Acute coronary syndrome in very young adults (<35 years of age) - time to awake and act! A prospective analytical study from South India

Background: Acute coronary syndrome in very young adults (<35 yrs) was considered as an uncommon entity, recently shows rising incidence especially in India. Hence we planned this study with the aim, to investigate the incidence, clinical, angiographic profile and outcome of ACS in this population. Methods: This is a prospective analytical study included patient <35 yrs with ACS admitted to cardiology department in a tertiary hospital of South India. Risk factors, clinical, angiographic profile and follow up data were recorded and analyzed. Results: Among the total 2180 patients with ACS, 5.8% (n=127) were very young adults. Youngest one was 11 yrs old with coronary anomaly. Median age was 30yrs (SD� and only 8.6% (n=10) were obese. Smoking, male sex were the major conventional risk factors followed by low HDL (52%). Family history of premature coronary event seen in 12.9%, hyperhomocysteinemia, elevated LPA and high fibrinogen were observed in 15%, 20% and 3.5% respectively. Anterior wall MI with LAD occlusion was the commonest type (66.3%). Angiographically 31.4% (36/116) had recanalised vessels, coronary anomaly was seen in 3 (2.5%) patients and pure ectasia in 4 (3.4%) patients. Only 2 were undergone primary PCI (1.7%), 61% (n=71) received thrombolytic therapy. Median delay for angiogram was 72 hrs (3 days). In-hospital mortality was 3.4% and 4.5% (n=5) during follow up. Conclusions: The incidence of ACS among very young adults is on the rising trend (5.8%). Obstructive CAD in 56.9% patients implies the rapid progression of atherosclerosis. With little contribution of novel risk markers of atherosclerosis, smoking and dyslipidemia accelerate the process of premature vascular aging in Indian subcontinent.

Failed limb salvage by microsurgery, resolved by super-microsurgery

Advances in perforating artery flaps have improved reconstruction in various body parts, particularly the lower extremities, offering benefits in patient quality of life and reduced public health service costs. The use of flaps and microsurgery extends beyond trauma to address conditions like osteomyelitis, tumor resection, osteoarthritis, and post-radiation necrosis. Notably, the superficial circumflex iliac artery perforator flap (SCIP) is highlighted for its thin profile and utility in limb coverage, minimizing donor site morbidity. Microsurgical techniques contribute to limb salvage, reducing amputation risks in severe fractures and post-osteosynthesis complications. A 29-year-old male with cerebral palsy suffered bimalleolar fracture from a high-energy motor vehicle accident. Initial ALT flap reconstruction failed, leading to flap removal and osteosynthesis exposure. After 48 hours, removal of the flap was necessary due to venous thrombosis. Salvage with SCIP flap involved anastomosis to perforators of both posterior tibial artery and vein. This case details a patient with a bimalleolar fracture post-motorcycle accident, initially treated with conventional microsurgery using an ALT flap. Complications arose from venous thrombosis, necessitating flap removal. Salvage was achieved through a SCIP flap with supermicrosurgery techniques, employing 0.5 mm anastomosis for improved functionality and reduced complications in flap recovery and donor site comorbidities. Successful outcomes in microsurgery and supermicrosurgery necessitate comprehensive training. Specialized limb salvage centers must possess specific equipment and instruments for these techniques. The literature reviewed doesn't indicate contraindications related to the patient's mental state for the execution of microsurgery and supermicrosurgery.

