Outcomes and management of ST-Elevation myocardial infarction patients before and during the COVID-19 pandemic: A retrospective cohort study

Background@#Ischemic heart disease is the leading cause of mortality and morbidity worldwide. The COVID-19 pandemic changed healthcare-seeking behavior and healthcare delivery.@*Methods@#This is a single-center, retrospective cohort study using a non-probability sampling of adult patients at the Philippine Heart Center who were diagnosed with ACS-STEMI. Baseline characteristics, clinical profile, management plan, and outcomes of patients were determined and analyzed in both periods.@*Results@#170 STEMI patients during each period were included in the study. The mean time for the onset of symptoms to consult was 8 hours in both periods. Majority of STEMI patient had undergone primary PCI in both periods. There is a significant decline in the number of patients undergoing primary PCI during the COVID 19 period (n=116, 68%). Fibrinolysis was performed more during the COVID 19 pandemic (n=9, 5%) and none in the pre-COVID 19 period. There was a statistically significant delay in the door-to-wiring time during the pandemic. Composite outcome was significantly higher during this time with 42 patients (25%, p=0.029). Composite outcomes were also higher in STEMI patients with COVID-19 infection (OR 1.9, 95% CI 1.0989 - 3.2960, p=0.022).@*Conclusion@#The study confirmed that there was an increase in the rate of fibrinolysis and medical therapy alone during the COVID-19 period. There was also a significant delay in the door-to-wiring time as well as an increase in composite outcomes during the COVID-19 pandemic.

Exploring the Feasibility of Machine Learning to Predict Risk Stratification Within 3 Months in Chest Pain Patients with Suspected NSTE-ACS / 生物医学与环境科学（英文）

OBJECTIVE@#We aimed to assess the feasibility and superiority of machine learning (ML) methods to predict the risk of Major Adverse Cardiovascular Events (MACEs) in chest pain patients with NSTE-ACS.@*METHODS@#Enrolled chest pain patients were from two centers, Beijing Anzhen Emergency Chest Pain Center Beijing Bo'ai Hospital, China Rehabilitation Research Center. Five classifiers were used to develop ML models. Accuracy, Precision, Recall, F-Measure and AUC were used to assess the model performance and prediction effect compared with HEART risk scoring system. Ultimately, ML model constructed by Naïve Bayes was employed to predict the occurrence of MACEs.@*RESULTS@#According to learning metrics, ML models constructed by different classifiers were superior over HEART (History, ECG, Age, Risk factors, & Troponin) scoring system when predicting acute myocardial infarction (AMI) and all-cause death. However, according to ROC curves and AUC, ML model constructed by different classifiers performed better than HEART scoring system only in prediction for AMI. Among the five ML algorithms, Linear support vector machine (SVC), Naïve Bayes and Logistic regression classifiers stood out with all Accuracy, Precision, Recall and F-Measure from 0.8 to 1.0 for predicting any event, AMI, revascularization and all-cause death ( vs. HEART ≤ 0.78), with AUC from 0.88 to 0.98 for predicting any event, AMI and revascularization ( vs. HEART ≤ 0.85). ML model developed by Naïve Bayes predicted that suspected acute coronary syndrome (ACS), abnormal electrocardiogram (ECG), elevated hs-cTn I, sex and smoking were risk factors of MACEs.@*CONCLUSION@#Compared with HEART risk scoring system, the superiority of ML method was demonstrated when employing Linear SVC classifier, Naïve Bayes and Logistic. ML method could be a promising method to predict MACEs in chest pain patients with NSTE-ACS.

Rotablation in complex ACS versus Non-ACS patients: Prospective follow up study from tertiary care centre in North India

The purpose of this study is to compare short term outcome of rotablation in ACS versus non-ACS patients. 60 Consecutive patients who underwent rotational atherectomy were followed prospectively. The mean duration of follow up was 13.05 ± 5.2 months. The mean ejection fraction was 52.41% ± 9.4%. 45% patients had diagnosis of CSA and 55% were ACS. The mean syntax score was 29.23 ± 7.99. LAD was the most common vessel treated by RA in 76.6%. Rotablation of LM was done in 30%. IVUS guided procedure was done in 66.7%. RA can be done with comparable safety and success in both non-ACS and ACS patients

Comparison of Serum Homocysteine and Highly Sensitive C- reactive protein Levels in Patients of Acute Coronary Syndrome with and without Type-2 Diabetes

