Influenza vaccination strategy in acute coronary syndromes: the VIP-ACS trial.

AIMS: To evaluate whether a strategy of double-dose influenza vaccination during hospitalization for an acute coronary syndrome (ACS) compared with standard-dose outpatient vaccination (as recommended by current guidelines) would further reduce the risk of major cardiopulmonary events. METHODS AND RESULTS: Vaccination against Influenza to Prevent cardiovascular events after Acute Coronary Syndromes (VIP-ACS) was a pragmatic, randomized, multicentre, active-comparator, open-label trial with blinded outcome adjudication comparing two strategies of influenza vaccination following an ACS: double-dose quadrivalent inactivated vaccine before hospital discharge vs. standard-dose quadrivalent inactivated vaccine administered in the outpatient setting 30 days after randomization. The primary outcome was a hierarchical composite of all-cause death, myocardial infarction, stroke, unstable angina, hospitalization for heart failure, urgent coronary revascularization, and hospitalization for respiratory causes, analysed by the win ratio method. Patients were followed for 12 months. During two influenza seasons, 1801 participants were included at 25 centres in Brazil. The primary outcome was not different between groups, with 12.7% wins in-hospital double-dose vaccine group and 12.3% wins in the standard-dose vaccine group {win ratio: 1.02 [95% confidence interval (CI): 0.79-1.32], P = 0.84}. Results were consistent for the key secondary outcome, a hierarchical composite of cardiovascular death, myocardial infarction and stroke [win ratio: 0.94 (95% CI: 0.66-1.33), P = 0.72]. Time-to-first event analysis for the primary outcome showed results similar to those of the main analysis [hazard ratio 0.97 (95% CI: 0.75-1.24), P = 0.79]. Adverse events were infrequent and did not differ between groups. CONCLUSION: Among patients hospitalized with an ACS, double-dose influenza vaccination before discharge did not reduce cardiopulmonary outcomes compared with standard-dose vaccination in the outpatient setting. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov number: NCT04001504.

Joint Theoretical and Experimental Study on the La Doping Process in In2O3: Phase Transition and Electrocatalytic Activity.

In2O3 and La3+-doped In2O3 nanostructures were synthesized through a facile and fast chemical route based on the microwave-assisted hydrothermal method combined with rapid thermal treatment in a microwave oven. The presence of the La3+ doping process modifies the size and morphology of the In2O3 nanostructures and also stabilizes the rhombohedral (rh) In2O3 phase with respect to the most stable cubic (bcc) polymorph. X-ray diffraction (XRD) patterns and Rietveld refinements, Raman, UV-vis, and energy dispersive X-ray (EDX) spectroscopies, transmission electron (TEM) and field-emission scanning electron (FE-SEM) microscopies, as well as PL emissions have been performed. To complement and rationalize the experimental results, first-principle calculations, based on density functional theory, are carried out to obtain the formation energies of the In2O3 and bcc- and rh-In2O3-doped phases, their geometry and electronic properties. Theoretical results are able to explain the relative stabilization of the rh-phase with respect to the bcc-phase based on the analysis geometry changes and the electronic redistribution induced by the La3+ doping process. In addition, Wulff construction is employed to match the theoretical and experimental morphologies of the cubic phase. The synthesized samples were applied for the O2 evolution reaction (OER). The La3+-doped In2O3 film presents superior electrocatalytic activity, with an onset potential lower than the undoped In2O3 film that can be associated with the increase in electron density caused by the La3+ doping process. This study provides a versatile strategy for obtaining In2O3 and La3+-doped In2O3 nanostructures for practical applications.

A comparison study of cleanup techniques for oil spill treatment using magnetic nanomaterials.

Magnetic nanoparticles have been successfully used to recovery oil from oil spilled on water. Two different methods, floating and vortex, were employed to promote the interaction of four oil samples with different API (e.g., 10, 20, 28 and 45) spilled on seawater and deionized water with three magnetic materials, namely: magnetite nanoparticles (N); magnetic nanocomposites of yeast biomass provided by ethanol industry (Y); and magnetic nanocomposites of cork powder (C). The magnetic nanomaterials exposed to oil on water were taking out by a neodymium magnet, and the oil recoveries were determined by gravimetric analysis before and after lyophilization. The lyophilization was determinant to guarantee the accuracy of the experiments, and without this step, the masses of oil recovered would be overestimated due to the drag of water during the oil and magnetic material removal process. Three main factors, API, contact method and magnetic material, and two interactions (i.e., API × contact method, and contact method × magnetic material) presented a statistically significant effect on oil recovery. It was observed that oil recovery increases as API decreases, and it was possible to establish a model to predict the amount of recovered oil according to this effect. Higher oil recoveries were also obtained by magnetic nanocomposites of yeast biomass (Y), regardless of the contact method and type of water, recoveries of 23% and 100% for 45 and 10 API, respectively, employing around 20 mg of Y on 300 mg of spilled oil. These percentages correspond to 0.29 ±â€¯0.01 kg/kg and 15.98 kg/kg of recovering oil by the magnetic procedure. The increase of mass of magnetic material improved the recovery of oils with higher APIs. The reusability of the spent materials presents potential for its application in oil spill cleaning technologies.

