Analysis of the GSTM1-null polymorphism in patients with pterygium from Goiânia, Goiás Brazil.

The first reports about pterygium date back to Hippocrates, and this disease still threatens vision health around the world. Pterygium is a formation of fibrous tissue consisting of highly vascularized epithelial and subepithelial tissue that grows excessively and with an abnormal shape on the cornea. Many physical and biological factors are associated with the pathogenesis of pterygium, including heat, dust, and other particles in the atmosphere, and immunological mechanisms, mechanisms involving extracellular matrix reorganization, growth factors, cytokines, apoptosis, and angiogenesis. The aim of this study was to further investigate the association between polymorphisms in GSTM1 and the formation of pterygium. We collected peripheral blood samples from 90 patients diagnosed with pterygium and from 23 subjects with-out the disease in order to perform molecular analysis of the GSTM1 gene. Subjects with one or two copies of the GSTM1 allele had a normal genotype while those without any copies of the allele had a null geno-type. The chi-square test or the Fisher exact test was performed in order to investigate possible associations between the molecular analysis and the risk of pterygium. A significant difference between the frequency of the GSTM1-null genotype in patient and control groups was identified. However, sub-group analysis found that the GSTM1-null genotype was statistically significant in men, but not in women, and in Caucasians, but not in Brown or Black groups. Furthermore, the GSTM1-null geno-type was not related to any of the risk factors analyzed: cases in family, occupational exposure, smoking, hypertension, and diabetes.

Pterygium in patients from Goiânia, Goiás, Brazil.

Pterygium is an inflammatory and degenerative ocular surface disease in which the conjunctiva on the cornea grows to form a fibrous tissue in the shape of a triangle. The disorder may be characterized by cell proliferation, inflammatory processes, fibrosis, angiogenesis, and destruction of the extracellular matrix. The anomaly is considered a degenerative eye disease and is erroneously confused with cataract. It displays similar features to those of tumors, such as local invasion, metaplasia of epithelial cells, presence of oncogenic viruses (human papilloma virus), inactivation of tumor suppressor genes (e.g., p53), and loss of heterozygosity. The treatment of pterygium is based on factors such as the evolution and progression of the disease, risk factors, symptoms, and patient age. Considerations about the best technique for the surgical removal of pterygium remain controversial, and complications and recurrence are very common. The development of new surgical techniques and adjuvant drugs is thus necessary. This study aims to analyze and compare the frequency of the GSTT1 genotypes in relation to pterygium through statistical analyzes in order to build a genotypic profile for the Replicon patients. The genotypic profile of the GSTT1-null polymorphism in Goiânia showed no significant difference when the frequency of the null genotype was compared between the control and experimental groups. The null genotype was more frequent in the population studied. Furthermore, the GSTT1 genotype was not related to the analyzed risk factors for pterygium, namely gender, ethnicity, family history, occupational exposure, smoking, hypertension, and diabetes.

Assessment of genotoxic effects in nurses handling cytostatic drugs.

Several antineoplastic drugs have been classified as carcinogens by the International Agency for Research on Cancer (IARC) on the basis of epidemiological findings, animal carcinogenicity data, and outcomes of in vitro genotoxicity studies. 5-Fluorouracil (5-FU), which is easily absorbed through the skin, is the most frequently used antineoplastic agent in Portuguese hospitals and therefore may be used as an indicator of surface contamination. The aims of the present investigation were to (1) examine surface contamination by 5-FU and (2) assess the genotoxic risk using cytokinesis-block micronucleus assay in nurses from two Portuguese hospitals. The study consisted of 2 groups: 27 nurses occupationally exposed to cytostatic agents (cases) and 111 unexposed individuals (controls). Peripheral blood lymphocytes (PBL) were collected in order to measure micronuclei (MN) in both groups. Hospital B showed a higher numerical level of contamination but not significantly different from Hospital A. However; Hospital A presented the highest value of contamination and also a higher proportion of contaminated samples. The mean frequency of MN was significantly higher in exposed workers compared with controls. No significant differences were found among MN levels between the two hospitals. The analysis of confounding factors showed that age is a significant variable in MN frequency occurrence. Data suggest that there is a potential genotoxic damage related to occupational exposure to cytostatic drugs in oncology nurses.

