Sex differences in treatment strategy for coronary artery aneurysms: Insights from the international Coronary Artery Aneurysm Registry.

INTRODUCTION: Sex disparities exist in coronary artery disease (CAD) in terms of risk profile, clinical management and outcome. It is unclear if differences are also present in coronary aneurysms, a rare variant of CAD. METHODS: Patients were selected from the international Coronary Artery Aneurysm Registry (CAAR; ClinicalTrials.gov: NCT02563626), and differences between groups were analysed according to sex. The CAAR database is a prospective multicentre registry of 1565 patients with coronary aneurysms (336 females). Kaplan-Meier method was used for event-free survival analysis for death, major adverse cardiac events (MACE: composite endpoint of death, heart failure and acute coronary syndrome) and bleeding. RESULTS: Female patients were older, were more often hypertensive and less frequently smoker. They were treated conservatively more often compared to male patients and received significantly less frequently aspirin (92% vs 88%, p = 0.002) or dual antiplatelet therapy (DAPT) (67% vs 58%, p = 0.001) at discharge. Median DAPT duration was also shorter (3 vs 9 months, p = 0.001). Kaplan-Meier analysis revealed no sex differences in death, MACE or bleeding during a median follow-up duration of 37 months, although male patients did experience acute coronary syndrome (ACS) more often during follow-up (15% vs 10%, p = 0.015). CONCLUSIONS: These CAAR findings showed a comparable high-risk cardiovascular risk profile for both sexes. Female patients were treated conservatively more often and received DAPT less often at discharge, with a shorter DAPT duration. ACS was more prevalent among male patients; however, overall clinical outcome was not different between male and female patients during follow-up.

Developing and implementing a protocol for bilateral trade agreements: the Philippines' shift to a risk assessment policy and meeting its challenges.

The livestock and poultry industries in the Philippines have been continuously growing for the past six years, as reflected in the Philippine Statistics Authority annual reports from 2013 to 2018. To augment supplies and ensure food sufficiency, as well as to fulfil trade agreements, the government has adopted a policy of importing some livestock commodities. Currently, the Philippines imports about 20% of its total meat requirements, and this figure is expected to increase over the next few years. Private traders and companies could import buffalo meat without restriction until 1996, when the Department of Agriculture (DA) intervened by sending inspection missions to exporting countries due to the concerns of the livestock industry about the foot and mouth disease challenges during that time. But, at that point, there were still no clear rules, regulations or standards governing the importation of meat and meat products into the Philippines. By 2003, as outbreaks of transboundary animal diseases were occurring in the region (avian influenza as well as foot and mouth disease), the government saw the need to protect its borders from the entry, establishment and spread of animal diseases. Measures were needed to prevent the introduction of disease-carrying, contaminated or adulterated meat and meat products that could endanger the lives and health of Filipino consumers and, consequently, have potentially serious economic impacts on the livestock industry and other allied industries. As more and more requests were received to import meat and meat products, and as various stakeholder groups began to question why increasing numbers of imports were being allowed into the country, the DA began to shift to a risk-based policy rather than a policy of 100% inspection. The Philippine Government ensured that there was a legal basis as well as a scientific basis for orders governing the importation of meat and live animals. As the country shifts to a risk-based policy, making the public understand why it is implementing this policy remains a major challenge. Other areas that need to be developed and strengthened include quarantine and border security procedures, certification programmes, identification and traceability, export procedures, periodic auditing schemes, animal health programmes, capacities for risk analysis, and provincial border controls, which can be set by local governments to allow provinces to protect their locality.