Background: The association of high serum homocysteine concentration and C- reactive protein as a risk factor for the acute coronary syndrome. The aim of study was to evaluate serum homocysteine and hs-CRP level in newly diagnosed ACS patients together with comparison of homocysteine and hs-CRP level in ACS patients with & without type 2 diabetes and also to find out the correlation between serum homocysteine and hs- CRP level among the ACS patient with and without type 2 DM.Material & Methods:This was a cross sectional study and total of 260 patients with new onset of ACS admitted in the CCU, Department of Cardiology, DMCH were included in the study during Jan, 2011 to Feb, 2012. Among them 72 ACS patients with type 2 diabetes was considered as group I and 188 ACS patients without diabetes was considered as group II. Serum total homocysteine level, hs-CRP level and traditional risk factors for ACS were documented from all the study population.Results:Most of the patients were found in 4th decade in both groups. Acute STEMI was more common clinical feature in both groups. The mean serum homocysteine level in all groups of ACS patients were significantly higher in patients without DM in comparison to type 2 DM. Similarly, the mean hs-CRP level in all groups of ACS patients were significantly higher in patients without type 2 DM. The mean serum homocysteine and hs-CRP level were significantly higher in nondiabetic ACS patients. However, dyslipidaemia was significantly higher in patients with type 2 DM. Hypertension, obesity and family history of ACS were not significant between two groups. There was no correlation found between serum homocysteine with serum hs-CRP in ACS patients with type 2 DM and ACS patients without DM respectively.Conclusion: So, both serum homocysteine and hs-CRP level in ACS patients were significantly higher in patients without DM. In ACS, C-reactive protein elevation was a better marker of extension of myocardial damage than homocyesteine. No correlation was found between serum homocysteine with hs-CRP level in ACS patients with and without type 2 DM respectively.

Correlation analysis of serum NT-pro-BNP and Lp-PLA2 levels with the severity of coronary artery lesions in patients with acute coronary syndrome and type 2 diabetes mellitus / 中华内分泌外科杂志

Objective:To investigate the correlation between serum N-terminal pro-brain natriuretic peptide (NT-pro-BNP) and lipoprotein phospholipase A2 (Lp-PLA2) levels and the severity of coronary artery lesions in patients with acute coronary syndrome (ACS) complicated with type 2 diabetes mellitus (T2DM) .Methods:A total of 68 patients with ACS and T2DM who were admitted to our hospital from Jun. 2018 to Oct. 2020 were selected as the experimental group, and the control group was 52 patients with simple ACS. The serum NT-pro-BNP and Lp-PLA2 levels of the two groups of patients were detected, and the correlation between the serum NT-pro-BNP and Lp-PLA2 levels and the degree of coronary artery disease in patients with ACS complicated with T2DM was analyzed to screen for ACS complicated with T2DM. Influencing factors of moderate to severe coronary artery disease in diabetic patients were selected.Results:The serum levels of NT-pro-BNP[ (349.18±45.98 vs 235.68±26.37) ] ng/L and Lp-PLA2 [ (421.84±55.84 vs 318.62±36.69) ] ng/mL in the experimental group were higher than those in the control group ( P<0.05) . The levels of serum NT-pro-BNP [ (374.35±39.42 vs 320.88±35.41) ] ng/L and Lp-PLA2 [ (452.67±48.32 vs 387.16±40.45) ]ng/mL in the moderate-severe group were higher than those in the mild group ( P<0.05) . Serum NT-pro-BNP and Lp-PLA2 levels were positively correlated with the severity of coronary artery lesions in patients with ACS and T2DM ( r=-0.585, P=0.000; r=-0.595, P=0.000) . Serum NT-pro-BNP and Lp-PLA2 were risk factors for moderate to severe coronary artery disease in patients with ACS complicated with T2DM ( P<0.05) . Conclusion:Serum levels of NT-pro-BNP and Lp-PLA2 in patients with ACS complicated with type 2 diabetes mellitus are related to the degree of coronary artery disease.

Two Cases of Combined Performance of Endovascular Aortic Aneurysm Repair (EVAR) and Off-Pump Coronary Artery Bypass Grafting (OPCAB) / 日本心臓血管外科学会雑誌

Concomitant occurrence of coronary arterial disease (CAD) with abdominal aortic aneurysm (AAA) is not rare. Combined performance of open surgery (OS) of AAA repair and coronary arterial bypass grafting (CABG) has been reported to be effective as the way to avoid the risk of rupture of the aneurysm and acute coronary syndrome (ACS), while it's highly invasive. We successfully performed a combination performance of endovascular aneurysm repair (EVAR) and off-pump CABG (OPCAB) with the support of an intra-aortic balloon pump (IABP) in 2 cases with AAA and unstable angina pectoris (UAP). It was suggested that this strategy is a reasonable clinical option for the patient with UAP complicated with large AAA.

Correlação entre suporte social percebido e conflito trabalho-família em agentes comunitários de saúde / Correlation between perceived social support and work-family conflict in community health agents / Correlación entre apoyo social percibido y conflicto trabajo-familia en ACS

Este estudo tem como objetivo avaliar se existe correlação entre conflito trabalho-família e suporte social percebido em Agentes Comunitários de Saúde (ACS). Ademais, este é um estudo transversal e correlacional com delineamento quantitativo, em que foram ocupadas a Escala Multidimensional de Conflito Trabalho-Família (EMCT-F) e a Escala de Percepção de Suporte Social (2-Way SSS). Os participantes da pesquisa foram 139 ACS atuantes em quatro municípios do interior do Rio Grande do Sul. Para a análise dos dados, foram utilizadas a Estatística Descritiva, Estatística Paramétrica e Correlação de Pearson. Os resultados entre as correlações das escalas foram estatisticamente significativos (p<0,05) nos fatores dar suporte emocional e conflito família-trabalho, e receber suporte instrumental e conflito família trabalho. Assim, o estudo permitiu compreender melhor a relação entre as variáveis destacadas, sendo que esse entendimento poderá subsidiar intervenções baseadas na Psicologia Positiva para os ACS.(AU)

