , Fibrinolíticos/uso terapéutico , Infarto del Miocardio/tratamiento farmacológico , Infarto del Miocardio/fisiopatología , Estreptoquinasa/uso terapéutico , Terapia Trombolítica , Función Ventricular Izquierda/efectos de los fármacos , Anciano , Método Doble Ciego , Femenino , Hemodinámica/efectos de los fármacos , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Sístole/efectos de los fármacos , Factores de Tiempo , Resultado del TratamientoRESUMEN
One hundred twenty-eight patients with myocardial infarction who underwent operation for myocardial revascularization and 147 patients who received medical therapy were followed up for up to 6 years: all patients had received treatment with intravenous streptokinase. In the surgical group, 91.5% of the patients had the region related to the infarction revascularized, and in 82.8% of them the mammary artery was used. Statistically significant differences were not detected between the groups according to infarct size, clinical features, and left ventricular ejection fraction. However, there was a higher risk in the surgical group, as compared with that in the medical group, in terms of anatomic characteristics: 99.2% versus 77.1% of the patients showed more than 70% residual obstruction at the "culprit" coronary artery (p < 0.001, 95% confidence interval 14.1% to 30.1%) and 76.8% versus 40.7% showed multivessel coronary disease (p < 0.001, 95% confidence interval 23.7% to 48.5%). In-hospital survival was 95.3% in the surgical group and 89.1% in the medical group (p = 0.096, 95% confidence interval -0.2% to 12.6%). Significantly higher survivals were obtained for the surgical group both during the first (93% +/- 2.3% versus 80.3% +/- 3.3%, p = 0.005) and the sixth (86.4% +/- 3.4% versus 68.4% +/- 4.3%, p = 0.003) year of follow-up. Statistically significant differences were also obtained when in-hospital deaths were excluded. A Cox regression model with 13 variables showed that only age (p = 0.0422) and medical treatment (p = 0.0194) correlated independently with mortality. It is concluded that in this nonrandomized study, operation led to a significantly higher survival both on a medium- and long-term basis, when compared with that obtained for patients receiving medical therapy.
Asunto(s)
Infarto del Miocardio/tratamiento farmacológico , Infarto del Miocardio/cirugía , Revascularización Miocárdica , Estreptoquinasa/uso terapéutico , Terapia Trombolítica , Análisis Actuarial , Femenino , Mortalidad Hospitalaria , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/mortalidad , Estudios Prospectivos , Análisis de Regresión , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
PURPOSE: To analyze the in-hospital predictors of survival in a population of infarcted patients submitted to the same therapeutic protocol that included IV streptokinase (SK) in the dose of 750,000 units. METHODS: Three hundred and thirty two patients (mean age 55.6 +/- 10 years, 82.3% men) with acute myocardial infarction (AMI) were studied within six hours of onset of symptoms in a prospective and consecutive protocol. Using simple and multiple regression analysis, the following variables were selected for correlation with survival: LV ejection fraction by contrast ventriculography > 50%; CK-MB peak < or = 100 UI/1; male sex; invasive treatment (surgery or angioplasty); patent "culprit" coronary on cineangiography; age < or = 65 years; time interval between the onset of pain and the beginning of SK infusion < 3 hours; residual obstruction < 70% at the "culprit" coronary; inferior AMI location on ECG; absence of hypotension per-peri SK infusion, previous AMI, multivessel coronary artery disease and reinfarction. RESULTS: By simple regression analysis, ejection fraction > 50% (p < 0.001), CK-MB peak < or = 100 UI/1 (p = 0.003), and the absence of hypotension (p < 0.001), previous AMI (p = 0.009), multivessel coronary artery disease (p = 0.02) and reinfarction (p = 0.049), correlated significantly with survival. By multiple regression analysis ejection fraction > 50% (p = 0.017) and the absence of hypotension (p < 0.01), multivessel coronary artery disease (p = 0.032) and reinfarction (p = 0.037) correlated independently with survival. CONCLUSION: The data presented strongly support the concept of preventing atherosclerosis and maintaining myocardial viability using either direct measures such as recanalization, or indirect measures such prevention of hypotension and reinfarction.