Pregnancy Arrhythmias: Management in the Emergency Department and Critical Care.

Pregnancy is closely associated with an elevated risk of arrhythmias, constituting the predominant cardiovascular complication during this period. Pregnancy may induce the exacerbation of previously controlled arrhythmias and, in some instances, arrhythmias may present for the first time in pregnancy. The most important proarrhythmic mechanisms during pregnancy are the atrial and ventricular stretching, coupled with increased sympathetic activity. Notably, arrhythmias, particularly those originating in the ventricles, heighten the likelihood of syncope, increasing the potential for sudden cardiac death. The effective management of arrhythmias during the peripartum period requires a comprehensive, multidisciplinary approach from the prepartum to the postpartum period. The administration of antiarrhythmic drugs during pregnancy necessitates meticulous attention to potential alterations in pharmacokinetics attributable to maternal physiological changes, as well as the potential for fetal adverse effects. Electric cardioversion is a safe and effective intervention during pregnancy and should be performed immediately in patients with hemodynamic instability. This review discusses the pathophysiology of arrythmias in pregnancy and their management.

Geriatric Population Triage: The Risk of Real-Life Over- and Under-Triage in an Overcrowded ED: 4- and 5-Level Triage Systems Compared: The CREONTE (Crowding and R E Organization National TriagE) Study.

Elderly patients, when they present to the emergency department (ED) or are admitted to the hospital, are at higher risk of adverse outcomes such as higher mortality and longer hospital stays. This is mainly due to their age and their increased fragility. In order to minimize this already increased risk, adequate triage is of foremost importance for fragile geriatric (>75 years old) patients who present to the ED. The admissions of elderly patients from 1 January 2014 to 31 December 2020 were examined, taking into consideration the presence of two different triage systems, a 4-level (4LT) and a 5-level (5LT) triage system. This study analyzes the difference in wait times and under- (UT) and over-triage (OT) in geriatric and general populations with two different triage models. Another outcome of this study was the analysis of the impact of crowding and its variables on the triage system during the COVID-19 pandemic. A total of 423,257 ED presentations were included. An increase in admissions of geriatric, more fragile, and seriously ill individuals was observed, and a progressive increase in crowding was simultaneously detected. Geriatric patients, when presenting to the emergency department, are subject to the problems of UT and OT in both a 4LT system and a 5LT system. Several indicators and variables of crowding increased, with a net increase in throughput and output factors, notably the length of stay (LOS), exit block, boarding, and processing times. This in turn led to an increase in wait times and an increase in UT in the geriatric population. It has indeed been shown that an increase in crowding results in an increased risk of UT, and this is especially true for 4LT compared to 5LT systems. When observing the pandemic period, an increase in admissions of older and more serious patients was observed. However, in the pandemic period, a general reduction in waiting times was observed, as well as an increase in crowding indices and intrahospital mortality. This study demonstrates how introducing a 5LT system enables better flow and patient care in an ED. Avoiding UT of geriatric patients, however, remains a challenge in EDs.

Innovative systems for cultural heritage conservation. Millimeter wave application for non-invasive monitoring and treatment of works of art.

A novel non invasive technique and a suitable apparatus for disinfestation of artworks is introduced. Non destructive and non invasive techniques are often irreplaceable in order to preserve and restore cultural heritage objects in its structure and shape. Although many techniques are available for art and archaeological works the non invasive methods are preferred as they leave the object untouched after treatment. Environmental parameters, such as humidity, can damage culture heritage objects and also results in spring up variety of pests and other micro-organisms. Non-invasive monitoring of these damage and also disinfestation treatments and drying with help of electromagnetic waves are preferred as they keep the object untouched after treatment. Application of millimeter waves for solving this problem is discussed here. Millimeter waves have high spatial resolution and absorption in water as well as in bio-objects that are usually moist and at the same time minimal interaction with dry culture heritage objects by itself. Different phases of the microwaves treatment (MW) of artworks are described, some results are shown and discussed. Many biological forms don't survive over a certain temperature, called lethal temperature which, for most xylophages is about 53-55 degrees C, while for moulds and funguses is between 65 and 70 degrees C. In order to evaluate the management of disinfestation of works of art, incident power, temperature, exposure time were monitored. The monitoring of temperature is essential in order to prevent damages. A computer simulation allows to predict and monitor the heating process.

