Registro ARGEN-IAM-ST: infarto de miocardio con elevación del segmento ST en el "nuevo" adulto mayor / ARGEN-IAM-ST Registry: ST-elevation myocardial infarction in "new" older adults

RESUMEN Introducción: La Organización Mundial de la Salud (OMS) considera adulto mayor (AM) a las personas que tienen 60 años o más. Es sabido que la mortalidad por infarto agudo de miocardio (IAM) aumenta a edades más avanzadas, pero siempre se han utilizado umbrales de edad mayores que el propuesto por la OMS, por lo cual describir las características y evolución intrahospitalaria de este subgrupo (de acuerdo con la definición de la OMS) se torna relevante. Objetivos: 1) conocer la prevalencia de los AM según la OMS, con IAM con elevación del segmento ST en Argentina y 2) com- parar sus características, tratamientos de reperfusión y mortalidad con los adultos jóvenes. Material y métodos: Se analizaron los pacientes ingresados en el Registro Nacional de Infarto (ARGEN-IAM-ST). Se compara- ron las características clínicas, tratamientos y evolución de los AM y los adultos jóvenes. Resultados: Se incluyeron 6676 pacientes, de los cuales 3626 (54,3%) eran AM. Los AM fueron más frecuentemente mujeres (37,6% vs. 31,4%, p <0,001), hipertensos (67,8% vs. 47%, p <0,001), diabéticos (26,1% vs. 19,9%, p <0,001), dislipidémicos (45,4% vs. 37%, p <0,001), y tuvieron más antecedentes coronarios (16% vs. 10,3%, p <0,001). El tiempo a la consulta de los AM fue mayor (120 min vs. 105 min, p <0,001) con similar tiempo total de isquemia (314 min vs. 310 min, p = 0,33). Recibi- eron menos tratamiento de reperfusión (89,9% vs. 88,6%, p = 0,04) y más angioplastia primaria (91 % vs. 87,4%, p <0,001). Tuvieron más insuficiencia cardíaca (27,3% vs. 18,5%, p <0,001), similar incidencia de sangrado (3,7 vs. 3,1%, p = 0,33) y una mortalidad significativamente mayor (11,4% vs. 5,5%, p <0,001). Ser AM fue predictor independiente de mortalidad. Conclusiones: Más de la mitad de los IAM en nuestro país ocurren en AM. Los pacientes mayores tienen menor probabilidad de recibir reperfusión, más insuficiencia cardíaca y el doble de la mortalidad que los pacientes menores de 60 años.

ABSTRACT Background: The World Health Organization (WHO) defines an Older Adult (OA) as any individual aged 60 or older. It is known that mortality due to acute myocardial infarction (AMI) increases with age, but age thresholds higher than those proposed by the WHO have been consistently used; therefore, describing the characteristics and in-hospital progress of this subgroup of patients, in accordance with the WHO definition, becomes relevant. Objectives: 1) To know the prevalence of OA with acute ST-elevation myocardial infarction (STEMI) in Argentina according to the WHO, and 2) to compare their characteristics, reperfusion treatments, and mortality against those in young adults. Methods: Patients included in the National Registry of ST- Elevation Myocardial Infarction (Registro Nacional de Infarto con Elevación del ST, ARGEN-IAM-ST) were analyzed. Clinical features, therapies, and progress were compared in OA versus young adults. Results: A total of 6676 patients were enrolled, 3626 of which (54.3%) were OA. OA were mostly female (37.6% vs 31.4%, p <0.001), had hypertension (67.8% vs 47%, p <0.001), diabetes (26.1% vs 19.9%, p <0.001), dyslipidemia (45.4% vs 37%, p <0.001), and a longer coronary artery disease history (16% vs 10.3%, p < 0.001). The time to consultation in OA was longer (120 min vs 105 min, p <0.001), with a similar total ischemic time (314 min vs 310 min, p = 0.33). They received less reperfu- sion treatment (89.9% vs 88.6%, p = 0.04) and more primary angioplasty (91% vs 87.4%, p <0.001). Heart failure was more common in OAs (27.3% vs 18.5%, p <0.001), with a similar bleeding incidence (3.7% vs 3.1%, p = 0.33), and significantly higher mortality (11.4% vs 5.5%, p<0.001). Being an OA was an independent mortality predictor. Conclusions: More than half the cases of AMI in our country occur in OA. Older patients are less likely to receive reperfusion, more likely to have heart failure, and show twice the rate of mortality as compared to patients under 60.

