Effects of a healthy diet enriched or not with pecan nuts or extra-virgin olive oil on the lipid profile of patients with stable coronary artery disease: a randomised clinical trial.

BACKGROUND: The present study aimed to assess the effect of a healthy diet, enriched or not with pecan nuts or extra-virgin olive oil, on the lipid profile of patients with stable coronary artery disease (CAD). METHODS: This was a randomised clinical trial conducted for 12 weeks with patients aged between 40 and 80 years with stable CAD for more than 60 days. Individuals were randomised into groups [control group (CG) with 67 patients, pecan nut group (PNG) with 68 patients and olive oil group (OOG) with 69 patients]. The CG was prescribed a healthy diet according to the nutritional guidelines; the PNG was prescribed the same healthy diet plus 30 g day-1 of pecan nuts; and the OOG was prescribed a healthy diet plus 30 mL day-1 of extra-virgin olive oil. RESULTS: In total, 204 subjects were submitted to an intention-to-treat analysis. After adjustment for baseline values and type of statin used, there was no difference regarding low-density lipoprotein (LDL)-cholesterol (primary outcome), high-density lipoprotein (HDL)-cholesterol, LDL-cholesterol/HDL-cholesterol ratio and HDL-cholesterol/triglycerides ratio according to groups. However, the PNG exhibited a significant reduction in non-HDL-cholesterol levels [PNG: 114.9 (31) mg dL-1 ; CG: 127 (33.6) mg dL-1 ; OOG: 126.6 (37.4) mg dL-1 ; P = 0.033] and in the total cholesterol/HDL-cholesterol ratio [PNG: 3.7 (0.7); CG: 4.0 (0.8); OOG: 4.0 (0.8); P = 0.044] compared to the CG and OOG. CONCLUSIONS: Supplementing a healthy diet with 30 g day-1 of pecan nuts for 12 weeks did not improve LDL-cholesterol levels but may improve other lipid profile markers in patients with stable CAD.

A mixed-drug intoxication involving venlafaxine and verapamil.

This case report describes the suicide of a 52-year-old woman whose cause of death was attributed to a mixed-drug intoxication involving venlafaxine and verapamil. Venlafaxine is prescribed for the treatment of depression and should be used with caution in patients with cardiovascular disease. Verapamil is a calcium channel blocker primarily used for treatment of cardiovascular disorders. The following drug concentrations were determined in postmortem fluids: verapamil--3.5 mg/L (femoral blood), 9.4 mg/L (subclavian blood), and 1.0 mg/L (vitreous fluid); norverapamil--1.0 mg/L (femoral blood), 2.1 mg/L (subclavian blood), and 0.20 mg/L (vitreous fluid); verapamil and norverapamil could not be detected in bile or urine due to the high levels of erythromycin present; venlafaxine--6.2 mg/L (femoral blood), 8.6 mg/L (subclavian blood), 5.3 mg/L (vitreous fluid), 54.0 mg/L (bile), and 72.3 mg/L (urine); and O-desmethylvenlafaxine--5.4 mg/L (femoral blood), 8.3 mg/L (subclavian blood), positive (vitreous fluid), 29.2 mg/L (bile), and 9.5 mg/L (urine). The cause of death was determined to be a mixed-drug intoxication resulting from an overdose of verapamil and venlafaxine. The manner of death was determined to be suicide.

Weapon location following suicidal gunshot wounds.

The location of the gun following suicidal gunshot wound was studied by reviewing 574 such deaths in which the scene was investigated by a medical examiner investigator and the body was examined at the Bexar County Medical Examiner's Office in San Antonio, Texas. The position of the gun could not be established in 76 cases. In the remaining 498 cases, the gun remained in the deceased's hand in 24% of the cases. In 69% of the cases, the gun was on or near the body but not in the hand (i.e., touching the body or within 30 cm of the body). The gun was found >30 cm from the body in the remaining 7% of cases. In the case of handguns, the gun was found in the hand in 25.7% of individuals. For individuals using long guns, the firearm was in the hand of the decedent in 19.5% of cases. The gun had a greater chance of remaining in the deceased's hand if the person was lying or sitting when the gunshot wound was received. Variables such as gender of the individual, wound location, and caliber of handgun were not significant in predicting whether the gun stayed in the hand after a suicidal gunshot wound.

Intramuscular (infiltrating) lipoma of the tongue.

A patient with an intramuscular lipoma (infiltrating lipoma) located within the tongue is presented. There is only one previously reported case of an intramuscular lipoma located within the oral cavity. Because of its infiltrating nature, this tumor may be mistaken for a liposarcoma. Here, as in other sites, the important characteristics serving to distinguish an infiltrating lipoma from a liposarcoma are the absence of lipoblastic proliferation, myxoid differentiation, cellular pleomorphism, increased vascularity, and mitotic activity. Achievement of adequate surgical margins is essential, as the recurrence rate may be as high as 62.5% without complete excision.