Children's perceptions regarding functional limitations due to oral problems.

AIM: To evaluate factors associated with difficulty eating and speaking due to oral problems according to the reports of children. METHODS: A cross-sectional study was conducted with 769 5-year-old children at preschools in a city in northeast Brazil. Parents/caretakers answered a questionnaire addressing socio-demographic data and a history of dental pain. The children answered the scale of oral health outcomes for 5-year-old children, which was used to evaluate the dependent variables. Clinical examinations of the children were performed by examiners who had undergone calibration exercises. Data analysis involved descriptive statistics and Poisson regression analysis (α = 5%). RESULTS: The prevalence of the perception of functional limitations on the part of the children was 35.5% for difficulty eating and 22.9% for difficulty speaking. Difficulty eating was associated with a history of dental pain (PR = 1.68; 95% CI 1.27-2.22) and the occurrence of traumatic dental injury (TDI) (PR = 1.23; 95% CI 1.01-1.52). Difficulty speaking due to oral problems was associated with studying at a public preschool (PR = 1.71; 95% CI 1.19-2.46), a history of dental pain (PR = 1.54; 95% CI 1.07-2.20), and the occurrence of TDI (PR = 1.52; 95% CI 1.12-2.06). CONCLUSIONS: Pain symptoms and the occurrence of TDI can exert an influence on the development of functional limitations. With regard to socioeconomic factors, studying at a public preschool can influence difficulty speaking in children.

Self-Perceptions of the Impact of Oral Problems on the Social Behavior of Preschoolers.

INTRODUCTION: Investigating preschool children's social behaviors and the association with oral health variables helps to understand child development. Besides that, different perceptions need to be explored regarding the impact of oral problems on the social behavior between the child's self-report and parent's/caregiver's proxy report. OBJECTIVE: To determine which socioeconomic and oral factors are associated with difficulty sleeping and playing and the avoidance of smiling in preschoolers. METHODS: A cross-sectional study was conducted with a representative random sample of 769 pairs of parents/caregivers and 5-y-old preschoolers. The preschoolers answered a questionnaire on difficulty sleeping, difficulty playing, and the avoidance of smiling for reasons related to oral problems. The parents/caregivers answered a questionnaire addressing socioeconomic characteristics as well as the use of dental services. Two calibrated dentists examined the children for the determination of dental caries, traumatic dental injury (TDI), malocclusion, and bruxism. Descriptive and Poisson regression analysis for complex samples with robust variance was used to test the associations (α = 5%). RESULTS: The variables associated with difficulty sleeping were low household income (confidence interval [CI]: 1.40-3.01), number of untreated dental caries (CI, 1.02-1.04), dental pain (CI, 1.76-3.59), TDI (CI, 1.08-2.11), and anterior open bite (CI, 1.11-2.20). Difficulty playing also was associated with the low household income (CI, 1.34-3.15), number of untreated dental caries (CI, 1.01-1.04), dental pain (CI,1.42-3.61), and TDI (CI, 1.13-2.33). The number of untreated dental caries (CI, 1.02-1.05), dental pain (CI, 1.03-2.88), anterior open bite (CI, 1.30-3.26), and not using dental services (CI, 1.13-2.73) were determinant factors for the avoidance of smiling. CONCLUSION: Socioeconomic, symptomatic, and/or oral esthetic problems exerted an impact on the social behavior of the preschoolers analyzed, such as playing, sleeping, and smiling. KNOWLEDGE TRANSFER STATEMENT: The results of the present study may help parents and clinicians to understand better the association of oral problems with the social behavior of preschool children. Moreover, this study shows the importance of listening to children in clinical decisions. These results also can help in the elaboration of oral health policies.

Dataset on share issuance, abnormal returns and market timing in the Brazilian stock market.

This article presents a dataset to investigate the determinants of firms' decision for primary share issuance and the effects of market timing on primary share issues in the Brazilian stock market. The data refer to Brazilian nonfinancial firms that issued primary shares (IPOs and SEOs) in the 2004-2015 period. The data were gathered from the online bases of Economatica® and the São Paulo Securities, Commodities and Futures Exchange (BM&FBovespa). The final sample was composed of 123 firms and 165 primary share issues: 97 initial public offerings and 68 follow-on offerings. The dataset was developed to support a model that captures market timing behavior through cumulative abnormal returns and shows the effects of this behavior on the amount of proceeds raised. The dataset contains subsamples and different analysis time windows, processed and unprocessed data. Researchers can use the dataset for future research and comparisons with other markets and models. The related research article using part of the current dataset was published under the following title: "Effects of market timing on primary share issues in the Brazilian capital market" (Gomes et al.).

