Acaricidal activity of Derris floribunda essential oil and its main constituent

Objective To evaluate the acaricidal activity of the essential oil obtained from roots of Derris floribunda (D. floribunda) (Miq.) Benth, and its main constituent nerolidol against the Mexican mite Tetranychus mexicanus (T. mexicanus) (McGregor). Methods The essential oil from the roots of D. floribunda collected in the Amazon region (Brazil) was obtained by hydrodistillation. Its chemical composition was determined by GC–MS analysis. The acaricidal activities of this essential oil and nerolidol, were evaluated by recording the number of dead females (mortality) and eggs (fertility). Results The essential oil showed sesquiterpenes as major volatile components. Nerolidol, the main component, represented 68.5% of the total composition of the essential oil. D. floribunda essential oil and nerolidol showed acaricidal activity, with LC

Modelagem de Processos de Negócios usando BPMN para Desenvolvimento de um Prontuário Eletrônico de Pacientes / Business Process Modeling using BPMN for Development of an Electronic Health Record Patient / Modelaje de Procesos de Negocios usando BPMN para Implementación de un Prontuario Electrónico de Pacientes

O desenvolvimento de sistemas de informação em saúde é uma atividade complexa, entre outros fatores, pela necessidade de explicitar problemas do domínio em consonância com o processo de desenvolvimento do sistema. A modelagem de processos de negócios é uma atividade usada em diversas áreas para melhoria do entendimento do problema a ser resolvido, mas ainda incipiente no desenvolvimento de sistemas de informação em saúde. Neste artigo, é descrito como a modelagem de processos de negócios usando a linguagem BPMN pode ajudar no estabelecimento dos requisitos, características, processos e fluxos de dados entre diferentes sistemas de informações legados no projeto de uma aplicação de Prontuário Eletrônico de Paciente. A vantagem da modelagem dos processos de negócios é o mapeamento de tarefas efetivamente necessárias para o desenvolvimento, implantação e uso eficiente da aplicação.

Developing health information systems is a complex activity for many reasons, including the necessity of explaining domain problems according to the system development process. Business process modeling is an activity often applied in many domains to improve understanding of the problem to be solved. In this article, business process modeling is considered by using BPMN language to help in requirements documentation, characteristics, processes and data flow between different legacy information systems in the design of an Electronic Health Record application. The advantage of process modeling is the mapping of activities effectively necessary to develop, deploy and operate the application.

EL desarrollo de sistemas de información en salud es una actividad compleja, entre otros factores, por la necesidad de explicitar problemas del dominio en consonancia con el proceso de desarrollo del sistema. El modelaje de procesos de negocios es una actividad usada en diversas áreas para la mejoría del entendimiento del problema a ser resuelto, aún más incipiente en el desarrollo de sistemas de información en salud. En este artículo es descrito como el modelaje de procesos de negocios, usando el lenguaje BPMN, puede ayudar en el establecimiento de los requisitos, características, procesos y flujos de datos entre diferentes sistemas de informaciones legados de la institución em ló projecto de un Prontuario Electrónico de Paciente. La ventaja del modelaje de los procesos de negocios es el mapeado de tareas efectivamente necesarias para el desarrollo, implantación y uso eficiente de la applicacion.

Impact of CPAP on physical exercise tolerance and sympathetic-vagal balance in patients with chronic heart failure / Impacto da CPAP sobre a tolerância ao exercício físico e a modulação simpatovagal de pacientes com insuficiência cardíaca crônica

Background: Chronic heart failure (CHF) leads to exercise intolerance. However, non-invasive ventilation is able to improve functional capacity of patients with CHF. Objectives: The aim of this study was to evaluate the effectiveness of continuous positive airway pressure (CPAP) on physical exercise tolerance and heart rate variability (HRV) in patients with CHF. Method : Seven men with CHF (62±8 years) and left ventricle ejection fraction of 41±8% were submitted to an incremental symptom-limited exercise test (IT) on the cicloergometer. On separate days, patients were randomized to perform four constant work rate exercise tests to maximal tolerance with and without CPAP (5 cmH2O) in the following conditions: i) at 50% of peak work rate of IT; and ii) at 75% of peak work rate of IT. At rest and during these conditions, instantaneous heart rate (HR) was recorded using a cardiofrequencimeter and HRV was analyzed in time domain (SDNN and RMSSD indexes). For statistical procedures, Wilcoxon test or Kruskall-Wallis test with Dunn's post-hoc were used accordingly. In addition, categorical variables were analysed through Fischer's test (p<0.05). Results: There were significant improvements in exercise tolerance at 75% of peak work rate of IT with CPAP (405±52 vs. 438±58 s). RMSSD indexes were lower during exercise tests compared to CPAP at rest and with 50% of peak work rate of IT. Conclusion: These data suggest that CPAP appears to be a useful strategy to improve functional capacity in patients with CHF. However, the positive impact of CPAP did not generate significant changes in the HRV during physical exercises. .