Phosphatidylethanolamine functionalized biomimetic monolith for immobilized artificial membrane chromatography / 药物分析学报

In this research,a new phospholipid based monolith was fabricated by in situ co-polymerization of 1-dodecanoyl-2-(11-methacrylamidoundecanoyl)-sn-glycero-3-phosphoethanolamine and ethylene dimethacrylate to mimick bio-membrane environment.Excellent physicochemical properties of this novel monolith that were achieved included column efficiency,stability,and permeability.Moreover,the biomimetic monolith showed outstanding separation capability for a series of intact proteins and small molecules.In particular,it exhibited good potential as an alternative to the commercial immobilized artificial membrane(IAM)column(IAM.PC.DD2)for studying drug-membrane interactions.This study not only enriched the types of IAM stationary phases,but also provided a simple model for the prediction of phosphatidylethanolamine related properties of drug candidates.

Complicaciones intrahospitalarias del infarto agudo de miocardio. Incidencia y momento de aparición / In-hospital complications of acute myocardial infarction. Incidence and timing of their occurrence

Resumen Aunque la mortalidad del infarto de miocardio con elevación del segmento ST (IAMCEST) ha disminuido con el progreso de la reperfusión, la incidencia de sus complicaciones no ha cambiado. El objetivo del estudio es conocer la incidencia de las complicaciones hospitalarias del IAMCEST, su cronología de aparición e identificar sus predictores. Se realizó un análisis prospectivo de todos los pacientes consecutivos con IAMCEST ingresados en una unidad coronaria de un Hospital público de la ciudad de Buenos Aires desde septiembre de 2017 a marzo de 2020. De 263 pacientes con IAMCEST, el 47.2% (124) presentó complicacio nes siendo la insuficiencia cardíaca (IC) la más frecuente. El paro cardiaco previo al ingreso (PCR) (OR: 9.8; IC: 1.2-81.9; p = 0.03), la fracción de eyección del ventrículo izquierdo (Fey VI) < del 40% (OR: 2.3 IC: 1.3-3.9; p = 0.004) y la edad > de 68 años (OR: 2.2; IC: 1.2-4,0; p = 0.01) fueron sus predictores. La reperfusión exitosa (OR: 0.2 IC: 0.005-0.7; p = 0.02) y la presentación de Killip y Kimball (KK) A (OR: 0.0002 IC: 0.00001-0.003; p = < 0.00001) fueron factores protectores. El 88.7% (110) se complicó el primer día de internación y todos (con excepción de un solo paciente) dentro de las 48 horas. Las complicaciones post IAMCEST son muy frecuentes, suceden dentro de los primeros dos días de internación y la IC es la más prevalente. Detectamos un grupo con menor riesgo que podría tener una internación abreviada de solo 48 horas.

Abstract Although ST-segment elevation myocardial infarction (STEMI) mortality decreased with the progress of reperfusion, the incidence of hospital complications has not changed. We aimed to describe the incidence of STEMI complications in the coronary unit, the timing of their occurrence and to identify their predis posing and protective factors. This is a prospective analysis of all consecutive patients with STEMI admitted to a coronary care unit of a third level reference hospital from September 2017 to March 2020. Of the 263 STEMI, 124 developed complications (47.2%), and the most frequent was heart failure. In the multivariate analysis, pre-admission cardiac arrest (CA) (OR: 9.8; CI: 1.2-81.9; p = 0.03), left ventricular ejection fraction (Fey VI) < 40% (OR: 2.3 CI: 1.3-3.9; p = 0.004) and age > 68 years (OR: 2.2; CI: 1.2-4.0; p = 0.01) were predictors of complica tions. Successful reperfusion (OR: 0.2 CI: 0.005-0.7; p = 0.02) and the presentation of Killip and Kimball (KK) A (OR: 0.0002 CI: 0.00001-0.003; p = < 0.00001) were protective factors. Most complications occurred on the first day (88.7%) and in all but one patient within the first 48 hours. Acute complications of STEMI occurred very frequently and the most prevalent was heart failure. KKA and successful reperfusion are low risks predictors, while 6 out of 10 patients with Fey VI < 40%, Cardiac arrest before admission or age >68 years suffered an event. Almost all complications happened within the first 48 hours.

