A randomized non-inferiority study comparing imipenem/cilastatin/relebactam with standard-of-care Gram-negative coverage in cancer patients with febrile neutropenia.

BACKGROUND: Antibiotic overuse leads to the emergence of antibiotic resistance that threatens immunocompromised cancer patients. Infections caused by MDR Gram-negative pathogens are difficult to treat and associated with high mortality. Hence, empirical therapy with standard-of-care (SOC) antibiotics could be suboptimal in these vulnerable patients. New antibiotics covering potential resistant pathogens may be considered. METHODS: We conducted a randomized non-inferiority study comparing safety and efficacy of imipenem/cilastatin/relebactam (IPM/REL), a ß-lactam/ß-lactamase inhibitor combination, with SOC antibiotics (cefepime, piperacillin/tazobactam or meropenem) in cancer patients with febrile neutropenia. Patients received at least 48 h of IV antibiotics and were assessed at end-of-IV (EOIV) therapy, test of cure (TOC; Days 21-28), and late follow-up (LFU; Days 35-42). RESULTS: A total of 100 patients were enrolled (49 IPM/REL and 50 SOC). Demographics and rates of documented microbiological infections were similar in both groups. In the SOC arm, 86% of antibiotics consisted of cefepime. Patients on IPM/REL had a higher favourable clinical response at EOIV than those on SOC (90% versus 74%; P = 0.042); however, responses were similar at TOC and LFU. Microbiological eradication was comparable at all three timepoints. Study drug-related adverse events and adverse events leading to drug discontinuation were similar in both groups, with no study drug-related mortality. CONCLUSIONS: Our results suggest that compared with SOC antibiotics, predominantly cefepime, IPM/REL for empirical coverage of febrile neutropenia in cancer patients is generally safe and could be associated with a better clinical outcome at EOIV. The current SOC consisting mainly of agents that do not cover for ESBL-producing and carbapenem-resistant Enterobacterales bacteria should be reconsidered.

Comparing Molnupiravir to Nirmatrelvir/Ritonavir (Paxlovid) in the Treatment of Mild-to-Moderate COVID-19 in Immunocompromised Cancer Patients.

BACKGROUND: Nirmatrelvir/Ritonavir has been shown to reduce the risk of COVID-19 progression by 88% compared to placebo, while Molnupiravir reduced it by 31%. However, these two agents have not been compared head-to-head. We therefore compared the safety and efficacy of both agents for the treatment of mild-to-moderate COVID-19 in immunocompromised cancer patients. METHODS: We identified 240 cancer patients diagnosed with COVID-19 and treated with Molnupiravir or Nirmatrelvir/Ritonavir. Patients were matched using a 1:2 ratio based on age group (18-64 years vs. ≥65) and type of cancer. The collected data included demographics, comorbidities, and treatment outcome. RESULTS: Both groups had comparable characteristics and presenting symptoms. However, dyspnea was more prevalent in the Molnupiravir group, while sore throat was more prevalent in the Nirmatrelvir/Ritonavir group. The rate of disease progression was comparable in both groups by univariate and multivariable analysis. Treatment with Molnupiravir versus Nirmatrelvir/Ritonavir revealed no significant difference in disease progression by multivariable analysis (adjusted OR = 1.31, 95% CI: 0.56-3.14, p = 0.70). Patients who received Nirmatrelvir/Ritonavir, however, were significantly more prone to having drug-drug interactions/adverse events (30% vs. 0%, p < 0.0001). CONCLUSIONS: In the treatment of mild-to-moderate COVID-19 in cancer patients, Molnupiravir was comparable to Nirmatrelvir/Ritonavir in preventing progression to severe disease/death and rebound events, and it had a superior safety profile.

Serum amyloid A in children and adolescents: association with overweight and carotid intima-media thickness.

