Cardiopulmonary exercise test in patients with refractory angina: functional and ischemic evaluation

Abstract Objectives Refractory angina (RA) is a chronic condition clinically characterized by low effort tolerance; therefore, physical stress testing is not usually requested for these patients. Cardiopulmonary exercise testing (CPET) is considered a gold standard examination for functional capacity evaluation, even in submaximal tests, and it has gained great prominence in detecting ischemia. The authors aimed to determine cardiorespiratory capacity by using the oxygen consumption efficiency slope (OUES) in patients with refractory angina. The authors also studied the O2 pulse response by CPET and the association of ischemic changes with contractile modifications by exercise stress echocardiography (ESE). Methods Thirty-one patients of both sexes, aged 45 to 75 years, with symptomatic (Canadian Cardiovascular Society class II to IV) angina who underwent CPET on a treadmill and exercise stress echocardiography on a lower limb cycle ergometer were studied. ClinicalTrials.gov: NCT03218891. Results The patients had low cardiorespiratory capacity (OUES of 1.74 ± 0.4 L/min; 63.9±14.7% of predicted), and 77% of patients had a flattening or drop in O2 pulse response. There was a direct association between Heart Rate (HR) at the onset of myocardial ischemia detected by ESE and HR at the onset of flattening or drop in oxygen pulse response detected by CPET (R = 0.48; p = 0.019). Conclusion Patients with refractory angina demonstrate low cardiorespiratory capacity. CPET shows good sensitivity for detecting abnormal cardiovascular response in these patients with a significant relationship between flattening O2 pulse response during CEPT and contractile alterations detected by exercise stress echocardiography. Highlights OUES analysis is useful for assessing functional capacity in refractory angina. O2 pulse curve is correlated with contractile alterations in exercise echocardiogram. Cardiopulmonary exercise test is useful toll in patients with refractory angina.

Prevalência dos indicadores de risco para perda auditiva nos resultados 'falha' da triagem auditiva neonatal / Prevalence of risk indices for hearing loss in 'failure' results of newborn hearing screening

OBJETIVO: estabelecer qual indicador de risco para perda auditiva apresenta maior prevalência de resultados 'falha' da Triagem Auditiva Neonatal. MÉTODOS: a partir de análise retrospectiva de 702 prontuários de lactentes submetidos à triagem auditiva neonatal no Ambulatório de Audiologia da Universidade Federal da Bahia no período de 2007 a 2011, foi realizado o teste do qui-quadrado para a hipótese de ausência de associação entre os indicadores de risco e a 'falha' da Triagem Auditiva Neonatal. RESULTADOS: dos lactentes pesquisados, 352 (50,29%) foram do sexo masculino e 348 (49,71%) do sexo feminino, dois não tinham referências quanto ao gênero. A maioria dos bebês tinha idade entre um a três meses de vida e 45,40% dos bebês nasceram prematuros. Verificou-se que os bebês apresentaram os seguintes indicadores de risco: 28,83% tinham hiperbilirrubinemia; 22,54% tinham história de infecção congênita; 15,06% nasceram com peso inferior a 1.500g; 8,21% tiveram boletim Apgar de 0 a 4 no 1º minuto; 5,07% apresentaram boletim Apgar de 0 a 6 no 5º minuto; 9,09% receberam ventilação mecânica; 4,09% tinham síndromes associadas à perda auditiva e apenas 1 (0,84%) lactente teve meningite bacteriana. Entre esses lactentes, 92,45% não tinham histórico familiar de deficiência auditiva e 97,09% não apresentavam malformação craniofacial. CONCLUSÃO: houve associações entre cinco indicadores de risco e 'falha' na triagem auditiva neonatal. Os indicadores de risco apresentaram a seguinte ordem decrescente de prevalência: boletim de Apgar de 0 a 4 no 1º minuto; malformações craniofaciais; síndrome associadas a perdas auditivas; boletim de Apgar de 0 a 6 no 5º minuto; ventilação mecânica. .