This study aimed to assess whether there is a correlation between work-family conflict and perceived social support in Community Health Agents (CHA). Moreover, this is a cross-sectional and correlational study with quantitative design, in which the Multidimensional Work-Family Conflict Scale (MWFCS) and the 2-Way Social Support Scale (2-Way SSS) were used. The participants in this study were 139 CHA workers in four municipalities in the interior of Rio Grande do Sul. Descriptive Statistics, Parametric Statistics, and Pearson Correlation were used to analyze the data. The results between the correlations of the scales were statistically significant (p<0.05) in the factors give emotional support and work family conflict, and receive instrumental support and work family conflict. Therefore, the study allowed us to better understand the relationship between the variables highlighted, and this understanding may support interventions based on Positive Psychology for the CHA.(AU)

El presente estudio tuvo como objetivo evaluar si existe correlación entre conflicto trabajo-familia y apoyo social percibido en trabajadores Agentes Comunitarios de Salud. Además, este es un estudio transversal y correlacional con delineamiento cuantitativo, en que fueron empleadas la Escala Multidimensional de Conflicto Trabajo-Familia (EMCT-F) y la Escala de Percepción de Suporte Social (2-Way SSS). Los participantes de este estudio fueron 139 trabajadores que actúan como agentes comunitarios de salud (ACS) en cuatro municipios del interior de Rio Grande do Sul. Para el análisis de los datos fueron empleadas la Estadística Descriptiva, Estadística Paramétrica y Correlación de Pearson. Los resultados entre las correlaciones de las escalas fueron estadísticamente significativos (p<0,05) en los factores dar apoyo emocional y conflicto familia trabajo y recibir apoyo instrumental y conflicto familia trabajo. Por tanto, el estudio permitió comprender mejor la relación entre las variables destacadas, siendo que ese entendimiento podrá subsidiar intervenciones basadas en la Psicología Positiva para los ACS.(AU)

A Study Of Platelet Indices And Angiographic Profile In Patients With Acute Coronary Syndrome

Background:ISCHEMIC HEART DISEASES continues to be a major public health problem becoming an increasingly important problem in developing countries constitutes around 12.8% of total deaths (7.2 million).Objectives:To evaluate the clinical course of ACS patient’s admitted to KIMS HUBLI ICCU. Material & Methods:Patients admitting to ICCU KIMS, HUBLI diagnosed as Acute Coronary Syndrome.The study included 156 patients admitted to ICCU KIMS Hubli who diagnosed as ACUTE CORONORY SYNDROME. Results:There wassignificant difference in the platelet indices betweenthe three groups. The platelet Indices -mean platelet volume, platelet distribution width and platicrit were significantly higher in STEMI and NSTEMI groups when compared to the USA group and severity of CAD more in patients who were having higher platelet indices. Conclusion:The platelet indices: mean platelet volume (MPV), platelet distribution width (PDW) and platecrit are significantly higher in STEMI and NSTEMI groups when compared to USA group.

The influence of the gut microbiota on the bioavailability of oral drugs

Due to its safety, convenience, low cost and good compliance, oral administration attracts lots of attention. However, the efficacy of many oral drugs is limited to their unsatisfactory bioavailability in the gastrointestinal tract. One of the critical and most overlooked factors is the symbiotic gut microbiota that can modulate the bioavailability of oral drugs by participating in the biotransformation of oral drugs, influencing the drug transport process and altering some gastrointestinal properties. In this review, we summarized the existing research investigating the possible relationship between the gut microbiota and the bioavailability of oral drugs, which may provide great ideas and useful instructions for the design of novel drug delivery systems or the achievement of personalized medicine.

The clinical profile of patients with intracerebral hemorrhage after receiving acute coronary syndrome regimen in a tertiary hospital: A case series

@#Coronary heart disease, which includes acute coronary syndromes (ACS) is a major cause of death and morbidity. Treatment for this condition includes dual anti-platelet treatment combined with an anti-coagulant and an anti-dyslipidemic. Bleeding complications may occur and one fatal adverse event is intracerebral hemorrhage (ICH). ACS cases in a tertiary hospital for the years 2014-2018 showed that there were 7 patients who presented with symptomatic ICH after treatment administration that accounts for 0.01% of a total of 1,097 patients. These patients were over the age of 50, but with no sex predilection. Common comorbidities were hypertension and malignancy. All patients presented with acute onset neurologic deficits within 1-4 days after administration of ACS regimen, with ICH scores of 3-4 signifying a high mortality rate of 72-90%. 6 out 7 patients had significant volume of ICH with mass effects, and 1 with subarachnoid hemorrhage. This lead to poor outcome in all patients with 6 out of 7 mortalities and 1 left with substantial disability. It was found that given the total number of patients administered with the said treatment, there is a low incidence of ICH.