OBJECTIVE: To compare serum amyloid A concentrations between overweight and eutrophic children and adolescents and to relate it to lipid profiles, glucose tolerance, and carotid intima-media thickness. METHODS: One hundred children and adolescents (mean age: 10.8±3.16 years) were included and divided into two groups: overweight and non-overweight. The following were evaluated: Z-score body mass index, carotid intima-media thickness, lipid metabolism biomarkers (lipid profile and apolipoproteins A1 and B), inflammatory biomarkers (ultra-sensitive C-reactive protein and serum amyloid A), and glucose homeostasis model assessment of insulin resistance. RESULTS: The groups were homogeneous in age, sex, and pubertal stage. Higher levels of triglycerides, apolipoprotein B, homeostasis model assessment of insulin resistance, ultrasensitive C-reactive protein, serum amyloid A, and carotid intima-media thickness were observed in the overweight group. In the multivariate analysis, age (OR=1.73; 95%CI: 1.16-2.60, p=0.007), Z-score body mass index (OR=3.76; 95%CI: 1.64-8.59, p=0.002), apolipoprotein-B (OR=1.1; 95%CI: 1.01-1.2, p=0.030), and carotid intima-media thickness (OR=5.00; 95%CI: 1.38-18.04, p=0.014) were independently associated with serum amyloid A levels above the fourth quartile of the studied sample (>9.4mg/dL). CONCLUSION: Overweight children and adolescents had higher serum amyloid A concentrations than eutrophic children. There was an independent association between higher concentrations of serum amyloid A and Z-score, body mass index, apolipoprotein B, and carotid intima-media thickness, indicating the importance of this inflammatory biomarker in identifying the early risk of atherosclerosis.

Medicine in Unplanned Mass Gatherings: A Qualitative Study of Health-Care Providers' Response and Recommendations to Beirut's Protests.

OBJECTIVE: This study aims at exploring the dynamics of health-care provision during recent unplanned public mass gatherings in Beirut, and how the health-care system adapts to mass movements in protests. METHODS: A qualitative study was conducted using semi-structured interviews with 12 health-care providers who volunteered at medical tents set during protests in Beirut, Lebanon. Responses were transcribed and coded. RESULTS: Three themes were noted: preparedness and logistics, encountered cases, and participants' proposed recommendations. In terms of preparedness and logistics, participants lacked knowledge of field medicine protocols and an organizational structure. They faced difficulties in securing equipment and advertising their services. Most encountered cases were physical injuries rather than mental health problems. The participants proposed both short-term recommendations, including advice on how to boost care provided, and long-term recommendations on structuring the health-care system to be better prepared. CONCLUSIONS: On-site health-care provision during unplanned mass gatherings is a vital need. We recommend forming a task force of health-care workers from various fields led by the Ministry of Public Health in every respective country to plan protocols, train personnel, and secure resources beforehand.

Hydroxychloroquine with azithromycin in patients hospitalized for mild and moderate COVID-19.

OBJECTIVES: To assess the efficacy of hydroxychloroquine in combination with azithromycin in terms of clinical and biochemical outcomes in adult patients with COVID-19 hospitalized for acute respiratory distress syndrome (ARDS), and to describe the occurrence of adverse events. METHOD: Retrospective comparative study, based in a quaternary private hospital in Rio de Janeiro, Brazil, involving 193 adult patients hospitalized for mild and moderate COVID-19 related ARSD, analyzing treatment efficacy based on clinical and biochemical outcomes. RESULTS: The active group comprised 101 (52.3%) patients using hydroxychloroquine associated with azithromycin and the control group 92 (47.7%) patients who did not take these medications. Median age was 59 (47-70) in the active group and 65 (47-77) in the control group (p < 0.05). Patients in the control group had greater extent of pulmonary involvement on baseline chest CT scans (p < 0.05). All other baseline variables (BMI, comorbidities, previous use of medications and biochemical assessments) were similar between groups. In the medication group, 25% (25 out of 101) were admitted to the ICU, compared to 21% (19 out of 92) in the control group (p > 0.05). No difference in mortality, duration of non-invasive oxygen use or duration of hospitalization was seen between groups. The therapeutic regimen was well tolerated, with only eight (7.9%) patients presenting gastrointestinal symptoms and eight (7.9%) patients withdrawn treatment due to QTc prolongation. CONCLUSIONS: Patients treated with hydroxychloroquine combined with azithromycin and the control group had similar clinical outcomes. This therapeutic regimen was considered ineffective in hospitalized patients with mild to moderate COVID-19 related ARDS and was associated with few non-severe adverse events.

Autologous bone-marrow mononuclear cell transplantation after acute myocardial infarction: comparison of two delivery techniques.