Cytogenetic evaluation of tannery workers in the city of Teresina, northeastern Brazil.

Assessments of chromosomal integrity and structure enable the prevention of diseases associated with the work environment, with the frequencies of chromosomal aberrations and micronuclei often being used as markers in biomonitoring. Owing to their routine manipulation of potentially toxic chemicals, tannery workers as a group merit a more thorough evaluation and discussion. This study investigated chromosomal damage in 30 workers from a tannery in the city of Teresina, the state capital of Piauí, northeast Brazil, and a control group consisting of 30 employees from a nearby accounting firm. The frequencies of chromosomal aberrations (CAs) and binucleated cell micronuclei (MN) were assessed as a measure of damage. Means were compared using the Student t-test and ANOVA-Dunnett test. Our results indicated a higher number of CAs in exposed individuals compared to the control group, including dicentric (P < 0.0001) and tricentric chromosomes (P < 0.001), and those in ring (P < 0.0001) and acentric ring forms (P < 0.001). Assessment of MN frequency demonstrated a similar trend (exposed vs control, P < 0.0001). It was concluded that the tannery workers in this study exhibited a higher incidence of genetic damage than comparable unexposed individuals. However, further research on this subject is needed, particularly in regard to potentially clastogenic agents used in the tanning process.

In-Hospital influenza vaccination to prevent cardiorespiratory events in the first 45 days after acute coronary syndrome: A prespecified analysis of the VIP-ACS trial.

BACKGROUND: Influenza vaccination prevents major cardiovascular events in individuals presenting a recent acute coronary syndrome (ACS), however the early effect of an in-hospital double-dose vaccination strategy remains uncertain. METHODS: The VIP-ACS was a randomized, pragmatic, multicenter, open-label trial with a blinded-adjudication endpoint. Patients with ACS ≤ 7 days of hospitalization were randomized to an in-hospital double-dose quadrivalent inactivated influenza vaccine (double-dose) or a standard-dose influenza vaccine at 30 days post-randomization. The primary endpoint was a hierarchical composite of death, myocardial infarction, stroke, hospitalization for unstable angina, hospitalization for heart failure, urgent coronary revascularization, and hospitalization for respiratory infections, analyzed with the win ratio (WR) method in short-term follow-up (45-days after randomization). RESULTS: The trial enrolled 1,801 patients (≥18 years old). Median participant age was 57 years, 70 % were male. There were no significant differences between groups on the primary hierarchical endpoint: there were 5.7 % wins in the double-dose in-hospital group and 5.5 % wins in the standard-dose delayed vaccination group (WR: 1.03; 95 % CI: 0.70---1.53; P = 0.85). In a sensitivity analysis including COVID-19 infection in the hospitalizations for respiratory infections endpoint, overall results were maintained (WR: 1.03; 95 % CI 0.71---1.51; P = 0.87). Results were consistent for major cardiovascular events only (WR: 0.82; 95 % CI: 0.48---1.39; P = 0.46). No serious adverse events were observed. CONCLUSION: In patients with recent ACS, in-hospital double-dose influenza vaccination did not significantly reduce cardiorespiratory events at 45 days compared with standard-dose vaccination at 30 days post-randomization.

Maize resistance to witchweed through changes in strigolactone biosynthesis.

Maize (Zea mays) is a major staple crop in Africa, where its yield and the livelihood of millions are compromised by the parasitic witchweed Striga. Germination of Striga is induced by strigolactones exuded from maize roots into the rhizosphere. In a maize germplasm collection, we identified two strigolactones, zealactol and zealactonoic acid, which stimulate less Striga germination than the major maize strigolactone, zealactone. We then showed that a single cytochrome P450, ZmCYP706C37, catalyzes a series of oxidative steps in the maize-strigolactone biosynthetic pathway. Reduction in activity of this enzyme and two others involved in the pathway, ZmMAX1b and ZmCLAMT1, can change strigolactone composition and reduce Striga germination and infection. These results offer prospects for breeding Striga-resistant maize.

