Multi-resistant diarrheagenic Escherichia coli identified by FTIR and machine learning: a feasible strategy to improve the group classification.

The identification of multidrug-resistant strains from E. coli species responsible for diarrhea in calves still faces many laboratory limitations and is necessary for adequately monitoring the microorganism spread and control. Then, there is a need to develop a screening tool for bacterial strain identification in microbiology laboratories, which must show easy implementation, fast response, and accurate results. The use of FTIR spectroscopy to identify microorganisms has been successfully demonstrated in the literature, including many bacterial strains; here, we explored the FTIR potential for multi-resistant E. coli identification. First, we applied principal component analysis to observe the group formation tendency; the first results showed no clustering tendency with a messy sample score distribution; then, we improved these results by adequately selecting the main principal components which most contribute to group separation. Finally, using machine learning algorithms, a predicting model showed 75% overall accuracy, demonstrating the method's viability as a screaming test for microorganism identification.

Rivaroxaban to prevent major clinical outcomes in non-hospitalised patients with COVID-19: the CARE - COALITION VIII randomised clinical trial.

Background: COVID-19 progression is associated with an increased risk of arterial and venous thrombosis. Randomised trials have demonstrated that anticoagulants reduce the risk of thromboembolism in hospitalised patients with COVID-19, but a benefit of routine anticoagulation has not been demonstrated in the outpatient setting. Methods: We conducted a randomised, open-label, controlled, multicentre study, evaluating the use of rivaroxaban in mild or moderate COVID-19 patients. Adults ≥18 years old, with probable or confirmed SARS-CoV-2 infection, presenting within ≤7 days from symptom onset with no clear indication for hospitalization, plus at least 2 risk factors for complication, were randomised 1:1 either to rivaroxaban 10 mg OD for 14 days or to routine care. The primary efficacy endpoint was the composite of venous thromboembolic events, need of mechanical ventilation, acute myocardial infarction, stroke, acute limb ischemia, or death due to COVID-19 during the first 30 days. ClinicalTrials.gov: NCT04757857. Findings: Enrollment was prematurely stopped due to sustained reduction in new COVID-19 cases. From September 29th, 2020, through May 23rd, 2022, 660 patients were randomised (median age 61 [Q1-Q3 47-69], 55.7% women). There was no significant difference between rivaroxaban and control in the primary efficacy endpoint (4.3% [14/327] vs 5.8% [19/330], RR 0.74; 95% CI: 0.38-1.46). There was no major bleeding in the control group and 1 in the rivaroxaban group. Interpretation: On light of these findings no decision can be made about the utility of rivaroxaban to improve outcomes in outpatients with COVID-19. Metanalyses data provide no evidence of a benefit of anticoagulant prophylaxis in outpatients with COVID-19. These findings were the result of an underpowered study, therefore should be interpreted with caution. Funding: COALITION COVID-19 Brazil and Bayer S.A.

Damage Propagation by Cyclic Loading in Drilled Carbon/Epoxy Plates.

Fiber reinforced composites are widely used in the production of parts for load bearing structures. It is generally recognized that composites can be affected both by monotonic and cyclic loading. For assembly purposes, drilling is needed, but holes can act as stress concentration notches, leading to damage propagation and failure. In this work, a batch of carbon/epoxy plates is drilled by different drill geometries, while thrust force is monitored and the hole's surrounding region is inspected. Based on radiographic images, the area and other features of the damaged region are computed for damage assessment. Finally, the specimens are subjected to Bearing Fatigue tests. Cyclic loading causes ovality of the holes and the loss of nearly 10% of the bearing net strength. These results can help to establish an association between the damaged region and the material's fatigue resistance, as larger damage extension and deformation by cyclic stress contribute to the loss of load carrying capacity of parts.

Differences in postural control between healthy and subjects with chronic ankle instability.