The objective of this study was to investigate safety and feasibility of autologous bone marrow mononuclear cells (BMMNC) transplantation in ST elevation myocardial infarction (STEMI), comparing anterograde intracoronary artery (ICA) delivery with retrograde intracoronary vein (ICV) approach. An open labeled, randomized controlled trial of 30 patients admitted with STEMI was used. Patients were enrolled if they 1) were successfully reperfused within 24 h from symptoms onset and 2) had infarct size larger than 10% of the left ventricle (LV). One hundred million BMMNC were injected in the infarct-related artery (intra-arterial group) or vein (intravenous group), 1% of which was labeled with Tc(99m)-hexamethylpropylenamineoxime. Cell distribution was evaluated 4 and 24 h after injection. Baseline MRI was performed in order to evaluate microbstruction pattern. Baseline radionuclide ventriculography was performed before cell transfer and after 3 and 6 months. All the treated patients were submitted to repeat coronary angiography after 3 months. Thirty patients (57 +/- 11 years, 70% males) were randomly assigned to ICA (n = 14), ICV (n = 10), or control (n = 6) groups. No serious adverse events related to the procedure were observed. Early and late retention of radiolabeled cells was higher in the ICA than in the ICV group, independently of microcirculation obstruction. An increase of EF was observed in the ICA group (p = 0.02) compared to baseline. Injection procedures through anterograde and retrograde approaches seem to be feasible and safe. BMMNC retention by damaged heart tissue was apparently higher when the anterograde approach was used. Further studies are required to confirm these initial data.

Lymphoscintigraphic appraisal of the lower limbs after liposuction.

BACKGROUND: The trauma resulting from liposuction damages the subcutaneous cellular tissue and subsequently the lymphatic structures. In turn, this damage can reduce lymphatic drainage, which may or may not appear clinically as some degree of edema. OBJECTIVE: It is possible to evaluate the function of the lymphatic system using lymphoscintigraphy. We conducted a study to evaluate the lymphatic system using this technique both before and after liposuction of the lower limbs. METHODS: The study included seven women ranging from 18 to 42 years of age, all of whom were diagnosed with lipodystrophy solely in the lateral and medial regions of the upper third of the thighs. This study was conducted in three stages: preoperative lymphoscintigraphy, liposuction, and postoperative lymphoscintigraphy three months postoperatively. The Wilcoxon signed-rank test was used for the statistical analysis of the results. RESULTS: A comparison of values for the average time of the radiopharmaceutical acquisition curve and clearance in the areas of lymphoscintigraphic interest both before and three months after liposuction did not reveal significant results. CONCLUSIONS: A comparison of preoperative and postoperative lymphoscintigraphic findings showed no significant damage to the lymphatic system associated with liposuction of the lower limbs.

Serum amyloid A in children and adolescents: association with overweight and carotid intima-media thickness

ABSTRACT Objective To compare serum amyloid A concentrations between overweight and eutrophic children and adolescents and to relate it to lipid profiles, glucose tolerance, and carotid intima-media thickness. Methods One hundred children and adolescents (mean age: 10.8±3.16 years) were included and divided into two groups: overweight and non-overweight. The following were evaluated: Z-score body mass index, carotid intima-media thickness, lipid metabolism biomarkers (lipid profile and apolipoproteins A1 and B), inflammatory biomarkers (ultra-sensitive C-reactive protein and serum amyloid A), and glucose homeostasis model assessment of insulin resistance. Results The groups were homogeneous in age, sex, and pubertal stage. Higher levels of triglycerides, apolipoprotein B, homeostasis model assessment of insulin resistance, ultrasensitive C-reactive protein, serum amyloid A, and carotid intima-media thickness were observed in the overweight group. In the multivariate analysis, age (OR=1.73; 95%CI: 1.16-2.60, p=0.007), Z-score body mass index (OR=3.76; 95%CI: 1.64-8.59, p=0.002), apolipoprotein-B (OR=1.1; 95%CI: 1.01-1.2, p=0.030), and carotid intima-media thickness (OR=5.00; 95%CI: 1.38-18.04, p=0.014) were independently associated with serum amyloid A levels above the fourth quartile of the studied sample (>9.4mg/dL). Conclusion Overweight children and adolescents had higher serum amyloid A concentrations than eutrophic children. There was an independent association between higher concentrations of serum amyloid A and Z-score, body mass index, apolipoprotein B, and carotid intima-media thickness, indicating the importance of this inflammatory biomarker in identifying the early risk of atherosclerosis.