Spondylodiscitis in hemodialysis patients: a case series.

BACKGROUND: Although bacterial spondylodiscitis is one of the most serious complications in hemodialysis patients, it is often underdiagnosed, and few reports describe its course and clinical management. PATIENTS AND METHODS: We retrospectively reviewed 11 hemodialysis patients diagnosed with spondylodiscitis, during a 5-year period, and compared them with the general population followed at our center. Nine patients presented with fever on admission. Blood cultures were positive in all patients and Staphylococcus aureus was identified in 8. Ten patients had a central venous catheter as access for hemodialysis and the number of vascular accesses in the patients´ medical history was superior to the rest of our HD population. RESULTS: Four patients (36%) died during follow-up. None of the patients that underwent vancomycin and gentamicin antibiotic therapy died. CONCLUSION: Bacterial spondylodiscitis must be suspected whenever a patient on hemodialysis is admitted with fever and/or back pain. The presence of a central venous catheter and a history of multiple vascular accesses may be important risk factors. Prolonged antibiotic therapy with initial broad-spectrum coverage seems to be the best therapeutic approach.

Primary endometrial B-cell lymphoma: case report.

The female genital tract is usually involved with lymphoma as part of disseminated disease. Primary lymphoid neoplasms of the female genital tract are rare; the frequency was reported to be 2% among extranodal lymphomas in women. Most of the time, primary female genital tract lymphoma occurs in the ovary and cervix, whereas endometrial lymphoma is extremely rare. The case of an 89-year-old patient that presented with postmenopausal bleeding is reported. An endometrial polypoid formation was found on hysteroscopic examination and the biopsy revealed a diffuse large B-cell lymphoma. Total abdominal hysterectomy and bilateral salpingo-oophorectomy were surgically performed. The histologic diagnosis was primary diffuse large B-cell lymphoma of the endometrium. Adjuvant therapy was not performed. Five months after initial diagnosis, the patient died. Only a few case reports of primary endometrial lymphoma have been published; therefore, information concerning etiologic factors, histologic type, treatment and prognosis is limited.

Effect of pre-treatment and supporting media on Ni(II), Cu(II), Al(III) and Fe(III) sorption by plant root material.

In this work Paspalum notatum root material was used to elucidate the influence of acid leaching pre-treatment and of sorption medium on metal adsorption. Ground P. notatum root was leached with 0.14M HNO(3). Leached root material (LRM) and non-leached root material (NLRM) were employed to flow sorption of Ni(II), Cu(II), Al(III) and Fe(III) in 0.5M CH(3)COONH(4) medium at pH 6.5. For LRM the sorption was also studied in 0.5M KNO(3) medium. The acid pre-treatment increased the sorption capacity (SC) for all ions studied. For the KNO(3) medium, Cu(II) and Fe(III) sorption was higher than in CH(3)COONH(4) and the type of the Ni(II) isotherm's model changed. The Freundlich model was the most representative isotherm model to describe metallic ions sorption. The (1)H NMR spectra showed differences between LRM and NLRM and the acid-basic potentiometric titration elucidated that acid-leaching procedure affected the root material sorption sites once only two predominant sorption sites were found for LRM (phenolic and amine, both able cations sorption) and five sorption sites (two carboxylic, amine and two phenolic) were founded for NLRM.

Detection of axillary metastases in breast cancer patients using ultrasound and colour Doppler combined with fine needle aspiration cytology.

The aims of this study were to evaluate the diagnostic value of ultrasonography and colour Doppler combined with fine needle aspiration (FNA) cytology for the detection of non-palpable axillary lymph node metastases in breast cancer patients. Forty patients with operable breast cancer (T1/T2), invasive carcinoma, not submitted to neo-adjuvant therapy, underwent axillary ultrasonography and colour Doppler preoperatively. FNA cytology was performed on axillary lymph nodes presenting ultrasonographic and/or Doppler suspicious features. A total of 542 lymph nodes were surgically removed from the 40 patients; 19 were metastatic lymph nodes. Ultrasound-guided FNA detected metastases in six out of 11 histologically node-positive patients. Sensitivity and specificity in this preliminary study was 55% and 100%, respectively. These are the preliminary results of a prospective study that has the purpose of reducing the sentinel node procedures in breast cancer patients with clinically negative axillae, but positive FNA cytology.

[Concentrations of serum cholesterol in Spanish children: results of a study on the isle of Menorca]. / Concentraciones de colesterol sérico en los niños españoles: resultados del estudio en la isla de Menorca.