Prophylactic Use of Laser Light and Methylene Blue on Ischemia and Liver Reperfusion Injury.

OBJECTIVE: This study aimed to evaluate the effect of hepatic preconditioning with laser light in the presence of methylene blue (MB) in the liver ischemia-reperfusion injury process. METHOD: Forty male Wistar rats were divided into 8 experimental groups (n = 5). Saline (.5 mL) or MB (15 mg/kg) was injected intravenously (inferior vena cava). After 2 minutes, 660 nm laser light was applied at a dose of 112.5 DE. Fifteen minutes after the application of saline or MB, 1 hour partial ischemia followed by 15 minutes of reperfusion was applied when the rats were sacrificed. The mitochondrial function parameters (O2 consumption rates in states 3 and 4 and the respiratory control ratio), osmotic swelling, and determination of malondialdehyde were evaluated. Hepatic function was studied using the serum determination of the alanine aminotransferase and aspartate aminotransferase enzymes. RESULTS AND CONCLUSIONS: MB therapy alone showed the capacity of preserving the rate of oxygen consumption in the mitochondrial respiratory state of the group submitted to ischemia compared to the sham group. However, when combined with low-intensity laser therapy, it failed to replicate the relevant protective effects in relation to oxidative phosphorylation or the mitochondrial membrane ischemia/reperfusion injury. Whether or not MB was combined with laser treatment, it was shown to be efficient in reducing oxidative stress. In relation to alanine aminotransferase enzymes, whether or not laser treatment was combined with MB had a protective effect on the hepatic lesion, whereas in relation to aspartate aminotransferase enzymes only laser treatment was able to provide this protection.

Ocular tuberculosis - A closer look to an increasing reality.

INTRODUCTION: Ocular tuberculosis (OTB) is a rare form of tuberculosis. Diagnosis is usually presumptive based on epidemiology, clinical findings and positivity of immune response. The aim of the study was to characterize the OTB cases identified in Lisbon. METHODS: Retrospective study on OTB cases diagnosed in Lisbon from 2012 to 2015. The authors gathered data regarding demographic characteristics, diagnostic criteria, type of treatment as well as therapeutic results. RESULTS: There were 39 reported cases of presumed OTB which accounted for 12.2% of all reported TB cases. Patients had a mean age of 55.5 years. All had ocular manifestations (mainly uveitis). Diagnostic criteria included positive tuberculin skin test (TST) and/or Interferon Gamma Release Assay (IGRA). Culture testing or PCR could not be determined in any patient. Patients had OTB treatment for an average of 9.08 months. Clinical improvement was reported in 91.4% of treated patients. There were no relapses. CONCLUSION: This is the first published series about OTB in Lisbon. All cases had a presumptive diagnosis made through TST and/or IGRA testing. Most of treated patients improved, with no signs of relapse and a median 29.9-month follow up. OTB seems to be a growing diagnosis and treatment may be beneficial even in patients with a presumptive diagnosis.

Effects of ischemic liver preconditioning on hepatic ischemia/reperfusion injury in the rat.

To minimize bleeding during major liver resections or liver transplantation, surgical measures have been adopted that induce ischemia-reperfusion injury (I/R) which may significantly contribute to morbidity and mortality of partial liver resections. Several methods have sought to minimize I/R hepatic lesions. The present project assessed the protective role of ischemic preconditioning (IPC) in rat livers. The IPC was accomplished by clamping the hepatic pedicle for 5 minutes, followed by a 5-minute reperfusion (R) period before a 2-hour ischemia. Thereafter, reperfusions of 1, 3, and 24 hours were compared among IPC and control groups without IPC. Liver biopsy and blood samples were measured for mitochondrial respiratory control ratio (RCR), serum aspartate aminotransferase (AST), and alanine aminotransferase (ALT). IPC protected liver mitochondrial function. Serum aminotransferase levels were significantly lower among animals undergoing IPC compared with groups without IPC. Thus, we verified the effects of IPC for hepatocellular protection against I/R lesions.