Au cours des six dernières années, les secteurs de l'élevage de bétail et de volailles des Philippines ont enregistré une croissance continue, comme l'indiquent les rapports annuels de 2013 à 2018 publiés par l'Autorité philippine des statistiques. Afin d'accroître l'offre, de garantir la suffisance de l'approvisionnement alimentaire et de respecter ses accords commerciaux, le gouvernement a adopté une politique de soutien aux importations de certains produits d'élevage. Les Philippines importent actuellement près de 20 % de la viande consommée dans le pays, proportion qui devrait augmenter dans les prochaines années. Les négociants et entreprises privées ont pu importer de la viande de buffle sans aucune restriction jusqu'en 1996, date à laquelle le ministère de l'Agriculture est intervenu en dépêchant des missions d'inspection dans les pays exportateurs afin de répondre aux préoccupations exprimées par le secteur de l'élevage philippin face au problème de la fièvre aphteuse. Mais à ce stade, le pays ne s'était encore doté d'aucune règle, réglementation ou norme régissant clairement les importations de viande et de produits carnés aux Philippines. En 2003, face aux foyers de maladies animales transfrontalières survenus dans la région (influenza aviaire, mais aussi fièvre aphteuse), le gouvernement a pris acte de la nécessité de protéger ses frontières contre les risques d'introduction, d'établissement et de propagation de maladies animales. Il fallait donc prendre des mesures pour empêcher l'introduction de viandes et de produits carnés susceptibles de véhiculer des maladies et d'être contaminés ou frelatés et pouvant de ce fait mettre en danger la vie et la santé des consommateurs philippins, voire entraîner de graves conséquences économiques pour le secteur de l'élevage et d'autres secteurs connexes. À mesure que le nombre des demandes d'importations de viande et de produits carnés augmentait et que plusieurs groupes intéressés ont voulu connaître les raisons du nombre croissant d'autorisations délivrées à cette fin, le ministère de l'Agriculture a décidé de passer d'une politique d'inspection de l'intégralité des importations à une politique fondée sur le risque. Le gouvernement des Philippines a veillé à fournir un cadre juridique ainsi qu'une base scientifique aux nouvelles dispositions régissant les importations de viande et d'animaux vivants. La principale difficulté pour réussir cette mutation vers une politique fondée sur le risque consiste à faire comprendre au public les raisons de sa mise en oeuvre. D'autres aspects doivent également être développés et renforcés, en particulier les procédures de quarantaine et de sécurité des frontières, les programmes de certification, l'identification et la traçabilité, les procédures applicables aux exportations, les schémas périodiques d'audit, les programmes de santé animale, les capacités dédiées à l'analyse du risque et les contrôles aux frontières provinciales mis en place par les autorités locales pour protéger leur territoire.

Los sectores ganadero y avícola de Filipinas llevan seis años de continuo crecimiento, como se desprende de los informes anuales del Organismo de Estadística de Filipinas que cubren de 2013 a 2018. Con objeto de incrementar la oferta y asegurar la suficiencia alimentaria, y también de cumplir los acuerdos comerciales que tiene suscritos, el Gobierno ha optado por importar una serie de productos ligados a la ganadería. Actualmente, el país importa alrededor del 20% de la carne que necesita, porcentaje que en los próximos años irá previsiblemente en aumento. Las empresas e intermediarios privados podían importar sin restricciones carne de búfalo hasta 1996, cuando el Departamento de Agricultura (DA) intervino enviando misiones de inspección a los países exportadores en respuesta a la inquietud expresada por el sector ganadero sobre los problemas que planteaba a la sazón la fiebre aftosa. Por aquel entonces, sin embargo, aún no había reglas, reglamentos y normas claros que rigieran la importación a Filipinas de carne y productos cárnicos. En 2003, cuando la región estaba sufriendo brotes de enfermedades animales transfronterizas (influenza aviar y fiebre aftosa), el Gobierno juzgó necesario proteger sus fronteras de la penetración, implantación y propagación de enfermedades animales. Se precisaban medidas para evitar la introducción de carne y productos cárnicos portadores de enfermedades, contaminados o adulterados que pudieran poner en peligro la vida o la salud del consumidor filipino y causar, en consecuencia, graves perjuicios económicos a la ganadería y otros sectores conexos. A medida que se iban recibiendo cada vez más peticiones para importar carne y productos cárnicos a la par que diversos interlocutores y colectivos empezaban a preguntar por qué se permitía la entrada en el país de un número creciente de importaciones, el DA fue orillando la inspección del 100% de las partidas para privilegiar en su lugar una política basada en la determinación del riesgo. El Gobierno filipino se aseguró de que los decretos que regían la importación de carne y animales vivos reposaran en sólidas bases jurídicas y científicas. Ahora que el país está virando hacia una política basada en el riesgo, una de las grandes dificultades siguen siendo la de hacer entender a la población el porqué de tal política. Otros ámbitos que es preciso desarrollar y potenciar son, por ejemplo, los procedimientos de cuarentena y seguridad fronteriza, los programas de certificación, la identificación y trazabilidad, los procedimientos de exportación, los dispositivos de auditoría periódica, los programas de sanidad animal, la capacidad de análisis del riesgo y los controles de las fronteras provinciales que pueden instaurar los gobiernos locales para que las provincias puedan proteger su propio territorio.