Avaliação da atividade antimicrobiana e antioxidante das espécies Plectranthus amboinicus (Lour.) e Mentha x villosa (Huds. ) / Assessment of antimicrobial and antioxidant activity and toxicity of the species Coleus amboinicus (Lour.) and Mentha x Villosa (Huds. )

O uso de plantas medicinais com potencial terapêutico tem motivado a realização de estudos através de ensaios experimentais que visam fornecer informações úteis e de extrema importância. Assim o presente trabalho objetivou avaliar a atividade antimicrobiana e antioxidante das espécies de Coleus amboinicus (Lour.) e Mentha x villosa (Huds). A atividade antimicrobiana foi avaliada pelo método de difusão em disco, cepas bacterianas padronizadas Gram negativas Escherichia coli (ATCC 25922 e ATCC 35218)), cepas Gram positivas Staphylococcus aureus (ATCC 25923) e S. aureus ATCC27853), assim como fungos padrões de Cryptococcus neoformans (pertencentes à coleção de microrganismos do CESMAC). Como controle positivo foi usado o imipenem e fluconazol e como controle negativo um disco com etanol absoluto. A determinação do potencial antioxidante foi realizada utilizando os métodos DPPH, FTC e determinação de compostos fenólicos. Os extratos etanólicos de C. amboinicus e M. x villosa apresentaram excelentes resultados tanto relacionado à atividade antimicrobiana quanto à antioxidante. Nossos resultados mostram a potencialidade das plantas analisadas na prevenção e no combate de doenças...

The popular use of medicinal plants with therapeutic potential has motivated experimental studies aimed at providing useful information of the utmost importance. Thus, in the present study, the antimicrobial and antioxidant activities of the species Coleus amboinicus(Lour.) and Mentha x villosa (Huds.) were assessed. Antimicrobial activity was determined by the disk diffusion method with standard Gram-negative (Escherichia coli: ATCC 25922 and ATCC 35218) and Gram-positive (Staphylococcus aureus: ATCC 25923and ATCC 27853) bacterial strains, as well as a standard strain of the fungus Cryptococcus neoformans (belonging to the CESMAC collection of microorganisms). Discs with imipenen and fluconazole were used as positive controls and a disc with absolute ethanol as a negative control. The antioxidant power was assayed by the DPPH and FTC methods and determination of total phenolic compound contents. The ethanolic extracts of C. and M. amboinicus x villosa showed excellent results with regard to both antimicrobial and antioxidant activities. Our results show the potential of these plants for preventing and fighting disease...

Ação antimicrobiana de medicações intracanal sobre dentina infectada de dentes decíduos e permanentes

Objetivo: o objetivo deste estudo foi avaliar a efetividade antimicrobiana de medicações intracanal em dentina infectada de dentes decíduos e permanentes. Métodos:blocos de dentina foram inoculados com Enterococcus faecalis a cada 72 horas durante 60 dias; após, foram irrigados,secos e completamente preenchidos com uma das misturas a seguir: 1) pó de hidróxido de cálcio, própolis e propilenoglicol, 2) pó de hidróxido de cálcio e propilenoglicol,3) pó de hidróxido de cálcio e água destilada,4) própolis e propilenoglicol, 5) própolis e água destilada.Após 30 dias, as amostras foram lavadas com água destilada esterilizada, imersas em Letheen broth e incubadas por 48 horas a 37ºC. Resultados e Conclusão: a hipótese de que a associação do hidróxido de cálcio com própolis poderia ser mais eficaz do que os outros medicamentos não foi confirmada, pois os resultados indicaram que todas as misturas testadas não foram capazes de inibir o biofilme de E. faecalis, tanto nos blocos de dentina de dentes decíduos como permanentes

Structure and microstructure of coronary dentin in non-erupted human deciduous incisor teeth

The dentin structure of non-erupted human deciduous mandibular and maxillary central and lateral incisor teeth was studied employing light and scanning electron microscopy. For light microscopy, nitric-acid-demineralized and ground sections were used. The sections were stained by hematoxylin-eosin, picrosirius and azo-carmim methods, and ground specimens were prepared using a carborundum disk mounted in a handpiece. For SEM study, teeth were frozen in liquid nitrogen and fractured at longitudinal and transversal directions. Structurally, demineralization and ground methods revealed tubules with primary and secondary curvatures, canaliculi, giant tubules, interglobular dentin, predentin, and intertubular dentin. Scanning electron microscopy showed three-dimensional aspects of dentinal tubules, canaliculi, peritubular dentin, intertubular dentin, and predentin. This study contributes to knowledge about dentin morphology showing characteristics of teeth not yet submitted to mastication stress