Effect of hyperbaric oxygen on liver regeneration in a rat model.

Hyperbaric oxygen therapy is a treatment that has been gradually implemented for the treatment of several pathologic conditions. The present study evaluated the effect of hyperbaric oxygen therapy for hepatic regeneration and its relationship to mitochondrial function. Male Wistar rats underwent partial hepatectomy (70%) and subsequently underwent two sessions of hyperbaric oxygen (90 minutes each, at a pressure of 2 ATA). The animals were sacrificed at 24 and 48 hours after surgery. Hepatic regeneration was evaluated by the dry weight of the remaining liver, the hepatic regeneration rate, the hepatic DNA content, and the hepatocyte proliferation rate using the "proliferating cell nuclear antigen" (PCNA) content. Function of the mitochondria was evaluated by its oxygen consumption during respiratory states 3 and 4, its respiratory control ratio (RCR), its membrane potential, as well as its osmotic swelling. We also measured serum levels of aminotransferases. The results revealed an increased dry weight of the remaining liver, regeneration rate, and DNA content at 24 and 48 hours after hepatectomy. The hepatocyte proliferation rate was significantly higher among animals treated with hyperbaric oxygen therapy at 48 hours after surgery. There was no significant difference in aminotransferase levels. Mitochondrial respiration revealed reduced oxygen consumption in state 3 after 48 hours. These results demonstrated that hyperbaric oxygen stimulates hepatic regeneration at 24 and 48 hours after 70% hepatectomy. The effect of hyperbaric oxygen on hepatic tissue occurs without tissue damage and protects mitochondria after 48 hours.

Effects of Walker 256 carcinoma on metabolic alterations during the evolution of pregnancy.

The control of pregnant cancer patients is difficult because it involves both mother and fetus, and the metabolic alterations in the cancer host induce a massive mobilization of nutrients diverted to the neoplastic cells. The purpose of the present study was to determine the evolution of the Walker 256 carcinoma in pregnant rats and its consequences on fetal development. The results showed that the tumors displayed a very rapid rate of growth and induced a reduction in fetal weights in the pregnant tumor-bearing rats. The tumor-bearing and pregnant tumor-bearing groups showed a decrease in blood glucose and total serum protein, suggesting an increase in energy utilization of these substrates and synthetic activity by the tumoral cells. An imbalance between protein synthesis and catabolism may occur in the tumor-bearing rats which may be related to the degree of nutritional depletion.

Evaluation of left ventricular function after acute myocardial infarction. Two-dimensional echocardiography versus radionuclide angiography. Study of 50 patients.

Two-dimensional echocardiography and gated blood radionuclide angiography was performed in 50 patients (mean age 51.3 years; 48 men and 2 women) after acute myocardial infarction, before discharge from the hospital. The aim of this study was to compare the wall motion score, determined by two-dimensional echocardiography (2DE), with the ejection fraction obtained by radionuclide angiography (RNA). The correlation between the results obtained by 2DE and RNA was good (r = 0.75; p less than 0.0001). We conclude that 2DE is a powerful diagnostic tool for the evaluation of left ventricular function.

[Long-term follow-up of anatomic heart transplantation. Apropos of 60 patients with a mean follow-up of 36 months]. / Suivi à long terme de la transplantation cardiaque anatomique. A propos de 60 patients dont le suivi moyen est de 36 mois.