INTRODUCTION: Chronic ankle instability (CAI) is characterized by the occurrence of repetitive inversion mechanism of the ankle, resulting in numerous ankle sprains. CAI occurs in approximately 70% of patients with a history of a lateral ankle sprain. Many causes of functional ankle instability have been postulated and include deficits in proprioception, impaired neuromuscular-firing patterns, disturbed balance and postural control. OBJECTIVE: The purpose of this study was to compare postural control behaviour in subjects with chronic ankle instability and healthy subjects, using the traditional linear and nonlinear variables for the centre of pressure (CoP) displacement, during one-leg stance on stable and unstable surfaces. METHODS: 16 CAI subjects and 20 healthy subjects were evaluated with the single leg stance on a stable surface and an unstable surface, for 60 s with a force plate. The traditional linear variables like CoP displacement, CoP amplitude and CoP velocity were calculated. Variability of CoP displacement was also submitted to nonlinear analysis and the approximated entropy, sample entropy, correlation dimension and Lyapunov exponent were calculated. RESULTS: On the stable surface, no differences between groups for all the traditional variables were found but the correlation dimension of CoP mediolateral displacement had lower values on the CAI group with statistical significance (p < 0.05). On the unstable surface, no differences were found neither with linear variable neither with variability nonlinear analysis. CONCLUSION: Correlated dimension of CoP displacement during one-leg stance on a stable surface was the only variable that show significant differences between the two groups. The lower values of this variable in the CAI subjects may implicate a balance control system with more difficulties to adapt to the environment and the task demands. More studies are needed to better understand CAI subjects balance control.

Comparison of the Masticatory Force (with 3D Models) of Complete Denture Base Acrylic Resins with Reline and Reinforcing Materials.

The reinforcement of acrylic denture base remains problematic. Acrylic prosthesis fractures are commonly observed in prosthodontic practice and have not been reliably resolved. This study compared the resistance to masticatory force of acrylic bases of removable complete conventional prosthesis in 3D upper models. Forty acrylic base test specimens containing two types of reinforcement meshes (20 with glass fiber meshes (FIBER-FORCE®- Synca, Bio Composants MédicauxTM, Tullins, France), 20 with metal meshes (DENTAURUM®-Ispringen, Germany)), 20 with a conventional PMMA acrylic base (LUCITONE 199®-Dentsply Sirona, York, PA, USA), and 20 using a permanent soft reline material (MOLLOPLAST-B®-DETAX GmbH & Co. KG, Ettlingen, Germany) were tested-a total of 80 specimens. Half of the specimens were made for a low alveolar ridge and half for a high alveolar ridge. The data were analysed using one-way analysis of variance and Student's t-test for independent test specimens. In the high-alveolar-ridge group, the prosthesis reinforced with the glass fiber mesh was the most resistant to fracture, while in the low-alveolar-ridge group, the non-reinforced prosthesis showed the highest resistance masticatory force. Prostheses with the permanent soft reline material showed the lowest resistance to fracture in both high and low-alveolar-ridge groups. The results show that the selection of the right reinforcement material for each clinical case, based on the height of the alveolar ridge, may help to prevent prosthesis fractures.

Comparison of CAD-CAM and traditional chairside processing of 4-unit interim prostheses with and without cantilevers: Mechanics, fracture behavior, and finite element analysis.