In vivo and in vitro effect of imipramine and fluoxetine on Na+, K+-ATPase activity in synaptic plasma membranes from the cerebral cortex of rats

The effects of in vivo chronic treatment and in vitro addition of imipramine, a tricyclic antidepressant, or fluoxetine, a selective serotonin reuptake inhibitor, on the cortical membrane-bound Na+,K+-ATPase activity were studied. Adult Wistar rats received daily intraperitoneal injections of 10 mg/kg of imipramine or fluoxetine for 14 days. Twelve hours after the last injection rats were decapitated and synaptic plasma membranes (SPM) from cerebral cortex were prepared to determine Na+,K+-ATPase activity. There was a significant decrease (10 percent) in enzyme activity after imipramine but fluoxetine treatment caused a significant increase (27 percent) in Na+,K+-ATPase activity compared to control (P<0.05, ANOVA; N = 7 for each group). When assayed in vitro, the addition of both drugs to SPM of naive rats caused a dose-dependent decrease in enzyme activity, with the maximal inhibition (60-80 percent) occurring at 0.5 mM. We suggest that a) imipramine might decrease Na+,K+-ATPase activity by altering membrane fluidity, as previously proposed, and b) stimulation of this enzyme might contribute to the therapeutic efficacy of fluoxetine, since brain Na+,K+-ATPase activity is decreased in bipolar patients

A importância do uso de filtros durante a infusäo de nutrições parenterais adicionadas de emulsões lipídicas / The importance of the use of filters during the infusion of parenteral nutrition containing lipid emulsions

Nutrições parenterais com adicionamento de emulsões lipídicas podem apresentar alterações físico-químicas, caracterizadas pela formaçäo de precipitados amorfos ou cristalinos, bem como pelo aumento do tamanho das gotículas de gordura que se agregam. A verificaçäo macroscópica dessas alterações nem sempre é possível, tendo em vista o aspecto opaco das emulsões. Utilizando-se estudo in vitro, este trabalho teve como objetivo evidenciar a presença de precipitados de fosfato de cálcio, de gotículas de gordura da emulsäo lipídica com diâmetros superiores aos de hemácias, em nutrições parenterais, e a importância do uso de filtros na retençäo dos mesmos. Esses eventos foram demonstrados por meio de inspeçäo macroscópica e microscópica, em nutrições parenterais contendo fosfato dibásico de potássio e de gluconato de cálcio, como fonte de fósforo e de cálcio, respectivamente, adicionados à mistura de soluções de aminoácidos a 10 por cento p/v, com glicose a 50 por cento p/v, emulsäo lipídica a 20 por cento p/v e minerais em diferentes proporções. Os resultados mostraram presença de precipitado de cálcio e de gotículas de gordura aumentadas e/ou agregadas antes da filtraçäo, e ausência dos mesmos imediatamente após. Conclusäo: o uso de filtros com poros de 1,2 μm foi capaz de reter precipitados e de impedir a passagem das gotículas de gordura com dimensões tais que pudessem causar embolias microvasculares em pacientes submetidos à nutriçäo parenteral

A sem study of prismless enamel in non-erupted human deciduos teeth

The frequency, structure, and thickness of the prismless enamel layer in the bucal and lingual surfaces of nonerupted anterior deciduous teeth were described. The samples were fixed in a modified Karnovsky solution, longitudinally fractured in liquid nitrogen and observed by scanning electron microscopy. The aprismatic area was observed in the incisal and perpendicular to the enamel outer surface. Some depressions were observed on the enamel surface. The statistical analysis showed no significant differences related to prismless enamel thickness among upper and lower central incisors, lateral incisors and canines, which varied from 4,19 to 5.15um.