The aim of this study was to collect different problems seen in long-term evolution of patients who had anatomical cardiac transplantation and to compare with those seen in patients with standard transplantation. During the mean follow-up of 36 months, we analysed different data of 60 patients mean aged 51, who underwent anatomical cardiac transplantation. Six patients (10%) died within the 30 days after surgery. No patient needed the use of permanent pacemaker. Echocardiographic examination found normal atrial shape. One month after surgery, echocardiography described 16 tricuspid regurgitations (22.66%) and 8 mitral regurgitations (13.33%), 1 year later, there was respectively 13.33 and 6.66% tricuspid and mitral regurgitation. We had 8 late deaths: 1 sudden death, 2 chronic rejections, 1 pancreatitis and 4 cancers. The survival analysis pointed out 84% at 1 year, 80 at 2 years, 78 at 3 years and 73 at 5 years. Six months after surgery, 80% of patients were treated for high blood pressure; 85% had serum creatinine level equal or superior to 13 mg/L, with mean serum ciclosporin at 130 ng/mL. At the 3rd month, 6 endomyocardial biopsies were equal or superior to grade 2 rejection (International Society for Heart Transplantation). Between the 3rd and 12th month, 3 endomyocardial biopsies were equal or superior to grade 2 rejection, and the same between the 12th and 24th month. The infections rate was 0.8 episode per patient. Long term follow-up of anatomical cardiac transplantation faces the same problems as in standard cardiac transplantation. It is better to perform anatomical cardiac transplantation because of its early postsurgical advantages. Long term care is the same as in standard cardiac transplantation.

[Veno-occlusive disease of the liver: report of 2 cases in the northeast of Brazil]. / Doenca veno-oclusiva do fígado: registro de dois casos no nordeste do Brasil.

Two cases of veno-occlusive disease of the liver (VOD) are reported in eleven and twelve-year-old children. The number of Brazilian cases of this entity amounts to five, with the addition of the present cases. One patient was in a subacute stage (central hepatic fibrosis) and had her diagnosis based on hepatic biopsy and venography; the other one was necropsied in a cirrhotic stage. Aspects concerning differential diagnosis with other regional hepatic disease, as well as the currently known geographic distribution and etiologic possibilities of VOD were reviewed.

[The SAVE trial: rational basis, results, and reflections]. / Estudo "SAVE": bases racionais, resultados e reflexões.

Recent concepts about post-infarction left ventricular remodeling, which is the basis for heart failure in these patients, as well as its prevention by ACE inhibitors are briefly summarized. Those data were the rationale for the SAVE trial. The most important initial aspects of this trial (general objective, pre-specified endpoints, inclusion and exclusion criteria, etc.) are then described as well as the basal characteristics of the respective cohort. The most important results of the SAVE trial, now in press, are subsequently presented. Several clinical guidelines, derived from these results, are then suggested. Finally, some new questions, both clinical and pathophysiological, and originated by the results from the SAVE results, are commented.

[Epidemiologic features of congestive heart failure. Retrospective analysis of 2561 hospitalizations]. / Aspectos epidemiológicos da insuficiência cardíaca congestiva. Análise retrospectiva de 2561 internamentos.

OBJECTIVES: The aim of this study was to characterise the epidemiology of congestive heart failure namely assessing demographic, etiologic and prognostic aspects, and the hospital admission trends in the last 6 years. METHODS: Retrospective analysis of computerised data concerning patients with congestive heart failure admitted to the department of Internal Medicine. LOCATION: A central hospital in the North of Portugal. SUBJECTS: Two thousand five hundred and sixty-one patients older than 10 years, admitted to the Internal Medicine Department of a central hospital in the North of Portugal between January 1, 1989 and December 31, 1994 and discharged with the principal or first listed diagnosis of congestive heart failure (ICD-9-CM code 4280). RESULTS: Eighty per cent of the patients had more than 60 years of age and the mean age was 69 years (female: 70.40 +/- 12.65; male: 66.24 +/- 12.25; p < 0.0001). Fifty-four per cent were females and 46 per cent males. The prevalence of congestive heart failure in the Internal Medicine Department was 4.8%. Between the ages of 15 and 44 years the hospital age-specific prevalence was between 16.1/10,000/year and 26.7/10,000/year for women and between 14.5/10,000/year and 16.1/10,000/year for men. For ages equal or greater than 75 years it was between 508.9/10,000/year and 561.3/10,000/year for women and between 300.2/10,000/year and 421.8/10,000/year for men. Possible causes of congestive heart failure were: valve disease in 26 per cent of patients, coronary artery disease in 24 per cent and hypertension in 20 per cent. The average case-fatality rate was 15.15% (female: 15.54%; male: 14.69%; chi 2 = 0.36; p > 0.55) evolving from 19.45% in 1989 to 12.59% in 1994 (chi 2 = 6.85; p < 0.01). Between the ages of 15 and 44 years the hospital cause-specific mortality rate was 16.2/100,000 and for ages equal or greater than 75 years it was 743.6/100,000. Stepwise logistic regression produced the following odds ratios for the variables significantly associated with dead during hospital admission: age (> or = 70 years)--1.48; infectious diseases--1.37; central nervous system diseases--2.28; chronic renal diseases--1.96; cardiac arrest--24.1; pulmonary embolism--2.26; acute renal failure--7.93; clinical signs of severe sodium and water retention--1.49; hyponatremia--3.39; other electrolyte abnormalities and acid-base balance disturbances--1.78. The simple linear regression of daily admissions on time produced a positive slope of 0.0002 (p < 0.002). CONCLUSIONS: The hospital prevalence of congestive heart failure is identical to other Western countries and is greater among the elderly patients. Valve disease, coronary artery disease and hypertension are the most frequent causes of congestive heart failure. An increasing trend in hospital admissions for congestive heart failure was observed. The hospital mortality was reduced in the last 6 years and was greater among the elderly patients. Age (> or = 70 years), the presence of comorbidity (infectious disease, central nervous system disease, acute renal failure, chronic renal disease and pulmonary embolism), hyponatremia, other electrolyte abnormalities and acid-base balance disturbances, resuscitated cardiac arrest and the presence of severe sodium and water retention have prognostic significance.