Hydroxychloroquine with azithromycin in patients hospitalized for mild and moderate COVID-19

ABSTRACT Objectives: To assess the efficacy of hydroxychloroquine in combination with azithromycin in terms of clinical and biochemical outcomes in adult patients with COVID-19 hospitalized for acute respiratory distress syndrome (ARDS), and to describe the occurrence of adverse events. Method: Retrospective comparative study, based in a quaternary private hospital in Rio de Janeiro, Brazil, involving 193 adult patients hospitalized for mild and moderate COVID-19 related ARSD, analyzing treatment efficacy based on clinical and biochemical outcomes. Results: The active group comprised 101 (52.3%) patients using hydroxychloroquine associated with azithromycin and the control group 92 (47.7%) patients who did not take these medications. Median age was 59 (47-70) in the active group and 65 (47−77) in the control group (p < 0.05). Patients in the control group had greater extent of pulmonary involvement on baseline chest CT scans (p < 0.05). All other baseline variables (BMI, comorbidities, previous use of medications and biochemical assessments) were similar between groups. In the medication group, 25% (25 out of 101) were admitted to the ICU, compared to 21% (19 out of 92) in the control group (p > 0.05). No difference in mortality, duration of non-invasive oxygen use or duration of hospitalization was seen between groups. The therapeutic regimen was well tolerated, with only eight (7.9%) patients presenting gastrointestinal symptoms and eight (7.9%) patients withdrawn treatment due to QTc prolongation. Conclusions: Patients treated with hydroxychloroquine combined with azithromycin and the control group had similar clinical outcomes. This therapeutic regimen was considered ineffective in hospitalized patients with mild to moderate COVID-19 related ARDS and was associated with few non-severe adverse events.

Efficacy Evaluation of a non-human experimental model for ultrasound-guided superficial venous puncture: clinical randomized assay / Avaliação da eficácia de um modelo experimental não humano para punção venosa superficial guiada por ultrassom: ensaio clínico randomizado

INTRODUCTION: The use of a venipuncture simulator facilitates technique learning and improves skills, which reduces the risk of venipuncture complications in humans. OBJECTIVE: To evaluate the efficacy of a non-human experimental model for Ultrasound guided superficial venipuncture. METHODS: We randomized 39 nurses in two groups: A and B. The training had three steps: 1 - theoretical class, 2 - practical class, with the ultrasound device and 3 - ultrasound-guided puncture training in the non-human model. The group A participated in steps 1, 2 and 3 and group B in steps 1 and 2. After training, both groups were released for ultrasound guided venipuncture. RESULTS: The success in puncture in group A (n = 20) was 90% and in group B (n = 19) it was 68.42%. In the sum of the identification and the puncture times, the average of group A was 61.5 seconds (95% CI, 33.58; 106.95) and in group B was 148.0 seconds (95% CI, 114.54; 208.44), which was statistically significant (p = 0.007, without overlapping the interval estimates. CONCLUSION: Nurses who received training with the non-human model had better identification and puncture times.

INTRODUÇÃO: A utilização de um simulador de punção venosa, facilita o aprendizado da técnica e aprimora as habilidades, o que diminui o risco de complicações na punção venosa em humanos. OBJETIVO: Analisar a eficácia de um modelo experimental não humano para punção venosa superficial guiada por ultrassom. MÉTODO: Foram randomizados 39 enfermeiros em dois grupos: A e B. O treinamento apresentou três etapas: 1 - aula teórica, 2 - aula prática no aparelho de ultrassonografia e 3 - treinamento de punção guiada por ultrassonografia no modelo não humano. O grupo A participou das etapas 1, 2 e 3 e o grupo B das etapas 1 e 2. Após o treinamento, ambos os grupos foram liberados para punção venosa guiada por ultrassom. RESULTADOS: O sucesso na punção no grupo A (n = 20) foi de 90% e no grupo B (n = 19) foi de 68,42%. Na somatório dos tempos de identificação e de punção, a média no grupo A foi de 61,5 segundos (IC 95% 33,58; 106,95) e no grupo B de 148,0 segundos (IC95% 114,54; 208,44), o que foi estatisticamente significante (p = 0,007, sem sobreposição das estimativas intervalares. CONCLUSÃO: As enfermeiras que receberam treinamento com o modelo não humano obtiveram melhores tempos de identificação e de punção da veia.

Intracoronary stem-cell injection after myocardial infarction: microcirculation sub-study.