PURPOSE: to establish which risk index for hearing loss shows the highest prevalence of 'failure' in newborn hearing screening. METHODS: using a retrospective analysis of medical records involving 702 infants undergoing neonatal hearing screening in the Audiology Clinic of the Federal University of Bahia in the period 2007-2011, the chi-square test was carried out for the hypothesis of no association between the risk indices and 'failure' of the newborn hearing screening. RESULTS: in relation to the infants studied, 352 (50.29%) were male and 348 patients (49.71%) were females, two had no references as to their gender. Most babies were between one to three months of age and 45.40% of babies were born prematurely. It was found that infants showed the following risk indices: 28.83% had hyperbilirubinemia; 22.54% had a history of congenital infection; 15.06% were born weighing less than 1,500 grams; 8.21% had Apgar scores of 0-4 in the 1st minute; 5.07% had Apgar scores 0-6 in the 5th minute; 9.09% received artificial respiration; 4.09% had syndromes associated with hearing loss and only 1 (0.84%) infant had bacterial meningitis. Among these infants, 92.45% had no family history of hearing impairment and 97.09% had no craniofacial malformation. CONCLUSION: there were associations between five risk indices and 'failure' in neonatal hearing screening. Risk indices showed the following decreasing order of prevalence: Apgar score 0-4 in the 1st minute; craniofacial malformations; syndromes associated with hearing loss; Apgar score 0-6 in the 5th minutes; artificial respiration. .

Revisão sistemática do uso da dexametasona como terapia adjuvante na meningite bacteriana em crianças / Systematic review of dexamethasone as an adjuvant therapy for bacterial meningitis in children / Revisión sistemática del uso de la dexametasona como terapia adyuvante en la meningitis bacteriana en niños

OBJETIVO: Analisar a melhor evidência disponível nos últimos 15 anos com relação aos benefícios da terapia adjuvante com dexametasona na meningite bacteriana em população pediátrica. FONTES DE DADOS: Das bases de dados Medline, Lilacs e SciELO, foram analisados ensaios clínicos randomizados de 1996 a 2011, os quais comparavam a dexametasona ao placebo e/ou a outra terapia adjuvante em pacientes com meningite bacteriana diagnosticada laboratorialmente por critérios quimiocitológicos e/ou bacteriológicos, na faixa etária de 29 dias aos 18 anos. Os desfechos avaliados foram mortalidade e ocorrência de sequelas neurológicas e/ou auditivas. Foram excluídos estudos relacionados à meningite tuberculosa. SÍNTESE DOS DADOS: Com os critérios utilizados, foram identificadas cinco publicações correspondentes a quatro protocolos de estudo. Nenhum dos estudos mostrou diferenças entre a dexametasona e o placebo para os desfechos avaliados. Os estudos analisados tiveram alta qualidade (escore de Jadad et al=5). CONCLUSÕES: As evidências encontradas na literatura são insuficientes para indicar de forma rotineira o uso da dexametasona como terapia adjuvante para redução de mortalidade, perda auditiva e sequelas neurológicas em pacientes pediátricos com meningite bacteriana não tuberculosa.

OBJECTIVE: To analyze the best available evidence from the last 15 years on the benefits of adjuvant therapy with dexamethasone for bacterial meningitis in children. DATA SOURCES: Randomized controlled trials comparing dexamethasone to placebo and/or other adjuvant therapies in patients with bacterial meningitis diagnosed by biochemical, cytological and/or microbiological data. Studies with patients from 29 days to 18 years of age, from 1996 to 2011, were searched at Medline, Lilacs and SciELO databases. The evaluated outcomes were mortality and development of neurological and/or hearing impairment. Studies related to tuberculous meningitis were excluded. DATA SYNTHESIS: With the specified criteria, five published studies were identified corresponding to four study protocols. None of the studies showed differences between dexamethasone and placebo for the evaluated outcomes. All analyzed studies had high methodological quality (Jadad et al score=5). CONCLUSIONS: Current evidence is insufficient to support routine adjuvant therapy with dexamethasone to reduce mortality, hearing impairment, or neurological sequelae in pediatric patients with non-tuberculous bacterial meningitis.