Catheter ablation of atrial fibrillation in patients with diabetes mellitus type 2: results from a randomized study comparing pulmonary vein isolation versus antiarrhythmic drug therapy.

INTRODUCTION: Atrial fibrillation (AF) and diabetes mellitus type 2 (DM2) often coexist; however, a small number of patients with DM2 undergoing catheter ablation (CA) of AF have been included in previous studies. The aim of this study was to evaluate safety and efficacy of ablation therapy in DM2 patients with drug refractory AF. METHODS AND RESULTS: From January 2005 to September 2006, 70 patients with a diagnosis of DM2 and paroxysmal (n = 29) or persistent (n = 41) AF were randomized to receive either pulmonary vein isolation or a new antiarrhythmic drug treatment (ADT) with a 1-year follow-up. The primary endpoint was the time to first AF recurrence. By Kaplan-Meier analysis, at the end of follow-up, 42.9% of patients in the ADT group and 80% of patients who received a single ablation procedure and were without medications were free of AF (P = 0.001). In the ablation group, a significant improvement in quality-of-life (QoL) scores as compared with ADT group was observed. Six patients in the ADT group (17.1%) developed significant adverse drug effects. Hospitalization rate during follow-up was higher in the ADT group (P = 0.01). The only complication attributable to ablation was one significant access-site hematoma. CONCLUSION: In patients with DM2, CA of AF provides significant clinical benefits over the ADT and appears to be a reasonable approach regarding feasibility, effectiveness, and low procedural risk.

MW pallets disinfestations.

Wood packaging represents a pathway for the introduction and spread of pests. In March 2002, the Food and Agriculture Organization (F.A.O.) issued regulations describing globally approved phytosanitary measures that significantly reduce the risk provoked by most pests. The main purpose of this work is to describe the disinfesting system of pallets through microwave treatment.

Multislice computed tomography in an asymptomatic high-risk population.

Approximately 50% of all acute coronary syndromes occur in previously asymptomatic patients. This study evaluated the value of multislice computed tomography for early detection of significant coronary artery disease (CAD) in high-risk asymptomatic subjects. One hundred sixty-eight asymptomatic subjects with >or=1 major risk factor (hypertension, diabetes, hypercholesterolemia, family history, or smoking) and an inconclusive or unfeasible noninvasive stress test result (stress electrocardiography, echocardiography, or nuclear scintigraphy) were evaluated in an outpatient setting. After clinical examination and laboratory risk analysis, all patients underwent multislice computed tomographic (MSCT) coronary angiography within 1 week. In all subjects, conventional coronary angiography was also carried out. Multislice computed tomography displayed single-vessel CAD in 16% of patients, 2-vessel CAD in 7%, and 3-vessel CAD in 4%. Selective coronary angiography confirmed the results of multislice computed tomography in 99% of all patients. Sensitivity and specificity of MSCT coronary angiography were 100% and 98%, respectively, with a positive predictive value of 95% and a negative predictive value of 100%. In conclusion, MSCT coronary angiography is an excellent noninvasive technique for early identification of significant CAD in high-risk asymptomatic patients with inconclusive or unfeasible noninvasive stress test results.

Vascular, metabolic, and inflammatory abnormalities in normoglycemic offspring of patients with type 2 diabetes mellitus.