Lisinopril and diltiazem reduce left ventricular mass without changing blood pressure in normotensive subjects with exaggerated blood pressure response to exercise.

OBJECTIVE: To determine whether high left ventricular mass may be reduced by antihypertensive drugs in normotensives with exaggerated blood pressure response to exercise as it occurs in hypertensive patients. DESIGN AND METHODS: Randomized, single blind, controlled parallel study evaluating the influence of placebo; lisinopril 20 mg/day, diltiazem 180 mg/d for 5-6 months on left ventricular mass (LVM), evaluated by echo and on "casual" and 24-h ambulatory blood pressure (24-h BP) in normotensive subjects with exaggerated blood pressure response to exercise (Group I) and in weight--and age--matched mild-moderated hypertensive patients (Group II), all with high left ventricular mass. PATIENTS: Placebo, lisinopril and diltiazem, were administered for 5-6 months in respectively 8+9+9 subjects of Group I and 8+9+10 patients in Group II. RESULTS: Placebo did not change either LVM index or 24-h BP values in Group I and Group II. Diltiazem and lisinopril reduced LVM index in both Groups I and II but 24-h BP values were only reduced in Group II. Lisinopril appeared to be more potent than diltiazem on LVM regression. Slopes of LVM index regression were not different between Groups I and II for each drug. Drug-induced changes of LVM index did not correlate with blood pressure changes. CONCLUSIONS: Drug-induced regression of LVM may be achieved in man (Group I) without any reduction of blood pressure. This may be explained by interference with growth-promoting systems other than with cardiac unloading. Also, the similar pattern of LVM regression that was observed in both Groups I and II suggests that similar underlying mechanisms may be involved in the LVH regression in these two populations.

[Pharmacologic treatment of acute myocardial infarction: 2 large clinical trials at a central hospital]. / Terapêutica farmacológica do enfarte agudo do miocárdio: dos grandes ensaios à prática clínica num hospital central.

OBJECTIVES: To analyse the clinical practice concerning the pharmacological therapy of acute myocardial infarction (AMI), comparing it with the guidelines for the management of AMI and exploring the reasons for its under use or over use. METHODS: Retrospective analysis of clinical records of patients with the discharge diagnosis of AMI. LOCATION: A central hospital in the North of Portugal. SUBJECTS: One hundred and ninety-one patients admitted to the Internal Medicine Department of a central hospital in the North of Portugal between January 1, 1993, and December 31, 1994. RESULTS: Thrombolytic therapy was performed in 24.1% of the patients. At discharge 32.6% of the patients were on therapy with beta blockers, 68% with angiotensin converting enzyme inhibitors (ACEI) and 88.4% with aspirin. Stepwise logistic regression produced the following odds ratios for the variables significantly associated with: a) thrombolytic therapy: hypertension - 0.38; non-Q wave infarction - 0.17; time between onset of symptoms and hospital admission greater than 6 hours - 0.18; admission to coronary unit - 14.72; b) beta blocker therapy: age > 60 years - 0.23; serum LDH > 1000 U/L - 0.41; diastolic blood pressure > 85 mmHg - 3.73; Killip > 1 - 0.08; concomitant therapy with calcium antagonist - 0.33; previous therapy with beta blocker - 14.87; hospital stay greater than 10 days - 2.67; c) ACEI therapy: anterior wall infarction - 3.07; non Q wave infarction - 0.13; congestive heart failure - 9.36; serum creatinine > or = 15 mg/dl - 0.03. CONCLUSIONS: Beta blockers and thrombolytic are under used and ACEI overused. The delay in hospital admission is the most important factor opposing the use of thrombolytic therapy, imposing the need for measures that ean reduce this delay. Therapy with beta blockers (highly cost-effective) can be increased by educational intervention among the physicians. The overuse of ACEI can be ascribed to the good results of randomised trials.

