Implementation of a Brazilian Cardioprotective Nutritional (BALANCE) Program for improvement on quality of diet and secondary prevention of cardiovascular events: A randomized, multicenter trial

Background Complex percutaneous coronary intervention (PCI) is associated with higher ischemic risk, which can be mitigated by long-term dual antiplatelet therapy (DAPT). However, concomitant high bleeding risk (HBR) may be present, making it unclear whether short- or long-term DAPT should be prioritized. Objectives This study investigated the effects of ischemic (by PCI complexity) and bleeding (by PRECISE-DAPT [PRE dicting bleeding Complications in patients undergoing stent Implantation and Sub sequent Dual Anti Platelet Therapy] score) risks on clinical outcomes and on the impact of DAPT duration after coronary stenting. Methods Complex PCI was defined as ≥3 stents implanted and/or ≥3 lesions treated, bifurcation stenting and/or stent length >60 mm, and/or chronic total occlusion revascularization. Ischemic and bleeding outcomes in high (≥25) or non-high (<25) PRECISE-DAPT strata were evaluated based on randomly allocated duration of DAPT. Results Among 14,963 patients from 8 randomized trials, 3,118 underwent complex PCI and experienced a higher rate of ischemic, but not bleeding, events. Long-term DAPT in non-HBR patients reduced ischemic events in both complex (absolute risk difference: −3.86%; 95% confidence interval: −7.71 to +0.06) and noncomplex PCI strata (absolute risk difference: −1.14%; 95% confidence interval: −2.26 to −0.02), but not among HBR patients, regardless of complex PCI features. The bleeding risk according to the Thrombolysis In Myocardial Infarction scale was increased by long-term DAPT only in HBR patients, regardless of PCI complexity. Conclusions Patients who underwent complex PCI had a higher risk of ischemic events, but benefitted from long-term DAPT only if HBR features were not present. These data suggested that when concordant, bleeding, more than ischemic risk, should inform decision-making on the duration of DAPT. (AU)

Acompanhamento eletrocardiográfico no desenvolvimento de ratos Wistar / Eletrocardiographic monitoring in the development of Wistar Rats

A atividade elétrica cardíaca pode ser registrada por meio do eletrocardiograma (ECG), registro capaz de captar as alterações do percurso elétrico. Na literatura científica, não existe descrição de padrões eletrocardiográficos de ratos Wistar desde a fase de recém-nascidos até serem considerados envelhecidos. O objetivo do presente estudo foi avaliar o padrão eletrocardiográfico de ratos Wistar desde a fase de recém-nascidos até serem considerados envelhecidos, no intuito de que os resultados possam contribuir como referencial dos padrões da espécie. Foram utilizados ratos Rattus novergicus albinus, da linhagem Wistar. Os ratos foram divididos em cinco grupos experimentais, sendo definidos de acordo com a idade e assim denominados: grupo 21 dias (21D), dois meses (2M), três meses (3M), sete meses (7M) e 18 meses (18M), sendo n=20 por grupo. Para a realização do ECG, eletrodos conectados aos canais do eletrocardiógrafo foram posicionados nos animais e captaram o sinal elétrico do coração em seis derivações. Os dados foram agrupados e submetidos a comparação por meio de ANOVA e teste de Tukey-Kramer, P≤0,05. Os resultados mostraram que, de forma geral, as modulações ao longo do processo de envelhecimento diante dos parâmetros relacionados ao ECG se iniciam a partir do período 2M, com aparente estabilidade até 3M e/ou 7M, seguindo por exacerbação das modulações em 7M e/ou 18M, a depender da variável eletrocardiográfica em questão. Em relação à frequência cardíaca (FC), concomitantemente, nota-se um padrão similar, ou seja, diminuição dela a partir do período 2M, com estabilidade até 7M, seguindo por diminuição mais pronunciada em 18M. Os resultados sugerem que, devido ao processo de envelhecimento, o coração de ratos Wistar apresenta modificações na condução do estímulo elétrico, bem como redução na FC, fatores que merecem atenção enquanto indicadores de inclusão/exclusão de animais em grupos experimentais por parte de [...].(AU)

The cardiac electrical activity can be recorded through the electrocardiogram (ECG), this recording is able to capture the changes in the electric route. In the scientific literature, there is no description of electrocardiographic patterns of Wistar rats at the stage of newborn to be considered aged. The aim of this study was to evaluate the electrocardiographic pattern of Wistar rats at various stages of growth, in order for the results to contribute as a standard reference. Rattus norvegicus albinus rats of the Wistar lineage were used. The rats were divided into 5 experimental groups being defined according to age and named as follows: group 21 days (21D), 2 months (2M), 3 months (3M), 7 months (7M) and 18 months (18M), where n = 20 per group. For the realization of ECG, electrodes connected to the electrocardiograph channels were positioned in animals to capture the electrical signal of the heart in 6-lead. The data were grouped and subjected to comparison by ANOVA and Tukey-Kramer test, P=0.05. The results showed that, overall, the modulations along the front aging process, related to the ECG, are initiated from 2M period, apparent stability by 3M and/or 7M, followed by exacerbation of modulations in 7M and/or 18M, depending on the electrocardiographic variable in question. Front of heart rate (HR), concomitantly, there is a similar pattern, that is, decreasing from 2M period with stability until 7M, followed by more pronounced decrease in 18M. The results suggest that due to the aging process, the heart of Wistar rats shows changes in the conduction of electrical stimulation and reduction in heart rate, factors that deserve attention as indicators of inclusion / exclusion of animals in experimental groups by researchers using that species as a model.(AU)

Acompanhamento eletrocardiográfico no desenvolvimento de ratos Wistar / Eletrocardiographic monitoring in the development of Wistar Rats