Construction of acetyl-CoA and DBAT hybrid metabolic pathway for acetylation of 10-deacetylbaccatin III to baccatin III

10-Deacetylbaccatin III (10-DAB) C10 acetylation is an indispensable procedure for Taxol semi-synthesis, which often requires harsh conditions. 10-Deacetylbaccatin III-10-

Clinical depression among patients after acute coronary syndrome: a prospective single-tertiary centre analysis

INTRODUCTION@#Clinical depression is a known consequence of acute coronary syndrome (ACS) and is associated with an adverse outcome among these patients, although this is often under-recognised. Through this study, we investigated the incidence of depression in post-ACS patients and its associated factors.@*METHODS@#We conducted a prospective cohort study in 95 patients with ACS admitted to University Malaya Medical Centre, Malaysia. Clinical depression was assessed during the index admission and at 30 days after discharge, using the Patient Health Questionnaire-9 (PHQ-9). Data was analysed using IBM SPSS Statistics, and binary logistic regression was used to determine the independent factors associated with depression, after adjusting for significant demographic variables and clinical characteristics. The strength of this association was presented as odds ratio and 95% confidence interval, and the significance level was set at 0.05.@*RESULTS@#The mean age of the study population was about 60 years, and 72.6% of the patients were male. Symptoms of depression were present in 88.4% of the patients at baseline. Depression at 30 days was more likely in female patients, patients with diabetes mellitus and patients on dialysis (p = 0.024, p < 0.001, p = 0.008, respectively). Patients with baseline moderate to severe depression were more likely to have moderate to severe depression at 30 days (p < 0.001). Baseline depression was the strongest predictor of depression at 30 days. An increment of one unit in PHQ-9 baseline score increased the risk of developing severe depression at 30 days by 31%.@*CONCLUSION@#Depression was prevalent in our post-ACS patients. The associated factors were female gender, diabetes mellitus and dialysis treatment.

Acortamiento en la relación Tp-f/QTc tras angioplastia en pacientes con síndrome isquémico coronario agudo / Shortening in the Tp-e/QTc ratio after angioplasty in patients with acute coronary syndrome

Resumen Objetivo: La dispersión transmural de la repolarización ventricular (DTMRV) es un factor de riesgo para muerte en pacientes con síndrome isquémico coronario agudo (SICA). Con el objetivo de conocer el efecto de la realización de angioplastia sobre la DTMRV, se estudió la relación Tp-f/QTc en pacientes con SICA sometidos a angioplastia. Método: Se diseñó un estudio observacional, retrospectivo y descriptivo. Se incluyeron 150 pacientes (N = 150) con diagnóstico de SICA. Se valoró la relación Tp-f/QTc inicial y se evaluó su acortamiento posangioplastia. Como objetivo secundario, se comparó la asociación de dichos cambios en la relación Tp-f/QTc con la mortalidad cardiovascular y los eventos adversos cardiovasculares. Resultados: El promedio en la relación Tp-f/QTc inicial fue de 0.2529, mientras que posangioplastia fue de 0.2397. Por medio de prueba de rangos de Wilcoxon se evidenció un descenso significativo en la relación Tp-f/QTc posterior a la angioplastia, con un valor Z de −2.051 y una p < 0.04. En el análisis secundario se encontró que una Tp-f/QTc ≥ 0.29 posangioplastia es factor de riesgo para presentación de los siguientes eventos adversos: muerte intrahospitalaria (7.4 vs 0%; p < 0.003), nuevo SICA en seguimiento a 1 año (25.9 vs. 18.5%; p < 0.006) y reintervención en seguimiento a 1 año (29.6 vs. 15.0%; p < 0.002). Conclusiones: Existe un acortamiento significativo en la relación Tp-f/QTc posangioplastia en pacientes con SICA. Esta medida de la DTMRV puede servir como un predictor de muerte intrahospitalaria, eventos cardiovasculares y reintervención a 1 año en pacientes con SICA tratados con angioplastia.

Abstract Objective: Transmural Dispersion of Repolarization (TDR) is a Risk factor for Death in patients with Acute Coronary Syndrome (ACS). In order to know the effect of angioplasty on TDR, the Tp-e/QTc ratio was studied in patients with ACS undergoing angioplasty. Method: An observational, retrospective and descriptive study was designed. 150 patients (N = 150) with diagnosis of ACS were included. The initial Tp-e/QTc ratio was assessed and then its post-angioplasty shortening was evaluated. As a secondary objective, we compared the association of these Tp-e/QTc ratio changes with cardiovascular mortality and cardiovascular adverse events. Results: The average in the initial Tp-e/QTc ratio was 0.2529, while post-angioplasty was 0.2397. Through a Wilcoxon rage test, a significant decrease in the Tp-e/QTc ratio after angioplasty was observed, with a Z value of −2.051 and p < 0.04. In the secondary analysis, it was found that a Tp-e/QTc ≥ 0.29 post-angioplasty is a risk factor for presenting the following adverse events: in-hospital death (7.4 vs. 0%; p < 0.003), new ACS in 1-year follow-up (25.9 vs. 18.5%; p < 0.006), and reintervention in 1-year follow up (29.6 vs. 15%; p < 0.002). Conclusions: There is a significant shortening in the Tp-e/QTc ratio post-angioplasty in patients with ACS. This measure of TDR can serve as a predictor of in-hospital death, cardiovascular events and 1-year reintervention in patients with ACS treated initially by angioplasty.