BACKGROUND: The little knowledge about the distribution of total cholesterol (TC) in childhood and adolescence in Spain, makes the planification of preventive measures for cardiovascular diseases difficult. The aim of this study is to determinate these values in the island of Menorca. METHODS: A sample of 1,062 boys and girls 6 to 18 years of age was studied. Blood samples were obtained by venipuncture and were analyzed by the enzymatic techniques of cholesterol-esterase, cholesterol-oxidase, and peroxidase. RESULTS: Boys showed lower mean TC values than girls in almost all age groups. In both sexes, a descending phase was observed in the TC by age curve at the beginning of the adolescence. TC values above 5.17 mmol/l (200 mg/dl) were recorded for 7% of participants, being this proportion lower than the value found in the Spanish study of Fuenlabrada (13%). CONCLUSIONS: Results obtained are compared with other national and international studies. The values of this study rank an intermediate position between the highest mean TC values registered in Norway and the lowest registered in Israel.

[Duchenne muscular dystrophy in a girl with chromosomal translocation]. / Distrofia muscular de Duchenne em menina com translocação cromossômica.

It is reported the case of an 8-year-old girl with clinical and laboratory findings suggestive of Duchenne muscular dystrophy who had a chromosome translocation involving the X chromosome, 46,X,t(Bp+,Xq-). A review about Duchenne muscular dystrophy in females is made, with emphasis about chromosome abnormalities, mainly chromosome translocations.

[Third ventricle meningioma in a child: case report]. / Meningioma do terceiro ventrículo na infância: relato de caso.

Meningiomas in childhood are rare, and those located in the third ventricle are even rarer, with only 16 cases reported. A five-year-old girl was seen at our hospital with headache and bilateral papilledema. CT scan showed a large third ventricular mass and associated hydrocephalus. Transcallosal interfornical approach was performed with total removal of the tumor, that was attached to the choroid plexus of the anterior third ventricle. Histologically the lesion proved to be a transitional meningioma. The recovery was uneventful, a permanent shunt was not necessary. The diagnosis of these tumors can be done using CT scan or MRI, that usually are sufficient for surgical planning. Angiography usually is not required, unless a vascular lesion is concerned, or embolization is necessary. The treatment of these tumors is surgical, aiming the total removal of the lesion, usually curative once it is acomplished. We report this case, and add a brief review of the literature on third ventricle meningiomas.

[Tethered spinal cord syndrome: report of 2 cases]. / Síndrome da medula presa: registro de dois casos.

The tethered spinal cord syndrome is a disease that is part of the group of spinal dysraphisms, that was recently recognized as an individualized nosological entity, yet not frequently diagnosed among us. It is characterized by shortening and thickening of the filum terminale which prevents the ascent of the spinal cord into spinal canal, the conus medularis abnormally remaining in a low place. It is associated in all cases with spina bifida. The diagnosis is simple, once the disease is suspected. It is manifested by progressive motor or sensory deficit in the legs, urinary incontinence, scoliosis and leg or back pain, specially in young children. The plain lumbosacral RX always shows spina bifida. Myelography makes the diagnostic. It shows, basically, the negative image of the thickened filum terminale and the low placed conus medularis. Other exams which can help are the computerized tomography and the ultra-sound of the spinal cord. The surgical treatment is very simple and heals without sequels if done in due time. It consists in a sectioning of the filum terminale through laminectomy. Two cases diagnosed and treated at Hospital da Baleia, from Fundação Benjamin Guimarãcs, Belo Horizonte, are reported in this paper.

[Unusual association of Kallmann syndrome and arachnoid cyst of the middle fossa. Report of a case]. / Associação singular de síndrome de Kallmann e cisto aracnóide da fossa média. Relato de caso.

Hypogonadotrophic hypogonadism can result from different abnormalities in the central nervous system. The clinical picture depends upon the time of onset the deficiency, the magnitude of the gonadotropins deficiency and whether there are other pituitary hormone deficiencies as well. We report on a 18-year-old boy, who was investigated because of pubertal and growth delay. He also had learning disabilities. On physical examination he exhibited mild eunuchoid aspect, 162 cm height (z score = 2.17), pubertal development on stage G II, P II, and 4 cm3 testis. Laboratory investigation revealed pre-pubertal levels of testosterone and normal results of the combined test of anterior pituitary function, except for in GnRH acute and prolonged test. Brain CT showed an arachnoid cyst on left middle fossa with expansion to suprasellar cisterna. He was diagnosed as having hypogonadotrophic hypogonadism secondary to compression by the cyst, and a cyst-peritoneal derivation was performed. After surgery there was no improvement of the pubertal state and bilateral anosmia was discovered, so Kallmann's syndrome was then diagnosed and was confirmed by MRI, even though the hormonal results are not totally matched with the referred syndrome. We did not find in the literature any description of the association between Kallmann's syndrome and arachnoid cyst and we believe that in this case the results of the hormonal measurement may be due to such association that provoked an additional hypophysis dysfunction.