A atividade elétrica cardíaca pode ser registrada por meio do eletrocardiograma (ECG), registro capaz de captar as alterações do percurso elétrico. Na literatura científica, não existe descrição de padrões eletrocardiográficos de ratos Wistar desde a fase de recém-nascidos até serem considerados envelhecidos. O objetivo do presente estudo foi avaliar o padrão eletrocardiográfico de ratos Wistar desde a fase de recém-nascidos até serem considerados envelhecidos, no intuito de que os resultados possam contribuir como referencial dos padrões da espécie. Foram utilizados ratos Rattus novergicus albinus, da linhagem Wistar. Os ratos foram divididos em cinco grupos experimentais, sendo definidos de acordo com a idade e assim denominados: grupo 21 dias (21D), dois meses (2M), três meses (3M), sete meses (7M) e 18 meses (18M), sendo n=20 por grupo. Para a realização do ECG, eletrodos conectados aos canais do eletrocardiógrafo foram posicionados nos animais e captaram o sinal elétrico do coração em seis derivações. Os dados foram agrupados e submetidos a comparação por meio de ANOVA e teste de Tukey-Kramer, P≤0,05. Os resultados mostraram que, de forma geral, as modulações ao longo do processo de envelhecimento diante dos parâmetros relacionados ao ECG se iniciam a partir do período 2M, com aparente estabilidade até 3M e/ou 7M, seguindo por exacerbação das modulações em 7M e/ou 18M, a depender da variável eletrocardiográfica em questão. Em relação à frequência cardíaca (FC), concomitantemente, nota-se um padrão similar, ou seja, diminuição dela a partir do período 2M, com estabilidade até 7M, seguindo por diminuição mais pronunciada em 18M. Os resultados sugerem que, devido ao processo de envelhecimento, o coração de ratos Wistar apresenta modificações na condução do estímulo elétrico, bem como redução na FC, fatores que merecem atenção enquanto indicadores de inclusão/exclusão de animais em grupos experimentais por parte de pesquisadores que utilizam a referida espécie como modelo de estudo.(AU)

The cardiac electrical activity can be recorded through the electrocardiogram (ECG), this recording is able to capture the changes in the electric route. In the scientific literature, there is no description of electrocardiographic patterns of Wistar rats at the stage of newborn to be considered aged. The aim of this study was to evaluate the electrocardiographic pattern of Wistar rats at various stages of growth, in order for the results to contribute as a standard reference. Rattus norvegicus albinus rats of the Wistar lineage were used. The rats were divided into 5 experimental groups being defined according to age and named as follows: group 21 days (21D), 2 months (2M), 3 months (3M), 7 months (7M) and 18 months (18M), where n = 20 per group. For the realization of ECG, electrodes connected to the electrocardiograph channels were positioned in animals to capture the electrical signal of the heart in 6-lead. The data were grouped and subjected to comparison by ANOVA and Tukey-Kramer test, P=0.05. The results showed that, overall, the modulations along the front aging process, related to the ECG, are initiated from 2M period, apparent stability by 3M and/or 7M, followed by exacerbation of modulations in 7M and/or 18M, depending on the electrocardiographic variable in question. Front of heart rate (HR), concomitantly, there is a similar pattern, that is, decreasing from 2M period with stability until 7M, followed by more pronounced decrease in 18M. The results suggest that due to the aging process, the heart of Wistar rats shows changes in the conduction of electrical stimulation and reduction in heart rate, factors that deserve attention as indicators of inclusion / exclusion of animals in experimental groups by researchers using that species as a model.(AU)

Genomic characterization of oxacillin-resistant Staphylococcus epidermidis and Staphylococcus haemolyticus isolated from Brazilian medical centres.

Studies on the genetic diversity of oxacillin-resistant coagulase-negative staphylococcal (CNS) isolates are important for the control and prevention of infections. The present study evaluated the clonal diversity of oxacillin-resistant Staphylococcus epidermidis (ORSE) and Staphylococcus haemolyticus (ORSH) strains, isolated from patients in nine Brazilian medical centres by using pulsed-field gel electrophoresis (PFGE) after digestion of bacterial DNA using SmaI. PFGE analysis of ORSE (N=44) and ORSH (N=25) strains showed the presence of 29 restriction profiles clustered in 16 PFGE types, and 21 distinct profiles in 15 PFGE types, respectively, indicating a large genetic diversity among isolates of both of these species. Among the ORSE isolates, 23 (52%) strains belonged to two predominant PFGE types (named A and B), which were observed in most of the hospitals assessed, indicating the spread of these PFGE types in hospitals located in Rio de Janeiro. The spread of PFGE types of ORSH was also detected in some of the hospitals investigated. The results show that PFGE is a suitable tool for epidemiological studies of oxacillin-resistant CNS, and can be used as a basis for infection control procedures for these multiresistant organisms.

Simulação computacional de estratégias de manutenção de equipamentos de mamografia / Computer simulation of maintenance strategies of mammography equipment

The elaboration of a maintenance strategy is a main concern for hospital administrators. The strategies can be optimized through computational simulation of discrete events. The objective of this work is to present a model of a standard mammography clinic and to analyze the impact of different mammograph maintenance strategies on the clinic routine...

Análise de desempenho do fluxo de atendimento hospitalar com auxílio da simulação computacional / Performance analysis of the flow of patient care with the aid of computer simulation

Healthcare management is a dificult enterprise, which can be helped by modern computacional approaches such as the use of models based on computer simulation. The objective of this studt is to present an application of this tool to the analysis of the performance of a hospital clinic (an ophthalmologic clinic in a large hospital)...