Long term prognostic significance of thrombolysis in myocardial infarction risk score after revascularization in non-ST elevation acute coronary syndrome

Background: Non-ST elevation acute coronary syndrome (NSTE-ACS) patients are complex and varied population. Primarily thrombolysis in myocardial infarction (TIMI) risk score was developed to guide therapy and assess the short term (14 days) prognosis of these patients. However, few studies have evaluated the long term prognostic significance of TIMI risk score after revascularization. This study aims at assessing the long term prognostic significance of TIMI risk score, 36 months after revascularization in NSTE-ACS.Methods: This was a retrospective observational cohort study of consecutive NSTE-ACS patients (n=150) treated by percutaneous coronary intervention between January 2017 to June 2017 in a tertiary care center. TIMI risk score was calculated for each patient at admission. The primary endpoint was a composite of MACE (death, repeat target-vessel revascularization, and non-fatal recurrent MI) at the end of 36 months of follow up. Clinical secondary endpoints included the individual components of the primary endpoint, death, nonfatal recurrent MI, and repeat target vessel revascularization.Results: Baseline characteristics for 150 participants were as follows, age 56±9.5 years, 78.7% male, 25% diabetics, 82% hypertensives, and 36% had hypercholesterolemia. The event rates of the primary endpoint and its components after 36 months were 26.6%. Event rates increased significantly as the TIMI risk score increased as determined by regression analysis (p=0.004). The relative risk increased by 66% as the TIMI risk score increased from low risk category (TIMI score 0-2) to high risk (TIMI score 5-6).Conclusions: TIMI risk score can be used for long term prognostication of NSTE-ACS patients after revascularization, and thus can be used by clinicians for therapeutic decision making.

A clinical study of arrhythmias associated with acute coronary syndrome: a hospital based study of a high risk and previously undocumented population

Background: ACS represents a global epidemic. Arrhythmia in ACS is common. Careful investigation may lead to further improvement of prognosis. Retrospectively analyzed the year- round data of our center. Study was undertaken to analyze the incidence, frequency and type of arrhythmias in ACS. This is to aid timely intervention and to modify the outcome. Identification of the type of arrhythmia is of therapeutic and prognostic importance.Methods: This cross sectional analytical study was conducted in the Department of Cardiology, Apollo Hospitals Dhaka, from January 2019 to January 2020 with ACS patients. Enrolled consecutively and data analyzed.Results: There were 500 patients enrolled considering inclusion and exclusion criteria. Sample was subdivided into 3 groups on the type of ACS. Group-I with UA, Group-II with NSTE - ACS and Group-III with STE - ACS. Different types of arrhythmia noted. Types of arrhythmia were correlated with type of ACS. 500 patients included. Mean age 55.53±12.70, 71.6% male and 28.4% female. 60.4% hypertensive, 46.2% diabetic, 20.2% positive family history of CAD, 32.2% current smoker, 56.4% dyslipidaemic and 9.6% asthmatic. 31.2% UA, 39.2% NSTE-ACS and 29.6% STE-ACS. Type of arrhythmias noted. 22% sinus tachycardia, 20.2% sinus bradycardia, 9% atrial fibrillation, 5.2% ventricular ectopic, 4.8% supra ventricular ectopic, 2.8% bundle branch block, 2.2% atrio-ventricular block, 1% broad complex tachycardia, 0.4% narrow complex tachycardia, 0.2% sinus node dysfunction and 32.2% without any arrhythmia. Significant incidences of arrhythmia detected - respectively 29.8%, 39.2% and 31%, p<0.001.Conclusions: In conclusion, arrhythmias in ACS are common. More attention should be paid to improve their treatment and prognosis.

Role of emergency coronary artery bypass grafting in the era of percutaneous interventions

Background: In acute coronary syndrome, prompt restoration of myocardial blood flow is essential to optimize myocardial salvage and decrease mortality. Coronary artery reperfusion, if performed in a timely manner improves clinical outcomes compared to no reperfusion. Fibrinolysis and percutaneous interventions can restore blood flow in an acutely occluded coronary artery in most of the patients; but in a few subset of patients coronary artery bypass grafting (CABG) is needed to effectively restore blood flow.Methods: A retrospective study was conducted among all CABGs performed during March 2016 - February 2018. During this period, 366 CABGs were performed and 57 patients underwent emergency CABG as per the inclusion criterias. Pre-operative, intra-operative and post-operative data was analysed of these patients. Patients were divided into four groups based on the time of surgery from the time of onset of myocardial infarction.  Results: 57 patients underwent emergency CABG with males constituting 94.7% of the study population. 78.9% of them had an ejection fraction less than 35%. 52% presented with low cardiac output status, 10% needed intra-aortic balloon pump support and 15% required mechanical ventilation prior to surgery. All patients received an average of 2.8 grafts. Mortality was 5%Conclusions: Immediate surgical revascularisation of patients presenting with acute MI is feasible. Emergency CABG not only treats the culprit lesion but also achieves complete revascularization and offers a clear advantage for patients. The optimal timing of CABG for patients with acute MI remains difficult to establish.