Vernonanthura polyanthes leaves aqueous extract enhances doxorubicin genotoxicity in somatic cells of Drosophila melanogaster and presents no antifungal activity against Candida spp / O extrato aquoso das folhas de Vernonanthura polyanthes potencializa a genotoxicidade da doxorrubicina em células somáticas de Drosophila melanogaster e não apresenta atividade antifúngica contra Candida spp

Abstract Vernonanthura polyanthes (Spreng.) A.J. Vega & Dematt. (Asteraceae), known as “assa-peixe”, has been used in ethnomedicine for the treatment of various diseases such as bronchitis, pneumonia, hemoptysis, persistent cough, internal abscesses, gastric and kidney stone pain. Moreover, some studies demonstrated that species of Genus Vernonia present antifungal activity. Due to the biological relevance of this species, the aim of this study was to investigate the toxic, genotoxic, antigenotoxic and antifungal potential of V. polyanthes leaves aqueous extract in somatic cells of Drosophila melanogaster or against Candida spp. The aqueous extract of the plant showed no toxic, genotoxic and antigenotoxic activity in the experimental conditions tested using the wing somatic mutation and recombination test (SMART/wing). However, when the extract was associated with doxorubicin, used in this work as a positive control, the mutagenic potential of doxorubicin was enhanced, increasing the number of mutations in D. melanogaster somatic cells. In the other hand, no inhibitory activity against Candida spp. was observed for V. polyanthes leaves aqueous extract using agar-well diffusion assay. More studies are necessary to reveal the components present in the V. polyanthes leaves aqueous extract that could contribute to potentiate the doxorubicin genotoxicity.

Resumo Vernonanthura polyanthes (Spreng.) A.J. Vega & Dematt. (Asteraceae), conhecida como “assa-peixe”, tem sido utilizada na medicina popular para o tratamento de várias doenças, como bronquite, pneumonia, hemoptise, tosse persistente, abcessos internos, afecções gástricas e cálculo renal. Além disso, alguns estudos já demonstraram que espécies do Gênero Vernonia apresentam atividade antifúngica. Devido à relevância biológica dessa espécie, o objetivo deste estudo foi investigar os efeitos citotóxico, genotóxico, antigenotóxico e antifúngico do extrato aquoso das folhas de V. polyanthes em células somáticas de Drosophila melanogaster ou contra Candida spp. O extrato aquoso da planta não apresentou atividade citotóxica, genotóxica e antigenotóxica nas condições experimentais testadas usando o teste de recombinação e mutação somática em asa (SMART-asa). No entanto, quando o extrato foi associado com a doxorrubicina, utilizada neste trabalho como controle positivo, o potencial mutagênico da doxorrubicina foi potencializado, aumentando o número de mutações em células somáticas de D. melanogaster. Por outro lado, nenhuma atividade inibitória contra Candida spp. foi observada utilizando o extrato aquoso das folhas de V. polyanthes por meio do método de difusão em ágar. Mais estudos são necessários para desvendar os componentes presentes no extrato aquoso das folhas de V. polyanthes que possam contribuir para potencializar a genotoxicidade da doxorrubicina.

Vernonanthura polyanthes leaves aqueous extract enhances doxorubicin genotoxicity in somatic cells of Drosophila melanogaster and presents no antifungal activity against Candida spp.