STATEMENT OF PROBLEM: How processing by computer-aided design and computer-aided manufacturing (CAD-CAM) or traditional chairside fabrication techniques affects the presence of defects and the mechanical properties of interim dental prostheses is unclear. PURPOSE: The purpose of this in vitro study was to compare the effects of CAD-CAM versus traditional chairside material processing on the fracture and biomechanical behavior of 4-unit interim prostheses with and without a cantilever. MATERIAL AND METHODS: Two types of 4-unit interim prostheses were fabricated with abutments on the first premolar and first mandibular molar, one from a prefabricated CAD-CAM block and one with a traditional chairside polymer-monomer autopolymerizing acrylic resin (n=10). Both groups were assessed by compressive strength testing and additionally with or without a cantilevered second molar by using a universal testing machine with a 5-kN load cell. A finite element model (FEM) was built by scanning both prosthesis designs. Finite element analysis (FEA) replicated the experimental conditions to evaluate the stress distribution through the prostheses. RESULTS: Interim fixed prostheses manufactured by CAD-CAM showed significantly higher mean fracture loading values (3126 N to 3136 N) than for conventionally made interim fixed prostheses (1287 N to 1390 N) (P=.001). The presence of a cantilever decreased the fracture loading mean values for CAD-CAM (1954 N to 2649 N), although the cantilever did not influence the traditional prostheses (1268 N to 1634 N). The highest von Mises stresses were recorded by FEA on the occlusal surface, with the cantilever design, and at the transition region (connector) between the prosthetic teeth. CONCLUSIONS: Interim partial prostheses produced by CAD-CAM had a higher strength than those manufactured traditionally. The presence of a cantilever negatively affected the strength of the prostheses, although the structures manufactured by CAD-CAM still revealed high strength and homogenous stress distribution on occlusal loading.

Analysis of the common bean (Phaseolus vulgaris L.) transcriptome regarding efficiency of phosphorus use.

Common bean is a highly important food in tropical regions, where most production occurs on small farms with limited use of technology and, consequently, greater vulnerability to abiotic stresses such as nutritional stress. Usually phosphorus (P) is the most limiting nutrient for crop growth in these regions. The aim of this study was to characterize the gene expression profiles of the genotypes of common bean IAC Imperador (P-responsive) and DOR 364 (P-unresponsive) under different P concentrations using RNA-seq transcriptome sequencing technology. Plants were grown hydroponically, with application of two P concentrations (4.00 mg L-1 restrictive level and 8.00 mg L-1 control level). Differential expression analyses, annotation, and functional classification were performed comparing genotypes within each P rate administered and comparing each genotype response to the different P levels. Considering differential expression analyses within genotypes, IAC Imperador exhibited 1538 up-regulated genes under P restriction and 1679 up-regulated genes in the control, while DOR 364 exhibited 13 up-regulated genes in the control and only 2 up-regulated genes under P restriction, strongly corroborating P-unresponsiveness of this genotype. Genes related to phosphorus restriction were identified among the differentially expressed genes, including transcription factors such as WRKY, ERF, and MYB families, phosphatase related genes such as pyrophosphatase, acid phosphatase, and purple acid phosphatase, and phosphate transporters. The enrichment test for the P restriction treatment showed 123 enriched gene ontologies (GO) for IAC Imperador, while DOR 364 enriched only 24. Also, the enriched GO correlated with P metabolism, compound metabolic processes containing phosphate, nucleoside phosphate binding, phosphorylation, and also response to stresses. Thus, this study proved to be informative to phosphorus limitation in common bean showing global changes at transcript level.

Diabetes mellitus and acquired haemophilia: new association?

Diabetes mellitus encompasses a group of highly prevalent carbohydrate metabolic disorders with an increasing incidence. Some subtypes are thought to be associated with other immune-mediated diseases. Acquired haemophilia on the other hand is a quite rare autoimmune disease that is thought to be secondary to the emergence of inhibiting anticoagulation factor VIII antibodies (inhibitors) in patients with previously normal haemostatic function. More recently, numerous different diseases have been associated with acquired haemophilia namely immune-mediated diseases, drugs and solid and haematologic neoplasms. The authors report on a case of a patient with new onset acquired haemophilia arising in the setting of diabetic ketoacidosis.

The Relationship Between Muscular Strength and Dance Injuries: A Systematic Review.

