ABSTRACT
ABSTRACT Introduction: In patients undergoing coronary artery bypass grafting (CABG), stroke is a major complication that increases morbidity and mortality. The presence of carotid stenosis (CS) increases risk of stroke, and the optimal treatment remains uncertain due to the lack of randomized clinical trials. The aim of this study is to compare three management approaches to CS in patients submitted to CABG. Methods: From 2005 to 2015, 79 consecutive patients with significant CS submitted to CABG were retrospectively evaluated. Patients were divided in three groups, according to CS treatment: 17 underwent staged carotid endarterectomy (CEA)-CABG, 26 underwent synchronous CEA-CABG, and 36 underwent isolated CABG without carotid intervention. The primary outcomes were composed by 30-day postoperative acute myocardial infarction (MI), 30-day postoperative stroke, and death due to all causes during the follow-up. Results: Patients were evaluated during an average 2.05 years (95% confidence interval = 1.51-2.60) of follow-up. Major adverse cardiac events, including death, postoperative MI, and postoperative stroke, occurred in 76.5% of the staged group, 34.6% of the synchronous group, and 33.3% of the isolated CABG group (P=0.007). As for MI, the rates were 29.4%, 3.85%, and 11.1% (P=0.045), respectively. There was no statistically significant difference in total mortality rates (35.3%, 30.8%, and 25.0%, respectively; P=0,72) and stroke (29.4%, 7.7%, and 8.3%, respectively; P=0,064) between groups. Conclusion: Staged CEA-CABG is associated with higher major adverse cardiac events and MI rate when compared to the strategy of synchronous and isolated CABG, but without statistically difference in total mortality during the entire follow-up.
ABSTRACT
O objetivo deste trabalho foi avaliar a qualidade microbiológica de farinha e fécula durante as diferentes etapas do processamento de mandioca, em unidades tradicionais e em uma unidade modelo. Foram determinados índices de coliformes totais e termotolerantes, Bacillus cereus, Salmonela spp., bactérias e fungos nas farinhas e féculas. Não foram observadas presenças de B. cereus e Salmonella spp. na farinha e fécula de mandioca produzidas nas unidades estudadas. A incidência microbiana diminui com o avanço da etapa do processamento para obtenção de farinha e foi menor na unidade modelo. Após o processo de torra, a carga microbiana estava de acordo com os valores preconizados pela legislação brasileira, concluindo-se que essa etapa pode ser considerada como crítica na obtenção de farinha. Na obtenção de fécula, a carga microbiana nas unidades tradicionais são maiores que na modelo, e o aumento do número de extrações promove o aumento da incidência de microrganismos, sendo recomendadas apenas quatro extrações.
The objective of this research was to evaluate microbiological contamination in the flour and starch during cassava processing in traditional and model units. The total and fecal coliforms indexes, Bacillus cereus, Salmonella, bacteria, yeast and fungi were determined. Bacillus cereus and Salmonella were not detected in any sample. The incidence of microorganisms decreased along the processing to obtain cassava flour, and is lower in model unit. After the roasting process, the microbial load was below the values established by the Brazilian legislation, and can be regarded as a critical step in obtaining cassava flour. Concerning starch production, the microbial load in the traditional units was higher than in the model units, and the increase of the extraction steps has promoted the growth of microorganisms. It's recommended the used of only 4 extractions.