BACKGROUND: The injection of stem cells in the context of acute myocardial infarction (AMI) has been tested almost exclusively by anterograde intra-arterial coronary (IAC) delivery. The retrograde intravenous coronary (IVC) delivery may be an additional route. OBJECTIVE: To compare the cell distribution and retention pattern in the anterograde and retrograde routes. To investigate the role of microvascular obstruction by magnetic resonance imaging in cell retention by cardiac tissue after the injection of bone marrow mononuclear cells (BMMC) in AMI. METHODS: This was a prospective, open label, randomized study. Patients with AMI who presented: (1) successful chemical or mechanical reperfusion within 24 hours of symptom onset and (2) infarction involving more than 10% of the left ventricle (LV) at the myocardial scintigraphy were included in the study. One hundred million BMMC were injected into the infarction-related artery through IAC route, or vein through the IVC route. One percent of the injected cells were labeled with 99mTc-hexamethyl-propylene-amine-oxime (99mTc-HMPAO). Cell distribution was evaluated at 4 and 24 hours after the myocardial scintigraphy injection. Cardiac magnetic resonance imaging was performed before cell injection. RESULTS: Thirty patients were randomized into three groups. There were no serious adverse events related to the procedure. The early and late retention of labeled cells was higher in the IAC group than in IVC group, regardless of the presence of microcirculation obstruction. CONCLUSION: The injection using the retrograde approach was feasible and safe. Cell retention by cardiac tissue was higher using the anterograde approach. More studies are needed to confirm these findings.

Systolic function of patients with myocardial infarction undergoing autologous bone marrow transplantation.

BACKGROUND: Several studies have been published on the effect of bone-marrow stem cells on the left ventricle when acting on post- acute myocardial infarction remodeling. However, the results have been controversial. OBJECTIVE: To carry out an echocardiographic analysis of the systolic function of patients with acute myocardial infarction after autologous mononuclear bone marrow cell transplantation (AMBMCT) as performed via the intracoronary and intravenous routes. METHODS: This is an open-label, prospective, randomized study. INCLUSION CRITERIA: patients admitted for ST-elevation acute myocardial infarction (MI) who had undergone mechanical or chemical reperfusion within 24 hours of the onset of symptoms and whose echocardiogram showed decreased segmental wall motion and fixed perfusion defect related to the culprit artery. Autologous bone marrow was aspirated from the posterior iliac crest under sedation and analgesia of the patients randomly assigned for the treatment group. After laboratory manipulation, intracoronary or intravenous injection of 100 x 106 mononuclear cells was performed. Echocardiography (Vivid 7) was used to assess ventricular function before and three and six months after cell infusion. RESULTS: A total of 30 patients were included, 14 in the arterial group (AG), 10 in the venous group (VG), and six in the control group (CG). No statistical difference was found between the groups for the echocardiographic parameters studied. CONCLUSION: Autologous mononuclear bone marrow cell transplantation did not improve the echocardiographic parameters of systolic function.

Multicenter double blind trial of autologous bone marrow mononuclear cell transplantation through intracoronary injection post acute myocardium infarction - MiHeart/AMI study.

BACKGROUND: Myocardial infarction remains as a major cause of mortality worldwide and a high rate of survivors develop heart failure as a sequel, resulting in a high morbidity and elevated expenditures for health system resources. We have designed a multicenter trial to test for the efficacy of autologous bone marrow (ABM) mononuclear cell (MC) transplantation in this subgroup of patients. The main hypothesis to be tested is that treated patients will have a significantly higher ejection fraction (EF) improvement after 6 months than controls. METHODS: A sample of 300 patients admitted with ST elevation acute myocardial infarction (STEMI) and left ventricle (LV) systolic dysfunction, and submitted to successful mechanical or chemical recanalization of the infarct-related coronary artery will be selected for inclusion and randomized to either treated or control group in a double blind manner. The former group will receive 100 x 106 MC suspended in saline with 5% autologous serum in the culprit vessel, while the latter will receive placebo (saline with 5% autologous serum). IMPLICATIONS: Many phase I/II clinical trials using cell therapy for STEMI have been reported, demonstrating that cell transplantation is safe and may lead to better preserved LV function. Patients with high risk to develop systolic dysfunction have the potential to benefit more. Larger randomized, double blind and controlled trials to test for the efficacy of cell therapies in patients with high risk for developing heart failure are required. TRIAL REGISTER: This trial is registered at the NIH registry under the number NCT00350766.

