Myocardial Infarction in a Young Cocaine User with Atrial Myxoma: What is the Central Cause?

The differential diagnosis of myocardial infarction in patients with a number of potential causes can be challenging, especially when there is no angiographic evidence of coronary obstruction. We describe a case of extensive anterior ST-elevation myocardial infarction in a young male smoker who had a left atrial myxoma and a history of cocaine use 10 hours before the event. Clinical reasoning during a myocardial infarction investigation should be oriented by the probability of the causal relationship between the ischemic event and each factor present in the clinical context.

Reference Equations for Impulse Oscillometry System Parameters in Healthy Brazilian Children and Adolescents.

BACKGROUND: The impulse oscillometry system is a noninvasive method of evaluating respiratory mechanics that is being increasingly used in the pediatric population. To date, no reference equations have been developed for healthy Brazilian children and adolescents. The purpose of the study was to determine the reference equations for impulse oscillometry system parameters in healthy children and adolescents. METHODS: We undertook an observational cross-sectional analytical study with healthy students age 6-14 y from educational institutions in the Greater Florianópolis area. Biometric data were evaluated (weight, height, body mass index, and body surface area) as predictors and for sample characterization. All participants were submitted to evaluation of respiratory mechanics using an oscillometry system following American Thoracic Society standards. Three tests were recorded, with data acquisition for ≥20 s. For data normality verification, the Kolmogorov-Smirnov test was applied, and Pearson's correlation test identified the relationship between the predicted values of height, age, and weight and the oscillometric variables of resistance at 5 and 20 Hz reactance; respiratory impedance at 5 Hz resonant frequency; and reactance area. Models were developed using simple linear regression and multiple analyses. RESULTS: After the recruitment of 864 children, 123 subjects with an average age of 10.0 ± 2.4 y for boys and 9.9 ± 2.4 y for girls (P = .94) were considered for final analysis. Correlations were identified between the dependent and predictor oscillometric variables, with height identified as having the greatest predictive power in the equations developed for boys in all oscillometric parameters, with a mean adjusted R(2) of 46.51%. Age had greater influence on resonant frequency (adjusted R(2) = 40.1%) and reactance area (adjusted R(2) = 48.8%) for girls. CONCLUSIONS: Reference equations were developed for males and females, and height was the most influential predictor variable for most impulse oscillometry system parameters in the population studied.

Anti-Mycobacterium tuberculosis Activity of Calophyllum brasiliense Extracts Obtained by Supercritical Fluid Extraction and Conventional Techniques.

The conventional techniques used to extract natural products have many disadvantages, and alternative methods have been used, such as supercritical fluid extraction (SFE-CO2). We compared the anti-Mycobacterium tuberculosis activity and cytotoxicity of extracts and major pure compounds were obtained from the leaves of Calophyllum brasiliense by SFE-CO2, maceration and Soxhlet. Anti-M tuberculosis activity was evaluated by resazurin microtiter assay plate and cytotoxicity assay was performed using 3-(4,5-dimethyl thiazol-2-yl)-2,5-diphenyl tetrazolium bromide. The (-) mammea A/BB, (-) mammea B/BB, mammea B/BB cyclo D, ponnalide, mammea A/BA cyclo D, and amentoflavone were identified as the majority compounds. SFE-CO2, especially at 313 K and 10.92 MPa showed better yield for (-) mammea A/BB. Anti-M. tuberculosis activity (62.5 µg/mL) and cytotoxicity (Selectivity Index = 0.320-0.576) were similar for the three extracts. Mammea B/BB cyclo D had a minimum inhibitory concentration (MIC) of 125 µg/mL, and ponnalide and mammea A/BA cyclo D had MICs > 250 µg/mL. The pure compounds isolated showed low Selectivity Index (< 0.09). SFE-CO2 may be more promising than conventional methods for the extraction of compound (-) mammea A/BB, which presented the best anti-M. tuberculosis activity in our previous study. This is important for current industrial requirements to obtain extracts from medicinal plants using clean technologies.

Sistema de oscilometria de impulso em pediatria: revisão de literatura / Impulse Oscillometry System in pediatrics: review

A oscilometria de impulso (IOS) é considerado um método de avaliação da mecânica respiratória, e por ser não invasivo, vem sendo crescentemente indicado na assistência e investigação do paciente pediátrico. Estudos tem tido como interesse a determinação de valores de referência e a verificação da relação do IOS com outros métodos de avaliação respiratória. Objetivo: apresentar uma atualização da literatura quanto ao sistema, critérios técnicos e interpretação de dados, bem como, a relação do sistema com outros métodos de avaliação respiratória e sua aplicabilidade clínica. Método: revisão bibliográfica com consulta nas bases de dados MEDLINE/PubMed e Ebsco, utilizando as palavras-chaves:“impulse oscillometry”, “reference values” e “child”. Considerou-se todo material com informações sobre o equipamento, suas indicações e aplicação como instrumento de avaliação em diferentes situações clínicas. Resultados: foram identificados 45 documentos, sendo 41 ensaios clínicos e 4 revisões, complementados com 20 trabalhos: 1 guideline, 1 manual sobre o equipamento e 18 artigos referentes ao tema. Esse material foi caracterizado por abordar o equipamento, seus parâmetros de avaliação, técnica de execução e posicionamento do paciente durante o exame, critérios de aceitabilidade e reprodutibilidade e interpretação dos dados obtidos. São várias as publicações dessa ferramenta na avaliação da mecânica respiratória de disfunções como asma e fibrose cística e geração de valores de referência em crianças saudáveis. Conclusão: o IOS é um recurso relativamente novo, cuja indicação em pediatria tem sido crescente, mas que ainda carece investigações, tanto técnicas quanto clínicas...

Impulse oscillometry (IOS) is considered a method of evaluation of respiratory mechanics, and being non-invasive, has been increasingly mentioned in the care and research of pediatric patients. Studies have considered the interest of determining reference values and check the IOS relationship with other methods of respiratory assessment. Objective: to present an update of the literature regarding the system, technical criteria and interpretation of data, as well as the relationship of the system with other methods of respiratory assessment and its clinical applicability. Method: literature review with consultation in the databases MEDLINE / PubMed and Ebsco, using the keywords: “impulse oscillometry”, “reference values” and “child”. It was considered all material with information about the equipment, their indications and application as an evaluation tool in different clinical situations. Results: 45 documents were identified, (41 trials and 4 reviews), supplemented with 20 papers (1 guideline, 1 manual on equipment and 18 articles on the subject). This material was characterized by approaching the equipment, its parameters evaluation, performance technique and positioning of the patient during the examination, criteria for acceptability and reproducibility, and interpretation of the data obtained. There are several publications of this tool in the evaluation of respiratory mechanics disorders such as asthma and cystic fibrosis, and making on reference values in healthy children. Conclusion: IOS is a relatively new feature, whose indicationin pediatrics has been increasing, but still required investigations, both technical and clinical investigations...