BACKGROUND: The physical demands placed on dancers put them at significant risk for injury, with rates similar to ones sustained by athletes in sports at the same level of performance. Muscle strength has been suggested to play a preventative role against injury in dancers. OBJECTIVE: To systematically search and examine the available evidence on the protective role of muscle strength in dance injuries. METHODS: Five electronic databases and two dance-specific science publications were screened up to September 2015. Study selection was based on a priori inclusion criteria on the relation between muscle strength components and injuries. Methodologic quality and level of evidence were assessed using the Downs and Black (DB) checklist and the Oxford Centre of Evidence-Based Medicine (OCEBM) 2011 model. RESULTS: From 186 titles found, only 8 studies met the inclusion criteria and were considered for review. Because of the significant heterogeneity of the included studies, meta-analysis was deemed inappropriate. The DB quality assessment results ranged from 18.7% to 75% (mean 42.3±16.9) and the OCEBM between 2b and 4. Some level 2b evidence from 2 studies suggested that pre-professional ballet dancers who get injured exhibit lower overall muscle strength scores on the lower extremity, and that lower extremity power gains may be associated with decreased bodily pain but not injury rate. CONCLUSIONS: Although there might be an association trend toward low muscle strength and dance injuries, the nature of that relation remains unclear, and presently the state of knowledge does not provide a solid basis for designing interventions for prevention.

Butyltins, polyaromatic hydrocarbons, organochlorine pesticides, and polychlorinated biphenyls in sediments and bivalve mollusks in a mid-latitude environment from the Patagonian coastal zone.

Butyltins (BTs), polyaromatic hydrocarbons (PAHs), organochlorine pesticides (OCPs), and polychlorinated biphenyls (PCBs) were assessed in a mid-latitude environment of the Patagonian coast, distant from significant pollutant sources. Bioaccumulation processes through bottom sediment resuspension were suggested by BTs level (expressed as ng of tin [Sn] g(-1) dry wt) found in surface sediment (

Oil spill effects on macrofaunal communities and bioturbation of pristine marine sediments (Caleta Valdés, Patagonia, Argentina): experimental evidence of low resistance capacities of benthic systems without history of pollution.

The Patagonian coast is characterized by the existence of pristine ecosystems which may be particularly sensitive to oil contamination. In this study, a simulated oil spill at acute and chronic input levels was carried out to assess the effects of contamination on the macrobenthic community structure and the bioturbation activity of sediments sampled in Caleta Valdés creek. Superficial sediments were either noncontaminated or contaminated by Escalante crude oil and incubated in the laboratory for 30 days. Oil contamination induced adverse effects on macrobenthic community at both concentrations with, for the highest concentration, a marked decrease of approximately 40 and 55 % of density and specific richness, respectively. Besides the disappearance of sensitive species, some other species like Oligochaeta sp. 1, Paranebalia sp., and Ostracoda sp. 2 species have a higher resistance to oil contamination. Sediment reworking activity was also affected by oil addition. At the highest level of contamination, nearly no activity was observed due to the high mortality of macroorganisms. The results strongly suggest that an oil spill in this protected marine area with no previous history of contamination would have a deep impact on the non-adapted macrobenthic community.

Skeletal deterioration following ovarian failure: can some features be a direct consequence of estrogen loss while others are more related to physical inactivity?

Findings on experimental animals show that ovarian failure is accompanied by a decrease in motor activity. As mechanical loading has a vital role in the maintenance of skeletal health, our aim was to determine to what extent this decrease in motor activity contributes to ovariectomy-induced bone loss. Thirty-two female Wistar rats were ovariectomized or sham-operated and housed in standard cages or with access to running wheels for 36 weeks with their running distance monitored. Markers of bone turnover were assayed in the serum, and bone geometry, trabecular and cortical bone microarchitecture, mineralization degree, and biomechanical properties were assessed in the femur. Differences between groups were determined by one-way ANOVA. Although reduced motor activity and sex steroid deficiency both resulted in decreases in trabecular bone volume, trabecular number decreases were mostly associated with sex steroid deficiency, whereas trabecular thickness decreases were mostly associated with sedentary behavior. Cortical bone appeared to be more sensitive to variations in motor activity, whereas bone turnover rate and bone tissue mineralization degree seemed to be primarily affected by sex steroid deficiency, even though they were further aggravated by sedentary behavior. Increases in femur length were mostly a consequence of sex steroid deficiency, whereas femoral neck length was also influenced by sedentary behavior. Differences in mechanical properties resulted mostly from differences in physical activity. Both the direct effect of sex steroid deficiency and the indirect effect of motor activity changes are implicated in bone loss following ovariectomy.