OBJETIVO: El presente estudio tiene por objetivo el análisis de la mejor evidencia disponible los últimos 15 años respecto a los beneficios de la terapia adyuvante con dexametasona en la meningitis bacteriana en población pediátrica por medio de revisión sistemática. FUENTES DE DATOS: De las bases de datos Medline, Lilacs y ScieLO, se analizaron ensayos clínicos aleatorios de 1996 a 2011 que comparaban la dexametasona al placebo y/u otra terapia adyuvante, en pacientes con meningitis bacteriana diagnosticada laboratorialmente por criterios quimiocitológicos y/o bacteriológicos, en la franja de edad de 29 días a 18 años. Los desenlaces evaluados fueron mortalidad y ocurrencia de secuelas neurológicas y/o auditivas. Se excluyeron estudios con meningitis tuberculosa. SÍNTESIS DE LOS DATOS: Con los criterios utilizados, se identificaron cinco publicaciones correspondientes a cuatro protocolos de estudio. Ninguno de los estudios mostró diferencias entre la dexametasona y el placebo para los desenlaces evaluados. Todos los estudios analizados tuvieron alta calidad (escore Jadad=5). CONCLUSIÓN: Las evidencias encontradas en la literatura son insuficientes para indicar, de modo rutinario, el uso de la dexametasona como terapia adyuvante para reducción de la mortalidad, pérdida auditiva y secuelas neurológicas, en pacientes pediátricos con meningitis bacteriana no tuberculosa.

Análise sensorial do leite humano ordenhado e sua carga microbiana / Sensorial analysis of expressed human milk and its microbial load

OBJETIVO: Verificar a existência de relação entre a presença de off-flavor e a carga de microrganismos em amostras de leite humano ordenhado rejeitadas pelo controle de qualidade de um banco de leite humano. MÉTODOS: Testou-se em 30 amostras de leite humano ordenhado com presença de off-flavor a ocorrência dos seguintes microrganismos: aeróbios mesófilos, psicrotróficos, proteolíticos, proteolíticos-psicrotróficos, termodúricos, termodúricos-psicrotróficos, bactérias lácticas, lipolíticos, bolores e leveduras e Staphylococcus aureus, coliformes totais e coliformes termotolerantes, de acordo com métodos oficiais. RESULTADOS: A ocorrência percentual dos microrganismos foi a seguinte: aeróbios mesófilos = 80 por cento; psicrotróficos = 36,7 por cento; proteolíticos = 46,7 por cento; proteolíticos-psicrotróficos = 16,7 por cento; termodúricos = 6,7 por cento; termodúricos-psicrotróficos = 0 por cento; bactérias lácticas = 50 por cento; lipolíticos = 10 por cento; bolores e leveduras = 6,7 por cento; S. aureus = 30 por cento; coliformes totais = 53,3 por cento; e coliformes termotolerantes = 16,7 por cento. CONCLUSÃO: Observou-se relação consistente entre a presença de off-flavor e elevadas contagens dos microrganismos nas amostras analisadas, o que reforça a importância da pesquisa de off-flavor na seleção e no controle da qualidade dos bancos de leite humano.

OBJECTIVE: To verify the existence of a relationship between presence of off-flavor and microorganism load in quality control rejected samples of expressed human milk from a donor milk bank. METHODS: A total of 30 samples of expressed human milk with off-flavor were tested for the occurrence of the following microorganisms: aerobic mesophilic, psycrotrophic, proteolytic, psycrotrophic proteolytic, thermoduric, psycrotrophic thermoduric, lactate and lipolytic bacteria, molds and yeasts and Staphylococcus aureus, total coliforms and thermophilic coliforms, in accordance with official methods. RESULTS: Percentage occurrence of microorganisms was as follows: aerobic mesophilic = 80 percent; psycrotrophic = 36.7 percent; proteolytic = 46.7 percent; psycrotrophic proteolytic = 16.7 percent; thermoduric = 6.7 percent; psycrotrophic thermoduric = 0 percent; lactate bacteria = 50 percent; lipolytic = 10 percent; molds and yeasts = 6.7 percent; S. aureus = 30 percent; total coliforms = 53.3 percent; and thermophilic coliforms = 16.7 percent. CONCLUSION: A consistent relationship between presence of off-flavor and elevated microorganism counting was observed in the analyzed samples. This correlation highlights the importance of off-flavor research during selection and quality control processes in human milk banks.

Possibility of public health hazards by contamination of toxin producing Vibrio cholerae through fishes reared in sewage fed fishery.

This study was undertaken to explore the possibility of contamination of Vibrio cholerae serogroups 01 and 0139, the most important causative organisms for life threatening acute secretory diarrhoea and also potential public health importance, by isolating these organisms from body surface, gill and intestine of common table fishes like Labeo rhoita, Catla Catla, Cirrhinus mirgala and Tilapia mosambica which were reared in sewage and raw human excrita enriched fishery ponds. Vibrio Cholerae 01 or 0139 were not isolated from body surface swabs, gills and intestine of these common table fishes. Water samples of sewage enriched fishery ponds and sewage of Calcutta municipal corporation were also processed for isolation of these organisms, however, these samples were also negative for V. Cholerae 01, 0139 and non 01-0139 serogroups. Present study indicated that there was less chance of contamination of toxigenic and disease producing strains of V. cholerae by common table fishes which were reared in sewage and raw faecal matter enriched fishery ponds.