Injeção intracoronariana de células tronco após infarto do miocárdio: subestudo da microcirculação / Intracoronary stem-cell injection after myocardial infarction: microcirculation sub-study

FUNDAMENTO: A injeção de células-tronco no contexto do infarto agudo do miocárdio (IAM) tem sido testada quase exclusivamente pela via anterógrada intra-arterial coronariana (IAC). A via retrógrada intravenosa coronariana (IVC) pode ser uma via adicional. OBJETIVO: Comparar o padrão de distribuição e retenção celular nas vias anterógrada e retrógrada. Investigar o papel da obstrução microvascular pela ressonância magnética na retenção de células pelo tecido cardíaco após a injeção de células mononucleares da medula óssea (CMMO) no IAM. MÉTODOS: Estudo prospectivo, aberto, randomizado. Foram incluídos pacientes com IAM que apresentassem: (1) reperfusão mecânica ou química com sucesso em até 24 horas do início dos sintomas e (2) infarto acometendo mais de 10 por cento da área do ventrículo esquerdo (VE) pela cintilografia miocárdica. Cem milhões de CMMO foram injetadas na artéria relacionada ao infarto pela via IAC ou veia, pela via IVC. Um por cento das células injetadas foi marcado com Tc99m-hexametil-propileno-amina-oxima(99mTc-HMPAO). A distribuição das células foi avaliada 4 e 24 horas após a injeção da cintilografia miocárdica. Ressonância magnética cardíaca foi realizada antes da injeção de células. RESULTADOS: Trinta pacientes foram distribuídos aleatoriamente em três grupos. Não houve eventos adversos graves relacionados ao procedimento. A retenção precoce e tardia das células marcadas foi maior no grupo IAC do que no grupo IVC, independentemente da presença de obstrução da microcirculação. CONCLUSÃO: A injeção pela abordagem retrógrada mostrou-se viável e segura. A retenção de células pelo tecido cardíaco foi maior pela via anterógrada. Mais estudos são necessários para confirmar esses achados.

BACKGROUND: The injection of stem cells in the context of acute myocardial infarction (AMI) has been tested almost exclusively by anterograde intra-arterial coronary (IAC) delivery. The retrograde intravenous coronary (IVC) delivery may be an additional route. OBJECTIVE: To compare the cell distribution and retention pattern in the anterograde and retrograde routes. To investigate the role of microvascular obstruction by magnetic resonance imaging in cell retention by cardiac tissue after the injection of bone marrow mononuclear cells (BMMC) in AMI. METHODS: This was a prospective, open label, randomized study. Patients with AMI who presented: (1) successful chemical or mechanical reperfusion within 24 hours of symptom onset and (2) infarction involving more than 10 percent of the left ventricle (LV) at the myocardial scintigraphy were included in the study. One hundred million BMMC were injected into the infarction-related artery through IAC route, or vein through the IVC route. One percent of the injected cells were labeled with 99mTc-hexamethyl-propylene-amine-oxime (99mTc-HMPAO). Cell distribution was evaluated at 4 and 24 hours after the myocardial scintigraphy injection. Cardiac magnetic resonance imaging was performed before cell injection. RESULTS: Thirty patients were randomized into three groups. There were no serious adverse events related to the procedure. The early and late retention of labeled cells was higher in the IAC group than in IVC group, regardless of the presence of microcirculation obstruction. CONCLUSION: The injection using the retrograde approach was feasible and safe. Cell retention by cardiac tissue was higher using the anterograde approach. More studies are needed to confirm these findings.

Função sistólica de pacientes com infarto miocárdico submetidos a transplante autólogo da medula óssea / Systolic function of patients with myocardial infarction undergoing autologous bone marrow transplantation

FUNDAMENTO: Diversos estudos foram publicados sobre a ação de células tronco da medula óssea no ventrículo esquerdo, ao atuarem no remodelamento pós-infarto agudo do miocárdio. Os resultados, no entanto, têm se mostrado controversos. OBJETIVO: Avaliar através do ecocardiograma a função sistólica de pacientes com infarto agudo do miocárdio após o Transplante Autólogo de Células Mononucleares da Medula Óssea (TACMMO) através de duas vias injeção: intracoronariana e intravenosa. MÉTODOS: Estudo aberto, prospectivo, randomizado. Foram incluídos pacientes admitidos por infarto agudo do miocárdio (IAM) com supradesnivelamento do segmento ST e submetidos à reperfusão mecânica ou química, dentro de 24 horas após o início dos sintomas, que apresentavam ao ecocardiograma redução da contratilidade segmentar e defeito fixo da perfusão relacionada à artéria culpada pelo IAM. A medula óssea autóloga foi aspirada da crista ilíaca posterior sob sedação e analgesia, nos pacientes randomizados para o grupo tratado. Após manipulação laboratorial, 100 milhões de células mononucleares foram injetadas por via intracoronariana ou intravenosa. Utilizamos o ecocardiograma (Vivid 7) para avaliar a função ventricular antes e após três e seis meses da infusão de células. RESULTADOS: Foram incluídos trinta pacientes, 14 no grupo arterial (GA), dez no grupo venoso (GV) e seis no grupo controle (GC). Não houve diferença estatística dos parâmetros ecocardiográficos estudados entre os grupos. CONCLUSÃO: O transplante autólogo de células mononucleares da medula óssea não demonstrou melhora dos parâmetros ecocardiográficos da função sistólica.