Nutrient content in sludge profiles from a full-scale stabilization pond in a temperate location.

The inorganic nutrient concentrations in sludge profiles from a full-scale municipal facultative pond in Puerto Madryn City (Argentina) were measured. Sludge samples were collected with cores during autumn, winter, and summer at three sites: inlet, intermediate, and outlet. In general, the sludge accumulates NH4+ and PO4(3-), increasing their concentrations with depth. However, NH4+ presented a different behavior at the outlet station during the summer, when the lower concentrations were recorded. This finding reflects a nutrient release, originating in their greater demand from the water column. In the sludge, the NO3- followed the spatial and seasonal pattern recorded in the surface water: detectable concentrations in the warmer months at the outlet. The vertical reduction of NO3- could be an indication of denitrification. The study supported the hypothesis that the sludge can act as a nutrient trap or source, depending on factors such as the temperature, nutrients/oxygen concentration, mixing processes, and location.

Distribution and origin of trace metals in sediments of a marine park (Northern San Jorge Gulf) from Argentina.

The Northern San Jorge Gulf (NSJG) was designated Interjurisdictional Coastal Marine Park "Patagonia Austral" in 2008 with the objective of conserving biodiversity and natural resources. Metals released to the environment can be accumulated by organisms and can be toxic in some cases, making it necessary to evaluate their presence and biological risk. This study examined concentrations of Fe, Mn, Zn, Cu, Cr, Ni, Cd and Pb in intertidal sediments of the NSJG, and was the first study of its kind to be conducted in this area. Concentrations of all metals fell below biological risk levels. Anthropogenic enrichment was only found for Ni around the Aristizábal lighthouse and was attributed to the frequent oil spills that impact this particular area.

Mercury levels in feathers of Magellanic penguins.

Feathers are useful to determine mercury (Hg) contamination. We evaluated the mercury concentration in feathers of Magellanic penguins (Spheniscus magellanicus) age 1.5 years to 25 years at Punta Tombo, Argentina before and during their molt. Mercury ranged between <1.4 and 367 ng/g dry weight, with three extreme high values (8996 ng/g, 3011 ng/g and 1340 ng/g) all in young adults. The median concentration was lowest for juveniles and significantly higher for adults but with high variation among older adults. Males and females had similar mercury loads. Compared with other penguin species, concentrations in Magellanic penguins were low. Mercury levels for Magellanic penguins in the Southwest Atlantic for older adults averaged 206±98 ng/g, and serve as a baseline for biomonitoring and/or ecotoxicological studies.

An immunohistochemical study of interleukin-8 (IL-8) in breast cancer.

The use of prognostic markers for breast cancer is important for routine diagnosis and research. Interleukin-8 is a chemotactic cytokine produced by several cell types in response to inflammation, however, its expression, regulation and function are poorly understood. Recent studies have associated angiogenesis and inflammatory processes with tumor malignancy. The present study investigated the correlation between interleukin-8 expression and breast cancer prognosis. Interleukin-8 expression was assessed in 72 women with mammary neoplasia by immunohistochemistry and the results were statistically correlated with clinical-pathological findings. There was an inverse correlation between interleukin-8 expression and metastasis (p=0.03) and/or local recurrence (p=0.02). In the patient group that received post-surgery chemotherapy and radiotherapy, a lower interleukin-8 expression was found in those women that showed local recurrence (p=0.01). Multivariate logistic regression showed estrogen receptor negativity, progesterone positivity and metastasis with increased risk of death (p<0.05). The data reflect the complexity of the role of interleukin-8 in tumor microenvironment and support its classification as a possible prognostic marker, although more studies are necessary for its inclusion in clinical practice.