Infarto Agudo del Miocardio: conducta en el período prehospitalario / AMI: Management in the pre-hospitalization period

RESUMEN: El tratamiento del Infarto Agudo del Miocardio con supradesnivel del segmento ST debe iniciarse en el escenario prehospitalario, en el sitio del primer contacto médico. El diagnóstico electrocardiográfico precoz debe ser realizado, idealmente, dentro de los primeros 10 min después de la consulta y confirmado por un especialista. A este respecto, la teletransmisión del electrocardiograma a un centro de llamados atendido por especialistas en horario 24/7 es un modelo muy eficiente, idealmente como parte de una red de tratamiento. El control del dolor y la administración de agentes antiplaquetarios son imperativos y si la intervención coronaria percutánea (angioplastia primaria) no es factible dentro de las ventanas de tiempo universalmente recomendadas, se debiera realizar un tratamiento fibrinolítico, seguido por angioplastia diferida.

ABSTRACT: Treatment of acute myocardial infarction should be initiated in the prehospital scenario at the site of first medical contact. Prompt electrocardiographic diagnosis should be performed ideally within 10min after consultation and diagnosis confirmed by a specialist. Teletransmission of the electrocardiogram to a call center staffed with specialists on a 24/7 basis is a very efficient model, ideally as part of a network of treatment. Pain control and administration of antiplatelets agents are mandatory and if primary percutaneous intervention is not feasible within time limits universally recommended, prehospital fibrinolyisis should be performed followed by deferred angioplasty.

Contribution of the IAM Pathway to IAA Pool in Developing Rice Grains

A possible role for the indole-3-acetamide (IAM) pathway in the indole-3-acetic acid (IAA) production was investigated in developing rice grains. IAM-hydrolase proposed to convert IAM to IAA primarily through the identification of IAM and IAM-hydrolase activity in some plant species. Expression profiles of the two putative rice IAM-hydrolase genes, OsAMI1&2, were compared to the previously quantified IAA level. The abrupt increase in IAA level between 4 and 7 days after anthesis (DAF) was not found to correlate with changes in the expression of OsAMI1 or OsAMID2 suggesting that the IAM pathway may not contribute significantly to IAA pool in rice grains. Production of a biological compound other than IAA may explain the high activity of OsAMI1&2 in developing rice grains. OsAMI1 that reported to be conserved across the plant kingdom showed higher expression level in most analyzed reproductive rice tissues whereas OsAMID2 showed more fluctuation in expression comparing to OsAMI1. Role of the IAM pathway in IAA production was also discussed in other plant systems and Arabidopsis seed was recommended as an ideal tissue to identify enzyme(s) convert(s) tryptophan to IAM as well as physiological effects of IAA produced via this pathway.

Valor pronóstico de la microalbuminuria en el paciente con infarto agudo del miocardio con elevación del ST / Prognostic value of microalbuminuria in ST-elevation myocardial infarction

Introducción: La microalbuminuria (MA) es un marcador de disfunción endotelial, y se ha asociado con mayor morbimortalidad en la enfermedad cardiovascular. En México, las enfermedades isquémicas del corazón ocupan los primeros lugares de mortalidad, por lo que resulta necesario estudiar marcadores que puedan proporcionar pronóstico en los sujetos con síndrome coronario agudo. Objetivo: Determinar el valor pronóstico de la microalbuminuria sobre la evolución de los pacientes con infarto agudo del miocardio con elevación del segmento ST (IAMST). Material y métodos: Estudio de cohorte, observacional, longitudinal, prospectivo y analítico. Se incluyeron pacientes consecutivos con diagnóstico de IAM en las primaras 24 horas de evolución, de cualquier género, mayores de 18 años, que ingresaron a la Unidad de Cuidados Cardiovasculares de un Hospital de Tercer Nivel. Se definió la cohorte expuesta a microalbuminuria en orina de 24 horas (albúmina > 20 µg/min) dentro de las primeras 72 horas de su ingreso, y se dio seguimiento a 30 días registrando la presentación de eventos cardiovasculares. Resultados: Se estudiaron a 99 pacientes, 51 (51.5%) sujetos presentaron MA. Las características basales no presentaron diferencias significativas. Los pacientes con MA tuvo mayor puntuación de las escalas APACHE II, TIMI, GRACE y EUROSCORE (todos p < 0.05). La presentación de Killip-Kimball ≥ III, arritmias, bloqueo atrioventricular avanzado, choque cardiogénico, reinfarto y muerte, se asociaron significativamente con la presencia de MA (todos p < 0.05), y esta asociación es independiente para la presencia de muerte ajustado para las puntuaciones de TIMI, GRACE y la presencia de infarto ventricular derecho. De la misma manera, los sujetos con IAM portadores de MA tienen una supervivencia significativamente menor que aquellos sin MA, p = 0.002. Conclusiones: La microalbuminuria se asocia de manera independiente con muerte a 30 días, y puede ser un biomarcador a medirse rutinariamente en los pacientes con síndrome coronario agudo con elevación del ST.