Contextualização: A insuficiência cardíaca (IC) crônica cursa com intolerância ao exercício físico. A ventilação não invasiva (VNI) tem se mostrado benéfica para a melhora da performance desses pacientes. Objetivos: Avaliar a eficiência da pressão positiva contínua nas vias aéreas (CPAP) sobre a tolerância ao exercício físico e a variabilidade da frequência cardíaca (VFC) de pacientes com IC crônica. Método: Sete homens com IC crônica (62±8 anos) e fração de ejeção do ventrículo esquerdo de 41±8% foram submetidos ao teste incremental (TI) sintoma-limitado em cicloergômetro. Posteriormente, foram aleatorizados para a realização de exercícios físicos de carga constante até a tolerância máxima com e sem CPAP (5 cmH2O) nas condições: i) 50% da carga pico do TI e ii) 75% da carga pico do TI. Em repouso e durante os testes, a frequência cardíaca (FC) instantânea foi obtida pelo cardiofrequencímetro, e a VFC foi analisada no domínio do tempo. A análise estatística foi realizada pelos testes de Wilcoxon ou Kruskall-Wallis com post-hoc de Dunn e as variáveis categóricas, pelo teste de Fischer (p<0,05). Resultados: Durante a CPAP, houve aumento significativo no tempo de exercício físico (405±52 vs. 438±58 s) e da FC pico (97±3 vs. 105±2 bpm) somente na intensidade de 75%. Em relação à VFC, observou-se que o RMSSD foi significativamente menor em exercício físico quando comparado ao repouso com CPAP na intensidade 50%. Conclusão: Em conclusão, a CPAP com 5 cmH20 mostrou-se um útil na melhora da capacidade funcional dos pacientes estudados com pouco impacto sobre a VFC. .

Determination of anaerobic threshold through heart rate and near infrared spectroscopy in elderly healthy men

BACKGROUND: Aging leads to low functional capacity and this can be reversed by safe and adequate exercise prescription. OBJECTIVE: The aim of this study was to identify the anaerobic threshold (AT) obtained from the V-slope method as well as visual inspection of oxyhemoglobin ( O2Hb) and deoxyhemoglobin (HHb) curves and compare findings with the heteroscedastic (HS) method applied to carbon dioxide production ( CO2), heart rate (HR), and HHb data in healthy elderly men. A secondary aim was to assess the degree of agreement between methods for AT determination. METHOD: Fourteen healthy men (61.4±6.3 years) underwent cardiopulmonary exercise testing (CPX) on a cycle ergometer until physical exhaustion. Biological signals collected during CPX included: ventilatory and metabolic variables; spectroscopy quasi-infrared rays - NIRS; and HR through a cardio-frequency meter. RESULTS: We observed temporal equivalence and similar values of power (W), absolute oxygen consumption (O2 - mL/min), relative O2 ( mL.Kg - 1.min -1), and HR at AT by the detection methods performed. In addition, by the Bland-Altman plot, HR confirmed good agreement between the methods with biases between -1.3 and 3.5 beats per minute. CONCLUSIONS: (i) all detection methods were sensitive in identifying AT, including the HS applied to HR and (ii) the methods showed a good correlation in the identification of AT. Thus, these results support HR as valid and readily available parameter in determining AT in healthy elderly men. .