Síndrome de Apert. Reporte de caso / Apert syndrome. Case report

Introducción: El síndrome de Apert, o acrocefalosindactilia tipo I, es un síndrome caracte­rizado por craneosinostosis, acompañada de sindactilia simétrica en las cuatro extremidades, alteraciones maxilofaciales, cutáneas y retardo mental variable. Este síndrome se debe a una mutación en el gen del receptor 2 del factor del crecimiento fibroblástico (FGFR2), el cual se expresa de manera autosómica dominante (AD) Caso clínico: Se presenta caso de adolescente masculino de 24 años de edad, con las características fenotípicas clásicas de este síndrome como la acrocefalia y la sindactilia en manos y pies. Discusión: El síndrome de Apert hace parte de lo que hoy se denomina un espectro de enfermedades causadas por la mutación en el gen FGFR2 que se caracterizan por anorma­lidades en el cráneo y las extremidades. Este gen es necesario para la osificación normal y también está implicado en la diferenciación neural. Sus mutaciones producen un receptor anormal que funciona aun sin la unión de su ligando "ganancia de función", lo que se traduce en una osificación temprana de los huesos, en grados variables, dependiendo del sitio exacto de la mutación.

Introduction: Apert's syndrome or acrocefalosindactyly tipe I, is a syndrome character­ized by craniosynostosis, symmetric syndactylia in hands and feet's, maxillofacial and cutaneous disorders, and variable mental retardation. This syndrome is due to a mutation in the gene that encode the fibroblast growth factor Receptor 2 (FGFR2), which has an autosomal dominant inheritance (AD). Case report: We report a male24 yearsoldteen, with the classical phenotypic characteristics of this syndrome, as acrocefalia and syndactyly of hands and feet. Discussion: Apert's syndrome is part of what today is called a spectrum of disease caused by a mutation in the FGFR2 gene, which is characterized by abnormalities in the skull and extremities. This gene is required for normal ossification and is also involved in neural differentiation. Mutations cause an abnormal receptor that functions even without the binding of its ligand "gain of function", which translates into an early ossification of the bones, in varying degrees, depending on the exact site of the mutation.

Caracterización del síndrome de Wellens y su relación como predictor de obstrucción grave de la arteria descendente anterior. Unidad de Cuidados Coronarios Intensivos Hospital Manuel Fajardo 2016-2017 / Characterization of Wellens syndrome and its relationship as a predictor of severe obstruction of the left anterior descending artery. Intensive Coronary Care Unit Hospital Manuel Fajardo 2016-2017

RESUMEN Introducción: El síndrome de Wellens es un patrón electrocardiográfico que se ha sugerido desde la década del 80 como indicador de obstrucción grave de la arteria descendente anterior, a pesar de ello es poco conocido y no se encuentra en las principales guías de tratamiento de los síndromes coronarios agudos. Objetivo: Demostrar la utilidad del diagnóstico del síndrome de Wellens como predictor de obstrucción grave de la descendente anterior. Método: Se realizó un estudio transversal con componente analítico, que abarcó a los 40 pacientes ingresados en la Unidad de Cuidados Coronarios Intensivos del Hospital Manuel Fajardo, en el período enero de 2016 hasta diciembre de 2017, con diagnóstico de síndrome coronario agudo sin elevación del segmento ST, a los que se les realizó coronariografía. Resultados: Se encontró la presencia de síndrome de Wellens en un 13,5% de los pacientes ingresados con este tipo de síndrome coronario agudo. La edad, el sexo y la presencia de comorbilidades no se relacionaron significativamente con la presencia de este síndrome. El estudio angiográfico evidenció, en los pacientes con un síndrome de Wellens, un riesgo relativo 3,4 veces mayor que el resto, de presentar una obstrucción grave de la arteria descendente anterior. Conclusiones: La identificación oportuna del síndrome de Wellens y su relación con una obstrucción coronaria grave deben motivar una estrategia intervencionista precoz en estos casos.

ABSTRACT Introduction: Wellens syndrome is an electrocardiographic pattern that has been suggested, since the 1980s, as indicator of severe obstruction of the left anterior descending artery, although it is poorly understood and it is not found in the main treatment guidelines for acute coronary syndromes. Objective: To demonstrate the usefulness of the diagnosis of Wellens syndrome as a predictor of severe obstruction of the left anterior descending artery. Method: A cross-sectional study with an analytical component was carried out, covering the 40 patients admitted to the Intensive Coronary Care Unit of the Hospital Manuel Fajardo, in the period from January 2016 to December 2017, with a diagnosis of non-ST-segment elevation acute coronary syndrome, who underwent coronary angiography. Results: The presence of Wellens syndrome was found in 13.5% of the patients admitted with this type of acute coronary syndrome. Age, sex and the presence of comorbidities were not significantly related to the presence of this syndrome. The angiographic study showed, in patients with a Wellens syndrome, a relative risk -3.4 times greater than the rest- of presenting a severe obstruction of the left anterior descending artery. Conclusions: The timely identification of Wellens syndrome and its relationship with a severe coronary obstruction should motivate an early interventionist strategy in these cases.

