RESUMEN
BACKGROUND: A significant proportion of patients with complex, advanced coronary artery disease have refractory angina (RA) despite maximal pharmacological therapy and are deemed suboptimal candidates for revascularization. These patients are frequently termed "no-option" patients. However, despite this designation, many subsequently undergo coronary revascularization. We sought to determine the incidence, etiology and outcome of revascularization in "no-option" patients. METHODS AND RESULTS: We examined a comprehensive, prospective RA database to identify 342 of 1363 (25.1%) patients who subsequently underwent revascularization after a median interval of 2.2 years from the "no-option" diagnosis. Coronary revascularization was achieved by percutaneous coronary intervention (PCI) (n = 274, 20.1%), coronary bypass graft surgery (n = 44, 3.2%) or both (n = 24, 1.8%). During a median follow-up of 5.1 years, patients who underwent revascularization had lower annual mortality (2% vs. 4.4%, P < .001). Detailed paired angiographic records were available for 181 PCI patients with a combined 302 lesions. Of these interventions, 48% were for a new lesion, 31% for an existing lesion and 21% for restenosis. The location was a native vessel in 77% and a bypass graft in 23%. CONCLUSIONS: The "no-option" or non-revascularizable designation is frequently based on angiography at a single time-point. However, coronary artery disease is a progressive and dynamic process and new lesions often develop in such patients. Given the association between revascularization and better survival, careful consideration should be given to repeat revascularization in patients with refractory angina previously classified as "no-option".
Asunto(s)
Angina de Pecho/terapia , Puente de Arteria Coronaria , Enfermedad de la Arteria Coronaria/terapia , Intervención Coronaria Percutánea , Anciano , Angina de Pecho/diagnóstico por imagen , Angina de Pecho/mortalidad , Canadá/epidemiología , Angiografía Coronaria , Puente de Arteria Coronaria/efectos adversos , Puente de Arteria Coronaria/mortalidad , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/mortalidad , Bases de Datos Factuales , Progresión de la Enfermedad , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Intervención Coronaria Percutánea/efectos adversos , Intervención Coronaria Percutánea/mortalidad , Puerto Rico/epidemiología , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Estados Unidos/epidemiologíaRESUMEN
The kinetics of interaction of Co(III)TSPcNO (TSPc = 4,4',4'',4'''-tetrasulfophthalocyanine) with various thiols of biological relevance, e.g., reduced glutathione (GSH), captopril (CapSH), N-acetyl-L-cysteine (NALC), and L-cysteine ethyl ester (LCEE) have been investigated spectrophotometrically. The observed rate constants for transnitrosation are all first-order with respect to the respective thiols. The second-order rate constants which were determined at physiological temperature, 37 degrees C are 258+/-8, 159+/-3, 66.7+/-1.3 and 37.4+/-0.6 M(-1) s(-1), respectively. The second-order rate constants decreased according to the sequence LCEE > CapSH > GSH > NALC. The activation parameters (DeltaH(not equal) and DeltaS(not equal)) were derived from the Eyring's equation. The experimental activation parameters were then correlated by an isokinetic plot, for the reduction of [Co(III)TSPc(NO(-))](4-) by the thiols, making use of the expression: DeltaH(double dagger) = DeltaG(0)(double dagger) + beta(0)DeltaS(double dagger) where DeltaG(o)(double dagger) is the intrinsic free energy of activation, and beta(o) the isokinetic temperature. The plot which showed very good linearity (R(2) = 0.997), gave values of DeltaG(o)(double dagger) (61+/-1 J K(-1) mol(-1)) from the intercept, and beta(o) (260+/-11 K) from the slope. It is concluded that a common mechanism is adhered to in the reduction of Co(III)TSPcNO, irrespective of the type of thiol being used, to give the corresponding S-nitrosothiol, which is further confirmed by high performance liquid chromatography with mass spectrometric detector.