Changes in mandible and femur proteoglycans. Physico-chemical properties after hydrocortisone treatment.

Male Wistar rats were injected with 5 mg/kg/day of hydrocortisone during 21 days. Femur and mandible proteoglycans (PG) were isolated and their physico-chemical properties were compared with bone PG from a control and a starved group. The PG molecular weight decreased as a result of the hydrocortisone treatment but to a lower degree than in starvation, whereas the PG density seemed to be more affected by corticosteroid injection. These results allow us to conclude that bone alterations found after glucosteroid treatment may be due--at least partially--to changes in the PG physico-chemical properties of that tissue.

[Emotional intelligence: testing the future nursing]. / Inteligência emocional: testando a enfermagem do futuro.

This study traces the nursing students' profile in order to have a prospective professional vision on the emotional intelligence of these workers. Considering that, nowadays, emotional intelligence is a basic requirement for any kind of profession, this research analysed patterns of cognitive, behavioral and emotional skills among the nursing workers. This is a descriptive exploratory study, accomplished in a public institution in the city of Fortaleza-CE, with 138 students enrolled in the first term of 1999. For this analyses an emotional intelligence questionnaire, available in internet, was applied. The subjects also answered questions related to their behavioral, cognitive and emotional skills. As a result, it was concluded that the majority of the students (78.26%) presented a satisfying level of emotional intelligence and only 16.67% would need improvement. In the classification of the three skills as sufficient, regular and insufficient, the cognitive skill exceeded the other two positively. The research showed that students have the basic characteristics of emotional intelligence. They can be in tune and understanding with patients, and also make themselves understood.

Diabetes and exercise in the elderly.

Type 2 diabetes mellitus is highly prevalent among the elderly. Age-associated changes in body composition, obesity and sedentary behavior are some of the main factors responsible for the increased prevalence of diabetes in this population. Elderly patients experience important and specific issues, including the association of comorbidities and geriatric syndromes, use of many medications, the presence of dependencies and frailty. Physical activity has been shown to be as effective for the treatment of diabetes in the elderly as in younger patients, so that its practice must be strongly encouraged. Resistive activities are preferable for the frail and vulnerable diabetic elderly. Aerobic activities should be prescribed whenever possible, and the association of both modalities is the best choice. Moderate- to high-intensity exercises are more effective for glycemic control and, unlike previously thought, are generally safe for the elderly population. The frequency of exercising should be at least 3 days/week for aerobic and 2 days/week for resistance activities. Balance exercises may be beneficial in special situations. In the elderly patient, special care must be taken for: the presence of contraindications for the practice of each exercise modality; the interactions and limitations imposed by medications, chronic comorbidities and geriatric syndromes; the higher possibility of developing hypoglycemia, especially if insulin is used for treatment, and the prevention of orthostatic hypotension that may be worsened by dehydration. The prescription of exercises tailored for each patient's preferences and limitations is highly effective not only for glycemic control, but also for improving independence, self-esteem and quality of life.

Antifungal activity of the naphthoquinone beta-lapachone against disseminated infection with Cryptococcus neoformans var. neoformans in dexamethasone-immunosuppressed Swiss mice.

The in vivo antifungal activity of the naphthoquinone beta-lapachone against disseminated infection by Cryptococcus neoformans was investigated. Swiss mice were immunosuppressed daily with dexamethasone (0.5 mg per mouse) intraperitoneally for 3 days, the procedure was repeated 4 days later, and the animals were then challenged intravenously with C. neoformans (10(6) CFU/mL) 1 week later. Seven days after infection, the mice were divided into groups and treated daily with beta-lapachone (10 mg/kg, iv) for 7 (N = 6) and 14 days (N = 10). Amphotericin B (0.5 mg/kg) was used as comparator drug and an additional group received PBS. Treatment with beta-lapachone cleared the yeast from the spleen and liver, and the fungal burden decreased approximately 10(4) times in the lungs and brain 14 days after infection when compared to the PBS group (P < 0.05). This result was similar to that of the amphotericin B-treated group. Protection was suggestively due to in vivo antifungal activity of this drug and apparently not influenced by activation of the immune response, due to similar leukocyte cell counts among all groups. This study highlights the prospective use of beta-lapachone for treatment of disseminated cryptococcosis.