General Approach to Acute Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA): A Systematic Review

Abstract Background Acute myocardial infarction (AMI) without obstructive coronary arteries (MINOCA) is a medical condition of great relevance, with clinical characteristics of AMI, but without evidence of coronary artery obstruction. The mechanism involved in the pathophysiology of the disease and its possible etiologies are important objects of study due to their impact on the morbidity and mortality of affected patients. Objectives The aim of this study was to systematically review MINOCA and its characteristics, with emphasis on the clinical profile of patients, etiology, pathophysiology, diagnosis, and treatment of the syndrome. Methods Relevant articles related to MINOCA were analyzed in the PubMed and LILACS databases. In the initial search stage, 619 eligible articles were obtained, with final inclusion criteria being: original systematic reviews with clinical, epidemiological, diagnostic, or treatment data on MINOCA, published in Portuguese or English, with an abstract, and a publication date limit of September 2020. Results A total of 10 articles classified as systematic reviews that considered clinical data on MINOCA were included in this review. Conclusion After analyzing various literature, the present study provided a tool to better understand MINOCA, not only regarding its casuistry but also in grouping parameters and information that contribute to a healthy approach to this clinical situation. It was possible to identify and better outline the clinical profile of patients who presented this condition and the use of appropriate tools for correct diagnosis and ideal treatment.

Perfil epidemiológico dos atendimentos em um serviço público de urgência oftalmológica / Epidemiological profile of visits in a public ophthalmic emergency service

Resumo Objetivo: Identificar os principais diagnósticos e características epidemiológicas dos pacientes atendidos em um serviço público de urgência oftalmológica. Métodos: Estudo transversal e retrospectivo, com análise de prontuários de 2834 pacientes atendimentos no período de julho a setembro de 2017, no serviço de Urgência Oftalmológica do Complexo Hospitalar Ouro Verde, Campinas, Brasil. As variáveis estudadas foram idade, gênero e diagnóstico. Resultados: Houve a prevalência do gênero masculino (52,6%) e da faixa etária de 30 a 59 anos (43,5%); 21,1% eram idosos. Os diagnósticos mais prevalentes foram conjuntivite infecciosa (23,9%), trauma ocular (15,7%) e doenças da superfície ocular (14,6%). Entre mulheres e crianças houve o predomínio de quadros infecciosos/inflamatórios; 83,6% dos traumas ocorreram em homens, sendo 62,2% devido a corpo estranho. Conclusão: Os diagnósticos mais prevalentes no serviço de urgência oftalmológica foram conjuntivite infecciosa e trauma ocular. Medidas de educação e prevenção são necessárias para reduzir morbidade e absenteísmo e evitar o uso inapropriado dos serviços especializados de emergência.

Abstract Objective: To identify the most frequent diagnosis and epidemiological characteristics of patients attended in a public ophthalmic emergency service. Methods: This is a retrospective and transverse study based on 2834 patients' chart attended from July to September 2017 at the Ouro Verde Hospital Complex, Campinas, Brazil. The following variables were investigated: age, gender, and diagnosis. Results: Most patients were male (52.6%) and aged between 30 to 59 years (43.5%); 21.1% were elderly. The most frequent diagnostics were conjunctivitis (23.9%), ocular trauma (15.7%), and ocular surface disorders (14.6%). Infectious/inflammatory conditions predominated among children and female; 83.6% of traumas occurred in man, and 62.2% were due to a foreign body. Conclusion: The most prevalent diagnoses in the ophthalmologic emergency department were infectious conjunctivitis and ocular trauma. Education and prevention measures are necessary to reduce morbidity and absenteeism and to avoid inappropriate use of specialized emergency services.

Causas de no trombólisis: en pacientes en ventana terapéutica con accidente cerebrovascular isquémico atendidos en Hospital Herminda Martín de Chillán / Causes of non-thrombolysis in patients in therapeutic window with ischemic stroke treated in Hospital Herminda Martín de Chillán