Asunto(s)
Compuestos Organometálicos/química , Compuestos de Sulfhidrilo/química , Agua/química , Captopril/análogos & derivados , Captopril/química , Cromatografía Líquida de Alta Presión , Cinética , Espectrometría de Masas , Nitrosación , Relación Estructura-Actividad , TemperaturaRESUMEN
This study was concerned with preferences for inpatient models of care by the HIV/AIDS client group, in particular the difference between gay white men (European) and black heterosexuals of African/Caribbean origin. Satisfaction with the care currently provided was also an area of interest. Thirteen per cent (n = 79) of the were surveyed. Seventy per cent (n = 56) of the HIV/AIDS client group indicated a preference for a dedicated care model. Significant results were obtained demonstrating differences in the care model preferred by gay white men and black heterosexuals (p < 0.01). Gay white men were much more likely to state they would leave the trust to receive dedicated care (p < 0.01). Black heterosexuals were more likely to state that they would change treatment areas to avoid dedicated care (p < 0.01) Differences in concern about confidentiality were noted between the two groups. Confidentiality may be one of a number of factors influencing preference of care for African/Caribbeans and this needs to be studied further. The clients surveyed were not universally satisfied with the care they had been receiving. Following the results of the survey radical changes in the management of HIV inpatient care were made.
Asunto(s)
Infecciones por VIH/terapia , Hospitalización , Pacientes Internos/psicología , Satisfacción del Paciente , África/etnología , Asia/etnología , Confidencialidad , Atención a la Salud , Femenino , Infecciones por VIH/etnología , Humanos , Londres/epidemiología , Masculino , Atención de Enfermería , Habitaciones de Pacientes , Encuestas y Cuestionarios , Indias Occidentales/etnologíaRESUMEN
Equine leukoencephalomalacia (ELEM), swine pulmonary oedema and human oesophageal cancer have been associated with fumonisine B1 (FB1) ingestion. For the first time in this study it is reported that FB1 was identified as being associated with an outbreak of ELEM at Oaxaca, Mexico. Symptoms of ELEM and Equine Venezuelan Encephalitis (EVE) are similar and a different diagnosis is obligatory. In the geographical area (Oaxaca, Mexico) where donkeys died showing a neurological syndrome, 14 corn samples were collected. With the use of TLC (Thin layer chromatography) and HPLC (High performance liquid chromatography) all collected samples resulted positive to FB1. In the area of study, this syndrome was reported to be the cause of death of 100 donkeys, after 3 postmortem examinations in which macroscopic and microscopic cerebral white manner liquefactive necrosis were observed, when FB1 concentration was determined in the samples collected, using HPLC and TLC. It was concluded that HPLC is a highly sensitive method for the detection of FB1 through the formation of an OPA derivative. However, the reverse phase TLC plate and the visualisation of the coloured reaction with the vanillin acidic solution is more objective. FB1 concentration in the studied samples ranged from 0.67 to 13.3 ppm. It was concluded that FB1 was the cause of leukoencephalomalacia reported in donkeys in the state of Oaxaca, Mexico.
Asunto(s)
Ácidos Carboxílicos/efectos adversos , Brotes de Enfermedades/veterinaria , Encefalomalacia/veterinaria , Equidae , Fumonisinas , Micotoxinas/efectos adversos , Alimentación Animal/análisis , Alimentación Animal/microbiología , Animales , Ácidos Carboxílicos/análisis , Encefalomalacia/epidemiología , Encefalomalacia/etiología , México/epidemiología , Micotoxinas/análisis , Zea mays/química , Zea mays/microbiologíaRESUMEN
To evaluate the effect of maternal dietary vitamin D intake on infant vitamin D status in a country with a temperate climate, but where the commercial milk supply is not vitamin D fortified, this randomized, double-blind study was conducted on term mother-infant pairs during the winter months. Well-nourished, white nursing mothers were given a placebo, 500 IU vitamin D/day or 1,000 IU vitamin D/day; their infants were not given supplemental vitamin D. After six weeks, mothers receiving supplemental vitamin D had higher levels of 25-hydroxyvitamin D than had mothers receiving placebo. A direct relationship was observed between maternal and infant levels of 25-hydroxyvitamin D at six weeks, implying that maternal vitamin D intake directly affects the vitamin D concentration in breast milk. A control group of infants who had received 400 IU vitamin D/day had even higher concentrations of 25-hydroxyvitamin D, suggesting that infant supplementation with vitamin D is more efficacious than maternal supplementation. Despite the favorable climate in South Africa, during winter breast-fed infants have low serum vitamin D values if maternal dietary vitamin D intake is low.