Endothelial dysfunction, insulin resistance, and elevated levels of circulating proinflammatory markers are among the earliest detectable abnormalities in people at risk for atherosclerosis. Accelerated atherosclerosis is a leading contributor to morbidity and mortality in type 2 diabetes mellitus, a complex genetic disorder. Therefore, we hypothesized that normoglycemic offspring of patients with type 2 diabetes mellitus (NOPD) may have impaired vascular and metabolic function related to an enhanced proinflammatory state. We compared NOPD (n = 51) with matched healthy control subjects without family history of diabetes (n = 35). Flow- and nitroglycerin-mediated brachial artery vasodilation were assessed by ultrasound to evaluate endothelium-dependent and -independent vascular function. Each subject also underwent an oral glucose tolerance test to evaluate metabolic function. Fasting levels of plasma adiponectin and circulating markers of inflammation (high-sensitivity C-reactive protein, CD40 ligand, interleukin 1beta, tumor necrosis factor alpha, vascular cell adhesion molecule 1, and intracellular adhesion molecule) were measured. Both NOPD and the control group had fasting glucose and insulin levels well within the reference range. However, results from oral glucose tolerance test and quantitative insulin sensitivity check index revealed that NOPD were insulin resistant with significantly impaired flow- and nitroglycerin-mediated dilation compared with the control group. Adiponectin levels were lower, whereas many circulating markers of inflammation were higher, in NOPD compared with the control group. Normoglycemic offspring of patients with type 2 diabetes mellitus have impaired vascular and metabolic function accompanied by an enhanced proinflammatory state that may contribute to their increased risk of diabetes and its vascular complications.

Composite model for DNA torsion dynamics.

DNA torsion dynamics is essential in the transcription process; a simple model for it, in reasonable agreement with experimental observations, has been proposed by Yakushevich (Y) and developed by several authors; in this, the nucleotides (the DNA subunits made of a sugar-phosphate group and the attached nitrogen base) are described by a single degree of freedom. In this paper we propose and investigate, both analytically and numerically, a "composite" version of the Y model, in which the sugar-phosphate group and the base are described by separate degrees of freedom. The model proposed here contains as a particular case the Y model and shares with it many features and results, but represents an improvement from both the conceptual and the phenomenological point of view. It provides a more realistic description of DNA and possibly a justification for the use of models which consider the DNA chain as uniform. It shows that the existence of solitons is a generic feature of the underlying nonlinear dynamics and is to a large extent independent of the detailed modeling of DNA. The model we consider supports solitonic solutions, qualitatively and quantitatively very similar to the Y solitons, in a fully realistic range of all the physical parameters characterizing the DNA.

Distribution and prognostic significance of QT intervals in the lowest half centile in 12,012 apparently healthy persons.

The presence of an abnormally short QT interval has been noted among survivors of idiopathic ventricular fibrillation and among close relatives of victims of unexplained sudden death. Most reported cases have had rate-corrected QT (QTc) intervals of <300 ms. The prevalence of such values in the community has not been documented. We reviewed the electrocardiograms (ECGs) of 12,012 subjects who underwent routine medical examinations for occupational reasons. The QT interval was measured by 2 physicians in all cases, and QTc interval was calculated. All ECGs with QTc values in the lowest 5% were reviewed by 2 cardiologists expert in QT analysis, and the QT measurement was corrected if necessary. Information about subsequent survival was obtained from the case file or from public records. In the lowest 1/2 centile, the distribution of QTc values continued to follow a normal pattern without evidence of a distinct subpopulation of low values. The shortest QTc encountered was 335 ms. Information about subsequent survival was available for 36 of the 60 subjects with the lowest 1/2 centile of QTc values. None of these subjects died during the 7.9 +/- 4.5 years subsequent to the ECG that demonstrated the short QT interval. In conclusion, a QTc interval of

Decreased plasma adiponectin concentration in major depression.

Adiponectin is the most abundant adipose-derived plasma protein. Recently adiponectin levels have been linked to most variables of metabolic syndrome and conventional risk factors for cardiovascular disease. However, its relation with major depression is yet unclear. We evaluated plasma adiponectin levels in 32 first-episode drug-naïve major depression (DSM-IV-TR) patients without conventional risk factors for cardiovascular disease and 32 matched healthy subjects. Major depression patients displayed lower adiponectin plasma levels compared to controls (P<0.01). Adiponectin significantly correlated with depression severity, as assessed by HAM-D (rho=0.83, P<0.001). This study shows decreased plasma adiponectin concentrations in major depression patients and relates adiponectinemia reduction to major depression severity.

A realistic model for the analysis of heart magnetic stimulation.