INTRODUCCIÓN: El ataque cerebro vascular (ACV) es una emergencia médica, que ocurre cuando se interrumpe el suministro de sangre al cerebro o cuando existe un sangrado en el cerebro. EL OBJETIVO de esta investigación fue determinar las causas de la no trombolisis en pacientes con ventana terapéutica en accidente cerebral isquémico. MATERIALES Y MÉTODOS: Se realizó un estudio descriptivo con el fin de conocer el argumento de no utilización de tratamiento trombolítico en pacientes dentro de ventana terapéutica en accidente cerebral isquémico que consultaron o fueron derivados al Hospital Clínico Herminda Martín de Chillán, desde octubre de 2017 a marzo de 2018. Se revisaron las fichas clínicas tanto de pacientes egresados vivos como fallecidos. Estas se obtuvieron del Servicio de Neurología, extrayendo la información de Datos de Atención de Urgencias (DAU) y/o ficha clínica. RESULTADOS: Una muestra de 78 pacientes cumplió con los criterios de inclusión del estudio, cuya principal causa de no trombolisis en ventana terapéutica fue presentar un puntaje en la escala de NIHSS menor a 5 puntos, representando el 20,51% del total. DISCUSIÓN: Según la literatura, los principales motivos de exclusión en este grupo de pacientes fueron los ACV con manifestaciones leves (13,1%), mejoría clínica (18,2%) y exclusiones percibidas en el protocolo (13,6%), los cuales coinciden con esta investigación, donde el principal motivo fue un puntaje de NIHSS < 5, manifestando déficit neurológico leve al ingreso. Se recomienda la inclusión del criterio de funcionalidad previa a terapia trombolítica, en este grupo de pacientes. En pacientes en ventana terapéutica con accidente cerebrovascular isquémico atendidos en Hospital Herminda Martín de Chillán.

INTRODUCTION: Vascular brain attack (CVA) is a medical emergency, which occurs when the blood supply to the brain is interrupted or when there is bleeding in the brain. The OBJECTIVE of this research was to determine the causes of non-thrombolysis in patients with therapeutic windows in ischemic stroke. MATERIALS AND METHODS: A descriptive study was carried out in order to know the argument of non-use of thrombolytic treatment in patients with therapeutic window in ischemic stroke who consulted or was referred to the Hospital Clínico Herminda Martín de Chillán Clinical, from October 2017 to March of 2018. The clinical records of both living and deceased patients were reviewed. These were obtained from the Neurology Service, extracting the information from Emergency Care Data (DAU) and / or clinical record. RESULTS: A sample of 78 patients met the inclusion criteria of the study, whose main cause of non-thrombolysis in the therapeutic window was to present a score on the NIHSS scale of less than 5 points, representing 20.51% of the total. DISCUSSION: According to the literature, the main reasons for exclusion in this group of patients were stroke with mild manifestations (13.1%), clinical improvement (18.2%) and perceived exclusions in the protocol (13.6%), which, coincide with this investigation where the main reason was an NIHSS score <5, manifesting mild neurological deficit upon admission. The inclusion of the functionality criterion prior to thrombolytic therapy is recommended in this group of patients.

Neuroactive compounds obtained from arthropod venoms as new therapeutic platforms for the treatment of neurological disorders

The impact of neurological disorders in society is growing with alarming estimations for an incidence increase in the next decades. These disorders are generally chronic and can affect individuals early during productive life, imposing real limitations on the performance of their social roles. Patients can have their independence, autonomy, freedom, self-image, and self-confidence affected. In spite of their availability, drugs for the treatment of these disorders are commonly associated with side effects, which can vary in frequency and severity. Currently, no effective cure is known. Nowadays, the biopharmaceutical research community widely recognizes arthropod venoms as a rich source of bioactive compounds, providing a plethora of possibilities for the discovery of new neuroactive compounds, opening up novel and attractive opportunities in this field. Several identified molecules with a neuropharmacological profile can act in the central nervous system on different neuronal targets, rendering them useful tools for the study of neurological disorders. In this context, this review aims to describe the current main compounds extracted from arthropod venoms for the treatment of five major existing neurological disorders: stroke, Alzheimer's disease, epilepsy, Parkinson's disease, and pathological anxiety.(AU)

Neuroactive compounds obtained from arthropod venoms as new therapeutic platforms for the treatment of neurological disorders

The impact of neurological disorders in society is growing with alarming estimations for an incidence increase in the next decades. These disorders are generally chronic and can affect individuals early during productive life, imposing real limitations on the performance of their social roles. Patients can have their independence, autonomy, freedom, self-image, and self-confidence affected. In spite of their availability, drugs for the treatment of these disorders are commonly associated with side effects, which can vary in frequency and severity. Currently, no effective cure is known. Nowadays, the biopharmaceutical research community widely recognizes arthropod venoms as a rich source of bioactive compounds, providing a plethora of possibilities for the discovery of new neuroactive compounds, opening up novel and attractive opportunities in this field. Several identified molecules with a neuropharmacological profile can act in the central nervous system on different neuronal targets, rendering them useful tools for the study of neurological disorders. In this context, this review aims to describe the current main compounds extracted from arthropod venoms for the treatment of five major existing neurological disorders: stroke, Alzheimers disease, epilepsy, Parkinsons disease, and pathological anxiety.