Biological activity & interaction of Vibrio cholerae bacteriophages in rabbit ileal loop.

A set of ten V. cholerae EITor phages is in routine use for phage typing of V. cholerae O1 biotype EITor strains. These phages were used in rabbit ileal loop experiment to investigate whether these phages have any prophylactic value as regards their lytic capability on V. cholerae strains. The phages were found to have no prophylactic use as they were unable to lyse the standard bacterial strain V. cholerae MAK 757.

In vitro antimicrobial activity of potash alum.

This study reports the bactericidal activity of potash alum when added to water, against various epidemic causing enteric pathogens like Vibrio cholerae 01, V. cholerae 0139 and Shigella dysenteriae 1 by lowering the pH of water (from 6.0 to 4.0). Growth of the enteric pathogens was monitored in vitro by inoculating broth cultures of the different organisms in distilled water containing increasing concentrations of potash alum and quantitatively determining the concentration of viable organisms over a 48 h period by the standard plate count method. Controls constituted cultures of each organism grown in the absence of potash alum. The pH of alum administered water was measured in each test tube before inoculation of organisms. Potash alum was found to inhibit growth (10(5) viable count per ml) of most of the organisms examined, particularly V. cholerae 01 and V. cholerae 0139 in a dose dependent fashion. Reduction of colony forming units was observed in presence of 0.25 g/dl of alum after 5 h and no growth was noticed after 24 h.

Validity of new phage typing scheme against Vibrio cholerae 01 biotype ElTor strains.

A total of 538 strains of V. cholerae 01 biotype ElTor were phage typed by the conventional Basu and Mukerjee and also the new typing scheme developed at the National Institute of Cholera and Enteric Diseases, Calcutta. The strains could be clustered into seven types by the new scheme as against only two by the conventional method. The results provide conclusive evidence on the validity of the new scheme for phage typing of V. cholerae strains.

Acute diarrhoea caused by Vibrio mimicus in Calcutta.

Out of 539 acute diarrhoea cases studied, Vibrio mimicus was isolated as a sole pathogen in the faeces of 7 (1.3%) cases. The chief clinical presentations of the seven cases were watery diarrhoea and vomiting. Bloody diarrhoea was observed in 2 (28.5%), abdominal pain in 2 (28.57%) and fever in one (14.29) cases. All cases could be effectively treated with ORS except 3 (42.85%) cases who required IV Ringer's lactate. All V. mimicus strains isolated in the study were uniformly susceptible to tetracycline, chloramphenicol, norfloxacin and ciprofloxacin.

An outbreak of acute diarrhoeal disease amongst tribal population in Tripura.

A massive outbreak of acute diarrhoeal diseases occurred during March-April, 1992 in the north district of Tripura. Investigation of the outbreak revealed Vibrio cholerae 01 biotype ElT or as the main etiologic agent in 50 per cent of patients. The outbreak which started amongst the tribal population might have spread due to prevailing illiteracy, poverty, low personal and domestic hygiene and vulnerable water sources (chhara water).

Prospective study of nosocomial enteric infections in a pediatric hospital, Calcutta.

Hospital acquired enteric infections were investigated by studying 3138 children under 5 years of age who were admitted without diarrhea in nine medical words of a pediatric hospital, Calcutta during the period between March and September 1987. Three hundred and twenty (10.2%) children developed nosocomial diarrhea during their hospital stay. Fecal samples from 178 nosocomial diarrhea, 345 hospitalized diarrhea cases, 178 hospital controls and 200 outpatient controls were collected for detection of established enteropathogens. There were no statistically significant differences in the detection of most of the enteropathogens from fecal samples of nosocomial diarrhea, hospitalized diarrhea and hospital controls. Enteric pathogens were detected at a higher frequency (statistically significant) from fecal samples of nosocomial diarrhea cases as compared to outpatient controls. This study highlights the importance of most of the enteropathogens like Shigella, Salmonella, rotavirus, enteropathogenic E. coli as the cause of hospital cross infection. This study reinforces the importance of developing preventive measures in order to reduce the frequency of illness.