BACKGROUND: Several studies have been published on the effect of bone-marrow stem cells on the left ventricle when acting on post- acute myocardial infarction remodeling. However, the results have been controversial. OBJECTIVE: To carry out an echocardiographic analysis of the systolic function of patients with acute myocardial infarction after autologous mononuclear bone marrow cell transplantation (AMBMCT) as performed via the intracoronary and intravenous routes. METHODS: This is an open-label, prospective, randomized study. Inclusion criteria: patients admitted for ST-elevation acute myocardial infarction (MI) who had undergone mechanical or chemical reperfusion within 24 hours of the onset of symptoms and whose echocardiogram showed decreased segmental wall motion and fixed perfusion defect related to the culprit artery. Autologous bone marrow was aspirated from the posterior iliac crest under sedation and analgesia of the patients randomly assigned for the treatment group. After laboratory manipulation, intracoronary or intravenous injection of 100 x 106 mononuclear cells was performed. Echocardiography (Vivid 7) was used to assess ventricular function before and three and six months after cell infusion. RESULTS: A total of 30 patients were included, 14 in the arterial group (AG), 10 in the venous group (VG), and six in the control group (CG). No statistical difference was found between the groups for the echocardiographic parameters studied. CONCLUSION: Autologous mononuclear bone marrow cell transplantation did not improve the echocardiographic parameters of systolic function.

Avaliação linfocintilográfica dos linfedemas dos membros inferiores: correlação com achados clínicos em 34 pacientes / Lymphoscintigraphic evaluation of lower limb lymphedema: correlation with clinical findings in 34 patients

OBJETIVO: Correlacionar a localização das alterações clínicas de portadores de linfedema com as dos achados linfocintilográficos. MÉTODO: Foram avaliados 34 pacientes com linfedema dos membros inferiores atendidos no Setor de Linfologia da Disciplina de Cirurgia Vascular da Faculdade de Medicina do ABC. As linfocintilografias com imagens adquiridas em dois tempos - 20 minutos e 3 horas - foram analisadas quanto aos seguintes parâmetros: vasos linfáticos, refluxo dérmico, circulação colateral, linfonodos poplíteos e inguinais. Correlacionaram-se os resultados com a localização do edema no membro: grupo A (sem edema), grupo B (pé), grupo C (tornozelo), grupo D (perna) e grupo E (coxa). RESULTADO: A maioria das imagens linfocintilográficas apresentou anormalidades nos vasos linfáticos e linfonodos inguinais e pouca alteração em relação aos outros parâmetros. Dos 34 pacientes, 12 apresentaram linfedema unilateral clinicamente. Destes, 11 apresentaram alteração linfocintilográfica bilateral. CONCLUSÃO: A localização do linfedema ao exame físico não correspondeu, na maioria dos casos, às alterações linfocintilográficas. Em todos os grupos, as alterações linfocintilográficas ocorreram na perna e na coxa. O exame físico do membro pode estar normal e ainda assim apresentar anormalidades na linfocintilografia.

OBJECTIVE: To correlate the location of clinical alterations of patients with lymphedema with lymphoscintigraphic findings. METHOD: Thirty-four patients with lower limb lymphedema were assessed at the Service of Lymphology at the Faculdade de Medicina do ABC. The lymphoscintigraphic images were acquired at 20 minutes and 3 hours and analyzed according to the following parameters: lymphatic vessels, dermal backflow, collateral circulation, popliteal and inguinal lymph nodes. Results were correlated with the location of the edema in the limb: group A (without edema), group B (foot), group C (ankle), group D (leg), and group E (thigh). RESULT: Most lymphoscintigraphic images presented abnormalities in lymphatic vessels and inguinal lymph nodes, and few alterations concerning the other parameters. Of the 34 patients, 12 had clinically unilateral lymphedema. Of these, 11 had bilateral lymphoscintigraphic alterations. CONCLUSION: The location of the lymphedema at physical examination did not corresponded, in most cases, to the lymphoscintigraphic alterations. In all groups, the lymphoscintigraphic alterations occurred in the leg and thigh. The physical examination of the limb may be normal, even though the lymphoscintigraphy could be abnormal.