Actividad angiogénica comparada de líquido cefalorraquídeo de pacientes con tumores primarios del sistema nervioso central / Compared angiogenic activity of cerebrospinal fluid of patients with primary central nervous system tumors

Introducción: Los tumores cerebrales continúan siendo una patología de mal pronóstico, lo que se refleja en la baja expectativa de vida de quienes los padecen. La angiogénesis es un proceso cardinal en el crecimiento tumoral y en la producción de metástasis. No obstante el conocimiento de los mecanismos subyacentes a la oncogénesis, las terapias continúan obteniendo resultados modestos. Está demostrado que el parénquima tumoral secreta factores que estimulan la cascada angiogénica. Sin embargo, no existen trabajos que evalúen el efecto angiogénico del líquido cefalorraquídeo (LCR). La hipótesis propuesta en este trabajo es que el LCR de los pacientes con tumores primarios del sistema nervioso central (SNC), posee en sí mismo propiedades angiogénicas. Material y Método: Estudio experimental preclínico. Se utilizó, en ciento ochenta huevos de gallina White Leghorn, el modelo de membrana alantocoriónica (MAC) de pollo. Estos huevos fueron incubados y sobre la membrana se implantaron filtros de metilcelulosa con líquidos cefalorraquídeos de pacientes con diferentes tumores cerebrales. Al grupo control se le adicionó suero fisiológico. Tras diez días de incubación se realizaron cortes histológicos de las muestras y se procedió al conteo de vasos sanguíneos en un microscopio con rejilla graduada. Resultados: Se demostró con significancia estadística (p<0,05) que existe efecto angiogénico en el LCR de pacientes con tumores primarios del SNC. Discusión: A partir de los resultados obtenidos, podemos proyectar futuros trabajos hacia nuevas terapias enfocadas en la angiogénesis diferencial. Los factores angiogénicos presentes en el LCR podrían constituir un nuevo blanco terapéutico contra los tumores cerebrales.

Introduction: Nowadays, brain tumors remains being a poor-prognosis pathology, which is reflected in the low life expectancy of the patients. The angiogenesis, is a fundamental process in the tumoral growing and the metastatic feasibility. In spite of knowing of the underlying mechanism of the oncogenesis, therapies still get poor results. It is demonstrated that tumoralparenchyma secretes factors that enhance the angiogenic cascade. However, any work has ever evaluated the angiogenic effect in the cerebrospinal fluid (CSF) itself. We hypothesize that CSF belonging of patients with primary central nervous system (CNS) brain tumors, presents angiogenic properties on their own. Material and Method: Preclinical experimental trial. In 180 eggs of White Legorn chicken it was used the chorioallantoic membrane (CAMA) assay. This eggs were incubated for tendays and over the membrane were implanted methylcellulose filters containing cerebrospinal fluid coming from patients affected by different brain tumors. The control group was instilledwith saline solution. It was performed different histological sections of the samples and then proceeded to the counting of the vessels in a microscope with a squared grille inside it. Results:We demonstrated with statistical significance (p<0.05) that CSF from primary brain tumor’s affected patients presents angiogenic effect. Discussion: Owing the presented results, we can plan future investigations targeting new therapies focused on the differential angiogenesis. The angiogenic factors in the CSF could represent a new therapeutic target against brain tumors.

Endocarditis infecciosa por Aerococcus species: caso clínico y revisión de la literatura / Bacterial endocarditis caused by Aerococcus species: case report and literature review

Introducción: Aeroccus species es una bacteria Gram positiva considerada como un agente inusual de infecciones del tracto urinario y de endocarditis infecciosa. Clásicamente los adultos mayores varones con anomalías genitourinarias crónicas están expuestos a esta infección. Presentación del caso: Hombre de 55 años consulta por un cuadro de dos meses de evolución caracterizado por compromiso del estado general, fiebre continua, diaforesis, dolor torácico sordo lateralizado a izquierda, y baja de peso de 8 kg en un mes, con anorexia. Sin antecedentes mórbidos salvo estenosis uretral crónica con requerimiento de dilataciones transureterales, las cuales realiza con termómetro de mercurio. Paciente ingresa en regulares condiciones generales, quejumbroso. Examen pulmonar con disminución del murmullo pulmonar en la base izquierda más broncofonía. Tacto rectal doloroso a la palpación. Los exámenes complementarios revelan: hemograma con leucocitosis de 13.100/mm3, VHS de 63 mm/h, PCR de 21 mg/dL. En el estudio de fiebre de origen desconocido se realiza ecocardiografía transtorácica la que reveló vegetación en velo coronario izquierdo de 0,9 cm x 1 cm. Los hemocultivos resultan positivos para Aerococcus species sensible a cloranfenicol/ceftriaxona, por lo que se inicia antibioticoterapia con ceftriaxona-gentamicina, mostrando el paciente una notable mejoría clínica, disminuyendo su malestar general y normalizando la temperatura. Discusión: Debido a la difícil interpretación microbiológica de los cultivos, Aerococcus sp es un germen identificado tardíamente, lo cual puede ensombrecer el pronóstico. La antibioticoterapia precoz y la continua monitorización clínica y de laboratorio son las estrategias más útiles en su tratamiento.