The aim of the paper is the development of an accurate numerical model to compute the current density flowing through the heart of a virtual human body, and induced by an external electric or magnetic excitation. The model has been experimentally validated and then applied to investigate the main characteristics of the heart magnetic stimulation. This has been carried out by comparing the current density induced in the cardiac region by an external magnetic pulse with the corresponding quantity due to the more traditional electric source. Magnetic stimulation is studied because it offers some advantages: in fact, compared with the electrical stimulation, this technique is contactless and might allow the stimulation of a dressed patient. The design constraint of the whole system is represented by the current density, whose waveform and intensity are a compromise between the strength of the magnetic induction field and the pulse rise time.

Correlations between personality factors and coronary artery disease: from type A behaviour pattern to type D personality.

During the last 50 years, many studies have analysed the correlations between personality factors, behavioural pattern, personality type, psychiatric disorders and coronary artery disease (CAD). Although consistent evidence of causal association between CAD and major depressive disorders does exist, the role and importance of personality factors and character traits in CAD development and manifestations are still debatable. We reported the most important studies from the literature on type A behaviour pattern (TABP), the first correlated to CAD. After the initial enthusiasms, large clinical trials raised doubts about the role of TABP as CAD risk factor. We reported subsequent researches aimed at extracting from TABP components predisposing to atherosclerosis, such as hostility and anger. Finally, we analysed a recent personality type (type D) introduced in 1995 and identified as a negative prognostic factor in CAD patients.

Gender-related differences in catheter ablation of atrial fibrillation.

AIMS: Women have an increased risk for atrial fibrillation (AF)-related complications and there is evidence towards a reduced efficacy of the rhythm control strategy than men. A catheter-based strategy is therefore widely attractive, but the impact of gender on catheter ablation (CA) of AF remains undefined. METHODS AND RESULTS: We included 221 consecutive patients (150 men) who underwent CA of drug-refractory AF. Gender differences in clinical presentation and outcomes were compared. Women were older (P = 0.002), had a longer history of AF (P = 0.04), and were more likely to have hypertension (P = 0.04). Moreover, a concomitant valvular heart disease tended to be more common in women (32.4 vs. 23.3%; P = 0.28) and left atrium dimensions were significantly larger (P = 0.003). However, acute success rate and complications rate were similar between genders. After 22.5 +/- 11.8 months of follow-up, the overall freedom from arrhythmia recurrences was similar (83.1 vs. 82.7% in men), and a similar improvement in SF-36 quality of life scores was achieved in both groups. CONCLUSION: Women are referred for AF ablation later with a more complex clinical pre-operative presentation. Despite this higher risk profile in women, no differences were detected in clinical outcomes. Our findings indicate that CA of AF appears to be safe and effective in women as in men.

Association between enhanced soluble CD40 ligand and proinflammatory and prothrombotic states in major depressive disorder: pilot observations on the effects of selective serotonin reuptake inhibitor therapy.

OBJECTIVE: Major depressive disorder (MDD) is associated with low-grade inflammation, and it is considered a risk factor for coronary artery disease (CAD). CD40 ligand (CD40L) plays an important role in inflammation, platelet activation, and clotting system activation. We investigated soluble CD40L (sCD40L) expression in MDD and assessed whether it may represent a molecular mechanism that links inflammation and a prothrombotic state and whether this condition may be modified by selective serotonin reuptake inhibitor (SSRI) therapy. METHOD: Levels of sCD40L, interleukin-1beta (IL-1beta), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), soluble P-selectin (sP-selectin), activated factor VII (FVIIa), and prothrombin fragment 1+2 (F1+2) were measured in 46 drug-naïve, first-episode MDD patients without conventional CAD risk factors and in 46 matched healthy controls. Participants were screened between March 2002 and November 2005. Twenty of the 46 MDD patients were then randomly assigned to either sertraline 100 mg/day (N = 10) or citalopram 20 mg/day (N = 10); the aforementioned variables were measured at baseline and after 6 weeks of treatment. RESULTS: Compared with control subjects, MDD patients had higher baseline levels of sCD40L, IL-1beta, IL-6, TNF-alpha, sP-selectin, FVIIa, and F1+2. In the clinical group, sCD40L levels, HAM-D total scores, and proinflammatory markers were strongly intercorrelated. In contrast, there were no significant correlations in the control group. Mood improvement achieved with SSRI therapy was associated with significant reduction in sCD40L, proinflammatory markers, and prothrombotic markers expression. (All p values < .0001.) CONCLUSIONS: This pilot study shows that CD40/ CD40L pathway up-regulation in MDD patients relates increased levels of sCD40L to a prothrombotic state and, preliminarily, indicates that SSRI therapy may significantly reduce sCD40L and CD40L levels associated with proinflammatory and prothrombotic states.