Sources and distribution of aliphatic and polyaromatic hydrocarbons in coastal sediments from the Ushuaia Bay (Tierra del Fuego, Patagonia, Argentina).

The environmental quality of Ushuaia Bay, located at the southernmost tip of South America, is affected by the anthropogenic pressure of Ushuaia city. In this study, levels and sources of hydrocarbons in coastal sediments were assessed. Aliphatic hydrocarbon fractions ranged between 5.5 and 1185.3 µg/g dry weight and PAHs from not detected to 360 ng/g. Aliphatic diagnostic indices, the nalkanes homologous series occurrence, Aliphatic Unresolved Complex Mixtures (AliUCMs), and pristane and phytane isoprenoids indicated a petrogenic input. Some sites showed biogenic features masked by the anthropogenic signature. Particularly in port areas biodegradation processes were evident. PAH ratios showed a mixture of petrogenic and pyrogenic sources. Aliphatic and aromatic UCMs were strongly correlated, reflecting chronic pollution. Three areas were distinguished inside the bay: (1) east, with low hydrocarbons impact; (2) central, where hydrocarbons accumulation was related to source proximity and sediment characteristics; (3) south-west, where sediment characteristics and current circulation favour hydrocarbons accumulation.

The influence of a balance training program on the electromyographic latency of the ankle musculature in subjects with no history of ankle injury.

BACKGROUND: Balance training is often employed for the prevention of ankle injuries. However, until now, most of the studies have focused on the prevention of a recurrent injury. The objective of this study was to look into the effects of balance training on the onset of peroneal muscle activity in healthy subjects. METHODS: 34 participants (mean age = 19.5 years ± 1.5; height = 1.70 m ± 0.12; weight = 62.06 kg ± 11.24), physically active, with no history of injuries took part in this study. The participants underwent a 4-week balance training program using an ankle disk. Onset of peroneal muscles activation was measured using surface electromyography and a trap-door. FINDINGS: Parametric and non-parametric tests showed no significant differences between the control group and the experimental group (P > 0.05). INTERPRETATION: The results indicate that the use of balance training, for a 4-week period with two training sessions per week, on physically active subjects with no history of injuries in the ankle joint, does not cause noteworthy changes on the onset of peroneal muscles activity.

Voluntary exercise has long-term in vivo protective effects on osteocyte viability and bone strength following ovariectomy.

Osteocytes are recognized as having a pivotal role in bone tissue homeostasis, and stimuli that increase osteocyte death result in decreased bone tissue quality. Previous in vitro studies have shown that mechanical stimulation prevents osteocyte death; however, in vivo evidence of this protective effect is limited. The aim of this study was to investigate if mechanical stimulation provided by voluntary exercise reduces osteocyte death caused by estrogen deficiency. Thirty-two female Wistar rats (5 months old) were either sacrificed as baseline controls (BSL, n = 7), ovariectomized or sham-operated and housed in cages with a voluntary running wheel (OVXEX, n = 7; SHAMEX, n = 6), or ovariectomized or sham-operated and housed in standard cages of equivalent size (OVXSED, n = 6; SHAMSED, n = 6) and sacrificed at age 14 months. Histomorphometric analysis of femur mid-diaphysis cortical bone revealed a significantly higher osteocyte number (N.Ot) and lower empty lacunae number (N.Lc) in both the OVXEX and SHAMEX groups compared to their SED counterparts. Intracortical porosity (Po.Ar) was also lower in both EX groups compared to their SED counterparts and significantly correlated with N.Lc (r = 0.616; P < 0.001). Three-point bending testing showed a significantly higher Young's modulus and ultimate stress in OVXEX compared to OVXSED and significant correlations between N.Lc and both yield stress (r = -0.376, P < 0.05) and ultimate stress (r = -0.369, P < 0.05) and between intracortical porosity and bone ultimate stress (r = -0.451, P < 0.05). Our results show that voluntary exercise prevented osteocyte death and that this protective effect was associated with increases in femur ultimate stress, which could be partially explained by decreases in Po.Ar.