Introduction: Aerococcus species is a Gram-positive bacteria regarded as a rare cause of urinary tract infections and infective endocarditis. Most cases have been described in elderly males with underlying genitourinary tract abnormalities. Case report: 55 years old male complains two-month period of malaise, continuous fever, diaphoresis, left-thoracic dull pain and weight loss of 8 kg in a month, presenting anorexia. With an unremarkable history except for a chronic urethral stricture with needed of periodic transurethral dilation, which where performed using a mercurial thermometer. Patient comes to the emergency room in regular conditions, querulous. Pulmonary examination with diminished left base vesicular breath sound plus bronchovesicular breath sound. Digital rectal examination painfull at palpation. Complementary laboratory test shows: 13.100/mm3 WBC, VHS of 63 mm/h, PCR on 21 mg/dL. In the context of fever of unknown origin it was performed a transthoracic echocardiography, which showed a 0.9 x 1 cm vegetation in left coronary valve. Blood cultures were positive for Aerococcus sp. sensitive to chloramphenicol /ceftriaxone, showing the patient a remarkable clinical improvement, diminishing his malaise and normalizing his temperature. Discussion: Owing to the frequent microbiologic misinterpretation of the cultures, the bacterial identification often is delayed, which could potentially lead to a fatal outcome. Aggressive-fast establishment of antiobiotic therapy and a continuous monitoring of the patient's clinical status and laboratory results are the most effective strategies in treatment.

Controle autonômico da frequência cardíaca de pacientes com doenças cardiorrespiratórias crônicas e indivíduos saudáveis em repouso e durante a manobra de acentuação da arritmia sinusal respiratória / Autonomic control of heart rate in patients with chronic cardiorespiratory disease and in healthy participants at rest and during a respiratory sinus arrhythmia maneuver

OBJETIVO: Avaliar a modulação autonômica da frequência cardíaca (FC) em repouso, na postura supina e durante a manobra de acentuação da arritmia sinusal respiratória (M-ASR) de pacientes com doença pulmonar obstrutiva crônica (DPOC) ou com insuficiência cardíaca crônica (ICC). MÉTODOS: Vinte e oito homens foram subdivididos em três grupos: 10 com DPOC (GD) e 69±9 anos; 9 com ICC (GI) e 62±8 anos; e 9 saudáveis (GC) com 64±5 anos. Em repouso, os intervalos R-R a partir do sinal eletrocardiográfico foram obtidos nas seguintes situações: 1) 15 minutos na posição supina e 2) 4 minutos durante M-ASR na posição supina. Os dados foram analisados nos domínios do tempo (índices RMSSD e SDNN) e da frequência. Durante M-ASR, foram calculadas a razão expiração/inspiração (E/I) e a diferença inspiração/expiração (∆IE). RESULTADOS: Os principais achados mostraram que os pacientes com ICC apresentaram menores valores de RMSSD (12,2±2,6 vs 20,4±6,5), BFab (99,2±72,7 vs 305,3±208,9) e AFun (53,4±29,9 vs 178,9±113,1) quando comparados ao controle. Além disso, a banda de BFab foi significantemente reduzida no grupo DPOC quando comparado ao controle (133,8±145,5 vs 305,3±208,9). Adicionalmente, pacientes com ICC e DPOC mostraram menor razão E/I (1,1±0,06 vs 1,2±0,1 e 1,1±0,03 vs 1,2±0,1) e ∆IE (7,0±3,5 vs 12,7±0,1 e 4,9±1,6 vs 12,7±0,1), respectivamente, comparados ao GC durante a M-ASR. CONCLUSÃO: Os resultados deste estudo sugerem que tanto a DPOC como a ICC produzem impacto negativo sobre o controle autonômico da FC.