Environmental Risk Assessment of Glufosinate-Tolerant Genetically Modified Oilseed Rape T45 for Food and Feed Uses, Import and Processing under Regulation (EC) No 1829/2003 (Application EFSA/GMO/UK/2005/25)

In preparation for a legal implementation of EU-regulation 1829/2003, the Norwegian Scientific Committee for Food Safety (VKM) has been requested by the Norwegian Directorate for Nature Management to conduct final environmental risk assessments for all genetically modified organisms (GMOs) and products containing or consisting of GMOs that are authorized in the European Union under Directive 2001/18/EC or Regulation 1829/2003/EC. The assignment includes a scientific environmental risk assessment of oilseed rape T45 (Reference EFSA/GMO/UK/2005/25) from Bayer CropScience for food and feed uses, import and processing. Oilseed rape T45 has previously been risk assessed by the VKM Panel on Genetically Modified Organisms (GMO), commissioned by the Norwegian Food Safety Authority related to the EFSAs public hearing in 2007 (VKM 2007a). Food additives produced from T45 oilseed rape were notified in the EU as existing food additives within the meaning of Article 8 (1)(b) of Regulation 1829/2003, authorized under Directive 89/10/EEC (Community Register 2005). Feed materials produced from T45 were also notified as existing feed products containing, consisting of or produced from T45 according to Articles 8 and 20 of Regulation (EC) No 1829/2003 in 2003. A notification for placing on the market of T45 according to the Directive 2001/18/EC was submitted in March 2004 (C/GB/04/M5/4), covering import and processing of T45 into food and feed. The application was further transferred into Regulation (EC) No 1829/2003 in November 2005 (EFSA/GMO/UK/2005/25). An application for renewal of authorisation for continued marketing of food additives and feed materials produced from T45 oilseed rape was submitted under Regulation (EC) No 1829/2003 in 2007 (EFSA/GMO/RX/T45). The EFSA GMO Panel performed one single comprehensive risk assessment for all intended uses of genetically modified oilseed rape T45, and issued a comprehensive scientific opinion for both applications submitted under Regulation (EC) No 1829/2003. The scientific opinion was published in January 30 2008 (EFSA 2008), and food and feed products containing or produced from oilseed rape T45 was approved by Commission Decision 26 March 2009 (Commission Decision 2009/184/EC). The oilseed rape T45 is however currently being phased out (EU-COM 2009). The commercialisation of T45 oilseed rape seeds in third countries was stopped after the 2005 planting season and stocks of all oilseed rape T45 lines have been recalled from distribution and destroyed. The applicant commits not to commercialize the event in the future and the import will therefore be restricted to adventitious levels in oilseed rape commodity. Thus the incidence of oilseed rape T45 in the EU is expected to be limited. The environmental risk assessment of the oilseed rape T45 is based on information provided by the notifier in the application EFSA/GMO/UK/2005/25 and EFSA/GMO/RX/T45, and scientific comments from EFSA and other member states made available on the EFSA website GMO Extranet. The risk assessment also considered other peer-reviewed scientific literature as relevant. The VKM GMO Panel has evaluated T45 with reference to its intended uses in the European Economic Area (EEA), and according to the principles described in the Norwegian Food Act, the Norwegian Gene Technology Act and regulations relating to impact assessment pursuant to the Gene Technology Act, Directive 2001/18/EC on the deliberate release into the environment of genetically modified organisms, and Regulation (EC) No 1829/2003 on genetically modified food and feed. The Norwegian Scientific Committee for Food Safety has also decided to take account of the appropriate principles described in the EFSA guidelines for the risk assessment of GM plants and derived food and feed (EFSA 2006, 2011a), the environmental risk assessment of GM plants (EFSA 2010), the selection of comparators for the risk assessment of GM plants (EFSA 2011b), and for the post-market environmental monitoring of GM plants (EFSA 2006, 2011c). The scientific risk assessment of oilseed rape T45 include molecular characterisation of the inserted DNA and expression of target proteins, comparative assessment of agronomic and phenotypic characteristics, unintended effects on plant fitness, potential for horizontal and vertical gene transfer, and evaluations of the post-market environmental plan. In line with its mandate, VKM emphasised that assessments of sustainable development, societal utility and ethical considerations, according to the Norwegian Gene Technology Act and Regulations relating to impact assessment pursuant to the Gene Technology Act, shall not be carried out by the Panel on Genetically Modified Organisms. The glufosinate ammonium-tolerant oilseed rape transformation event T45 (Unique Identfier ACSBNØØ8-2) was developed by Agrobacterium-mediated transformation of protoplast from the conventional oilseed rape cultivar “AC Excel”. T45 contains a synthetic version of the native pat gene isolated from the bacteria Streptomyces viridochromogenes, strain Tü 494. The inserted gene encodes the enzyme phosphinothricin acetyltransferase (PAT), which confers tolerance to the herbical active substance glufosinate ammonium. The PAT enzyme detoxifies glufosinate-ammonium by acetylation of the L-isomer into N-acetyl-L-glufosinate ammonium (NAG) which does not inhibit glutamine synthetase and therefore confers tolerance to the herbicide. Glufosinate ammonium-tolerant oilseed rape transformation event T45 has been conventionally bred into an array of spring-type oilseed rape varieties. Molecular characterization: The molecular characterisation data established that only one copy of the gene cassette is integrated in the oilseed rape genomic DNA. Appropriate analysis of the integration site including sequence determination of the inserted DNA and flanking regions and bioinformatics analysis have been performed. Bioinformatics analyses of junction regions demonstrated the absence of any potential new ORFs coding for known toxins or allergens. The genetic stability of transformation event T45 was demonstrated at the genomic level over multiple generations by Southern analysis. Segregation analysis shows that event T45 is inherited as dominant, single locus trait. Phenotypic stability has been confirmed by stable tolerance to the herbicide for T45 lines and varieties derived from the event grown in Canada since 1993. Oilseed rape transformation event T45 and the physical, chemical and functional characteristics of the proteins have previously been evaluated by The VKM Panel on Genetically Modified Organisms, and considered satisfactory (VKM 2007a). Comparative assessment: Based on results from comparative analyses of data from field trials located at representative sites and environments in Canada in 1995-1997, it is concluded that oilseed rape T45 is agronomically and phenotypically equivalent to the conventional counterpart and commercial available reference varieties, with the exception of maturity and the herbicide tolerance conferred by the PAT protein. The field evaluations support a conclusion of no phenotypic changes indicative of increased plant weed/pest potential of event T45 compared to conventional oilseed rape. Furthermore, the results demonstrate that in-crop applications of glufosinate herbicide do not alter the phenotypic and agronomic characteristics of event T45 compared to conventional oilseed rape. Environmental risk: According to the applicant, the event T45 has been phased out, and stocks of all oilseed rape T45 lines have been recalled from distribution and destroyed since 2005. However, since future cultivation and import of oilseed rape T45 into the EU/EEA area cannot be entirely ruled out, the environmental risk assessment consider exposure of viable seeds of T45 through accidental spillage into the environment during transportation, storage, handling, processing and use of derived products. Oilseed rape is mainly a self-pollinating species, but has entomophilous flowers capable of both self- and cross-pollinating. Normally the level of outcrossing is about 30%, but outcrossing frequencies up to 55% are reported. Several plant species related to oilseed rape that are either cultivated, occurs as weeds of cultivated and disturbed lands, or grow outside cultivation areas to which gene introgression from oilseed rape could be of concern. These are found both in the Brassica species complex and in related genera. A series of controlled crosses between oilseed rape and related taxa have been reported in the scientific literature. Because of a mismatch in the chromosome numbers most hybrids have a severely reduced fertility. Exceptions are hybrids obtained from crosses between oilseed rape and wild turnip (B. rapa ssp. campestris) and to a lesser extent, mustard greens (B. juncea), where spontaneously hybridising and transgene introgression under field conditions have been confirmed. Wild turnip is native to Norway and a common weed in arable lowlands. There is no evidence that the herbicide tolerant trait results in enhanced fitness, persistence or invasiveness of oilseed rape T45, or hybridizing wild relatives, compared to conventional oilseed rape varieties, unless the plants are exposed to herbicides with the active substance glufosinate ammonium. Glufosinate ammonium-containing herbicides have been withdrawn from the Norwegian market since 2008, and the substance will be phased out in the EU in 2017 for reasons of reproductive toxicity. Accidental spillage and loss of viable seeds of T45 during transport, storage, handling in the environment and processing into derived products is, however, likely to take place over time, and the establishment of small populations of oilseed rape T45 cannot be excluded. Feral oilseed rape T45 arising from spilled seed could theoretically pollinate conventional crop plants if the escaped populations are immediately adja