[Study of the autonomous nervous system with heart rate spectral analysis in acute myocardial infarction]. / Estudo do sistema nervoso autónomo pela análise espectral da frequência cardíaca no enfarte agudo do miocárdio.

OBJECTIVES: Characterize power spectrum pattern of heart rate variability (HRV) and assessment of relative cardiac nervous system in patients with acute myocardial interaction of sympathetic and parasympathetic infarction. We also compared the spectral power with some known prognostic risk variables. STUDY DESIGN: Study of patients with acute myocardial infarction (AMI) and sedentary healthy subjects sex matched. SUBJECT AND METHODS: 19 postinfarction patients aged 55.7 +/- 10.5 years and 19 healthy subjects controls aged 53.9 +/- 11.0. ECG signals were recorded after 15 minutes of supine rest with controlled breathing at 15 cycles/min. Signal acquisition was done at 300 samples/sec. From 512 consecutive sinus beats, we calculated the average, standard deviation, maximum and minimum values and rate between the longest and shortest R-R interval (E/I). We also calculated, after computing the fast Fourier transform, the total spectrum power, low frequency component (LF, from 0.01 to 0.15 Hz), high frequency component (HF, from 0.15 to 0.50 Hz) and its ratio (LF/HF). Thereafter, we correlated these results with radionuclide ejection fraction, duration of treadmill test, Holter ventricular premature complex and localization of infarction. RESULTS: The average R-R interval was 757.9 +/- 116.3 and 850.9 +/- 133.9 msec (p less than 0.05), the R-R corrected standard deviation was 15.3 +/- 6.0 and 38.2 +/- 8.5 msec (p less than 0.001) and ratio E/I was 1.13 +/- 0.06 and 1.32 +/- 0.09 (p less than 0.001) in AMI and control group, respectively. In AMI group, low frequency spectral band was very decreased (LF = 0.03 +/- 0.02 sec2) and high frequency was virtually absent (HF = 0.01 +/- 0.01 sec2) compared with control group (LF = 0.13 +/- 0.06 and HF = 0.14 +/- 0.15 sec2), p less than 0.001; ratio LF/HF was increased in AMI group. There were no significant differences between groups for normalized LF (LF%) and HF (HF%). CONCLUSIONS: These results showed that spectral pattern in AMI patients had very low LF and HF power density. Decreased HRV in that group was mainly due to diminished parasympathetic influence in cardiac regulation; nevertheless ratio LF/HF was increased which represents an imbalance of sympatho-vagal activity with predominance of sympathetic tone. We found poor correlation between frequency domain indices and other risk variable; best correlation was between total spectral power and radionuclide ejection fraction (r = 0.642, p less than 0.01), which could express independent prognostic value in AMI patients risk stratification.

[Malignant vasovagal syncope: a case of prolonged asystole induced by the "tilt" test and aggravated by therapy with a beta blocker (a clinical case and diagnostic, physiopathologic and therapeutic review)]. / Síncope vasovagal maligna: um caso de assistolia prolongada induzida pelo teste de "tilt" e agravada pela terapêutica com bloqueador beta (caso clínico e revisão diagnóstica, fisiopatológica e terapêutica).

The authors describe a case of a middle-age male with recurrent syncope, in whom the tilt test was useful in the diagnosis and therapeutic evaluation. Malignant criteria of vasovagal syncope were established and the beta blocking worsening effect was documented, in spite of the general agreement of the first choice drug.