OBJECTIVE: To evaluate the autonomic modulation of heart rate (HR) at rest in the supine position and during a respiratory sinus arrhythmia maneuver (M-RSA) among participants with chronic obstructive pulmonary disease (COPD) or with chronic heart failure (CHF). METHODS: Twenty-eight men were divided into three groups: ten with COPD, aged 69±9 years; nine with CHF, aged 62±8 years; and nine healthy participants aged 64±5 years (controls). At rest, the R-R interval of the electrocardiographic signal was obtained in the following situations: 1) 15 min in the supine position; and 2) 4 min during M-RSA in the supine position. The data were analyzed in the time domain (RMSSD and SDNN indices) and the frequency domain (LFab and HFab). During M-RSA, the expiratory/inspiratory ratio (E/I) and the inspiratory/expiratory difference (∆IE) were calculated. RESULTS: The main findings showed that the CHF patients presented lower RMSSD (12.2±2.6 vs. 20.4±6.5), LFab (99.2±72.7 vs. 305.3±208.9) and HFab (53.4±29.9 vs. 178.9±113.1), compared with the controls. The LFab band was significantly lower in the COPD group than in the controls (133.8±145.5 vs. 305.3±208.9). Additionally, both CHF patients and COPD patients showed lower E/I ratios (1.1±0.06 vs. 1.2±0.1 and 1.1±0.03 vs. 1.2±0.1) and ∆IE values (7.0±3.5 vs. 12.7±0.1 and 4.9±1.6 vs. 12.7±0.1), respectively, compared with the controls during M-RSA. CONCLUSION: The results from this study suggest that both COPD and CHF have a negative impact on the autonomic control of heart rate.

Cardiac surgery-challenges and surprises in a country at war

The challenges and results of cardio-vascular surgery at the American University of Beirut Medical Center [AUBMC] during the civil strife in Lebanon are presented. Dependence on local resources is emphasized. Temporary interruption of open-heart surgery in a university setting may be the product of absence of essential materials and/or personnel. Ingenuity and team approach have contributed to the success and survival of the open-heart program. The operative results and mortality rate were indirectly related to the intensity of fighting in the vicinity of a Medical Center that served as a field hospital

Delayed primary colorectostomy after endorectal abdominoperineal pull through for Hirschsprung's disease

A personal experience with 40 consecutive patients undergoing 41 delayed primary colo-rectostomy [DPCR] after endorectal abdomino-perineal pull-through [ERAPP] for the treatment of Hirschsprung's disease [H.D.] between 1978 and 1983 is presented. Three patients underwent a rectal myectomy before the [ERAPP]. Twenty-three of 38 patients [58%] had the decompressive preliminary colostomy performed in the first month of life. The ERAPP was done under cover of colostomy in two of 38 patients, the remainder having had their colostomy resected at the time of pull-through. Three patients were recolostomized in the immediate post-DPCR period to permit adequate healing of the pulled-through segment. The DPCR was practised 5 to 7 days after the ERAPP in all patients. One patient had evidence of postoperative hypoganglionosis of the pulled-through colon requiring a redo of the ERAPP. Two patients developed postoperative enterocolitis which led to the death of one infant six weeks postoperatively. The functional results indicate complete fecal continence for 30 patients, i.e. a rate of 76%, within two years after operation. This rate Increased to 90% during the subsequent two years. The variability in the age at which complete fecal continence was acquired is noted

Tetralogy of fallot

The management and results of 72 consecutive patients with TOP during a 4-year period at the AUBMC are presented. Thirteen patients had a systemic to pulmonary artery shunt performed prior to total repair. Fourteen other patients required shunts during the same period, of whom 5 were done on an emergency basis after a cardiac catheterization. The operative mortality rate in 27 patients during the last 2 years of this survey was 7%, whereas the previous mortality rate in 45 patients during a comparable period was 11%. The operative mortality rate in shunted patients was 15% after total repair vs. 10% in non-shunted patients. The indications for shunt procedures in this retrospective survey were: anomalous LAD crossing RVOT, repeated cyanotic spells in infants less than 2 years of age, hypoplastic pulmonary arteries, unavailability of open-heart facilities, or a rare blood group rendering open-heart operation practically not safe. Eight patients [11%] had an associated anomaly of the coronaries, of whom two succumbed after total repair. Mediastinal bleeding was noted post-repair in 1 of 13 shunted patients [7.6%] versus 7 of 59 non-shunted patients [11.8%]. The use of properly tailored Gore-Tex to patch the VSD and reconstruct the right ventricular outflow tract has yielded satisfactory results. The optimal age of about one year for total primary repair of TOF is presently favored