Valor prognóstico do Escore de Risco GRACE versus Escore de Risco TIMI em síndromes coronarianas agudas / Prognostic Value of GRACE Scores versus TIMI Score in acute coronary syndromes

FUNDAMENTO: Embora o Escore de Risco TIMI seja o mais utilizado em síndromes coronarianas agudas sem supradesnível do segmento ST (SCA), o Escore GRACE tem potencial superioridade prognóstica, pois foi criado a partir de um registro observacional, parte das variáveis são tratadas de forma semiquantitativa e a função renal é computada em seu cálculo. OBJETIVO: Testar a hipótese de que o Escore de Risco GRACE tem superior valor prognóstico hospitalar, comparado ao Escore TIMI em pacientes admitidos com SCA. MÉTODOS: Foram incluídos indivíduos com angina instável ou infarto do miocárdio sem supradesnível do segmento ST, consecutivamente internados em unidade coronariana entre agosto de 2007 e janeiro de 2009. RESULTADOS: Foram estudados 154 pacientes, idade 71 ± 13 anos, 56 por cento do gênero feminino, mediana do GRACE de 117 e mediana do TIMI de 3. Durante o período de internamento, a incidência de eventos foi 8,4 por cento (12 óbitos e 1 infarto não fatal). O teste de Hosmer-Lemeshow aplicado ao Escore GRACE apresentou χ2 de 5,3 (P = 0,72), enquanto Escore TIMI apresentou χ2 de 1,85 (P = 0,60). Desta forma, ambos os escores apresentaram boa calibração. Quanto à análise de discriminação, o Escore GRACE apresentou estatística-C de 0,91 (95 por cento IC = 0,86 - 0,97), significativamente superior à estatística-C de 0,69 do Escore TIMI (95 por cento IC = 0,55 - 0,84) - P = 0,02 para diferença entre os escores. CONCLUSÃO: Em relação à predição de eventos hospitalares em pacientes com SCA, o Escore GRACE tem superior capacidade prognóstica quando comparado ao Escore TIMI.

BACKGROUND: Although the TIMI score is the one most frequently used in acute coronary syndromes (ACS) without ST-segment elevation, the GRACE score has potential prognostic superiority, as it was created based on an observational registry, part of the variables is treated in a semi-quantitative form and renal function is taken into account in its calculation. OBJECTIVE: To test the hypothesis that the GRACE risk score has superior in-hospital prognostic value, when compared to the TIMI score in patients admitted with ACS. METHODS: Individuals with unstable angina or myocardial infarction without ST-segment elevation, consecutively admitted at the Coronary Unit between August 2007 and January 2009, were included in the study. RESULTS: A total of 154 patients aged 71 ± 13 years, of which 56 percent were females, with a GRACE median of 117 and a TIMI median of 3 were studied. During the hospitalization period, the incidence of events was 8.4 percent (12 deaths and 1 non-fatal infarction). The Hosmer-Lemeshow test applied to the GRACE score presented an χ2 of 5.3 (P = 0.72), whereas the TIMI score presented an χ2 of 1.85 (P = 0.60). Therefore, both scores presented good calibration. As for the analysis of discrimination, the GRACE score presented a C-statistics of 0.91 (95 percentCI= 0.86 - 0.97), significantly superior to the C-statistics of 0.69 of the TIMI score (95 percentCI = 0.55 - 0.84) - P = 0.02 for the difference between the scores. CONCLUSION: Regarding the prediction of hospital events in patients with ACS, the GRACE score has superior prognostic capacity when compared to the TIMI score.