Plasma ghrelin in anorexia, bulimia, and binge-eating disorder: relations with eating patterns and circulating concentrations of cortisol and thyroid hormones.

The present study was designed to investigate the relations between plasma ghrelin concentrations, eating patterns, and circulating concentrations of cortisol and thyroid hormones in women with anorexia nervosa, bulimia nervosa, and binge-eating disorder. The patterns of disordered eating behavior were assessed using the Eating Attitudes Test (EAT-26) and the Bulimia Test-Revised (BULIT-R). In women with eating disorders, but not in healthy control women, plasma ghrelin concentrations were negatively correlated with body mass index (BMI) and plasma concentrations of thyreotropin (TSH), free T3 and free T4, and positively correlated with plasma concentrations of cortisol. The ghrelin concentrations of women with binge-eating and purging behavior were significantly lower than those of women with anorexia nervosa, restricting type, and there was a negative relation between the frequency and severity of binge-eating and purging behavior, as measured by the BULIT-R total score, and ghrelin concentrations. In a multivariate regression model controlling for the confounding effects of body mass index (BMI) and age, higher ghrelin concentrations were correlated with lower BULIT-R total scores. The results of this study did not confirm the hypothesis advanced in previous studies that ghrelin concentrations are higher in patients with binge-eating/purging forms of eating disorders. Based on these data, we suggest that, in women with eating disorders, ghrelin concentrations best reflect nutritional status rather than specific patterns of disordered eating behavior.

Expressão de iNOS, COX-2, GLUT1, e Nitrotirosina como biomarcadores preditivos da evolução do adenocarcinoma prostático em pacientes com margens positivas pós-prostatectomia radical / Expression of iNOS, COX-2, GLUT1, and nitrotirosina as predictive biomarkers from progression of prostatic adenocarcinoma in patients with positive surgical margins post-radical prostatectomy

Apesar dos bem estabelecidos parâmetros clínicos, cirúrgicos e anatomopatológicos utilizados na atualidade para podermos predizer a evolução para recidiva bioquímica do adenocarcinoma da próstata, após seu tratamento cirúrgico, sobretudo quando da presença de margens cirúrgicas positivas, análises imunoistoquímicas tem se revelado importantes ferramentas para apoiar a indicação de tratamentos adjuvantes precocemente ou não com base na expressão de determinados marcadores que sinalizam a agressividade do tumor. O iNOS (sintase do óxido nítrico induzível) sintetiza óxido nítrico (NO) que tem importante papel no crescimento tumoral e na angiogênese, como também influencia a citotoxicidade de macrófagos e a imunosupressão induzida pelo tumor, sendo um marcador muito encontrado em células do adenocarcinoma da próstata diferenciando este de tecido benigno. A COX-2 que tem produção estimulada pelo NO, também tem sido associada a diversas neoplasias por sua ação angiogênica e no processo da inflamação, sendo estudada como via alvo terapêutico. O GLUT1 é um ativo transportador de glicose expressado em tecidos normais e expresso em altos níveis em numerosos tumores, sendo um marcador intrínseco e mediador de hipóxia reduzindo a fosforilação oxidativa e agindo na via de sinalização oxigênio-dependente através do fator de hipóxia induzida (HIF-1). A Nitrotirosina é um produto da nitração da tirosina mediado por espécies reativas do nitrogênio, tais como o ânion peroxinitrito e o dióxido de nitrogênio, sendo detectado em condições patológicas como em neoplasias sendo considerado marcador de estresse oxidativo dependente de NO. Os objetivos deste trabalho foram avaliar as expressões desses marcadores em espécimes cirúrgicos de próstatas com adenocarcinoma e avaliar suas relações com o prognóstico pós-prostatectomia radical em pacientes com margens cirúrgicas positivas, fator este considerado na literatura como significativo para recidiva bioquímica. Foram analisados...