Evaluation of Glycated Hemoglobin (HbA1c) in Acute Coronary Syndrome (ACS)

Aim:The aim of our study was to estimate the level of HbA1c in patients with Acute Coronary Syndrome (ACS). To determine any correlation between HbA1c, admission blood glucose (Random blood sugar), serum lipid profile among the cases and to evaluate the outcome during hospitalization. Study Design and Setting:Cohort study.Place and Duration of the Study:Department of Biochemistry and General Medicine including ICCU and Cardiology unit, RIMS, Imphal, between September 2015 to August 2017.Methodology:Data were collected from 98 patients admitted in Medicine ward who were diagnosed with ACS irrespective of their diabetes status and they were divided into three groups according to their HbA1c levels (<5.7%, 5.7-6.4%, > 6.5%). The blood samples collected by venipuncture were analyzed for HbA1c level, done by RANDOX HbA1c Rx series (latex agglutination inhibition assay), admission blood glucose (measured by Trinder’s method) and serum lipid profile (RANDOX enzymatic Endpoint Method Rx series). The data were analyzed using statistical tools like Chi Square test, Independent sample t test, Pearson’s Correlation, Fisher’s exact test through SPSS 21.0.Results:Majority of the patients were men (72.4%) & (27.6%) women and in the age group of 51-65 years. The mean ageis 62.14 years. 54.1% of the ACS patients were already diagnosed cases of type 2 diabetes mellitus whereas 45.9% were non-diabetic. Out of 98 patients, 60 had HbA1c level in the diabetic range (≥6.5%), 25 in the pre-diabetic range (5.7-6.4%) and the remaining 13 were within normal range (<5.7%). Admission blood glucose, total cholesterol and LDL were positively correlated with HbA1c value. Conclusion:The mortality of the ACS patients irrespective of diabetic status during hospitalization was associated with HbA1c value irrespective of diabetic status during hospitalization. However, it was not associated with thirty days mortality