Estudo comparativo das reações teciduais ao implante de pericárdio bovino e a inclusão de politetrafluoroetileno expandido em ratos / A comparison of tissue reactions to bovine pericardial implants and expanded polytetrafluoroethylene inclusions in a rat model

OBJETIVO: Comparar a reação tecidual à inclusão de politetrafluoroetileno-expandido com a reação tecidual ao implante de pericárdio bovino. MÉTODOS: Vinte ratos foram divididos em dois grupos iguais: 7 e 30 dias. Um disco de cada material foi introduzido no dorso de cada animal. As peças e o tecido reacional foram retirados 7 e 30 dias após a introdução, para a realização do estudo morfométrico. Para análise estatística foram aplicados os testes de Mann-Whitney e Wilcoxon. RESULTADOS: No PTFE-E, no grupo 30 dias, houve um aumento significante no número de fibroblastos e uma diminuição significante no número de neutrófilos, linfócitos e apilares. Em relação ao pericárdio bovino, ocorreu uma diminuição significante no número de fibroblastos. Quando os mesmos períodos foram comparados, o número de fibroblastos foi significativamente maior no PTFE-E, aos 30 dias, assim como o número de plasmócitos e linfócitos no grupo 30 dias , no pericárdio bovino. CONCLUSÕES: A reposta inflamatória foi menor e menos durável no PTFE-E; a reparação foi menor no PTFE-E e não houve reação de corpo estranho para ambos os materiais.

Linfedema: Análise dos pacientes acompanhados no ambulatório de linfologia da disciplina de angiologia e cirurgia vascular da Faculdade de Medicina do ABC / Lymphedema: Faculdade de Medicina do ABC angiology and vascular surgery discipline patient analysis

Introdução: Linfedema é uma doença crônica decorrente da insuficiência da drenagem linfática que geralmente acomete membros e evolui com aumento do volume deste, diminuição de sua imunidade e limitação funcional. Pouco se sabe sobre a incidência do linfedema em nosso meio, bem como sua distribuição etiológica e suas formas clínicas. Objetivo: Descrever a incidência e distribuição de linfedema quanto a etiologia e as formas clínicas entre os doentes acompanhados no ambulatório de linfologia da Disciplina de Angiologia e Cirurgia Vascular da FMABC no Hospital de Ensino Padre José Anchieta. Casuística e métodos: Analisados 53 pacientes portadores de linfedema que foram classificados quanto a etiologia, o local de acometimento, o tempo de evolução da doença e sua forma clínica. Resultados: Em nossa análise, 54,71 porcento dos pacientes apresentaram linfedema primário e 45,29 porcento, secundário. A maioria apresentou acometimento dos membros inferiores (apenas 9,43 porcento de membros superiores) e grau II...

Infarto agudo do miocárdio: síndrome coronária aguda com supradesnivelamento do segmento ST - parte 2 / Acute myocardial infarction: ST elevation acute coronary syndrome: part 2

O infarto agudo do miocárdio (IAM) é uma das principais causas de mortalidade em todo o mundo. A incidência de morte por IAM era alta na década de 50. Com o surgimento das unidades de tratamento intensivo e das unidades coronarianas, essa mortalidade foi reduzida pela metade. Na década de 80 - com o início da recanalização da artéria coronária relacionada ao IAM, através do uso de fibrinolítico ou dos novos processos de intervenção percutânea - houve queda na incidência de óbitos de 6 por cento a 10 por cento. O presente artigo visa demonstrar os principais aspectos do tratamento do IAM.

Acute myocardial infarction (AMI) is a leading cause of mortality worldwide. The mortality rate for AMI had high incidence in the 50's, with the emergence of intensive Care Units and Coronary Units, mortality was reduced by half. In the 80's the early recanalization of coronary artery related to the AMI with the use of fibrinolytic and new procedures for percutaneous intervention, there was a decrease in the incidence of deaths in patients from 6 percent to 10 percent. This article aims to demonstrate the main aspects of the treatment of AMI.