Vernonanthura polyanthes (Spreng.) A.J. Vega & Dematt. (Asteraceae), known as "assa-peixe", has been used in ethnomedicine for the treatment of various diseases such as bronchitis, pneumonia, hemoptysis, persistent cough, internal abscesses, gastric and kidney stone pain. Moreover, some studies demonstrated that species of Genus Vernonia present antifungal activity. Due to the biological relevance of this species, the aim of this study was to investigate the toxic, genotoxic, antigenotoxic and antifungal potential of V. polyanthes leaves aqueous extract in somatic cells of Drosophila melanogaster or against Candida spp. The aqueous extract of the plant showed no toxic, genotoxic and antigenotoxic activity in the experimental conditions tested using the wing somatic mutation and recombination test (SMART/wing). However, when the extract was associated with doxorubicin, used in this work as a positive control, the mutagenic potential of doxorubicin was enhanced, increasing the number of mutations in D. melanogaster somatic cells. In the other hand, no inhibitory activity against Candida spp. was observed for V. polyanthes leaves aqueous extract using agar-well diffusion assay. More studies are necessary to reveal the components present in the V. polyanthes leaves aqueous extract that could contribute to potentiate the doxorubicin genotoxicity.

The use of the acute Pd/Pa drop after intracoronary nitroglycerin infusion to rule out significant FFR: CANICA (Can intracoronary nitroglycerin predict fractional flow reserve without adenosine?) multicenter study.

OBJECTIVE: Functional assessment of coronary artery stenosis is performed by measuring the fractional flow reserve (FFR) under hyperemic conditions (Adenosine). However, the use of adenosine portends limitations. OBJECTIVE: We sought to investigate the relationship and correlation between FFR and the Pd/Pa value obtained just after the intracoronary infusion (acute drop) of nitroglycerin (Pd/Pa-NTG) and if this parameter enhances diagnostic accuracy for FFR prediction compared to the resting baseline Pd/Pa. METHODS: We conducted a multicenter study including prospectively patients presenting intermediate coronary artery stenosis (30-70%) evaluated with pressure wire. Resting baseline Pd/Pa, Pd/Pa-NTG and FFR were measured. RESULTS: 283 patients (335 lesions) were included. Resting baseline Pd/Pa value was 0.72 to 1.0 (0.93 ± 0.04), Pd/Pa-NTG was 0.60 to 1.0 (0.87 ± 0.07) and FFR 0.55 to 1.0 (0.83 ± 0.08). The ROC curves for resting baseline Pd/Pa and for Pd/Pa-NTG, using a FFR ≤ 0.80 showed an AUC of 0.88 (95% CI: 0.84-0.92, P < 0.001) and 0.94 (95% CI: 0.92-0.96, P < 0.001) respectively. The optimal cutoff values of resting baseline Pd/Pa and Pd/Pa-NTG for an FFR > 0.80, were >0.96 and >0.88, respectively. These values were present in a 29.8% (n = 100) and a 47.1% (n = 158), of the total lesions. Scatter plots showed a better correlation and agreement points with Pd/Pa-NTG than resting baseline Pd/Pa. The cutoff value of Pd/Pa-NTG > 0.88 showed an excellent NPV (96.2% for FFR > 0.8 and 100% for FFR > 0.75) and sensitivity (95% for FFR > 0.8 and 100% for FFR > 0.75) which were consistently high across all the subgroups analysis. CONCLUSION: The cutoff value of acute Pd/Pa-NTG > 0.88 has a high NPV meaning adenosine-FFR can be avoided in almost half of lesions.

The economic impact of foot and mouth disease control and eradication in the Philippines.

The authors evaluate the impact of foot and mouth disease (FMD) and control of the disease in the Philippines using cost-benefit analysis. A scenario in which FMD control is maintained at recent levels with continued presence of the disease is compared to scenarios in which a publicly funded programme achieves eradication by 2005 (current policy objective), 2007 and 2010. Under varying assumptions regarding the development of exports of livestock products following eradication, estimated benefit-cost ratios for the investment in eradication range from 1.6 (2010, no exports) to 12.0 (2005, export of 5,000 tons each of low-value and high-value livestock products annually), indicating eradication to be an economically viable investment. The commercial swine sector is estimated to capture 84% of the benefits generated by the public investment in eradication, versus 4% by backyard swine producers. The implications of these results within the context of regional efforts to control FMD in South-East Asia are explored.