Análise da força de tração necessária para a remoção de cimento resinoso fixado em raízes preparadas com diferentes substâncias químicas / Analysis of the force required to remove resin cement from roots prepared with different chemicals

OBJETIVO: Avaliar in vitro, a influência das substâncias químicas utilizadas durante o preparo endodôntico na força de tração do cimento resinoso Rely-X (3M, Sumaré, Brasil) na dentina radicular bovina. MÉTODOS: Utilizou-se 72 dentes bovinos que tiveram suas coroas seccionadas e raízes padronizadas. A seguir, os espécimes foram incluídos em blocos de resina e receberam tratamento químico por 10 minutos com hipoclorito de sódio nas concentrações de 0,5 por cento, 1 por cento, 2,5 por cento, 5,25 por cento ou gel de clorexidina a 2 por cento, além do grupo-controle que recebeu água destilada. Em seguida os espécimes foram imersos em solução de EDTA a 17 por cento por 3 minutos. Dois espécimes de cada grupo foram submetidos à microscopia eletrônica de varredura para avaliação da superfície. Os espécimes para o ensaio de teste de tração receberam condicionamento com ácido fosfórico a 37 por cento por 15 segundos, sistema adesivo Single-Bond (3M, Sumaré, Brasil) e sobre este aplicado o cimento resinoso Rely-X (3M, Sumaré, Brasil). RESULTADOS: Os resultados em Kgf foram: GClorex (2,26); GNaOCl-0,5 por cento (7,92); GNaOCl-1 por cento (9,70); GNaOCl-2,5 por cento (9,05); GNaOCl-5,25 por cento (8,91); GA (0,61). CONCLUSÃO: O hipoclorito de sódio nas concentrações testadas aumentou a força de adesão do cimento resinoso na dentina de forma significativa frente água destilada e gel de clorexidina a 2 por cento. A observação na microscopia eletrônica de varredura mostrou que a estrutura de dentina radicular que fora tratada com hipoclorito de sódio apresentava túbulos dentinários com diâmetros aumentados, menor quantidade de dentina intertubular, além de áreas de depressões, diferentemente dos grupos-controle e gel de clorexidina a 2 por cento.

OBJECTIVE: This study assessed in vitro how the chemicals used in the preparation of root canals affected the force required to remove the resin cement Rely-X (3M, Sumaré, Brazil) from bovine root dentin. METHODS: The crowns of 72 bovine teeth were sectioned and the roots were standardized. The specimens were then placed in resin blocks and treated for 10 minutes with sodium hypochlorite at 0.5 percent, 1 percent, 2.5 percent or 5.25 percent or chlorhexidine gel at 2 percent. The control group was treated with distilled water. Next, the specimens were soaked in 17 percent EDTA for 3 minutes. The surfaces of two specimens from each group were assessed by electron scanning microscopy. The tested specimens were then treated with 37 percent phosphoric acid for 15 minutes, adhesive system Single-Bond (3M, Sumaré, Brazil) and the resin cement Rely-X (3M, Sumaré, Brazil) was applied over it. RESULTS: The results in Kgf were: GChlorhex (2.26); GNaOCl-0.5 percent (7.92); GNaOCl-1 percent (9.70); GNaOCl-2.5 percent (9.05); GNaOCl-5.25 percent (8.91); GA (0.61). CONCLUSION: Sodium hypochlorite in the tested concentrations increased the adhesion of the resin cement to the dentin significantly when compared with water and 2 percent chlorhexidine. Electron scanning microscopy showed that the structure of the root dentin treated with sodium hypochlorite presented widened dentinal tubules, less intertubular dentin and depression areas, all of which were not observed in the roots treated with water and 2 percent chlorhexidine gel.