Introduction: Microalbuminuria (MA) is an endothelial dysfunction biomarker, and has been associated to higher morbidity and mortality in cardiovascular disease. The ischemic heart disease is among the leading causes of death, and it's necessary to study new risk and prognostic biomarkers in patients with ST-elevation acute myocardial infarction (ST-AMI). Objective: To determine the predict value of microalbuminuria in patients with ST-AMI. Material and methods: We developed an observational, longitudinal, prospective and analytical cohort study, patients older than 18 years old, any sex, within 24 hours evolution ST-AMI were included. Exposed cohort was defined as MA > 20 µg/min in a 24-hour urine sample within 72 hour of myocardial infarction, and were followed for 30 days and cardiovascular events were recorded. Results: We studied 99 patients; 51 (51.5%) presented MA. Basal clinical features were not significantly different. MA subjects had higher APACHE II, TIMI, EUROSCORE and GRACE scores (p < 0.05 for all). Killip-Kimball ≥ III, arrhythmia, advanced atrioventricular block, cardiogenic shock, re-infarction and death were significantly associated to MA (p < 0.05 for all), and this association remains as an independent death predictor adjusted to TIMI and GRACE scores and right ventricle infarction. In the same way, MA is associated with lower survival rate at 30 day, p = 0.002. Conclusions: Microalbuminuria is an independent risk factor for death at 30 days, and should be included as part of biochemical markers in patients with ST elevation acute myocardial infarction.

Agrowaste-based Polyhydroxyalkanoate (PHA) production using hydrolytic potential of Bacillus thuringiensis IAM 12077

The study identified the innate enzymatic potential (amylase) of the PHB producing strain B.thuringiensis IAM 12077 and explored the same for cost-effective production of PHB using agrowastes, eliminating the need for pretreatment (acid hydrolysis and/or commercial enzyme). Comparative polyhydroxyalkanoate (PHA) production by B. thuringiensis IAM 12077 in biphasic growth conditions using glucose and starch showed appreciable levels of growth (5.7 and 6.8 g/L) and PHA production (58.5 and 41.5%) with a PHA yield of 3.3 and 2.8 g/L, respectively. Nitrogen deficiency supported maximum PHA yield (2.46 g/L) and accumulation (53.3%). Maximum growth (3.6 g/L), PHB yield (2.6 g/L) and PHA accumulation (72.8%) was obtained with C:N ratio of 8:1 using starch as the carbon source (10 g/L). Nine substrates (agro and food wastes) viz. rice husk, wheat bran, ragi husk, jowar husk, jackfruit seed powder, mango peel, potato peel, bagasse and straw were subjected to two treatments- acid hydrolysis and hydrolysis by innate enzymes, and the reducing sugars released thereby were utilized for polymer production. All the substrates tested supported comparable PHB production with acid hydrolysis (0.96 g/L-8.03 g/L) and enzyme hydrolysis (0.96 g/L -5.16 g/L). Mango peel yielded the highest PHB (4.03 g/L; 51.3%), followed by jackfruit seed powder (3.93 g/L; 29.32%). Varied levels of amylase activity (0.25U-10U) in all the substrates suggested the enzymatic hydrolysis of agrowastes.