In spite of the well-established clinical, surgical and anatomopathological parameters currently used to allow us to predict the evolution to biochemical recurrence of adenocarcinoma of the prostate, after its surgical treatment, especially when in the presence of positive surgical margins, immunohistochemical tests have become very important tools to support the indication of adjuvant therapies, either precociously or not, based on the expression of certain markers that signalize the tumor’s aggressiveness. The iNOS (inducible nitric oxide synthase) synthesizes nitric oxide (NO) which plays an important role in the tumor’s growth and in the angiogenesis, affecting as well the macrophages cytotoxicity and the tumor-induced immunosuppression, being a marker very commonly found in prostate adenocarcinoma cells, thus differentiating this from a benign hyperplasia. The COX-2, which production is stimulated by the NO, has also been associated to various neoplasias due to its angiogenic action and to its influence on the inflammation process as well, being then studied as a therapeutic target via. The GLUT1 is an active glucose transporter expressed in normal tissues and expressed at high levels in numerous tumors, playing the role as intrinsic and mediator hypoxia marker, reducing oxidative phosphorylation and acting on the oxygen-dependent signalizing via through hypoxia inducible factor (HIF-1). Nitrotyrosine is a product of tyrosine nitration mediated by reactive nitrogen species such as peroxynitrite anion and nitrogen dioxide, being detected in pathological conditions such as in neoplasias, thus being considered a marker of NO-dependent oxidative stress. The objectives of this work were to evaluate the expressions of those markers in surgical specimens of prostates with adenocarcinoma, as well as to evaluate their relation with prognosis after radical prostatectomy in patients with positive surgical margins, factor which has been considered...

Oviposition by Schistosoma mansoni during "in vitro" cultivation

A ovoposicao "in vitro" do Schistosoma mansoni durante o cultivo de vermes adultos, durante um periodo de 10 dias mostrou que a cinetica da ovoposicao apresenta caracteristicamente 3 fases bem distintas. Uma fase inicial com baixa producao de ovos, um periodo de maxima ovoposicao e finalmente uma progressiva queda no numero de ovos nas fases tardias do cultivo. A cinetica da ovoposicao, bem como o numero de ovos depositados pelos parasitas nao influenciados pelo numero de casais pela quantidade de meio RPMI 1640, como tambem pelo tempo de desenvolvimento do parasita no interior do hospedeiro vertebrado e finalmente pelo tipo de soro utilizado no meio de cultivo

Effects of Goyazensolide during in vitro cultivation of Schistosoma mansoni

Goyazensolide, a component extracted of Eremanthus goyazensis showed a significant inhibitory effect on egg-laying of Schistosoma mansoni during in vitro cultivation of this parasite. Motility of the worms was also reduced under treatment with goyazensolide and 90 per cent of mortality was reached with concentration up to 4 µg/ml. It has found that separated worms were more susceptible than worms pairing during drug exposition and female alone was significantly more susceptible than male worm in the same conditions of in vitro cultivation. Natural products isolated from plants represent potencial sources for the identification of structures useful for the design of alternative molecules to be used as new drug substances against several infectious deseases.

Aspectos imunologicos do sistema enzimatico fenoloxidase de Schistosoma mansoni / Immunological aspects of the phenol oxidase enzymatic system of Schistosoma mansoni

O sistema enzimatico fenoloxidase (EC1.10.3.1, EC1.10.3.2) esta amplamente distribuido entre os seres vivos, tendo sido descrito em diferentes especies do reino animal e vegetal. Apesar de desempenhar um papel fundamental na formacao da capsula ou parede dos ovos de trematodeos, o sistema enzimatico fenoloxidase (PO) tem sido pouco estudado nesses organismos. No presente trabalho sao apresentados os resultados iniciais de imunizacoes de coelhos contra PO de femeas adultas de S. mansoni e tirosinase de cogumelo (Sigma). As analises imunologicas, realizadas atraves de imunodifusao dupla (teste de Ouchterlony) e imunoeletroforese, revelaram identidade imunitaria parcial entre PO de machos e femeas....