Utilidad de Fibrinolisis en pacientes con infarto agudo de miocardio durante las seis primeras horas de evolución / Usefulness of fibrinolysis in patients with acute myocardial infarction during the first six hours of development

Objetivo: determinar el grado de preservación de la función cardíaca después de infarto agudo de miocardio (IAM), mediante la aplicación de fibrinolisis con previa administración de antiagregantes plaquetarios dentro de las primeras seis horas de evolución y establecer el número de pacientes que fueron sometidos a revascularización posterior a la fibrinolisis. Metodología: estudio observacional, prospectivo, realizado en el hospital regional del IESS “Dr. Teodoro Maldonado Carbo”, de Guayaquil; el tamaño muestral fue de 35 pacientes; quienes fueron sometidos a fibrinolisis luego de presentar infarto agudo de miocardio (con elevacióndel segmento ST). Debido a que la muestra fue homogénea se utilizaron como medidas estadísticas media aritmética, y desviación estándar. Además, prueba de Chi cuadrado para obtener el valor p. Resultados: de los 35 pacientes de la muestra, 28 (80 por ciento) fueronhombres y 7 (20 por ciento) mujeres. A todos los pacientes se los sometió a terapia fibrinolítica; en 20 (57 por ciento) el tratamiento resultó eficaz mientras que a 15 (43 por ciento), se les realizó revascularización con STENT. Se observó una mejoría de los valores de fracción de eyección diferencial, que compara los niveles después del tratamiento realizado, con 17 por ciento±7 para pacientes sometidos sólo a fibrinolisis y de 19 por ciento±12 a quienes se les realizó posteriormente revascularización con STENT. Conclusión: a partir de los resultados se puede concluir que la fibrinolisis como medida terapéutica en el manejo agudo del IAM mejora el grado de función cardíaca.

Aim: to determine the degree of perseveration of the cardiac function after an acute myocardial infarction (AMI), through the application of fibrinolysis with prior use of antiplatelet agents within the first six hours of development and to establish the number of patients who underwent a subsequent revascularization to fibrinolysis. Methodology: The prospective observational research took place at the “Dr. Teodoro Maldonado Carbo” IESS Regional Hospital of Guayaquil. The sample size was 35 patients; who underwent fibrinolysis after presenting an acute myocardial infarction (with ST segment elevation). Due to the homogeneous sample, Arithmetic Mean and Standard Deviation were used as statistical measures. In addition, Chi-squared test was used for the p value. Results: out of the 35 patients of the sample, 28 (80 percent) were male and 7 (20 percent) were women. All the patients weresubjected to a fibrinolytic therapy, in 20 (57 percent) of them the mentioned treatment was effective while 15 (43 percent) patients underwent a revascularization with STENT. An improvement of the values of the fraction of differential ejection was observed, which compares the levels after the treatment, with 17 percent±7 for patients undergoing only fibrinolysis, and 19 percent±12 who subsequently underwent a revascularization STENT. Conclusion: from the results it can be concluded that the fibrinolysis as a therapeutic measure in acute management of AMI improves the level of cardiac function.

Prolapsed Antral Mucosa: Variant of Maxillary Sinus Mucocele / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: An array of diseases may cause masses in the maxillary sinus. Among the various diseases, the prolapsed antral mucosa (PAM) presents an inflammed, swollen maxillary antral mucosa which becomes redundant and prolapsed into the nasal cavity through a widened natural ostium, mimicking an antrochoanal polyp. The purposes of this study were to introduce prolapsed antral mucosa and evaluate the differences between prolapsed antral mucosa and other diseases, particularly maxillary sinus mucocele. MATERIALS AND METHODS: We retrospectively analyzed 18 patients who were diagnosed with prolapsed antral mucosa at the Kangbuk Samsung Hospital between 1990 and 1998. The presenting signs and symptoms, endoscopic finding, radiological finding, histopathological finding were reviewed. RESULTS: Of the symptoms reported by patients in this study, nasal obstruction was the most frequent, followed by rhinorrhea, postnasal drip, foul odor and headache. Endoscopic findings showed protruding maxitlary antral mucosa into the middle meatus. On the CT, the prolapsed antral mucosa presented features such similar to antrochoanal polyp as unilateral and homogeneous soft tissue density which extended into the middle meatus. MR imaging was useful for differentiating the prolapsed antral mucosa from neoplasms and antrochoanal polyp. Prolapsed antral mucosa and maxilla sinus mucocele showed the same histopathological features such as epithelial lining of columnar or metaplastic squamous cells with varying glandular structures, and dense fibrous stroma intiltrated by infiammatory cells. CONCLUSIONS: The prolapsed antral mucosa is considered as a variant of maxillary sinus mucocele. History, physical examination, biopsy, CT and MM are useful for differentiating the prolapsed antral mucosa from other diseases. Although a prolapsed antral mucosa is rare, it should be considered in the diagnosis and the treatment of unilateral maxillary sinus lesion.